One victim, not wearing a police uniform, taken away in an ambulance today. The name has not yet been released from the shooting.
St John Ambulance, branded as St John in some territories, is a common name used by a number of affiliated organisations in different countries dedicated to the teaching and practice of medical first aid and the provision of ambulance services, all of which derive their origins from the St John Ambulance Association founded in 1877 in the United Kingdom. Each national group falls within the charge of a Priory or National Council of the Venerable Order of Saint John in which each Priory ranks alongside the others.
In several priories St John Ambulance has commercial sections or subsidiaries operating to generate surplus for charitable activities; these are structured much like other commercial bodies. The membership aspect of St John Ambulance is largely ranked, and members fall into a hierarchical structure of command. Ranks run from corporals, through sergeants and officers all the way up to high national ranks, but there is significant variation between Priories and it is hard to generalise the structure too much from an international perspective.
Most members of St John Ambulance are not themselves members of the Order, and vice versa, so a major presence of the Order does not dictate a major presence of St John Ambulance. Most notably, the Order of St John is a Christian organisation, whereas St John Ambulance is keen to ensure there is no allegiance to any particular religion or denomination, so as to remain available to all. St John Ambulance works on a more geographical nature than the Order, and has to contend with the differing national laws, medical practices and cultures of countries.
The legal status of each organisation varies by country; in both England and Wales the resident St John Ambulance organisations are simultaneously but separately registered as charities and companies, whereas St John Ambulance South Africa (for the sake of example) is a distinct entity registered as a "public benefit organisation".
The presence of St John Ambulance in different between different countries:
Another foundation the Order of St. John maintains is the Ophthalmic Hospital in Jerusalem, which provides free comprehensive patient care and nursing treatment to sufferers from eye disease and injury in the Jerusalem region, regardless of the religion or ethnicity of the patient.
In the consequence of World War II, British soldiers established St John brigades in Germany. In cooperation with "Johanniter Orden" (the German Order of St. John) "Johanniter-Unfall-Hilfe" was founded in 1952. In the recent years more national St. John cooperations not directly linked to their British "mother" have been installed in Europe.
At the international meeting of the enterprises of the Orders of St John, in the course of celebrations to mark the Order's 900th anniversary in 1999, the idea to cooperate more intensively within Europe was born. As a result Johanniter_International today links 16 national St. John organisations all over Europe.
In the phrase "Order of St John", St is an abbreviation for Saint, and corporate and national logos began to reflect this as a change from St. (with the dot) in 2006-7.][
The unusual name of the organisation has been known to cause confusion to members of the public, and many people often assume that the "St John" prefix indicates a church related organisation. In fact, in its modern form, the prefix refers to the Order of St. John (which in fact is a Christian organisation) and is used as an adjective. However, it is often assumed to be used as a noun, and this leads to the organisation being frequently incorrectly termed "St John's Ambulance", a long standing source of irritation to some members. This is further perpetuated since members on duty are often referred to collectively as "St Johns". In terms of the Order, the original allegiance was to John the Baptist; this allegiance is not however inherited by St John Ambulance.
The Order's mottoes are Pro fide (For the faith) and Pro utilitate hominum (For the service of mankind). The 'Priory of England and The Islands' has recently replaced the Latin mottoes with a single English sentence: "For the faith and in the service of humanity", which some see as a controversial move. However in December 2006 it was agreed by Priory Council that this move should be partially reversed and the Latin mottoes were reintroduced in the Cadet Code of Chivalry.
The Order is not to be confused with the Sovereign Military Order of Malta or other members of The Alliance of the Orders of St. John of Jerusalem. There are also "copycat" organisations using the St John name which are not generally recognised by members of the Alliance of Orders of St John.
Falling under the direction of the Order of St John, St John Ambulance mirrors the structure of the Order. The Order is divided internationally into Priories, reflecting the monastic history of the original Knights Hospitaller. However, these modern priories are not monastic in nature and are used purely as terminology within the organisation. Eight priories are prescribed by the Order of St John Regulations:
The Priory of England and The Islands is the home priory of the Order, and any country which does not belong to its own dedicated priory is assumed into this home priory. Most of these are small Commonwealth islands, or countries in which there is only a minor presence.
That said, the relationship between the Order of St. John and St. John Ambulance is not directly paralleled. This explains somewhat why a breakdown into Priories may not be tantamount to a breakdown of St John Ambulance.
An ambulance is a vehicle for transportation of sick or injured people to, from or between places of treatment for an illness or injury, and in some instances will also provide out of hospital medical care to the patient. The word is often associated with road going emergency ambulances which form part of an emergency medical service, administering emergency care to those with acute medical problems.
The term ambulance does, however, extend to a wider range of vehicles other than those with flashing warning lights and sirens. The term also includes a large number of non-urgent ambulances which are for transport of patients without an urgent acute condition (see functional types, below) and a wide range of urgent and non-urgent vehicles including trucks, vans, bicycles, motorbikes, station wagons, buses, helicopters, fixed-wing aircraft, boats, and even hospital ships (see vehicle types, also below).
The term ambulance comes from the Latin word ambulare, meaning to walk or move about which is a reference to early medical care where patients were moved by lifting or wheeling. The word originally meant a moving hospital, which follows an army in its movements. During the American Civil War vehicles for conveying the wounded off the field of battle were called ambulance wagons. Field hospitals were still called ambulances during the Franco-Prussian War of 1870 and in the Serbo-Turkish war of 1876 even though the wagons were first referred to as ambulances about 1854 during the Crimean War.
There are other types of ambulance, with the most common being the patient transport ambulance (sometimes called an ambulette). These vehicles are not usually (although there are exceptions) equipped with life-support equipment, and are usually crewed by staff with fewer qualifications than the crew of emergency ambulances. Their purpose is simply to transport patients to, from or between places of treatment. In most countries, these are not equipped with flashing lights or sirens. In some jurisdictions there is a modified form of the ambulance used, that only carries one member of ambulance crew to the scene to provide care, but is not used to transport the patient. Such vehicles are called fly-cars. In these cases a patient who requires transportation to hospital will require a patient-carrying ambulance to attend in addition to the fast responder.
The history of the ambulance begins in ancient times, with the use of carts to transport incurable patients by force. Ambulances were first used for emergency transport in 1487 by the Spanish, and civilian variants were put into operation during the 1830s. Advances in technology throughout the 19th and 20th centuries led to the modern self-powered ambulances.
Ambulances can be grouped into types depending on whether or not they transport patients, and under what conditions. In some cases, ambulances may fulfil more than one function (such as combining emergency ambulance care with patient transport).
Ambulances can be based on many types of vehicle, although emergency and disaster conditions may lead to other vehicles serving as makeshift ambulances:
A paramedic's scooter in Israel
In large, congested cities, paramedics may travel by bicycle, such as this one of the London Ambulance Service
An air ambulance in Austria
A water ambulance in the Scilly Isles
A Russian hospital train
Soviet-made ambulance Type RAF-2203 "Latvija" as used in Bulgaria until the end of the 1990s
Ambulance design must take into account local conditions and infrastructure. Maintained roads are necessary for road going ambulances to arrive on scene and then transport the patient to a hospital, though in rugged areas four-wheel drive or all-terrain vehicles can be used. Fuel must be available and service facilities are necessary to maintain the vehicle.
Methods of summoning (e.g. telephone) and dispatching ambulances usually rely on electronic equipment, which itself often relies on an intact power grid. Similarly, modern ambulances are equipped with two-way radios or cellular telephones to enable them to contact hospitals, either to notify the appropriate hospital of the ambulance's pending arrival, or, in cases where physicians do not form part of the ambulance's crew, to confer with a physician for medical oversight.
Ambulances often have two manufacturers. The first is frequently a manufacturer of light trucks or full-size vans (or previously, cars) such as Mercedes-Benz, Nissan, Toyota, or Ford. The second manufacturer (known as second stage manufacturer) purchases the vehicle (which is sometimes purchased incomplete, having no body or interior behind the driver's seat) and turns it into an ambulance by adding bodywork, emergency vehicle equipment, and interior fittings. This is done by one of two methods – either coachbuilding, where the modifications are started from scratch and built on to the vehicle, or using a modular system, where a pre-built 'box' is put on to the empty chassis of the ambulance, and then finished off.
