CEN 1789
Encyclopedia
CEN 1789:2007 is the European Union
standard
for ambulances and medical transportation vehicles. This European standard specifies requirements for the design, testing, performance and equipping of road ambulances used for the transport and care of patients. This standard is applicable to road ambulances capable of transporting at least one person on a stretcher.
', in Germany with 'DIN
', and so on. Because of the likelihood of significant changes between versions, on the most current version of any standard should be used. The Comité Européen de Normalisation is an agency of the government of the European Union
, with membership from the National Standards Body of each participating member country.
While CEN 1789:2007 represents the current European standard for the design of ambulances, it is by no means the only example of such a standard. Standards for ambulance design have existed in the United States
since 1976, where the standard is known as KKK-1822-A. This standard has been revised several times, and is currently in version 'F', known as KKK-1822-F. As with the European system, only the most current version of the standard should be used. One of the first known standards for ambulance design occurred in London
, England
, as the result of efforts by the Metropolitan Asylums Board
, acting in response to the cholera
outbreak
of 1832. While horse-drawn, this provided the actual standard for many of the earliest civilian ambulances around the world. More contemporary versions of ambulance design standards also exist at a local level in Canada
, Australia
and New Zealand
. In each case, the country or jurisdiction develops such standards based upon its own needs, priorities, and realities, and this is also true of the European standard. In some cases, standards compliance may not be planned, and may occur as an incidental result of normal operations. To illustrate, a small country has no domestic ambulance manufacturers, but imports its vehicles from a larger country in which the manufacturer must comply with a published standard. In most cases, the ambulances imported by the smaller country will end up complying with the larger country's standard, regardless of whether or not this outcome was intended. American and Australian standards were reviewed and considered during the development of the European standard, but were not precisely followed because European needs and priorities were different.
personnel from one country able to quickly adapt to the use of a vehicle from another country, if required. Above all, such vehicles would be safe for those being transported in them, those working in them, other users of the road, and the general public.
Requirements are specified for categories of road ambulances based in increasing order of the level of treatment that can be carried out. The standard includes both vehicle type and also engine type and performance characteristics, including vehicle dimensions, acceleration rate, braking capacity, traction control, fire safety, and heating/cooling.
, dynamic and impact testing.
Generally only used for the non-emergency transportation of patients, either between facilities or between a facility and a residence. The emphasis is on transportation; such ambulances have limited treatment or equipment space. Such ambulances may also be used because of cost by smaller communities, particularly if there is no ALS service, or if ALS is provided by another vehicle, as with a Notarzt.
The most commonly seen type of emergency ambulance. This vehicle type permits increased treatment space and also the ability to store significantly larger amounts of medical equipment. Such vehicles will typically respond independently to emergency calls, providing some level of treatment. For high priority emergency calls, these will often be supplemented by the response of a Notarzt.
This type of ambulance is commonly seen in the movement of high acuity (ICU) patients between hospitals. It provides adequate space for not only the medical equipment commonly seen in ambulances, but also to accommodate hospital equipment, such as ventilators, during transport. In some locations, vehicles of this design may be used to provide mobile resuscitation services, either supplemented by a Notarzt response, or with the Notarzt as a part of the crew.
, or by its own standards organization
. To illustrate, this standard, which has been accepted by the United Kingdom
, is known locally as BS EN 1789:2007, with the 'BS' referring to British Standards
. As a result, the adoption of this standard has varied considerably from one country to another. Most countries, for example, have adopted the sections dealing with vehicle design and performance, while only a few (the UK, Ireland
, and Sweden
at this writing), have fully adopted the colour, warning system, and livery schemes for such vehicles. To further complicate matters, some countries have adopted some portion of the visual identity standards, but not all. In the Netherlands
, Belgium
, and some parts of Germany
, the conversion to the basic identifying colour (yellow) is occurring, but the balance of visual identity provisions are not. In addition, some countries which are not currently members of the European Union, such as Norway
are adopting some portions of the standards, primarily because few other good standards exist for this purpose, particularly those that reflect European realities. The rate and degree of compliance with the standard is a conscious choice by individual countries, while in others, compliance is a matter of the priorities for the changing of older, country specific, legislation. As previously stated, compliance with the standard is purely voluntary. There are no untoward financial implications to compliance, since only ambulances purchased after ratification of the standard by each country are required to be compliant. There is no mandatory provision for the retrofitting of existing ambulances.
