Over the last four years, there have been many changes that affect the design and performance of ambulances — new standards, new designations, new chassis, new configurations, new technology and even a new maintenance standard. The result is a new generation of ambulances that are safer, more efficient and more versatile.

If you haven't purchased an ambulance in several years, you need to take a new look at ambulances.

Standards and specs

The General Services Administration KKK-A-1822 Federal Specification for the Star-of-Life Ambulance reflects the minimum requirements for ambulances purchased by the federal government and is widely accepted as a standard for ambulance design in the United States. The E revision, which went into effect in June 2002, contains approximately 110 pages of detailed requirements for the design and performance of ambulance chassis, bodies, and related components and systems.

One of the biggest changes in the KKK-A-1822E specification is the establishment of two new designations for ambulances in recognition of the growing trend to larger, multipurpose, patient-transport vehicles. Prior to revision E, ambulances were designated as Type I, II or III depending on the chassis and body configuration. These designations were further broken down into configurations A for ALS ambulances and B for BLS ambulances. Each type and configuration could be specified with 4×2 or 4×4 drive.

A Type I ambulance has a modular body mounted on a light-duty, regular-cab commercial chassis with the engine mounted in front of the cab. There is usually no walk-through connection between the cab and the body. The Type I offers a large patient compartment, room for storage and easy engine access, but it has a higher floor height and a longer wheelbase than a Type III. It is chosen by customers who want a combination of extra room and good engine access.

A Type II ambulance is built into a light-duty commercial chassis van with a raised roof for additional headroom. It has a low floor height and a short wheelbase, but it has the disadvantages of a small patient compartment and difficult engine access. A Type II is the least expensive ambulance to meet the GSA standard and generally is used by fire departments and private companies where funding is restricted, usage is low or there's no requirement to carry extra equipment.

A Type III ambulance is built on a light-duty, cutaway-cab commercial chassis with the engine mounted partway into the cab. There is a walk-through connection between the cab and the body. The Type III has a large patient compartment, room for equipment, a low floor height and a short wheelbase, but the engine access is more difficult than in a Type I. It is often favored by fire departments that want the additional space and lower floor height.

As more and more fire departments take on patient-transport services, there has been a trend for them to purchase Type I and Type III ambulances because of the additional equipment space afforded by these designs. With additional space, however, there has been a growing need for them to carry additional weight. In response, the latest KKK-A-1822E standard added a Type I additional duty and a Type I additional duty designation. Both of the new designations apply to vehicles with increased gross vehicle weight ratings, storage space and payload capacities.

Additional-duty ambulances usually are built on medium-duty chassis and are designed to carry additional personnel, EMS gear, rescue tools, generators and lights, and even fire suppression equipment to handle several tasks. These multipurpose vehicles are typically used by fire departments where limited staffing or other restrictions prevent the department from dispatching two or three vehicles to the scene of an incident. Instead, a single additional-duty ambulance can potentially take the place of an engine company, a light-rescue squad and a patient-transport ambulance.

Chassis

The shift to larger ambulances with greater payload capacities has resulted in the introduction of several new ambulance chassis. Vehicle chassis are divided into weight classifications depending on their gross vehicle weight rating. Weight classifications range from Class 1 to Class 8; the higher the classification, the greater the weight rating.

Customers who need an ambulance with additional weight capacity usually select a chassis in the Class 4-7 range. Class 4-5 trucks like the Ford F-450 and F-550 and the GMC C4500 and C5500 are used for applications that require only a few thousand pounds more payload capacity than more traditional chassis. Class 6-7 range trucks like the Freightliner M2 and the International 4200 and 4300 are used for the heaviest applications, or where customers want the durability of a larger medium-duty chassis.

Ford offers their F-series chassis for Type I ambulance applications and their E-series chassis for Type I and III ambulance applications. Both series are available with a factory-installed ambulance prep package. The F-350, F-450 and F-550 models include a regular cab and a choice of 4×2 or 4×4 drive. The F-650 4×2 model with a regular cab is sometimes used for very heavy applications. The E-series includes the E-150, E-250 and E-350 models in a full van configuration and the E-350 and E-450 models in a cutaway cab configuration. The E-series is only available with a 4×2 drive.

