Many fire departments across the country are responding to emergency medical services calls in a new generation of lightweight and highly maneuverable small vehicles. It's a growing trend that can be found from the snowy Northeast to the sunny Southwest.

Departments that operate these compact EMS vehicles say they cost significantly less than larger, more traditional vehicles. Departments also say that because these new vehicles are smaller, they can go where others can''t — into parking structures, through narrow passageways and even across rough terrain.

Small outside, but big inside

Although these compact vehicles are smaller than most on the outside, they're well equipped on the inside and are capable of providing first response, Basic Life Support or Advanced Life Support medical services. Some are designed with defibrillators and drug cabinets, while others have room for rescue gear and patient stretchers. In fact, a few have enough space to transport a patient.

Many compact EMS vehicles are based on popular sport-utility vehicles, such as the Chevrolet Suburban and Tahoe or the Ford Excursion and Expedition. The size of the vehicle, and therefore the specific SUV model selected, depends on the department''s budget, the amount of equipment carried, and whether the vehicle will be used to transport patients.

A typical SUV modification might involve changes to the vehicle electrical system and the addition of warning lights and sirens. If a roof-mounted light tower is specified, a larger alternator or an inverter system would be installed.

Interior cabinetry might include large pullout drawers that give instant access to the contents, open compartments for medical bags and secure storage areas for oxygen bottles. The vehicle''s exterior usually is painted and trimmed with reflective graphics to match the department''s other vehicles.

Other popular SUV options include extendable light towers, auxiliary roof-mounted air conditioners, 4x4 drive, front brush guards and roof racks for patient litters. Interior options include command and communications consoles in the front and rear, temperature-controlled drug boxes, and enclosed cabinets for turnout gear. Large extendable cargo beds that can be pulled out of the rear door are sometimes specified to give complete access and visibility to the contents. They're especially useful on vehicles that carry a lot of bulky rescue gear.

Another popular configuration is a low-profile compartmented body mounted on a small light-duty truck chassis, such as a Ford F-250. Some of the claimed advantages include a lower overall cost than an SUV-based EMS vehicle, larger storage space and the ability to remount the body on a new chassis.

Departments that use a single vehicle for both rescue and EMS calls often specify this configuration because of the greater amount of compartment space it offers.

Double trouble

One of the most common uses for these compact vehicles is in dual roles as both an EMS vehicle and a command vehicle. Because many departments already use SUVs as command cars, this is a natural extension that adds flexibility to an existing vehicle function.

In small departments where the chief may be the only full-time person on duty during the day, a combination command and EMS vehicle allows the chief to arrive on the scene and render emergency medical service while waiting for the volunteers to bring the department's rescue or ambulance.

In other departments, assigning a combination command/EMS vehicle to the duty officer gives the flexibility to handle multiple incidents if the primary ems vehicles are tied up elsewhere. This arrangement also allows the department to better handle incidents involving multiple injuries or mass casualties by giving the incident commander a vehicle that can double as an EMS workstation.

To transport or not

The question of using these compact ems vehicles to transport patients is a difficult one.

For example, cash-strapped departments may have a real need to provide emergency medical services over a large rural area where access is difficult and ambulance service is either limited or non-existent. For those departments, a compact EMS vehicle with provisions for patient transport may be the only alternative.

On the other hand, existing state or local regulations may exclude these smaller vehicles from transporting patients because they don't meet certain criteria regarding space, equipment, warning systems or some other features. Departments that fall under those regulations may face severe potential liabilities for “aggravated injuries” if they choose to transport patients in non-compliant EMS vehicles.

Some departments try to limit their liability by restricting patient transport in compact EMS vehicles to areas where regular ambulances can't go, such as offroad or in heavy snow. The rationale is that delivering a patient to a hospital quickly, or at least to another vehicle, is often more important than the temporary limitations of service en route.

Other departments use their compact EMS vehicles strictly to treat the patient on the scene. Once the patient is stable, they use a helicopter or regular ambulance for transport.

With these potential difficulties in mind, departments that want to use these smaller EMS vehicles for patient transport should be aware of the laws in their area.

Manufacturers

Command Designs
775-885-1011, <www.commanddesigns.com>

Odyssey Automotive Specialty
800-535-9441, <www.odysseyauto.com>

Swab Wagon
800-834-7922, <www.swabwagon.com>

Multi-role may mean multiple standards

Most EMS vehicles don't fall under the requirements of NFPA 1901, Automotive Fire Apparatus (1999). Although that standard covers fire, rescue and various support vehicles, it doesn't cover vehicles that are specifically and solely designed to provide emergency medical services.

NFPA 1901 also doesn't cover any vehicle under 10,000 pounds GVWR, which would include most SUVs and some light-duty trucks. However, if the vehicle has a GVWR of 10,000 pounds or more and performs multiple functions, such as both EMS and rescue, then it would fall under the applicable sections of the NFPA 1901 standard.

NFPA 1071, Emergency Vehicle Technician Professional Qualifications (2000), defines the minimum qualifications required for people who inspect, diagnose, maintain, repair or test motorized emergency response vehicles. This standard applies to all vehicles that respond to an emergency, including ambulances and other EMS vehicles.

The General Services Administration KKK-A-1822E Federal Specification for the Star-of-Life Ambulance reflects the minimum requirements for ambulances purchased by the federal government and is widely accepted by many states. EMS vehicles that are designed to transport patients may fall under these requirements, depending on the state in which such vehicles operate. Some states have their own requirements governing warning lights and equipment for non-transport EMS vehicles as well.

The federal Occupational Safety and Health Administration sets standards regarding decontamination of areas where bloodborne pathogens may be present, such as the interior of ambulances and other patient transport vehicles. These standards require the establishment of decontamination procedures, appropriate training of personnel, administrative control, and specific record keeping. The OSHA requirements affect anyone who enters the patient compartment — not just paramedics and ambulance attendants, but also emergency vehicle technicians and mechanics.