public review draft minimum ground ambulance requirements · draft kenyan standard ks2469:2012 4 1....

DRAFT KENYAN STANDARD KS2469:2012

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PUBLIC REVIEW DRAFT

Minimum ground ambulance requirements

© KEBS 2012 First Edition 2012

KENYA BUREAU OF STANDARDS


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TECHNICAL COMMITTEE REPRESENTATION

The following organizations are represented on the technical Committee:

Ministry of Medical services Ministry of Public Health and Sanitation Ministry of state for special programmes National Disaster Operations Centre Kenya Police (traffic department) AAR Kenya Red Cross St. John Ambulance Kenya Council for Emergency Medical Technicians Center for Disease Control and prevention Avenue Rescue services


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Foreword This Kenya Standard was prepared by the ---- Technical Committee under the guidance of the Standards Projects

Committee, and it is in accordance with the procedures of the Kenya Bureau of Standards


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1. Scope

This standard establishes the minimum requirements for performance, design, testing, operation and equipping of emergency medical services (EMS) Ground ambulances used for out-of-hospital medical care and patient transport. It contains requirements for the patient’s compartment.

It does not cover the requirements for approval and registration this is the responsibility of the relevant authority/authorities in the country where the ambulance is to be registered. Requirements are specified for categories of road ambulances based in increasing order of the level of treatment that can be carried out.

The Standard is applicable to road ambulances capable of referring at least one person on a stretcher.

1.2 Purpose The purpose of this document is to establish minimum specifications, performance parameters and essential criteria for the design of ambulances and to provide a practical degree of standardization. The main objective of this standard is to provide ambulances that are nationally recognized, properly constructed, easily maintained, and, when professionally staffed and provisioned, will function reliably in all phases of pre-hospital

2 Normative references

The documents or portions thereof listed in this chapter are referenced within this standard and shall be considered part of the requirements of this document. For dated references, only the edition cited applies. For undated references, the latest edition of the referenced document (including any amendments) applies.

EN 1789:2007 – Medical vehicles and their equipment – Road ambulance NFPA 1917 - Standard for Automotive Ambulances KCEMT training manual Federal specification for the star of life Ambulance Minimum norms and standards for private ambulance services

3. Terms and definitions

3.1 Shall means a must.

3.2 patient

Person whose condition requires appropriately trained personnel to provide medical care and/or suitable transport

3.3 emergency patient Patient who through sickness, injury or other circumstances is in immediate or imminent danger to life unless emergency treatment and/or monitoring and suitable transport to diagnostic facilities or medical


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treatment is provided

3.4

ambulance

A vehicle used for emergency medical care that provides a driver’s compartment; a patient compartment to accommodate an emergency medical services provider (EMSP) and at least one patient located on the primary cot so positioned that the primary patient can be given intensive life-support during transit; equipment and supplies for emergency care at the scene as well as during transport; safety, comfort, and avoidance of aggravation of the patient’s injury or illness; two-way radio communication; and audible and visual traffic warning devices.

3.5 compartment.

3.5.1 enclosed Compartment An area designed to protect stored items from environmental damage (weather resistant) that is confined on six sides and equipped with an access opening(s) that can be closed and latched.

3.5.2 Patient Compartment The portion of the ambulance aft of the cab

3.5.2.1 type I Patient Compartment The modular body area added on behind the cab

3.5.2.2 type II Patient Compartment The body area beginning immediately behind the forward bulkhead

3.5.2.3 type III Patient Compartment The modular body area added on behind the cab

3.6 seat 3.6.1 child Restraint Seat

A seat capable of transporting a child 66 lb or less in accordance with FMVSS 213and mounted in accordance with the seat manufacturer’s recommendation.

3.6.2 infant Restraint Seat


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A seat capable of transporting an infant 22 lb or less in accordance with FMVSS 213 and mounted in accordance with the seat manufacturer’s recommendation.

3.7 side Entry Door The body door on the side of the ambulance body that provides entry into the patient compartment and through which patients may be loaded/unloaded

3.8 sign A visual indication whether in pictorial or word format that provides a warning to the operator or other persons near the ambulance

3.9 striker

A mechanical device with which the latch engages on the opposing member of the body framework

3.10 Switch Any set of contacts that interrupts or controls current flow through an electrical circuit

3.11 turning Clearance Radius One-half the larger of the left or right full circle wall-to-wall turning diameter

3.12 Weight 3.12.1 curb Weight The total weight of the complete ambulance less the payload. The curb weight includes such items as the chassis; cab; body; batteries; spare tire; jack tire changing tools; and any other permanently attached or dedicated equipment along with a full complement of fuel, lubricants and coolant.

3.12.2 estimated In-Service Weight The amount that the ambulance manufacturer estimates the ambulance will weigh when it is placed in service with all fixed and portable equipment installed, all tanks full, and all personnel seating positions occupied.

3.12.3 in-Service Weight The maximum actual vehicle weight under any conditions of mobile operation sometimes referred to as gross vehicle weight.

3.13


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weight Rating

3.13.1 Gross Axle Weight Rating (GAWR) The final stage manufacturer's specified maximum load-capacity of an axle system, as measured at the tire-ground interfaces

3.13.2 gross combination weight rating (GCWR) The final stage manufacturer’s specified maximum loaded weight for a combination (articulated) vehicle consisting of a tow vehicle and one or more towed units.

3.13.3 gross vehicle weight rating (GVWR) The final stage manufacturer’s specified maximum load carrying capacity of a single vehicle.

3.13.4 wet location A non sheltered location inside a compartment with a door or cover that, while open, exposes the electrical enclosure or panel board to the same environmental conditions as the exterior of the ambulance. A location on a non enclosed, exterior surface of a ambulance body or driving and crew compartment where the enclosure or panel is exposed to the environment.

3.14 levels of ground ambulances

3.14.1 level A: Advanced life support road ambulance designed and equipped for the transport, advanced treatment and monitoring of patients

3.14.2 level B: Intermediate life support road ambulance designed and equipped for the transport ,limited invasive treatment and monitoring of patients

3.14.3 level C: Basic life support road ambulance designed and equipped for the transport, basic treatment and monitoring of patients

3.15 net vehicle mass unloaded mass vehicle mass according to 92/21/EEC modified of the road ambulance including the driver taken as 75 kg and all fixed installations NOTE:- Loose portable patient handling, sanitary, medical and technical equipment are not included in net vehicle mass.


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3.16 permissible gross vehicle mass permissible total mass vehicle mass comprising the net vehicle mass, the mass of sanitary, medical and technical equipment, the mass of passengers, taken as 75 kg per person, and any reserve mass

3.17 loading capacity difference between the gross vehicle mass and the vehicle mass NOTE:- This represents the mass that may be distributed on the road ambulance such that the permissible axle loads are not exceeded.

3.18 fixation system system or device to ensure the permanent fixation of medical devices or other equipment into the ambulance

3.19 maintain system bracket or other interface device used to secure a mobile or transportable item of equipment or medical device of the vehicle without the use of tools

3.20 authority having jurisdiction (AHJ). An organization, office, or individual responsible for enforcing the requirements of a code or standard, or for approving equipment, materials, an installation, or a procedure

3.21 labeled Equipment or materials to which has been attached a label, symbol, or other identifying mark of an organization that is acceptable to the authority having jurisdiction and concerned with product evaluation, that maintains periodic inspection of production of labeled equipment or materials, and by whose labeling the manufacturer indicates compliance with appropriate standards or performance in a specified manner.

3.22 listed Equipment, materials, or services included in a list published by an organization that is acceptable to the authority having jurisdiction and concerned with evaluation of products or services, that maintains periodic inspection of production of listed equipment or materials or periodic evaluation of services, and whose listing states that either the equipment, material, or service meets appropriate designated standards or has been tested and found suitable for a specified purpose.

3.23 Types of Ambulances

3.23.1 type a1 basic life support suitable for transport of single patient

3.23.2 type a2 basic life support suitable for transport of one or more patient(s) (on stretcher(s)/chair(s))


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3.23.3 type b intermediate

3.23.4 type c advanced life support Abbreviations OEM- Original Equipment Manufacturer

4 Requirements 4.1 General requirements The road ambulance shall comply with the requirements ambulances or corresponding national requirements for approval of vehicles.

Road ambulances equipment shall, when operated in normal use and maintained according to the instructions of the manufacturer, because no safety hazard which could reasonably be foreseen using risk management procedures and which is connected with their intended application, in normal condition and in single fault condition.

Annex B and C give an example of "test summary" and "certificate of compliance".

All vehicles intended for ambulance use shall have a:- a) Current and valid provincial motor vehicle registration and inspection certificate according to highway traffic act. b) Be main trained in good and safe mechanical condition and repair

4.2 Maximum overall dimensions

4.2.1 Length Overall length of the ambulance (OAL) shall be specified by the purchaser, including bumpers, rear step and bumper guards. 4.2.2 Width The overall width of ambulance bodies having dual rear wheels shall be a maximum of 96", excluding mirrors, lights, and other safety appurtenances. The ambulance body sides, on a chassis with dual rear wheels, shall be symmetrical and within +/- 2.5" of the overall width of the tires (outside sidewalls). The 2.5" allowance is not cumulative; it applies individually to each side. Tires shall not extend beyond the fenders.

4.2.3 Height The purchaser shall specify the overall height of the ambulance when loaded to curb weight. This includes roof-mounted equipment, but excludes two-way radio antenna(s).

