FARGO — The temperature is zero degrees. On the west side of the Fargodome, where in fall there are tailgaters for Bison football games, large patches of ice make walking hurried and difficult. The wind chill is somewhere near minus 20.

The parking lot is empty except for an ambulance and cones. Lots of cones. Orange cones. Green cones. Tall cones. Short cones.

Lauren Bryan sits at the wheel of the ambulance. She has been an EMT for a couple years, but she’s a new hire for F-M Ambulance. This is her first time driving. Paramedic Bob Klein is her instructor.

We line up at the beginning of a straight, narrow course and Bob asks her to drive to the end. No problem.

“Now back up to the beginning,” he says. She cannot hit a cone.

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Lauren nails it. “How much room does she have on each side?” I ask.

“Three inches,” he says. “But it’s not about speed. It’s never about speed. It’s all about learning to use your mirrors.”

Perception vs. reality

Back in the office, Brett Wigglesworth, Paramedic and Manager of EMS Operations, and I talk about the common perception.

Hit the lights and sirens. Stomp on the gas. Drive a hundred miles an hour through city streets and screech around corners. There might even be theme music. This is an emergency. We have to get to the hospital fast.

“It starts off with 'this is awesome,'” he said. “But it moves quickly to you don’t like to do it. It’s kind of a scary deal when you realize that people don’t look for you. They’ll stop in front of you. They’ll swerve in front of you. A lot of drivers panic when they see the ambulance behind them.”

I ask what civilians who see an ambulance do wrong on the road.

“The toughest part these days is the hearing,” he said, “or drivers that are just on autopilot. Distracted driving. People panic when they see us close. We’ve even had people follow us to a scene to yell at us for scaring them. I think the biggest thing is just moving to the right. We’ve seen people in the right lane move to the left.”

“What do you want me to do,” I asked, “when I’m at a red light and you show up behind me?”

“We will turn off our lights and sirens and wait. Don’t run the red light.”

There are eight hours of classroom training followed by road tests before EMTs and paramedics are allowed to drive the trucks at F-M ambulance.

“It begins with the vehicle,” Brett explained “We’re trying to prevent negligence in taking care of the vehicle. Some of it is as easy as checking the oil. Some of it is more complicated, like when do we turn it off. If you’re on a call, you don’t turn off the ambulance. If it’s out, it’s running. If it’s in the garage, it’s hooked up to a power source.

They also consider what he calls "the legality of due regard," which means the person driving must consider whether they are using the lights and sirens appropriately for the call they're responding to or the patient they're transporting.

“When 911 receives a call,” he said, “the dispatcher asks questions that result in code for us. It tells us if we should be going lights and sirens or not. It always assumes worst intent and injuries. So we’re always looking for ways to get there faster. Actually, not faster — more efficiently.

“Things have changed through the years,” he said. “There used to be a saying that the best thing you could give a patient was diesel — foot to the floor. Now (the main question) is how can we get them to the hospital efficiently.”

All the paramedics and EMTs at F-M Ambulance become certified drivers. Crews go through the whole training course every two years. There are no drivers who are not part of the medical team.

Each of the 18 ambulances in the F-M fleet, not including the medical supplies on board, costs roughly $250,000. There are video cameras that look into the cab as well as outside. Even something as simple as brushing a trash can is reviewed.

“We have hardware in the ambulance called RoadSafe,” Brett said. “It uses an accelerometer and gyroscopes to determine your turning and starting and stopping. We can also see your speed, headlights, braking habits, RPMs. There’s a set of parameters. If a driver turns to the left too hard, for example, they’re going to start hearing clicking. Clicks mean your partner in the back and the patient are feeling G-force. If they turn too hard, the driver will hear a tone, which is an infraction.”

I tell him I know the goal is to arrive on scene in less than nine minutes. Most of the time they arrive within five or six. “The cliché is hundred miles an hour through city streets.”

“No way,” he said. “We have a policy. The drivers can’t go more than 10 miles an hour over the posted speed limit. If they do go over that, they have to have due regard in their mind to justify it. Fast is not always efficient.”

Routes are planned using GIS and CAD with trains and construction in mind for each of the 80-100 calls F-M Ambulance responds to daily.

We talk about success stories, times when the ambulance was exactly right.

“The happiest calls for me,” he said, “were the two babies I delivered. One was in a blizzard in a parking lot. The other one was in the driveway of a house. I literally caught the baby as it came out, as we were lifting the woman into the cot.”

No matter the conditions, an ambulance crew will never turn down a call. Blizzard. Tornado. Flood. If the truck can’t get to a site, the crew will get out and hike.

“One time, my partner and I had a call for a rollover accident out toward Casselton,” Brett said, “and the highway was all glare ice. It was 5 mph the whole way out and the whole way back, because otherwise we were going sideways. The patient was quite bad. It was probably the longest call of my life.

“If there is a call for an ambulance,” he said, “it’s somebody’s worst day. We have to be there.”

Back at the Fargodome, Lauren drives through a serpentine course backwards. She pulls into a simulated loading dock. The ambulance is huge, visibility is poor and the wind is strong. The ambulance acts like a huge sail. But the cones are untroubled. There is a braking exercise, a figure eight, a sharp turn exercise and an off-road exercise. She even has to parallel park. On ice.

“My car has a backup camera,” she tells Bob.

He points at a white square in the rearview mirror.

“This does, too,” he says. “It’s just covered up.”