Sales of Ambulance Cots to Gather Pace in Line with Growing Number of EMS Providers Worldwide, Fact.MR

The ambulance cots market report projects that the ambulance cots market is expected to reach ~ US$ 223 Mn by the end of 2019 in terms of value, and is estimated to reach ~ US$ 273 Mn by the end of 2029.

Launch of New Ambulance Services and New Opportunities in Developing Countries

There are several air ambulance services and other innovative types of ambulances that are developed in the emergency medical service industry that utilize pneumatic ambulance cots or electric ambulance cots. For instance, in India, motorbike ambulances were launched in Delhi in 2017 and Mumbai in 2018. Similarly, in the U.S., Malley Industries, a supplier of New Brunswick’s ambulances, expanded its fleet into the U.S. market in 2016 with electric and pneumatic ambulance cots. Several private ambulance service providers offer air ambulance services across the world that use electric or pneumatic ambulance cots. The trend of adopting air ambulances in both developed and developing regions is expected to positively influence the growth of the ambulance cots market during the forecast period. According to WHO, 1 ambulance per 50,000 populations is a standard that a country should have or aim to reach, in order to meet the growing demand. However, in Nanjing, China, there are only 50 ambulances for a population of 8 million in 2013. Thus, there is a requirement for more ambulances in the APAC region, which is an opportunity for the ambulance cots market in the region.

Rising Installed Base of Ambulances offer Significant Growth Opportunities

According to the WHO and several scientists, the minimum number of ambulances required is estimated to be one in 50,000 populations across the world. Some countries exceed the number of minimum ambulance requirement norms. To meet the rising incidence of emergencies across the globe and to reduce the duration of response, more ambulances are required. Most countries, such as the U.S., the U.K., and Germany, have ambulances more than the required norms and yet are facing several conditions, such as delay in response, unequal distribution of ambulances in urban and rural areas, and increasing emergencies. This results in an increased demand for ambulance services in these regions that influence the growth of the ambulance cots market. Some countries, such as Singapore and Burma (Myanmar), have ambulances below the required norms. The number of ambulances needed in Burma is around 1149. However, the country recently launched its first ambulance service in 2015 and has only 230 ambulances in its fleet. Other countries, such as Indonesia, have slightly more ambulances than the required norms, and still faces similar problems as those with insufficient ambulances. Thus rising number of ambulances in both the developed and developing nations drive the growth of the ambulance cots market.

Rising Number of Accidents Increasing the Usage of Ambulances – A Key Influencer

According to the World Bank data, 1.3 million people are killed in road accidents every year. Furthermore, there are about 30 million people that are seriously impacted by injuries caused by road traffic. Number of people injured, along with the number of deaths due to road accidents, are factors that are used to assess the number of road accidents. This excludes suicide involving the use of road motor vehicles. In 2014, it was assessed that 22% of GDP per capita in Thailand was associated with deaths and injuries due to the road traffic. India and China also estimated that 14% and 15% respectively of the GDP per capita was associated with road accidents. According to a survey in India, in 2016, a total of 480,652 road accidents occurred that resulted in the death of 150,785 and 494,624 people with serious injuries. The rising proportion of vehicles and accidents are leading to the increasing use of emergency services, such as ambulance, which is expected to drive the growth of the ambulance cots market. 

Key Manufacturers of Ambulance Cots

Stryker Corporation and Ferno-Washington Inc. are the prominent players in the ambulance cots market. Other players in the ambulance cots market are Zhangjiagang New Fellow Med Co. Ltd., Jiangsu Rixin Medical Equipment Co. Ltd., Jiangsu Saikang Medical Equipment Co. Ltd., Dragon Industry (ZJG) Co., Ltd., Omega Surgical Industries, and Paramed International FZ Co., among others.

Emergency Medicine Education in The DRC

Author: Michael Emmerich

Published in: Winter 2017 Edition of Ambulance Today Magazine

The Africa Quarterly editorial discusses the challenges facing emergency medicine educators in The Democratic Republic of Congo (DRC). The DRC is the second largest country on the African continent with a population of almost 80 million. It is a major crossroad through Africa as it borders nine countries. The DRC continues to experience current political and social instability, as it has over its chequered past; and active fighting is still prevalent in certain regions today. The last two decades of conflict, mainly in the North-Eastern regions, has devastated the civilian population and led to the collapse of the healthcare infrastructure.