European Union
The European Union is an economic and political union of 27 independent member states which are located primarily in Europe. The EU traces its origins from the European Coal and Steel Community and the European Economic Community , formed by six countries in 1958...
standard
International standard
International standards are standards developed by international standards organizations. International standards are available for consideration and use, worldwide...
for ambulances and medical transportation vehicles. This European standard specifies requirements for the design, testing, performance and equipping of road ambulances used for the transport and care of patients. This standard is applicable to road ambulances capable of transporting at least one person on a stretcher.
History
The current version of standard CEN 1789 was published by the Comité Européen de Normalisation (European Committee on Standardization) on June 29, 2007. This replaced an early version of the standard, published in 2000. European standards are generally annotated by the organization, standard number and year of publication (e.g. CEN 1789:2000 or CEN 1789/2007). Within member countries, the annotation is likely to be adapted to include the local standards body, so that in Britain, the 'C' is dropped from the prefix, and replaced with 'BSBS
BS, B.S., Bs or bs may refer to:-Academics:*Bachelor of Science degree, also abbreviated BSc*Bachelor of Surgery*Behavioural sciences-Standards:*Venezuelan bolívar's currency sign*Bolivian boliviano's currency sign...
', in Germany with 'DIN
Din
DIN or Din or din can have several meanings:* A din is a loud noise.* Dīn, an Arabic term meaning "religion" or "way of life".* Din is one of the ten aspects of the Ein Sof in Kabbalah ....
', and so on. Because of the likelihood of significant changes between versions, on the most current version of any standard should be used. The Comité Européen de Normalisation is an agency of the government of the European Union
European Union
The European Union is an economic and political union of 27 independent member states which are located primarily in Europe. The EU traces its origins from the European Coal and Steel Community and the European Economic Community , formed by six countries in 1958...
, with membership from the National Standards Body of each participating member country.
While CEN 1789:2007 represents the current European standard for the design of ambulances, it is by no means the only example of such a standard. Standards for ambulance design have existed in the United States
United States
The United States of America is a federal constitutional republic comprising fifty states and a federal district...
since 1976, where the standard is known as KKK-1822-A. This standard has been revised several times, and is currently in version 'F', known as KKK-1822-F. As with the European system, only the most current version of the standard should be used. One of the first known standards for ambulance design occurred in London
London
London is the capital city of :England and the :United Kingdom, the largest metropolitan area in the United Kingdom, and the largest urban zone in the European Union by most measures. Located on the River Thames, London has been a major settlement for two millennia, its history going back to its...
, England
England
England is a country that is part of the United Kingdom. It shares land borders with Scotland to the north and Wales to the west; the Irish Sea is to the north west, the Celtic Sea to the south west, with the North Sea to the east and the English Channel to the south separating it from continental...
, as the result of efforts by the Metropolitan Asylums Board
Metropolitan Asylums Board
The Metropolitan Asylums Board was established under Poor Law legislation, to deal with London's sick poor. It was established by the Metropolitan Poor Act 1867 and was wound up in 1930, its functions being transferred to the London County Council. Despite its name, the MAB was not involved in...
, acting in response to the cholera
Cholera
Cholera is an infection of the small intestine that is caused by the bacterium Vibrio cholerae. The main symptoms are profuse watery diarrhea and vomiting. Transmission occurs primarily by drinking or eating water or food that has been contaminated by the diarrhea of an infected person or the feces...
outbreak
Outbreak
Outbreak is a term used in epidemiology to describe an occurrence of disease greater than would otherwise be expected at a particular time and place. It may affect a small and localized group or impact upon thousands of people across an entire continent. Two linked cases of a rare infectious...
of 1832. While horse-drawn, this provided the actual standard for many of the earliest civilian ambulances around the world. More contemporary versions of ambulance design standards also exist at a local level in Canada
Canada
Canada is a North American country consisting of ten provinces and three territories. Located in the northern part of the continent, it extends from the Atlantic Ocean in the east to the Pacific Ocean in the west, and northward into the Arctic Ocean...
