I recently saw a press release about a new ambulance the U.S. Army purchased for the treatment and transport of wounded soldiers from the battlefield. The mine resistant, ambush protected, heavy armored ground ambulance (HAGA) is like nothing I’ve ever seen.
The HAGAs, which will be deployed to Iraq and Afghanistan, are designed to protect the crew and patient from improvised explosive devices and rocket grenade attacks. They have a specialized interior compartment design that allows four ambulatory patients or two stretcher patients to be transported side by side. They also have on-board oxygen, military-grade medical equipment and power for other medical equipment.
A similar attempt—although dramatically different in design—is being made in the civilian sector to protect crews from “rockets” in the form of cars and trucks that hit ambulances head-on, at intersections and on our nation’s highways. Since the 1970s, the federal government specifications (KKK-A-1822) have been widely used by many ambulance services and state governments when designing, building and licensing ambulances. These federal specifications were intended to standardize purchasing. They weren’t developed with a primary focus on safety.
For the past several years, a committee of EMS professionals, ambulance manufacturers and others have been working on ambulance specifications that may become the industry standard. The organization heading the change is the National Fire Protection Association (NFPA), and the committee is developing the NFPA 1917 standard for automotive ambulances.
Initially, some critics said the NFPA was heading the writing and designing of specifications so the fire service could take control of the process. Not true. The NFPA has a long track record and a proven method for developing standards for manufacturing fire and EMS-related equipment and procedures that are widely used by many outside the fire service. Many of those standards take safety into consideration.
In the case of the ambulance specifications committee, the intent wasn’t to write specifications for just fire department ambulances, but for all ambulances, regardless of the operator. To accomplish this process, committee members were selected from diverse backgrounds within the EMS profession, including private services, third-service agencies and fire departments.
It’s also important to note that any ambulance specifications the NFPA 1917 committee develops will be consensus standards. Nothing will mandate the use of these standards unless the federal or a state government decides to adopt them and turn them into law. It’s important to point out, however, that in lawsuits, the courts consider consensus standards when determining fault.
In late 2010, the NFPA released the 83-page draft document that contained the ambulance specifications. As part of the process, the NFPA had an open comment period during which anyone could provide comments. This process closed Dec. 15, and the comments are being reviewed before the document is finalized and released in 2013.
The new document has some changes to ambulance specifications that, if adopted, will increase the cost of ambulances in the future. The changes primarily come in the form of required equipment, testing and documentation that we didn’t have in the past.
One potential change would be the requirement for a “black box,” or data recorder that traces such things as speed, the use of sirens, headlights or emergency lighting, where providers were seated and whether they had their seatbelt on. Black boxes have been used for years in airplanes and were recently incorporated into some of the other NFPA standards for fire apparatus.
One standard in the document puzzled me, and to date, I haven’t been able to get a clear explanation. The standard would limit the top speed of an ambulance to 72 mph. Why 72 and not 75 or 71? We need some empirical evidence or a study that shows why ambulance speeds should be limited to 72 mph.
One intention of the 1917 standard is to enhance the safety of those who ride in ambulances, whether they’re a patient, a caregiver, the driver or a passenger.
A National Institute for Occupational Safety and Health analysis of data from 1991–2002 showed there were 300 fatal ambulance crashes during that time period. Of those 300 fatal crashes, 275 of those killed were pedestrians and occupants of other vehicles, and 82 deaths occurred in ambulances. Twenty-seven of these deaths involved EMS providers, of which 41% were drivers, 19% were in the right front seat and 26% were in the rear patient compartment.
It will be interesting to see what the final standard looks like. Will the committee lean more toward safety, or will it slant more toward savings on vehicle costs?
My preference is safety. JEMS
This article originally appeared in April 2011 JEMS as “NFPA Draft 1917: EMS rigs may change.”