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When the chips are down: Ambulance chassis availability now at crisis levels

AAA, IAFC, IAFF and NAEMT write to Secretary Pete Buttigieg to restore production levels


Ambulance chassis and chip supply issues have dramatically impacted ambulance costs and delivery times.

Recently, the American Ambulance Association (AAA), International Association of Fire Chiefs (IAFC), International Association of Fire Fighters (IAFF) and National Association of Emergency Medical Technicians (NAEMT) wrote a joint letter to United States Secretary of Transportation Pete Buttigieg, sharing their concerns over the availability of ambulance chassis and its impact on the delivery of ambulances to all services nationwide.

Ambulance chassis and chip supply issues have dramatically impacted ambulance costs and delivery times.

The national associations advised Secretary Buttigieg that the issue is now at a crisis level and services and agencies across the nation are experiencing the strain of a vehicle shortage. All signatories asked that Department of Transportation leadership encourage the chassis manufacturers to prioritize ambulance chassis productions and raise vehicle inventory to the appropriate and necessary levels.

Typical ambulance production timeline and delay

Before the pandemic, lead times for new ambulances ranged from 90-120 days (from order to delivery). At this time, the wait is now 24 months and longer. Ambulance chassis are supplied by Ford (accounting for about 80% of demand), GM, Chrysler, Daimler Trucks-North and Navistar.

In a typical year, the North American ambulance industry receives about 6,000 orders. Since 2020, that demand has continuously grown and in 2021, orders increased to 8,500 a year (an increase of 41%). For the past year and a half, ambulance manufacturers have been receiving only a fraction of their chassis orders from these companies and, as a result, production has slowed to a trickle.

I spoke with Chris Anderson, director of operations of Bell Ambulance Milwaukee, who said, “Order banks for GM and Ford should be opening any day now, for the 2023 manufacturing year - but getting a confirmation on how many chassis will be built is pretty impossible.”

A further effect of the disrupted production has seen furloughs and layoffs of skilled staff at ambulance factories. This reduction and loss of staff could further jeopardize an eventual return to normal production levels as reinstating or recruiting and retraining staff could further add to the woes.

Vehicle replacements

The joint letter notes that supply issues are occurring at a time when ambulance demand from EMS providers is at record-high levels and when an EMS agency loses an ambulance to a crash, or when it exceeds its useful/safe life, they may have to wait almost two years to replace it.

Ambulances operating under contract to counties or municipalities are usually mileage capped and should be replaced when they pass the designated mileage or engine hour point. In areas of California, local EMS authorities have already granted exceptions to this point, but it then increases the number of vehicles to be replaced once the supply chain recovers and waivers are removed.

Operational peril

The joint associations observe that while the nation faces supply chain issues in every sector, this issue represents a rapidly emerging threat to public safety. The lack of proper, new and serviceable equipment places additional pressure on an EMS system that is already over-stressed. As vehicle holdings reduce, demand on EMS increases, and in addition to still dealing with the COVID-19 pandemic, we are in the middle of both hurricane and peak fire seasons, during which ambulance strike teams could be deployed in support.

This year, lack of ambulances and crews could add to the depth of such emergencies. Pointing to Secretary Buttigieg’s own departmental initiative to reduce roadway fatalities with enhanced levels of post-crash care, the letter’s authors note that the availability of ambulances is a critical element of post-crash care, the safety of the patients and of the first responders, and action must be taken immediately.

The ask

AAA, IAFC, IAFF and NAEMT, as well as ambulance manufacturers, have been raising this issue with the chassis manufacturers, federal government organizations and lawmakers across the country, all to no meaningful avail, and they have little choice but to formally bring it to the attention of the Secretary.

Even though manufacturers have already indicated that their supply and construction issues will continue well into 2023, Secretary Buttigieg has been asked to step in. He has been asked to help resolve this situation and work with Ford, GM, Chrysler, Daimler Trucks-North and Navistar to prioritize EMS by allocating a larger portion of their builds to ambulance manufacturers.

It remains to be seen if the letter gets any traction and the secretary responds, but, as the saying goes, the squeaky wheel gets the grease ... if there is any in stock!


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Rob Lawrence has been a leader in civilian and military EMS for over a quarter of a century. He is currently the director of strategic implementation for PRO EMS and its educational arm, Prodigy EMS, in Cambridge, Massachusetts, and part-time executive director of the California Ambulance Association.

He previously served as the chief operating officer of the Richmond Ambulance Authority (Virginia), which won both state and national EMS Agency of the Year awards during his 10-year tenure. Additionally, he served as COO for Paramedics Plus in Alameda County, California.

Prior to emigrating to the U.S. in 2008, Rob served as the COO for the East of England Ambulance Service in Suffolk County, England, and as the executive director of operations and service development for the East Anglian Ambulance NHS Trust. Rob is a former Army officer and graduate of the UK’s Royal Military Academy Sandhurst and served worldwide in a 20-year military career encompassing many prehospital and evacuation leadership roles.

Rob is a board member of the Academy of International Mobile Healthcare Integration (AIMHI) as well as chair of the American Ambulance Association’s State Association Forum. He writes and podcasts for EMS1 and is a member of the EMS1 Editorial Advisory Board. Connect with him on Twitter.