The Freightliner Business Class M2 100 and 106 models are medium-duty chassis with regular cabs for very heavy Type I ambulances. They are designed to provide a short bumper-to-back-of-cab dimension for maximum body space, high-capacity axle ratings for maximum payload and a 55° wheelcut for outstanding maneuverability. The cab is aluminum for light weight and corrosion resistance. The M2 is available with 4×2 drive. Freightliner also offers the Mercedes-Benz Sprinter chassis for Type II ambulances that require a small vehicle with a large patient compartment. The Sprinter is available with a 4×2 drive.

GMC offers their TopKick C4500 and C5500 models in regular or cutaway cab configurations for heavier Type I and Type III ambulance applications. Chevrolet offers identical models under the Kodiak brand. The new models have a 54° front wheel cut for excellent maneuverability and a sloped hood for outstanding forward visibility. An ambulance package is available. The C4500 and C5500 are available with 4×2 drive.

The International medium-duty 4200 and 4300 Lo-Profile models with regular cabs provide the extra payload capacity required for very heavy Type I ambulances. The low-profile frame configuration is specially designed to give a lower floor height for easier patient loading and entry. Both models are available with 4×2 drive.

Designs

Ambulance manufacturers also have responded to the changing needs of their fire service customers with several new designs.

Jim Biedenharn, vice president of sales, marketing and product development for Braun Industries, sees “an overall concern with safety issues” as the number-one trend in ambulance design. That concern was one of the reasons Braun recently introduced their EZ Glide sliding side-entry door, which hugs the side of the ambulance body without interfering with activity in the incident area or protruding into traffic.

Biedenharn also says that as towns merge their fire and EMS budgets there will be a need for multi-use ambulance configurations, so the company introduced the Advance combination rescue/ambulance, which includes a full-width equipment compartment in the forward portion of the body. The compartment is equipped with roll-up doors, slide-out trays and a 10KW electrical generator.

Road Rescue took a giant step in meeting the need for more interior space and more weight capacity when they introduced their Inter-Urban Multiple Response Unit. The new ambulance is built on a Spartan ATR-1 custom cab and chassis based on fire apparatus design with seating for a crew of four. In a recent press release, Chuck Drake, president of Road Rescue, says they chose a custom chassis “both because of the roomier cab, which accommodates the desire for larger crews and more equipment to respond to emergency situations, and the ride-and-handling benefits offered by a custom chassis.” The new unit can carry light-rescue and extrication equipment, as well as provide patient transport and space for a variety of diagnostic equipment.

Paul Holzapfel, director of sales for Wheeled Coach, cites “occupant protection in the patient compartment” as a major concern that was addressed in the recent KKK-A-1822E standard. The new standard specifies additional occupant restraints, more rounded interior corners, and more secure locations of the sharps container for needles and other potentially dangerous items. Holzapfel notes that the company's proprietary Pure Air Filtration system further protects occupants in the patient compartment by exchanging the air every 90 seconds and triple-filtering microorganisms with a 99.97% efficiency to exceed the new KKK requirements. Wheeled Coach also uses a third-party inspection service to check their body welds on a monthly basis to ensure strength and integrity.

At Medtec Ambulance, the majority of orders are for the roomier Type III style, according to Denny Neff, sales manager. Neff says the larger Type I style is also popular. Medtec recently delivered eight Type I ambulances with 250gpm pumps and 150-gallon tanks to a rural department in Florida that protects a large, but sparsely populated, area. For fires the small crew at each station takes a pumper, but for motor vehicle accidents, rescues and emergency medical calls they take the ambulance because of its versatility.

American LaFrance continues to see a trend for ambulances built on the M2 chassis, which they say offers an exceptional front wheelcut, multiple engine options and many cab configurations, including two-door traditional designs, extended cabs, extended cabs with built-in EMS cabinets and four-door cabs. Various pump options are available also.

