After receiving more than 1,000 public comments on its draft ambulance standard, a National Fire Protection Association (NFPA) committee is considering some changes based on technology, economics and plain-old common sense.
Committee liaison Larry Stewart, an NFPA fire service specialist, said the committee received 1,785 public comments, and hundreds were identical. In the end, he said, the committee considered 1,195 distinct public comments covering many different aspects of the draft standard, but five issues stood out: vehicle data recorders (VDRs), vehicle governors for a maximum speed limit, seatbelt monitors for all passengers, tire pressure monitors and weight calculations for patient payload.
Committee members met in February to discuss the public comments for what is destined to become the NFPA 1917 Standard for Automotive Ambulances, and they will vote on proposed changes this month. Results of the balloting are due in May, and acting committee chair Jim Juneau, a Texas public safety liability attorney, predicted it’s unlikely the requirements for vehicle data recorders and seatbelt monitors will make it to the final version. He said that’s because ambulance manufacturers don’t yet have the precise technology to comply.
“It’s pointless to have a minimum standard that requires you to incorporate a vehicle technology that doesn’t exist,” Juneau said. “You end up with a situation that if you require a seatbelt monitor or a vehicle data recorder, then we are putting the manufacturer of the ambulance to the task of modifying the seats or the restraint system, which already have [federal] testing requirements. That means once you modify them, you have to re-test them, which gets very expensive.”
Stewart said a proposed governor to limit the maximum speed of ambulances to 60 mph is under review after comments from rural fire departments and emergency medical service representatives. “Rural ambulances are required to travel at highway speeds,” he said, “and the speed limits are already at 75, so they wouldn’t be keeping up with regular traffic.”
As for the vehicle weight issue, Stewart said the draft standard accounts for a 200-pound patient payload, but several people who submitted proposals asked for that to be reduced, “so the vehicle could hold more equipment or have a larger capacity to carry more items.”
One requirement that probably will not change is a tire pressure monitoring system. Both Juneau and Stewart said many people misinterpreted the requirement to mean the system needs to be electronic, when inexpensive plastic monitors that fit over valve stems would be sufficient. Stewart said the wording for the tire pressure monitoring requirement will be changed to remove any doubt about what’s needed.
He said there are some in the fire service who fear the NFPA standard will put an unreasonable financial burden on fire departments that plan to buy new ambulances in the next few years. But he pointed out that the NFPA standard is not all that different from the old government-sponsored KKK-A-1822 specification and that manufacturers have been following for years.
“I think what will finally come out as an NFPA document will look a lot like triple-K is now,” Stewart said. Federal officials have said the KKK-A-1822 spec will be retired once the NFPA standard takes effect.
Although the draft NFPA 1917 standard doesn’t stray far from the KKK-A-1822 specification, Juneau said it definitely will be modified and strengthened a few years down the road. He said the committee voted to go immediately back into revision mode once the draft of 1917 is finalized, so it can build on what it started. He said the National Institute for Occupational Safety and Health (NIOSH) is already coming up with new ambulance crash data to work into future versions of the standard. The normal NFPA revision cycle is five years.
Meanwhile, there are small differences between the new NFPA standard, KKK-A-1822 and AMD that fire departments will notice.
“For example, we’ve added a requirement on reflective striping, because everyone knows [visibility] is an issue,” Juneau said. “We believe for a matter of safety, it’s not particularly expensive or technologically demanding to put a reflective stripe on the side of an emergency vehicle.”
He also described how the standard introduces minimum gravitational-force protection for equipment that’s mounted in the back of an ambulance, for example, cardiac monitors. “We dealt with the issue of how strong does that bracket need to be and how strong does that mount need to be in order to withstand the kind of forces expected in a moderate crash,” he said.
The current draft calls for 10 Gs of force, which is the standard in European ambulances. But depending on what the NIOSH data shows, Juneau said that number could go up in future versions of NFPA 1917.
“I’ll tell you right now that 10 Gs is not enough. You can exert 10 Gs on a monitor jerking it around with your hands,” he said. “The number is probably more like 50 or 60 Gs, but we don’t have that data for certain yet, and we are committed to tie changes to real data.”
The public will be able to comment on the new changes to the NFPA 1917 draft standard starting in June. The committee will meet again in September to discuss the new comments and work them into the draft version.
Stewart said the final NFPA ambulance standard is scheduled to be released in June 2012 and go into effect in January 2013.