, Australia
Australia
Australia , officially the Commonwealth of Australia, is a country in the Southern Hemisphere comprising the mainland of the Australian continent, the island of Tasmania, and numerous smaller islands in the Indian and Pacific Oceans. It is the world's sixth-largest country by total area...
and New Zealand
New Zealand
New Zealand is an island country in the south-western Pacific Ocean comprising two main landmasses and numerous smaller islands. The country is situated some east of Australia across the Tasman Sea, and roughly south of the Pacific island nations of New Caledonia, Fiji, and Tonga...
. In each case, the country or jurisdiction develops such standards based upon its own needs, priorities, and realities, and this is also true of the European standard. In some cases, standards compliance may not be planned, and may occur as an incidental result of normal operations. To illustrate, a small country has no domestic ambulance manufacturers, but imports its vehicles from a larger country in which the manufacturer must comply with a published standard. In most cases, the ambulances imported by the smaller country will end up complying with the larger country's standard, regardless of whether or not this outcome was intended. American and Australian standards were reviewed and considered during the development of the European standard, but were not precisely followed because European needs and priorities were different.
Intent
The standard is intended to gradually transform the existing 'patchwork' of ambulance design and equipment across Europe into a single set of standards. An ambulance from one country would possess sufficiently common characteristics to be immediately recognizable by the residents of another country. Such vehicles would be similar enough in design to be interchangeable, with emergency medical servicesEmergency medical services
Emergency medical services are a type of emergency service dedicated to providing out-of-hospital acute medical care and/or transport to definitive care, to patients with illnesses and injuries which the patient, or the medical practitioner, believes constitutes a medical emergency...
personnel from one country able to quickly adapt to the use of a vehicle from another country, if required. Above all, such vehicles would be safe for those being transported in them, those working in them, other users of the road, and the general public.
Vehicle standards
Interior design standards
The standard contains ergonomic requirements and design specifications for the patient compartment, and also places practical restrictions on the physical lifting of patients in and out of the vehicle, for safety reasons. Other safety factors addressed include lighting, doors & windows, cabinet securing systems, seatbelt and seat anchorage, seat size & position, and restraint of medical equipment, with provisions for static testingStatic testing
Static testing is a form of software testing where the software isn't actually used. This is in contrast to dynamic testing. It is generally not detailed testing, but checks mainly for the sanity of the code, algorithm, or document. It is primarily syntax checking of the code and/or manually...
, dynamic and impact testing.
Classification of ambulances
- Patient transport ambulances (Types A1 A2)
Generally only used for the non-emergency transportation of patients, either between facilities or between a facility and a residence. The emphasis is on transportation; such ambulances have limited treatment or equipment space. Such ambulances may also be used because of cost by smaller communities, particularly if there is no ALS service, or if ALS is provided by another vehicle, as with a Notarzt.
- Emergency ambulances (Type B)
The most commonly seen type of emergency ambulance. This vehicle type permits increased treatment space and also the ability to store significantly larger amounts of medical equipment. Such vehicles will typically respond independently to emergency calls, providing some level of treatment. For high priority emergency calls, these will often be supplemented by the response of a Notarzt.
- Mobile intensive care unit (Type C)
This type of ambulance is commonly seen in the movement of high acuity (ICU) patients between hospitals. It provides adequate space for not only the medical equipment commonly seen in ambulances, but also to accommodate hospital equipment, such as ventilators, during transport. In some locations, vehicles of this design may be used to provide mobile resuscitation services, either supplemented by a Notarzt response, or with the Notarzt as a part of the crew.
