EMS groups take a hit as costs of ambulances rise
The National Fire Protection Association is revising its new guidelines for ambulance design, which is expected to increase costs for financially ailing EMS agencies.
Local EMS officials said they've heard the guidelines could add $10,000 to $20,000 to the price tag of a new ambulance.
“We opposed it as much as we could,” said Terry Pfund, vice president of Pfund Superior Sales, an ambulance dealer in Lower Burrell. “The problem EMS services are faced with today is that the cost of operations has continued to escalate and their (Medicare and insurance) reimbursements have declined.”
The National Fire Protection Association-written standard, dubbed NFPA 1917, went “into revision” almost immediately after its September release, said Ken Holland, senior EMS specialist at the Quincy, Mass.-based group.
The revision has delayed implementation of the new standards until 2016. They were to take effect this year.
Ambulance manufacturers and EMS services in the 44 states that regulate ambulance design — including Pennsylvania — will likely continue to follow guidelines written by the U.S. General Services Administration. Those regs, scheduled to expire in October, have been extended until 2015.
Even after the association finalizes its revisions, it could take two years for states to change their legislation and adopt the guidelines, Holland said.
The current and new specifications regulate everything from weight distribution to bumper size to flooring and paint used in the patient compartment.
Ambulance services and manufacturers are not required by law to follow the specifications, but most do because of liability issues, said Rich Heuser, chief of operations at Eureka Fire Rescue EMS, in Tarentum.
“Most manufactures will adopt them as standard … which ultimately results in a heftier price tag,” he said.
EMS agencies typically replace their ambulances — which already cost about $150,000 unequipped — every five to seven years. Outfitting one can tack on $100,000 more, said Tom Izydore, director of Plum Emergency Medical Services, which is looking to buy an ambulance in the next 18 months.
“A cardiac monitor alone is about $30,000,” said Joe Johnson, manager of Shaler Area Emergency Medical Services, which recently bought two ambulances.
“At one time, our subscription drive covered what we paid for our ambulances and more but, with expenses rising and reimbursements shrinking, we had to tap some of those monies for operations,” Johnson said.
Before the NFPA delayed the effective date, some ambulance services ordered replacements, either new or used, earlier than planned so that the vehicle would be “grand-fathered in,” under the current standards, Pfund said.
“If you choose to buy an NFPA-compliant ambulance, you can do so, or you can buy one under the specs we've had for years,” Pfund said.
He said his company has not received any calls from services requesting an NFPA-compliant vehicle.
Once the regulations go into effect, manufacturers will be required to produce a “statement of exceptions,” listing which components fully comply and which do not and whether the change was requested by the purchaser.
The American Ambulance Association, based in McLean, Va., criticized the new guidelines: “(They) may be inappropriate or unsuitable for ambulances” and will “appreciably raise the cost of vehicles produced under this standard,” it said in a statement.
The group said the cost of a new ambulance could climb $5,000 to $11,000.
Increased costs could hurt a small company like the Oklahoma-Vandergrift Ambulance Service, which does numerous non-emergency transfers via van ambulance to cover costs that include providing free emergency response service in five municipalities, said director Dan Mertz.
“They (NFPA) want most of the ambulances to be larger because they don't believe that a van is safe enough in the event of a collision,” he said. “If given the option to buy a $60,000 van or a $220,000 Freightliner (ambulance) we would opt on the lower end and put the money into maintenance and repairs and employees.
“To be a self-sufficient organization like we are, you have to count your pennies.”
Heuser said he anticipates that Eureka's new ambulance, slated to be delivered next month, will come equipped with most of the new standards.
Despite the higher cost, he's in favor of the regulations.
“They look at a lot of safety issues, like emergency and scene lighting, issues of equipment stored in vehicles, like whether it's in crash-worthy restraints,” he said. “A big issue more recently has been heating and cooling in ambulances and whether they can maintain an adequate temperature in the patient compartment. If you have a respiratory or cardiac patient and you're stuck in city traffic and it's 95 degrees outside, then it plays an important role.”
Among the most controversial of the new regulations are speed governors to prevent ambulances built under the new rules from exceeding 77 mph and seat belt monitors that would sound if ambulance personnel leave their seats.
“That might be good for fire trucks, but in our business, you can't be strapped in all the time,” said Pfund. “Performing CPR or administering an IV or kneeling next to your patient can't be done if you're belted in.”