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Scripps News Investigates: The deadly toll of a US ambulance shortage

Aging and damaged ambulances are making it tough for emergency departments around the country to provide reliable service.
Posted at 9:14 AM, Sep 20, 2023

Jennifer Cowan didn’t used to worry about breaking down. 

When she became an EMT in Clay County, Tennessee nearly 20 years ago, she knew she could depend on the ambulance she drove to make it to any emergency call that came in.  

But now, a nationwide shortage of ambulance chassis is leaving Cowan and other EMTs constantly worried about breaking down on the way to an emergency — or with a patient in back, when seconds often can mean the difference between life or death. 

“I’ve broken down running an emergency with a patient in the back before. [You’re] worried about not being able to get someone’s child or grandma to the hospital because you don’t have an ambulance to get them there,” Cowan said. 

She’s not alone. 

Scripps News Investigates found local emergency medical services departments across the country that have been waiting years for replacements and repairs of aging and damaged ambulances.  

 “It’s always in the shop for something. We’ve been ready to buy a new ambulance for years,” Cowan said of her ambulance as she navigated the country roads in the rural part of the state. 

How we got here

The paint is peeling on some of Clay County’s ambulances. Maintenance and repair bills are piling up. 

Nationally, the problem began in 2020 when the COVID-19 pandemic ground global trade to a halt, preventing automakers from getting enough of the microchips that are critical to making modern cars, trucks — and ambulances.

Ambulances are made by a small number of specialized companies, which build them on top of bare chassis — the engine and frame of a truck — purchased from companies like Ford Motor Company and General Motors. 

Vehicles using the components of those chassis continued rolling off the assembly lines during the pandemic, but in lower numbers than usual. 

As the backlog grew, EMTs said they had more and more trouble with their aging vehicles. 

In fact, in 2021 there were a reported 13,540 mechanical failures that prevented ambulances from responding, and in 2022 that figure climbed to 14,905, according to U.S. Department of Transportation data. That’s a 10% increase. 

And, critics charge, automakers simply did not prioritize chassis for them over passenger trucks and other products analysts say are more lucrative than bare chassis. 

“Our customers are in dire demand for ambulances. The fact that we know a lot of our customers are running ambulances way past their life expectancy, the reliability of products on the road is very concerning,” said Randy Smith, president of Iowa-based Life Line Emergency Vehicles. 

Among the critics is American Ambulance Association president Randy Strozyk, who represents public and private ambulance service providers. 

He’s frustrated that automakers and public officials haven’t heeded emergency responders’ repeated warnings.  

“You would think we wouldn’t have had to jump up and down. This should have been an easy decision to make,” Stroyzk said. 

Clay County’s aging fleet

Clay County ordered a new ambulance in March 2022. But it still hasn’t arrived, and EMS director Andy Hall’s not optimistic. 

“We are looking at our next ambulances five years down the road,” Hall explained. 

Hall’s agency has four ambulances to cover a county that encompasses an area of 259 square miles.  

The newest is a 2019 model, purchased and delivered before the pandemic. 

The oldest is a 2010 with more than 235,000 miles on it — so many miles Hall had to get special permission from the state of Tennessee to keep using it. 

And in Clay County, the situation is compounded by a larger issue in rural health care. Back in 2018, the county’s only hospital shut down, leaving this county of 7,555 people without an emergency room.  “We are their hospital, we’re their ER until we can get them to a facility,” Cowan said 

In fact, the closest ER is now 20 miles away.  A typical round-trip call for EMTs lasts around 90 minutes. 

That increases the chance that the oldest vehicles in the fleet will be put into use — and increases the chance that the newer, more reliable units will be tied up when a call comes in. 

The new normal

Meanwhile, in 2022 representatives of the nation’s ambulance operators, fire chief, EMTs and firefighters sent a joint letter to Secretary of Transportation Pete Buttigieg that called the situation a “crisis” and asked that DOT push ambulance makers to prioritize them now and in the future. 

But a spokesman for Buttigieg said DOT lacks jurisdiction — and that its role enforcing safety and environmental regulations actually prevents the agency from pushing for changes in “production decisions.” 

At Buttigieg’s urging, a White House task force on supply chain issues did examine the chassis shortage.  

Automakers told officials that the supply chain issues preventing chassis manufacture have been resolved, said U.S. Department of Commerce spokesman Charlie Andrews. 

A representative of Ford, the leading provider of chassis to ambulance makers, echoed that. 

“From our vantage point, Ford is not the current constraint in the ambulatory supply chain,” spokeswoman Catherine Hargett said. “Beginning last year, we allocated more chassis to ambulance converters to address a vehicle backlog created by pandemic-driven supply chain issues and demand.”  

But ambulance makers, EMS workers and fire departments interviewed by Scripps News said they still are unable to place orders for chassis in the volume needed to reach pre-pandemic needs — much less account for a two-year backlog. 

Before the pandemic, Life Line made about 250 vehicles per year. The company should reach 220 this year, Smith said. But that’s nowhere near what’s needed by those using ambulances day in and day out. 

“I’m not saying I want a year’s worth of chassis in two weeks but they have the ability to do that,” Smith told Scripps News.  

Meanwhile, the people who put their lives on the line said their concern is not just the current backlog — but what will happen when another pandemic or disaster disrupts global supply chains. 

“We want priority. We should’ve been able to raise our hand once and this was recognized,” said Stroyzk, the head of the ambulance association. 

Other EMS officials say they see long delays as a new normal that agencies need to simply plan for. 

“They are coming through, it just takes some time,” said assistant EMS chief Dave Edgar of West Des Moines, Iowa. 

 But back in Clay County, Cowan and Hall said they’re just hoping their time comes soon. 

“Our hands are tied, there’s nothing we can do,” Cowan said. “We can’t help people if we can’t get to people.” 

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