Safer New World

The recent focus on safety in the ambulance transport environment comes to a bit of fruition next year with the publication of the National Fire Protection Association’s NFPA 1917: Standard for Automotive Ambulances. That won’t have any force of federal law (though it could be enforced in states), but as a voluntary standard to which safe and responsible organizations can adhere, it will change the ambulance-transport game considerably. Here representatives of three top manufacturers talk about the current economic environment, purchasing trends, what they’re doing for safety, and the potential impact of 1917.

NFPA 1917: Raising the Bar for Everybody

Dave Cole is vice president of sales and marketing for Iowa-based Life Line Emergency Vehicles, as well as a member of the committee developing the forthcoming NFPA 1917: Standard for Automotive Ambulances.

Where does the 1917 document stand today?

The committee will be meeting in October to review comments that have come back from the proposal [version of the standard] released in 2010. The final comment period ended at the end of August. We’ll review those comments and hope to have the document published around May of 2012 for implementation in January 2013.

What kinds of reaction to the proposed 1917 have you gotten as you talk to people in the industry?

I think feelings have been mixed. For the NFPA, what this process involved was incorporating its 1901 Standard for Automotive Fire Apparatus, as well as the KKK-A-1822 federal procurement specs, and the 25 AMD standards within that, into a document that is now called NFPA 1917. That document combines a bunch of things that certainly were important to the fire service, but maybe aren’t as practical to the EMS side of things. There are components that will raise the test standards and some of the requirements ambulance manufacturers have to build to, and those will be passed down as additional costs to users.

There’s a substantial difference in testing. The previous testing included static loads; the proposed new standard includes more dynamic crash-style testing. That’s good, and the end user certainly benefits from it, but it’s very expensive. The costs are a concern to many people. Also, there are many different varieties of people providing ambulance services, and it will raise the bar for all of them. All ambulances will have to meet the same testing requirements—people doing standard nonemergent transfers, along with the people responding to emergency calls.

Do you find safety is more on buyers’ minds these days, or is it still a subordinate factor to cost?

It is definitely on their radar. Over the last five years or so, buyers in general are more concerned about safety than they’ve ever been. We see a good percentage looking for designs or changes in what they currently do—to better anchor a piece of equipment, or put it in a crash-stable bracket, or anchor their bag in a compartment, or design an ambulance where they can treat the patient while seated and wearing a seat belt. It’s tough to make change happen, but it’s certainly much more common and thought about than it was.

What other elements of 1917 will enhance safety?

There are some components I think will be part of the final document that won’t necessarily be required, but may be options or recommendations. One could be seat belt indicators that make sure people are seated before the vehicle moves. Those were very much opposed in the comments and taken out as a requirement so people could still move about in the back of the ambulance when treating a patient. The black box devices are also probably going to be an option.

What’s your company doing in the realm of safety?

Life Line’s niche, if you will, is being able to provide value in terms of a change in design. Everybody does things their own way, but we were talking about things like dual switch panels almost eight years ago. So we feel like we helped bring about the idea of trying to stay seated and wear your seat belt in terms of the locations of particular switches, and in the concept of moving that standard action area over to the opposite side of the truck, and creating more of a work area that brings your equipment closer to you.

Even though it’s a very custom and customer-driven industry, there are many designs we’ve incorporated that have provided equipment at a closer reach, with a harness, with a seat forward facing, that still allows you to take care of patients and remain in a safely belted, seated position.

Concerns About Multiple Standards

Dale Leich is special-projects manager for Huntsville, AL-based manufacturer Excellance, Inc.

It’s been a rough couple of years for everyone in EMS; how has that affected the ambulance industry? Are people delaying purchases and trying to stretch more life out of their vehicles?

Since the recession started, we’ve seen many providers cut back or delay the purchase of new vehicles. Many organizations simply had their capital budgets for vehicles reduced or frozen until the economy improved. We have a large number of clients sending their current modular ambulances back to us for factory remounting where the chassis is replaced and the module refurbished. Vehicles are coming in to us with higher accumulated mileage, which means those organizations are doing all they can to extend their vehicles’ lives.

Among buyers, what kinds of trends are you seeing these days?

Safety is a renewed concern among some clients. We are seeing more demand for camera and event-recording systems, alternative seating arrangements in the module, rear chevron striping, and secure mounting systems for defibrillators, oxygen cylinders, litters, etc. On-board temperature-controlled cabinets for ALS bags and medications are popular and will probably be mandated by many state EMS regulators in the coming years as part of their licensing process. While many of these items have been around for some time, only a few clients really took the time to invest in them until the last few years.

It really depends on who’s doing the specifying and purchasing. While everyone “talks” safety as a primary concern, you can see by walking around at any of the trade shows that “traditional” designs are still in demand. Adding new safety items does increase costs, sometimes to the point of nearly doubling the cost of the base vehicle. While that may sound extreme, we do see clients specifying (and buying) their ultimate vehicle design, since they plan to keep it for a while.