4.2.4 Bumper and Steps


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Patient Compartment Side Door Step (a) The side entrance to the patient compartment shall include a stepping surface that is at least 200 mm deep from edge to riser. (b) The step shall be positioned approximately halfway between the ground and the finished floor of the ambulance, or a second fixed or retractable step must be provided.

4.2.5 Rear Step Bumper (a) A step bumper shall be located at the rear doors of the ambulance. (b) The rear step shall be positioned so that the stepping surface is approximately halfway between the ground and the finished floor of the ambulance. A safety grating step shall run the width of the rear door opening, be at least 240 mm deep and pivot to permit ambulance attendants to move closer when loading and unloading a cot. The rear bumper, rear step and any step at the curbside or cab entrances, whether fixed or retractable, must meet the approvals of the KBS

4.3 Wheel arch clearance Vehicle converters shall maintain the minimum wheel arch clearance specified by the chassis manufacturer.

4.4 Performance 4.4.1 Acceleration A road ambulance loaded to permissible gross vehicle mass shall be able to accelerate from 0 km/h to 80 km/h within 35 s.

4.4.2 Braking An original equipment manufacturers anti-lock braking system shall be fitted.

4.4.3 Safety system The vehicle should be fitted with a control system for stabilization and a passive safety system. NOTE :Examples of a control system for stabilization are an electronic brake distribution system and traction control.

Examples of a passive safety system could be an air bag, a collapsible steering column and an energy absorbing body structure.’

4.4.4 Fuel system


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The fuel system shall conform to all applicable NEMA requirements. The fuel system components shall be installed, connected, and routed in accordance with all Manufacturers guidelines. A permanent label at the fuel filler opening shall be furnished specifying the specific type of fuel required.

4.4.5 Suspension Vehicle shall be equipped with laterally matched sets (front and rear) of spring, torsion, or air suspension system components. Components shall have a rated capacity in excess of the load imposed on each member. Only corrections permitted by the Manufacturers’ to compensate for lean due to normal spring tolerance variations are permitted. Correction of lean due to imbalance is not permitted.

4.4.6 Shock absorbers Shock absorbers, double-acting type, heaviest duty available from the Manufacturer for model offered, shall be furnished on the front and rear axles.

4.4.7 Wheels Wheels shall conform to the recommendations of the vehicle manufacturer, and shall be identical in type, size, and load rating for all wheels on the ambulance.

4.5 Electrical requirements 4.5.1 General The vehicle shall be fitted with a visual and audible warning system to assist emergency passage.

4.5.2 Electromagnetic compatibility (EMC) 4.5.2.1 General To minimise any risk to the safe operation of the complete ambulance and any of the equipment operated on or in the vehicle from the effects of electromagnetic influences created by the vehicle or its equipment.

The complete operational vehicle shall consist of components, equipment or sub systems that are certified as conforming to the respective industry EMC regulations.

4.5.2.2 Communication equipment Communication equipment (e.g. radio installation) shall comply with national regulations.


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4.5.2.3 Electric/electronic system and components The vehicle’s electric/electronic system, components, sub systems and all permanently fixed equipments shall be e-marked

4.5.3 Battery and alternator Batteries shall be positioned to allow maintenance without removing the battery from its securing device. The construction of the battery and all connections to it shall be such as to prevent any possibility of an inadvertent short circuit. All Ambulances shall have 2 batteries (one for normal operations of the vehicle engine and the other for additional ambulance equipment. The characteristics of starter batteries shall comply with Table 1. The characteristics of additional batteries, if fitted, shall comply with Table 1. The characteristics of the alternator shall comply with Table 1.

Table 1 — Minimum capacity/power

Type of Ground ambulance

A1 A2 B C Starter battery(ies)

Nominal voltage 12 V

54 Ah

54 Ah up to 4 seats and 80 Ah more than 4 seats in the compartment

80 Ah

80 Ah


–

–

63 Ah (2 � 12

V)

63 Ah (2 � 12

V) Additional b battery(ies)


–

–

80 Ah a

80 Ah


– – 63 Ah a (2 � 12 V)

63 Ah (2 � 12

V)

Alternator power 700 W 700 W 1 200 W 1 200 W

a Recommended for special operational conditions. b Additional batteries shall have high cyclic stability (e.g. gel batteries) and of a sealed type.

NOTE 2 :-when the engine is idling electrical stability should be maintained between electrical load and alternator output. In order to achieve this it may be necessary to fit an electrical load prioritisation device to the vehicle.

4.5.4 Electrical installation


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4.5.4.1 In class B and C road ambulances there shall be a recessed externally mounted power connector to enable external power to be provided for operations such as the following:

a) charging battery (ies);

b) operating medical devices, when installed;

c) operating a patient compartment heater, when installed;

d) operating an engine preheated, when installed.

The connector for 220 V or 240 V shall be a f emale connector and not interfere with the electrical and mechanical safety.

It shall be not possible to start the engine whilst it is connected to an external 220/240 V power supply unless an automatic mechanical disconnection is fitted.

If no automatic mechanical disconnection is fitted, the connector shall be on the driver’s side.

The 220 V or 240 V circuit shall be protected either by an "earth leakage device" with a maximum setting of 30 mA or by a separate transformer. If the protection is given only by an "earth leakage device" there shall be a label near the plug that reads as follows: "CAUTION! CONNECT ONLY TO AN AUTHORISED SOCKET."

4.5.4.2 The patient’s compartment shall be fitted with the minimum number of connections as given in Table 2. For these connections a permanent power supply shall exist.

Table 2 — 12 V connections for medical devices in patient’s compartment

Type of ground ambulances’

A B C Minimum number of connections

2 2 4

4.5.4.3 Any additional electrical systems fitted to the base vehicle shall be separate from the base vehicle electrical system and the body or chassis shall not be used as an earth return for additional circuits.

All circuits in the additional system(s) shall have separate overload protection). All circuits shall be well defined and cables clearly marked at the connection points and at a maximum of 1m intervals along its length.

The system shall have enough circuits and be so constructed that when/if a circuit fails all illumination and medical technical equipment can be switched to an alternative power source.

4.5.4.4 The wiring and, where applicable conduits, shall withstand vibrations. No wiring shall be


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located in or pass through conduit intended for medical gas installation. The wiring shall not be loaded higher than that stated by the wire manufacture.

4.5.4.5 Where there are different voltage systems, the connections shall be non-interchangeable.

4.6 Vehicle body 4.6.1 Fire safety All interior materials shall have a burning rate of less than 100 mm/min when tested

4.6.2 cab-body driver compartment and equipment All cab compartments shall be of sufficient size to accommodate a driver and passenger, with space to perform driving and control activities. The cab shall be organized and designed with the specified and required equipment and accessories for ease of operation and safety. There shall be a console convenient to driver in the drivers cab. The console shall contain all added switches for operation of the ambulance.

4.6.3 cab-body provisions An OEM two door cab shall be furnished that is suitable for the subsequent mounting of various ambulance equipment and bodies. Driver’s cab section shall provide:

a) Forward hinged doors. b) Opening side windows. c) Door stops. d) External key operated door locks with two sets of keys. e) Trim or closed panels and headliner (washable vinyl upholstery, or flooring type materials). f) Floor covering (OEM’s heat, noise and appearance trim packages). g) Panel mounted instruments. h) n. All exposed interior surfaces shall be painted. i) Armrests, mounted on each side door.

j) Key operated ignition/starter switch. k) Fuel gauge(s). l) Oil pressure gauge. m) Engine temperature gauge. n) Speedometer with odometer. o) Environmental controls (heater-defroster/air conditioner, etc.). p) Type II Seatbelts and shoulder harness for driver and passenger. q) Cab lighting and controls. r) Dual electric horn(s).

4.6.4 Driver's seat configuration For all types of road ambulances the ergonomic space of the driver’s compartment and of the seat adjustment as approved by the base vehicles manufacturer shall not be reduced.


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4.6.4.1 Cab compartment driver and passenger seat The driver’s compartment shall be OEM two individual bucket-type seats (driver and passenger). The seats shall be frame constructed with cushioned springs or foam rubber, padded and upholstered to provide riding comfort. The seats shall be covered with fire-retardant, washable, nonabsorbent material. Driver’s seat shall have the OEM’s full, unobstructed seat track travel range of longitudinal adjustment, and a minimum of 30% of the range of inclination, but not less than the angle furnished on the OEM’s standard non-reclining high back seat.

4.6.4.2 Controls and operating mechanism All controls and operating mechanisms shall be located for right-hand drive. Lever controls, equipment, items, and devices shall be installed, located, and stowed for the convenience of the purpose intended and shall not interfere with the EMSP or patient’s ingress or egress of respective compartments.

4.6.4.3 outside rearview mirrors Dual rearview OEM mirrors having a combination flat/convex mirror system, shall be furnished. The mirrors shall be the largest available from the OEM. When available from the OEM, all four mirror head faces shall be independently adjustable. Hardware and mirror heads shall have a corrosion resistant exterior finish.

4.6.4 Minimum loading capacity The minimum loading capacity shall be in accordance with Table 3.

Table 3 — Minimum loading capacity (persons)

Type ofground ambulance

A B C Number of seats and/or stretcher facilities (in addition to the drivers seat)

2

3

3

a With two stretchers.

4.6.5 Bulkhead

A full bulkhead or a bulkhead with a door shall separate the driver’s compartment from the patient’s compartment. Where a door is fitted, it shall not be possible to drive the vehicle with the door in the open position. This door shall be secured against opening if the road ambulance is in motion.

