The End Of The Squad Bench!

[x635 4,066]

I just read somewhere, and this is probably old news, but the Federal Ambulance Standard AKA "KKK Spec".

One reason this makes me happy is because the useless squad bench can be deleted from specs. Of course, you lose patient capacity on that rare occasion, but you make it safer for the crew.

Also, turning the squad bench into a workstation for the provider, with equipment mounts and other tools and supplies right there, makes for a more efficient patient care environment, and also makes it safer for the crew member not having to get up to do various things....they can have everything right there and stay belted in.

And I guess that stupid, useless "exhaust vent" that was required will also go away, as that never worked. Maybe we will also see the end to the digusting "walk throughs".

Is there another agency or association that will be setting basic specs for ambulances?

[FireMedic049 597]

I just read somewhere, and this is probably old news, but the Federal Ambulance Standard AKA "KKK Spec".

One reason this makes me happy is because the useless squad bench can be deleted from specs. Of course, you lose patient capacity on that rare occasion, but you make it safer for the crew.

Also, turning the squad bench into a workstation for the provider, with equipment mounts and other tools and supplies right there, makes for a more efficient patient care environment, and also makes it safer for the crew member not having to get up to do various things....they can have everything right there and stay belted in.

And I guess that stupid, useless "exhaust vent" that was required will also go away, as that never worked. Maybe we will also see the end to the digusting "walk throughs".

Is there another agency or association that will be setting basic specs for ambulances?

Your kind of late to the game with this post.

It's been known for months now that the KKK spec is soon to be extinct. It should be noted though that the KKK spec was created as an ambulance purchasing specification for the federal government, not as a manufacturing standard for the ambulance industry. As I understand it, basically if a manufacturer wanted to build ambulances for Uncle Sam, their unit had to meet the KKK spec in order to get the work. Over the years it was pretty much the manufacturing standard by default since nothing else existed.

Many EMS agencies have been moving away from the traditional open end bench seat configuration for several years now.

The NFPA has been working on an ambulance standard for the past few years (NFPA 1917). It either just went into effect this year or will be shortly.

I recall reading a couple months ago that there's work being done from the EMS side of things on some sort of standard since the NFPA standards are viewed as "Fire" standards and not necessarily applicable for non-fire-based EMS agencies.

Edited October 12, 2013 by FireMedic049

[SRS131EMTFF 471]

So does this mean the new standard does not call for the capability to transport a second liter bound pt?

And I guess that stupid, useless "exhaust vent" that was required will also go away, as that never worked. Maybe we will also see the end to the digusting "walk throughs".

That vent is quite handy to get hot air out of the rig if it has been sitting outside, parked for hours. Also, if a pt feels too hot but the rig will not cool down any faster, turning on the vent during transport will help the pt think it is getting cooler even if it is not.

[EMT111 149]

I justOne reason this makes me happy is because the useless squad bench can be deleted from specs. Of course, you lose patient capacity on that rare occasion, but you make it safer for the crew.

Also, turning the squad bench into a workstation for the provider, with equipment mounts and other tools and supplies right there, makes for a more efficient patient care environment, and also makes it safer for the crew member not having to get up to do various things....they can have everything right there and stay belted in.

I actually don't see the squad bench as useless, however my corps usually gets out with at least three on a call, so we put someone on either side of the patient and a crew member/family member in the captain's chair. I also have a local pd who calls us out to every mva with an unaccompanied patient under 18 for "evaluations", so I just cram as many as I can onto the bench seat if I have to transport them. As for turning the bench seat into a workstation, I was invited to come down and test ride some of the demo rigs when we were looking at new rigs a couple months ago, and wheeled coach brought down a demo with what they call a "medic in mind" interior. Essentially, they cut the bench seat down to a double seat and placed in a workstation with draws at the end of the bench seat, and then if you wanted, you could spec your attendant seat/ cpr seat as a double wide seat so you didn't loose patient capacity in the rig. I liked the idea since I hate having the medics set up all their stuff on the bench seat and then having to hold it and watch stuff go flying all the way to the hospital.

[x635 4,066]

That vent is quite handy to get hot air out of the rig if it has been sitting outside, parked for hours.

The KKK spec standard vent doesn't do anything, hot air or smelly patient. It's too small. There needs to be something that actually exhausts, maybe those reversible type ceiling mount fans that they use RV's.

[STAT213 332]

We took the squad bench out of our ambulance spec six years ago. If you have two patients, you use two ambulances.

