By Gary Morris

This past June, the National Fire Protection Association (NFPA) approved the release of its second edition of a ground ambulance vehicle standard known as NFPA 1917, Standard for Automotive Ambulances.

The standard is expected to substantially increase safety and survival of emergency medical services (EMS) personnel as well as the patients involved in ambulance crashes. Additionally, as a result of the standards-setting work by the NFPA, the National Institute for Occupational Safety and Health (NIOSH) and the National Institute of Standards and Technology (NIST) were able to secure funding to conduct crash testing and other safety-related research regarding ambulance vehicle safety and survivability that was inserted into the second edition.

Origin

Over the decade leading to the NFPA’s entry into an ambulance standard development, there had been considerable discussion about the safety of ambulance vehicles used by both private EMS transport companies and fire departments. Studies of crashes involving ambulances showed that the rate of injuries and fatalities was greater than what was experienced in crashes involving police vehicles. More disturbing, if an EMS professional was riding in the patient compartment at the time of a crash, he would be 2.7 times more likely to be killed than the occupants of the ambulance vehicle cab. Over a 10-year study period, 350 fatalities were reported along with 23,000 injuries (involving EMS personnel and patients).1 Media coverage often showed an ambulance with a patient compartment sheared off the vehicle frame or simply “exploded” during the collision. Little crash testing had occurred that would have led to improved vehicle safety.

In late 2008, with no other organization actively pursuing improvements in ambulance vehicle safety, the Safety, Health, and Survival Section of the International Association of Fire Chiefs (IAFC) stepped up to the plate, seeking a better safety standard for ambulance vehicle designs. The IAFC agreed and called on the NFPA to develop a performance standard for ambulance vehicles. The NFPA was selected for its international reputation and decades-long history at producing high-quality standards while strictly adhering to the American National Standards Institute (ANSI) standard development criteria. The NFPA also had decades of experience developing standards for fire apparatus as well as other EMS-related standards, which brought an elevated level of expertise to developing an ambulance standard.

Note that ANSI’s “essential requirements” document is internationally recognized as the premium guideline for developing standards. The key element in the document is due process, which ensures standards are developed in an environment that is equitable, accessible, and responsive to the requirements of various stakeholders. This ensures there is an equitable balance in stakeholder groups so that no one group can unfairly dominate an outcome.

For more than four decades, the EMS transport industry and fire departments have used the federal Government Services Administration (GSA) purchase specification, known as “KKK-A-1822 F,” as an ambulance design document. This specification became the “de facto” unofficial vehicle design “standard” for many EMS transport organizations. The problem was, little scientific research had been conducted to justify the specifications, and there was no crash-worthiness testing of the cab or patient compartment.

Early Meetings

The NFPA 1917 technical committee first met at NFPA headquarters in June 2009 to begin work on the first edition of the standard. In accordance with ANSI requirements, the 33 members of the committee represented a broad spectrum of EMS organizations in America.

Chris Mc Loone

The 2015 F.I.E.R.O. Station Design Symposium just wrapped and, as usual, the 21⁄2-day event brought together architects, end users, and consultants to provide information to those who are considering a brand new station or modifying a current one.

As I listened to architects and end users, certain themes kept repeating: be specific; be clear; and plan, plan, plan. It struck me how close specifying a station is to specifying a fire apparatus.

“Apparatus Purchasing” author Bill Adams often says that if it’s not in the specs, it doesn’t exist. And if you are not specific about where you want something, an apparatus builder will place it where it thinks it makes the most sense or where it fits, which is the same for an architect-if you’re not specific, the architect will do something the way he thinks it should be done. And, just like taking delivery of a fire truck, the ribbon cutting for the new station is not the time to discover a glaring error like a front apron that is too steep.

Enough cannot be said about the role a fire station plays in our health and safety. Cancer has understandably been receiving a lot of attention lately as firefighters continue to develop it at an alarming rate. In more than one session, a speaker would mention how we hear stories every day about firefighters who devote 30 years to their departments, retire, but pass away just a few years later because of job-related cancer. Just getting our PPE off the apparatus floor can reduce our chances of contracting certain cancers attributable to diesel exhaust exposure. But, don’t stop there. Getting as much of the exhaust out of the firehouse as possible is the next step. It’s very true that when you start an apparatus today, you don’t get the same black exhaust you used to. But, that doesn’t mean you shouldn’t look for ways to limit your exposure to anything that is coming out of that exhaust pipe.

Many people hear the words “station design” and might think about its physical appearance on the outside, the furniture, and fancy accoutrements. But, it goes beyond that. It’s about spec’ing out a facility that is practical, safe, built with expansion in mind, and that flows. Firefighters who have to make 14 turns to get from the bunk area to the apparatus floor are on duty at a station that does not feature response efficiency.

I had the opportunity to visit a newly constructed station recently. The advantages a new station brings are obvious: more space, modern amenities, ADA compliance, brand new furnishings, state-of-the-art technology, built-in training elements, and so on. There was plenty of parking, and the interior of the station was split logically between the career personnel for the fire department-fire administrator and fire marshal-and the volunteer fire company side. The station features training props on site, a modern radio room, its own compressor for refilling self-contained breathing apparatus cylinders, and a modern meeting room. The station is well-thought-out.

