For EMS professionals, the prospect of driving such large vehicles with patients in the back can be intimidating, especially since you're allowed to break traffic laws when necessary — that's a lot of power and responsibility. Knowing what to expect, and what's expected of you, before you get behind the wheel is the best way to ensure that you'll be worthy of both.

Before You Start the Engine

Cliché as it may sound, the safe operation of an EMS vehicle starts at home. A healthy diet and regular, high-quality sleep are essential to maintaining consistent energy levels throughout the day. It's critical that you show up to work refreshed and alert so that you can stay that way throughout your shift. Of course, sleep deprivation is inevitable in this line of work, especially while you're on duty, but you can mitigate its negative effects by resting well at home.

Continuing Education

It's also important to stay on top of your continuing educational requirements, even when you're off the clock. EMS safety standards evolve and change constantly and many departments fall behind, often because life at the station can be so hectic. You don't need to do a ton of reading and studying at home, but it never hurts to keep one eye on EMS news and to encourage your coworkers to think and talk about vehicle safety standards at work.

Pre-Shift Inspections and Preventative Maintenance

A thorough vehicle inspection should be at the top of your to-do list each workday. If possible, complete one before you become officially responsible for responding to calls. Your chief will provide a detailed list of things to check on your vehicle, such as the oil level, the radio, and the stock levels of all medical supplies. If there are any problems with your vehicle that may make it unsafe to operate, you'll want to discover them now, not when you're driving with your patient and partner in the back.

Preventative maintenance is another crucial component of safe EMS vehicle operation. This covers things like new tires, oil changes, and in-depth inspections by a knowledgeable mechanic. Some departments employ mechanics to service their vehicles regularly, whereas others (usually smaller, rural departments) may expect medical personnel to also have basic vehicle repair skills. Ask your chief or captain what level of mechanical knowledge you'll be expected to have, if any.

Broadly speaking, you should think about your vehicle the same way you think about your patients and their needs: proactively. Look for warning signs that indicate potential problems and focus on prevention over cures whenever possible.

General Defensive Driving

The basic principles of safe driving are the same whether you're in your personal vehicle, an ambulance or a fire truck, although the details are very different. Most obviously, emergency vehicles are much larger and heavier than most personal vehicles, meaning they require a lot more finesse and caution from the driver.

Maintaining Situational Awareness

Before you can predict or react to the actions of other drivers, you must know where they are and what they're doing to the greatest extent possible. This is especially important when driving an ambulance or fire truck, both of which are less agile than most other vehicles. You won't be able to react to changing road conditions very quickly, so you must actively anticipate them.

EMS vehicles have more, and larger, blind spots than most other vehicles. It's entirely possible for two cars to be stopped behind you at a light and for both of them to be invisible in your side mirrors. Similarly, it's not uncommon for ambulance drivers to unintentionally cut someone off while changing lanes because they couldn't see behind them.

In short, you should always assume that there is another vehicle in each of your blind spots at all times. Use your turn signal to indicate turns and lane changes at least five full seconds in advance. By doing so, you give other drivers ample time to react if you can't see them. Brake and accelerate gradually, and note that other cars may come into or disappear from your view as your speed changes.

There are many other aspects of situational awareness to think about. Your captain or chief should be able to provide you with up-to-date vehicle safety materials that cover this topic more extensively — don't hesitate to ask for them.

Managing Speed

EMS providers can be an excitable lot, especially those who are new to the field. Most of them take their responsibility to help the sick and injured very seriously. You've probably already heard of the "Golden Hour" rule, which refers to the critical importance of rendering aid within the first hour after a serious injury. It's important to get to your patient quickly to maximize their chances of recovery. However, none of that matters if you or your partner are incapacitated or so severely injured that you also need medical attention.

In most cases, extra speed is far more harmful than helpful. Let's do a bit of math. Say your patient is ten miles away. It will take you ten minutes to get there at 60 miles per hour, whereas driving 90 miles per hour will only shave three minutes off the trip. Contrary to what we usually see in movies, three minutes is almost never the difference between life and death, or between full function and permanent disability.

That being said, if you have a specific reason to believe that those few extra minutes might make a difference for a specific patient, then drive faster — and exercise extreme caution.

There's a common saying in the military: "Slow is smooth, smooth is fast." It refers to the process by which shooters learn to shoot quickly and accurately by first learning to shoot slowly and accurately, but it's just as applicable to EMS workers. Getting to your patient in ten minutes is infinitely faster than not getting there at all.

Braking Appropriately

The relationship between a vehicle's weight and how long it takes to come to a stop is not linear. An ambulance that weighs twice as much as a pickup truck doesn't take twice as long to stop — it's closer to three or four times as long. You'll also have a patient in the back, and your partner may be trying to render treatment that requires a steady hand.