Modern ambulances are typically powered by internal combustion engines, which can be powered by any conventional fuel, including diesel, gasoline or liquefied petroleum gas, depending on the preference of the operator and the availability of different options. Colder regions often use gasoline powered engines, as diesels can be difficult to start when they are cold. Warmer regions may favor diesel engines, as they are thought to be more efficient and more durable. Diesel power is sometimes chosen due to safety concerns, after a series of fires involving gasoline powered ambulances during the 1980s. These fires were ultimately attributed in part to gasoline's higher volatility in comparison to diesel fuel. The type of engine may be determined by the manufacturer: in the past two decades, Ford would only sell vehicles for ambulance conversion if they are diesel powered. Beginning in 2010, Ford will sell its ambulance chassis with a gasoline engine in order to meet emissions requirements.
Many regions have prescribed standards which ambulances should, or must, meet in order to be used for their role. These standards may have different levels which reflect the type of patient which the ambulance is expected to transport (for instance specifying a different standard for routine patient transport than high dependency), or may base standards on the size of vehicle.
For instance, in Europe, the European Committee for Standardization publishes the standard CEN 1789, which specifies minimum compliance levels across the build of ambulance, including crash resistance, equipment levels, and exterior marking. In the United States, standards for ambulance design have existed since 1976, where the standard is published by the General Services Administration and known as KKK-1822-A. This standard has been revised several times, and is currently in version 'F', known as KKK-1822-F, although not all states have adopted this version. The National Fire Protection Association has also published a design standard, NFPA 1917, which some administrations are considering switching to when KKK-1822 is withdrawn in 2015.
The move towards standardisation is now reaching countries without a history of prescriptive codes, such as India, which approved its first national standard for ambulance construction in 2013.
Ambulances, like other emergency vehicles, are required to operate in all weather conditions, including those during which civilian drivers often elect to stay off the road. Also, the ambulance crew's responsibilities to their patient often preclude their use of safety devices such as seat belts. Research has shown that ambulances are more likely to be involved in motor vehicle collisions resulting in injury or death than either fire trucks or police cars. Unrestrained occupants, particularly those riding in the patient-care compartment, are particularly vulnerable. When compared to civilian vehicles of similar size, one study found that on a per-accident basis, ambulance collisions tend to involve more people, and result in more injuries. An 11-year retrospective study concluded in 2001 found that although most fatal ambulance crashes occurred during emergency runs, they typically occurred on improved, straight, dry roads, during clear weather. Furthermore, paramedics are also at risk in ambulances while helping patients, as 27 paramedics have died during ambulance trips in the US since 1991.
In addition to the equipment directly used for the treatment of patients, ambulances may be fitted with a range of additional equipment which is used in order to facilitate patient care. This could include:
In parts of the world which lack a high level of infrastructure, ambulances are designed to meet local conditions, being built using intermediate technology. Ambulances can also be trailers, which are pulled by bicycles, motorcycles, tractors, or animals. Animal-powered ambulances can be particularly useful in regions that are subject to flooding. Motorcycles fitted with sidecars (or motorcycle ambulances) are also used, though they are subject to some of the same limitations as more traditional over-the-road ambulances. The level of care provided by these ambulances varies between merely providing transport to a medical clinic to providing on-scene and continuing care during transport.
The design of intermediate technology ambulances must take into account not only the operation and maintenance of the ambulance, but its construction as well. The robustness of the design becomes more important, as does the nature of the skills required to properly operate the vehicle. Cost-effectiveness can be a high priority.
Emergency ambulances are highly likely to be involved in hazardous situations, including incidents such as a road traffic collision, as these emergencies create people who are likely to be in need of treatment. They are required to gain access to patients as quickly as possible, and in many countries, are given dispensation from obeying certain traffic laws. For instance, they may be able to treat a red traffic light or stop sign as a yield sign ('give way'), or be permitted to break the speed limit. Generally, the priority of the response to the call will be assigned by the dispatcher, but the priority of the return will be decided by the ambulance crew based on the severity of the patient's illness or injury. Patients in significant danger to life and limb (as determined by triage) require urgent treatment by advanced medical personnel, and because of this need, emergency ambulances are often fitted with passive and active visual and/or audible warnings to alert road users.
The passive visual warnings are usually part of the design of the vehicle, and involve the use of high contrast patterns. Older ambulances (and those in developing countries) are more likely to have their pattern painted on, whereas modern ambulances generally carry retro-reflective designs, which reflects light from car headlights or torches. Popular patterns include 'checker board' (alternate coloured squares, sometimes called 'Battenburg', named after a type of cake), chevrons (arrowheads – often pointed towards the front of the vehicle if on the side, or pointing vertically upwards on the rear) or stripes along the side (these were the first type of retro-reflective device introduced, as the original reflective material, invented by 3M, only came in tape form). In addition to retro-reflective markings, some services now have the vehicles painted in a bright (sometimes fluorescent) yellow or orange for maximum visual impact.
Another passive marking form is the word ambulance (or local language variant) spelled out in reverse on the front of the vehicle. This enables drivers of other vehicles to more easily identify an approaching ambulance in their rear view mirrors. Ambulances may display the name of their owner or operator, and an emergency telephone number for the ambulance service.
Ambulances may also carry an emblem (either as part of the passive warning markings or not), such as a Red Cross, Red Crescent or Red Crystal (collective known as the Protective Symbols). These are symbols laid down by the Geneva Convention, and all countries signatory to it agree to restrict their use to either (1) Military Ambulances or (2) the national Red Cross or Red Crescent society. Use by any other person, organization or agency is in breach of international law. The protective symbols are designed to indicate to all people (especially combatants in the case of war) that the vehicle is neutral and is not to be fired upon, hence giving protection to the medics and their casualties, although this has not always been adhered to. In Israel, Magen David Adom, the Red Cross member organization use a red Star of David, but this does not have recognition beyond Israeli borders, where they must use the Red Crystal.
The Star of Life is widely used, and was originally designed and governed by the U.S. National Highway Traffic Safety Administration, because the Red Cross symbol is legally protected by both National and international law. It indicates that the vehicle's operators can render their given level of care represented on the six pointed star.
Ambulance services that have historical origins such as the Order of St John, the Order of Malta Ambulance Corps and Malteser International often use the Maltese cross to identify their ambulances. This is especially important in countries such as Australia, where St. John Ambulance operate one state and one territory ambulance service, and all of Australia's other ambulance services use variations on a red Maltese cross.
Fire service operated ambulances may display the Cross of St. Florian (often incorrectly called a Maltese cross) as this cross is frequently used as a fire department logo (St. Florian being the patron saint of firefighters).
The active visual warnings are usually in the form of flashing lights. These flash in order to attract the attention of other road users as the ambulance approaches, or to provide warning to motorists approaching a stopped ambulance in a dangerous position on the road. Common colours for ambulance warning beacons are blue, red, amber, and white (clear). However the colours may vary by country and sometimes by operator.
There are several technologies in use to achieve the flashing effect. These include flashing a light bulb or LED, and strobe lights, which are usually brighter than incandescent lights. Each of these can be programmed to flash singly or in groups, and can be programmed to flash in patterns (such as a left -> right pattern for use when the ambulance is parked on the left hand side of the road, indicating to other road users that they should move to the right (away from the ambulance). Incandescent and LED lights may also be programmed to burn steadily, without flashing.
Emergency lights may be housed in special fittings, such as in a lightbar, or may be hidden in a host light (such as a headlamp) by drilling a hole in the host light's reflector and inserting the emergency light. These hidden lights may not be apparent until they are activated. Additionally, some of the standard lights fitted to an ambulance (e.g. headlamps, tail lamps) may be programmed to flash. Flashing headlights (typically the high beams, flashed alternately) are known as a wig-wag.
In order to increase safety, it is best practice to have 360° coverage with the active warnings, improving the chance of the vehicle being seen from all sides. In some countries, such as the United States, this may be mandatory.
See also Emergency vehicle equipment.
In addition to visual warnings, ambulances can be fitted with audible warnings, sometimes known as sirens, which can alert people and vehicles to the presence of an ambulance before they can be seen. The first audible warnings were mechanical bells, mounted to either the front or roof of the ambulance. Most modern ambulances are now fitted with electronic sirens, producing a range of different noises which ambulance operators can use to attract more attention to themselves, particularly when proceeding through an intersection or in heavy traffic.
