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CEN 1789:2020 is the European Union standard for ambulances and medical transportation vehicles. This European standard specifies requirements for the design, testing, performance and equipping of road ambulances used for the transport and care of patients. This standard is applicable to road ambulances capable of transporting at least one person on a stretcher. [1]
The current version of standard CEN 1789 was published by the Comité Européen de Normalisation (European Committee on Standardization) on October 1, 2020. This replaced an early version of the standard, published in 2007. European standards are generally annotated by the organization, standard number and year of publication (e.g. CEN 1789:2000 or CEN 1789/2007). Within member countries, [2] the annotation is likely to be adapted to include the local standards body, so that in Britain, the 'C' is dropped from the prefix, and replaced with 'BS', in Germany with 'DIN', and so on. Because of the likelihood of significant changes between versions, only the most current version of any standard should be used. The Comité Européen de Normalisation is an agency of the government of the European Union, with membership from the National Standards Body of each participating member country.
While CEN 1789:2020 represents the current European standard for the design of ambulances, it is by no means the only example of such a standard. Standards for ambulance design have existed in the United States since 1976, where the standard is known as KKK-1822-A. [3] This standard has been revised several times, and is currently in version 'F', known as KKK-1822-F. As with the European system, only the most current version of the standard should be used. One of the first known standards for ambulance design occurred in London, England, as the result of efforts by the Metropolitan Asylums Board, acting in response to the cholera outbreak of 1832. While horse-drawn, this provided the actual standard for many of the earliest civilian ambulances around the world. More contemporary versions of ambulance design standards also exist at a local level in Canada, Australia and New Zealand. In each case, the country or jurisdiction develops such standards based upon its own needs, priorities, and realities, and this is also true of the European standard. In some cases, standards compliance may not be planned, and may occur as an incidental result of normal operations. To illustrate, a small country has no domestic ambulance manufacturers, but imports its vehicles from a larger country in which the manufacturer must comply with a published standard. In most cases, the ambulances imported by the smaller country will end up complying with the larger country's standard, regardless of whether or not this outcome was intended. American and Australian standards were reviewed and considered during the development of the European standard, but were not precisely followed because European needs and priorities were different.
The standard is intended to gradually transform the existing 'patchwork' of ambulance design and equipment across Europe into a single set of standards. An ambulance from one country would possess sufficiently common characteristics to be immediately recognizable by the residents of another country. Such vehicles would be similar enough in design to be interchangeable, with emergency medical services personnel from one country able to quickly adapt to the use of a vehicle from another country, if required. Above all, such vehicles would be safe for those being transported in them, [4] those working in them, other users of the road, and the general public.
Requirements are specified for categories of road ambulances based in increasing order of the level of treatment that can be carried out. The standard includes both vehicle type and also engine type and performance characteristics, including vehicle dimensions, acceleration rate, braking capacity, traction control, fire safety, and heating/cooling. [2]
The standard contains ergonomic requirements and design specifications for the patient compartment, [5] and also places practical restrictions on the physical lifting of patients in and out of the vehicle, for safety reasons. Other safety factors addressed include lighting, doors & windows, cabinet securing systems, seatbelt and seat anchorage, seat size & position, and restraint of medical equipment, with provisions for static testing, dynamic and impact testing.
This Standard gives general requirements for medical devices carried in road ambulances and used therein and outside hospitals and clinics in situations where the ambient conditions can differ from normal indoor conditions. [6]
The standard states that medical Devices, equipment and controls which are required while the vehicle is in motion should be positioned so that they can be operated by a paramedic with their seat belt fastened when the vehicle is in motion.
The standard states that crew seating must be fitted with a seatbelt alarm to alert the driver visually or acoustically when someone is seated in the patient compartment but not secured by the seatbelt. [7]
Please note that while the classification is standardized in the European Union, the crew and its abilities are not. The same vehicle may be used differently in varying countries. There are also emergency physician based systems in some European states, often with (non-EU regulated) vehicles with medical equipment and therefore lowering the need for the amount of equipment in the ambulance.
Type A1 is without lights and sirens Type A2 with lights and sirens and can function as emergency ambulances. Generally only used for the non-emergency transportation of patients, either between facilities or between a facility and a residence. The emphasis is on transportation; such ambulances have limited treatment or equipment space. Such ambulances may also be used because of cost by smaller communities, particularly if there is no ALS service.
The most commonly seen type of emergency ambulance. This vehicle type permits increased treatment space and also the ability to store significantly larger amounts of medical equipment. Such vehicles will typically respond independently to emergency calls, providing some level of treatment.