One or two laminated windows with a minimum separation of 100 mm shall be provided in the bulkhead. The windows shall allow direct visual contact with the driver. The opening area of the window shall have a maximum area of 0,12 m². It shall be secured against self-opening and shall


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have an adjustable blind or other means of preventing the driver being disturbed by the light of the patient’s compartment.

4.6.6 Openings (doors, windows, emergency exits) 4.6.6.1 General There shall be a minimum of two openings – one at the rear (door/tailgate) and one at the side (door/window) of the patient’s compartment.

All openings shall have seals to protect against the ingress of water.

All openings shall comply with the minimum dimensions provided by the original manufacturer.

4.6.6.2 Doors

Each external door of the patient’s compartment shall be fitted with a security system which enables the following:

a) lock and unlock from inside without use of a key

b) lock and unlock from outside with use of a key

c) unlock from the outside using a key when the door is locked from the inside. d) Each door shall have suitable hold open devices for the type and size of door and door stops to

prevent damage to body sides.

e) Each door shall have effective seals to prevent water leakage or carbon monoxide intrusion and to reduce siren and road noise intrusion.

f) The rear door(s) shall provide a minimum clear opening of 1120mm x 1270mm. Dual rear doors

with vertical hinges shall open to a minimum door angle of 150 degrees.

The curbside door opening shall be of sufficient size to accommodate the emergency removal of patients on both cots

NOTE:-This security system may be integrated with an optional central locking system.

The patient’s compartment doors shall be capable of being positively restrained in the open position.

An audible and/or visual signal shall warn the driver when any door is not completely closed when the vehicle is in motion.

4.6.6.3 Windows

In the patient’s compartment, there shall be a minimum of two external windows. There shall be one on each side or one on one side and the rear.


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The windows shall be positioned or screened to ensure patient’s privacy when required. Windows shall be made of laminated material.

4.6.7 Loading area

The loading area dimensions shall be in accordance with Table 5.

Table 4 — Loading area dimensions Type of ground ambulance

A1

A2

B C

Tailgate height (in the open H2 minimum position)

(see Figure 1) a

1

800

mm

1

800

mm

1

900

mm

1

900

mm

Loading angle (stretcher) maximum 16° b 16° b 16° b 16° b

Loading height (stretcher) When the patient is manually loaded or unloaded on the stretcher, the centre of the stretcher handles shall be no more than 825 mm above ground level. The maximum height of either the floor or the loading holding assembly above ground level shall not exceed 750 mm at net vehicle

a From ground to lowest point of fully opened tailgate at gross vehicle mass. b The loading angle shall be kept as low as possible.

Where a ramp or lift is installed between ground level and vehicle floor level it shall be covered with a anti-slip surface and capable of taking a constant load of 350 kg. In the event of a power failure the loading device shall be capable of being operated manually.

Figure 1 — Tailgate height (in the open position)


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4.7 Patient’s compartment 4.7.1 General

4.7.1.1 The patient’s compartment shall be designed and constructed to accommodate all medical devices in accordance with the vehicle type.

4.7.1.2 The ceiling, the interior side walls and the doors of the patient’s compartment shall be lined with a material that is non-permeable and resistant to disinfectant.

4.7.1.3 The edges of surfaces shall be designed and/or sealed in such a way that no fluid can infiltrate. If the floor arrangement does not allow fluids to flow away, one or more drain with plugs shall be provided.

4.7.1.4 Exposed edges that could come into contact with the occupant's hands, legs, head etc., during normal use shall have a radius of curvature of not less than 2,5 mm except in the case of projections of less than 3,2 mm, measured from the panel. In this case, the minimum radius of curvature shall not apply provided the height of the projection is not more than half its width and its edges are blunted.

4.7.1.5 All installations in the patient compartment above 700 mm shall not have sharp exposed edges and shall terminate in rounded edges. A sharp exposed edge is defined as an edge of a rigid material having a radius of curvature of less than 2,5 mm.

4.7.1.6 Edges that can be contacted by using the apparatus and procedure described in 5.4 shall have an edge with radius of curvature greater than or equal to 2,5 mm or shall be made from a non-rigid material. Medical equipment and their holding devices (for example stretchers, platforms, suction units etc.) are excluded.

4.7.1.7 Drawers should be secured against self-opening and where lockers are fitted with doors that open upwards they should be fitted with a positive hold open mechanism. Type B and C road ambulances shall be equipped with a lockable drugs compartment with security lock.

4.7.1.8 Floor coverings shall be chosen that will provide adequate grip for the attendant including when wet and should be durable and easy to clean.

4.7.1.9 Type B and C ground ambulances shall be fitted with a hand-holding device positioned above the stretcher. For type C the hand-holding device shall be positioned along the longitudinal axis.

4.7.1.10 If the patient’s compartment is to be equipped with a non-foldable sedan chair, space shall be provided with a width of at least 600 mm measured at elbow height and a ceiling height above the seat squab of at least 920 mm (see Table 7, footnote a).

4.7.1.11 Vehicle maintenance equipment (e.g. spare wheel and tools) shall not be accessible from within the patient’s compartment.


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4.7.1.12 The dimensions relate to the patient's compartment with lining. To achieve only structural solidity a reduction of the dimensions of up to 5 % is acceptable in limited areas; door openings excluded.

4.7.1.13 The ambulance body and patient compartment shall be sufficient in size to transport occupants and all specified stretchers, cots, and litters. There shall be space around the patient(s) to permit an EMSP to administer life support treatment to the primary patient during transit. 4.7.1.14 The ambulance and body bulkheads shall have an aligned window opening of at least 150 sq. in., for visual checking and voice communications between the cab and the patient’s compartment for non walk through vehicles. The window in the cab or body shall be of the sliding type, shall be aligned, and connect with the modular body window opening and shall conform to requirements of the partition. The window shall be latchable from the cab side and shall be an adjustable, transparent, shatterproof panel. 4.7.1.15 The EMSP shall be provided with a seat conforming to all applicable Kenyan Standards, and be equipped with a safety belt and a padded back and a padded headrest. The seat shall be not less than 15" deep by 18" wide and a minimum distance of 43" from the top of the padded seat to any overhead obstruction. The EMSP seat shall be located to allow for the care of the primary patient. 4.7.1.16 The patient compartment shall provide a minimum of 325 cubic feet of space (275 cubic feet of space for a Type II), less volume for cabinets, while complying with the following:

a) The length measured from the partition to the inside edge of the rear loading doors at the floor, shall be at least 122". The compartment configuration shall provide at least 25" of unobstructed space at the head of the primary patient, measured from the face of the backrest of the EMSP seat to the nearest edge of the cot. A minimum of 10" shall be provided, from the rear edge of the cot mattress to the rear loading doors, to permit clearance for traction or long board splints.

b) The compartment shall provide a minimum of 12" of clear aisle walkway between the edge of the primary patient cot and base of the nearest vertical feature measured along the floor.

c) The patient compartment shall provide at least 60" height, over the primary patient area, measured from floor to ceiling panels.

4.7.1.17 Patient’s compartment dimensions for level A, B and C ground ambulances

The patient’s compartment shall comply with the minimum dimensions set out in Figures 2 to 4 (without cupboards, seats, medical devices and equipment).

W = width measured from RH-side to LH-side, except the roof curvature;

L = length measured from rear to bulkhead at height of stretcher;

H = height, measured from floor to roof;

X = height of stretcher holding assembly to roof measured in the middle of the longitudinal axis


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of the stretcher; h1 = height between centre of seat and roof;

h2 = height between centre of seat and floor covering.

Figure 2 — Patient's compartment dimensions for type A1 (schematic)

Dimensions in millimetres


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a Dimensions for Type A2 with more than four seats in the patient’s compartment. The length (L)

shall be 3 100 mm, width (W) 1 500 mm. From a heights of 1 500 mm to 1 750 mm the sides shall have a radius no greater than 250 mm. The height (H) shall be 1 750 mm.

Figure 3 — Patient's compartment dimensions for type A2 (schematic)


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a Area I

When it is necessary to facilitate emergency treatment there shall be a minimum of 500 mm between the lining of the bulkhead and the head-end part of the stretcher frame or stretcher platform measured in the mid-axis and at the height of the stretcher. A minimum height of 1 600 mm shall be provided.

Area II A minimum height of 1 600 mm shall be provided. Area III

A flat and horizontal surface of a minimum length of 400 mm shall be provided alongside the stretcher from the head-end part of the stretcher frame. A minimum height of 1 300 mm shall be provided.

Figure 4 — Patient's compartment dimensions for type B (schematic)


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4.7.1.18 Patient’s compartment and treatment area dimensions for type C

In type C road ambulances the patient’s compartment shall be large enough to incorporate the

treatment area provided with dimensions as set out in Figure 5. Any protrusions into the treatment area shall be designed and constructed to fold away to provide these minimum dimensions. A seat (in stored position) and the medical technical equipment operated from this seat may intrude into the treatment area as follows:

• in this case the maximum intrusion shall be 125 mm at the head end of the

stretcher

• or 125 mm on one side or a sum of 125 mm on both sides. Verification of conformity of dimension of the treatment area shall be made when the stretcher is placed in the mean position of the treatment area.

h = A working height of the stretcher surface (excluding mattress) between 400 mm (minimum) and 650 mm (maximum) shall be ensured.

R = 500 mm (maximum), where R is the radius.

Dimensions in millimetres


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a Reduced (25 mm maximum) in the roof area over the stretcher.

b Where the height of the wheel arch exceeds 400 mm, the clearance width between the wheel

arches above 400 mm shall not be less than 1 250 mm.

Figure 5 — Treatment area dimensions for type C

4.7.2 Protection of patients and crew Upholstered padding/cushions shall be provided at the upper interior areas of the doorframes.