We now have that workstation design Seth mentioned. All needed items in arms reach. Radio, all controls, 95 % of your equipment.

Way better, and way safer. The patient on the bench was never well restrained and moving them from bench to stretcher was a back injury waiting to happen.

[antiquefirelt 994]

We took the squad bench out of our ambulance spec six years ago. If you have two patients, you use two ambulances.

Pretty much the same here, 2 of our 3 buses have no squad bench. I will say that some personnel report the single seat is not as easy to work from though as it's not always in the optimal place for all patients. This means the EMT might have to "unbelt" and move outside the captains chair "cubby" area more often depending on your seat layout and restraint system (and actual use).

[x129K 1,393]

Where the hell do you sleep then!?

[sympathomedic 383]

Oh Em Gee, Dan! I was thinking the same thing!

But really, it was time for something better. Too many of us die in ambulance crashes, and many are unbelted in the back.

I do wish the NFPA would stay the hell out of my ambulance. I do not trust that group. They seem to rep the manufacturers, not me. I do not need firemen from Massachussetts with too little fire work to do getting involved in EMS. Prefer to see the AMA not the NFPA.

[WAS967 97]

I was about to ask how we'd meet Part 800.24(a) but it only mentions the need to carry a device capable of carrying a second recumbent patient. It doesn't seem to say that said patient need to be able to be carried in the ambulance at the same time as the first. Hmmm.

[x129K 1,393]

Oh Em Gee, Dan! I was thinking the same thing!

But really, it was time for something better. Too many of us die in ambulance crashes, and many are unbelted in the back.

I do wish the NFPA would stay the hell out of my ambulance. I do not trust that group. They seem to rep the manufacturers, not me. I do not need firemen from Massachussetts with too little fire work to do getting involved in EMS. Prefer to see the AMA not the NFPA.

I love you Billy.

[FireMedic049 597]

I do wish the NFPA would stay the hell out of my ambulance. I do not trust that group. They seem to rep the manufacturers, not me. I do not need firemen from Massachussetts with too little fire work to do getting involved in EMS. Prefer to see the AMA not the NFPA.

The reality is that it makes sense for the NFPA to expand their apparatus standards to include ambulances when you consider just how many fire departments provide EMS transport services. We could debate the validity of the NFPA standards and their process, but I really have no interest in doing so as there wouldn't be much point to it.

Regardless, if you don't want the NFPA in your ambulance, then don't let them into your ambulance. Unless codified by the local AHJ, the NFPA standards are not law and it is possible to get non-compliant apparatus from the manufacturers. You may have to sign a waiver of some sorts in order to do so, but you should be able to find somebody to build what you want. FDNY has been purchasing apparatus that is not fully NFPA compliant. One obvious sign of this is the fact that their apparatus continues to be delivered without the rear reflective chevrons specified in NFPA 1901.

[Arbrow06 5]

Also there are ways to not loose the two patient capacity because most two seaters in lieu of the squad bench fold down so that you can fit a back board on there and if you have more that 3 people sitting in the back (2 seater and captains chair) you have too many people in back. Send someone up to the front seat.

[Bnechis 3,961]

But really, it was time for something better. Too many of us die in ambulance crashes, and many are unbelted in the back.

I do wish the NFPA would stay the hell out of my ambulance. I do not trust that group. They seem to rep the manufacturers, not me. I do not need firemen from Massachussetts with too little fire work to do getting involved in EMS. Prefer to see the AMA not the NFPA.

Bill so you want something better, but you do not want the group that has done more to protect people than any other group to do it and you want a group that has never had anything to do with EMS or Vehicles to do it?

Have you ever been to NFPA meeting? You say they rep the manufacturers, but having been on an NFPA committee I can tell you that is not the case.

How about firefighter Paramedics from Fla. CA. AZ, etc. you forget that 80% of EMS in the US is provided by the Fire Service.

[Bnechis 3,961]

Regardless, if you don't want the NFPA in your ambulance, then don't let them into your ambulance. Unless codified by the local AHJ, the NFPA standards are not law and it is possible to get non-compliant apparatus from the manufacturers. You may have to sign a waiver of some sorts in order to do so, but you should be able to find somebody to build what you want. FDNY has been purchasing apparatus that is not fully NFPA compliant. One obvious sign of this is the fact that their apparatus continues to be delivered without the rear reflective chevrons specified in NFPA 1901.

