What is the compliance of an ambulance?

Sanitary vehicles are subject to special attention from health authorities, notably the ARS (Regional Health Agency). To ensure the safety of patients, a set of standards has been established. To enforce these standards, the ARS conducts inspections on a more or less regular basis. In cases where these standards are not complied with by sanitary transporters, sanctions may possibly be imposed against them.

Download the report on sanctions in case of ARS inspection

Types of ambulances

Type A 1 and A 2 -  Category C: light ambulance designed and equipped for the sanitary transport of a patient whose state of health does not suggest that they might become a distressed patient.Type B - Category A: emergency care ambulance for transport in a lying or semi-sitting position. Type C - Category A: ambulance for transport, intensive care and monitoring of patients.Category D : lightweight sanitary vehicle capable of transporting a maximum of 3 patients in a seated position.

Approval and regulatory framework

Before any discussion, a sanitary transporter must have an authorization to use sanitary vehicles in the context of an economic activity.

The authorization of a sanitary transport company may cover:

Sanitary transport performed under the emergency medical assistance (EMA):

In this case, the company holding the authorization must have at least 2 vehicles of ambulance type (category C = Type A) or ASSU (category A = Type B or Type C).

Sanitary transport performed under emergency medical assistance and sanitary transport performed on medical prescription:

In this second case, the company holding the authorization must possess 2 vehicles INCLUDING at least one ambulance (category C = Type A) or ASSU (category A = Type B or Type C).

1: The difference with the first case is quite minimal. In both cases, at least 2 vehicles are required, but in this case, it is simply necessary to have only one vehicle of Category A or C (The 2nd vehicle can be of category D). Conversely, in the first case (EMA), at least 2 vehicles of category A or C are required.

The approval standards for ambulances

Vehicles specially adapted for sanitary transports must be approved according to the European standard NF 1865. This standard specifies the requirements regarding the vehicle, performance criteria, and resistance to a crash test. It applies to ambulances of type A1, A2, B, and C, as well as medical equipment on board.

The objective of the standard NF 1865 is to ensure optimal comfort for the patient and especially to guarantee their safety during the journey. It requires a "Crash test", simulating a shock at 2 to 10 G, of the sanitary cell of each type of ambulance to evaluate the equipment's resistance and the behavior of the anchorage points.

2: By simulation of shock, we mean strong braking when the vehicle is launched at a high speed. 10 G = 10 times the weight of the vehicle;

This approval will be carried out by a service named UTAC (Technical Union of automotive, motorcycle, and bicycle). This private entity ensures that the conditions established in the standard NF 1865 are respected on the vehicle. The UTAC is responsible for these simulations and inspections and also issues the corresponding certificate, required for the ambulance approval.

Putting into service

Before the commissioning of any vehicle, the sanitary transporter requests the ARS to organize the vehicle inspection appointment (a 7-day notice is required).

For this purpose, the sanitary transporter must send a letter requesting authorization for commissioning specifying the anticipated date of commissioning and, if necessary, the vehicle registration.

He must attach to his letter:

The vehicle registration certificateThe certificate of conformity UTAC according to the characteristics of the standard NF 1865.The technical inspection report dated less than one year if the vehicle has been in circulation for more than a year

With these different elements, the ARS decides whether or not the vehicle can operate as a sanitary vehicle.

The mandatory equipment on board an ambulance

The standard NF EN 1789 comes into play this time. It specifies the mandatory equipment inside a sanitary vehicle based on its type (Type A, B, or C).

The vehicle must contain mandatory equipment:

Lifting and stretcher equipment

ResuscitationCommunicationOxygen therapyImmobilizationDiagnosisHygiene.

The link below provides the list of mandatory equipment

List of mandatory equipment in ambulances and VSL

It is then the turn of the DASS (Departmental Directorate of Health and Social Affairs) to validate and control the compliance of the equipment based on several elements.

The transmission of the quality assurance system certificate or the service certification from the ambulance staff.A regular inspection of each vehicle.

This regulatory process has been in effect since January 1, 2011, for new vehicles. Since January 1, 2021, this process also applies to vehicles already in service.

Possible controls

This regulatory process naturally leads to regular inspections by the ARS as well as law enforcement agencies. The goal is to ensure that transported patients are in optimal conditions.

