The document discusses transportation in hospitals. It covers the history of medical transportation from using carts in the 1700s to modern ambulances. It describes various types of intramural transportation within hospitals like trolleys, lifts, stairways and ramps. It also discusses extramural transportation like ambulances and their classification into types A through D based on care level. The document provides details on infrastructure, equipment and national standards for ambulance construction and visibility.

1. Transportation
in
Hospitals
Dr. Ruchi Kushwaha
Hospital Administrator

2. Conduct Protocol
 National Ambulance Code
 Types of ambulances- type A,B,C,D
 Recognition and visibility of ambulances
 National Ambulance Service (NAS)
 Transportation Barrier
 Role of Hospitals
 Conclusion
 References
 History
 Background
 Introduction
 Types of transportation in Hospitals
 Infrastructure for Transportation
 Organogram
 Intramural Transportation- trolley, stair,
ramps, lift, elevator, dumbwaiter
 Extramural Transportation- Ambulances

3. History
 In past time patients were left to die during calamities
 With the progress of time, carts were used as early as 1762 AD in France
 Mobile Hospital- Hospital Ambulant
 1880s- wheeled trolleys used in England
 1903- motorised ambulance introduced
 During World War I & II, high technology ambulance services had been used

4. Background
 Health and well-being are inextricably linked to the social and economic
conditions in which people live
 Research has shown that only 20% of health can be attributed to medical
care, while social and economic factors like access to healthy food, housing
status, educational attainment and access to transportation account for 40%
 Transportation is an economic and social factor that shapes people’s daily
lives and thus a social determinant of health

5. Background

6. Introduction
 Transport or transportation is the movement of people, animals and goods
from one location to another
 Medical Transportation enable patients to reach their destination quickly and
efficiently while in transit, highly trained drivers, emergency medical
technicians (EMTs) and paramedics provide medical services that may be
needed to ensure a safe arrival
 Patient transports between visits, treatments and operations represent a
logistical challenge for hospitals

7. Types of Transportation in Hospitals
 On b/o severity of the situation & patient’s medical condition-
1. Non-emergency Medical Transportation
• Ambulatory transportation
• Stretchers
• Wheelchair
• Courier Service
• Flight service
2. Emergency Medical Transportation
• Advanced Life Support (ALS)
• Basic Life Support (BLS)

8. Transportation
Staff & Material Transport
Staff Bus Store Van
Patient Transport
Hearse Van Ambulances
ALS BLS
Types of transportation

9. Transportation
Extra mural
Ambulances Hearse Van
Intramural
Lift, Trolley, Stretcher, Ramps,
Dumb waiters, Elevators

10. Infrastructure for Transportation
Infrastructure
Transport bay
Administrative
office
Workshop

11. Transportation Bay
 There s/b a designated area for parking of hospital vehicle
 Size- No. of vehicles
 Properly secured
 Provision for water supply & electrical points
 Daily inspection – preventive maintenance
 O.T. tech.- equipt in ALS/BLS ambulances
 In-charge Transport- fuel & grease

12. Workshop
 For minor repairs
 Size- vehicle loads
 Trained mechanics
 Adequate light
 Vehicle washing system
 Welding & cutting facilities

13. Administrative Office (Vehicle Cell)
 Office of I/C transport Services
 Office of transport supervisor
 Record room
 Rest room for drivers & other staff
 Store room

14. Organogram
Chief Medical Superintendent
Medical Superintendent
Transport In-charge
Transport Supervisor
Stretcher
Bearer
Drivers Cleaner
Technica
l Staff
Mechani
cs

15. Intramural Transportation- Trolley System
 A goods vehicle with a platform body with
four small wheels of equal size, mounted
underneath it, the front two on a turntable
undercarriage
 This trolleys usually used in hospitals to
carry linen, instruments, food, to patient
transfer to various departments

16. Trolley System
Trolley for Food Trolley for Linen

17. Trolley System
Dressing Trolley BMW Bins Trolley

18. An elevator
 An elevator is a transport device used to move goods or people vertically,
from one floor to another
 They usually handle any types of traffic including Patients, Visitors, personnel
and service
 Under emergency situations the patients has to be moved quickly for which
the elevator is a must in all hospitals
 Passenger elevator capacity: Capacities from 1500 to 5000 lb (680 to 2300
kg)
 Speed is up to 300ft/min (1.5 m/s)