In NY many NFPA standards are law. NYS courts have made it clear that if no law exists, national consensious standards will be used and unless you can prove that "your" standard is superior to NFPA or that their is another recognized national standard, thats how you will be judged in NYS.

Any agency can sign a waiver to NFPA, all that means is if their is a lawsuit, the builder has a "get out of jail free" card.

[sympathomedic 383]

Barry:

I don't want to steer this away from its original intent- which was to discuss the changes brought about by the expiration of the kkk specs.

I find the NFPA to be a massive failure, an example of what occurs when an industry is allowed to self regulate. America has a terrible fire loss rate compared to the other developed counties in the world.(Sweden is best) We have a horrible firefighter death rate in the same comparison. Developments like the FIT device and fire retardant paint have come alongshowing great promise, and the NFPA seems to kind of ho-hum them. We build 1000's of residential homes a day with no sprinklers and no inspections despite that most fireman who die, die in home fires. So I see little proof of the NFPA being effective at its mission of reducing fire loss and loss of firemen's lives. I see it as one disfunctional agency taking the lead from another.

I also doubt that 80% stat. FD's may be on 80% of 911 EMS calls, but I don't think that 80% of peopel transported in ambulances are transported by "firefighters". NYC is a prime and local example. Of course, that has no bearing on the thread, but just saying.

[x635 4,066]

There needs to be a EMS counterpart to the National FIRE Protection Association that sets basic EMS standards, like the NFPA does for the fire service.

It should consist of industry professionals and other leaders that focus on EMS. Just because some FD's run EMS doesn't mean they can or should dictate ambulance standards.

I don't care what percentage of the fire service does EMS, you don't see the police groups setting fire engine standards.

[Bnechis 3,961]

1) I find the NFPA to be a massive failure, an example of what occurs when an industry is allowed to self regulate.

2) America has a terrible fire loss rate compared to the other developed counties in the world.(Sweden is best)

3) We have a horrible firefighter death rate in the same comparison.

4) Developments like the FIT device and fire retardant paint have come alongshowing great promise, and the NFPA seems to kind of ho-hum them.

5) We build 1000's of residential homes a day with no sprinklers and no inspections despite that most fireman who die, die in home fires.

6) So I see little proof of the NFPA being effective at its mission of reducing fire loss and loss of firemen's lives. I see it as one disfunctional agency taking the lead from another.

1) So where is your proof? Everything you have referenced is failure of comunities to not follow NFPA standards. Which industry is that? "the fire service"? If thats the case you have barely scratched the surface of what NFPA does. They have 1,000's of standards, but only about 3 dozzen that have anything to do with the fire service.

2) Yes we do and why? Is because of NFPA or the lack of effort from NFPA? No its because of the U.S. Constitution. Every American has the right to keep the government out of their home (where most fires occur). The Fire Department (read government) may not come into my home and tell me not to do things that are unsafe, or to mandate many things that might save me, my family and my property, They can in most other developped countries. I have the right to be a horder, the right to run extension cords under rugs, the right to leave unattended candles burning, the right to go shopping with food cooking on the stove, but in other countries the FD can come in and fine me for it.

Also in the U.S. our culture is so concerned with short term gain, that we do not worry about next month or next year. Developers fight to not put in safety features to save $$, municipalities want short term development so they generally will let the developpers get away with it.

Also, the US builds most homes of wood, and lots of void spaces. Much of the devellopped countries use NONCOMBUSTABLE materials with few voids.

3) Yes we have a horrible firefighter death rate, but of the of the 81 firefighter LODD in 2012 only 22 were killed during fires, cant really blame NFPA for failure to stop at intersections when responding or heart attacks (since we lead the rest of the world in those also). Its also interesting that 4 of the 5 states (including NY) with the highest LODD have the least training requirements and the lowest use of NFPA standards.

4) Can you define ho-hum? NFPA 703 Standard for Fire Retardent Coatings has been around since 1979 and has been updated 8 times since.

The FIT device is still very contraversal and is unlikely you will see a standard anytime soon since you need to use it in an unihabited space. Currently extingushing systems are either fixed (and warn occupants to get out if hazardous) or are extingushers, which require an operator to be able to see the seat of the fire, FIT is neither.

5) So thats NFPA's fault? NFPA standards require both. If your village, town, city, county or state refuse to follow the standard why is it NFPA's fault? Some communities in NYS wanted mandatory sprinklers. Did the FASNY lobby for this...NO. The state said no...because the building industry lobbied against it. What about inspections in new constructions?

