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Extra ambulance attendant, ground (als or bls) or air (fixed or rotary winged); (requires medical review)

HCPCS code

Name of the Procedure:

Extra Ambulance Attendant

  • Common Name(s): Additional Ambulance Crew, Extra Paramedic
  • Technical/Medical Term: Extra Ambulance Attendant, Ground (ALS or BLS) or Air (Fixed or Rotary Winged) (HCPCS Code: A0424)


An Extra Ambulance Attendant is an additional medical crew member provided during an ambulance transport, which can be ground (Advanced Life Support [ALS] or Basic Life Support [BLS]) or air (fixed-wing or rotary-wing aircraft). This additional attendant is needed when the patient's medical condition requires more intensive monitoring and care during transport.


  • Addresses: Critical medical conditions requiring continuous, high-level care en route to a healthcare facility.
  • Goals: To ensure patient safety by providing necessary medical interventions and monitoring during transportation.


  • Severe trauma or injuries
  • Cardiac emergencies (e.g., heart attack)
  • Respiratory distress requiring advanced airway management
  • Unstable vital signs necessitating close monitoring
  • In cases where the primary EMS provider determines that an additional attendant is essential for optimal patient care


  • Pre-transport assessment by EMS providers
  • Necessary medical equipment and medications must be prepared
  • Prior planning and coordination with receiving medical facility
  • No specific patient preparation required, as this provision is determined based on immediate need

Procedure Description

  1. Assessment: Initial patient assessment by primary EMS providers.
  2. Decision: EMS providers determine the need for an extra attendant based on patient's condition.
  3. Coordination: Arrangements are made to include an additional attendant (paramedic or EMT).
  4. Transport: Patient is loaded into the ambulance or air transport.
  5. Care and Monitoring: The extra attendant assists with continuous monitoring and necessary medical interventions during transport.
  6. Handover: Upon arrival at the receiving facility, a comprehensive handover is provided to the medical staff.

Tools/Equipment Used:

  • Standard ambulance or air ambulance equipment (e.g., cardiac monitor, oxygen supply, emergency medications)

Anesthesia/Sedation: Not typically required, but patient comfort and pain management are prioritized.


  • Variable, depending on the distance to the healthcare facility and the complexities of patient's condition.


  • Performed in either a ground ambulance (ALS or BLS) or an air ambulance (fixed-wing or rotary-wing).


  • Primary EMS providers (paramedics, EMTs)
  • Additional EMS employee (typically a paramedic)

Risks and Complications

  • Common Risks: Minimal, associated mostly with patient's underlying condition.
  • Rare Risks: Potential delays in transport or complications during care transitions.


  • Enhanced patient monitoring and immediate capability for advanced interventions.
  • Increased likelihood of stabilizing the patient en route to the healthcare facility.
  • Improved patient outcomes through high-quality pre-hospital care.


  • No specific recovery post-transport procedure.
  • Continued care coordinated at the receiving healthcare facility depending upon patient's condition.


  • Standard BLS or ALS transport without additional attendant, which may not be suitable for critically ill patients.
  • Pros of alternatives: Lower cost.
  • Cons of alternatives: Reduced level of care, higher risk for deterioration during transport.

Patient Experience

  • During Procedure: Patient will experience close monitoring; depending on the condition, they might receive medications or other medical care.
  • After Procedure: Patient is typically transitioned to the emergency room or appropriate medical unit for further care.
  • Pain Management: Addressed as part of the emergency medical treatment, ensuring patient comfort.

Overall, an Extra Ambulance Attendant ensures that critically ill patients receive the attention and medical care they need during transport to improve overall outcomes.

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