When is it OK to Put a Rider Up Front in the Ambulance?

Emergency Medical Services has become a customer-service driven industry, with the ultimate goals of providing excellent patient care while meeting both their needs and the family’s needs as well. It’s all about serving the community you work in.

And we realize that we can’t make everyone happy all the time; sometimes, those goals collide and the outcome isn’t pretty. One such controversy is letting a civilian rider sit up front in the rig while the crew is transporting their loved one to the hospital. EMS personnel have forever been divided on this issue. On one hand, we want to do what we can for the family, and on the other hand, we want to preserve the safety and wellbeing of everyone in the truck at the same time.

Most agencies offer guidelines – or may even have stringent protocols – on the subject of civilian riders in the ambulance, but ultimately, it is up to the crew that is transporting. So where do you weigh in on this issue, and why?

I can think of a host of reasons to consider when making the decision to buckle a citizen up in the passenger seat and take off transporting (emergency or downgraded) to the hospital. First and foremost, of course, is safety.

Safety Issues

  • There is always an added liability when taking a civilian rider in the rig with you should there be an accident en route to the hospital. Family riders, even with all safety precautions in place, have been critically injured, or even killed in some instances, during a wreck.
  • People slipping getting in and out of the unit. This sounds funny, but it isn’t. We’re well used to the dimensions of our mobile workspace, and sometimes we even slip, fall, trip, and whack our heads on things. But the risk increases with a civilian rider, especially if they are distraught, elderly, etc. They might not be able to navigate that running board and high step up into the passenger seat, even with guidance.
  • A rider refusing to wear their seatbelt, and trying to peer in through the cab window to see what’s going on in the patient compartment and what’s happening with their loved one. Understandable, but it cannot be allowed. They need to be buckled up, secured and face front for the entire trip to the ER.

ambulancesPediatric Patients and Hysterical Parents

  • Sometimes, having mom or dad in the back with you when you’ve got a sick kid is very helpful; the child feels reassured because their primary care giver is there, the parent feels like they are doing something to help their child which gives them back some control in what usually feels like an out-of-control experience, and if you’re lucky, everything goes well.
  • But what about when that child is critically sick or injured? And the parents are both hysterical? Obviously, you cannot have them in the back with you at this point, as they would do more harm than good. Now you are also faced with the risk of putting a very emotional parent up front to ride with you to the hospital, vs. the risk of having that same very emotional parent get behind the wheel of a vehicle and try to follow you while you’re saving their child’s life. If there is no one else around to drive that parent, and given the choice between risks, I have always taken that parent with me.

Drunk/High/Belligerent Riders

  • Depending on the person’s behavior, this is usually a deal-breaker for most EMS crews. You just can’t predict what someone under the influence of drugs or alcohol (or both) is going to do in the front of your truck. And that’s a safety risk I’m not willing to take. If you are afraid of them getting behind the wheel and driving to follow you, then call in law enforcement to assist. And don’t let it distract you from patient care.

People Who Steal/Damage Property

  • It’s too bad to even have to mention this, but some folks out there do not have the best of intentions. Crews have reported having personal items like wallets, lunch bags, drinks and other things disappearing after the rider gets out. Riders have stolen equipment, have attempted to steal narcotics, and in quite a few cases, stolen the unit itself. (This is why you always keep your rig locked, even if you’re going to be outside of it for only a few moments.)

Negative Psychological Impact

  • This goes back to having that critical patient and taking their loved one with you. Even seat belted in correctly, in most ambulances riders can still peer around through the cab window and see inside the patient compartment. And we all know that some of our interventions for critical patients look absolutely brutal to a loved one that is watching. Intubation, defibrillation, multiple IVs, nasogastric tube insertion, etc. all of these things look like we are torturing the patient, and that can take a real psychological toll on someone who is already distraught. There are arguments for and against this, but it’s something to consider.

So evaluate every situation individually. Watch each other’s backs, and pay attention when any of those little instinctual red flags pop up about taking a rider with you. And stay safe out there!

Disclaimer: The content in this article is the opinion of the writer and does not necessarily reflect the policies or opinions of US Patriot Tactical.

Leah Dallaire

Leah Dallaire

Leah G. Dallaire is a highly accomplished freelance writer, editor and consultant with 28 years of experience. She has also concurrently been a paramedic for 20 years; the last 17 she spent serving the citizens of Pinellas County, Florida, which has a call volume of about 209,000 runs per year. She holds an M.A. and a B.A. in Writing & Literature from Union University. She has also just finished her first novel.
Leah Dallaire
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