My station is a legacy station, built in 1927, with additions from the 1960s and 1970s. It stands on the location of the original station, a one-story, two-bay structure resembling a detached garage at someone’s house more than a fire station. The current station’s first addition is one story and features two bays. The second addition was built to the rear of the original building and first addition and is also one story. Having written the fire company’s history for our 100th anniversary in

By Alan M. Petrillo

The Mesa (AZ) Fire and Medical Department is having success with an emergency medical services (EMS) program that keeps low-acuity patients out of hospital emergency departments (EDs) and directs them to a more appropriate level of care for their particular situation through its Community Care Concept.

The Program

Tony Lo Giudice, Mesa’s program administrator, says the project is a result of a $12.5 million federal grant from the Centers for Medicare and Medicaid Services to test a model that offers comprehensive delivery systems to address the impact of chronic disease, falls prevention, self-management skills, and medication adherence. “The idea is to reduce high-risk patient returns post-discharge from hospitals and treat and divert low-acuity patients from the use of the 911 systems and the ED,” Lo Giudice says. “We had a perfect storm over a five-year period where overcrowding of the EDs was tying up a lot of our paramedics at the hospitals. Working with our fire department, we came up with the concept of pairing a paramedic with a physician’s assistant (PA) or nurse practitioner (NP) to streamline the process of getting the patient to the hospital.”

When the economy crashed in 2007, Lo Giudice says that Mesa went to a transitional response vehicle (TRV) program that staffed a vehicle with a firefighter paramedic and emergency medical technician (EMT) to handle basic life support medical services calls. “Low-urgency calls were coming into the 911 system-people with colds, the flu, and minor trauma-that we were sending to the hospital, which was an expensive way to treat them by sending a fire truck with four firefighters,” he says. “We wanted to make the system more efficient and improve the service to the patients, which bred the idea of our Community Care Concept.”

The Mesa (AZ) Fire and Medical Department runs five Community Care Unit (CCU) ambulances that are built on Dodge 4500 chassis with Medtech bodies and powered by Cummins 8.3-liter diesel engines. Two of the CCU ambulances are bariatric units. [Photos courtesy of the Mesa (AZ) Fire and Medical Department.]

The program takes a firefighter-paramedic and an NP or PA and puts them on a rig to handle low-acuity medical calls that come into the 911 system, which amounts to about 38 percent of Mesa’s low-acuity runs, Lo Giudice says. “We partnered with Mountain Vista Medical Center to provide the NP or PA to ride the truck.”

The Community Care Unit (CCU) ran on a 40-hour-per-week basis from the end of 2011, but Mesa identified another issue: Behavioral-related calls (suicides and mental health problems) were cropping up that the CCU was not equipped to handle. “We came up with the idea to pair a licensed mental health counselor with a firefighter-paramedic in a separate vehicle, a community care specialist (CCS) unit, to deal with those kinds of calls,” Lo Giudice says. “The patient got a basic medical evaluation by the paramedic and a mental health evaluation from the licensed counselor. Most of the time we were able to bypass the ED and go to a mental health facility or do safety reviews of patients at their homes.”

Read more 597 0 Article rating: No rating Posted: Nov 5, 2015 Update: PA Aerial Failure with Injury There was one injury after an outrigger reportedly failed during a certification for a ladder truck. The ladder struck one individual who was performing a certification test on the fire truck. Visit http://www.wpxi.com/news/news/local/1-person-taken-hospital-after-accident-fire-dept/npD54/ for more information Read more 0 0 Article rating: No rating RSS FirstPrevious4457445844594460446144624463446444654466NextLast Theme picker Section Quick Links   Fire Mechanics Documents EVT Discussion Forum Fire Mechanic Photo Gallery Training & Testing 2019 Scholarship Logo Wear Store Upcoming Events Theme picker Sponsors Fire Mechanics Section Board Chair Posted: Oct 21, 2015 Chair Elliot Courage North Whatcom Fire & Rescue Read more 0 0 Article rating: No rating Vice Chair Posted: Oct 21, 2015 Vice Chair Mike Smith  Pierce County Fire District #5 Read more 0 0 Article rating: No rating Secretary Posted: Oct 21, 2015 Secretary Greg Bach South Snohomish County Fire & Rescue Read more 0 0 Article rating: No rating Director #1 Posted: Oct 21, 2015 Director #1 Doug Jones South Kitsap Fire & Rescue Read more 0 0 Article rating: No rating Director #2 Posted: Oct 21, 2015 Director #2 Paul Spencer  Fire Fleet Maintenance LLC Read more 0 0 Article rating: No rating Director #3 Posted: Oct 21, 2015 Director #3 Jim Morris Mountain View Fire Department Read more 0 0 Article rating: No rating Director #4 Posted: Oct 21, 2015 Director #4 Arnie Kuchta Clark County Fire District 6 Read more 0 0 Article rating: No rating Director #6 Posted: Oct 21, 2015 Director #6 Brett Annear Kitsap County Fire District 18 Read more 0 0 Article rating: No rating Director #5 Posted: Oct 21, 2015 Director #5 Jay Jacks Camano Island Fire & Rescue Read more 0 0 Article rating: No rating Legislative Representative Posted: Oct 21, 2015 Legislative Representative TBD TBD Read more 3253 0 Article rating: No rating Immediate Past Chair Posted: Oct 20, 2015 Immediate Past Chair Brian Fortner Graham Fire & Rescue Read more 0 0 Article rating: No rating RSS Theme picker 2020 CAR SHOW Terms Of Use | Privacy Statement - Copyright 2024 by Washington Fire Chiefs Home Members About Us News Calendar Resources Documents Sections County Fire Chiefs FRWC WSAFM