Ambulances and the standard EN 1789: the applicable standards in Europe updated to 2020
Yellow colour body and star of life on the sides. This is how ambulances should be all over Europe, to be immediately recognized by all citizens of the EU member states. The standard EN 1789:2020 lays down a series of standards in order to harmonize the rescue practice in the European countries. Let’s find out the different ambulances and the standard EN 1789 in Europe updated to 2020.
Yellow is the most visible colour even at night, immediately perceptible. The colour code is RAL 1016, commonly named sulphur yellow. In addition, it should be alternated with green checkered pattern, totally covering the vehicle or a horizontal strip on the sides, according to the ambulance category.
The star of life, international symbol of rescue (6-points, stylized, with a Rod Of Aesculapius in the middle) can be found on the ambulances of all countries. We cannot say the same of the colour: let’s see why.
Adoption of the standard EN 1789:2020 in Europe
The CEN (European Committee for Standardization) agency is recognized by the EU and is made of national organizations for standardization. Each country adopts and harmonizes the standards, this is why the letter C of the acronym CEN is replaced by the country initials: for instance BS stands for British Standard, NF for France, DIN for Germany, UNI for Italy.
The standard EN 1789:2020 has significantly changed the previous one dated 2014 that, in its turn, had update the 2007 one, while the first version dates back to 1999. Usually adaptations in this sector occur every seven years.
The standard EN 1789:2020 is based on a basic principle of ambulance transport: to ensure the safety of patients and operators. This principle is often disregarded.
Legislation governing the standards shall be adopted by institutional organizations of all countries in order to have legal power, but this does not always happen in a short time. For example, the standard EN 1789 released in 1999 is in force in Germany and Spain since years. In France it applies to all ambulances since 2021 and to vehicles registered before 2011.
In Italy a previous standard is still on force (DM 553 del 1987). This is why Italian ambulances are still white. Yellow prevails all around Europe with a few exceptions: in Scotland ambulances are white, while in France the use of a colour depends on the category A, B or C.
Ambulance classification in Europe
If colours may be a question of aesthetics, there is a substantial difference in vehicle classification. The standards EN 1789 establishes the following types:
- type A, ambulance for transport of non-serious patients, divided in A1 (single patient) or A2 (for the transport of two or more patients), the so-called deferrable transport;
- type B, first-aid ambulance, for emergency and transport service, basic treatment and monitoring of serious patients;
- type C, intensive care and transport mobile unit, advanced treatment and monitoring of serious patients: this type is also called resuscitation mobile unit.
French ambulances
In France these categories are identified with different letter-codes: all the above belong to category A, diversified by type (type B; type C). In addition to these ones there are two more categories: C for private ambulances for non-serious medical transport; D for light medical vehicles (VSL) intended for patient transport in a seated position.
Specifically:
- A1 type B for fire-fighters’ rescue and casualty assistance vehicles (Véhicule de Secours et d’Assistance aux Victimes -VSAV);
- A2 type B for patient first-aid ambulances (Véhicule de Premiers Secours à Personnes-VPSP), equipped with medical devices to assist the medical emergency staff of SAMU/SMUR or fire-brigades. This type of vehicle is used by the French Red Cross, Civil Protection, White Cross and other first-aid units.
- A1 type C for SAMU ambulances (first-aid service) and SMUR (emergency and resuscitation mobile service) with complete medical equipment and compulsory presence of a doctor and a nurse.
Ambulances in Belgium
Belgium rather refers to the basic categories: A-ambulances for secondary transport, white with a yellow reflective strip with green checkered pattern, while emergency rescue ambulances belong to category B, easy to identify because they are totally yellow (always with horizontal green checkered pattern strip on the sides).
Ambulances in Italy
In Italy A and B stand for the opposite ambulance category (A = emergency; B = patient transport). C identifies mobile resuscitation units.
Categorisation is rather based on the crew and equipment. We identify:
- MSB, basic rescue vehicles with rescuers and basic devices on-board;
- MSI, intermediate rescue vehicles with one nurse on-board;
- MSA, advanced rescue vehicles with a nurse and a doctor on-board.
Equipment and operation strategy
In compliance with European regulations, rescue ambulance should have the driving compartment separated from the rear compartment, dedicated to medical treatments.
The equipment in the medical compartment includes: materials for medication and first-aid, resuscitation kit, oxygen-therapy devices, personal protective equipment (PPE), basic diagnostics tools, anti-trauma immobilization devices and patient transport equipment.
Ambulance equipment may vary if the operation strategy adopted is “scoop and run” (recover and quickly bring the patient to the hospital) or “stay and play” (aiming at stabilizing the patient before going to the hospital) and entailing wider equipment.
The first model is mainly used in the Anglo-Saxon world, while the second one is mostly spread in the French, German and central-European rescue systems.
Recently a hybrid model called “run and play” is becoming popular and consists in working on the patient while rushing to the hospital.
