Today's fire departments and private paramedic companies spend considerable dollars when purchasing ambulances. There's a lot to ponder before a penny is spent, including how the vehicle rides at high speeds, its functionality and its onboard technology, said Bill Vidacovich, vice president of fleet management for Lafayette, La.?based Acadian Ambulance Service.

Acadian Ambulance grew from a two-ambulance shop in 1971 to a staff of more than 2,500 today. Vidacovich said that to provide quality emergency care, the company's ambulance fleet needs to be in tip-top shape and often customized to meet his satisfaction. In addition, he's always looking toward the future and the “perceived need of the upcoming year.” For example, this year the company purchased 49 units for expansion of operations and for replacement.

“If we know we are going to buy out a company, we plan for that buy-out, knowing what type of ambulances we may be buying or needing to replace,” Vidacovich said. “Or, if we just expand our existing operation through taking on more territory or contracts, then we also look at that.”

When specifying an ambulance, Vidacovich said he looks at whether the space, size and organization is conducive to the medic's job — meaning it must be well designed and functional. He often takes trips to the factories to review products from the ground up to determine whether he's satisfied with their manufacturing techniques. This helps him determine the longevity of the equipment, in terms of the truck as well as the finished product, he said.

Most recently, the company has been looking at an ambulance's fuel mileage when specifying. Acadian's fleet of ambulances have a typical gas consumption of 9 mpg. New units available on the market offer better gas mileage, Vidacovich said.

“Some of the new units we are buying get 15 mpg,” he said. “That's a pretty significant increase for us in terms of mileage.”

Vidacovich offered some advice to those chiefs making purchasing decisions: don't be penny wise and dollar foolish when specifying ambulances. Buyers need to look beyond the upfront cost and also consider the expected life span of the vehicle and its anticipated maintenance costs. Buyers often pay less for the product initially but considerably more over the long run, he said.

“If you buy a modular ambulance — basically a box on the back of a pickup truck — we have used those up to 250,000 miles … and we sell them at that point,” Vidacovich said. “We take the module off and we refurbish that module and put it back on a new chassis — the longevity of the module is 20 years or longer — as opposed to buying a whole new one.”

From the Chief

Networking with other chiefs is essential before making any purchase, in order to share in-the-field experiences, including those related to equipment reliability and functionality, said Mark Ober, chief of Anderson Township Fire and Rescue Department in southeastern Ohio. The only way to really know whether a piece of equipment is worth the money is to tap into the knowledge of fellow chiefs.

“I get a lot of calls from chiefs who ask me a question about equipment purchases and what works best in the field,” Ober said. “Then, I go ahead and do the same thing.”

Ober's said he asks chiefs whether their product purchase met their specifications as well as the needs of the department's external and internal clients. For example, he wants to ensure all paramedics who work on the rig are safe, which includes having a seatbelt in the rear of the module. In fact, he said he stripped out the squad benches in his department's modules and installed a captain chair with a seatbelt harness. However, it changed the ambulance's classification.

“The move made them Type IIs, so they can't haul two patients anymore,” he noted.

But removing the squad benches also left room for larger patients, including the bariatric. Ober said he is meeting with an ambulance company now to discuss adding lift and ramp systems to the rear of the ambulances.

“Why are we doing all of this lifting?” Ober asked. “I've lost five guys in my 34-year career on my department who all went out with bad backs, and if we can get the equipment right we can prevent this.”

A replacement plan in place until 2017 dictates when Anderson Township ambulances are purchased. The department replaces ambulances because of the high mileage and hours of usage on the vehicles. In addition, the department wants “the latest and greatest,” he said.

“We like new electronics, sliding doors are on there now … there are feature's we like to have,” he said.

No matter the bells and whistles, reliability is crucial when lives are on the line. So Ober said chiefs need to discuss upfront with manufacturers the level of customer service they can expect.

“When's it getting fixed? When's it getting back on the streets and who's gonna do it,” Ober said. “Those are the things you work out when you are specifying. For example we specify service centers to be within a certain proximity and issues need to be addressed within a certain time period.”

From the Committee

There are myriad issues to consider when specifying ambulances, with few broadly agreed-upon standards. So the National Fire Protection Association will meet this autumn to continue its work on developing ambulance standards for specifying and purchasing, said Larry Stewart, fire-service specialist in the NFPA's public-fire protection division. Stewart said the impetus for creating a standard was to set minimum requirements for ambulance safety and operation.

“The NFPA took on writing a standard because [while] there were national fire standards that apply to apparatus, they didn't apply to ambulances, which didn't need to meet the same level of performance as a fire engine,” Stewart said.

David Fischler, the committee chair, said the new NFPA standard will provide guidelines on the development of a safer vehicle, not only for the patients but also for the operators and paramedics onboard.

“Over the last few years, we've seen accidents in which the providers as well as the patients have been killed or seriously injured,” Fischler said. “The intent of the committee is to look at what currently exists out there and come up with a standard that will provide a safer ambulance for everyone concerned.”

Standards will focus strictly on construction and operation, such as how the vehicle's mechanical components work on the vehicle, how it is constructed and more. The development of a standard will mimic what has been previously done for fire apparatus, Stewart said.

“They looked at the existing NFPA 1901, Automotive Fire Apparatus, and how they assembled the chapters,” Stewart said. “So right now, we are in the infant steps of tackling the work.”

NFPA standards will identify benchmarks an ambulance must meet. Stewart said they will look at occupant safety, vehicle stability, power requirements, lighting and warning systems, and the arrangement of patient-care areas, “to make sure that if the vehicle is in an accident, everyone onboard us in the best position possible so that they are not going to be compromised,” he said.

The next meeting is yet to be scheduled but is expected to take place in the next few months. The committee will then be divided into the various task groups that write each chapter. Meetings will be held until the NFPA has a working draft of a document, Stewart said. He noted committee members have the existing ambulance standards published through the U.S. General Services Administration.

“The federal government is looking for someone else to take over writing the specifications for ambulances,” Stewart said. “The … document was never meant to be a standard; it was really a specification used by the federal government to buy ambulances. It never really had performance requirements, as far as how the vehicle had to perform.”

Chiefs shouldn't wait for the standards to make purchasing decisions, Stewart said.

“I doubt the industry will want to prolong distributing ambulances, and don't think those who need ambulances should wait, because our process is going to take two years before we have a product available as a standard.”

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