4.7.3 Floor coverings and color


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Floor covering shall be easily cleaned, sanitized, and harmonize with the interior color and décor of the patient compartment. The floor covering shall be seamless, one piece, no wax type, solid linoleum, vinyl, or poured epoxy or acrylic not less than 1/16" thick and permanently applied to the sub floor. The floor material shall cover the entire length and width of the compartment’s working area. The covering of joints (corners, etc.), where the sidewalls and covering meet, shall be sealed and bordered with corrosion resistant cove molding or the covering shall extend at least 3" up the sidewalls.

4.7.4 Bulkhead/ partition for type ii, iii, and iii ad vehicles A full height and width partition or bulkhead (with or without compartments), with a walkthrough opening with a door shall be placed between the driver and patient’s compartment. This partition shall be located directly behind the driver and companion seats when in the rearmost position. The partition shall be secured on the sides, ceiling, and floor by welding or bolting to tapping plates.

4.7.5 Door / walkthrough for type ii, iii, and iii ad vehicles The door opening shall be at least 17" wide and 46" high and shall provide an aisle between the compartments. The door shall have at least a 150 sq. in., transparent, shatterproof viewing panel in the center section at the driver’s eye level. The door shall be secured with a driver’s side self-latching device in the open and closed positions.

4.7.6 Insulation The entire body, sides, ends, and roof of the patient’s compartment shall be completely insulated to enhance the performance of the environmental systems and prevent external noise from entering the vehicle interior. The insulation shall be a non-settling type, vermin-proof, mildew-proof, fire retardant, non-toxic, and non-hygroscopic. If fiberglass insulation is used, it shall not be exposed to water, e.g. door panels.

4.7.7 Interior surfaces The interior of the body shall be free of all sharp projections. All hangers or supports for equipment and devices shall be mounted as flush as possible with the surrounding surface. Interior body lining and cabinetry materials, excluding the cab compartment, shall be selected to minimize dead weight. The finish of the entire patient compartment, including interiors of storage cabinets, shall be: 1. impervious to soap, water and disinfectants. 2. Mildew resistant. 3. Fire resistant. 4. Easily cleaned/disinfected (carpeting, cloth, and fabrics are not acceptable)

4.7.8 Patient compartment seating All seats in the patient compartment shall conform to applicable Kenyan Standards, will be padded and have the largest practical padded back and headrests. Padding material shall be rubber or polyester urethane foam of a medium to firm density, with a minimum finished thickness (padding and upholstery)


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of 2.5" for seat pads, and 2" for head and backrests. All padding and upholstery shall be fire retardant. The upholstery shall be non-absorbent, washable and impervious to disinfectants. Non-OEM seats shall have reinforced vinyl upholstery. To facilitate cleaning and disinfecting, all seats shall be furnished and installed as per the public health Act, and all exposed surfaces shall be free of vent devices that would permit the entrapment of biological contaminates. All seating positions in the patient compartment shall be provided with a vertical overhead clearance measurement of 43".

4.7.8.1 Patient seating The seats shall provide seating space for two persons and shall not be less than 15" deep by 18" wide (per seating position), and the seat backs shall be a minimum of 18" wide by 7" tall. The requirement to provide patient seating space for two persons shall not apply to Type II ambulances.

4.7.8.2 Seat safety belts and anchorages All designated seating positions in the patient compartment shall be equipped with safety restraint systems appropriate for each type of seating configuration.

4.7.8.3 Patient and attendant seating

The minimum number of patient and attendant seats shall be as given in Table 6.

Table 5 — Number of patient and attendant seats

Type of road ambulance

A1

A2

B C

Minimum number

1 2 2 2

Position(s) on one side of the stretcher

1

1

–

–

on one side of the stretcher upper 2

–

–

1

1

Position(s) at head or side of stretcher

– 1 a 1 1

a Only when fewer than four seats.

The seats shall comply with the minimum dimensions set out in Table 7.

Table 6 — Minimum dimensions for seating


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Single seat

(patient

)

Single seat

(attendan

t)

Folding seat

(attendan

t) Width 450 450 450

Depth 400 330 330

Height above seat a 920 920 920

Thickness of upholstery 50 50 50

a Measured vertically above and in the middle of the 75 kg loaded seat.

NOTE Where possible the seat height should be adjustable.

Seats fitted in accordance with Tables 6 and 7 shall be installed in either forward or rear-facing positions. Backrests shall be constructed to a minimum dimension of 300 mm × 100 mm, the upholstery of which shall be a minimum thickness of 20 mm.

Seats for patients and attendants shall not be permanently fixed in a side-facing position.

4.8 Storage compartments Storage compartments shall be furnished for all items required by this specification and/or specified by the purchaser and include storage for, but not be limited to; backboards, portable cots/litters, stair chairs, and any other specified patient handling devices. Any absorbent material such as carpeting, fabric, or inside/outside plastic type carpeting, etc. that resists cleaning and decontamination shall not be used in any storage or patient compartment.

4.8.1 Interior stowage accommodations The interior of the patient compartment shall provide a minimum volume of 35 cubic feet of enclosed stowage cabinetry, compartment space, and shelf space which shall be conveniently located for medical supplies, devices, and installed systems as applicable for the service intended. The 35 cubic feet of enclosed stowage cabinetry requirement does not apply to type II ambulances. Enclosed compartments and spaces shall be located at, in, or on the partition, sidewalls, overhead, seating areas, and doors. Compartment(s) under the floor, with opening panel(s) inside the patient compartment, shall not be acceptable. When furnished, top opening squad bench lids shall be fitted with an automatic hold open device and a quick release slam type latching device when closed.

4.8.2 Location of medical equipment and supplies Supplies, devices, tools, etc., shall be stored in enclosed compartments and drawers designed to accommodate the respective items. All medical devices and equipment shall be stowed or properly fastened in/on the action area according to the medical device manufacturer’s directions.

4.8.3 Waste and sharps disposal


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The following shall be furnished: A trash receptacle compartment, with closure over opening, for general waste shall be furnished with a plastic/rubber trash can and disposable plastic liners, with 12 spare liners. The trash compartment shall be accessible to the EMSP seat. A sharps receptacle compartment/ storage or a commercially available container mounted in a convenient area shall be furnished for retention of a sharps container that meets public health standards.

4.8.4 Exterior storage accommodations Ambulance exterior storage compartments shall be weather resistant Exterior compartment doors and hardware shall be flush or near flush style construction. All doors shall have spring or gas tube type, hold open devices that permit one hand closure. Hardware (hinges, locks, latches, etc.) shall be rust resistant. All exterior compartments shall have latches with locks and shall be keyed alike. All exterior compartments shall be automatically lighted when opened.

4.8.5 Storage compartments and cabinets design Storage cabinets, drawers, and kits shall be easily opened but shall not come open in transit. For rapid identification of contents, medical supply cabinets above the litter patient shall have shatterproof, transparent or lightly tinted, sliding doors. 1) Doors shall be provided with near flush grip, or low profile handles. 2) Storage compartments shall be divided into sections. a) Drawers shall be marine style slide or tilt. b) All shelves shall be removable. 3) Sliding doors for cabinets designed to carry lightweight items such as dressings, bandages, etc shall be furnished. a) Shall automatically latch or be fitted with friction holding devices when in a closed position. 4) Doors shall have positively locked latches that are bolted to the door and the door frame structure and are designed to remain closed during transports. 5) All cabinets shall be firmly anchored (bolted or welded) to tapping plates of the body structure. a) Use of sheet metal or wood screws is not acceptable. 6) Tops of the cabinets and shelves shall be surrounded by a lip of not less than 1/2" in height covered in a soft, pliable molding. 7) Storage for the main oxygen cylinder shall be accessible for replacement from an outside position. 8) The oxygen compartment shall be provided with at least a 9 sq. in. of open vent to dissipate/vent leaking oxygen to the outside of the ambulance. 9) Oxygen cylinder compartment shall not be utilized for storage of any other equipment. 10) Oxygen cylinder(s) shall be mounted with a restraining device(s).

4.9 Ventilation

4.9.1 Ventilation system There shall be a ventilation system which shall provide a minimum of 20 air changes per hour when the vehicle is stationary.

4.9.2 Air conditioning criteria


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The air conditioning system(s) will have sufficient capacity to maintain the temperature in the patient compartment at a maximum dry bulb temperature of 78°F. When available, OEMs’ interconnection points will be utilized.

4.9.3 Ventilation criteria Ventilation system(s) of the driver and patient compartments will provide a complete change of ambient air within both compartments at least every two minutes with the vehicle stationary. Ventilation will be separately controlled within the cab and patient compartments. Fresh air intakes will be located towards the front of the vehicle and exhaust vents will be located on the upper rear of the vehicle. Exhaust vents may be located on the rear lower half of the module/body, provided the vent/device incorporates a reverse flow damper to prevent back draft and intrusion of vehicle engine exhaust, dust, dirt, or road spray. The patient compartment will be ventilated by the air delivery system of the environmental equipment (heater-air conditioner) or by separate system(s), such as power intake, exhaust ventilator(s).

The heating system shall be capable of meeting the performance criteria with the ventilation system switched off and the heating system set to re-circulate the air in the patient’s compartment. The installation of the system shall not encourage exhaust gases entering the patient’s compartment.

