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VAIL — Chris Marsh typically orders two new ambulances every year for Eagle County Paramedic Services. 

That keeps a steady flow of the crucial vehicles rolling into his stable of 14 ambulances that provide 24-hour service out of five stations in Eagle County from Vail to Gypsum. 

This story first appeared in The Outsider, the premium outdoor newsletter by Jason Blevins.

In it, he covers the industry from the inside out, plus the fun side of being outdoors in our beautiful state.

But no new ambulances were delivered this year. And it’s not likely any will come next year. Marsh, a paramedic who moonlights as the fleet coordinator for Eagle County Paramedic Services, has four ambulances on order. 

“I can’t get any answer when those will be ready,” said the 15-year paramedic. “When they arrive I’ll have four of the same model years in my fleet and all four will age out at the same time. It’s a compounding issue for us.”

And it’s a national problem. The vehicle manufacturing slowdown during the pandemic continues to send shockwaves as emergency services providers are waiting years for delivery of ambulances that used to take months. Manufacturers like Ford, Chevrolet and Dodge offer brief windows — a matter of a few days — for buyers to order new ambulance chassis. The chassis are the same as heavy-duty trucks or 15-passenger vans and manufacturers now are only building them to order, stacking up long delays for delivery. 

Eagle County Paramedic Chris Marsh checks on the retraction of the tire chains beneath the ambulance at the station in Vail. Eagle River Valley ambulance services are having years long delay in replacing their vehicles and new parts to serve rural communities. (Hugh Carey, The Colorado Sun)

Lining up grant funding with those three-day order windows is rarely possible, said Marsh, who ordered three of his still undelivered ambulances with his district’s cash reserves and the delays have increased the price as manufacturers shift production to next year. 

“Our budget is tax funded, so we obviously track every dollar we spend and now I have to go back to our board and tell them the chassis we ordered for this amount will cost this much more if it can even be delivered next year,” Marsh said. 

Fleet managers like Marsh need parts to keep ambulances running and meeting constantly changing emissions standards. Those parts are impossible to find as supply chain issues plague the makers of the thousands of parts that go into an ambulance.

As aging ambulances are pushed into longer service, the costs to run and maintain the vehicles can double. 

Ambulance buyers who secured grants and financing for new rigs are having to return to state grant writers and banks to renegotiate terms.

“Right now you are looking at ambulance builders with a backlog of three years. It’s a phenomenon that is happening everywhere,” said Mark Van Arnam, a 50-year veteran of the ambulance industry who now works with the American Ambulance Association on supply chain issues. 

The American Ambulance Association says emergency service providers typically order about 6,500 new ambulances a year. Last year, flush with federal stimulus dollars, orders peaked to a record 8,500 new ambulances ordered. But manufacturers will not be delivering anywhere close to that many new rigs. 

The ambulance group earlier this year joined associations of fire chiefs, firefighters and emergency medical technicians in asking the Department of Transportation to lean on manufacturers “to prioritize ambulance chassis productions.”

Eagle County Paramedic Chris Marsh checks both of his phones as they rang simultaneously during a local amber alert while inside the station in Vail. During shift, Chris holds three phones, a work phone, an EMT phone, and a personal phone. (Hugh Carey, The Colorado Sun)
Eagle County paramedics Kayla Telles, left, and Ande Rasmussen hop on the ambulance before leaving the station for a non-emergency run. (Hugh Carey, The Colorado Sun)

Dallas Mayor Eric Johnson last month fired off a letter to the U.S. Transportation Secretary Pete Buttigieg pleading for help to secure 27 new ambulance chassis and 401 service  vehicles. His city is renting fire trucks and pointed to the City of Houston getting only one of 70 emergency vehicles ordered through Ford, which pushed the rest of the order to 2023 at next year’s pricing. 

“These delays jeopardize public safety in Texas and across the United States,” Johnson wrote in his letter.

One of the challenges with the delayed delivery of ambulances involves the grant funding programs that help local emergency service providers pay for vehicles that can cost more than $250,000 each. 

The Colorado Department of Public Health and Environment, which oversees the state’s 11 Regional Emergency Medical and Trauma Services Advisory Councils — or RETACs — has worked closely with providers in the past two years to keep grant funds intact. Those grants are funded by a $2 fee assessed on every vehicle registration in Colorado. That fee revenue lagged during the pandemic and state lawmakers approved a one-time $2 million bump for the fiscal 2023 grant cycle. In June the Colorado Health Facilities and Emergency Medical Services Division announced $6.8 million in grants to 90 Colorado RETACs, fire and ambulance districts, hospitals, counties and municipalities. 

The state health department this year extended the completion date of acquisitions, allowing for more time while emergency service providers wait for manufacturers.

But “an emergency medical and trauma services provider agency would be required to revert the grant funding if the ambulance or EMS response vehicle is not purchased,” said health department spokeswoman Gabrielle Johnston. 

The state is working closely with local emergency service providers to protect that grant funding, “but I’m not sure how long they can extend those grants,” said Julie Ramstetter with the San Luis Valley Health Regional Medical Center who serves on the board for the San Luis Valley RETAC.

“Currently, I am not aware that it is completely affecting our services ability to run 911, but I do know it is affecting our ability to do more ground transportation in and out of the valley,” said Ramstetter, citing frustration among her members with supply chain issues impacting long-haul patient transports. 

The delays in getting new parts and new ambulances in the Eagle River Valley has not impacted paramedic response and services yet. 

But as the holidays arrive and the valley’s population swells with visitors, a steady rotation of ambulances means there can be only one machine as a backup in case an ambulance breaks down or is called to deliver a patient to the Front Range. 

“I’m running into situations where I have to make more hard decisions than I used to,” Marsh said. “I used to have the luxury of pulling ambulances out of service when they needed maintenance or repairs. Now I have to wait for when the parts are in stock.”

An Eagle County ambulance departs the station in Vail. (Hugh Carey, The Colorado Sun)

Jason Blevins lives in Eagle with his wife, two teenage girls and a dog named Gravy. He writes The Outsider, a weekly newsletter covering the outdoors industry from the inside out. Topic expertise: Western Slope, public lands, outdoors,...