The speakers for modern sirens can be integral to the lightbar, or they may be hidden in or flush to the grill to reduce noise inside the ambulance that may interfere with patient care and radio communications. Ambulances can additionally be fitted with airhorn audible warnings to augment the effectiveness of the siren system.
A recent development is the use of the RDS system of car radios. The ambulance is fitted with a short range FM transmitter, set to RDS code 31, which interrupts the radio of all cars within range, in the manner of a traffic broadcast, but in such a way that the user of the receiving radio is unable to opt out of the message (as with traffic broadcasts). This feature is built into every RDS radio for use in national emergency broadcast systems, but short range units on emergency vehicles can prove an effective means of alerting traffic to their presence. It is, however, unlikely that this system could replace audible warnings, as it is unable to alert pedestrians, those not using a compatible radio or even have it turned off.
Some countries closely regulate the industry (and may require anyone working on an ambulance to be qualified to a set level), whereas others allow quite wide differences between types of operator.
The cost of an ambulance ride may be paid for from several sources, and this will depend on the type of service being provided, by whom, and possibly who to.
There are differing levels of qualification that the ambulance crew may hold, from holding no formal qualification to having a fully qualified doctor on board. Most ambulance services require at least two crew members to be on every ambulance (one to drive, and one to attend the patient), although response cars may have a sole crew member, possibly backed up by another double-crewed ambulance. It may be the case that only the attendant need be qualified, and the driver might have no medical training. In some locations, an advanced life support ambulance may be crewed by one paramedic and one EMT-Basic.
Common ambulance crew qualifications are:
Military ambulances have historically included vehicles based on civilian designs and at times also included armored, but unarmed, vehicles ambulances based upon armoured personnel carriers (APCs). In the Second World War vehicles such as the Hanomag Sd Kfz 251 halftrack were pressed into service as ad hoc ambulances, and in more recent times purpose built AFVs such as the U.S. M1133 Medical Evacuation Vehicle serve the exclusive purpose of armored medical vehicles. Civilian based designs may be painted in appropriate colours, depending on the operational requirements (i.e. camouflage for field use, white for United Nations peacekeeping, etc.). For example the British Royal Army Medical Corps has a fleet of white ambulances, based on production trucks. Military helicopters have also served both as ad hoc and purpose-built air ambulances, since they are extremely useful for MEDEVAC.
Since laws of war demand ambulances be marked with one of the Emblems of the Red Cross not to mount offensive weapons, military ambulances are often unarmed. It is a generally accepted practice in most countries to classify the personnel attached to military vehicles marked as ambulances as non-combatants; however, this application does not always exempt medical personnel from catching enemy fire —accidental or deliberate. As a result, medics and other medical personnel attached to military ambulances are usually put through basic military training, on the assumption that they may have to use a weapon. The laws of war do allow non-combatant military personnel to carry individual weapons for protecting themselves and casualties. However, not all militaries exercise this right to their personnel.
Recently, Israel has modified a number of its Merkava main battle tanks with ambulance features in order to allow rescue operations to take place under heavy fire in urban warfare. The modifications were made following a failed rescue attempt in which Palestinian gunmen killed two soldiers who were providing aid for a Palestinian woman in Rafah. Since M-113 armored personnel carriers and regular up-armored ambulances are not sufficiently protected against anti-tank weapons and improvised explosive devices, it was decided to use the heavily armored Merkava tank. Its rear door enables the evacuation of critically wounded soldiers. Israel did not remove the Merkava's weaponry, claiming that weapons were more effective protection than emblems since Palestinian militants would disregard any symbols of protection and fire at ambulances anyway.][ For use as ground ambulances and treatment & evacuation vehicles, the United States military currently employs the M113, the M577, the M1133 Stryker Medical Evacuation Vehicle (MEV), and the RG-33 Heavily Armored Ground Ambulance (HAGA) as treatment and evacuation vehicles, with contracts to incorporate the newly designed M2A0 Armored Medical Evacuation Vehicle (AMEV), a variant of the M2 Bradley Fighting Vehicle (formerly known as the ATTV).
Some navies operate ocean-going hospital ships to lend medical assistance in high casualty situations like wars or natural disasters. These hospital ships fulfill the criteria of an ambulance (transporting the sick or injured), although the capabilities of a hospital ship are more on par with a Mobile Army Surgical Hospital. In line with the laws of war, these ships can display a prominent Red Cross or Red Crescent to confer protection under the appropriate Geneva convention. However, this designation has not always protected hospital ships from enemy fire.
When an ambulance is retired, it may be donated or sold to another EMS provider. Alternately, it may be adapted into a storage and transport vehicle for crime scene identification equipment, a command post at community events, or support vehicle, such as a logistics unit. While others are refurbished and resold  or may just have their emergency equipment removed to be sold to private businesses or individuals who then can use them as small recreational vehicles.
Toronto’s City Council has begun a "Caravan of Hope" project to provide retired Toronto ambulances a second life by donating them to the people of El Salvador. Since the Province of Ontario requires that ambulances be retired after just four and a half years in service in Ontario, the City of Toronto decommissions and auctions 28 ambulances each year.
Hospital Train [WWII ETO by US Forces]
A uniform is a type of clothing worn by members of an organization while participating in that organization's activity. Modern uniforms are most often worn by armed forces and paramilitary organizations such as police, emergency services, security guards, in some workplaces and schools and by inmates in prisons. In some countries, some other officials also wear uniforms in their duties; such is the case of the Commissioned Corps of the United States Public Health Service or the French prefects. For some public groups, such as police, it is illegal for non members to wear the uniform. Other uniforms are trade dresses (such as the brown uniforms of UPS).
Workers sometimes wear uniforms or corporate clothing of one nature or another. Workers required to wear a uniform include retailer workers, bank and post office workers, public security and health care workers, blue collar employees, personal trainers in health clubs, instructors in summer camps, lifeguards, janitors, public transit employees, towing and truck drivers, airline employees and holiday operators, and bar, restaurant and hotel employees. The use of uniforms by these organizations is often an effort in branding and developing a standard corporate image but also has important effects on the employees required to wear the uniform. However the term 'uniform' is misleading because employees are not always fully uniform in appearance and may not always wear attire provided by the organization, while still representing the organization in their attire. Academic work on organizational dress by Rafaeli & Pratt (1993) referred to uniformity (homogeneity) of dress as one dimension, and conspicuousness as a second. Employees all wearing black, for example, may appear conspicuous and thus represent the organization even though their attire is uniform only in the color of their appearance not in its features. Pratt & Rafaeli, (1997) described struggles between employees and management about organizational dress as struggles about deeper meanings and identities that dress represents. And Pratt & Rafaeli (2001) described dress as one of the larger set of symbols and artifacts in organizations which coalesce into a communication grammar.
Uniforms are required in many schools. School uniforms vary from a standard issue T-shirt to rigorous requirements for many items of formal wear at private schools. School uniforms are in place in many public schools as well.
Countries with mandatory school uniforms include Japan, South Korea, Thailand, India, Australia, U.A.E, Singapore,some schools in China, New Zealand and the United Kingdom, among as many other places. In some countries, uniform types vary from school to school, but in the United Kingdom, many pupils between 11 and 16 of age wear a formal jacket, tie and trousers for boys and blouse, tie and trousers, skirt, or culottes for girls. The ties will usually be in a set pattern for the school, and jackets will usually carry a patch on the breast pocket with the school's name, coat of arms, and motto or emblem. Jackets are being replaced in many schools by sweatshirts bearing the school badge. Children in many United Kingdom state primary schools will have a uniform jumper and/or polo shirt with the school name and logo.
From about 1800 to after the Second World War, diplomats from most countries (and often senior civilian officials generally) wore official uniforms at public occasions. Such uniforms are now retained by only a few diplomatic services, and are seldom worn.
A prison uniform is any uniform worn by individuals incarcerated in a prison, jail or similar facility of detention.
Most, if not all, professional sports teams also wear uniforms, made in the team's distinctive colors, often in different variations for "home" and "away" games. Jeff Bzdelik, the premier basketball coach in the United States, established white uniforms as "home" uniforms during his winning tenure in the NBA. In the United Kingdom, especially in football the terms "kit" or "strip" (as in 'football kit') are more common.