4.10 Ambulance interior lighting The basic interior ambulance lighting configuration shall be designed to minimize electrical loads and include: A driver’s compartment dome light; instrument panel lights; master switch panel; and console light(s). Lighting shall be designed and located so that no glare is reflected into the driver’s eyes or his line of vision, from switch control panels or other areas that are illuminated while the vehicle is in motion. The EMSP’s control panel shall be separately illuminated. All lights shall have lampshells and housings grounded. The colour temperature of the light will change the appearance of skin and organs. Therefore it is important that the interior lighting is suitable for patient care during transport. It is believed that it is not necessary in ambulance use to define "daylight" or "natural colour balance" in a more exact way other than the colour temperature. Regarding the colour temperature a comparison can be that examining lights in hospitals are normally between 3 800 to 4 300 degrees Kelvin.

4.11 Patient compartment illumination The patient compartment floor shall not be less than 15 foot candles intensity, measured along the centerline of the clear floor. The primary cot shall be provided with a minimum of 35 foot candles of illumination measured on at least 90% of the cot’s surface area. Blue light(s) or lenses shall not be used. Patient compartment lights shall not be powered by the vehicle’s AC system if so equipped. The patient compartment dome lighting (in the dim setting) and exterior corresponding loading lamp(s) shall be automatically activated when the side entry or rear entry patient compartment doors are opened. All interior dome lighting, including “checkout” lights, shall be near flush mounted and not protrude more than 1.5".


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Dome lighting shall not consume more than 25 amps in the bright setting and shall have two separately protected and controlled circuits. Switches, electronic controls, or fireproofed rheostats may be used to control lighting.

Light levels shall be measured along the central longitudinal axis of the stretcher at the head, mid-point

and foot position with the stretcher in its normal position for transportation in the ambulance.

4.12 IV holder for intravenous fluid containers One ceiling mounted “hook” style device specifically designed for holding IV containers shall be provided, including Velcro type straps to adequately secure an IV bag/bottle. The device shall not protrude more than 1", and shall be located adjacent to, or on the cabinetry near the head of the primary Patient. Swing down IV hangers with rigid support arms that can cause injury shall not be specified

4.13 Holding system for infusion A holding system shall be provided to support two vertically fixed infusions in such a way as to use the maximum available height above the stretcher holding assembly. It shall be possible to position the infusions for use at either end of the stretcher holding assembly. The infusion mounting shall have a minimum capacity of 5 kg and be able to hold two bags of fluids independent of each other and shall be designed to minimize oscillation.

4.14 Litter fasteners and anchorages. A cot fastener assembly with quick release latch shall be furnished. The installed cot fastener device(s) for wheeled cots shall be installed per the manufacturer’s directions. At a minimum, the litter retention system, anchorages, and litter fastener(s) shall not fail or release when subjected to a force of 2,200 pounds applied in the longitudinal, lateral, and vertical direction. Should the manufacturer of the cot fastener assembly specify a greater force, the litter retention system, anchorages, and litter fastener(s) shall be tested to that greater force. NOTE:- all cots and infant transporters should only be used with the required fastener assemble as prescribed by the cot/transporter manufacturer.

4.15 Mounting systems

Permanent seats and their anchorages in the patients’ compartment, designed for use by patients and attendants when the ambulance is in motion. The seat belts anchorages of such seats shall comply with the requirements The seat belts shall comply with the requirements. The forward facing seats shall be fitted with three-point seat belts of the type Ar4m All persons and items e.g. medical devices, equipment and objects normally carried on the road ambulance shall be restrained, installed or stowed to prevent them becoming a projectile when subjected to accelerations/decelerations of 10 g in the forward, rearward, left, right and vertical directions.

When subjected to these accelerations/decelerations, the distance travelled by a person or item shall not endanger the safety of persons on the road ambulance.

After being subjected to these accelerations/decelerations: a) no items shall have sharp edges or endanger the safety of persons in the road ambulance;


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b) the maximum distance the stretcher and any item attached to either the holding assembly or

stretcher may travel shall be no more than 150 mm. The displacement of the patient during the test may exceed 150 mm;

c) it shall be possible to release all persons in the road ambulance without the use of equipment not

carried on the road ambulance. All tested lockers, rails and non-dedicated storage locations or storage devices shall be labeled to show the total maximum permissible weight allowed.

The body shall be mounted to the chassis with high strength fasteners and vibration isolating rubber body mounts designed and installed in accordance with the chassis manufacturer's guidelines.

4.16 Ambulance exterior

4.16.1 General The road ambulance shall comply with the requirements ambulances or corresponding national requirements for approval of vehicles.

Road ambulances equipment shall, when operated in normal use and maintained according to the instructions of the manufacturer, cause no safety hazard which could reasonably be foreseen using risk management procedures and which is connected with their intended application, in normal condition and in single fault condition.

4.16.2 Noise and sound level limits, exterior. Unless more stringent sound levels are regulated by the counties where the ambulance will be based, the exterior noise level produced by the vehicle, except siren, shall not exceed NEMA regulations

4.16.3 Warning lights A red rotating light or strobe light or lights, mounted on the roof and visible from 150 metres from the front and rear of the vehicle; two flashing lights on the grill or front face of the vehicle; and an intersection light mounted on the side of each front fender;

4.16.5 Painting & branding 4.16.5.1 An “AMBULANCE” decal, in letters at least 150 mm high and using a bold font shall be installed below the windows on the rear doors. 4.16.5.2 A mirror image “AMBULANCE” decal, in letters at least 100 mm high and using a bold font, shall be installed on the front of the ambulance. 4.16.5.3 The decal required for the name “AMBULANCE” shall be located below the bottom of the windshield, above the headlights, and be oriented not less than 60 degrees from horizontal.

4.16.5.4 One Star of Life decal, with a diameter of at least 300 mm and not more than 500 mm, shall be installed on each side of the ambulance body.


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4.16.5.5 A Star of Life decal shall not be interrupted by, incorporated into or partially covered by any other graphics. NOTE:- A star of life will only be given subject to approval as per the certificate of compliance

4.16.6 Chevrons A two-colour, retro reflective chevron pattern shall be installed on the rear plane of the ambulance. The chevron shall:

a) be positioned as high as practicable, but in no case shall it be above a horizontal line drawn across the top of the rear entry doors; and

b) cover at least 50% and, when including the area required for the “AMBULANCE” decal, not more than 60% of the total rear surface area as measured between horizontal lines across the top and bottom of the rear entry doors.

4.19.7 Conspicuity Stripes A branding stripe shall be reflective and shall have a minimum coefficient of retro reflection of 450mm, shall run vertically on the left and right sides of the ambulance body as follows:

5 Tests.

5.5.1 Test criteria. The ambulance shall be prepared for operation in accordance with chassis manufacturer’s recommendations. The ambulance shall be manned and loaded when applicable, to simulate the maximum payload required for the Type, Class, and plan being tested. Road tests and test course(s) shall be documented with pictures and route map. Test room(s) designed and equipped to simulate ambient temperature environments shall be used to perform tests.

5.5.2 Performance tests. The following ambulance items, systems, and equipment shall be inspected, tested, and verified for conformance to the specification:

a) Ambulance physical dimensions b) Vehicle weight distribution c) Road test and performance tests d) Electrical systems and components inspect and verify compliance e) Electrical generating system f) Electromagnetic radiation and suppression g) Warning light and siren system(s) h) Environmental systems tests i) Patient compartment sound level test j) Painting and branding

5.5.3 Vehicle weights. The vehicle shall be weighed to determine curb weight and distribution of curb weight on front and rear axle. The imposed loading on front and rear axle shall be computed using the curb weight and the


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payload. Calculated imposed loads on front and rear axle shall be utilized to ascertain that suspension, axles, and tires furnished are of adequate capacity to meet contract requirements.

5.5.3.1 Weight distribution tolerance. The mathematical method to calculate the weight distribution shall be in accordance with relevant standards a. Find the curb weight on each wheel of a given axle; b. Divide the weight of each wheel by the total curb weight of both wheels (i.e., curb weight of the axle), times (X) 100 = percentage of weight on each side; c. Subtract the smaller percentage from the larger percentage; d. This is the percent difference between the left and right side of the axle. If this difference is 5 percent or less, that particular axle’s weight distribution is efficient

5.5.4 Road test. The vehicle shall be subjected to a minimum 241 km (150 mile) road test of which 121 km (75 miles) shall be continuous miles on paved highways at highway speeds up to 113 km/hr (70 mph); 48 km (30 miles) on city streets; 24 km (15 miles) on gravel or dirt roads at speeds up to at least 56 km/hr (35 mph); and not less than 8 km (5 miles) in simulated or actual cross-country operation at speeds applicable to the terrain. Cross-country operation is defined as travel over open fields, rolling and side-sloping hills, rough and muddy terrain. Class 2 vehicles shall demonstrate cross-country operation in 4-wheel drive for an additional32 km (20 miles). Ambulances shall meet performance requirements during road tests or by certification. Balance of the 241 km (150 miles) road test may be accumulated during other tests and checks requiring vehicle movements. After completion of the road test, vehicle shall be subjected to the water spray test (see4.4.5). Road test may be performed at any ambient temperature.

5.5.4.1 Test failure of first ambulance. Vehicle utilized for the road test shall successfully complete 241 km (150 miles) of test. Rejection of the test vehicle shall be for deficiencies, including but not limited to the following: a. Damage caused by collision. b. Failure of any major component. c. Vibration due to misalignment of wheels, frame, driveshaft, or defective tires, etc. d. Vibration due to type of body construction or mounting. e. Evidence of abnormal tire wear due to misalignment or unbalanced wheels/tires. f. Failure of any vehicular safety device such as brakes, steering assembly, windshield washers and wipers, or electrical circuits. g. Evidence of structural weakness in any part of the vehicle, vehicle components, or accessories. h. Loose mountings of parts or accessories due to workmanship or vehicular operation. i. Failure of any vehicular performance requirements

5.5.5 Water spray test. Ambulance undergoing quality conformance inspection (see 4.2.3) shall be subjected to water spray test for not less than 2 minutes duration. Evidence of water leakage shall because for rejection until leaks are corrected.