In order to brake gently and safely, you'll need to develop a consistent habit of looking as far down the road as you can see and planning your reactions to traffic conditions well in advance. Leave at least 150 feet between your vehicle and the one in front of you whenever road conditions allow it. When they don't, leave as much distance as possible.

An ambulance traveling at 60 miles per hour can take ten seconds or longer to gently come to a full stop. Ten seconds is a very long time on the road, where conditions can change in the blink of an eye.

Backing Up

Simply put, you should never drive an emergency vehicle in reverse if you can avoid it. EMS vehicles are large, difficult to maneuver with precision, and have many blind spots. Even if yours has a back-up camera, you still can't see everything around you.

Whenever possible, drive in such a way that backing up isn't necessary. If your patient is stable, make a U-turn, or drive to the next street and circle around the block. If you must back up, have someone outside the vehicle direct you.

Managing Fatigue

Anyone who's been in EMS for longer than a month knows that no matter how vigilantly you monitor your health and sleep patterns, there will come a time when you feel tired behind the wheel. It's within the nature of the work and it's impossible to avoid it entirely.

That's why it's critically important to learn the difference between feeling a little sleepy and true fatigue — and to be honest with yourself, your coworkers, and your chief about your condition. EMS workers often put tremendous pressure on one another to always be alert and ready for action. Unfortunately, that pressure can often manifest as harmful statements like, "Suck it up and do your job."

If you're too tired to drive safely or to care for a patient, you need to ask for help. Don't ignore clear signs that you're temporarily unfit for duty — acknowledge reality and prioritize the health and safety of everyone involved. It's better to mildly annoy a coworker by asking them to drive than to endanger yourself and others by pushing through serious fatigue.

Minimizing Cell Phone Usage

All EMS vehicles have radios, and these should be your primary means of communication. Your cell phone should be used while driving only for important matters related to patient care, and only if your radio is not functioning well enough to facilitate clear communication in both directions.

If possible, pull over before dialing a call. If you must place a call while driving, do so with voice dialing or another hands-free method. Never send or read text messages while driving, even for work-related matters. Ask your partner to send or read such messages if they're truly important.

Driving Code 3: Special Considerations

While operating an emergency vehicle, you have a certain degree of freedom to ignore some traffic laws, but only when absolutely necessary. The prospect of driving code 3 (with lights and/or sirens on) is terrifying to many inexperienced EMS workers, but it doesn't need to be. There are only a few additional best practices to be aware of, and most of them are simple common-sense measures.

Using Your Emergency Lights and Siren

You should never turn on your lights or siren if you aren't transporting, or trying to get to a critical patient, but if you suspect that the need may be critical, go ahead and turn them on. The main purpose of your lights and siren is to make other drivers aware of you, although you should never assume that this will actually happen. It's maddeningly common for other drivers to remain totally unaware of your presence until you've driven right past them. Also, your lights and sirens must both be on before you perform any of the emergency maneuvers below.

Exceeding the Speed Limit

You are legally allowed to drive at any speed that is reasonable and prudent with respect to the needs of a critical or potentially critical patient. Defining "reasonable and prudent" in this context is tricky, to say the least. There are many factors to weigh in deciding how fast you should drive.

In general, you should drive at high speeds only when three things are true: when the time saved is more likely to significantly benefit your patient than the increased speed is to harm them, when you have clear visibility for at least 1,000 feet ahead and to both sides and when the road conditions don't significantly increase the danger.

When in doubt, your lights and sirens should be on, but you should take a more conservative approach to your speed: When in doubt, slow down.

Driving through Red Lights and Stop Signs

Again, never do this if your patient's needs aren't critical and immediate. If they are, come to a complete stop and look in all directions before you drive through a red light or stop sign. Do your best to ensure that other drivers seem to be aware of you and have stopped, or clearly will be able to stop at a safe distance. Then, proceed slowly through the intersection.

Driving Offroad or against Traffic

It's very rare that driving against the flow of traffic is truly necessary. In most cases, if you must get around stopped cars, it's vastly safer to drive on the shoulder. You may drive against traffic if and only if oncoming cars are stopped or moving very slowly (under 20 miles per hour) and if the danger posed to your patient by doing so is less than the danger posed by further delays.

You may also drive over medians and sidewalks under the same conditions and restrictions. Driving this way is dangerous to everyone in the area, so these are truly last-resort options.

No single article could exhaustively cover the safe operation of EMS vehicles. Hopefully, this one has shed some light on the most essential considerations and increased your confidence in your ability to drive an ambulance or fire truck safely.

Your captain or chief can provide you with more resources on the most current EMS vehicle safety standards. Many state agencies, professional associations and private companies have published helpful resources as well. Driving an emergency vehicle can be a little nerve-racking at first, but as long as you follow these guidelines, exercise common sense, and err on the side of caution, you'll be just fine.