CEN 1789

The current version of standard CEN 1789 was published by the Comité Européen de Normalisation (European Committee on Standardization) on October 1, 2020. This replaced an early version of the standard, published in 2007. European standards are generally annotated by the organization, standard number and year of publication (e.g. CEN 1789:2000 or CEN 1789/2007). Within member countries,[2] the annotation is likely to be adapted to include the local standards body, so that in Britain, the 'C' is dropped from the prefix, and replaced with 'BS', in Germany with 'DIN', and so on. Because of the likelihood of significant changes between versions, only the most current version of any standard should be used. The Comité Européen de Normalisation is an agency of the government of the European Union, with membership from the National Standards Body of each participating member country.

While CEN 1789:2020 represents the current European standard for the design of ambulances, it is by no means the only example of such a standard. Standards for ambulance design have existed in the United States since 1976, where the standard is known as KKK-1822-A.[3] This standard has been revised several times, and is currently in version 'F', known as KKK-1822-F. As with the European system, only the most current version of the standard should be used. One of the first known standards for ambulance design occurred in London, England, as the result of efforts by the Metropolitan Asylums Board, acting in response to the cholera outbreak of 1832. While horse-drawn, this provided the actual standard for many of the earliest civilian ambulances around the world. More contemporary versions of ambulance design standards also exist at a local level in Canada, Australia and New Zealand. In each case, the country or jurisdiction develops such standards based upon its own needs, priorities, and realities, and this is also true of the European standard. In some cases, standards compliance may not be planned, and may occur as an incidental result of normal operations. To illustrate, a small country has no domestic ambulance manufacturers, but imports its vehicles from a larger country in which the manufacturer must comply with a published standard. In most cases, the ambulances imported by the smaller country will end up complying with the larger country's standard, regardless of whether or not this outcome was intended. American and Australian standards were reviewed and considered during the development of the European standard, but were not precisely followed because European needs and priorities were different.

The standard is intended to gradually transform the existing 'patchwork' of ambulance design and equipment across Europe into a single set of standards. An ambulance from one country would possess sufficiently common characteristics to be immediately recognizable by the residents of another country. Such vehicles would be similar enough in design to be interchangeable, with emergency medical services personnel from one country able to quickly adapt to the use of a vehicle from another country, if required. Above all, such vehicles would be safe for those being transported in them,[4] those working in them, other users of the road, and the general public.

Vehicle standards

Austrian MICU; interior design and equipment restraint meet the standard

Requirements are specified for categories of road ambulances based in increasing order of the level of treatment that can be carried out. The standard includes both vehicle type and also engine type and performance characteristics, including vehicle dimensions, acceleration rate, braking capacity, traction control, fire safety, and heating/cooling.[2]

Please note that while the classification is standardized in the European Union, the crew and its abilities are not. The same vehicle may be used differently in varying countries. There are also emergency physician based systems in some European states, often with (non-EU regulated) vehicles with medical equipment and therefore lowering the need for the amount of equipment in the ambulance.

• Patient transport ambulances (Types A1 and A2)

Type A1 is without lights and sirens Type A2 with lights and sirens and can function as emergency ambulances. Generally only used for the non-emergency transportation of patients, either between facilities or between a facility and a residence. The emphasis is on transportation; such ambulances have limited treatment or equipment space. Such ambulances may also be used because of cost by smaller communities, particularly if there is no ALS service.

• 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.

• 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 an emergency physician response, or with the physician as a part of the crew. In Germany, the vast majority of primary emergency ambulances (Rettungswagen) are required to be Type C ambulance without being dedicated to intensive care transports.[9]

• European Ambulance Classes
• 
  Type A Ambulance in Poland
• 
  Type B Ambulance in Switzerland
• 
  Type C Ambulance in Germany

As with most European standards, compliance by the member countries of the European Union is purely voluntary, and to be determined at the level of the member country, usually by means of legislation, or by its own standards organization.[14] 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.