5.5.6 Oxygen system test.


34

The installed medical oxygen piping and outlet system shall be leak tested for a time period of four hours. The system shall be tested in accordance with relevant standards with dry air or nitrogen gas or equal and kept decontaminated. After the successful completion of tests, the system shall be capped then tagged with date and signature of person and firm performing the tests

6.0 Storage compartments. Storage compartments shall be furnished for all items required by this specification and/or specified by the purchaser and include storage for, but not be limited to; backboards, portable cots/litters, stair chairs, and any other specified patient handling devices. Any absorbent material such as carpeting, fabric, or inside/outside plastic type carpeting, etc. that resists cleaning and decontamination shall not be used in any storage or patient compartment.

6.1.1 Interior stowage accommodations. Unless otherwise specified by the purchaser, the interior of the patient compartment shall provide a minimum volume of 1 cubic meter (35 cubic feet) of enclosed stowage cabinetry, compartment space, and shelf space which shall be conveniently located for medical supplies, devices, and installed systems as applicable for the service intended. Enclosed compartments and spaces shall be located at, in, or on the partition, sidewalls, overhead, squad bench, technician seat, and doors. Compartment(s) under the floor, with opening panel(s) inside the patient compartment, shall not be acceptable.

6.1.2 Location of medical equipment and supplies. Location of medical supplies and equipment shall be dictated by their relative importance and shall be readily accessible to the Emergency Medical Technician (EMT). Priority shall be given to items necessary to cope with life threatening conditions at the scene and in transit. The equipment and supplies necessary for airway maintenance, ventilation, oxygenation, and suction shall be at the head of the primary litter (action area). When items for cardiac monitoring/defibrillation, mechanized CPR, administration of intravenous fluids/medications, and the monitoring of blood pressure are furnished, they shall also be readily available to the EMT at the action area. Supplies, devices, tools, etc., shall be stored in enclosed compartments and drawers designed to accommodate the respective items. All medical devices and equipment shall bestowed or properly fastened in/on the action area or in cabinets or to the rail system(s) brackets, when specified (3.15.4 M1), to prevent items from becoming projectiles in the patient compartment that can cause injury while the vehicle is in motion or involved in an accident.

6.1.3 Interior compartment with exterior access. When specified by the purchaser, on Types I and III vehicles, an interior/exterior compartment with 2 shelves, or other interior configuration as specified by the purchaser, shall be provided in the front, right corner of the body or other location as specified. This compartment shall also have an exterior door and, unless otherwise specified or permitted by the purchaser, a roll-up, inside door with an enclosed, roller assembly. When viewed from the vehicle’s interior, this compartment shall have the following minimum dimensions: W 76 cm (30"), D 46 cm (18"), and H 102 cm (40"). The door shall be equipped with the necessary gaskets, seals or other vibration and noise silencing devices, a positive mechanical latch and a grab handle to facilitate opening and closing.


35

The shelves shall be adjustable and have an approximate 3/4" lip covered with automotive edge molding.

6.1.4 Waste and sharps disposal. The following shall be furnished: A trash receptacle compartment, with closure over opening, for general waste shall be furnished with a plastic/rubber trash can and disposable plastic liners, with 12 spare liners. The trash compartment shall be accessible to the EMT seat and to the head of the squad bench. The consignee shall furnish bags/liners that meet OSHA requirements, for disposing regulated medical waste (as defined by OSHA). A sharps receptacle compartment/storage or a commercially available container mounted in a convenient area shall be furnished for retention of a sharps container that meets OSHA requirements.

6.1.5 Exterior storage accommodations. On Types I & III and when specified on Type II vehicles, outside entered, weatherproof, storage compartments shall be provided in the ambulance body for extrication, spare tire, oxygen, and miscellaneous equipment. When specified, additional exterior storage compartments shall be furnished. Exterior compartment doors and hardware shall be flush or near flush style construction. All doors shall have spring or gas tube type, hold open devices that permit one hand closure. Hardware (hinges, locks, latches, etc.) shall be rust resistant. All exterior compartments shall have latches with locks and shall be keyed alike. All exterior compartments, except the long narrow backboard storage compartment, shall be automatically lighted when opened. When top and vertically hinged doors are furnished, they shall employ ratchet or spring loaded or gas tube hold open devices.

6.1.6 Extrication equipment and storage. The extrication equipment compartments, maximum of two, shall provide at least 0.28 cumeters (10 cu feet) of storage accommodations. Small hand-tools shall be contained in a single pouch type carrying device. An example of items and other miscellaneous extrication equipment which shall be stored in the extrication storage compartment(s) follows. The contractor shall furnish specific items as specified under 3.15.3-18:

6.1.7 Storage compartments and cabinets design. 6.1.7.1 Storage cabinets, drawers, and kits shall be easily opened but shall not come open in transit. For rapid identification of contents, medical supply cabinets above the litter patients shall have shatterproof, transparent or lightly tinted, sliding doors provided with two recessed metal finger cups, near flush grip, or low profile handles. Storage compartments shall be divided into sections, shelves shall be adjustable, drawers shall be marine style slide or tilt, and all shall be removable. 6.1.7.2 Sliding doors for cabinets designed to carry light weight items such as dressings, bandages, etc.shall automatically latch or be fitted with friction holding devices when in a closed position. 6.1.7.3 Other compartments designed to carry heavier items such as first aid and drug kits, portable and spare oxygen bottles, suction units, etc. shall have positively locked latches that are bolted to the door and the door frame structure and are designed to remain closed in an accident, including rollovers. Use of sheet metal or wood screws is not acceptable. Side cabinet shelves shall be no more than 51 cm (20 in.) in depth, when located above the vehicle belt level. Storage compartments, cabinets, and support equipment area interior surfaces shall be finished. To preclude injury, in the event of an accident, all cabinets shall be firmly anchored (bolted or welded) to tapping plates of the body structure


36

6.1.7.4 Tops of the cabinets and shelves shall be surrounded by a lip of not less than 13 mm (1/2") in height covered in a soft, pliable molding. All shelves shall be continuously adjustable. 6.7.1.5 Storage for the main oxygen cylinder shall be accessible for replacement from an outside position. The oxygen compartment shall be provided with at least a 58 sq. cm (9 sq. in.) louvered device to dissipate/vent leaking oxygen to the outside of the ambulance. 6.7.1.6 Oxygen cylinder compartment shall not be utilized for storage of any other equipment. Any wiring and electrical devices within this compartment shall be mounted with a restraining device(s), as required.

6.1.8 Squad bench, seats, and backrests. 6.1.8.1 Unless otherwise specified by the purchaser, the squad bench shall have post cups and/or wheel cups to prevent lateral and longitudinal movement and support the Style 3folding stretcher, combination stretcher chair or other purchaser specified stretcher (3.15.4 M16, or Style 5). Unless otherwise , the squad bench top shall be between 48 cm (19") and 56 cm (22") wide, a minimum of 183 cm (72") long, and a height of between 43 cm (17") and 51 cm (20") measured from the floor to the top of the padded seat. Top opening squad bench platform(s) shall be fitted with an automatic hold open device, and when closed, a latching device for safety. 6.1.8.2 All seats in the patient compartment shall be padded, at least 46 cm (18") wide, and have the largest practical padded backrest. Padding furnished shall be rubber or polyester urethane foam of a medium to firm density, in covered, finish thickness of at least 6.3 cm (2.5 in.) for seats, and approximately 5.1 cm (2 in.) for head and backrests. All padding and upholstery shall be fire retardant. Additionally, the upholstery shall be non-absorbent, washable and impervious to disinfectants. Non-OEM seats shall have 40 oz. reinforced vinyl upholstery. To facilitate cleaning and disinfecting, all seats furnished and installed by the ambulance manufacturer shall be cleanable to public health standards, and all exposed surfaces shall be free of vent devices that would permit the entrapment of biological contaminates. 6.1.8.3 Squad bench shall be furnished with at least three sets of lap (Type I) safety belts for seated occupants and for retention of a cot/stretcher when positioned on the squad bench. The belts shall be positioned at the patient’s chest, hips, and legs. 6.1.8.4 The anchorages for the side facing seatbelt assembly shall withstand a minimum of 1134 kg (2,500 lbs.) force when tested. Other side facing seats shall have a Type I lap safety belt. 6.1.8.5 Sealed storage shall be provided for the specified oxygen bottle, when located under the rear of the squad bench, with separate compartment under the front of the bench, and the maximum possible cubic foot volume. The squad bench cover latching device(s) shall be a quick release, slam type latch similar to a Cleveland Model 3300 TL with 3400-15 striker pin. For configuration A (ALS) a side facing seat located on the street side of the vehicle at the patients thoracic region shall be furnished. This seat shall also be furnished with a seat belt meeting the above requirements and shall have rear and lateral padding at the head areas.

6.1.9 Stretchers, cots and litters


37

When specified the ambulance supplier shall provide the following: a Style 1 or Style 2 (with roll-in feature) cot for the primary patient, and a Style 3 folding stretcher or a combination stretcher chair, each with legs and two wheels designed to permit a patient to be carried (or wheeled) on stairways and through other narrow areas . Length and width measurements shall be taken at the metal framing, excluding joint fittings. Wheeled cots shall include foot and head pulls, when available from the cot manufacturer, and a polyester foam mattress at least 8 cm (3 in.) thick or an equivalent mattress covered with vinyl coated, nylon fabric or other non-porous fabric.

