As ambulances have become the workhorses in many departments, special attention should be given to developing an effective vehicle that reliably responds to the scene with crew and equipment, transports patients to the hospital, and allows for their care in a protective environment.

There are fewer than two dozen recognized ambulance manufacturers in North America, and they don't all offer a full range of ambulance models. Some concentrate on specific styles like modular-style vehicles, high-top van ambulances or even export sales. Some are adept at building lower-priced mass-produced models while many smaller firms specialize in more customized — and expensive — vehicles.

In the United States, ambulances are designated by multiple types in Federal Specification KKK-A-1822, typically referred to as “Triple K.” This specification, first developed in the early 1970s, describes a set of minimum design and performance requirements. Despite efforts by other groups over the years to develop alternative standards, it remains the definitive baseline.

Manufacturers are required to certify that their vehicles comply with this specification. Some local regulatory agencies require current certification documentation before they will license the vehicle to operate as an ambulance in their locality. A pending revision to the Triple K standard will mandate independent third-party certification of each ambulance type produced by the manufacturer instead of allowing self-certification by the manufacturer. Other upcoming changes in Triple K will change the traditional interior design of the patient compartment and allow for individual variations to meet customer requirements. It will remain a challenge to ensure that each design is prepared using best engineering practices and safe, ergonomic designs.

Many of the standards and related testing requirements incorporated into the Triple K specification were developed by the Ambulance Manufacturers' Division of the National Truck Equipment Association. AMD standards also have been revised recently to address a wider range of standards for a higher level of performance, durability, ergonomics and safety. Free copies of these documents are available at www.ntea.com.

In larger departments, ambulances are typically purchased in quantity and evolutionary changes may modify the basic design with each successive purchase. However, some departments simply order the same basic vehicle year after year from the same vendor without researching how the units really are being used and what needs improvements. If a department is satisfied with its current vendor and vehicles, then there may be no reason to change. Manufacturers appreciate brand loyalty from customers and strive to do all they can to retain those customers. Unfortunately, there are times where a vendor may become complacent about customer support and fail to live up to expectations. Then it may be time to go shopping for something better.

There are several reasons to consider a new ambulance, often prompted by changes within the department. Is a department transitioning from BLS to ALS or otherwise adding new equipment to its ambulances? Are single-function EMS crews transitioning to dual-function fire/EMS personnel? Can that new equipment be stored safely and accessed easily?

Create a list of all expected equipment and its weight plus the weight of the typical occupant load to provide an expected payload requirement. That total should be provided to vendors so they can offer suggestions as to body sizes, chassis and alternatives.

Perform a walk-around inspection of current ambulances at different stations. Open the doors and examine how the equipment is stored. Imagine the vehicle turned upside down; what would fall out? Are there medical kits sitting on the floor, an oxygen bottle wedged behind a seat cushion, or an expensive defibrillator resting unsecured on a counter top or in an open-faced cabinet? Are rescue tools or backboards lying in wait to fall out of an exterior compartment when the access door is opened? What in the cab can become safety hazards? Not only can these items become dangerous projectiles, but they can become easily damaged during a routine shift, thus requiring expensive repairs or even replacement.

Also inspect the overall vehicle. Do the door latches operate correctly? Are there any water or dust leaks or areas of high-wear or deterioration? Are there broken door hinges, loose ceiling or wall panels, or missing fasteners? What components are troublesome and require constant attention? Ask the crews about their vehicle issues and suggestions for improvement.

Schedule a visit with the fleet maintenance shop that cares for these vehicles. These people will share their experiences and have the maintenance records (and costs) to support their concerns. They can offer both an objective evaluation of a current fleet and suggestions to increase fleet availability and reduce operating costs. They should be made an integral part of any evaluation and selection process for new ambulances, both early in the process but especially when it comes time for final inspection and acceptance of the finished product.

Some organizations may rely on one or two in-house experts for their ambulance selections. While that can streamline the overall process, it does not guarantee that the selected vehicle and features really address the needs of the department. Personal bias may prevent useful alternatives or new concepts from being examined.

A user committee can do the research, contact vendors, collect information, review available features and even prepare a formal user survey for feedback from all of the ambulance crews. The committee should have:

• A clear process and defined goals;
• A representative from all concerned parties such as field staff, management, fleet services and the union;
• A list of assignments, responsibilities, authority and expectations for each committee member;
• A designated facilitator who can manage egos, agendas and distractions; and, most importantly,
• A timeline so the process keeps moving forward to an ultimate conclusion.

