As the pandemic-era backlog of emergency vehicles continues to delay new trucks from reaching Buncombe County, paramedics are left driving aging ambulances longer than they should just as they are needed more than ever before.
On Xpress’ recent trip to Buncombe County Emergency Medical Services, a two-person paramedic team reported that their ambulance was having mechanical issues, forcing them to return to the garage. Luckily, this time, they did not break down on the side of the road.
“We’ve had that happen before, where the truck is laid down and would not go,” said division manager Jamie Judd. “So we’ve had to tow the truck back to our garage facility for repair. But ideally, if we see something starting to happen, instead of waiting for a failure, we’ll take the truck out of service and get it addressed and then put the crew into a backup truck.”
Ambulances have been sidelined for engine or electrical malfunctions and broken temperature control in the back box, Judd says.
“During the winter, if the heat is not working, we’re not going to put a patient in a cold box,” he adds.
In keeping with industry standards, the county typically has four or five spare ambulances waiting in the wings, but as the aging vehicles require more maintenance, there have been times over the last three years when there have been more paramedics available than trucks, Judd says.
The county has struggled to replace its ambulances since the COVID-19 pandemic disrupted supply chains around the world, creating back orders on parts and forcing departments around the country to extend the lives of their vehicle fleets. Before 2020, Buncombe County swapped out all of its 15 or so ambulances every four to five years without trouble. Since the current fleet was purchased in 2017, the county was set for an upgrade in fiscal year 2021-22, but there were no trucks available.
As a result of those shortages and a confluence of other issues at the time, Buncombe’s EMS response times for 90% of its fleet peaked in 2021-22 at over 16 minutes on average, more than seven minutes more than the industry standard, according to a 2022 study conducted by N.C. Fire Chief Consulting.
Since then, Judd says things have improved, but as the study pointed out, more ambulances and EMS bases are still needed to completely close the gap.
Lay of the land
The aging fleet issues arise just as demand is soaring. Buncombe County EMS is the first responder in most of the county and second responder in five rural fire districts: Leicester, Barnardsville, Reems Creek, Riceville and Fairview.
The county has 10 EMS bases from Weaverville to Arden and Candler to Black Mountain, but the 2022 study shows it needs 12 more. According to the county’s position and pay dashboard, 97 paramedics cover Buncombe County around the clock.
The 2022 study by N.C. Fire Chief Consulting found that county EMS isn’t keeping up with increasing demand from a booming population — up 16% since 2010 to 276,000 residents — and more than 12 million tourists per year. Calls to EMS are up 20% since 2020, the study showed.
Six in 10 calls for service result in patient transportation, according to the study. It found that county EMS is “frequently responding to calls when out of position from their station location,” and concurrent calls during peak demand exacerbate the inefficiencies.
The 2022 study concluded that the county needs 19 ambulances during peak demand, with five to six more as spares.
Currently, the county runs 14-15 ambulances during peak daytime shifts, staffed by 30 paramedics, with four or five spares, Judd says.
At the beginning of the pandemic, departments across the country rushed to replace ambulances, worried supplies would dry up. So manufacturers got backlogged with orders while supply chain issues for electronic components and microchips further snarled production, Judd says.
Thus, Buncombe County’s planned fleet replacement in 2022 didn’t happen.
“What we’re seeing is most of those trucks have over 200,000 miles on them now. That’s about 25,000 to 50,000 more than we would normally like to run them,” Judd says. “When an engine gets run too long and too hard, we’ve had engine failure. So we’ve had to replace several engines and several transmissions in order to keep those units running.”
Unlike other government vehicles, ambulances run their engines longer to keep the back powered. Judd expects newer trucks to last longer because they are equipped with LED lights and built-in batteries in the box.
Now that it takes 24-36 months from order to delivery, the county plans to stagger purchases to prevent this backlog going forward, Judd says.
“If this situation happens again, we already have things in motion to better manage our fleet,” he says.
Turning tide
Judd says it finally feels as if the tide is turning.
At Emergency Services in early May, paramedic Fred Norris was getting one of two new ambulances stocked and ready to hit the streets. The new trucks, freshly emblazoned with the county’s new Emergency Services logo on top of a blue, mountain-clad background, were purchased from a manufacturer after another department canceled its order.
The county has dispersed its orders to four different manufacturers based in four states to increase its chances of finding new ambulances.
Two trucks ordered two years ago were delivered early this year. Judd expects four more ambulances to arrive by the end of the year.
“We’re starting to see the stuff we’ve been working on for the last almost three years, we’re starting to see the fruits of those labors starting to be delivered.”
New trucks mean the oldest ambulances can be retired, but Judd and Finance Director Melissa Moore have discussed another way to keep as many trucks in circulation as possible.
Instead of retiring full ambulances, the county might keep the ambulance boxes that house the stretcher and medical supplies and put it on a new chassis, which costs about $155,000 compared with $380,000 for a full ambulance, Judd says.
Judd predicts the county could get another four or five years out of a remounted box.
At the Reems Creek Fire Department, Chief Jeff Justice has employed that method to speed along ambulance replacement.
Between 2020 and 2022, one of the department’s two ambulances was breaking down with increasing regularity, sometimes while on a call. So Justice ordered a chassis and had its old box mounted on the new truck. The mounting process took longer than expected, but Justice says he’s likely to use that strategy again when needing a new truck.
The Reems Creek Fire Department — which handles about 2,000 calls a year compared with the county’s 38,000 calls in 2021-22 — has been waiting two years for a second truck replacement, and Justice says it will likely be another year before it gets one. Fortunately, its oldest truck still has about three years left on its lifespan.
At the county, funding for three new chassis is allocated in next year’s budget, up for a final vote June 16, and Judd says he expects those to be in by the end of the year as well.
It’s still unclear if the idea will lead to faster turnaround on orders long term since some of the remounters are seeing similar supply chain issues for chassis as full ambulances, Judd says.
As the ambulance supply issues get resolved, Judd says the county will start to look toward more EMS bases.
“We’re keeping trucks on the road more consistently now. But until we have true dedicated stations and places to put 24-hour trucks, that’s where everything’s going to start really coming together to address both the call volume and the response time,” Judd says.
The 2022 study identified a need for five additional urban EMS stations, including in West Asheville, where the county is in talks with Asheville City Schools to locate one at the former Asheville Primary School site on Haywood Road.
The study recommended three more on the outskirts of Asheville and four more out in the county, including a planned site near the Owen pool in Black Mountain.
If the ride in those dismally uncomfortable things (fault of the drivers or the dump trucks?) doesn’t kill you…Mission “Hospital” will complete the job.