This trend confirms the importance to have vehicles equipped according to the directions of European regulations, approved in October 2020 and valid for the next five years.
Ambulances and the standard EN 1789: the applicable standards in Europe updated to 2020
Yellow colour body and star of life on the sides. All citizens of the EU member states should immediately recognize ambulances that are present all over Europe. The CEN 1789:2020 sets rules to unify rescue practices in European countries.
Yellow is the most visible colour even at night, immediately perceptible. The colour code is RAL 1016, commonly named sulphur yellow.
The ambulance should have a green checkered pattern. The pattern can either cover the entire vehicle or be in the form of a strip on the sides. The choice depends on the type of ambulance.
The star of life, a symbol of rescue, is on ambulances worldwide. It has 6 points and a Rod Of Aesculapius in the middle. We cannot say the same of the colour: let’s see why.
Adoption of the standard CEN 1789:2020 in Europe
The EU recognizes the CEN (European Committee for Standardization) agency, which consists of national organizations for standardization. Every country follows and aligns the standards. That’s why the letter C in CEN is changed to the country’s initials. For example, BS represents British Standard, NF for France, DIN for Germany, and UNI for Italy.
The new EN 1789:2020 is a big change from the 2014 version, which was an update of the 2007 one. The first version came out in 1999. Usually adaptations in this sector occur every seven years.
EN 1789:2020 ensures patient and operator safety during ambulance transport, following a basic principle. This principle is often disregarded.
All countries’ institutional organizations must adopt laws to set standards, but this may not always happen quickly. For example, the standard EN 1789 released in 1999 is in force in Germany and Spain since years. In France it applies to all ambulances since 2021 and to vehicles registered before 2011.
In Italy a previous standard is still on force (DM 553 del 1987). This is why Italian ambulances are still white. Most ambulances in Europe are yellow, but there are some exceptions. In Scotland, they are white, and in France, the color depends on the category A, B, or C.
Ambulance classification in Europe
If colours may be a question of aesthetics, there is a substantial difference in vehicle classification. The standards EN 1789 establishes the following types:
- Type A ambulance is used to transport non-serious patients. It can be divided into A1 for single patients or A2 for two or more patients. It is known as deferrable transport.
- type B, first-aid ambulance, for emergency and transport service, basic treatment and monitoring of serious patients;
- type C, intensive care and transport mobile unit, advanced treatment and monitoring of serious patients: this type is also called resuscitation mobile unit.
French ambulances
In France, different letter-codes are used to identify categories. All the mentioned categories belong to category A, which is further divided into type B and type C.
There are two additional categories. Category C is for private ambulances used for non-serious medical transport. Category D is for light medical vehicles used for patient transport in a seated position.
Specifically:
- A1 type B for fire-fighters’ rescue and casualty assistance vehicles (Véhicule de Secours et d’Assistance aux Victimes -VSAV);
- A2 type B for patient first-aid ambulances (Véhicule de Premiers Secours à Personnes-VPSP), equipped with medical devices to assist the medical emergency staff of SAMU/SMUR or fire-brigades. This type of vehicle is used by the French Red Cross, Civil Protection, White Cross and other first-aid units.
- A1 type C for SAMU ambulances (first-aid service) and SMUR (emergency and resuscitation mobile service) with complete medical equipment and compulsory presence of a doctor and a nurse.
Ambulances in Belgium
In Belgium, there are two types of ambulances. Category A ambulances are used for secondary transport and are white with a yellow reflective strip and a green checkered pattern. Category B ambulances are for emergency rescue and are completely yellow with a green checkered pattern on the sides.
Ambulances in Italy
In Italy A and B stand for the opposite ambulance category (A = emergency; B = patient transport). C identifies mobile resuscitation units.
Categorisation is rather based on the crew and equipment. We identify:
- MSB, basic rescue vehicles with rescuers and basic devices on-board;
- MSI, intermediate rescue vehicles with one nurse on-board;
- MSA, advanced rescue vehicles with a nurse and a doctor on-board.
Equipment and operation strategy
In compliance with European regulations, rescue ambulance should have the driving compartment separated from the rear compartment, dedicated to medical treatments.
The medical compartment contains various items for medical purposes. These include medicine, first-aid supplies, a resuscitation kit, oxygen devices, protective gear, diagnostic tools, immobilization devices, and patient transport equipment.
Ambulance equipment may vary if the operation strategy adopted is “scoop and run” (recover and quickly bring the patient to the hospital) or “stay and play” (aiming at stabilizing the patient before going to the hospital) and entailing wider equipment.
The first model is used in the Anglo-Saxon world. The second model is spread in the French, German, and central-European rescue systems.
A new model called “run and play” is gaining popularity. It involves treating patients while hurrying to the hospital.
The trend indicates the necessity for vehicles to adhere to European regulations. These regulations were approved in October 2020 and will remain in effect for the next five years.