Military uniform is the standardised dress worn by members of the armed forces and paramilitaries of various nations. Military dress and military styles have gone through great changes over the centuries from colourful and elaborate to extremely utilitarian. Military uniforms in the form of standardised and distinctive dress, intended for identification and display, are typically a sign of organised military forces equipped by a central authority. The utilitarian necessities of war and economic frugality are now the dominant factors in uniform design. Most military forces, however, have developed several different uniform types. Military personnel or civilian officials generally wear e.g.:
- battledress, khakis;
- dress uniform: worn at ceremonies, official receptions, and other special occasions; medals are typically worn.
- mess dress, formal evening dress worn in the mess or at other formal occasions.
- everyday work uniform, often with abbreviated forms of embellishment (such as using duller buttons or replacing medals with ribbon bars);
The practice of wearing a form of full dress off duty ("walking out dress") has largely died out as the modern soldier prefers the casual clothing of his civilian peers.
Domestic workers are often required by their employers to wear a uniform.
The Scout uniform is a specific characteristic of the Scouting movement, in the words of Baden-Powell at the 1937 World Jamboree, "it covers the differences of country and race and make all feel that they are members one with another of one World Brotherhood". The original uniform, which has created a familiar image in the public eye, consisted of a khaki button-up shirt, shorts and a broad-brimmed campaign hat. Baden-Powell himself wore shorts since being dressed like the youth contributed to reducing perceived "distance" between the adult and the young person. Nowadays, uniforms are frequently blue, orange, red, or green, and shorts are replaced by long pants in areas where the culture calls for modesty, and in winter weather.
Some uniforms have specially-manufactured buttons, which, in the case of antiques, often outlast the fabric components of the uniform, and become highly collectable items.
In some countries or regions such as the UK, Australia or Hong Kong, the cost of cleaning one's uniform or work clothing can be partially deducted or rebated from the personal income tax, if the organization for which the person works does not have a laundry department or an outsourced commercial laundry.
A riot gun or less-lethal launcher is a type of firearm that is used to fire "non-lethal" ammunition for the purpose of suppressing riots. Less-lethal launchers may be special purpose firearms designed for riot control use, or standard firearms, usually shotguns and grenade launchers, adapted to riot control use with appropriate ammunition. Many of them are 40 mm or 37 mm (about 1.5 inches) caliber.
Less-lethal launchers can fire various sorts of ammunition:
To avoid breaking the projectile up, less-lethal cartridges are often propelled by black powder, which when fired may make an eruption of sparks and smoke which is spectacularly large to those accustomed to modern cartridges propelled by more modern propellants: see images at  .
Chemical agents may be dispersed in three ways:
This method is the simplest: the chemical agent is in the form of a loose powder, which is expelled by the propellant of the cartridge. These rounds are used at short range, and have effect from the muzzle to a range of about 30 metres (33 yards). This method is best used by operators wearing gas masks, as the chemical agent can easily be blown towards the operator.
These are also called gas grenades, and are used at longer ranges. They are analogous to rifle grenades, providing increased accuracy and range over hand-thrown gas grenades. Gas grenades may be used by operators without gas masks, as the agent is only dispersed in the area of impact, as far away as 150 yards (140 m). The agent in gas grenades is dispersed as a gas or an aerosol spray.
These are specialized gas grenades designed to penetrate light barriers, such as windows, hollow core doors, and interior walls, and disperse chemical agents on the far side.
Impact rounds come in a variety of shapes, sizes and compositions for varying roles. Impact rounds are made out of materials of much lower density than the lead normally used in bullets, are larger, and are fired at lower velocities. Rounds are designed with low mass, moderate velocity, and large surface area to prevent the rounds from penetrating the skin significantly or causing severe injury, so they merely provide a painful blow to the target: but instances have been reported where rubber or plastic bullets have caused significant injuries to the body or eyes, and in some cases caused death.
One broad classification of impact rounds is direct fire and indirect fire rounds. Direct fire rounds can be fired directly at the target, ideally targeted low on the target, away from vital organs that are more prone to damage from the impact. Indirect or skip fire rounds are intended to be fired into the ground in front of the target, where they dissipate some energy, and then rebound into the target.
Baton rounds, often called rubber bullets or plastic bullets, are cylinders made of rubber, plastic, wood, or foam, and can be as large as the full bore diameter of the launcher. Smaller baton rounds may be encased in a shell casing or other housing. Baton rounds may fire one long baton, or several shorter batons. Harder or denser baton rounds are intended for skip fire, while softer or less dense batons are intended for direct fire. Baton rounds are the subject of significant controversy, due to extensive use by British and Israeli forces, resulting in a number of deaths.
Beanbag rounds consist of a tough fabric bag filled with birdshot. The bag is flexible enough to flatten on impact, covering a large surface area, and they are used for direct fire. Beanbag rounds may be wide and flat, designed for close range use, or elliptical in shape, with a fabric tail to provide drag stabilization, for longer range use.
These, also called stinger rounds, consist of a number of rubber balls ranging from around 0.32 to 0.60 inches (8.1 to 15 mm) in diameter, and are used for direct fire. The small diameter means that each ball contains far less energy than a baton round, but it also limits the range. Rubber slugs, used in 12 gauge firearms, consist of a fin stabilized full bore diameter rubber projectile. These are used for long range, accurate direct fire shots on individual targets.
Pepper-spray projectiles, commonly called pepperballs, are direct-fire paintball-like capsules filled with a pepper spray solution of capsaicin. They provide a longer range, more user-friendly way to disperse pepper spray. Many sorts can be fired from paintball markers. Other sorts are designed to be fired from specially-designed pepperball guns whose muzzle velocity is greater than a paintball marker: if the velocity is not high enough the projectile will not break. As with paintball impacts, the capsule's impact is mildly painful and by itself can discourage rioters, but the pepper spray incapacitates and discourages more rioters than the capsule's impact.
Purpose-built launchers are commonly large bore guns, formerly 25 to 27 mm, modern versions are 37 to 40 mm. Dual-purpose guns are usually 12 gauge (18.5 mm) riot shotguns, firing special less-lethal shotgun shells.
Single-shot large bore launchers, such as the Milkor Stopper 37/38 mm riot gun, M79 Grenade launcher and ARWEN ACE, are generally break open designs. The barrels are relatively short, resulting in a carbine sized gun, and may have a shoulder stock and/or a forward handgrip to provide greater control. Pistol launchers do exist, but they are generally only used for short range, muzzle dispersing chemical agents.
Multishot large-bore launchers, such as ARWEN 37, are usually in the form of a revolver holding five or six rounds in the cylinder. Unlike normal revolvers, the cylinder of a revolving riot gun is too massive to be turned easily by the trigger pull, and is usually turned by a pre-tensioned spring or by a pump action.
Shotguns used for riot control are nearly always in 12 gauge, as that is the gauge in which nearly all riot control rounds are made. Generally riot shotguns are used, such as some models of the Remington 870 and Mossberg 500. Due to the reduced power of riot control rounds, there is insufficient energy to cycle the actions of gas operated and recoil operated firearms, so riot shotguns are manually operated, usually pump action. The advantage of using a riot shotgun for riot control is that the shotgun is a dual use firearm, and can switch quickly to and from the riot control role by changing the ammunition. The downside is that it can fire lethal projectiles, and so extra care must be taken in its use to prevent the wrong ammunition from being used.
A recent addition to the class of riot guns is the pepper ball gun, an example of which is the FN 303. This is essentially a paintball marker, either purpose built for riot control, or modified from a commercial paintball marker. The pepper ball guns use special pepper spray ammunition based on paintball technology, consisting of a gelatin capsule filled with the riot control agent. The guns use compressed gas and provide semiautomatic fire, and the pepperballs act just like paintballs, fracturing on impact and splattering the chemical agent on impact. These can be used for direct fire, to break the balls on the target, or indirect fire, breaking near the target and spraying the agent into the target's vicinity.
Police have been known to use paintball guns loaded with paint projectiles, to mark particular rioters so that police can easily identify and arrest them later.
Some weapons discharge teargas as a solution in water: see Category:Teargas solution squirters.
Large-bore launchers are classified as firearms in most countries. Shotguns intended for riot use are semi-automatic shotguns subject to relevant regulations. Riot control ammunition may be restricted in various jurisdictions, to a lesser or greater degree than normal shotgun shells.
