• G D van Olden, M J Edwards, and A B van Vugt.
• Academisch Ziekenhuis, afd. Heelkunde, Leiden.
• Ned Tijdschr Geneeskd. 1994 Nov 12; 138 (46): 2305-10.

ObjectiveTo inventory the difference in ambulance assistance in the Netherlands and the USA and to formulate recommendations to improve this assistance in the Netherlands.DesignStudy trip to the USA and enquiry.SettingUSA and Central Post Ambulance Transportation (CPAs) in the Netherlands.MethodAt 19 different ambulance and two helicopter services in the USA inventories were made of the training requirements, communication methods, logistics, methods of immobilization and extramural assistance. Questions on the same aspects were asked in an enquiry of 41 heads of Dutch CPAs.ResultsThirty-seven questionnaires were returned. It appears that the American ambulance attendant is much better trained than his Dutch counterpart. In 81% of the Dutch ambulances this is compensated by presence of a qualified nurse. The requirements to be met by dispatchers vary in the two countries, but the American dispatchers work according to fixed protocols and special dispatcher training exists. In the Netherlands, communication is unnecessarily delayed by lack of equipment and because the ambulance attendants can only communicate with the hospital via the dispatcher. In the USA, the ambulance that is closest is always sent out, in 6 Dutch CPAs this is not the case. In the USA, use is being made according to protocol of better immobilization materials than those used in the Netherlands.ConclusionThe training requirements for ambulance attendants and dispatchers should be tightened up and dispatchers should be issued with protocols. In addition, the communication between the switchboard, the ambulance and the hospital and the means of immobilization used should be improved. Use of the scoop stretcher is considered inadvisable.

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