to see firsthand how ambulances are manufactured abroad.
In this article, I share 10 key areas that can
enhance safety and improve the longevity of
your next ambulance. I also highlight construction methods that you’ll want to discuss with
your ambulance builder as you design your next
rig. Lastly, I compare EMS vehicle construction in the U.S. and Europe. I encourage you
to use these focus areas as discussion points to
improve ambulance safety at your department.
When it comes to ambulance construction,
the ambulance industry has had little national
oversight and few safety standards during the
past 40 years. The patient compartment, or
“box,” isn’t subject to standard automotive
safety regulations and has minimal structural
crash safety features.
The Federal KKK-A-1822F (KKK) standard, originally written for the purchase of
federal ambulances, was the industry’s only
standard and has seen many revisions. 1
Although there are general references to ambulance construction, safety wasn’t the basis for
this document. The KKK standard has since
been replaced by two new standards: the
Commission on Accreditation of Ambulance
Services (CAAS) Ground Vehicle Standard
(GVS) v1.0 and the National Fire Protection
Agency (NFPA) 1917.2, 3
The objective of both new standards is to
improve safety through new design guidelines,
performance standards and testing requirements. Important items addressed in the standards include: occupant seating and restraint,
seat belt warning systems, cot and equipment
retention, tire pressure monitoring, carbon
monoxide monitoring, payload requirements
and static and dynamic patient compartment
Your first steps toward building a safer
ambulance are to read and adopt the new
safety standards. This may seem simple, but
some consumers don’t follow safety standards. Why? Because “change wouldn’t be
popular,” or because of “our history and tradition,” or because “that’s the way we’ve always
done things.” The new standards are based on
sound research, data and safety testing. These
guidelines are a collaborative effort to improve
ambulance safety. Educate yourself on the new
standards and adopt their recommendations
into your ambulance design.
It’s important to note that the new ground
vehicle standards now encompass remounts.
Remounted boxes will be required to incorpo-
rate important safety aspects, such as stretcher
mounts. For more on remounts, see “Rethink-
ing remounts: Developing a national standard
for ambulance remounts,” by Laura Aguirre,
in the August issue.
Put a lot of extra time, effort and thought into
your design up front. Carefully design your
ambulance on paper, keeping crew comfort
and safety as top priorities. Develop a detailed
set of drawings and specifications that lay out
the plan. A committee made up of EMTs and
paramedics who will use the vehicle regularly
should ensure the design is functional, user-friendly and safe. A thoughtful, well-planned
design will avoid costly construction mistakes
that stay around for the life of vehicle.
The patient compartment should be laid
out in exact detail. Seat location should allow
for easy access to the patient, equipment and
vehicle controls without providers having to
constantly remove the seat belt. Kneeling in
the aisle to start an IV because the seat was
installed in a bad location is the result of poor
design specifications and may lead to injury.
All heavy equipment (e.g., monitors, oxygen
cylinders, mechanical CPR devices, computers, medical kits, etc.) should be restrained or
kept in a secure cabinet.
NFPA 1917 recommends that all equipment weighing more than three pounds be
mounted in a bracket that can withstand up
to 10 Gs of force. 3 An unrestrained cardiac
monitor can become a deadly missile during
a quick deceleration or an abrupt lane change.
If you’ve seen pictures of the patient compartment after a rollover, you wonder how anyone
could survive being tossed around in a metal
box with heavy objects flying around.
Take your time in the design phase. Do
your homework and have your selected manufacturer develop a solid set of drawings and
specifications. Gather a lot of input and carefully review the drawings and specifications
with your ambulance manufacturer before
Some manufacturers build ambulance boxes with
rounded corners, using extrusions to connect the walls
and the roof. Photo courtesy Wayne Zygowicz
A thoughtful, well-planned design will avoid costly construction and design mistakes that stay around for the
life of vehicle. Photo courtesy Wayne Zygowicz