Ambulance accidents causing serious injuries and fatalities are too common. Recent data from the National Highway Traffic Safety Administration shows alarming trends—more than one third of accidents involving an ambulance lead to either injury or death for at least one ambulance occupant.
In the 1970s, the U.S. General Services Administration (GSA) published KKK-A-1822 (the KKK specification), the purchasing specification for federal ambulances and the de facto ambulance standard for the country.
While the KKK specification has been revised over the past four decades and extended routinely by GSA, the number of patients and EMS personnel killed and injured in ambulance crashes continued to rise. In 2009, in response to alarming number of deaths and injuries, the IAFC worked with the National Fire Protection Association (NFPA) to begin developing a standard for a safer ambulance. NFPA 1917, Standard for Automotive Ambulances, vastly improves ambulance safety and crash survivability for occupants.
The NFPA 1917 Technical Committee represents an enormously diverse body, with representatives from EMS practitioners, ambulance manufacturers, state EMS officials, vehicle engineers and others. Over the course of three years, this group produced and unanimously approved the first consensus-driven standard on safer ambulances in August 2012. The NFPA adhered to the rigid requirements of the American National Standards Institute (ANSI) in the committee's makeup and in the standard-setting processes.
NFPA 1917 immediately went back into a revision cycle after being released due to the promise of new vehicle-safety data from the National Institute for Standards and Technology and the National Institute of Occupational Safety and Health. Research by the Society of Automotive Engineers and the American Society for Testing and Materials was also incorporated into the standard. This data and input from more than 500 public comments were used to develop the second edition of NFPA 1917, which will be released in 2015.
Much like any other standard, NFPA 1917 hasn't been without controversy. In 2012, the National Association of State EMS Officials (NASEMSO) expressed a desire for greater participation in the NFPA 1917 process. This resulted in two meetings sponsored by NASEMSO to get a better orientation to NFPA's standard-setting process and the details of the NFPA 1917 standard. Both the IAFC and the NFPA participated in these meetings.
In response to NASEMSO's interest, the NFPA established a task group, consisting of individuals recommended by NASEMSO. This group met for two days in January 2013 to review the NFPA 1917 standard in detail. The task group created a long list of public comments that were submitted to the NFPA. Most comments were accepted and will be incorporated in the second edition.
Rival CAAS Standard Development
In March 2014, the Commission on the Accreditation of Ambulance Services (CAAS) convened a group to create a new ground ambulance standard on the belief that NFPA 1917 wasn't developed on a consensus basis. The IAFC and the National Volunteer Fire Council were the only fire service organizations invited to the first meeting. CAAS didn't respond to an offer of assistance from the NFPA.
Following an analysis of CAAS's goals, the IAFC withdrew from the process primarily because this group lacked experts in vehicle design and safety and would be unlikely to produce a standard that provides the same level of safety for ambulance occupants as NFPA 1917.
Issues and Concerns
Unlike the NFPA, CAAS is not accredited by ANSI as a standard-setting organization; the IAFC feared this group would not be familiar enough with ANSI's policies to ensure its standard and standard-setting process would meet the requirements for receiving ANSI approval.
Furthermore, the IAFC was concerned that CAAS's goal of creating a standard by January 2015 would be too fast to yield a quality standard when compared to the five-year commitment made by the NFPA 1917 Technical Committee. Ultimately, the IAFC felt that a rushed process, led by a panel lacking in professional diversity, would result in duplicated efforts, a weaker standard and confusion for fire and EMS leaders.
Prior to, during and after the CAAS meeting, the IAFC and NFPA made numerous offers to help CAAS in redirecting their focus to compiling a list of public comments and submitting them to the NFPA 1917 Technical Committee. The IAFC and NFPA received no response to these offers of assistance.
IAFC Support for NFPA 1917
The IAFC believes that NFPA 1917 is a superior standard to what can be developed by CAAS by the schedule completion date of January 2015. NFPA 1917 has benefited from years of extensive research and development with broad representation of all parties interested in ambulance design, production and safety.
The IAFC eagerly awaits the release of the second edition of NFPA 1917 in mid-2015 and will encourage the GSA to adopt NFPA 1917 when the KKK specification is sunset that same year.
Ultimately, when EMS personnel board an ambulance, they deserve to arrive to their destination safe. When a patient enters an ambulance, we owe it to them to keep them safe. The ultimate purpose of an ambulance standard is to ensure this focus is never lost or compromised.