In the U.S. large-bore launchers are subject to BATFE regulations. Since firearms over .50 caliber (13 mm) with rifled barrels are considered destructive devices under the National Firearms Act, only smoothbore riot guns may be sold to civilians; a common form found on the civilian market are M203 grenade launcher replicas, which can be used to fire 37 mm practice rounds. The 40 mm guns are usually rifled, and may fire 40 mm grenades; explosive grenades rely on the spin both for stabilization and for arming the fuze.
Riot guns have been documented to be lethal in some cases. The death of American baseball fan Victoria Snelgrove is one such incident.
An air ambulance is a specially outfitted aircraft that transports injured or sick people in a medical emergency or over distances or terrain impractical for a conventional ground ambulance. These and related operations are called aeromedical. In some circumstances, the same aircraft may be used to search for missing or wanted people.
Like ground ambulances, air ambulances are equipped with medical equipment vital to monitoring and treating injured or ill patients. Common equipment for air ambulances includes medications, ventilators, ECGs and monitoring units, CPR equipment, and stretchers. A medically staffed and equipped air ambulance provides medical care in flight—while a non-medically equipped and staffed aircraft simply transports patients without care in flight. Military organizations and NATO refer to the former as medical evacuation (MEDEVAC) and to the latter as casualty evacuation (CASEVAC).
As with many Emergency Medical Service (EMS) innovations, treating patients in flight originated in the military. The concept of using aircraft as ambulances is almost as old as powered flight itself. Although balloons were not used to evacuate wounded soldiers at the Siege of Paris in 1870, air evacuation was experimented with during the First World War. The first true Air Ambulance flight was made when a Serbian officer was flown from the battlefield to hospital by a plane of the French Air Service. French records at the time indicated that the mortality rate of the injured was reduced from 60% to just under 10% if they were evacuated by air.
The first recorded British ambulance flight took place in 1917 in Turkey when a soldier in the Camel Corps who had been shot in the ankle was flown to hospital in a de Havilland DH9 in 45 minutes. The same journey by land would have taken some 3 days to complete. In the 1920s several services, both official and unofficial, started up in various parts of the world. Aircraft were still primitive at the time, with limited capabilities, and the effort received mixed reviews.
Exploration of the idea continued, however, and France and the United Kingdom used fully organized air ambulance services during the African and Middle Eastern Colonial Wars of the 1920s. In 1920, the British, while suppressing the "Mad Mullah" in Somalialand, used an Airco DH.9A fitted out as an air ambulance. It carried a single stretcher under a fairing behind the pilot. The French evacuated over 7,000 casualties during that period. By 1936, an organized military air ambulance service evacuated wounded from the Spanish Civil War for medical treatment in Nazi Germany. The first use of medevac with helicopters was the evacuation of three British pilot combat casualties by a US Army Sikorsky in Burma during WW2, and the first dedicated use of helicopters by U.S. forces occurred during the Korean War, between 1950 and 1953. The French used light helicopters in the First Indochina War. While popularly depicted as simply removing casualties from the battlefield (which they did), helicopters in the Korean War also moved critical patients to hospital ships after initial emergency treatment in field hospitals.
Knowledge and expertise of use of air ambulances evolved parallel to the aircraft themselves. By 1969, in Vietnam, the use of specially trained medical corpsmen and helicopter air ambulances led U.S. researchers to determine that servicemen wounded in battle had better rates of survival than motorists injured on California freeways. This inspired the first experiments with the use of civilian paramedics in the world. The US military recently employed UH-60 Black Hawk helicopters to provide air ambulance service during the Iraq War to military personnel and civilians. The use of military aircraft as battlefield ambulances continues to grow and develop today in a variety of countries, as does the use of fixed-wing aircraft for long-distance travel, including repatriation of the wounded. Currently, a NATO working group is investigating unpiloted aerial vehicles (UAVs) for casualty evacuation.
DH.9A D.3117 in Somaliland 1920
Older version of a Danish air ambulance
Light helicopters like this Bell 47 Sioux removed the wounded from the battlefield (Korea)
The first civilian uses of aircraft as ambulances were probably incidental. In northern Canada, Australia, and in Scandinavian countries, remote, sparsely populated settlements are often inaccessible by road for months at a time, or even year round. In some places in Scandinavia, particularly in Norway, the primary means of transportation between communities is by boat. Early in aviation history, many of these communities began to rely on civilian "bush" pilots, who fly small aircraft and transport supplies, mail, and visiting doctors or nurses. Bush pilots probably performed the first civilian air ambulance trips, albeit on an ad hoc basis—but clearly, a need for these services existed. In the early 1920s, Sweden established a standing air ambulance system, as did Siam (Thailand). In 1928 the first formal, full-time air ambulance service was established in the Australian outback. This organization became the Royal Flying Doctor Service and still operates. In 1934, Marie Marvingt established the first civil air ambulance service in Africa, in Morocco. In 1936, air ambulance services were established as part of the Highlands and Islands Medical Service to serve more remote areas of Highland Scotland.
Pilatus PC 12/45
Air ambulances quickly established their usefulness in remote locations, but their role in developed areas developed more slowly. After World War II, the Saskatchewan government in Regina, Saskatchewan, Canada, established the first civilian air ambulance in North America. The Saskatchewan government had to consider remote communities and great distances in providing health care to its citizens. The Saskatchewan Air Ambulance service continues to be active as of 2011.
J. Walter Schaefer founded the first air ambulance service in the U.S, in 1947, in Los Angeles. The Schaefer Air Service, operated as part of Schaefer Ambulance Service. Schaefer Air Service was also the first FAA-certified air ambulance service in the United States. When the Saskatchewan and Schaefer services began, paramedicine was still decades away, and unless a physician or nurse accompanied the patient, air ambulances primarily provided medical transportation. A great deal of the early use of aircraft as ambulances in civilian life, particularly helicopters, involved the improvised use of aircraft that belonged to the military. Eventually, this became more organized. This occurred not only in the United States, but also in other countries, and persists today. Today in the U.S., helicopters and airplanes carry out approximately a half million transports per year.
Swedish search and rescue
Israeli military helicopter as air ambulance
Polish navy helicopter W-3 as air ambulance, search and rescue
Two research programs were implemented in the U.S. to assess the impact of medical helicopters on mortality and morbidity in the civilian arena. Project CARESOM was established in Mississippi in 1969. Three helicopters were purchased through a federal grant and located strategically in the north, central, and southern areas of the state. Upon termination of the grant, the program was considered a success and each of the three communities was given the opportunity to continue the helicopter operation. Only the one located in Hattiesburg, Mississippi did so, and it was therefore established as the first civilian air medical program in the United States. The second program, the Military Assistance to Safety and Traffic (MAST) system, was established in Fort Sam Houston in San Antonio in 1969. This was an experiment by the Department of Transportation to study the feasibility of using military helicopters to augment existing civilian emergency medical services. These programs were highly successful at establishing the need for such services. The remaining challenge was in how such services could be operated most cost-effectively. In many cases, as agencies, branches, and departments of the civilian governments began to operate aircraft for other purposes, these aircraft were frequently pressed into service to provide cost-effective air support to the evolving Emergency Medical Services.
Hong Kong Government Flying Service
German 'Christoph' Air Ambulance of the Federal Ministry of the Interior
Italian Dauphin used in mountain rescue missions
As the concept was proven, dedicated civilian air ambulances began to appear. On November 1, 1970, the first permanent civil air ambulance helicopter, Christoph 1, entered service at the Hospital of Harlaching, Munich, Germany. The apparent success of Christoph 1 led to a quick expansion of the concept across Germany, with Christoph 10 entering service in 1975, Christoph 20 in 1981, and Christoph 51 in 1989. As of 2007, there are about 80 helicopters named after Saint Christopher, like Christoph Europa 5 (also serving Denmark), Christoph Brandenburg or Christoph Murnau am Staffelsee. Austria adopted the German system in 1983 when Christophorus 1 entered service at Innsbruck.