This type of ambulance is commonly seen in the movement of high acuity (ICU) patients between hospitals. It provides adequate space for not only the medical equipment commonly seen in ambulances, but also to accommodate hospital equipment, such as ventilators, during transport. In some locations, vehicles of this design may be used to provide mobile resuscitation services, either supplemented by an emergency physician response, or with the physician as a part of the crew. In Germany, the vast majority of primary emergency ambulances (Rettungswagen) are required to be Type C ambulance without being dedicated to intensive care transports. [8]
All ambulances will be equipped with flashing blue lights, visible for 360 degrees around the vehicle. [9]
All vehicles must also be equipped with an audible warning system (siren) which meets specified standards for both sound pattern and volume.
The Standard specifies that all ambulances will be painted yellow, with specific colour standards, as their primary body colour. [10] The colour yellow was chosen primarily because it remains visible to almost all people in all lighting conditions, including the majority of those with colour-blindness. One ambulance service in Europe that does not conform to the standard is the Scottish Ambulance Service, who use white vehicles with ambulance Battenburg markings.
All ambulances are to be equipped with highly reflective green and yellow 'checkerboard' markings (the English term is 'Battenburg' pattern), of specified proportions, running the entire length of the vehicle. The intent of this measure was to provide specific 'visual identities' for emergency vehicles, by reserving this pattern for ambulances, blue and yellow Battenburg for police cars, and red and yellow Battenburg for fire service vehicles. In addition, all lettering on the vehicle is required to be highly reflective, in order to boost vehicle visibility in all conditions. The colour combination selected was chosen for specific reasons. Under night time conditions, green is among the most visible (exceeded only by blue) of colours, creating high visibility (and safety) for ambulance vehicles. Unfortunately, for many of those who suffer from colour-blindness, neither green nor red is visible, washing out to shades of grey or dark yellow. In fact, almost 99 percent of all colour vision deficiency involves some form of red-green colour blindness, and includes an estimated 7-10 percent of all males, depending on location. [11] However, even for these individuals, the colour yellow is always visible (see diagram). The resulting pattern is both high visibility and eye-catching for the average person, provides improved night time visibility for most, and provides a combination which is identifiable, at least in part, by the majority of the population.
The blue Star of Life, the international EMS emblem, must be painted on both sides and on top of the vehicle. The mark must be a minimum of 500mm in diameter. This requirement may be waived if the ambulance is part of a national affiliate of the International Red Cross and Red Crescent Society. In this case, the Red Cross (or other authorized ICRC emblem) should be used instead. Emblems of the International Red Cross and Red Crescent Movement. This requirement may also be waived if use of the Star of Life emblem is restricted by local law. The standard also calls for the Star of Life to be used on EMS clothing and apparel. [12]
The vehicle must be marked with the English word "AMBULANCE" and/or the equivalent word in the local language. The text must utilize capital letters, have a letter height of at least 100mm, and the letters must contrast with the background colours. [12]
As with most European standards, compliance by the member countries of the European Union is purely voluntary, and to be determined at the level of the member country, usually by means of legislation, or by its own standards organization. [13] To illustrate, this standard, which has been accepted by the United Kingdom, is known locally as BS EN 1789:2007, with the 'BS' referring to British Standards. As a result, the adoption of this standard has varied considerably from one country to another. Most countries, for example, have adopted the sections dealing with vehicle design and performance, while only a few (the UK, Ireland, and Sweden at this writing), have fully adopted the colour, warning system, and livery schemes for such vehicles. To further complicate matters, some countries have adopted some portion of the visual identity standards, but not all. In the Netherlands, Belgium, and some parts of Germany, the conversion to the basic identifying colour (yellow) is occurring, but the balance of visual identity provisions are not. In addition, some countries which are not currently members of the European Union, such as Norway are adopting some portions of the standards, primarily because few other good standards exist for this purpose, particularly those that reflect European realities. The rate and degree of compliance with the standard is a conscious choice by individual countries, while in others, compliance is a matter of the priorities for the changing of older, country specific, legislation. As previously stated, compliance with the standard is purely voluntary. There are no untoward financial implications to compliance, since only ambulances purchased after ratification of the standard by each country are required to be compliant. There is no mandatory provision for the retrofitting of existing ambulances.
An ambulance is a medically equipped vehicle which transports patients to treatment facilities, such as hospitals. Typically, out-of-hospital medical care is provided to the patient during the transport.
A school bus is any type of bus owned, leased, contracted to, or operated by a school or school district. It is regularly used to transport students to and from school or school-related activities, but not including a charter bus or transit bus. Various configurations of school buses are used worldwide; the most iconic examples are the yellow school buses of the United States which are also found in other parts of the world.
The Star of Life is a symbol used to identify emergency medical services. It features a blue six-pointed star, outlined by a white border. The middle contains a Rod of Asclepius – an ancient symbol of medicine. The Star of Life can be found on ambulances, medical personnel uniforms, and other objects associated with emergency medicine or first aid. Elevators marked with the symbol indicate the lift is large enough to hold a stretcher. Medical bracelets sometimes use the symbol to indicate one has a medical condition that emergency services should be aware of.
