In November, several members of the NFPA 1917 Technical Committee gave attendees of the 2011 American Ambulance Association annual conference in Las Vegas a glimpse at some of the changes expected in the new ambulance specifications standards. Although some of the changes were applauded, a few raised eyebrows and serious concerns about costs.
Aarron Reinert, executive director for Lakes Region (Minn.) EMS, started the session with a history of how the KKK became the purchasing standard for more than 40 states. “It was never intended to be a state standard,” he says. It began in the 1970s when agencies using block grants to purchase ambulances were required to use the KKK as the minimum standard for safety specifications. As one of the very few standards available, it was ultimately adopted by the majority of state governments.
The federal government’s General Services Administration (GSA) announced in 2008 that it would no longer maintain the KKK. AMR Senior Vice President Professional Services and Integration, Ron Thackery, says there won’t be a KKK any longer. A new set of guidelines for ambulance specifications was needed. The GSA turned to the National Fire Protection Association because of the organization’s history of developing what are called “consensus” specifications—meaning, specifications that serve as the industry standard, allowing the federal government to adopt them wholesale without having to create their own.
Reinert admits that the selection of the NFPA raised concerns among non-fire-based ambulance providers, who worry that future ambulances would all be red and come equipped with a water tank. But, he notes that the AAA Technical Committee is represented by a variety of interests, including manufacturers, providers and regulators. Members from the National Institute for Occupational Safety and Health, labor, research and testing have a place at the table.
The Technical Committee first met in June 2009. With the standards set on a fast-track process, there was little time to bring in new ideas or innovative concepts. Instead, Reinert says, the committee chose to “grab low-hanging fruit” and set about revising sections of the KKK and translate it into NFPA language. The committee painstakingly reviewed the 100-plus page document line by line for what to keep and cut.
In June, a draft of the document was available for public comment. The committee met again in October to review the comments and revise the draft. “The committee goes through each and every comment,” Reinert says of the tedious process.
The work will be republished, and those who commented will have until February to respond to the changes. Responses are limited to the original comment only. Individuals will have an opportunity to comment on the draft, but the NFPA does not recognize comments from organizations.The Technical Committee will then make any changes, vote on the final product and send it to the NFPA membership for its approval. The goal is to publish the final standards in June 2013. At that time, the GSA will remove the KKK from its website. “There is still a lack of clarity around what state regulatory bodies will do,” Reinert says. States can choose to adopt the NFPA 1917 or revise the KKK on their own. Connecticut and Vermont are already creating their own standards.
Vehicles ordered before January 2013 won’t be required to meet the NFPA 1917 standards. However, some manufacturers are seeing vehicle bids specifying the new regulations. “This is still a moving target,” says American Emergency Vehicles President and Chief Executive Officer Mark S. Van Arnam. “They’re jumping the gun. It’s not doable.”
Thackery adds, “typically, with NFPA, you go through five years of that standard then you review it again.” In this case, however, as soon as it’s published, the NFPA 1917 will go directly to revision in order to allow for additional deliberation and input from researchers. Committee members say that NIOSH testing on specific types of restraint systems and how stretchers affix to hardware will be included in the revision.
What Will Change?
Among the hundreds of items in the document, the committee members shared a few that they believe will most dramatically affect ambulance specifications, including:
• Establishment of a 171-lb load capacity per seated position;
• A required seatbelt monitoring system that will provide an auditory and visual alarm in the cab and the patient compartment when someone is seated but not wearing a safety belt;
• A tire pressure monitor requirement;
• A designated seating position for the primary healthcare provider;
• A new zone and underbody lighting requirement that replaces the KKK lighting package;
• A maximum speed of 77 mph, as regulated by a governor device or speed limiter
• A mandatory color palette of red, fluorescent green or yellow for all Chevrons;
• Interior cab marking with maximum weight ratings;
• Carbon monoxide detectors for all gas-powered vehicles;
• The addition of grab rails at every point of ingress;
• A “do not move” light in the cab of the vehicle that lets the driver know a door or stowage rack is open or a particular device isn’t deployed;
• Back-up alarms that cannot be disabled; and
• Approval for the use of easily removable hub caps to view lug nuts during rig checks.
Mark Postma, chief operating officer for Sunstar Paramedics, in Largo, Fla., says a major concern is that many of the safety requirements originated on fire trucks. “The technology may exist, but not for ambulances,” he says. One such example is the seatbelt monitoring system. Rudimentary systems that would work for ambulances are available, but it’s unclear if off-the-shelf solutions will be in place in time for the new standards.
Potential for Liability
Although NFPA 1917 is voluntary, a certification of compliance requirement would help enforce the standards. It states that the manufacturer built the ambulance to NFPA 1917 standards. If the company or agency purchasing the vehicle chooses not to abide by one or more of the specifications, then it will be required by law to sign documents that it was the company’s decision, shifting the burn of compliance from the manufacturers to the purchaser.
“The potential for liability is huge,” says Van Arnam. If an accident occurs, it would be difficult to explain to a jury why the company or agency chose not to comply with industry standards.
Also, a very controversial product was not included in the document. Although the decision was far from unanimous, the committee decided not to require a vehicle data recorder, commonly referred to as a black box, on ambulances. Committee members expect to see the topic again during the revision.
The burning question is, “What will this add to the cost of a new ambulance?” Because the standards require products that don’t yet exist or haven’t been tried on ambulances, the answer is far from clear. According to Van Arnam, “it’s not going to be good news.” The majority of the changes—and resulting cost—will be on the converter side of the building process. Additional costs will include compliance procedures for new testing and credentialing regulations. If Van Arnam had to take a stab at it, he would estimate that the average conversion cost for a Type 2 or medium-duty ambulance would be between $8,000 & $12,000 per vehicle. Potsma says the committee members believe the new standards will be passed but they aren’t sure what else is in store for the future. “It’s very complicated what’s going to happen next,” he says.