What’s your company doing in the realm of safety?

We have always provided an all-aluminum welded body and also fabricate the patient compartment interior from aluminum, including aluminum cabinets welded to the body structure to remain secure in a crash. Crashes eventually happen in any organization, and we always seem to have a few in our plant where the chassis is destroyed but the modules can be refurbished and mounted onto a replacement chassis.

What kind of impact do you expect from NFPA 1917?

The pending standard seems to be a merger of existing ambulance standards with some fire apparatus items previously published. I know some expensive items have been removed due to the costs and feedback. Oddly, where there are structural standards for the ambulance ”body,” none of that exists for the fire apparatus “body” in NFPA standards—only the cab. There seems to be two diverse sets of thinking there.

While NFPA 1917 is expected to replace the current federal KKK standard, it may take years to become law in states that currently mandate KKK for their ambulances. So for several years we many actually see two separate ambulance standards in effect across the U.S., which may create design and licensing confusion, especially for providers that operate in multiple states and transfer vehicles between them.

Safety and Cost Still on Buyers’ Minds 

Alain Brunelle is president and general manager of Quebec-based Demers Ambulances.

It’s been a rough couple of years for everyone in EMS; how has that affected the ambulance industry? Are people delaying purchases and trying to stretch more life out of their vehicles?

It really depends on the region. In Canada we see people increasing the numbers of vehicles on the roads to provide better service. In the U.S., our customers are trending at about the same pace as before, and we do have more customers in the U.S. than we used to have. So we don’t see the stretching yet for our type of product.

What kinds of trends are you seeing among buyers these days? What are people looking for?

Over the last 2–3 years, safety has become a greater topic of discussion. We’ve focused a lot on that; one example is our sliding seat that lets the paramedic remain seated and strapped in while performing his function and can also be turned forward.

The other main topic is reducing the costs of operation. We have the aerodynamic roof to improve fuel economy, and just this week we announced the EcoSmart system, which reduces idling time and the costs of fuel and maintenance.

What kind of impact do you expect from NFPA 1917?

For us, it won’t be a big impact, because the provinces of Quebec, Ontario and Alberta are already quite close [to it] in terms of their specification processes. Many of these things are things we already do in all our vehicles.The good thing is, it will standardize the process in the U.S. That will be better for the paramedic, because all the vehicles we put on the road will all be the same.

What Manufacturers Are Doing for Safety

Ambulance manufacturers report a much greater buyer interest in safety features in recent years. Here’s some of what they’re doing to meet that demand.

• The ‘Triangle of Safety’—Road Rescue promotes safer seating in the patient compartment with its “Triangle of Safety” system. It’s scrapped the bench seat and instead uses three swiveling captain’s chairs linked to an LED display panel that warns the driver when chair occupants aren’t seated and buckled. The seats rotate and lock in multiple positions, allowing providers to render care or stay forward facing. The Triangle of Safety was named one of EMS World’s top innovations of 2009.

• Forward-facing—Miller Coach’s 2010 Mercedes Type II Sprinter featured three impact-stable safety seats in its compartment, each with a three-point harness. This let the provider in the forward side seat provide normal patient care from a forward-facing position. The two passenger side seats fold to accommodate a backboard or stretcher if a second patient is transported, and the attendant seat includes a built-in fold-away child carrier.

• Progressive Resistance—The Horton Occupant Protection System (HOPS), introduced last year, combines an array of air bags, multidensity cushioning and three-point restraints for those in the compartment. All squad bench and CPR seats have progressive-resistance head protection. Head strikes can be transmitted completely through traditional foam padding, “bottoming out” on the surface below, but Horton’s progressive resistance uses a laminated protective surface to dissipate energy and prevent the bottoming effect.

• Crash-tested—Citing estimates of 20 ambulance collisions a day in the U.S., American Emergency Vehicles promotes actual high-speed dynamic crash testing it conducted to demonstrate the safety of its product. While many companies perform static and simulator tests, AEV actually smashed up an ambulance, subjecting it to discrete 42-mph side-impact collisions—“the best way to validate the structural integrity and occupant-protection level of any vehicle during an actual collision.” See the results at www.aev.com.

• Eyes in the Back—Safety in the back of the box can only be enhanced by the driver’s knowing what’s going on back there. Life Line’s LifeGuard 850 system can accommodate four cameras in allowing simple real-time monitoring and one-touch control of electrical components from front or rear touchscreens.

• Better handling, mileage—For better handling on the road, Demers is known for an aerodynamic roof design available on all models. Testing has shown it can trim fuel costs by 14%, and on a Type II can reduce CO₂ emissions by up to 43 tons over a vehicle’s life.