Ambulance vendors should be invited to participate in a product demonstration at the department. Most are eager to comply with those requests. These demonstrations can be scheduled in various ways.

The committee can meet with each vendor individually so they can focus all of its attention on a single vendor brand and perform an in-depth evaluation without distraction. Each person on the committee should have time to address items that are of particular interest to them in discussions with the vendor and take as much time as they need without feeling rushed.

Some organizations arrange for all invited vendors to participate in a single day side-by-side evaluation event. While this method has some advantages to the committee by concentrating the amount of time it will spend during the evaluation, it may not provide adequate time to thoroughly inspect all of the vehicles, especially if you have several to review. Some vendors will want to monopolize all of the committee's time, showing gadgets and discouraging examination of their competitors' products.

Others find it preferable to have an initial evaluation with multiple vendors and then create a short list of acceptable vendors to consider after the evaluations are ranked. Those vendors are invited to return individually at a later date for a more in-depth evaluation of their product and discussions about options, pricing, availability, local service and more.

No matter the method, the committee chairman should keep the evaluation process focused and be designated as the single point of contact for any follow-up after vehicle evaluations. Vendors should be advised of this information and respect that decision. To keep the evaluation process objective, committee members should:

1. Develop a list of written questions to ask every vendor during the evaluation to maintain consistency and to have the information to assess later in the process.

2. Evaluate each vehicle as a team. This provides for consistency among the product evaluations. Solo inspections at separate times could result in accusations of bias toward a particular brand early in the process.

3. Complete a formal evaluation sheet for each vehicle with specific items of interest, rating them base on the established criteria. Scoring the responses will create a rough ranking of the vendors that is much more effective than relying on the foggy memories of the committee months later.

Vendors tend to bring vehicles loaded with costly options. Each vendor should be asked to clearly indicate what features are standard and what items are optional or additional cost so no one has faulty assumptions. Determine if the manufacturer has different levels or models of the same ambulance style, since they may show the Super Deluxe Limited model but the bid may actually quote a lesser model built with fewer standard features and cheaper materials. It is acceptable to ask vendors for price estimates to start the budget process, but remember that the must-have list will determine the final cost of the vehicle.

Some ambulances incorporate proprietary features or optional-cost items that are exclusive to one manufacturer. If the committee includes such an item on its must-have list, ask members to justify their choice, as that feature will restrict the available choices to a single manufacturer. Without sufficient justification of actual need, that decision may cause other potential vendors to complain to local officials claiming a department is too restrictive in its purchasing process. To minimize this potential roadblock, ask other manufacturers in advance if they offer suitable alternatives that can meet the intent of the proprietary item. If the unique item is requested by a number of ambulance buyers, several manufacturers will offer comparable features.

A great way to evaluate a product is to ask the person who owns one. Request an extensive list of customer references from each vendor. A questionnaire should document the responses for each reference contacted. If neighboring departments have vehicles from a particular vendor, the committee should inspect those vehicles and determine how well the product performs after it has been in use for some time. Ask the important question: “If they ordered again from the same vendor, what changes would they make?” The experiences of others may prevent an organization from making a costly mistake.

There is much focus today on emergency vehicle safety. While there is no substitute for a competent vehicle operator, consider adding some of these of safety items:

• Reverse-activated cameras,
• Backing sensors and proximity alarms,
• Cameras and recording systems,
• Vehicle data and driver behavior-modification computers,
• Remote tire pressure monitoring systems,
• High-visibility exterior graphics and safety chevrons,
• High-visibility, low-amperage LED exterior warning lights,
• Ergonomic crew seating with multiple high-visibility restraint systems,
• Additional padding and head strike protection in the patient compartment,
• Anti-skid floor covering and high-visibility grab rails in convenient locations, and
• Underbody perimeter lighting and HID floodlights.

Be aware that adding these optional cost features may result in a significant increase in overall price when compared to past ambulance purchases. Be prepared to justify your requirements to those who must authorize the purchase and approve the funding. They may have little understanding of the need for improved safety features and may base their decisions on previous ambulance expenditures over many years.

While the decision as to the final vehicle selection may ultimately rest with a different group of officials, a committee's recommendations will provide valid data to determine what is most suitable for your department and create buy-in to the entire process. Remember that the final selection is an expensive decision that you will have to live with — and possibly endure — for many years.

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Dale Leich is the special-projects manager for Excellance Inc. His experience in both career and volunteer emergency services spanned over four decades and he has been involved with emergency vehicle purchasing and sales since 1975.