Government expenditure on health per capita remains one of the lowest in the world and Emergency Medicine has yet to be established as a specialty in the DRC. While most hospitals have emergency rooms or salle des urgences, this designation is more in name than an actual ER room; many have no standardised format, no recognised emergency medical equipment and they are rarely staffed by doctors or nurses with hardly any trained in emergency care. Lack of formal, structured training,lack of (emergency) equipment and fee- for-service for all patients entering the healthcare system are cited as barriersto care. Pre-hospital care is also not an established specialty, with no EMT colleges, ambulances being a rarity and no outside major centres. Where there are ambulances they are at best staffed by a nurse or just a driver with no medical training.

The 39 nationally-recognised medical schools, most of which are in urbanareas, are typically underfunded and all medical studies including residency arefully self-funded. There has been a recent proliferation of technical schools (more than 500) which offer varied levels of medical training. These institutes are not regulated, open without official approval and often operate as for-profit enterprises. Few students from any of the schools can spend the required years in clinical rotations due to a lack of participating hospitals. The overall result is an education of doubtful quality. There is currently no dedicated emergencycare training integrated into medical or graduate schools.

A comprehensive study was undertaken1, jointly by the DRC Government and various international role players. Key findings ofthis 2012 report by USAID and Nursing Education Partnership Initiative (NEPI) noted the barriers to learning were as follows, including inadequate quality of health worker education:

• Lack of budget for maintenance and renovation of the existing infrastructures.

• Limited number of opening hours of libraries, skills labs and other infrastructures to students and teachers.

• Insufficient support of stakeholders including government and development partners regarding funding for construction.

• Insufficient budget for renovation of existing infrastructure.

• Lack of anatomic models in skills labs.

• Insufficient budget for purchasing basic materials and consumables that are necessary for clinical practice without necessarily relaying on what is found in clinical training sites.

• Inadequate system supply of books and other learning materials

• Lack of policy and budget for using the internet and computers in schools to encourage students and teachers to access information.

Although the report focuses on nurses and midwives, it must be stated that they serve at the frontline of most medical emergencies in the field and in hospitals and clinics. Therefore, the challenges they face in learning, will impact severely ontheir ability to work in an emergency medicine environment; added to the fact that emergency medicine is not part of their recognised curriculum.

I have been travelling and working in The DRC since 1999, across various provinces and regions, primarily teaching at a BLS, ILS and ALS level, (both pre- and in-hospital facilitating) and doing clinical governance and medical project management, so I can attest to the challenges. Short courses such as ACLS, PALS, ITLS, ATLS etc. which form the backbone of annual refresher training for many emergency medicine practitioners is relatively unknown, and only presentedin a few regions of The DRC by training providers from other countries.

I have been travelling and working in The DRC since 1999, across various provinces and regions, primarily teaching at a BLS, ILS and ALS level, (both pre- and in-hospital facilitating) and doing clinical governance and medical project management, so I can attest to the challenges. Short courses such as ACLS, PALS, ITLS, ATLS etc. which form the backbone of annual refresher training for many emergency medicine practitioners is relatively unknown, and only presentedin a few regions of The DRC by training providers from other countries.


1. Assessment of Nursing and Midwifery Education and Training Capacity at Seven Training Institutes in the Democratic Republic of Congo (2012)

Access the full report at: http://files.icap. assessment._2012.pdf

Tell Michael what you think about this article by emailing him at:

Air Ambulance doctor receives OBE

Date: 11 June 2019

Doctor Kevin Fong, a doctor with the Air Ambulance Kent Surrey Sussex, has been awarded an Order of the British Empire in this year’s Queen’s Honours List.

He has been awarded the OBE for his ‘Services to healthcare and medicine’.

Dr Fong is the third member of the Air Ambulance Kent Surrey Sussex team to be recognised for their work by Her Majesty the Queen. Earlier recipients for ‘Services to emergency medicine’ include Medical Director Malcolm Russell, who was awarded an MBE in 2014, and Associate Medical Director, Professor Richard Lyon, presented with an MBE in 2017.

