Ambulance Driving Is More Than Driving: Physiological Risks, Patient Safety, and Critical Decision Making.

By: Jhon Paul Balbin, Emergency Services Researcher and Training Specialist and Dr. Sunil Shah Kumar, MD.

An ambulance is a specially designed and medically equipped vehicle used to transport individuals requiring medical care, staffed by licensed emergency medical services professionals who provide prehospital assessment and treatment during transport.

Licensed EMS professionals are individuals trained in prehospital emergency care, typically through structured EMT, AEMT and paramedic education programs that include didactic instruction, skills labs and supervised clinical/field experience. Each of them understands emergency medical science and how to safely manage medical and traumatic emergencies in the out‑of‑hospital setting. 

According to Beard et al., even ground transfer of critically ill patients in an ambulance has physiological effects that can significantly affect patient status during the transfer process. This is largely due to the effects of acceleration and deceleration on patient physiology, which are best understood by first considering Newton’s laws of motion. [1]

1. Law of Inertia (first law of motion), which states that “an object at rest remains at rest, and an object in motion remains in motion at constant speed and in a straight line unless acted on by an unbalanced force.”[2]

   
   

2. Law of force (second law of motion), which states that “the acceleration of an object depends on the mass of the object and the amount of force applied.”[3]

   
   

3. Law of action and reaction (third law of motion), which states that “whenever one object exerts a force on another object, the second object exerts an equal and opposite force on the first.”[4]

   
   

For example, when an ambulance carrying a patient accelerates, inertial forces can displace bodily fluids (i.e blood) and non‑tethered organs toward the feet. This caudal redistribution of blood volume reduces venous return and cardiac output, and in vulnerable patients may result in systemic hypotension.[5]

Complications arising during ground transfer can lead to clinical deterioration and, in some cases, progression to cardiac arrest. At the moment of such deterioration, the healthcare professional attending the patient in the rear of the ambulance may have little opportunity to communicate detailed instructions to the driver about whether to slow down, stop, or adjust speed, even though these driving decisions are crucial to allow timely initiation of CPR and other life‑saving interventions.[6]

The ambulance operator, therefore, must understand how to respond in these scenarios. A trained and experienced EMT driving vehicle will often slow down or bring the ambulance to a controlled stop to allow the team to perform effective manual CPR on the patient, unless a mechanical chest compression device (such as LUCAS) is being used to maintain compressions during motion.[7] [8]

A randomized simulation study from Turkey and other transport studies have shown that manual CPR delivered in a moving ambulance is difficult to perform with consistent, guideline‑compliant compression quality, whereas mechanical devices can provide more constant rate and depth and represent a reliable alternative during ambulance transport.[9]

References above, it is reasonable to argue that the person driving the ambulance should hold, at minimum, EMT‑level qualifications and possess a foundational understanding of emergency pathophysiology.

[1] Laura Beard and Peter Lax, “Physiological Effects of Transfer for Critically Ill Patients,” Anaesthesia Tutorial of the Week 330, World Federation of Societies of Anaesthesiologists, May 4, 2016, accessed April 30, 2026, https://resources.wfsahq.org/wp-content/uploads/330_english.pdf.

[2] NASA Glenn Research Center, “Newton’s Laws of Motion,” Glenn Research Center, NASA, last modified June 12, 2024, https://www1.grc.nasa.gov/beginners-guide-to-aeronautics/newtons-laws-of-motion/#newtons-first-law-inertia.

[3] NASA Glenn Research Center, “Newton’s Laws of Motion.”

[4] NASA Glenn Research Center, “Newton’s Laws of Motion.

[5] Beard and Lax, “Physiological Effects of Transfer for Critically Ill Patients.”

[6] Beard and Lax, “Physiological Effects of Transfer for Critically Ill Patients.”

[7] Fox, Julia et al. “Mechanical versus manual chest compression CPR under ground ambulance transport conditions.” Acute cardiac care vol. 15,1 (2013): 1-6. doi:10.3109/17482941.2012.735675

[8] Personal Communication, Houdini Abonal, PH-RN, RM, DoH-Abu Dhabi Licensed EMT”, 2026.

[9] Şan, İshak et al. “Manual cardiopulmonary resuscitation versus mechanical cardiopulmonary resuscitation: Which one is more effective during ambulance transport?.” Turkish journal of emergency medicine vol. 21,2 69-74. 12 Feb. 2021, doi:10.4103/2452-2473.309135.