Why Ambulance Donations Often Do More Harm Than Good

This post has been adapted from an article originally published on EMSWorld.com


There is a widespread belief that ambulance donations can solve the emergency transport problems of entire communities. But the truth is, they can’t. In fact, ambulance donations will probably cause you more problems than they will solve. And we know what we’re talking about because we’ve seen it in countless countries. We’ve seen it in so many countries, Trek Medics has made it a policy to never donate used ambulances.


To help manage expectations and avoid the inherent problems of importing new or used ambulances in communities that don’t have the money or roads they need to maintain these vehicles, we’ve also included a short list of issues we’ve seen and heard time and time again.


Everyone knows what ambulances are meant to be used for – to transport the sick and injured – and the lights and sirens do a good job of ensuring the community’s aware of them. However, the lights and sirens can also be very distracting, and sometimes convince people that they represent an EMS system. This is not true. It’s important to make sure both recipients and donors agree what the intended purpose of the ambulance is, and if that purpose can be fulfilled with the recipient community’s full socio-economic status taken into consideration.


See the world as it is. Don’t ignore the red flags that are in front of you out of romantic ideas. Honestly evaluating the physical, financial and human resources in your community will prevent you from wasting resources and money on a vehicle that was not built for your infrastructure. Several simple questions can help avoid unexpected obstacles:


  • Do you have paved roads everywhere? Are they smooth, maintained asphalt like those we have in North America? Or, are they unpaved, pockmarked, washboard or pure vegetation? This is an important question: North American and European ambulances are very fragile and breakdown easily if not used on paved roads
  • What are the weather patterns? Most North American and European ambulances don’t do well in rain or snow.
  • How wide are the roads? Big cities in many developing countries are giant webs of narrow, wandering alleys and one-lane streets – and inaccessible to North American ambulances
  • How bad is the traffic? The more widespread the congestion, the more useless an over-sized ambulance—think, for example, of Calcutta or Port-au-Prince.
  • How costly is fuel? North America traditionally enjoys very low fuel costs compared to most other countries, including those in Europe[1]
  • How easy are spare parts to obtain within the country?
  • How familiar are the local mechanics with these engines and electrical wiring?

For every different ambulance model a community acquires, there are recurring costs for fuel, spare parts, and specialized mechanics to maintain and repair the vehicle, which will be regular. This can become especially overwhelming when communities acquire multiple ambulances from multiple vendors and donors, leading to “a disparate fleet of vehicles of varying suitability, age and function.”[1] Unfortunately, many communities are so desperate to improve access to healthcare that they may unwittingly continue to spend money trying to make use of the ambulance until they have wasted too much.


Above all, high-quality patient care is the ultimate goal, and safety must be a starting point. We can all attest to how bumpy it is working on an old.


If you think those issues aren’t going to be a problem, there are many bureaucratic rules and regulations you will need to navigate to successfully ship an ambulance across borders. There are many ambulances currently parked in ports around the world that serve as the only air-conditioned office in the whole shipyard. The sheer number of forms and permits necessary to ship an ambulance can itself be enough of a hassle to discourage people from engaging the process, so form relationships with established and experienced shipping companies who can at least ensure the ambulance gets where it was intended to.


Understanding as much as possible about the recipient community’s health care system will never work against you; get to know the people whose lives could be impacted by this ambulance – and don’t always assume it’s going to “save” lives, just because it’s an ambulance. Someone who dies while waiting for an ambulance that’s never going to arrive may have survived if the ambulance was never in the community to begin with. As Ivan Ilyich wrote, “The siren of one ambulance can destroy Samaritan attitudes in an entire Chilean neighborhood.”


Hospital waiting rooms are always a good place to begin to learn about existing resources and how patients access emergency care (even if there is no ambulance). Respect these systems, and don’t assume the community leaders are going to cooperate with each other once the keys have been handed over. In many countries, divisions between public and private agencies and providers are often vague, and donating an ambulance to an agency which does not traditionally provide patient transportation has great potential to further fracture dysfunctional public health and safety systems.

“Boy-scout training, good-Samaritan laws, and the duty to carry first-aid equipment in each car would prevent more highway deaths than any fleet of helicopter-ambulances. …”

“…For acute sickness, treatment so complex that it requires a specialist is often ineffective and much more often inaccessible or simply too late.” Ivan Illich