19. An elevator
Features-
 Call button to choose a floor
 Door open and door close buttons to instruct the elevator to
close immediately or remain open longer
 A stop switch to halt the elevator
 An alarm button or switch
 An elevator telephone
 A fireman’s key switch
 A medical emergency key switch
 Switches to control the lights and ventilation fans
 Up and down buttons

20. Lifts
 Usually the word elevator and lifts are used
interchangeably primarily both of them mean
the same thing
 The lift control system can be Car Switch or
Automatic Type
 Each lift is fully equipped with the latest safety
devices
 There s/b separate lifts for Doctors & patients
 There s/b separate lifts in case of fire

21. Stairways
 The minimum width of 1.11 metres and landings
are necessary for handling stretches in an
emergency, when patients have to be excavated
during a fire
 Continuous hand railings on both sides at a height
of approx. 0.9 metre (3ft)
 Surface s/b non-slippery

22. Ramps
 used in case of transporting stretcher
patients
 Gradient of 1:10; width – 2.5 metres
 width at landing at the U turn 3.0 mtr (10ft)
 concrete railings at a height of 0.9 mtr (3ft)
 The floor of the ramp should have grooves
perpendicular to the slope to avoid
skidding the floor may be tiles, stone slabs

23. Dumbwaiter
 A small box elevator designed for the carriage of light weight
freight is called a dumb waiter
 transport linens, clothes, food, and cleaning supplies
regularly b/w floors
 The main purpose of using this type of service is to transport
sterile supplies & instruments from one room to another but
both the rooms has to be one below the other in the same
building but different floors
 generally driven by a small electric motor with a counter
weight and there capacity is limited to about 340 kg

24. Stretchers
 primarily used in acute out-of-hospital care situations by emergency medical
services, military, and search and rescue personnel

25. Wheelchair
 A chair fitted with wheels for use as
a means of transport by a person
who is unable to walk as a result of
illness, injury, or disability

26. Extramural Transportation: Ambulances
Ambulance is a specially equipped and ergonomically designed vehicle for
transportation / emergent treatment of sick or injured people and capable of
providing out of hospital medical care during transit / when stationary,
commensurate with its designated level of care when appropriately staffed

27. National Ambulance Code
Constructional and Functional Requirement for Road Ambulances: National
Ambulance Code was given by The Ministry of Road Transport and
Highways, Govt. of India

28. National Ambulance Code
 The Ministry has set up five Working Groups on 4Es of Road Safety i.e.
Education, Engineering (Vehicles), Enforcement and Emergency Care on the
recommendation of the National Road Safety Council (NRSC)
 The Working Group on Emergency Care in its report observed that the real
concept of an ambulance is missing in India
 Existing ambulances are more like transport vehicles and any vehicle suitable
to lay a patient is called an ambulance without consideration to the overall
ambulance design
 Research has shown that ambulances are more likely to be involved in motor
vehicle collisions resulting in injury or death

29. National Ambulance Code
 It is, therefore, all the more necessary in an ambulance to take care of
occupant safety, patient care ergonomics, medical equipment selection and
placement, vehicle engineering and integration, etc.
 The working group recommended that there is a need to formulate the
“National Ambulance Code” with necessary amendments in Central Motor
Vehicle Rules (CMVR) that defines the Constructional and Functional
Requirements for Road Ambulances
 In view of above an expert Committee has formulated ‘National Ambulance
Code’ along with detailed specifications for various types of ambulances for
the country and prepared a draft amendment notification to CMVR 1989

30. Types of Ambulances
 Road Ambulances are designated as follows based on the level of care they
can provide
 Type A Road Ambulance /Medical First Responder
 Type B Road Ambulance/ Patient Transport Vehicle
 Type C Road Ambulance: Basic Life Support Ambulance
 Type D Road Ambulance: Advanced Life Support Ambulance

31. Type A Road Ambulance /Medical First Responder
 Road Ambulance designed to provide emergent out of hospital medical
care to patients when stationary
 This vehicle maybe any CMVR approved Category M or L vehicle suitable for
the terrain to be used in
 but will not have the capability to transport patients in supine state or provide
them medical care inside the vehicle

32. Type B Road Ambulance/ Patient Transport Vehicle
 Road ambulance designed and equipped for the transport patients who are
not expected to become emergency patients

33. Type C Road Ambulance: Basic Life Support
Ambulance
 A vehicle ergonomically designed, suitably equipped and appropriately staffed
for the transport and treatment of patients requiring non-invasive airway
management / basic monitoring

34. Type D Road Ambulance: Advanced Life Support
Ambulance
 A vehicle ergonomically designed, suitably equipped and appropriately staffed
for the transport and treatment of emergency patients requiring invasive
airway management / intensive monitoring