Type approval or certificate of conformity is granted to a product that meets a minimum set of regulatory, technical and safety requirements. Generally, type approval is required before a product is allowed to be sold in a particular country, so the requirements for a given product will vary around the world. Processes and certifications known as 'type approval' in English are generally called 'homologation', or some cognate expression, in other European languages.
Emergency vehicle lighting, also known as simply emergency lighting or emergency lights, is a type of vehicle lighting used to visually announce a vehicle's presence to other road users. A sub-type of emergency vehicle equipment, emergency vehicle lighting is generally used by emergency vehicles and other authorized vehicles in a variety of colors.
Emergency vehicle equipment is any equipment fitted to, or carried by, an emergency vehicle, other than the equipment that a standard non-emergency vehicle is fitted with.
A nontransporting EMS vehicle, also known as a squad car, fly-car, response vehicle, quick response service (QRS) vehicle, or fast response vehicle, is a vehicle that responds to and provides emergency medical services (EMS) without the ability to transport patients. For patients whose condition requires transport, an ambulance is necessary. In some cases they may fulfill other duties when not participating in EMS operations, such as policing or fire suppression.
Emergency medical services in Canada are the responsibility of each Canadian province or territory. The services, including both ambulance and paramedic services, may be provided directly by the province, contracted to a private provider, or delegated to local governments, which may in turn create service delivery arrangements with municipal departments, hospitals or private providers. The approach, and the standards, vary considerably between provinces and territories.
Emergency medical services in France are provided by a mix of organizations under public health control. The central organizations that provide these services are known as a SAMU, which stands for Service d’aide médicale urgente. Local SAMU organisations operate the control rooms that answer emergency calls and dispatch medical responders. They also operate the SMUR, which refers to the ambulances and response vehicles that provide advanced medical care. Other ambulances and response vehicles are provided by the fire services and private ambulance services.
Emergency Medical Service in Germany is a service of public pre-hospital emergency healthcare, including ambulance service, provided by individual German cities and counties. It is primarily financed by the German public health insurance system.
Emergency medical services in Norway are operated both by the government and private organizations such as the Norwegian People's Aid, the Norwegian Red Cross and commercial transportation companies. In most circumstances, emergency ambulance service is organized by a local Health Trust, and may be operated directly, or contracted to private providers, such as national transportation companies, for which ambulances are just a part of their business operations. Private organisations are also used frequently by the police in search & rescue operations.
Battenburg markings or Battenberg markings are a pattern of high-visibility markings developed in the United Kingdom in the 1990s and currently seen on many types of emergency service vehicles in the UK, Crown dependencies, British Overseas Territories and several other European countries such as the Czech Republic, Iceland, Sweden, Germany, Romania, Spain, Ireland, and Belgium as well as in New Zealand, Australia, Hong Kong, Trinidad and Tobago, and more recently, Canada. The name comes from its similarity in appearance to the cross-section of a Battenberg cake.
Emergency medical services in Italy currently consist primarily of a combination of volunteer organizations providing ambulance service, supplemented by physicians and nurses who perform all advanced life support (ALS) procedures. The emergency telephone number for emergency medical service in Italy is 118. Since 2017 it has also been possible to call by the European emergency number 112, although this is a general police/fire/medical number.
Emergency medical services in the Netherlands is a system of pre hospital care provided by the government in partnership with private companies.
Ambulance Services in Hong Kong are provided by the Hong Kong Fire Services, in co-operation with two other voluntary organisations, the Auxiliary Medical Service and the Hong Kong St. John Ambulance.
Emergency medical services in Australia are provided by state ambulance services, which are a division of each state or territorial government, and by St John Ambulance in both Western Australia and the Northern Territory.
State Medical Rescue in Poland is a system of free public emergency healthcare established by Ustawa o Państwowym Ratownictwie Medycznym, including ambulance service and Emergency Departments (EDs). While in Polish public hospitals and clinics NFZ common public insurance is required, PRM medical services in ambulances and EDs are completely free for everyone. Since 2018 emergency ambulances that operates in PRM, that is Polish 112 and 999 emergency numbers, are operated by public entities only.
The National Ambulance Service is the statutory public ambulance service in Ireland. The service is operated by the National Hospitals Office of the Health Service Executive, the Irish national healthcare authority.
Emergency Medical Service in Austria is a service of public pre-hospital emergency healthcare, including ambulance service, provided by individual Austrian municipalities, cities and counties. It is primarily financed by the Austrian health insurance companies.
Air medical services are the use of aircraft, including both fixed-wing aircraft and helicopters to provide various kinds of medical care, especially prehospital, emergency and critical care to patients during aeromedical evacuation and rescue operations.