“We are excited about the broad package of options we offer our customers,” says Marc Gustafson, president of American LaFrance Corp. “[The company] is focused on providing medium-duty ambulance customers the best the industry has to offer. Further, we present a strong case for buyers to upgrade to a medium-duty ambulance.” American LaFrance also offers ambulances on the Sterling Acterra series of chassis.

Technology and maintenance

Manufacturers also have brought some impressive new technology to the ambulance market. Multiplex electrical circuits and programmable electronic controls allow them to offer complex systems with simplified wiring. Warning light patterns can be varied to meet specific situations, and perimeter lighting can be activated with interlocks to the doors.

Other high-tech features include keyless door entry systems for improved security. The use of backup cameras is becoming more common and is an especially valuable feature when maneuvering at congested incident scenes. Video cameras also are being installed in the patient compartment to monitor and record actions as a defense against lawsuits. Electronic privacy windows in the patient compartment can be changed from clear to opaque with the flick of a switch.

In the area of vehicle lighting, several manufacturers note a definite trend to LEDs for warning lights, as well as for the stop/turn/tail lights. They say that LED models have longer life and a lower current draw, but still are more expensive than other lights. Manufacturers expect the price will continue to drop as demand increases and improved production techniques reduce costs.

And finally, the new specialized components and systems found on modern ambulances require service technicians with equally specialized qualifications. The average truck mechanic probably wouldn't know how to work on an ambulance electrical system, much less understand the safety precautions necessary to service the oxygen system or to avoid contamination from bloodborne pathogens that might be present in the patient compartment.

To ensure that service technicians are qualified to work on ambulances, NFPA 1071, Emergency Vehicle Technician Professional Qualifications, requires that all personnel who inspect, diagnose, maintain, repair and test emergency response vehicles be qualified. This standard defines an emergency response vehicle as “any motorized vehicle … where provisions have been made to include warning systems and specialized components … and that is capable of transporting emergency response personnel.” That definition clearly includes ambulances.

One way to establish a technician's qualifications to work on ambulances is through a series of examinations offered by the Emergency Vehicle Technician Certification Commission. The exams are offered at more than 150 locations nationwide twice a year, as well as at several emergency vehicle technician and fire mechanic association training events throughout the year. Successful completion of these exams must be coupled with successful completion of several Automotive Service Excellence exams for technicians to achieve specific levels of certification.

A new look

With all these changes, fire departments need to consider their options. Volunteer departments that provide Basic Life Support and occasional patient-transport services in a lightly populated area may find that a Type II ambulance is the most economical configuration. On the other hand, career departments that provide Advanced Life Support and frequent patient-transport services in a densely populated area may need a larger Type I or Type III ambulance.

In between these two extremes, certain departments that have only a minimum staff on duty during the day, but have the potential for handling frequent motor vehicle accidents and other serious incidents, may want to use a large Type I or Type III additional duty ambulance configuration that combines patient transport with either rescue or fire suppression capabilities — or all three.

No matter what the situation, fire department customers need to take a new look at the current generation of ambulances to see what is right for them.

For More Information

You can download a copy of the current KKK-A-1822E standard at www.fss.gsa.gov/vehicles/buying. You also can download the KKK-A-1822E standard cover letter, the entire text, and a comparison of the new E revision to the previous D revision requirements from the National Truck Equipment Association Web site at www.ntea.com/downloads.asp.

To download the current Ambulance Manufacturers Division 001 through 015 standards, go to the National Truck Equipment Association Web site at www.ntea.com/downloads.asp.

For information about OSHA safety standards and procedures for dealing with bloodborne pathogens, call 202-693-1999 for the telephone number of your OSHA regional office. You also may download OSHA Publication #3186 Model Plans and Programs for the OSHA Bloodborne Pathogens and Hazards Communications Standards by going to www.osha.gov and clicking on Publications.

For information about the Emergency Vehicle Technician Certification Commission ambulance certification exams, go to www.evtcc.org.

For information about the ambulance certification exam review classes offered at the National EVT Training Academy in Ocala, Fla., on March 29-April 2, go to www.faevt.org.

For information about the Automotive Service Excellence certification exams, go to www.ase.com.