6.1.9.1 Combination stretcher chair A combination Stretcher Chair shall be furnished, in lieu of the stored stairway stretcher. The stretcher shall conform to the dimensions of Style 3 . Stretcher shall have posts; wheels, folding handle at foot-end, straps, and convert to a stair chair or stretcher.

6.1.10 Seat safety belts and anchorages All seats, safety belts and anchorages shall comply with relevant standards except as otherwise specified. Seatbelts shall have retractor devices for all seat positions in the vehicle, including the squad bench.

6.1.11 Litter fasteners and anchorages A crash stable side or center mounting cot fastener assembly with quick release latch shall be furnished. It shall secure the Style 1 or Style 2 wheeled cot or infant transporter to the ambulance body. Style 4 and Style 5 litters need not be provided with fastening devices unless otherwise. Additional cot related hardware is permitted, provided the patient compartment exit/entry is not encumbered with the cot in place. The furnished devices shall have a bright colored finish, if the device presents a tripping hazard in the entry/exit area when the cot is removed.

6.1.12 Patient restraints

6.1.12.1 Cot straps. At least three strap type restraining devices (chest, hip, and knee) shall be provided per stretcher, cot, and litter to prevent longitudinal or transverse dislodgment of the patient during transit. Additionally, the head of the cot shall be furnished with upper torso (over shoulder) restraints that mitigate forward motion of the patient during severe braking or in a frontal impact accident. Restraining straps shall incorporate metal-to-metal quick release buckles, be not less than 51 mm (2 in.) wide, and fabricated from nylon or other materials easily cleaned and disinfected.

6.1.12.2 Infant/child carrier An infant/child spinal immobilization/carrier device shall be furnished that safely secures those patients to the cot.

6.1.13 I.V. Holders for intravenous fluid containers Two near flush style, I.V. ceiling holders specifically designed for holding I.V.’s, with a Velcro type strap to hold and control I.V. bags/bottles, shall be provided. The ceiling holders shall not protrude more than 2.5 cm (1 in.), be located on or adjacent to the sidewall, one at the head of the primary patient and one at the head of the secondary patient’s cot (squad bench). When an ALS configuration is specified, one additional l .V. hanger shall be furnished for each patient, at the lower extremities. A fold down, rigid, telescoping I.V. pole and holder shall be provided on the left side of the cot.


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7.0 Ambulance personnel An ambulance service provider must have a Qualified and licensed physician designated medical director . Ambulances have three different levels and for every level, these include:-

a) Basic support level There shall be a minimum of:-

1) A certified emergency vehicle operator 2) An emergency medical technician(EMT-B) 3) Both should have valid driving licenses 4) Must not have criminal record

b) Intermediate life support level There shall be a minimum of :-

1) An advanced emergency medical technician (EMT) 2) An advanced emergency medical technician (EMT-B) 3) Both should have valid driving licenses 4) Must not have criminal record

c) Advanced life support level

There shall be a minimum of:- 1) 2 emergency medical technicians (EMT-I) 2) The lead EMT must be a registered Nurse (KRN) 3) Both should have valid driving licenses 4) Must not have criminal record

8 Medical devices

8.1 Provision of medical devices

The road ambulance shall be designed and constructed to accommodate the items listed in Tables 9 to 19 and provide the following levels of care:

a) the patient transport ambulance (types A1 and A2) shall have basic professional equipment

for first aid and nursing care;

b) the emergency ambulance (type B) shall have equipment for basic treatment and monitoring of patients with the current methods of pre hospital care;

c) the mobile intensive care unit (type C) shall have equipment for advanced treatment and

monitoring of patients with the current methods of pre hospital intensive care.

8.2 Medical devices storage

All equipment required for a set procedure shall be stowed in a specified location. Essential equipment


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required for use outside the vehicle shall be easily accessible via normally used doors. All equipment shall be securely and safely stowed to prevent damage or injury whilst the vehicle is in motion (see 6.3.5).

8.3 Requirements for medical devices 8.3.1 General The device shall be designed for use in mobile situations and in field

applications7 If a medical device is designated as "portable" (except patient handling equipment according to Table 9) and shall

a) be possible to be carried by one person

b) have its own built in power supply (where relevant);

c) be capable of use outside the vehicle.

8.3.2 Temperature

8.3.2.1 Unless otherwise marked on the device, the device shall function as described in 8.3.2.2 and 8.3.2.3 when brought back to room temperature (20 °C) after storage in temperatures ranging from –30 °C to 70 °C.

8.3.2.2 Unless otherwise marked on the device, the device shall function throughout the temperature range from 0 °C to 40 °C. 8.3.2.3 Unless otherwise marked on the device, the device shall function for at least 20 min when placed in an environment at –5 °C after storage at room temperature (20 °C).

8.3.3 Humidity and ingress of liquids Devices shall comply with particular device standards.

8.3.4 Mechanical strength 8.3.4.1 General

Where there are not more stringent requirements for mechanical strength in particular devices standards exists, then the following mechanical strength requirements shall apply to medical devices for use in road ambulances.

8.3.4.2 Vibration and bump After vibration tests and bump test in accordance with 6.4.1 the maintain system and device shall function within the tolerances specified by the manufacturer.


40

8.3.4.3 Free fall If the medical device is fixed, it is exempted from the free fall test.

Medical devices which are taken out of holders and/or carried by hand shall be submitted to the free fall test according to 6.4.2 and shall then function within the tolerances specified by the manufacturer.

NOTE :-A medical device may consist of fixed and loose components, the free fall test applies to the loose components only.

8.3.5 Fixation of devices

The device shall be restrained by means of a fixation system.

The fixation system(s), maintain system(s) or storage system(s) shall hold the device to withstand accelerations or decelerations of 10 g longitudinal (forward, backward), 10 g transverse (left, right) and 10 g vertical.

Terminal units and electrical socket outlets shall not be used as part of the fixation

system.

NOTE:- Rail systems consist of e.g. rail supports, rails, rail clamps, equipment mount holders, equipment mounts, equipment pin holders and equipment pins.

8.3.6 Electrical safety

All devices shall be selected and mounted so that no harmful influence to the electrical supplies results.

8.3.7 User interface Buttons, switches, indicators and controls shall be easily accessible and visible. SI units (except for blood pressure and airway pressure) and standardized graphical symbols where applicable shall be used.

8.3.8 Gas installation

8.3.8.1 Source of supply The source of supply shall consist of one or more of the following:

a) gas in cylinders, e.g. oxygen, air;

b) non-cryogenic liquid in cylinders, e.g. N2O, CO2;

c) cryogenic liquid in cylinders, e.g. oxygen;

d) cryogenic liquid in stationary vessels, e.g. oxygen;


41

0

e) non-cryogenic liquid in stationary vessels, e.g. N2O, CO2; f) air compressor system;

g) proportioning system, e.g. oxygen and nitrogen;

h) vacuum system.

8.3.8.2 Gas piping Gas piping shall not pass through cupboards and compartments, all ducts for gas installations or gas piping shall be vented.

8.3.8.3 Stationary oxygen supply The stationary oxygen supply shall comprise a source in accordance with Table 11 (under normal temperature and pressure) pressure regulators and terminal units or pressure regulators with flow metering devices.

8.3.8.4 Portable oxygen supply The portable oxygen supply shall comprise a source in accordance with Table 11 (under normal temperature and pressure) and a pressure regulator with flow metering device.

8.3.8.5 Pressure regulators and flow metering devices

Pressure regulators and pressure regulators with flow metering devices shall conform to standards. The pressure regulators shall be directly connected to the source of supply.

8.3.8.6 Terminal units

Terminal units shall comply with EN 737-1.

8.3.8.7 Pneumatic power supply If the road ambulance is equipped with terminal units, the range of operating pressure shall be

a) for compressed medical gases 400 kPa �100 kPa; b) for vacuum�40 kPa absolute pressure and the maximum allowable pressure change between the source of supply and the terminal units shall be

c) for compressed medical gases10 % at a flow of 40 l/min;

d) for vacuum 20 % at a flow of 25 l/min.


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8.3.8.8 Additional outlet connectors For road ambulances complying with 6.3.8.7, one additional outlet connector (i.e. a terminal unit or a gas- specific connection point) shall be fitted in addition to the outlet connectors necessary for the devices intended to be normally used.

8.3.8.9 Test pressure The gas piping shall withstand a pressure of 1 000 kPa, i.e. twice the maximum operating pressure of 500 kPa

. 8.3.8.10 Pin-index cylinder values

Pin-index outlet connections of cylinder values shall be well connected

8.3.8.11 Flexible hoses Flexible hoses for connecting medical devices to outlet connectors (i.e. terminal units or a gas-specific connection points) shall comply with standards.

8.3.8.12 Alarms

If alarms are provided as part of the gas installation, they shall comply with standards

8.3.9 Marking and instructions Marking and instructions for use shall comply with standards

Operating and maintenance instructions, service records and any other appropriate regulations shall accompany the product. Standardized symbols should be used or it should be written in the native language of the area where the equipment is to be used.