It is required by NYS that ALL new construction must be inspected, so either it is or the municipality is violating state law. Now does your fire dept do this? Most FD's do not do inspections! Is this NFPA's fault?

And we already covered the constitutionality of inspecting existing properties.

6) You see little proof, because clearly you have no idea what NFPA does. While I see some issues with some of their process, it is far from disfunctional. In places that fully accept the Standards, there fire loss is close to zero. To bad most communities and the state are more concerned with many other issues.

[FireMedic049 597]

There needs to be a EMS counterpart to the National FIRE Protection Association that sets basic EMS standards, like the NFPA does for the fire service.

I would tend to agree, but the reality is that this pretty much already exists with medical command, treatment protocols and state oversight agencies.

It should consist of industry professionals and other leaders that focus on EMS. Just because some FD's run EMS doesn't mean they can or should dictate ambulance standards.

However, the fact remains that the fire service is a major player in the world of EMS care and transport and therefore should have a seat at the table for any discussion regarding ambulance standards.

I don't care what percentage of the fire service does EMS, you don't see the police groups setting fire engine standards.

Right, because for the most part the PD doesn't staff and operate fire engines, but firefighters do staff and operate ambulances every day.

[Bnechis 3,961]

There needs to be a EMS counterpart to the National FIRE Protection Association that sets basic EMS standards, like the NFPA does for the fire service.

It should consist of industry professionals and other leaders that focus on EMS. Just because some FD's run EMS doesn't mean they can or should dictate ambulance standards.

I don't care what percentage of the fire service does EMS, you don't see the police groups setting fire engine standards.

Again, not understanding that NFPA is not just fire service

Here is a sample of non-fire standards that NFPA has developped:

NFPA 31 - Standard for Drycleaning Plants

NFPA 40 - Standard for Storage & Handling of Cellulose Nitrate Film

NFPA 50 - Standard for Bulk Oxygen Systems

NFPA 52/57 - Vehicular Gaseous Fuel Systems Code (LNG, LPG, CNG cars & trucks)

NFPA 54 - National Fuel Gas Code (all the natural gas systems)

NFPA 58 - Liquified Petrolium Gas Code

NFPA 70 - National Electric Code (This one covers every single electrical fixture, switch, wire, system, fuse, etc.) And is the only one of its kind in the US.

NFPA 77 - Static Electricity

NFPA 79 - Electrical Standard for Industrial Machinery

NFPA 88A - Standard for Parking Structures

NFPA 90A - Standard for the Installation of Air Conditioning and Ventilation Systems

NFPA 99 - Health Care Facilities Code

NFPA 102 - Standard for Grandstandsm Folding and Telescopic Seating, Tents & Membrane Structures

NFPA 130 - Standard for Transit & Passenger Rail Systems

NFPA 140 - Standard on Motion Picture & TV Production Studios

NFPA 203 - Guide on Roof Coverings & Roof Deck Constructions

NFPA 214 - Standard on water-cooling towers

NFPA 231C - Standard for General Storage

NFPA 241 - Standard for Safeguarding Construction, Alteration and Demolition Operations

NFPA 350 - Guide for Safe Confined Space Entry & Work

NFPA 400 - Hazardous Materials Code

NFPA 410 - Standard on Aircraft MAintenance

NFPA 418 - Standard for Heliports

NFPA 434 - Code for the Storage of Pesticides

NFPA 473 - Standard for Competencies for EMS Personnel Responding to Hazardous Materials/WMD Incidents

NFPA 481 - Standard for the Production, Processing, Handling and Storage of Titanium

NFPA 501 - Standard on Manufactured Housing

NFPA 502 - Standard for Road Tunnels, Bridges, and other limited access highways

NFPA 560 - Standard for the storage, Handling and use of Ethylene Oxide for Sterilization (used for OR instriments)

NFPA 720 - Standard for the installation of Carbon Monoxide Detection & Warning Systems

NFPA 780 - Standard for the installation of Lightning Protection Systems

NFPA 900 - Building Energy Code

Skipping a few hundred

NFPA 1999 - Standard on Protective Clothing for Emergency Medical Operations

Thats a small sample and I did not even touch on the FIRE ones

[sympathomedic 383]

Barry, I truly love you man. I am 100% sure all those codes are very imporant to someone. I respectfully ask that wereroute this thread back to the talk about better ambulance design in the wake of the end of the KKK standards.

