Late last year, the National Fire Protection Association’s (NFPA’s) Technical Committee on Ambulances unveiled its proposed new standard for ambulance design and construction. The lengthy document, “NFPA 1917 Standard for Automotive Ambulances,” lists hundreds of manufacturing specifications for materials, parts, weight, and aspects of the passenger and patient compartments ranging from what floors have to be made out of to what types of latches interior storage compartments need.
Many of the details apply mostly to manufacturers and won’t be of much interest to the end user. But certain aspects of the new standard, particularly those related to safety, immediately became the subject of much discussion and controversy. Among the biggies:
- Ambulances without a vehicle stability system should go no more than 60 mph, or 72 mph for those with a stability system.
- New ambulances will be required to have vehicle data recorders, tire pressure monitors, and a visual and audible seatbelt indicator that lets the driver know if crew members in the rear compartment are fastened in their seatbelts.
- New ambulances will have to be constructed in such a way that crews are able to reach all necessary equipment while seated and belted.
While some in EMS are praising the safety measures as a step in the right direction, others are saying the committee missed an opportunity to make even more substantial—and desperately needed—improvements in ambulance safety. Still others are questioning how realistic, and costly, it will be to implement some of the new safety measures.
“I agree with the idea of making the vehicle safer for our staff and the community around us, but we have to make sure we do things that are proven to be effective and are things that we can purchase, that are readily available and that are cost-effective,” says Aarron Reinert, executive director of Lakes Region EMS in North Branch, Minn., who represented the National EMS Management Association on the committee.
Out with KKK, in with NFPA
For years, safety advocates have been calling for an overhaul of ambulance safety requirements. While the federal Motor Vehicle Safety Standards sets safety requirements for passenger cars and other vehicles, ambulance patient compartments are exempted. (The cab and chassis, which are made by the original equipment manufacturer, are subject to the federal safety rules.) Instead, ambulance manufacturers generally follow what’s known as the KKK standard. Originally intended as the federal government’s purchasing specifications for ambulances, in the absence of an agreed-upon national standard, over time, KKK became the default standard for ambulance design and construction. Many states and municipalities adopted either the KKK, or wording similar to the KKK, as their own minimum requirements for ambulances.
Over the years, the General Services Administration (GSA) periodically updated the KKK standard. But about two years ago, the GSA notified the NFPA that it would not update the KKK standard when it expires in 2012. The GSA asked the NFPA, a nonprofit that develops codes and standards for fire apparatus, protective gear and equipment used by the fire service, if it would take over writing and updating the standard. In 2009, the NFPA formed a committee made up of 31 stakeholders and other experts, including representatives of the National Truck Equipment Association, the National Institute for Occupational Safety and Health, the American Ambulance Association, the National EMS Management Association, the National Association of EMTs, fire departments and other EMS agencies.
Early on, the committee decided against a complete overhaul of the KKK standard, says Larry Stewart, NFPA fire service specialist and staff liaison to the technical committee. Instead, it would write a “transitional document” that would focus on putting the KKK standard into the NFPA style.
“What the committee wanted to do was introduce a document that wasn’t standing the industry on its ear or changing things in this first rendition of the NFPA standard,” Stewart says. “We have manufacturers, users, labor and testing entities on the committee. It was a consensus among those groups that we didn’t want to introduce a new document that was a whole lot different than what was there now.”
Part of the reason was timing, Stewart adds. The committee wanted to make sure it could reach an agreement when the KKK expires at the end of 2012. Another concern was making it relatively easy for states and others that had adopted the KKK to transition to NFPA 1917.
The committee also wanted to avoid making ambulances unaffordable by requiring lots of new safety features. “That consensus process helps to ensure we are not making vehicles so expensive you can’t afford to buy them,” Stewart says.
Change is difficult
Despite leaving much unchanged, there are enough differences between the old and the proposed standards to spark heated discussions—especially the 60 mph limit on vehicles without stability control.
“In North Dakota, there are freeways where the speed limit is 75 mph,” Reinert says. Having ambulances lagging behind the flow of traffic could pose safety risks for the crew and other drivers, while slower speeds might also increase response times, he adds.
And there’s another problem, says Mark Van Arnam, CEO of American Emergency Vehicles (AEV) Inc. in Jefferson, N.C., and a past president of the Ambulance Manufacturers Division of the National Truck Equipment Association. While all Type II, van-style ambulances come with stability control, the manufacturers of heavier Type III ambulances and some Type I’s don’t even offer stability control as an option, with the exception of the relatively uncommon Sprinter. “Half of all ambulances built in this country are Type IIIs,” he says.
In addition, the burden is on the manufacturer to meet the standard, which he interprets as meaning the manufacturer would need to install some sort of device to prevent the ambulance from speeding. “We’d have to invent something to regulate the speed of the vehicles, and it’s not appropriate to ask us to do that,” says Van Arnam, whose company had a representative on the committee.
Many of the requirements in the draft proposal, including the vehicle data recorder, seatbelt indicator and tire pressure monitor, are already requirements on fire trucks under NFPA 1901, according to Stewart. “The standards were written in a way so the manufacturers have a number of ways of accomplishing that,” he says. “We are not requiring elaborate new systems.”
For example, the tire pressure monitoring system is as simple as screwing an inexpensive valve cap on each tire that measures pressure, Stewart says.
Though not necessarily opposed to a vehicle data recorder, Reinert, for one, isn’t sure why it was made a priority and how it will improve safety. Nor do ambulance manufacturers currently offer it as standard or optional equipment, he adds. “I see its potential, though I’m not clear about how specifically a VDR would benefit my organization,” he says.
Van Arnam says the committee’s perceived missteps may stem from a misunderstanding about the way in which fire trucks and ambulances are manufactured. Fire truck chassis are custom-made by fire truck manufacturers, while ambulance chassis come from the car manufacturer’s factories and then companies such as AEV add the passenger compartment. Companies like his that do vehicle conversions are expressly prohibited by the manufacturer from altering the safety systems of the chassis. Doing so would expose them to liability, he says.
Items such as seatbelt systems are part of the chassis, he adds. So while he could add a seatbelt notification to the passenger compartment, he could not tie it into the system that controls the driver’s seatbelt notification.
Since introducing the proposal, the NFPA has received more than 500 comments. (The public comment period ended Dec. 15.) In February, the technical committee will review all of the comments and begin deciding which ones to incorporate into the proposed standard. This summer, the committee will publish a second draft, after which the public will again have the opportunity to comment.
The NFPA is expected to make a decision on the final draft in 2012, which would be implemented in 2013.
Reinert believes the committee may decide to almost immediately start the standard five-year revision process in 2012, though Stewart says he thinks it would be better for the committee to wait and see if NFPA 1917 improves safety before changing it.
“The timeline we’ve been on has been fairly fast. Some of the opportunities that could be in there aren’t in there,” Reinert says. “I’d like to see us go right into making revisions and improvements to the document.”
