This book describes the inner workings of ambulance services. Some insights include:

  • “Do Not Resuscitate” (DNR) orders are very important, especially as you get older: “the word of God Himself, written in triplicate.” (p. xvi)
  • Once someone dies in an ambulance, the crew has very few options for where to take them. Hospitals will not accept a corpse (p. xviii)
  • The difference between an EMT and a paramedic comes down to training. Paramedics are the senior members of the team, and have about eighteen months additional training. They also get paid more, and so very few ambulance services run crews with two paramedics (p. 10-11).
  • Nursing homes are more willing to call private ambulances than 911, due to reporting concerns (p. 40).
  • Ambulance services routinely claim that their transportation was necessary and that a cheaper option such as a wheelchair van would not have sufficed. This allows them to charge Medicare a higher rate (p. 40).
  • Ambulance crews have high turnover, with some members burning out after only a few months (p. 229). Hazzard categorizes crew members as either tourists (short-timers motivated by curiosity), true believers (dedicated to saving lives), and killers (those who have stayed past the point of burnout).
  • Ambulances operate similar to other transportation services such as trucking and taxis, including using fuel cards for bulk purchase discounts. However, sometimes the cards fail and the crews have to leave the station attendant with an IOU (p. 231).