By Richard Marinucci
There are many types and styles of ambulances available for purchase. I have been asked by policymakers and the public why the fire department buys a more expensive vehicle instead of the types of units used by other services. In my mind I want to ask them what kind of vehicle they drive and why they don’t select the cheaper model that others drive, but those questions will wait until I retire! I do need to have a logical reason for the choices that are made and be able to explain them to whoever may pose the questions. This preparation does not guarantee that others will be convinced the department makes the right decision but it does let others know that it performed research and that reasons exist for the selection.
National Fire Protection Association (NFPA) 1917, Standard for Automotive Ambulances, has yet to be published. In the meantime, two organizations provide guidance for specifying ambulances.
The United States General Services Administration has published specifications for ambulances that offer guidelines for anyone seeking to purchase this type of vehicle. In the document, a definition of an ambulance includes the following:
• It needs a driver’s compartment.
• It needs to have a patient compartment to accommodate a patient and provider, and the cot needs to be positioned so that care can be given.
• It needs equipment and supplies for treatment on the scene and during transport.
• It needs to provide for the safety, comfort, and avoidance of aggravation of the patient’s injury or illness.
• It needs emergency warning devices.
This broad definition allows manufacturers to develop many options for those purchasing an ambulance, and the entire document offers minimal standards. One way to look at this is to compare it to the options people have when purchasing an automobile. There are minimum standards that carmakers must meet for a vehicle to be legally operated on public roadways. Once the manufacturer meets these standards, there are many options it can add to the basic vehicle. These choices affect the price, safety, functionality, and comfort of the vehicle. This is also true for ambulances.
The Federal Specifications, also known as KKK, categorize types of ambulances-mostly based on the chassis, patient compartment, and gross vehicle weight rating (GVWR). Type I vehicles have a cab chassis with a modular ambulance body. Type II vehicles are long vans with an integral cab body. Type III ambulances are made with a van cutaway and modular body. Types I and III can have an additional duty (AD) designation if the GVWR is greater than 14,000 pounds.
Because there are choices, departments must consider various factors to determine the best vehicle to purchase. Fire departments have different needs because their service involves more than just patient treatment and transport. As a fire/rescue vehicle, it will have other uses that will help purchasers select the best apparatus for the jobs personnel will perform. These additional requirements often lead to the decision to purchase a vehicle that is more heavy duty.
First and foremost, determine the use of the unit you need. If it is solely a transporting vehicle dedicated to only EMS use, then you can consider the less expensive options. Even so, there might be a difference in needs depending on the level of EMS service your organization provides. Advanced life support services require more equipment and possibly different electrical requirements to charge and recharge equipment. Will the vehicle be expected to carry extrication equipment? If so, it will need space to carry it. Basically, the use of the vehicle will determine the compartment and patient area space requirements.
Equipment needs could affect the overall weight being carried, which impacts the total GVWR. Even though fire service members responsible for acquiring apparatus understand this, the inventory that is developed regarding use will be helpful when explaining to policymakers and financial people reasoning behind selecting specific vehicles.
It is a good idea to develop a long-term replacement schedule. Some may refer to this as part of capital improvement plans. Regardless, an established program that looks to the future is helpful in gaining support for specific purchases. Considering vehicles’ longevity definitely comes into the discussion when developing this schedule. Factors that affect longevity are anticipated mileage, whether or not the agency transports patients, cross uses, and expected run volume. Mileage is often the most significant factor. If this is the case, project the mileage likely to be covered in a year. It might be easier to take a typical day. If the unit is transporting a certain number of patients per day, the travel distance to and from the hospital emergency room can add significant wear and tear. Departments may also establish mileage limits-e.g., 100,000 miles-as the target for replacement. Though this could appear arbitrary, it does establish a baseline.
Reliability in the emergency service is critical. Obtaining vehicles that have proven track records of staying on the road is valuable. Hopefully these vehicles need less maintenance and do not break down at critical times. Manufacturers that offer a solid warranty and have a good reputation for taking care of issues that arise are very important. These are indicators that the company has confidence in its vehicles and will stand by its products. Even still, there will be times when things break. Access to parts and relatively easy repairs are important. In any case, the objective is to have a vehicle that is used, not in the shop.
There are ancillary issues to consider when searching for an ambulance. Some may not appear that critical at first but will be shortly after you have taken delivery. You need to consider patient comfort and the ride that people will receive when placed on a stretcher. Though you may be getting a truck, the smoothness of the ride should not be like a typical truck. Patients in the back must be made as comfortable as possible and should not feel every bump in the road. Research this aspect of the vehicles you are considering. This will turn out to be very important. Somewhat related is the noise element. This is for the entire vehicle-both the passenger compartment and for those riding up front. Purchasing vehicles that provide a quieter ride will be worth your effort.
There are also features of the vehicle that are applicable to personnel assigned to it. You may wish to add a camera in the back if it is likely that only one medic will be in the rear with the patient. This is a risk management issue and protects the medic from false claims. You must also account for the safety of firefighters. There must be a functional restraint system-one that firefighters are going to use-in the back. Although no one plans on accidents, they do happen. Take the added steps to offer protection.
Getting the Best Fit
Fire departments must obtain the vehicles that best fit their organizations. Various levels of expertise exist in the department on this topic. You must have personnel who know this side of the operation and become as much of an expert as possible. You must also know where to get help if you are not totally comfortable with your knowledge base. This will help you get the vehicle you need. The other part of the job is being able to explain why you need the type of vehicle you want. In these tough economic times, large purchases are scrutinized more. Proper preparation is necessary so you can defend your selection.
RICHARD MARINUCCI is chief of the Northville Township (MI) Fire Department. He retired as chief of the Farmington Hills (MI) Fire Department in 2008, a position he had held since 1984. He is a Fire Apparatus & Emergency Equipment editorial advisory board member, a past president of the International Association of Fire Chiefs (IAFC), and past chairman of the Commission on Chief Fire Officer Designation. In 1999, he served as acting chief operating officer of the U.S. Fire Administration for seven months. He has a master’s degree and three bachelor’s degrees in fire science and administration and has taught extensively.