Recent epidemiological studies have identified ambulances as high risk passenger transport vehicles, particularly the rear compartment. It appears in the absence of USA ambulance safety standards or guidelines, non engineer end-users are driving changes in practice and policy in place of independent peer reviewed biomechanical and crash injury outcome data. This study’s objective is to compare and analyze frontal crash biomechanical and crashworthiness research for ambulance vehicles, with a focus on application of the real world environment, and development needs for future standards. Frontal impact ambulance crashworthiness tests conducted over past 15 years, were identified and evaluated with a multidisciplinary approach consisting of automotive crashworthiness, emergency medicine, public health and EMS care delivery. Crash test data identified include:​ 25G to 34 G deceleration sled tests (delta V 20.9 to 32.3 mph);​ one full crash test of a bullet vehicle travelling at 36 mph crashing into another vehicle, impact Delta V of 30 km/h (18.5 mph) and deceleration of 14Gs to the rear compartment;​ and three fixed barrier frontal tests at a 40km/h (25 mph) delta V and 25 G impacts. There appeared to be a lack of correlation with real world crash forces in the conduct of the rigid barrier tests. The use of data from side facing occupants was also confounding. Ambulance crashworthiness is a complex system. Clearly demonstrated hazards have been identified in the limited real world crash injury/fatality data and the crash test data available. Testing must be based on meaningful real world parameters such as the forces that occur in actual crashes and the types of injury and fatality hazards to the occupants, so that development of standards and thus the design and construction of ambulance vehicles, can be focused to achieve adequate levels of occupant protection using current crashworthiness methodology already utilized in industry.