Fire departments that provide emergency medical services sometimes find that traditional EMS vehicles don't work well in certain situations. Perhaps there are events where so many people are present that the sheer size of the crowd hinders access for traditional vehicles. Or perhaps there are locations where traditional motorized vehicles can't be driven, or where access is restricted to a few points.

In these situations, some departments are using specialized EMS vehicles that allow emergency personnel to reach a victim quickly, and in many cases to transport the victim to a point where an ambulance, medic squad or paramedic engine company can take over.

Big crowds, big problems

One common problem for EMS vehicles is a large public event where crowds of people fill the area, such as a county fair, parade, street festival or racetrack. In some cases, a maze of display booths or equipment line the walkways and further hinder movement.

The Fire Department of New York's Bureau of EMS regularly faced this problem. If it wasn't New Year's Eve in Times Square, it was a sold-out summer concert in Central Park. To handle this problem, they recently purchased 10 John Deere Gator ATVS with diesel engines and 6×4 drives. The ATVS were modified by Chief Equipment Co. to include a rear patient-transport area and are designed to carry two EMS personnel and one patient. They're transported to special events and used to treat patients on the scene or carry them to the outskirts of the event where an ambulance can take over.

Another approach to the problem of providing EMS in crowded areas is the use of bicycle-mounted paramedics. The Seattle Fire Department has eight mountain bikes staffed by specially trained firefighter-paramedics operating in teams of two. Each team carries advanced life support equipment in saddlebag pouches that straddle a bicycle's rear tires. In addition to wearing bicycle helmets and gloves, the personnel have uniforms with zip-off legs and sleeves to allow them to comfortably operate in- and outdoors. Some of the bikes are kept at one of the two area sports stadiums, while the rest are transported to event sites in a trailer that doubles as a support base.

Limited access, limitless hassles

Another situation where traditional EMS vehicles might not be able respond effectively is in restricted-access areas, such as large airport terminals or along scenic trails or walkways.

Miami-Dade (Fla.) Fire Rescue provides fire suppression and emergency medical services at Miami International Airport, one of the busiest airports in the nation. Because of the large number of EMS calls within the terminal, the department established a sub-station inside the building. To reduce response times, they also purchased a Club Car Carryall VI electric ambulance and equipped it with Basic Life Support gear, including an automatic external defibrillator for heart-attack victims. The ambulance and sub-station are staffed during the airport's busiest hours, from 7:30 a.m. to 7 p.m., and have averaged about five calls a day.

The Lansing (Mich.) Fire Department faced a different problem of limited access when the city converted a formerly inaccessible area along the banks of the Grand River into a scenic riverfront walkway, known as Riverwalk. The walkway extends for several miles and is popular with joggers and strollers. To provide emergency medical service along this area, the department purchased a Kawasaki Mule four-wheel ATV and modified it for EMS use. The unit responds out of Central Station 1, near the midpoint of the walkway, and can quickly cross a bridge and gain access to the Riverwalk in either direction.

Any area with large shopping malls, amusement parks or high-rise parking structures might also be good candidates for a specialized EMS vehicle. Limited access urban or suburban trails with narrow, light-duty pedestrian bridges might be others. To decide if your department might need a specialized EMS vehicle, locate all the areas that are inaccessible to motor vehicles and ask yourself, “How would I provide emergency medical service here?”