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Ambulances are largely exempt from crashworthiness and occupant protection passive safety design standards in the USA, and have a poor road safety record. This comparative evaluation of USA ‘concept safety’ ambulances and a standard Australian ambulance is based on basic principles of crashworthiness and available crash test data. There are features of USA ambulance design that are not within known principles and technical aspects of crashworthiness and safety design, and include some predictable serious occupant protection hazards. The USA ambulance industry should recognize and apply crashworthiness and occupant protection principles to reduce current system failures for this fleet of essential service vehicles.