Ambulance and medical transportation companies are becoming more in demand as the elderly population grows. An ambulance company can provide emergency medical services, non-emergency transportation or both. Ambulance companies can be private or part of a city's public safety department. An ambulance company must pass state inspection requirements to operate. Specific equipment, such as backboards, medication and oxygen, may be part of state requirements.

Ideally, an ambulance company will be located in the center of the area where its patients are located. Communities that have clusters of nursing homes, hospitals and senior citizen housing are good places to base an ambulance company because vehicles will have faster response times to those most likely to need services. Locations near highway on- and off-ramps are more suited for companies that cover a wider area, such as areas where nursing homes, hospitals and senior citizen complexes are more spread out. Determine the location of the company by picking an area in the center of health care facility clusters and senior housing.

Scout out the competition to determine the approximate size the company needs to be and the area it will respond to. Estimating appropriate size can be accomplished by driving the area, including the emergency room parking lots, to see how many ambulances competing companies may have on the road. Contact ambulance companies in the area and surrounding areas and ask for a tour. Some companies may be willing to answer questions about their ambulance company.

Get financial backing. Contact local banks to apply for business loans to finance the start of the ambulance company. Having good credit and a good business plan highlighting company goals, estimated income and possible business locations is beneficial when applying and interviewing for a bank loan. Government funding and grants may be available in some states. Search online or contact the state's public safety department to see if grants and funding may be available. Ambulance franchises, such as Rural Metro and AMR, are also available for consideration in some areas. Franchise information can be found online.


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Find a medical director, write a policy and procedure manual, and obtain a drug license. Protocols are written by the company's medical director. Protocols give detailed instructions on how to treat patients suffering from specific symptoms and conditions. A medical director is an emergency room doctor who supervises and is responsible for all practicing EMS providers working for an ambulance company. Contact local emergency room physicians to see if one is interested in becoming the new ambulance company's medical director. A policy and procedure manual is written by management, such as a paramedic coordinator or supervisor, and explains the rules and consequences, the job descriptions and the benefits offered by the ambulance company. A drug license is obtained by meeting the state's requirements and applying for a license. Contact the state health department to determine requirements, applicable fees and information about the drug license application process.

Buy equipment and vehicles. Contact your state's Department of Public Safety to obtain lists of required equipment needed on each ambulance. Equipment can be purchased online or from medical equipment companies or catalogs. Purchase enough equipment to stock each ambulance plus additional equipment for storage to replace what is used during a shift. New and used ambulances are available for purchase through manufacturing companies (orders can be placed online) or car dealerships. Consider buying used ambulances online through ads and auction sites or from local dealerships. Companies that decide to purchase used ambulances may need to employ a mechanic to perform routine maintenance and repairs. Newer ambulances may be covered under factory warranties, which cover specific maintenance and repairs.

Generate business. Newspaper, television and radio commercials are ways to market and advertise the new ambulance company. Business card-style refrigerator magnets with the company's logo and contact information can be handed out to residents of the community or sent through the mail. Contracts providing both emergency and non-emergency transports (such as a doctor's appointment) can be signed with health care facilities like nursing homes and hospitals, who agree to use the ambulance company when patients need transporting. Many 9-1-1 centers rotate medical emergency calls among multiple ambulance companies in the area. Contracts with 9-1-1 dispatch centers can put the ambulance company on the 9-1-1 rotation to generate business.


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Get insured. Ambulance companies need multiple types of insurance. You need vehicle insurance coverage for each ambulance on the road, worker's compensation insurance for workers who may get injured on the job, and medical liability coverage to protect against medical malpractice and lawsuits. Purchase insurance online or through an insurance broker. Contact the state public safety department or the United States Department of Transportation National Highway Traffic Safety Administration for ambulance company insurance coverage guidelines.

Hire staff. Ambulance companies will need to hire emergency service providers, technicians and paramedics, who can be found by placing classified ads or through job sites. Hire billing specialists to keep track of payments and invoices, and dispatchers who alert the ambulance crews when calls come in and act as a communication hub for the company. Hire enough staff, full-time and part-time, to fill all shifts. The Bureau Labor and Statistics provides information on emergency medical technicians and paramedics, including average salaries, so you can pay your staff competitively.