Dr Fong joined the Air Ambulance Kent Surrey Sussex in 2014 as part of the crew providing around-the-clock pre-hospital emergency services. When not at Redhill, the air ambulance’s base, he works at University College Hospital in London where he specialises in anaesthesia and intensive care medicine.

His interest in high risk, high reliability systems, and organisations, began after graduating with degrees in Astrophysics, Medicine and Engineering, during which he spent time working with NASA’s human space exploration programme at Johnson Space Center, Houston.

He is also an honorary senior lecturer in physiology and was very recently appointed as Professor of Public Engagement for Science, Technology & Medicine at University College London.

Commenting on the award, Dr Fong said: “I was utterly bewildered to hear the news of this award.

“It’s one that I genuinely never expected but it’s a lovely surprise. I’d like to accept it on behalf of all the brilliant teams I’ve worked with, but especially the Air Ambulance Kent Surrey Sussex family who are a particularly important part of my life. This award represents everybody’s success.”

Dr Helen Bowcock, Chair of Air Ambulance Kent Surrey Sussex, added: “We congratulate Kevin, who along with our doctors, paramedics and pilots, does an amazing job every time the helicopter takes off on a mission, providing lifesaving treatment often in the most extreme of circumstances.”

Dr Fong, aged 47, qualified as a doctor in 1998 and lives in London.

The Miscarriage Association launches new e-learning resource for medical professionals

Date: 7 August 2019

The Miscarriage Association has developed a new e-learning resource to support medical professionals in providing the best care they can to women experiencing pregnancy loss. 

The resource is based on the real experiences of health professionals and those who have experienced miscarriage, ectopic or molar pregnancy, and includes films and interactive activities.

The resource takes around two hours to complete, and is an excellent tool for continuing professional development and learning towards revalidation.

Ruth Bender Atik, National Director at the Miscarriage Association, said: “Pregnancy loss can be a deeply distressing experience and the support health professionals give can make all the difference to helping women through this difficult time.

“We know it isn’t always easy for those working in clinical environments to find the time to reflect on the care they provide. This is why we wanted to create a resource that they can dip in and out of and access easily from their phone, iPad or computer, so the training is available to them anytime.” 

The five units focus on different aspects of care, such as having difficult conversations, considering language, and taking care of your own wellbeing while providing care.

Cerian Gingell has experienced two miscarriages and is passionate about improving the care that is provided to those who experience pregnancy loss. 

Cerian, said: “Miscarriage is a devastating loss, often without explanation. Nothing can take the pain away, but a kind word, the correct information on what to expect next, the truth about what’s happening – these things can all help make a horrible experience slightly less horrible.

“To me, good care is saying ‘I’m sorry your baby’s gone, it wasn’t your fault’. It’s letting me cry, answering my questions with honesty and sensitivity, reassuring me that because it’s happened once it doesn’t mean it’ll happen again. It’s about respect, sympathy and honesty.

“I think this resource is so important and will help create more consistent care across the country. Every single person that goes through pregnancy loss deserves to be treated with dignity and compassion.  Whether they’re speaking to their GP or being treated in hospital, every contact can have a huge impact on the way that person copes with their loss.” 

The resource was peer reviewed and produced with the help of Janet Birrell, Gynaecology Matron at Western Sussex Hospitals NHS Foundation Trust, Dr Nicola Davies, GP at The Pinn Medical Centre, Annmaria Ellard, Miscarriage Specialist Nurse at Liverpool Women’s NHS Foundation Trust, Amanda Mansfield, Consultant Midwife at  London Ambulance Service NHS Trust, and the Association of Early Pregnancy Units.

Dr. Sarah Bailey, Lead Nurse Recurrent Miscarriage Care and Clinical Research Specialist at University Hospitals Southampton, said: “The Miscarriage Association’s e-learning resource is extremely useful, informative and easily accessible. 

“I would thoroughly recommend this excellent training package to any care professional who is involved in caring for women with miscarriage.”

You can access the e-learning resource at: or call the Miscarriage Association on 01924 200795to find out more.

“Waiting on a Friend”

Author: Jerry Overton

Published in Spring 2019 Edition of Ambulance Today Magazine

In this column, Jerry Overton- who is viewed by many world EMS and healthcare leaders as one of the best when it comes to improving ambulance systems globally- gives his opinion on the allocation of funding in theEMS system. He identifies some of the issues within EMS systems globally and, whether it’s saving ambulance hours or reallocating funds, you can trust Jerry to have a pretty good idea on how to improve on the system.

