Safety in the New Ambulance Standard, Part 2

By Robert Tutterow

The new National Fire Protection Association standard, NFPA 1917, Standard for Automotive Ambulances, was finalized last summer. It is now in effect and applies to all ambulances contracted on or after January 1. This is the first time the NFPA has issued a standard for ambulances.

In last month’s column, I covered the general safety requirements and the chassis safety requirements. This column will cover the other safety aspects of the standard with primary emphasis on the patient compartment.

Patient Safety

Chapter 6 covers the patient compartment. A couple of the minimum space requirements are 275 cubic feet (less cabinets) and a minimum of 10 inches between the cot and the loading door. There are minimum structural strength requirements for the roof and body, depending on the ambulance type. Sealing requirements are stated for water penetration and exhaust gas penetration. Any window between the cab and patient compartment must be constructed of shatterproof glass. Handrails for both the interior and the exterior have minimum size and performance requirements. All door handles and hardware cannot protrude into the access areas, and all doors and door openings must be free of anything that will snag clothing. And, the doors must have hardware that prevents inadvertent opening.

The access doors must have an internal lock and must be keyed identically. All doors must have a 250-square-inch (minimum) window made of safety glass. There must be a minimum of two means of exit egress, and each egress must be at least two feet by two feet. All exterior and interior steps must meet a minimum slip resistance test. All doors wider than 14 inches must have a means to hold them open and still be able to close with one hand. If a compartment is larger than four cubic feet, it must have an interior light that is automatically activated when the compartment door is opened.

To maximize infection control, any type of material that might be absorbent in nature and difficult to decontaminate cannot be used. The floor must be flat with no “encumbrances” except for the cot retention hardware. Also, the floor must be seamless and impermeable.

To eliminate flying objects in the event of a crash, all tools, medical equipment and devices, and so on must be stored in an enclosed compartment or secured when the vehicle is in motion. Equipment that weighs three pounds or more must be secured in a manner to withstand 10 Gs of force in any direction. The patient care attendant seats must be anchored to pass a dynamic crash test. Self-contained breathing apparatus (SCBA) holders are prohibited in these seats.

The seating and seat belt requirements are a direct reflection of those found in NFPA 1901, Standard for Automotive Fire Apparatus. There are “spacing” requirements for the patient care attendant seats. There is also a requirement for a seat belt warning system, though it is not as specific as the one in NFPA 1901. The cot retention system must withstand 2,200 pounds in any direction.

Other Considerations

There are minimum requirements for the heating and air-conditioning system. There is also a minimum noise level inside the patient compartment of 80 decibels.

There are minimum requirements for the on-board oxygen system. The main oxygen cylinder must be interchangeable from the exterior of the ambulance. And, the oxygen tank holder must be capable of holding 25 times the weight of the cylinder when it is full. There are also minimum requirements for the design and performance of the oxygen system. Any permanently mounted suction unit must be vented to the outside.

It is important to note that this standard is scheduled to be revised in three years rather than the normal five years. This is due in part to strengthening the requirements of the patient compartment. The National Institute for Occupational Safety and Health (NIOSH) is currently doing extensive testing on patient safety and patient care provider safety inside ambulances. Its work was not completed in time to be considered for the initial release of the standard.

The optical and audible warning devices exceed those of NFPA 1901 such as light color and flash rates. As with NFPA 1901, there are measurements for the four quadrants and the upper and lower levels of the ambulance. The retroreflective requirements for the front and rear are the same as those found in NFPA 1901. Also, the chevron requirements for the retroreflectivity are the same as in NFPA 1901. Also included are provisions for blocking the right-of-way and asking for the right-of-way.

The annex of the standard contains a wealth of information that explains many of the requirements.

ROBERT TUTTEROW retired as safety coordinator for the Charlotte (NC) Fire Department and is a member of the Fire Apparatus & Emergency Equipment editorial advisory board. His 34-year career includes 10 as a volunteer. He has been very active in the National Fire Protection Association through service on the Fire Service Section Executive Board and technical committees involved with safety, apparatus, and personal protective equipment. He is a founding member and president of the Fire Industry Equipment Research Organization (F.I.E.R.O.).

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