35. Recognition and visibility of ambulances
 The Ambulance Conspicuity Code is split into six sections-
(i) Colour- vehicles basic colour
(ii) Conspicuity Improving Items (C2I)- all Symbols, Marking and Striping
(iii) Emblems- every item that doesn’t fall under the definition of C2I which can be private
company signs or corporate identities
(iv) Warning Lights- colour, position, alignment, luminosity, photometric brightness, flash
patterns and electrical current consumption of all used warning lights
(v) Sirens- volumes, frequencies & electrical current consumption of sirens and speakers
(vi) Recognition of personnel

36. Type- B Ambulance

37. Type- B Ambulance

38. Type- C Ambulance: BLS

39. Type- C Ambulance: BLS

40. Type- D Ambulance: ALS

41. Type- D Ambulance: ALS

42. Colour
 The basic colour of the complete exterior should be brilliant white,
 RAL-Code 9010, front, rear and side bumpers included
 The colour s/b weather resistant and withstand daily cleaning and washing

43. Conspicuity improving items
 This definition includes all marking, striping and symbols
 All C2I-markings should be in brilliant red, RAL Code 3024 and in retro
reflective quality
 Conspicuity Improving Items defined by this standard are:
 Chevron patterns in red/silver and
 Battenburg patterns ,in red/yellow
 “AMBULANCE” markings, the Star of Life and the emergency number symbol
 All “AMBULANCE” markings must follow a 7:1 ratio, length to height

44. Front
 No less than 50% of the front side of the vehicle should be sulfur yellow, RAL-Code
1016
 in contrast to no less of 10% brilliant red, RAL Code 9010
 The word “AMBULANCE” on yellow background, minimum of 65% of the hood width,
shall be in mirror image (reverse reading) for mirror identification by drivers ahead
 The front bumper or at least the lower vehicle front up to 70cm or a suitable height
within ±30cm should be equipped with retroreflective striping in a chevron pattern
sloping downward and away from the centreline of the vehicle at an angle of 45
degrees
 Each stripe in the chevron pattern shall be single colour alternating between
fluorescent red and silver
 Each stripe shall be 6in. (150mm) in width

45. Side
 The side of the vehicle should be equipped with a two lined red Battenburg pattern
on the white ground colour
 Starting at the vehicle front the Battenburg squares, with a size of 25cm x 25cm,
should reach the middle of the vehicle side and end in a top square, followed by an
“AMBULANCE” marking on the same height
 The “AMBULANCE” marking s/b at least 80% of the Battenburg squares height
 The front half of the Battenburg pattern s/b red/yellow squares
 The bottom line of the Battenburg pattern should be 25cm above the bottom line of
the vehicles chassis, so that the top line of the Battenburg pattern reaches 75cm
above the chassis bottom line

46. Side
 Displayed on the upper half of the left side should be a “Star of Life” symbol, with a
size of 40cm x 40cm, and the emergency number logo, with a size of 40cm x 75cm
 The vertical centre from both of them should match the vertical centre of the side
windows of the driver cabin
 Contour markings in form of a non continuous retro-reflecting silver stripe (each part
3cm x 10cm) s/b applied to the side profile to enhance Conspicuity of the vehicle
 In Type B, C and D ambulances, the words “Patient Transport”, “Basic Life Support”
and “Advanced Life Support” shall be marked respectively just above the word
ambulance in size no less than 50% of the size of the word “AMBULANCE”

47. Rear
 No less than 50% of the rear of the vehicle should be equipped with a
chevron pattern sloping downward and away from the centreline of the vehicle
at an angle of 45 degrees
 Each stripe in the chevron pattern shall be single colour alternating between
fluorescent red and yellow
 Each stripe shall be 6in. (150mm) in width
 To ensure that the standard rear lights of the vehicle are not camouflaged by
the chevron striping, the chevron striping must provide a distance of no less
than 10cm to the standard rear lights

48. Rear
 The word “AMBULANCE” on yellow background, minimum of 65% in width of the
rear facing side of the vehicle but not smaller than 70cm in width, must be mounted
at the bottom end of the rear facing doors
 Displayed on the left back window should be a “Star of Life” symbol, with a size of
85% of the window, and on the right back window the emergency number logo with
the same size
 The rear bumper should be provided with the same chevron pattern as the front one
 Contour markings in form of a non-continuous retro-reflecting silver stripe s/b applied
to the rear profile to enhance conspicuity of the vehicle