The first civilian, hospital-based medical helicopter program in the United States began operation in 1972. Flight For Life Colorado began with a single Alouette III helicopter, based at St. Anthony Central Hospital in Denver, Colorado. In Ontario, Canada, the air ambulance program began in 1977, and featured a paramedic-based system of care, with the presence of physicians or nurses being relatively unusual. The system, operated by the Ontario Ministry of Health, began with a single rotor-wing aircraft based in Toronto. An important difference in the Ontario program involved the emphasis of service. "On scene" calls were taken, although less commonly, and a great deal of the initial emphasis of the program was on the interfacility transfer of critical care patients. Operating today through a private contractor (ORNGE), the system operates 33 aircraft stationed at 26 bases across the province, performing both interfacility transfers and on-scene responses in support of ground-based EMS. Ornge operates the largest and most sophisticated program of aeromedical transport in North America. Over 17,000 admissions are dispatched annually, making Ornge North America's largest operator in the field of transport medicine. Today, across the world, the presence of civilian air ambulances has become commonplace, and is seen as a much-needed support for ground-based EMS systems.
London Air Ambulance - England
STARS - Alberta, Canada
SAMU - France
Mobiel Medisch Team - Netherlands
Memorial Hermann Life Flight - Texas, USA
Swedish King Air
Air ambulance service, sometimes called Aeromedical Evacuation or simply Medevac, is provided by a variety of different sources in different places in the world. There are a number of reasonable methods of differentiating types of air ambulance services. These include military/civilian models and services that are government-funded, fee-for-service, donated by a business enterprise, or funded by public donations. It may also be reasonable to differentiate between dedicated aircraft and those with multiple purposes and roles. Finally, it is reasonable to differentiate by the type of aircraft used, including rotary-wing, fixed-wing, or very large aircraft. The military role in civilian air ambulance operations is described in the History section. Each of the remaining models is explored separately. It should also be noted that this information applies to air ambulance systems performing emergency service. In almost all jurisdictions, private aircraft charter companies provide non-emergency air ambulance service on a fee-for-service basis.
In some cases, governments provide air ambulance services, either directly or via a negotiated contract with a commercial service provider, such as an aircraft charter company. Such services may focus on critical care patient transport, support ground-based EMS on scenes, or may perform a combination of these roles. In almost all cases, the government provides guidelines to hospitals and EMS systems to control operating costs—and may specify operating procedures in some level of detail to limit potential liability. However, the government almost always takes a 'hands-off' approach to actual running of the system, relying instead on local managers with subject matter (physicians and aviation executives) expertise. Ontario's ORNGE program and the Polish Lotnicze Pogotowie Ratunkowe (LPR) are examples of this type of operating system. The Polish LPR is a national system covering the entire country and funded by the government through the Ministry of Health but run independently, there is no independent HEMS operator in Poland. In North East Ohio, including Cleveland, the Cuyahoga County-owned MetroHealth Medical Center uses its Metro Life Flight to transport patients to Metro's level I trauma and burn unit. There are 5 helicopters for North East Ohio and, in addition, Metro Life Flight has one fixed-wing aircraft.
In the United Kingdom, the Scottish Ambulance Service operates two helicopters and two fixed-wing aircraft twenty-four hours per day. These represent the UK's only government-funded air ambulance service.
In some jurisdictions, cost is a major consideration, and the presence of dedicated air ambulances is simply not practical. In these cases, the aircraft may be operated by another government or quasi-government agency and made available to EMS for air ambulance service when required. In southern Queensland, Australia, the helicopter that responds as an air ambulance is actually operated by the local hydroelectric utility, with the Queensland Ambulance Service or New South Wales Ambulance Service providing paramedics, as required. In some cases, local EMS provides the flight paramedic to the aircraft operator as-needed.
Sometimes the air ambulance may be run as a dual concern with another governmental body - for example the Wiltshire Air Ambulance is run as a joint Ambulance Service and police unit.
In other cases, the paramedic staffs the aircraft full-time, but has a dual function. In the case of the Maryland State Police, for example, the flight paramedic is a serving State Trooper whose job is to act as the Observer Officer on a police helicopter when not required for medical emergencies.
In many cases, local jurisdictions do not charge for air ambulance service, particularly for emergency calls. However, the cost of providing air ambulance services is considerable and many, including government-run operations, charge for service. Organizations such as service aircraft charter companies, hospitals, and some private-for-profit EMS systems generally charge for service. Within the European Union, almost all air ambulance service is on a fee-for-service basis, except for systems that operate by private subscription. Many jurisdictions have a mix of operation types. Fee-for-service operators are generally responsible for their own organization, but may have to meet government licensing requirements. Rega of Switzerland is an example of such a service.
In some cases, a local business or even a multi-national company may choose to fund local air ambulance service as a goodwill or public relations gesture. Examples of this are common in the European Union, where in London the Virgin Corporation funds the Helicopter Emergency Medical Service, and in Germany and the Netherlands a large number of the 'Christoph' air ambulance operations are actually funded by ADAC, Germany's largest automobile club. In Australia and New Zealand, many air ambulance helicopter operations are sponsored by the Westpac Bank. In these cases, the operation may vary, but is the result of a carefully negotiated agreement between government, EMS, hospitals, and the donor. In most cases, while the sponsor receives advertising exposure in exchange for funding, they take a 'hands off' approach to daily operations, relying instead on subject matter specialists.
In some cases, air ambulance services may be provided by means of voluntary charitable fundraising, as opposed to government funding, or they may receive limited government subsidy to supplement local donations. Some countries, such as the U.K., use a mix of such systems. In Scotland, the parliament has voted to fund air ambulance service directly, through the Scottish Ambulance Service In England and Wales, however, the service is funded on a charitable basis via a number of local charities for each region covered, although the service to London receives most of its funding through the National Health Service.
Great strides were made in the UK between 2005 and 2008, when independent charities formed the National Association of Air Ambulance Charities (AAAC). This organization is widely credited for having created the political climate that made the helicopter industry and National Health Service recognise the enormous contribution charities make to trauma care in the United Kingdom. In 2008, NHS partners joined the association, and it renamed itself the Association of Air Ambulances.
In recent years, the service has moved towards the physician-paramedic model of care. This has necessitated some charities buying expensive clinical governance services from independent "for profit" companies. The industry is currently divided over whether it is ethically acceptable that income derived through philanthropy and altruism should be spent on buying this essential governance from profit-driven entrepreneurs. They have commissioned research (March 2010) and expect that in future, clinical governance will be provided either free or on a not-for-profit basis.
A final area of distinction is the operation of large, generally fixed-wing air ambulances. In the past, the infrequency of civilian demand for such a service confined such operations to the military, which requires them to support overseas combat operations. Military organizations capable of this type of specialized operation include the United States Air Force, the German Luftwaffe, and the British Royal Air Force. The Swedish National Air Medevac - SNAM is an exception to the military only rule where the system is owned by the Swedish Civil Contingencies Agency Myndigheten för samhällsskydd och beredskap and the Boeing 737 Next Generation#737-800 aircraft is provided under contract when so required by Scandinavian Airlines. Each operates aircraft staffed by physicians, nurses, and corpsmen/technicians, and each can providing long distance transport with full medical support to dozens of patients simultaneously.
However, in recent years, exceptions to the "military-only" rule have grown with the need to quickly transport patients to facilities that provide higher levels of care, or to repatriate individuals. ADAC, the German automobile club, and Mercy Jets, use both large and small fixed wing aircraft configured to provide levels of care that can be found in Trauma centers for individuals who subscribe to their own health insurance or affiliated travel insurance and protection plans.
German Luftwaffe A310
German Auto Club Dornier 328JET
USAF C-17 Globemaster
In most jurisdictions, air ambulance pilots must have a great deal of experience in piloting their aircraft because the conditions of air ambulance flights are often more challenging than regular non-emergency flight services. After a spike in air ambulance crashes in the United States in the 1990s, the U.S. government and the Commission on Air Medical Transportation Systems (CAMTS) stepped up the accreditation and air ambulance flight requirements, ensuring that all pilots, personnel, and aircraft meet much higher standards than previously required. The resulting CAMTS accreditation, which applies only in the United States, includes the requirement for an air ambulance company to own and operate its own aircraft. Some air ambulance companies, realizing it is virtually impossible to have the correct medicalized aircraft for every mission, instead charter aircraft based on the mission-specific requirements.