Oh, a storm is threat’ning

My very life today

If I don’t get some shelter

Oh yeah, I’m gonna fade away

 -“Gimme Shelter”

Yes, it is a storm that is constantly threatening, and it threatens us all. Cardiac events know no shelter; they
do not “fade away”. How sadly ironic
it is that the emphasis on this issue
of Ambulance Today is the recent London Cardiac Arrest Symposium last December, an event that Dec, lover of the Rolling Stones, had planned to cover. This all still just does not make any sense.

As always, the symposium was excellent, and I am sure the specifics will be comprehensively reported elsewhere. From this perspective, the welcome change was less on research and more on resources; human resources. The first, “Community CPR”, and second, “Kids Saving Lives”, really hit the mark.

This does not mean that cardiac research is not important, because itis. But, at the end of the day, whenone considers the amount of money committed to research compared to the amount of money needed to increaseour resources, one wonders if it is not time to discuss priorities.

Back in the day (okay, my day), the initial intervention for an out of hospital cardiac arrest was the precordial thump and if that did not work, there was always intracardiac epinephrine and sodium bicarb. Other meds came and went, depending on the latest research, and sometimes even who did the research. The contents of the drug box varied from system to system and the decisions of the local medical director. Sadly, ROSC rates failed to show any real improvement, whether in the United States, the United Kingdom, or Asia.

Today, every responder knows that two interventions make a difference, timely CPR and timely defibrillation, stressing the word “timely”. The question now, though, is what constitutes “timely”. It sure is not an eight-minute requirement. As has long been stressed by any paramedic, there will be little difference in outcome if the response time is 9 minutes 1 second rather than 8 minutes 59 seconds.

Response times are outputs, and what is needed are outcomes. And to achieve outcomes, we need resources. That, clearly, requires our most important resource, which is our people. If we really do have money for new programs, it is time to invest in the “research” necessary to seriously examine howwe can better recruit and retain those that can change patient outcomes. And if we do not have any “new”, perhaps reallocation of funds is in order.

There can be no debate that shaving seconds in telephone CPR instruction is important, but if there are insufficient dispatchers to answer the increasing number of calls, those seconds will make little difference. It is an under appreciated, almost invisible position, that drives the first link of the Chain of Survival.

The shortage of paramedics is even more acute. In the U.K., a 2017 report by the Comptroller and Auditor General of NHS England, reported 10 percent vacancy rate, with Trusts “struggling to recruit the staff they need and then retain them.” The U.S. is facing a similar problem. A recent broadcast from CNBC news reported that in the next six years, a 15 percent increase of paramedics would be required at a time “when unemployment continues to hover near historic lows”.

Of course, it is not just the out of hospital care world that is facing a crisis, other sectors of health care are also, and it directly impacts our ability to respond. That same 2017 report by the Comptroller and Auditor General found that in “2015-16, approximately 500,000 ambulance hours were lostdue to turnaround at accident and emergency departments taking more than 30 minutes, which equates to 41,000 12-hour ambulance shifts.”That is an almost unbelievable (but it is) staggering waste of both human AND financial resources.

Longer hours, more responsibility, higher utilization, fatigue, inequitable pay, and, of course, working conditions when considered together would make any sane person wonder why another sane person would ever consider makingthe commitment to a dispatcher or paramedic. The answer is, obviously, EMS personnel give a damn.

All too often, that is forgotten. It was just under three years ago that the first European congress dedicated to EMS was held in Copenhagen, EMS2016. The theme of that congress, and the subsequent congresses, was “It takesa system to save a life,” and indeed,it does. But the foundation for that system, or any system, is its people. In other words, without you, it is nothing.

That is my point. If we are ever to increase cardiac arrest outcomes,it will be done by human resources that have the education, experience, and motivation to make a difference. Telephone CPR does little good if a call goes unanswered. A medication has little impact if there is no paramedic to administer it.