4 types of controls:

The compliance inspections : This is the control carried out by ARS teams to verify compliance with technical standards in order to issue the authorization1 and to check ambulances. Inspections are performed upon presentation of the vehicle to the ARS before any commissioning.Random inspections : As part of its "inspection control" mission, the ARS can carry out vehicle inspections at any time, in collaboration with primary funds, law enforcement, and other government services.Technical inspections : An ambulance must undergo a periodic technical inspection each year from its first year of operation or immediately if the assignment for this use occurs after this timeframe. Sanitary transporters must then send the ARS the report of the annual technical visit.Inspections by law enforcement : Beyond the inspection of documents concerning the vehicle and the driver, law enforcement agencies are authorized to verify compliance with authorization and transport as per medical prescription. Failures are subject to fines and/or sanctions.

If significant problems are detected during these controls, the sanitary transporter exposes themselves to sanctions, including financial penalties or simply the temporary or unlimited withdrawal of their sanitary transporter authorization.

Compliance procedures

The disinfection of ambulances:

To limit the spread of germs and ensure quality service, cleaning and disinfection procedures have been established by the Ministry of Transport. An organization selected by the same ministry is responsible for validating these procedures. To this end, this organization will rely on various documents:

The implementation protocol between each transport.The weekly cleaning and disinfection protocol.The cleaning and disinfection protocol before transporting a fragile patient.The cleaning and disinfection protocol after transporting a contagious patient.The document chronologically retracing all cleaning and disinfection operations. It must be submitted to health authorities upon request.

The equipment of ambulances:

In addition to hygiene procedures, it is also important to ensure that ambulances have the appropriate equipment when they are dispatched for intervention. In this respect, there are also obligations concerning the equipment available in an ambulance.

More information by clicking on this  link:

List of mandatory equipment in ambulances and VSL

The implementation of procedures

Today, we observe two ways to implement these procedures.

Paper procedures : 

You print a sheet with a checklist and send this sheet to the ambulance staff who will handle the inspection of the vehicles. They fill in various details and then send back the quality controls in paper format. You finally retrieve the document and process the data on your Excel sheet.

Simple to implement, it becomes increasingly lengthy to process when the vehicle fleet is large. It is a viable solution when the fleet does not contain more than ten vehicles.

Digital procedures:

The principle is the same as for a paper procedure; however, digital has additional advantages. With the help of a smartphone, the ambulance staff conducts the vehicle inspections and fills out a digital checklist (as on paper).

They validate the various checkpoints, and if a problem is detected, the fleet manager is automatically alerted via notifications. No data processing is required; only the necessary corrections need to be applied.

Digital procedures have the advantage of being easily updated. A new checkpoint can be easily added to the procedure without even needing to print a new sheet or modify a document. A simple addition in the application does the integration work for you.

It is also a simpler way to share the history of quality procedures. With a single click, you have access to a timeline detailing the inspection history of vehicles. No need to store a stack of sheets and hassle with finding a document.

The goal here is to show you that the chore of quality procedures can be significantly alleviated by modernizing internal control processes.

The transmission of data and processing, being the most tedious part for a manager, digital procedures on a web/mobile application like VESUV allows this work to be delegated entirely. Be automatically alerted when an issue is detected with a vehicle and keep your vehicles operational and compliant more easily.

What to remember:

Sanitary vehicles are subject to special attention from health authorities, notably the ARS (Regional Health Agency).Sanitary vehicles must be approved by the UTAC according to the standards EN 1865.The mandatory equipment in a sanitary vehicle is defined according to the standard NF EN 1789.In case of non-compliance with these standards (requirements), financial and operational sanctions are possible.The use of business applications like VESUV allows you to ensure compliance with health standards more easily. In case of inspections, share the history of operations performed in just one click.

Conclusion

Compliance with standards and procedures for sanitary vehicles is essential to guarantee patient safety and regulatory compliance. Although these requirements may seem complex and time-consuming, digital tools like VESUV offer an effective solution to digitize inspections, optimize fleet management, and prevent non-compliance. By modernizing their processes, sanitary transporters can not only meet the expectations of authorities but also improve their organization and strengthen their credibility with clients and partners.