While in principle CAMTS accreditation is voluntary, a number of government jurisdictions require companies providing medical transportation services to have CAMTS accreditation to be licensed to operate. This is an increasing trend as state health services agencies address the issues surrounding the safety of emergency medical services flights. Some examples are the states of Colorado, New Jersey, New Mexico, Utah, and Washington. According to the rationale used to justify the state of Washington's adoption of the accreditation requirements, requiring accreditation of air ambulance services provides assurance that the service meets national public safety standards. The accreditation is done by professionals who are qualified to determine air ambulance safety. In addition, compliance with accreditation standards is checked on a continual basis by the accrediting organization. Accreditation standards are periodically revised to reflect the dynamic, changing environment of medical transport, with considerable input from all disciplines of the medical profession.
Other U.S. states require either CAMTS accreditation or a demonstrated equivalent, such as Rhode Island, and Texas, which has adopted CAMTS' Accreditation Standards (Sixth Edition, October 2004) as its own. In Texas, an operator not wishing to become CAMTS accredited must submit to an equivalent survey by state auditors who are CAMTS-trained. Virginia and Oklahoma have also adopted CAMTS accreditation standards as their state licensing standards. While the original intent of CAMTS was to provide an American standard, air ambulance services in a number of other countries, including three in Canada and one in South Africa, have voluntarily submitted themselves to CAMTS accreditation.
The makeup of the medical crew staffing an air ambulance varies depending on country, area, service provider, and type of air ambulance. In services operating under the Anglo-American model of service delivery, the helicopter is most likely to be used to transport patients, and the crew may consist of Emergency Medical Technicians, Paramedics, flight nurses, a Respiratory Therapist, or in some cases, a physician. Services that focus primarily on critical care transport are more likely to be staffed by physicians and nurses. In the Franco-German model, the aircraft is much more likely to be used to deliver high level support to ground-based EMS. In these cases, the crew generally consists of a physician, often a surgeon, anesthetist, trauma specialist or similar specialty, accompanied by a specially trained advance care paramedic or nurse. In these cases, the object is the rapid delivery of definitive care, occasionally even performing emergency surgical procedures in the field, with the eventual transport of the patient being accomplished by ground ambulance, not the helicopter.
The nature of the air operation frequently determines the type of medical control required. In most cases, an air ambulance staffer is considerably more skilled than a typical paramedic, so medical control permits them to exercise more medical decision-making latitude . Assessment skills tend to be considerably higher, and, particularly on inter-facility transfers, permit inclusion of functions such as reading x-rays and interpretation of lab results. This allows for planning, consultation with supervising physicians, and issuing contingency orders in case they are required during flight. Some systems operate almost entirely off-line, using protocols for almost all procedures and only resorting to on-line medical control when protocols have been exhausted. Some air ambulance operations have full-time, on site medical directors with pertinent backgrounds (e.g., emergency medicine); others have medical directors who are only available by pager. For those systems operating on the Franco-German model, the physician is almost always physically present, and medical control is not an issue.
Most aircraft used as air ambulances, with the exception of charter aircraft and some military aircraft, are equipped for advanced life support and have interiors that reflect this. The challenges in most air ambulance operations, particularly those involving helicopters, are the high ambient noise levels and limited amounts of working space, both of which create significant issues for the provision of ongoing care. While equipment tends to be high-level and very conveniently grouped, it may not be possible perform some assessment procedures, such as chest auscultation, while in flight. In some types of aircraft, the aircraft's design means that the entire patient is not physically accessible in flight. Additional issues occur with respect to pressurization of the aircraft. Not all aircraft used as air ambulances in all jurisdictions have pressurized cabins, and those that do typically tend to be pressurized to only 10,000 feet above sea level. These pressure changes require advanced knowledge by flight staff with respect to the specifics of aviation medicine, including changes in physiology and the behaviour of gases.
There are a large variety of helicopter makes that are used for the civilian HEMS models. The commonly used types are the Bell 206, 407, and 429, Eurocopter AS350, BK117, EC130, EC135, EC145, and the Agusta Westland 109 & 149. Due to the configuration of the medical crew and patient compartments, these aircraft are normally configured to only transport one patient but some can be configured to transport two patients if so needed. Additionally, helicopters have stricter weather minimums that they can operate in and commonly do not fly at altitudes over 10,000 feet above sea level.
Typical helicopter interior
Typical helicopter interior
Beginning in the 1990s, the number of air ambulance crashes in the United States, mostly involving helicopters, began to climb. By 2005, this number had reached a record high. Crash rates from 2000–2005 more than doubled the previous five year's rates. To some extent, these numbers had been deemed acceptable, as it was understood that the very nature of air ambulance operations meant that, because a life was at stake, air ambulances would often operate on the very edge of their safety envelopes, going on missions in conditions where no other civilian pilot would fly. As a result, nearly fifty percent of all EMS personnel deaths in the United States occur in air ambulance crashes. In 2006, the United States National Transportation Safety Board (NTSB) concluded that many air ambulances crashes were avoidable, eventually leading to the improvement of government standards and CAMTS accreditation.
Whilst some air ambulances do have effective methods of funding, in the UK, they remain almost entirely charity funded, as improved cost-benefit ratios are generally achieved with land based attendance and transfers. Health outcomes, for example from London's Helicopter Emergency Medical Service, remain largely the same for both air and ground based services.
St John Ambulance Australia (also known as St John First Aid) (SJAA) is a self-funding charitable organisation dedicated to helping people in sickness, distress, suffering or danger. It is part of an international organisation that consists of eight Priories that form the Order of St John.
St John First Aid training centres were established in Australia in the late 19th century. On the 13 June 1883 a public meeting was held in the Melbourne Town Hall to form a local branch of the association. By the end of June 1883, a centre had been established under the leadership of Edward Neild.
The first division of the St John Ambulance Brigade (now known as first aid services/operations branch) was established in Glebe, New South Wales in 1903. A division of this organisation is still in operation today and is known as St John Ambulance Glebe Division. After this initial division was established other states followed suit, with divisions being set up in other states soon after. In 1987, the organisation adopted a single public title, "St John Ambulance Australia". The cadet movement was established in Australia in 1925 with a division in Glebe, NSW. The first Grand Prior's Badge issued outside the UK went to a cadet from Marrickville Cadet Division in 1933 named Marion Higgins.
In 2005, it was decided that the organisation would adopt a corporate structure with closer relationships between the branches of St John, known as 'One St John'.
The national board oversees St John in the whole of Australia. The organisation is then divided into the states/territories who have their own boards and oversee the day to day running of St John. Some states are also divided into regions, who oversee all branches and report to the state boards. St John Ambulance Australia has four main branches, with each one having its own specific area of operation.
St John provides volunteer first aid services at events and emergencies. First Aid Services is divided into states, regions and divisions, headed nationally by Chief Commissioner Alan Eade ASM OStJ.
Events covered by St. John Australia include sports, such as the 2006 Melbourne Commonwealth Games, where a team of 5000 members treated over 3000 casualties. Other events covered include sporting events, such as the Australian Open, music concerts and community fetes.
One major venue covered by St. John is the Melbourne Cricket Ground, which is the among the safest places in the world to suffer a heart attack owing to the extent of the pre-hospital care provided primary by St. John volunteers at the venue.
St John First Aid volunteers support state emergency management and disaster plans in some states, in conjunction with other organisations like the State Emergency Service.
St John is the largest first aid training organisation in Australia. Apart from its flagship Apply First aid (formerly Senior First Aid) course, St John also offer instruction in advanced topics such as ALS (Advanced Life Support), which includes Advanced Resuscitation, AED (Automated External Defibrillation) and analgesic administration (including entinox gas and methoxyflurane analgesics).
St John Ambulance Australia raises funds and recruits staff for the St John Ophthalmic Eye Hospital in Jerusalem. Funds are raised through public donations, and income received from conducting first aid courses and selling first aid kits and merchandise.
St John Community Care conducts programs that are specific to each state. These activities range from assisting disadvantaged youth, to providing voluntary transport and support programs for the frail and elderly.
In Western Australia and the Northern Territory St John Ambulance provides the statutory ambulance service. This service is provided through a combination of paid and volunteer staff. Paid ambulance officers and paramedics are used in the metropolitan areas and larger regional centres. Volunteer ambulance officers are used in regional areas and some outer metropolitan areas.
^ Cadet Leaders are adult members who have undertaken a specific leadership course and are ranked above cadets but below all adult ranks
St John runs Cadet Divisions for children aged 8–17, this includes Juniors (8-11) and Cadets (11-17). These can be found in most towns or suburbs of major cities in Australia. Examples are Glebe Division and Bathurst Division in New South Wales, Greater Dandenong Division in Victoria and Playford Cadet Division in South Australia.