Just like human resources, economic resources are limited. And it is a basic tenet of EMS that “nothing in life is free”. That includes community and kids’ CPR. Wisely using the financial resources that we do have is key, and if that means reallocating research grant funds away from the latest in drone delivery systems that could potentially increase survival one-half of one-half percent (yes, that is sarcasm), it needs to happen if those same funds can help us better find the keys to retain the human resources that WILL make a difference (No, I am not naive, higher wages is definitely a major key!!!).

And just when you think that all of us have at least a basic understanding for the need for a resource, any resource, that can respond and make a difference, comes this from the western section of the United States. It seems that officials in a Pacific Northwestern state have decided that call taking in dispatch centers has become so structured, and telephone CPR so protocol driven that they are proposing a rule change that would permit local agencies to no longer require its dispatchers to be certified in CPR. Yes, you read that correctly, public safety responders will not need to know CPR.

It is not like a fellow dispatcher has not arrested in a control center, because it has happened. It is notlike a fellow public safety officer has not arrested at headquarters, becauseit has happened. And it is not likea dispatcher has never witnessed a cardiac arrest as a layperson, because it has happened. Whether the proposal passes will be decided in early spring. And, interestingly, most local public safety agencies are AGAINST it. Perhaps those state officials need to take a step back and consider this from the Rolling Stones. It certainly fits.

You can’t always get what you want

You can’t always get what you want

You can’t always get what you want

 But if you try sometimes well you just might find

 You get what you need

“You Can’t Always Get What You Want”

MDA Education: The skills to save a life

Published in: Summer 2018 Edition of Ambulance Today Magazine

Magen David Adom (MDA), Israel’s National EMS organisation and Blood Services provider, is also Israel’s largest volunteer organisation. On its way to gaining this formidable title, MDA has taken upon itself the vital role of educating not only its employees in basic and advanced life-saving skills, but also a large number of Israel’s general population. Youth, medical staff and many others from around the world benefit from Magen David Adom’s professional and experienced trainers. 

Our youngest volunteers are 15-years-old, and begin studying towards a First Aid Provider certificate that allows them to volunteer on front-line ambulances. Often these teenagers undertake this course as part of a national volunteering scheme which requires all of those leaving school to have served a certain number of volunteer hours in order to receive their matriculation certificates.

MDA volunteers go well beyond their required hours, with just the 60-hour course itself almost entirely filling their quota. Nevertheless, many of the young volunteers work several times a week in eight-hour shifts, assisting the EMS crews in their life-saving duties.

These young volunteers often run training sessions of their own, either for the next youth volunteers or for members of the public, at CPR stands in malls, train stations, schools and other public places. 

Within the MDA framework, there are other short courses provided to the general public, beginning with a 22-hour “Life Guardian” course. This teaches the basic life-saving skills required in order to begin treatment in life-threatening cases such as cardiac arrest. Volunteers on this scheme are provided with basic life-saving equipment and then download an “MDA Teams” mobile phone app that notifies them if there is a call nearby and sends them details of the address and nature of the incident. This has helped to reduce response times in many cases to a matter of seconds, thus increasing patients’ chances of survival. 

Courses provided to medical staff are conducted around the country, both in their medical facilities and in MDA stations. These courses include refresher courses, Basic Life Support (BLS) courses, Advanced Cardiac Life Support (ACLS) courses, and tailor-made training sessions. 

ACLS, PHTLS and PALS courses are all run under the auspices of the American Heart Association, with MDA being one of the few non-American organisations with AHA accreditation for running their courses and issuing certificates. These courses are run across the country for nurses and doctors who are required to attend refresher courses every two-to-three years. 

Magen David Adom runs several courses a year aimed at international teams of doctors who come to Israel to learn from the wealth of MDA’s experience particularly, but not exclusively, in the field of mass casualty incidents. There have been teams from as far apart as France, Canada and Mexico who have joined specialised courses set in an Israeli background. There are, of course, EMT courses being constantly run, providing a flowing stream of qualified staff, including both volunteers and employees, for our ambulances. 

Arguably, the pinnacle of Magen David Adom’s education services lie within the Paramedic Education Centre, located in MDA’s Ramat Gan station, but branches are located all across the country. All of Israel’s Paramedics undertake their training with Magen David Adom, either in part or in its entirety, regardless of which course or courses they may have joined. There are courses for volunteers, EMTs who wish to take the next step in their career, military Paramedics, university degree Paramedics, those who are undertaking their national service in MDA, and many others. There have been courses run for all sections of society, irrespective of gender, race or religion, often tailored towards specific communities.

