The extraordinary mission of the ambulance and crew
- You see at least one ambulance a day on the road. Here’s what’s inside those emergency vehicles that are equipped to transport the sick and the injured to the hospital.
- There are several organizations with a fleet of ambulances, among them, the hospitals, Philippine Red Cross, local government units, and private companies offering that service, like the Lifeline.
- The types of ambulances indicates the medical equipment and medicines each carry. There’s the basic and advance life support ambulances and the “ER on wheels” of Lifeline.
- The ambulances have saved thousands of lives but the stories behind the heroic acts of the crew who risked their own lives to do that are usually only shared among private groups. Despite the risks, they continue to follow the mission to respond to an emergency — to save lives.
A few years ago, a 20-year-old girl fell down a mountain ridge while trekking Pico de Loro in Batangas. An ambulance rescue team responded by chartering a helicopter to the site, but failing to find a landing area, the doctor jumped off, trekked the mountain and found her. He treated her injury; strapped her to the rescue board; carried her down half of the mountain. He bumped into military men on a mission to find the girl, and with their help, the girl was brought to an ambulance that transported her to a hospital. A life was saved.
At the height of typhoon Ondoy in 2009, a woman delivered a baby above the flooded floor of her house in Marikina, her husband following instructions from the voice of an ambulance rescuer on the phone. In the morning, the ambulance crew took a borrowed boat to rescue the couple from their house in an area submerged in water, dodging electric wires and jutting fences. As the water ebbed, the tide turned and the boat got washed away into the raging river but got stuck in debris on the flooded highway — the young couple and the newborn, and four rescuers — in the boat.
The CEO of Lifeline ambulance, who was driving the ambulance for lack of staff at that time, followed the flow of the water to Imelda Highway, where he disembarked and went on foot in chest-deep water to look for the boat and the people in it. He found them — brought the young couple and the newborn to a hospital — and to this day, the ambulance company gets an invitation to the birthday of that child every year!
Those are only two of some 18,000 calls Lifeline responds to in a year; only two of the thousands of dramatic stories that done in the line of duty for the members of the ambulance crew.
Everyday, we meet at least one ambulance on the road, perhaps with sirens blaring and lights flashing to indicate that it is on another mission to save a life.
But it’s not often that we will know what went into saving the life in that ambulance — the sophisticated medical equipment in the ambulance, the team work that went into the operation, the risks that the crew had taken — all in the line of duty.
An ambulance goes by many names — ER on wheels, basic life support ambulance, advanced life support ambulance, or Type 2 ambulance — each name indicating the medical equipment and medicines onboard that can save the life of a patient in transit to the hospital.
In the recent months, ambulances have been more than usual on the roads because of the COVID-19 pandemic, in addition to the usual cases of people with health issues, or victims of accidents being transported to hospitals.
There are many types of ambulances, each one categorized according to the medical equipment it contains.
Types of ambulances
The members of the San Lazaro Hospital-Health Emergency Management Services (SLH-HEMS) explained the equipment in its life-saving vehicle categorized as “advanced life support ambulance” or “Type 2,” as it is called by the Department of Health (DOH).
Among the equipment that are in the advanced life support ambulance are the cardiac monitor, automated external defibrillator (AED) to be used when the patient goes through cardiac arrest; medications for emergency situations; oxygen tank with regulator; suction machine to collect the fluids that blocks the patient’s airway; and First Aid kit.
Medicine kit 
First aid kit 
AED (Automatic External Defibrillator)
Dr. Alexis Dimapilis, the head of SLH-HEMS, said the type 2 ambulance is “fully equipped not only for trauma cases but for infectious cases as well.”
“The requirement of the Department of Health (DOH) is that ambulances should be Type 2. There are cardiac monitors, AED (among others). A patient who is having (cardiac) arrest or (heart) attack---we can manage them because the ambulance is fully equipped,” he added.
The team
Aside from the essential equipment, there is the team of responders. The medical responders of the San Lazaro Hospital include a doctor, a nurse, an emergency medical technician (EMT), and the ambulance driver.
“Of course, you have to be physically fit, trained, and then the members have different expertise when handling patients,” said Dr. Roberto Ibanez, who is part of the team.
Ibanez said that the nature of calls they are receiving varies---from infectious cases to minor injuries.
“Since we are an infectious hospital, so mostly (we handle) infectious cases. But we do not only handle such cases. We are also handling fracture, abrasion, open wounds, which are the most common cases during Traslacion,” he added.
‘ER on Wheels’
ER on wheels is how Lifeline, the biggest private ambulance company in the country, calls their ambulances. That’s because each is equipped with medical and life-saving equipment including ECGs, defibrillators, AEDs, suctions, fluids, oxygen, and medicines.
