The National Highway Traffic Safety Administration (NHTSA) estimates that annually there are 4,500 motor vehicle crashes involving ambulances, with nearly 35 percent resulting in a death or injury. Between 1992 and 2011, 25 percent of the fatalities in ambulance collisions were occupants of the ambulance itself, with the majority of those occurring while the vehicle was in emergency use. You see stories too often in the news or online of an ambulance being involved in a collision. By its physical characteristics, it often ends up on its side or completely overturned. So with one in four fatal incidents taking the life of someone in the ambulance, should we not as a group pay more attention? And pay attention to not only how we use the vehicle but also what it is that we are purchasing? Of course we should.
Over the past year, a group of ambulance industry stakeholders has been meeting to develop a new ambulance construction standard for vehicles built for use in the United States. The committee has representation from numerous EMS constituent groups, ambulance manufacturers, EMS administrators, and government agencies. This group, under the direction of the Commission for the Accreditation of Ambulance Services (CAAS), released a draft for public comment this past October. This draft document, known as the Ground Vehicle Standard (GVS), makes significant and long needed strides towards ensuring that ambulances are built with occupant safety as a primary focus. Per CAAS, the document was developed “to best serve patients by providing ground ambulances that are safe, nationally recognized, properly constructed, easily maintained, and when professionally staffed and provisioned, will function reliably in pre-hospital or other mobile emergency medical service.” As Mark Van Arnam, President of American Emergency Vehicles and GVS committee member stated in a conference this past February, “this is the biggest change in the ambulance industry since the Cadillac ambulance went away in the late 1970s.”
The GVS, officially referred to as the CAAS Ground Vehicle Standard – GVS 2015, represents to the industry what will hopefully be regarded and adopted as the replacement for the Federal General Services Administration (GSA) KKK “Star of Life” ambulance specification. The original GSA specification, version 1822-A, was released in 1976 and was originally intended to serve only as the purchasing specification for ambulances bought by the U.S. Government. During this time, any ambulance that was purchased with federally funded grants was required to use this specification as a procurement document. As a result, the GSA specification evolved unintentionally as the ambulance standard in the United States. There have been five revisions since the initial release, with 1822-F as the current and final rendition, to be retired on October 15, 2015. The Federal specification has served its purpose and it is past time to move on to a consensus standard that meets a broader spectrum of needs in EMS.
So what particular things are included within the GVS-2015 that will enhance the safety of both personnel and patients alike? First of all, the standard establishes that when delivered with all equipment options installed, the vehicle must have a minimum payload requirement of 1,300 pounds. For a vehicle to stop correctly and for the handling characteristics of the vehicle to perform to the engineered standards of the chassis, the module and its contents cannot exceed the intended weight the chassis was designed for. The 1,300-pound standard provides a sound margin to allow the necessary addition of bodies to perform the necessary work during a high acuity transport without overloading the braking and suspension systems. It may seem like a lot of weight, but when you start to total the patient, two or three responders, a firefighter or two, and maybe a family member, it will consume it quickly.
The new standard calls for all vehicles to meet NIOSH established SAE standards for patient compartment seating, litter fasteners and anchors, and equipment mounting and retention. These three required features alone would go to significant lengths to improve safety in the patient care areas of ambulances. While many manufacturers today install seating that is compliant with the various listed SAE standards, adoption of the GVS-2015 will make it a requirement. The biggest implication of these additions is likely to be in the area of the litter fasteners and anchors, SAE 3027. All too often in medium to high speed and rollover collisions, the cot is able to break free from the current mounting system, exposing both the patient and any attendants in the module to the potential for serious injury. The new standard represents a significant improvement over the common technology used today — technology that has been relatively unchanged for over 30 years. There is however going to be notable cost increase for compliance with this standard. Currently, available systems that are compliant with SAE 3027 average between $1000 and $4000 in additional cost over the legacy systems, while the power load compliant systems can represent a cost of $40,000 or more per vehicle, inclusive of the mounting system and the cot. On many of the ambulances produced today, this represents an increase of approximately 25 percent or more in the delivered price. But if you have ever had the opportunity to see an ambulance that experienced a fastener and/or anchor failure in a collision, it is but a small and clearly justifiable investment for the safety of the patient and providers.
While the GVS-2015 goes a long way towards improving the safety of those inside the ambulances, there are a number of areas that the current version does not address that hopefully will be looked at in future revisions. The first of those concerns is the one factor that is most commonly a factor in ambulance collisions — speed. The committee noted within the specification that the vehicle must be “capable of a sustained speed of not less than 65 mph over dry, hard surfaced roads.” Nowhere within the document was a top speed limitation established. The standard states in explicit detail how fast it should be able to go, but does not limit the speed at which it can travel. The National Fire Protection Association (NFPA) clearly states within the 1901 standard the speed to which fire apparatus cannot exceed and such a standard should be incorporated into an ambulance standard that is focused on improving occupant safety.
Secondly, the standard does not provide any specific guidance in regards to conspicuity requirements. While there is no basis for a standard that should dictate everything in regards to the graphical package on an ambulance, there is research to support there being a fundamental standard in regards to conspicuity. The 2005 document “Emergency Vehicle Visibility and Conspicuity Study” by the United States Fire Administration cites a number of “opportunities” to enhance a driver’s ability to see and recognize emergency vehicles. The opportunities, such as contour markings outlining the edges of a vehicle with reflective material, the use of highly reflective materials low on vehicles to maximize the impact from other vehicle headlights, and incorporating reflective material into logos and emblems, should serve as a basis for establishing a minimum standard for ambulance conspicuity and visibility. Too many emergency vehicles continue to be hit from behind on roadways to not have some future consensus for safety.
It is the author’s hope that future revisions to the GVS-2015 also take into account the need to retrofit many of the safety features into remounted and refurbished ambulances. Remounted ambulances represent a noteworthy portion of the vehicles on the road today and if the industry is truly moving into a provider safety-focused environment, the standard will need expanding in application to include these vehicles as well.
So take a walk out in the apparatus bay. Look at the mechanism by which your cot is affixed to the floor of the module. Look around and see where portable equipment is or is not appropriately mounted. Have your vehicle weighed on certified scales and calculate exactly what the marginal payload capacity of it is. All of these factors directly impact your safety and these things should not be taken lightly. The GVS-2015 standard represents a significant leap forward for responder safety and will soon impact your safety as well.
Jonathan Olson is the chief of operations for Wake County Emergency Medical Services and assistant fire chief with the Wendell Fire Department. He is a graduate of the NFA Executive Fire Officer program, has over 25 years of experience in EMS and fire operations, and is a co-author of “Management of Ambulance Services” by NEMSMA.