Staying Compliant in the Evolving World of Ambulances

By Steve Rowland, Ferno EMS


2015 was a busy year for the Fire Apparatus Manufacturers’ Association (FAMA) Ambulance Technical Committee. FAMA committee members work hard to advance the interests of both the emergency care provider and the patient as they relate to ambulance specifications, and there are several recent noteworthy changes. Whether and when each state will adopt these changes will likely be determined in the coming months.

Triple K Changes

July 1, 2015 saw the publication of Change Notice 8 to the Federal Government’s KKK-A1822-F Star-of-Life Ambulance Specification (the Triple-K). Developed in the 1970s, this specification is provided by federal government to agencies wishing to purchase ambulances. This document is followed by roughly 30 U.S. states, in whole or in part, as the minimum guideline under which a vehicle may be called an ambulance. It was written with the intent that an ambulance manufacturer could read and follow it to determine specific design elements and options, resulting in a finished ambulance that will meet the federal government’s criteria.

There are several additions to the Triple-K required in Change Notice 8. The two most significant changes are the addition of recommended practices from the Society of Automotive Engineers International (SAE), namely SAE J3026 Ambulance Patient Compartment Seating Integrity and Occupant Restraint and SAE J3027 Ambulance Litter Integrity, Retention, and Patient Restraint. Both guidelines from SAE describe the test forces which manufacturers of attendant seating and patient cots (regionally referred to as stretchers, litters, or gurneys) must design and certify to. Those G-forces are 22.5 Gs in a frontal impact and 26.0 Gs in a side impact over a very short time segment. This is roughly equal to the initial forces seen in a head-on crash between a 10,000-pound ambulance and a 3,000-pound car, both traveling at 55 miles per hour.

The take-away from these SAE-related changes is that the rear compartment seats and cot fasteners used in the past will likely not be compliant with the new guidelines. EMS providers already using “Captain’s Chairs” with four- or five-point harnesses will see only a minimal increase to become compliant. Providers using ambulances with squad benches and simple lap belts, however, will likely have to make a greater investment in safer seating alternatives for their medics and other rear-compartment passengers.

NFPA 1917 Changes

Also changing this year is National Fire Protection Association (NFPA) 1917, Standard for Automotive Ambulances. In August at the NFPA Standards Council meeting in Chicago, NFPA 1917 (2016 ed.) was issued for publication, and the new edition is now available at This document is nearly 70 pages long, describing the requirements to both construct and test an ambulance. As such, the consensus-developed aspects and requirements of the NFPA “standard” ambulance may exceed existing state minimum requirements. Throughout the revision process from the initial 2013 edition, a greater effort to involve the nonfire-based EMS community was solicited, with the majority of that community’s concerns addressed in the 2016 edition. It should be noted that this standard references the two SAE recommended practices as well.

New CAAS Standard

The Committee on Accreditation of Ambulance Services (CAAS) began crafting an alternate ambulance standard in its Ground Vehicle Standard v 1.0 (GVS v.1.0) document. From its Web site, “The CAAS Ground Vehicle Standard (GVS v.1.0) establishes minimum requirements, performance parameters, and essential criteria for the design of ground ambulances to provide a practical degree of standardization.” Largely developed through a consensus effort to combine the widely familiar components of the Triple-K specification together with the testing standards developed by the Ambulance Manufacturers Division (AMD) of the National Truck Equipment Association, the CAAS GVS v 1.0 document, when published, will offer another option for a “bumper-to-bumper” standard for purchasers to select when building new ambulances. This standard references the SAE recommended practices as well.

Patient Cot Cost Impacts

Common to all three standards is the need to upgrade patient cot mounting integrity. There are indeed premium compliant solutions available, but “compliant” does not necessarily equal “expensive.” For example, if you already use a manual or power “x-frame” style cot with traditional “antler and rail” fasteners, the cost to upgrade to an SAE-compliant solution is a net difference of around $1,000.

Common Ground

Whether your state adopts the new Change Notice 8 to the Triple-K specification, NFPA 1917 (2016 ed.), or plans to adopt the CAAS GVS v 1.0 standard when published, all three equally reference the latest scientifically determined and peer-reviewed data concerning rear-compartment seating and patient cot, restraint, and fastener design. The beauty of these documents referencing the same SAE recommended practices is that the manufacturers of seating and cots are able to design and test to one solid standard, and ambulance manufacturers do not need to build “state-specific” ambulances to provide these integrated options.

Indeed, it is a time of change in the emergency medical services (EMS) community. Just as forward thinking in the fire service over the last 30 years has brought about the prevailing “Everyone Goes Home” mindset—no tailboard riding; no open cabs; no dungarees and overcoats; and other extensive, safety-related changes—the EMS community is well underway in evolving a culture of safety to the point where the idea that “we’ve never done it that way before” will soon be a call to embrace new ideas rather than reject them. FAMA members will continue to stay involved in this evolution of standards, supporting the move to make ambulance designs safer for all.

FAMA is committed to the manufacture and sale of safe, efficient emergency response vehicles and equipment. FAMA urges fire departments to evaluate the full range of safety features offered by its member companies.

STEVE ROWLAND began his career in the emergency services in the mid 1980s in Bradenton, Florida, working as an EMT with Manatee County (FL) EMS, while also serving as a volunteer firefighter and auxiliary state trooper. He has worked with several manufacturers of public safety equipment and currently works with the Ambulance Systems team at Ferno EMS. Steve is a principal member of the NFPA 1917 Committee, Chairs the FAMA Ambulance Technical Subcommittee, and is an EVT-certified technician.