These communities, such as the Bedouin and Ultra-Orthodox communities, are underrepresented in the ranks of EMS in general, including Paramedics in particular. Providing each community with dedicated conditions allows their members to study in ideal conditions to complete the prestigious Paramedic course, and begin serving not only their communities, but the general public as a whole. 

Magen David Adom strives to educate as many people as possible in our primary, life-saving mission. We welcome all those who wish to learn to join us and be part of our education agenda. As it says in our logo – It’s a Matter of Life. 

Accidents are no film set

Author: Thijs Gras

Published in: Spring 2019 Edition of Ambulance Today Magazine

EMS staff have enough to deal with when responding to a call, the last thing they need is members of the public making harder work of it. In this column, Thijs Gras explains the difference between ‘innocent inquisitiveness’ and ‘sick sensationalism’ when it comes to the scene of an accident.

We got a call: probable resuscitationin a tram. When we arrived we founda man of about 70 years lying on the ground in a tiny space inside the tram. It was cold and rainy, so carrying him outside was not an option, at least not without proper preparation for which we had no time. The police were already performing CPR, all the passengers were out of the tram. We pulled the man a little under to create a bit more space and took over the resuscitation. While I was ballooning the man I suddenly noticed someone on the outside, looking curiously through the window of the tram as to what we were doing there.I was amazed and so were the police. After this guy was chased away, only a couple of moments later a woman took over. She gazed inside.

Now I must admit I have a certain degree of understanding, people being inquisitive when something happens involving lights and sirens. Mankind is naturally curious. In my younger years hearing the fire service acceleratedmy heartbeat and if I knew where they were going to, I went as well. A fire is fascinating to see. Smoke and flames, lights and sirens attract attention, which generally is okay, as long as you do not come too near or hamper rescue and/or fire fighting operations.

Labelling it positively, one could referto this as interest in the community, in society, in other people. The attraction could even have an evolutionary use: it is a way to mobilize help and assistance. It is only relatively recently that rescue and emergency medical care outside the hospital is professionalized and trusted to specially trained people from dedicated organizations and services. But even nowadays we value first responders and bystanders because they have one big advantage over the professionals: time. Professionals need to be informed there is a problem,find out where it is and who shouldbe handling this, and then alert the required units to rush to the scene. All these steps take time, so having people around to extinguish a fire, control a bleeding or perform CPR may be of great value.

But there are boundaries. Some people prefer filming to rendering first aid.This is ridiculous of course. Even after emergency services arrived on the scene and are doing their job, people may come very close, sometimes too close for comfort. Being a historian, I went through a lot of pictures of accidents. One would be amazed by the number of people watching accidents on some of the older pictures. Apparently this is of all ages. In the Netherlands we call this ‘disaster tourism’.

But do not forget, it may be dangerous! Even in The Netherlands we had a nasty experience in this field with the big explosion of a firework factory in the town of Enschede in May 2000. Among the 22 fatalities (including four fire fighters) and about 950 injured, were a number of people that had come to the incident just out of curiosity.

In recent years cell phones and iPhones have taken sensationalism a step further; everything is filmed nowadays. You make your own reality TV and broadcast it among your friends or nasty news channels. With a bit of luck your footage goes viral.

Last year in August there was a big collision on one of the Dutch highways. One person was so seriously injured he had to be resuscitated. People were filming everything. They bashed through the accident scene trying to get the best pictures, destroying important marks for the police investigation. They used lanes, marked with red crosses. A car even stopped on the opposite side of the motorway to film the accident, almost causing another accident with an oncoming lorry. Police noted as many registration plates as possible to give these people a big fine. Will they learn?

There are thin lines between innocent inquisitiveness, caring curiosity,sick sensationalism and pathologic papparazionism. The first two are relatively okay and can be dealt with, the other two are not okay and refutable.

As ambulance crews we ask the right honourable members of the public not to film patients and victims. And if you are struggling against the temptation, just reflect before you film: “What if this was me or my mother or my father? Do I want to go viral?” Accidents are no film sets. . .