ORLANDO – A lot is changing in the world of ambulance standards and EMS providers are facing confusing and conflicting information about what ambulances need and how they should be built.
Steve Rowland, Ferno-Washington’s OEM sales manager, lectured on the top of ambulance standards at the Fire Department Safety Officers Association annual symposium last week. In addition to his work with Ferno, he is actively involved with the National Fire Protection Association’s 1917 Ambulance Standard Committee and has served as the chairman of the Fire Apparatus Manufacturers Association’s Ambulance Technical sub-committee. He is also a repeat FDSOA apparatus symposium speaker.
“National ambulance standards fall into the same category as Big Foot and the Loch Ness Monster – there are no such things,” Rowland said to a room full of attentive learners.
Standards, even if they are voluntary and are not enforced provide some measure of making sure ambulances are safe and affordable, he said.
“I am sure everyone would like Titanium ambulances with radar on all four corners,” Rowland said. “But, no one want to spend $2 million for an ambulance.”
The closest thing EMS providers have had over the years is the U.S. General Services Administration (GSA) KKK A-1822 ambulance purchasing specifications, Rowland said, adding that even that document does not hold the power of an enforceable ambulance standard.
Complicating the issue even further is the announcement that GSA decided to sunset its purchasing standard in September. Rowland explained the federal government doesn’t want to be in the ambulance specification business any longer and is looking for a national recognized set of standards that meets its needs.
Rowland said GSA representatives asked NFPA officials if they were interested in developing ambulance standards.
“NFPA is already in the business of creating standards for fire apparatus, so NFPA said it was interested and started developing them,” Rowland said, noting that was the start of NFPA 1917. The first edition was created in 2013.
NFPA began creating standards in its usual process, including users, manufacturers, researchers, laboratory testing agencies, enforcing authorities, consumers and special experts, according to Rowland.
However, private ambulance providers were not keen on having NFPA develop standards that would also include their equipment, Rowland said. Complicating matters, the Ambulance Manufactures Division (AMD) of the National Truck Equipment Association wasn’t interested in providing test results and information to the NFPA, Rowland said.
“Reaction from the non-fire based EMS community was mixed,” Rowland said. “The privates were saying; ‘we’re not subject to NFPA, our states regulate ambulance certification.’ …Privates are saying; ‘you can’t tell us what to do Mr. Fireman and we’re going to do it ourselves.’”
Sensing the tension with the ambulance standards situation, Rowland said the Commission on Accreditation of Ambulance Services (CAAS), would develop a set of standards. CAAS started working on the standards in 2013 and in March 2014, developed a draft that has been available for public commenting into December 2014.
Consequently, there are now three competing standards available for those looking to purchase ambulances, Rowland said, and they are all advisory.
“There are no NFPA police, no CAAS police, no KKK police,” Rowland said.
Fortunately, there are some overlapping common themes and many of the differences are either minor or subjective, Rowland said.
Initially, private ambulance services were saying that to purchase ambulances that complied with NFPA standards would add $25,000 to the initial price tag on the cost of an ambulance, Rowland said, adding that the comments were nothing more than “propaganda.”
Rowland said NFPA initially included a chapter on testing which would be conducted by the manufacturer. That, he said was not necessarily a good idea because some of the smaller builders can’t do that kind of testing and there are some builders who are too eager to do their own testing and probably should not. He said it’s likely that standard will be revised to require third-party testing in future editions.
The KKK specification and the proposed CAAS standard both currently call for third-party testing, Rowland said.
Rowland outlined several differences between the three standards, indicating that the CAAS standard and the KKK specifications are most closely aligned.
NFPA includes some standards that are more restrictive than CAAS or KKK and Rowland said in many cases, that’s a good thing.
For example, when it comes to speed limits, NFPA standards say the vehicle speed is regulated by the tire ratings and speed limits. Other standards say 77 mph is the limit.
Rowland also pointed out that NFPA requires ambulances to be able to start and operate in a temperature range of 20 degrees below zero Fahrenheit to 110 degrees above. The CAAS standard and KKK specification both give a range of 0 degrees to 95 degrees Fahrenheit.
NFPA does not address stocking of equipment and supplies while CAAS and KKK provide worksheets to assist the purchaser with on-board equipment necessities.
Other difference is NFPA requires adjustable mirrors controlled from the driver’s position while CAAS and KKK require mirrors that are simply adjustable, according to Rowland, noting that without power mirrors, they’re seldom changed even though drivers may change from call to call and shift to shift.
“That means there will be people leaning forward and backwards just to see out of the mirrors,” Rowland said.
Perhaps one of the most important differences in the standards is the treatment of compartment door releases. Rowland said NFPA requires that all egress doors have a secondary emergency release mechanism in the event of a crash. CAAS recommends secondary releases and the KKK specification doesn’t address them at all Rowland said.
There are also differences in tire pressure monitoring, striping designs, cot loading heights, underbody lighting and a myriad of other details, Rowland said.
As time goes on, Rowland predicts there will be additional amendments, fine tuning and other adjustments to come up with standards that are acceptable to everyone.
“Regardless of the lack of national standards, each state must legislatively, or via other rule making, regulate ambulances,” Rowland said, adding that picking any of the standards or specifications would be a start.
“You may ask what can we do,” Rowland said. “Go out, and get involved. We’re all out there trying to make a difference.”
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Ed Ballam
Ed Ballam served as associate editor for Firehouse. He is the assistant chief of the Haverhill Corner, N.H. Fire Department, and a National Registered EMT. He is also a Deputy Forest Fire Warden for the New Hampshire Division of Forests and Lands. Professionally, he's been a journalist for over 35 years working for a variety of publications, including employment as managing editor of a national fire service trade journal for more than a decade.