The youth program in Australia, focuses on developing young people in a variety of aspects. Young members are taught first aid and participate in youth development and social activities. For cadets, it is also possible to study for various 'badges'. Some of the topics available include counter-disaster, animal care and cookery.
Across most divisions, youth and cadet divisions meet once a week, in a designated place, to conduct a training night. There is a designated training program for youth and cadet divisions
Youth members within Event and Emergency First Aid Service programs attend public duties to provide first aid at various events to members of the public. These duties include things such as: Big Day Out, Royal Easter Show (NSW), National Folk Festival (ACT), AFL Games (All AFL states), NRL, Super 12, and Rugby Union games, amongst other popular events. There are also many more lower profile events, like local fetes and markets. At these duties, St John members use treatment tools such as oxygen therapy equipment, defibrillators and analgesic gases on top of the standard first aid equipment.
In most states, new youth members(Minimum age 14)will be put through a Senior First Aid Course (SFA) free of charge.
St John youth also provides leadership opportunities for people of all ages. The program possesses a leadership program and a ranking system similar to the military.
First aid competitions are also held each year. In these competitions, cadets (in teams of up to 3, or on their own) are tested on their first aid skill, practical thinking and problem solving ability, and scene management skills. A national competition is held every year, at the National Cadet Camp.
Each State and Territory is encouraged to facilitate provision of a Youth Council, the National Office also facilitates the Australian Youth Council. Broadly, Youth Councils provide guidance to St John on issues affecting the organisation and its future development, particularly concerning the opinion and interests of young people.
In 2006, the Australian Youth Council (AYC) restructured to be made up of 16 State/Territory representatives (nominated by their State/Territory, including the State/Territory Chairperson and another representative) and 5 National portfolio holders, including a Communications Coordinator, Training and Leadership Coordinator, Research Development Coordinator, Policy Coordinator and Australian Chair. The AYC Chair also sits as a full member of the National Board of Directors for St John Ambulance Australia. The aims of the Australian Youth Council include:
1. To work across St John to make it the volunteering organisation of choice for young people in Australia.
2. To provide opportunity for young people to actively participate in the governance of St John.
3. To provide guidance to St John that will contribute to the further development and improvement of the organisation.
4. To develop young leaders in St John.
5. To be relevant to young people.
The AYC usually meets in person once or twice a year, usually including the National Conference or Priory in June, and another meeting (Youth Stakeholders Weekend) later in the year, as well as teleconferences during the year which may include either the entire Council or the National Team.
Youth councils consist of young people in the organisation who are aged 12 to 25 years.
In July 2009, the ABC's Four Corners broadcast a report identifying failures in St John's call-out system in Western Australia, where St. John run the ambulance service, specifically the failure of call centre operators to appropriately prioritise and respond ambulances. The program identified four deaths in which dispatch and prioritisation errors were involved. The WA Health Minister, Dr Kim Hames, has since promised to review "reports of significant wrongdoing, and see if it is correct" in order to prevent recurrence of such events.
The United States Capitol Police (USCP) is a federal law enforcement agency charged with protecting the United States Congress within the District of Columbia and throughout the United States and its territories. The USCP is the only full service federal law enforcement agency under the legislative branch of the U.S. government.
The United States Capitol Police has the primary responsibility for protecting life and property; preventing, detecting, and investigating criminal acts; and enforcing traffic regulations throughout a large complex of congressional buildings, parks, and thoroughfares. The Capitol Police has exclusive jurisdiction within the United States Capitol Grounds and has concurrent jurisdiction with other law enforcement agencies, including the United States Park Police and the Metropolitan Police Department of the District of Columbia, in an area of approximately 200 blocks around the complex. Officers also have jurisdiction throughout the District of Columbia to take enforcement action when they observe or are made aware of crimes of violence while on official duties. Additionally, they are charged with the protection of members of Congress, officers of Congress, and their families throughout the entire United States, its territories and possessions, and the District of Columbia.
The U.S. Capitol Police is one of many agencies that sends its recruits to the Federal Law Enforcement Training Center (F.L.E.T.C.), located in Glynco, GA for initial training. Rarely, recruits are sent to the FLETC location in Artesia, NM. Following 12 weeks at FLETC, recruits return to FLETC's location in Cheltenham, MD for an additional 13 weeks of training. Following the recruits' academy training, graduates are sworn in as law enforcement officers and assigned to one of four divisions to begin their careers. Initial salary at the start of training is $55,653.00, with an increase to $57,604.00 after graduation. After 30 months of satisfactory performance and promotion to Private First Class (PFC), salary is increased to $64,590.00.
The history of the United States Capitol Police dates back to 1801 when Congress moved from Philadelphia to the newly constructed Capitol Building in Washington, D.C. At the time, Congress appointed one lone watchman to protect the building and Congressional property. Created by Congress in 1828 following the assault on a son of John Quincy Adams in the Capitol rotunda, the original duty of the United States Capitol Police was to provide security for the United States Capitol. Its mission has expanded to provide the Congressional community and its visitors with a variety of security services. These services are provided through the use of a variety of specialty support units, a network of foot and vehicular patrols, fixed posts, a full-time Containment and Emergency Response Team (CERT), K-9, a Patrol/Mobile Response Division and a full time Hazardous Devices and Hazardous Materials Sections. The Library of Congress Police were merged into the force in 2003. The agency has 1,800 sworn personnel.
Three USCP officers have been killed in the line of duty. A 1984 training accident killed Sergeant Christopher Eney, while a mentally disturbed gunman named Russell Eugene Weston Jr. killed Officer Jacob Chestnut and Detective John Gibson in a shootout on July 24, 1998. Chestnut and Gibson were laid in honor in the Rotunda before burial in Arlington National Cemetery. (Chestnut was the first African American ever to lie in honor in the Rotunda.)
St John Ambulance, branded as St John in some territories, is a common name used by a number of affiliated organisations in different countries dedicated to the teaching and practice of medical first aid and the provision of ambulance services, all of which derive their origins from the St John Ambulance Association founded in 1877 in the United Kingdom. Each national group falls within the charge of a Priory or National Council of the Venerable Order of Saint John in which each Priory ranks alongside the others.
In several priories St John Ambulance has commercial sections or subsidiaries operating to generate surplus for charitable activities; these are structured much like other commercial bodies. The membership aspect of St John Ambulance is largely ranked, and members fall into a hierarchical structure of command. Ranks run from corporals, through sergeants and officers all the way up to high national ranks, but there is significant variation between Priories and it is hard to generalise the structure too much from an international perspective. War Conflict
The United States Capitol is the meeting place of the U.S. Congress, the legislature of the U.S. federal government. Located in Washington, D.C., it sits atop Capitol Hill at the eastern end of the National Mall. Though it has not been the geographic center of the District of Columbia since the retrocession of Alexandria County in 1847, the Capitol was initially situated at the absolute center of the District of Columbia and is the origin by which both the quadrants of the District are divided and the city was planned.
Officially, both the east and west sides of the Capitol are referred to as fronts. Historically, however, only the east front of the building was intended for the arrival of visitors and dignitaries. Like the federal buildings for the executive and judicial branches, it is built in the distinctive neoclassical style and has a white exterior.
Gun politics is a very controversial issue in American politics. For the last several decades, the debate regarding both the restriction and availability of firearms within the United States has been characterized by a stalemate between a right to bear arms found in the Second Amendment to the U.S. Constitution and the responsibility of government to prevent firearm-related crime.
As a vision of Henry W. Grady, (the editor of the Atlanta Constitution newspaper in the 1880s), Grady Memorial Hospital opened in May 1892 with 100 beds and established the first city-wide ambulance service in 1896 with several horse-drawn modified enclosed wagons. Prior to 1892, the city did not have any formal ambulance service and regular horse drawn wagons at best served to transport the sick and injured. Grady, along with Charity Hospital in New Orleans, Bellevue Hospital in New York City and Cincinnati General was among the first hospitals to operate ambulances in America. In 1890, the population of Atlanta was recorded as 65,533 and included both the downtown area and Inman Park. Its Northern limits did not extend much past 14th street and travelling further north quickly transitioned into rural countryside. By 1895 the city limits was expanded 9.6 square miles (25 km2) and saw the annexation of West End in 1896. Law Crime