Fire Apparatus (Non-Ambulance) Transports – Priority #1 for 2022

Author: Tim Nowak

(3-minute read)

COVID-19 aside, the consideration over whether fire apparatuses (not ambulances) can or should transport patients to hospitals will top headlines as a highly contentious practice as we progress in 2022 and it should be your #1 priority item as a fire chief entering this new year.

Let me first preface in saying that I am not an attorney, so you should absolutely consult with your own legal counsel regarding this matter, rather than waiting for your own department to hit the headlines!

“Status zero,” “system surge,” and other power phrases are being used to classify situations in which ambulance resources are drawn to either minimal or zero numbers during a given timeframe within a local system. Increased call volumes, decreased number of available crews due to illness, and delayed hospital turnaround times seem to be the culprit behind the reasoning for these status determinants. it’s all leading to different fire departments – or individual crews – to becoming creative.

When there are no ambulances around to transport – or the one “assigned” to the call is a significant response time away – departments have been turning to their fire apparatuses (those that are not ambulances – e.g., engines, command cars, ladder apparatus) to transport patients in both time-sensitive cases and non-urgent situations. This practice – in black & white, objective form – goes against every definition of what these apparatuses are designed to do and could be considered an illegal practice because they’re not licensed “ambulance” vehicles.

Subjectively, however, your injured or critically ill patient may not care how they get to the hospital. They just want to get there, and faster than 30 minutes.

As a fire chief, this is an uneasy decision to make but rest assured, it is one that you need to address. Here are three pressure points for you to consider (and consult on with your legal team).

Risks & Liability

Fire apparatus aren’t traditionally designed for patient transport, so how do you plan to safely transport an injured patient or a critically ill patient that would otherwise require stretcher transport? Are your crews able to safely perform critical interventions inside the cab of your fire engine, or are they better suited to respond and stay on scene? How about insurance? What coverage do you have by actively engaging in the patient transportation space? Overall, is the risk – whether administrative or clinical – worth it to condone this practice within your department?


Ambulance services can bill for transport, but what if your fire department provides the ambulance service using a fire apparatus (non-ambulance) to transport? This is something that your department needs to discuss with your billing personnel/vendor to assure that you do not break any billing laws, which are often charged as “fraud” (a term that you certainly don’t want associated with your agency).

Policy & Statue

As mentioned earlier, your department needs to develop a policy on this item. Whether you condone this practice or condemn it, you need to (at the very least) outline the process for making the decision to transport a patient via fire apparatus, establish the documentation process for this practice, and outline the phone tree of communication that needs to occur before your department hits the headlines. On a larger scale, your department also needs to consult with its state EMS office – and other applicable local regulatory authorities – related to this matter.

The Pressure is On

This very subject has the potential to lead to lawsuits, lost licenses, and even lost lives (and I don’t use the “life and limb” or “minutes count” cards often). Regardless of what your department decides to do, it needs to act now. Thoroughly review every aspect of each of the instances where this does occur and be prepared to make the headlines as either the hero or the defendant whenever you decide to engage in this practice.



To free up ambulances, Md. county is using fire trucks, other vehicles to transport patients (

Va. Fire Dept. That Transported Pediatric Patient in Engine Gets State Violations (

Transporting a child by fire engine instead of waiting for ambulance (

Posted by Rachel Ray

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