[FireMedic049 597]

Barry, I truly love you man. I am 100% sure all those codes are very imporant to someone. I respectfully ask that wereroute this thread back to the talk about better ambulance design in the wake of the end of the KKK standards.

The discussion really isn't off course. Part of the original post asked about a "replacement" for the KKK specs in addition to discussing "better ambulance design". I pointed out that the NFPA had already developed an ambulance standard that is just being rolled out. The validity of the NFPA creating that standard was then called into question by you and that was addressed. I guess you didn't like the answer since you are asking that we get back on course with the thread.

So, if you wish to discuss better ambulance design, then stop bashing the NFPA and the fire service's involvement in EMS and start talking about ambulance design.

[SRS131EMTFF 471]

Does the NFPA standard require the ability to transport two litter bound pts?

[Bnechis 3,961]

Barry, I truly love you man. I am 100% sure all those codes are very imporant to someone. I respectfully ask that wereroute this thread back to the talk about better ambulance design in the wake of the end of the KKK standards.

What I find interesting is that NFPA started working on their ambulance standard before the feds anounced dropping the KKK standard. I was at the Fire Department Safety Officers annual Vehicle Maintenance and Design Conference 2 years ago and they had a whole section on this. They descused the reasons for NFPA getting involved in this standard. They listed a few reasons:

1) The IAFC (International association of fire chiefs) requested it because "a majority of FD's buy ambulances" and "we place our firefighters in fire trucks that meet minimum safe standards, but into ambulances that are very questionable".

2) The ambulance manufacturers (three of the largest were at the conference taking questions) asked NFPA for a standard.

Bill, maybe if EMS had stepped up to the plate years ago they would have a standard, but we have so many examples of where EMS cant or wont step up, you should not be surprised.

I worked in a lot of different ambulances over the years and today how unsafe most were is amazing to me. The 2 driving forces in ambulance design has always been; High end for fire service units and dirt cheap for commercial transport. Yes there are others in the mix, but its a small percentage.

[FireMedic049 597]

Does the NFPA standard require the ability to transport two litter bound pts?

I don't know off hand. I haven't had the opportunity to read the full standard yet.

Regardless of what it says on that, requiring the ability to do so pretty much flies in the face of the safety push we're talking about and it isn't necessarily in the best interests of good patient care. Without some sort of revolutionary change in ambulance design, there's pretty much no practical way to securely transport 2 litter bound patients while affording EMS personnel the ability to care for them while seated and using seatbelts or other such device.

From a patient care perspective and 20 years of experience, if one of the patients requires ALS care whether due to specific injury/illness necessitating intervention or due to treatment protocol, you need at least 2 providers in the back otherwise patient care for one or both suffers. Accounting for a 2nd provider to be seated and restrained further complicates the situation.

With the exception of some volunteer based ambulance services, having more than 2 providers on an ambulance is not a common practice. So where does that 2nd provider in the back during transport come from? Another ambulance, the FD? If you're pulling from another ambulance, then why not just put the 2nd patient in that unit? Is pulling from the FD even a viable option - do they have a trained provider to spare?

IMO, I don't think we are in need of some sort of radical change in ambulance design. The current basic ambulance design is working pretty good and just needs to evolve some. The industry and designs are already evolving and moving towards the "work station" type set up for interior design. The biggest thing that really needs addressed is keeping the provider seated and restrained as much as possible. Developing a crashworthy seating & restraint system that is able to move side to side, forward and back, and pivots in order for the provider to adjust their position relative to the patient and care being provided without having to unbuckle would go a long, long way to accomplishing that.

[wcr20 17]

On a somewhat related note - Pheonix FD (I think it was them) used to use fall-arrester type devices in the back of the ambulances so a standing person would not get tossed around - Was that just an experiment - do they still do that?

[x635 4,066]

I worked in a lot of different ambulances over the years and today how unsafe most were is amazing to me. The 2 driving forces in ambulance design has always been; High end for fire service units and dirt cheap for commercial transport. Yes there are others in the mix, but its a small percentage.

Your FD is kind of in the middle. Does your department require certain ambulance vehicle safety standards in the contract with the provider? And if the NFPA comes out with an NFPA Ambulance standard, will your vendor be required to adhere to it?

[Bnechis 3,961]

Your FD is kind of in the middle. Does your department require certain ambulance safety standards in the contract with the provider? And if the NFPA comes out with an NFPA Ambulance standard, will your vendor be required to adhere to it?

The FD does not have a contract with the vendor, the city does. The City admin. would determine that.