Inspired by the original "Madness" cartoon, Madness Ambulation is a third person angle drive and shoot game.

The objective is to complete all ten levels, or waves, with your car intact and kill as many rag doll characters (agents) as possible. The agents attack from motorbikes, some with guns, and jump from the back of trucks. They will shoot at you and climb onto your vehicle, you must move back and forth to shake them off, you can also use your car to block their shots and knock them over.

Your car will sustain damage from their attacks and other obstacles that you must look out for, like: rocks, barriers, and pylons. The top of the screen indicates your speed, miles travelled, and car health. There are power ups available that will increase car health, or give you more powerful guns.