8.3.10 Maintenance The manufacturer shall supply instructions for carrying out preventive maintenance.

8.4 Mechanical strength – Test methods for medical devices for use in road

ambulances

8.4.1 Vibration and bump test

The medical device shall be submitted to the following tests:

a) vibration (sinusoidal) according to EN 60068-2-6, Test Fc;

b) frequency range: 10 Hz to 150 Hz;


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c) amplitude/acceleration: ±0,15 mm/2 g; d) sweep rate: 1 octave/minute;

e) number of sweep cycles: 4 in each axis;

f) random vibration broad-band – reproducibility medium according to EN 60068-2-64, Test Fh;

g) ASD9) 10 Hz to 20 Hz: 0,05 g²/Hz; h) ASD 20 Hz to 150 Hz: 0,05 g²/Hz, –3 dB/Octave;

i) total rms acceleration 1,6 grms; j) duration/axis/mounting: 30 min;

k) bump according to EN 60068-2-29, Test Eb;

l) peak acceleration: 15 g

m) pulse duration: 6 ms;

n) number of bumps: 1 000;

o) direction: vertical, with the medical device in its normal operating position(s).

8.4.2 Free fall

The medical device shall, while functioning, be submitted to the following test:

a) free fall according

b) height of fall: 0,75 m;

c) number of falls: 1 on each of the six surfaces.

8 .5 List of equipment

The Tables 9 to 19 designate the minimum equipment carried by the road ambulances according to their type A1, A2, B and C. Where national regulations for equipment are in conflict with Tables 9 to 19 the national regulations shall apply. Supplementary devices may be introduced depending on local requirements. However, if it is common practice for the road ambulances to cross national borders, equipment according to Tables 9 to 19 shall be carried in accordance with the vehicle type. For most items a specific quantity is given. "X" in the column indicates that quantity may be


44

varied in accordance with the local needs of the country/district. Where applicable the equipment shall be available across the full age range of patients. The minimum mass including a mass reserve required for the listed sanitary, medical and technical devices in Tables 9 to 19 shall be as follows:

Road ambulance

type A1 100 kg; type A2 115 kg; type B

type C

225 kg;

Table 9 — Type of patient handling equipment

No

Device

Type of road ambulances

A

A

B C

1 Main stretcher/undercarriage 1 1 1 1

2 Pick up stretcher – – 1 1

3 Vacuum mattress – – 1 1

4 Device for conveying a seated

patient a

1 1 1 1

5 Carrying sheet or transfer mattress

1 1 1 1

6 Long spinal board complete with head immobilizer and

1

1

1

1

Table 10 — Type of immobilization equipment

No

Device


A

A

B C

1 Traction device 1 1 1 1

2 Immobilization, set for fractures 1 1 1 1

3 Cervical upper spinal immobilization devices

1

1

1

1

4

Extended upper spinal immobilization Extrication devices or short spinal board

1

1

1

1


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Table 11— Type of ventilation/respiration equipment

No

Device


A

A

B C

1

Stationary oxygen a Minimum 2 000 l, (under normal temperature and pressure), flowmeter/- flowgauge with maximum capacity of at least 15 l/min and regu- lating valve

X

X

1

1

quick connecti

–

–

1

1

2

Portable oxygen b

Minimum 400 l, (under normal temperature and pressure), flowmeter/flowgauge with maximum capacity of at least 15 l/min and

1

1

1

1

quick connecti

–

–

1

1

3

Resuscitator with oxygen inlet and masks and airways for all ages and oxygen reservoir

X

X

1

1

4 Mouth to mask ventilator

with oxygen inlet

1

1

–

–

5

Non-manual suction device with a minimum pressure of –65 kPa with a minimum capacity of 1 l

–

–

1

1

6 Portable suction device

1

1

1

1


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Table 12 — Type of diagnostics equipment

No

Device


A

A

B C

1 Manual B P Monitor, Cuff size 10 cm – 66 cm

–

–

1

1

2

Automatic B P Monitor, Cuff size

10 cm – 66 cm A doppler type shall operate accurately in the conditions of electrical interference and vibration specified in

–

–

X

X

3 Oximeter – – 1 1

4 Stethoscope – – 1 1

5 Thermometer

Minimum range 28 °C to 42 °C

–

–

1

1

6 Device for blood sugar determination

– – 1 1

7 Diagnostic light – – 1 1

Table 13 — Type of drug

No

Type of drug


A

A

B C

1 Pain relief – – X X Table 14 — Type of infusion material or equipment

No

Device


A

A

B C

1 Infusion solutions, litre – – 4 4

2 Equipment for injections and infusions, set

–

–

2

2


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3

Infusion system which is designed to allow the administration of fluid warmed to (37 ± 2) °C. This system is not required

–

–

1

1

4 Infusion mounting 1 1 2 2

5 Pressure infusion device – – 1 1


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Table 15 — Type of equipment for managing of life-threatening problems

No

Device


A

A

B C

1 Defibrillator with rhythm and

patient data recording a

1

1

1

1

2 Cardiac monitor a – – 1 1

3 External cardiac pacing a – – X 1

4

Portable airways care system (p.a.c.s.) Manual resuscitator Mouth to mask ventilator with oxygen inlet Airways oro- or nasopharyngeal airway Aspirator

–

–

1

–

5

Portable advanced resuscitation system (p.a.r.s.) Contents of portable airways care system (p.a.c.s.) Infusion equipment – to include suitable venous indwelling cannulae Infusion administration sets Infusion solutions Adhesive fixing materials Intubation equipment – to include laryngoscope handle(s) with suitable blades Magill forceps Insertion stylets Endotracheal tubes with connectors Inflation tube

–

–

–

1

6 Nebulization apparatus – – 1 1

7 Thorax drainage kit – – – 1

8 Volumetric infusing device – – – 1

9 Central vein catheters – – – 1

10 Requirements for emergency and transport ventilators

– – – 1

11 PEEP-valve, adjustable or set – – – 1

12 Capnometer – – – 1


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50

Table 16 — Bandaging and nursing

No

Devic

e


A

A

B C

1 Bedding equipment

1

2

1

1

2 Blanket 2 4 2 2

3 Material for treatment of wounds 1 1 1 1

4

4

Material for treatment of burns and

corrosives

– – 1 1

5

Re-plantation container to maintain the internal temperature at (4 ��2)

-

-

X

X

6 Kidney bowl 1 2 1 1

7 Vomiting bag 1 2 1 1

8 Bed-pan X X X X

9 Non-glass urine bottle 1 2 1 1

10 Sharps container 1 1 1 1

11 Gastric tube with accessories – – X X

12

Sterile surgical gloves, pairs

X X 5 5

13 Non-sterile gloves for single use 100 100 100 100

14 Emergency delivery kit X X 1 1

15 Waste bag 1 1 1 1

16 Clinical waste bag X X X X

17 Non-wovens stretcher sheet 1 1 1 1


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Table 17 — Personal protection equipment (for each member of the crew for protection and to identify the staff as road ambulance personnel)

No

Devic

e


A1 a A2 a B a C a

1 Basic protective clothing including 1 1 1 1

2 Advanced protection wear – – X X

3 Safety/debris gloves, pairs 1 1 1 1

4 Safety shoes, pairs X X 1 1

5 Safety helmet _ _ 1 1

6 Personal protection equipment against

_ _ 1 1

Table 18 — Rescue and protection material

No

Device


A

A

B C

1 Cleaning and disinfection material

1 1 1 1

2 Seat belt cutter 1 1 1 1

3 Warning triangle/lights 2 2 2 2

4 Spotlight 1 1 1 1

5 Fire extinguisher 1 1 1 1


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Table 19 —

Communication

No

Devic

e


A

A

B C

1 Mobile radio transceiver 1 1 1 1

2 Portable radio transceiver – – 1 1

3

Access to the public telephone network e.g. via the normal radio transmitter or by mobile

–

–

1

1

4 Portable alerting system, per person

Can be included in portable

–

–

1

1

5 Internal communication between

driver and patient compartment

1

1

1

1


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Annex A

Test summary This is to certify that ambulance compartment.........................................................................on the chassis................................................equipped as a. . . . . . . . . . (Type A B or C) ambulance 4.5.9 and 5.3 Static and/or dynamic tests have been carried from…to ………. (dates) Detailed data are to be found in test report number.........................................

Authorized designated official........................................................................... (Name)

Signed.......................................

Date...........................................


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Annex B

Certificate of compliance

We certify that the ambulance as described hereunder is compliant Name of the converter of the ambulance: Base vehicle:

Conversion:

Type (A/B/C):

General

information:

Net vehicle mass (3.4):

Loading capacity

(3.6): Mass reserve

(6.5):

Patient and attendant seating (4.4.3/4.5.3): To ensure that we have carried out of the following tests:

Tested items

Completed by

Date

Test report Result

Acceleration (4.2.1/5.2)

EMC (4.3.2)

Fire safety (4.4.1)

Vehicle dimension (4.1.2/4.4.2/4.4.5)

Ergonomic space (4.5.2)

Loading angle (4.4.6)

M1 seats (4.5.3)

Ventilation system (4.5.4.1)

Temperature system (4.5.5)

Interior lighting (4.5.6)

Interior noise level (4.5.7/5.1)

Holding system for infusion (4.5.8)

Maintain systems and fixations (4.5.9/5.3)

A copy of the report of all the tests is at your disposal upon request.

It should be noted that the tests for maintain systems and fixations (4.5.9/5.3) are carried out by a notified body.

The compliance is checked in accordance with the full standard, the tests listed here above are not a proof of the certification by themselves.


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The (date) In the

city/country

Name

…………………...

Signature……………

…


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57


58


59


60

31


61


62

34


63


64


65


66


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public review draft minimum ground ambulance requirements · draft kenyan standard ks2469:2012 4 1....

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