Lifeline is a 25-year-old private ambulance company that has been providing pre-hospital services to around 5.4 million members in Metro Manila and neighboring provinces including Rizal, Bulacan, Cavite, and Laguna. In its corporate lifetime, it has responded to over 350,000 calls.
It has over 60 ambulances with over 400 first responders.
According to Lifeline President and CEO Michael Deakin, the company follows international standards for its fleet, and the team onboard the ambulances is composed of registered nurses and doctors.
"We only buy purpose-built ambulance units from the USA and use equipment that is approved for use in Australia, USA, and the United Kingdom. We assign registered nurses and doctors on board our ambulances which makes them 'Emergency Rooms On Wheels’,” he said.
Its fleet is categorized into three: Alpha, Charlie, and Sierra.
Alpha is the most advanced ambulance in the company's fleet, equipped with life-saving equipment and medicines and manned by a team of responders composed of doctors, nurses, emergency medical technicians, paramedics.
Charlie, the "little red cars," is Lifeline’s rapid first responders that get to the emergency ahead of the arriving ambulances. Each is manned by a doctor, nurses and it always carries additional supply.
Sierra, or the support vehicles, shuttle medical crew to and from posts, and deliver supplies and mechanics to the ambulances. It is usually manned by operation managers, field managers, and mechanical support teams.
12-minute response time
Because time is important in saving a life, Lifeline ambulances and crew are on standby at 30 strategic locations in Metro Manila, each site calculated to be an average of 12-minute response time to a call for help.
Lifeline has partnered with over 20 leading tertiary hospitals in Metro Manila to provide emergency medical response services. Among these hospitals are St. Luke's Medical Center, Makati Medical Center, Asian Hospital and Medical Center, The Medical City, Manila Doctors Hospital, Cardinal Santos Medical Center, and Medical Center Taguig.
Hotline 16-911
When a call is made to Lifeline via its hotline 16-911, the two nearest ambulances are deployed to respond while the two nearest private and government hospitals are alerted of an incoming patient. A Lifeline doctor would then be advised of the emergency for response and medical control if required.
From the minute the call is made, a dispatch team will manage all the patient's needs, records, history, preferred hospitals, and doctors for the endorsement protocols. They also help re-route traffic if required.
Lifeline will then endorse the patient to the contracted hospital.
Decontamination protocols
After every transport of a patient, the ambulance is taken out of rotation and it goes through decontamination protocol with a UV light for up to four hours.
Deakin said this has caused delays in both response time and downtime of the ambulances. To address the issue, Lifeline invested in “dry misting” technology from Switzerland that allowed them to decontaminate an ambulance in 33 minutes.
The system, which is only usually used by tertiary hospitals for its ICU and operating rooms, is also made available for Lifeline members to decontaminate their homes and rooms before and after home quarantine.
Philippine Red Cross
The Philippine Red Cross has been operating ambulances since the 1940s. Today, they have 164 active ambulances around the country.
The latest addition to its fleet are six Negative Pressure System Ambulances which acts as isolation chambers for COVID-19 patients with a system that does not allow air from the chamber to flow out and infect the outside air.
Its line-up of ambulances are impressive, among them 62 Toyota Hi-Ace, 43 Ford 4x4 and three Toyota Hi-lux vans with AEDs, portable ventilator, oxygen tank, wheeled stretcher, stair chair, Kendrick extrication device, traction splint, suction machine, bag valve mask, spine board with strap, fire extinguisher (dry chemical), PRC FA backpack, MCI Kit and Personal Protective Equipment.
Red Cross ambulances have been very visible in religious, political and sports events. One event where the PRC ambulances have been a mainstay is the annual feast of the Nazareno where hundreds of thousands of devotees flock to join the procession to fulfill a vow in gratefulness for a granted prayer-request.
Local government units
Ambulances are also among the fleet of vehicles of all local government units and some barangay centers.
Two of the LGUs with a fleet of ambulances are Makati City and Quezon City.
Makati City has 23 ambulances. One is an advance cardiac life support ambulance with a medical kit for pre-medical trauma, laryngoscope set, portable cardiac monitor, electronic vein locator, vital signs monitor, and other medical equipment.
Two are fully-equipped advance cardiac life support ambulances, and 20 are basic life support ambulances with medical equipment that includes a minor surgical kit.
Quezon City has 178 ambulances, six of them dedicated to transporting COVID patients. Its ambulances are fully equipped with equipment for medical emergencies. (With a report from Joseph Pedrejas)