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20 APRIL 2016 | EMSWORLD.com Vehicle Standards The construction and use of guidelines for the American ambulance fleet is at some- what of a crossroads at the current time. There are three ambulance standards either in existence or under developmental review: the GSA (General Services Administration) KKK-1822-F Star of Life standard, the NFPA 1917 standard and the CAAS GVS (Ground Vehicle Standard). Depending on your loca- tion, additional regulations may be in effect as directed by each state. When developing a f leet strategy, it is important not to attempt to second-guess which of the standards may be in effect when the final choice needs to be made. The design of a vehicle should comply with the standards in current use and, if neces- sary, add enabling components to be able to retrofit as needed to meet future standards. Always look for the best in the design and build process as possible; by doing this, the vehicles will cost less to meet the future standards if rechassis process is the choice or to just upfit to a new style for equipment such as power cots and crash-tested cot retention mounts. Future-proofng Over time, the choice of vehicle could become outdated quickly with changes in medical science. If the vehicle replace- ment time frame is set from 5–7 years, the vehicle design committee should include the operational medical director to provide the "crystal ball" of future changes and addi- tions required. For example, over the last 5–7 years, clinical, technical and safety factors have all changed the design, construction and use of EMS vehicles. Patient restraint, crash- worthiness, more complex interiors, less complex and cluttered interiors, manual and powered cots, loading systems, warmers, coolers, solar panels and DEF (diesel exhaust fluid) tanks have added to the conundrum of fleet planning and vehicle construction. Payload Allied to the future-proofing is the ques- tion of weight. Available vehicle payload is addressed in some of the vehicle standards, but the questions that need to be answered regarding the choice of vehicle include: • How much equipment is needed? • What is the weight capacity? • What are the needs of employees and the work environment where the vehicles will be operating? All component parts of the vehicle build must be combined with human factors. A vehicle with a remaining payload after equipment of 1,000 lbs sounds good until each seated position is counted, with per- sonnel weight assigned as between 171–175 lbs. per person dependent on which stan- dard is followed. A typical ambulance will have at least three seated positions in the back and two in the front; accounting for five persons at 171 lbs equals 855 lbs of weight, leaving 145 lbs for patient weight. An extreme example perhaps, but it brings into focus that our patients and equipment are not getting lighter and operating vehicles consistently at or over the functional weight capacity severely reduces the life of the vehicle and safety of operation. This article is primarily based on ambu - lance fleet design and strategy, but in the planning and purchase of rapid response and supervisor vehicles, weight is also a critical factor and many of these types of vehicle are regularly overloaded with equip- ment for the "just-in-case" situations. Operating Environment Understanding the requirements placed on your vehicle f leet in regard to both geog- raphy and system design is of paramount importance. Requirements in a static, station-based system may be different than a mobile, sys- tem status management (SSM) dynamic- deployment operation. The difference in the two from a fleet design perspective is vast. House or station-based vehicles do not P r o a c t i v e a n d R e a c t i v e D e v i ce s I m p r o v e P e r f o r m a n ce To assist with the task of keeping crews safe, as well as monitoring the behav- ior of other road users, both proactive and reactive devices are available in the EMS marketplace. In recent years the advent of dash cams has provided video evidence of incidents and accidents as they occur. They serve a purpose in identifying via recorded loop technology what's happened, more often than not who was at fault, and the exact actions—or distractions—of the vehicle operator. By and large, they do not play an active role in preventing the accident or crew behav- iors, but they form the basis of after-action reviews, ensuring that the work- force understands the need for safe and skilled vehicle operation. The other style of system in the current marketplace monitors data points in and around vehicle operation, such as the G forces that a vehicle encounters as a result of rapid acceleration or deceleration, tilt and even "bounce" via the use of vehicle-mounted gyroscopes. Once an operator has been identified by logging onto the system via a fob, sensors then detect the application of seat belts, emergency lights and siren, indicators and braking, and then records the overall driving habit of the individual and by aggregate, the organization. In such systems the required operating parameters for any vehicle can be set, such as upper speed, tilt encountered in cornering and over or under forc- es at work in both acceleration and deceleration. Once limits have been set, an audible warning alarm or alert can warn the operator that they are nearing the specified limits and to take appropriate and correcting action. The overarching aim of systems such as these is to avoid the accident in the first place, rather than watch it back on the video afterwards, although ven- dors are now able to offer a bundle package combining both pro- and reactive systems at the time of sale. The added bonus of driver monitoring systems is that they allow an organization to amass a body of safe driving evidence to drop insurance premiums based on the excellence of vehicle operation. Linking back to vehicle maintenance, less vehicle contact equals less expensive repair and lost unit hours, while safe, skilled and monitored vehicle operation decreases wear, prolongs life (of both provider and vehicle) and reduces overall maintenance cost.