49. Emblems
 Emblems defined as such by this Ambulance Conspicuity Rule are
government/ private / operator signs, corporate identities (XXX) and every
other sign, symbol, marking or striping not referred to in the “Conspicuity
Improving Items” section
 These emblems are only allowed in a non-reflecting manner and the size
can’t be bigger than 60% of the “AMBULANCE” markings
 Ambulance Calling Number (YYY) if available must be displayed prominently
on the side and back of the Road ambulance

50. Warning lights
 Type A and B Road Ambulances shall have flashers fitted at appropriate locations as
per the vehicle type
 Type C and D Road Ambulances shall have warning lights as follows:
 All warning lights have to be mounted rectangular to the horizontal ground
 They must provide 100% of their intensity in a vertical angle of ±4 degrees and 50%
in a vertical angle of ±8 degrees
 The minimum intensity is for blue and red lights at 100cd at daylight and 200cd in the
night
 The horizontal minimum angle should be at least 45 degrees
 All lights must flash between 2Hz and 4Hz

51. Warning lights
Flash Pattern
1. Indicates light flashing the same
time
2. Indicates light flashing 180 degree
out of phase with 1
3. ‘x’ indicates ‘ON’ lights in primary
and secondary mode
4. ‘y’ indicates ‘ON’ light only in primary
mode
5 ‘z’ indicates ‘ON’ light only in
secondary mode

52. Warning lights
 Lights marked with “red blue” must show red and blue in one pIECe one at a
time
 In daytime they must flash red in night time they must flash blue
 Two lights have to be mounted in the lower middle windshield only flashing to
the outside of the car
 To switch from Primary into Secondary Mode there has to be one switch that
allows only one mode

53. Sirens
 In Type A, B, C and D Road Ambulances, all siren loudspeakers have to be mounted on the
front of the vehicle
 Hidden installation is allowed
 The main sound direction must be in driving direction
 Permitted are wail and yelp signals that cycle between 10-18 respectively 150-250 per minute
at an sound pressure level of 110dB(A) to 120dB(A)
 The sirens s/b tested in accordance with IS 1884 (though not covered in the standard)
 The frequency range must be at least one octave and should be between 500Hz and 2.000Hz
 An additional electronic air horn can be used
 Further there should be a public address system that can be worked at all times
ergonomically from the driver’s seat
 The siren switch can only be used if the warning lights are on

54. Recognition of personnel
 Safety garments for ambulance personnel should conform to at least ISO
14116:2008

55. National Ambulance Service (NAS)
 31 States/UTs have the facility where people can dial 108 or 102 telephone
number for calling an ambulance
 108 is predominantly an emergency response system, primarily designed to
attend to patients of critical care, trauma and accident victims etc.
 102 services essentially consist of basic patient transport aimed to cater the
needs of pregnant women and children though other categories are also
taking benefit and are not excluded
 JSSK entitlements e.g. free transfer from home to facility, inter facility transfer
in case of referral and drop back for mother and children are the key focus of
102 service
)

56. National Ambulance Service (NAS)
 8942 ambulances are being supported under 108 emergency transport
systems including new
 9641 ambulances are operating as 102/104 patient transport including new
ambulances
 6183 empanelled vehicles are also being used in some States to provide
transport to pregnant women and children e.g. Janani express in MP, Odisha,
Mamta Vahan in Jharkhand, Nishchay Yan Prakalpa in West Bengal and
Khushiyo ki Sawari in Uttarakhand

58. The Role of Hospitals
 To address transportation issues and help to create better transportation options for
patients, hospitals can implement multiple strategies to increase patients’ access to
health care and other services-
 Understand and assess how transportation can affect overall community health
 Integrate access to transportation with organization’s mission and practices
 Expand partnerships to support addressing transportation issues
 Invest resources in understanding patients’ transportation needs
 Support or invest in programming or infrastructure to reduce travel for patients

59. Conclusion
 Transportation is an essential service function in every hospital regardless of
its size, sophisticated and means of transportation
 It encompasses a wide range of activities and areas in any hospital like
inpatient escort service, patient transportation too and fro ancillary
departments, movement of staff and visitors, movement of supplies, materials
and equipment's, food etc
 Some times movement of patients from their homes in the form of ambulatory
services

60. References
 Automotive Industry Standard (AIS): Constructional and Functional
Requirements for Road Ambulances (National Ambulance Code)
 www.aha.org/transportation
 www.nrhm.gov.in

61. Thank You!

62. Speaker Contact Information
Your feedback and comments will be appreciated !
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