Medical devices
This Standard gives general requirements for medical devices carried in road ambulances and used therein and outside hospitals and clinics in situations where the ambient conditions can differ from normal indoor conditions.Vehicle colour
The Standard specifies that all ambulances will be painted yellow, with specific colour standards, as their primary body colour. The colour yellow was chosen primarily because it remains visible to almost all people in all lighting conditions, including the majority of those with colour-blindness.Active warning systems
All ambulances will be equipped with flashing blue lights, visible for 360 degrees around the vehicle. All vehicles must also be equipped with an audible warning system (siren) which meets specified standards for both sound pattern and volume.Passive warning systems
All ambulances are to be equipped with highly reflective green and yellow 'checkerboard' markings (the English term is 'Battenburg' pattern), of specified proportions, running the entire length of the vehicle. The intent of this measure was to provide specific 'visual identities' for emergency vehicles, by reserving this pattern for ambulances, blue and yellow Battenburg for police cars, and red and yellow Battenburg for fire service vehicles. In addition, all lettering on the vehicle is required to be highly reflective, in order to boost vehicle visibility in all conditions. The colour combination selected was chosen for specific reasons. Under night time conditions, green is among the most visible (exceeded only by blue) of colours, creating high visibility (and safety) for ambulance vehicles. Unfortunately, for many of those who suffer from colour-blindness, neither green nor red is visible, washing out to shades of grey or dark yellow. In fact, almost 99 percent of all colour vision deficiency involves some form of red-green colour blindness, and includes an estimated 7-10 percent of all males, depending on location. However, even for these individuals, the colour yellow is always visible (see diagram). The resulting pattern is both high visibility and eye-catching for the average person, provides improved night time visibility for most, and provides a combination which is identifiable, at least in part, by the majority of the population.Application and compliance
As with most European standards, compliance by the member countries of the European Union is purely voluntary, and to be determined at the level of the member country, usually by means of legislationLegislation
Legislation is law which has been promulgated by a legislature or other governing body, or the process of making it...
, or by its own standards organization
Standards organization
A standards organization, standards body, standards developing organization , or standards setting organization is any organization whose primary activities are developing, coordinating, promulgating, revising, amending, reissuing, interpreting, or otherwise producing technical standards that are...
. To illustrate, this standard, which has been accepted by the United Kingdom
United Kingdom
The United Kingdom of Great Britain and Northern IrelandIn the United Kingdom and Dependencies, other languages have been officially recognised as legitimate autochthonous languages under the European Charter for Regional or Minority Languages...
, is known locally as BS EN 1789:2007, with the 'BS' referring to British Standards
British Standards
British Standards are the standards produced by BSI Group which is incorporated under a Royal Charter...
. As a result, the adoption of this standard has varied considerably from one country to another. Most countries, for example, have adopted the sections dealing with vehicle design and performance, while only a few (the UK, Ireland
Republic of Ireland
Ireland , described as the Republic of Ireland , is a sovereign state in Europe occupying approximately five-sixths of the island of the same name. Its capital is Dublin. Ireland, which had a population of 4.58 million in 2011, is a constitutional republic governed as a parliamentary democracy,...
, and Sweden
Sweden
Sweden , officially the Kingdom of Sweden , is a Nordic country on the Scandinavian Peninsula in Northern Europe. Sweden borders with Norway and Finland and is connected to Denmark by a bridge-tunnel across the Öresund....
at this writing), have fully adopted the colour, warning system, and livery schemes for such vehicles. To further complicate matters, some countries have adopted some portion of the visual identity standards, but not all. In the Netherlands
Netherlands
The Netherlands is a constituent country of the Kingdom of the Netherlands, located mainly in North-West Europe and with several islands in the Caribbean. Mainland Netherlands borders the North Sea to the north and west, Belgium to the south, and Germany to the east, and shares maritime borders...
, Belgium
Belgium
Belgium , officially the Kingdom of Belgium, is a federal state in Western Europe. It is a founding member of the European Union and hosts the EU's headquarters, and those of several other major international organisations such as NATO.Belgium is also a member of, or affiliated to, many...
, and some parts of Germany
Germany
Germany , officially the Federal Republic of Germany , is a federal parliamentary republic in Europe. The country consists of 16 states while the capital and largest city is Berlin. Germany covers an area of 357,021 km2 and has a largely temperate seasonal climate...
, the conversion to the basic identifying colour (yellow) is occurring, but the balance of visual identity provisions are not. In addition, some countries which are not currently members of the European Union, such as Norway
Norway
Norway , officially the Kingdom of Norway, is a Nordic unitary constitutional monarchy whose territory comprises the western portion of the Scandinavian Peninsula, Jan Mayen, and the Arctic archipelago of Svalbard and Bouvet Island. Norway has a total area of and a population of about 4.9 million...
are adopting some portions of the standards, primarily because few other good standards exist for this purpose, particularly those that reflect European realities. The rate and degree of compliance with the standard is a conscious choice by individual countries, while in others, compliance is a matter of the priorities for the changing of older, country specific, legislation. As previously stated, compliance with the standard is purely voluntary. There are no untoward financial implications to compliance, since only ambulances purchased after ratification of the standard by each country are required to be compliant. There is no mandatory provision for the retrofitting of existing ambulances.