I challenge you to finish reading this column, and then turn to your computer, go to Google’s search engine, click on the tab at the top that says, “News” and do a search using the terms “ambulance accident” or “ambulance crash.” You will find the latest news stories involving ambulance accidents.
My search gave me headlines such as “3 in hospital following Waterford ambulance crash,” “Accident sends 1 to hospital,” “EMT charged in deadly ambulance wreck that killed co-worker,” “Ambulance rolls with patient inside” and “Woman believes mother died as a result of ambulance crash.” There were more headlines, but you get the point. The sad part of my Google search was that all those news stories I listed, and more, were posted on newspaper or TV websites within the last day of my search. They did not go back months or even years.
What are we doing as a profession to protect those who work in ambulances and those who are transported in ambulances? Up to just a few years ago, we did nothing. We sat on our hands. Until now.
What the standard means
National Fire Protection Association (NFPA) 1917, Standard for Automotive Ambulances, 2013 edition, was released in late September. According to the NFPA 1917 Document Scope, the new standard “defines the requirements for new automotive ambulances designed to be used under emergency conditions to provide medical treatment and transportation of sick or injured people to appropriate medical facilities,” but “does not cover vehicles used solely to transport emergency medical care personnel that do not have patient transport capability, aircraft or watercraft used for patient transport under emergency conditions or mobile patient care vehicles that do not provide patient transport under emergency conditions.”
What does this development mean for the fire service and for fire-based EMS? This column describes the process that led to the release of this important standard.
Do a little research and you will find safety standards for almost all transportation, including automobiles, trucking, airline and maritime. But none exists for EMS transport. Except for military vehicles, nearly all ambulances in the United States are built using the General Services Administration (GSA) federal purchasing specification called Federal Standard KKK-A-1822F. Many states have adopted this purchasing specification for how ambulances should be built and designed in order to be licensed to operate. Unfortunately, the Federal Standard KKK-A-1822F is nothing but a purchasing specification. Nothing in the specification deals with ambulance safety or design and the standard is soon set to expire.
A few years ago, the EMS Section and the Safety, Health & Survival Section of the International Association of Fire Chiefs (IAFC) sat down together at Fire-Rescue International in Denver, CO, to talk about ambulance safety, design and the number of people being hurt and killed in ambulance crashes. Even though both sections of the IAFC are fire-oriented, the discussion did not center on just protecting those who work on ambulances from fire departments, but focused on protecting all who ride in ambulances. It did not matter what patches they wore on their shoulders. They could come from third-service ambulances, private ambulance companies or hospital-based ambulances. It did not matter.
As a result of this meeting, the decision was made to petition the NFPA), which has an excellent process for developing consensus standards for many issues that impact emergency services, to form a technical committee for ambulance design.
The NFPA accepted the petition and formed a technical committee called NFPA 1917, inviting many from across the profession to become involved. This included those from fire organizations, national EMS organizations and manufacturers of ambulances. Interestingly, only seven of the 41 principals and alternates who served on the technical committee came from the fire service. So the vast majority of people on the technical committee were not from the fire service, as some would think.
David Fischler, a retired fire commissioner from the Suffolk County, NY, Department of Fire Rescue and Emergency Services, was named committee chair for NFPA 1917. Fischler brought more than 30 years of experience to the process and it was his job to keep the group focused on developing standards for the construction and operation of ambulances.
The NFPA 1917 Technical Committee met numerous times over a two-year period and there were two rigorous public comment periods on the draft standard where many weighed in with comments. The NFPA 1917 process was very inclusive and involved many more non-fire participants than fire participants. The NFPA’s standard-development consensus is a proven process; there were two thorough and open comment periods when comments received from the public were taken into consideration; and finally the standard went through a proven adoption process. Despite all that, there are some who oppose NFPA 1917 – even though there is no other standard to protect those who ride in or operate ambulances.
What do opponents want?
There is belief that those opposed to NFPA 1917 are against it because the word “fire” is attached to the development due to the NFPA process and the genesis of the standard was started by the IAFC. Others do not think it is a good process because those who sat on the committee did not use science to develop the standard, while still others cannot give a reason; they are just against it because there are specific areas of the standard they do not like; so they choose to be against the entire NFPA 1917 standard. While the standard’s opponents cannot make any changes now, NFPA 1917 will be open for review in two years, as with any NFPA standard.
In late September, the National Association of State EMS Officials met in Boise, ID, and ambulance safety, standards and design were on the agenda, since all states regulate ambulance design and licensing. The attendees heard presentations on NFPA 1917. The Federal Standard KKK-A-1822F is going to “sunset” and states are trying to figure out what to do with their laws, including adopting the NFPA standard or some part of it.
Whatever comes of NFPA 1917, hopefully those who are against it will work through all the issues with those who endorse it and finally we can have a standard to protect everyone who works or rides in an ambulance and all of our people can go home safe at the end of their shift. n