It appears the city of Tower is poised to make another very expensive decision, without adequate vetting.
At issue is the desire by Ambulance Director Steve Altenburg to spend as much as $250,000 for a new ambulance. The city council gave Altenburg the okay to finalize the purchase of a new vehicle and related equipment at their Nov. 13 regular meeting, but did so without any public explanation of why the current ambulance is in need of replacement or a discussion of whether the city even needs to operate three ambulances. The city council recently approved spending upwards of $75,000 to bring a reserve ambulance back into service, which increased the city’s full-time fleet to three, up from the two ambulances the city had operated for a number of years.
We don’t fault Mr. Altenburg for advocating for resources for his department. It is the city council that should be asking to see the justification. It’s the council’s job to question whether the purchase fits with the city’s current spending priorities and if this expenditure is an actual need, rather than a desire. As it stands today, that questioning has not taken place, at least not in a public setting.
Here are questions that the city council should be asking before signing any contract for the purchase of a new ambulance:
Does the ambulance really need replacement? The ambulance that Altenburg seeks to replace is a 2011 diesel vehicle with only 110,000 miles on it. Other area ambulance services routinely expect to get at least twice that number of miles before replacing a vehicle. Virginia EMS shoots for 300,000 miles on a rig before replacement. If the city were going to obtain a substantial trade-in value by selling a relatively low-mileage vehicle, it could perhaps be justified. But Mr. Altenburg told the council that a glut of used ambulances has sent resale values plummeting. Which is all the more reason to get the maximum value out of the service’s existing rigs.
Mr. Altenburg has said the 2011 rig has issues with the ambulance box, but he’s never provided any details to justify replacement. There is no question that the area’s rough roads likely contribute to stress and added wear on all of the city’s ambulances, but is the current vehicle really ready to be essentially scrapped? Following the Nov. 13 council meeting, the Timberjay requested, in writing, a more detailed description of the deficiencies with the ambulance box and received no response as of this writing.
Is it necessary to operate three ambulances? The city’s ambulance service has managed to meet its mission for years without a third ambulance. It is only since the implementation of the city’s paid-on-call (POC) staffing model in April that Altenburg has pushed aggressively for a third rig to enable the service to take more non-emergency inter-hospital transfers, which help pay for the POC staffing. Yet the future of POC staffing is in serious doubt. As we report this week (see Page One), increased staffing at the Virginia Fire/EMS is likely to cut off most of the transfers that the Tower ambulance service is banking on. Without transfers from Essentia-Virginia, the POC model, at least as currently devised, is unsustainable for Tower. Without the POC model in place, there is absolutely no justification for operating three ambulances and the rig scheduled for replacement could simply be maintained as a reserve unit.
It comes down to adequate utilization. Virginia, for example, operates five ambulances to handle an average of about 3,500 runs per year. That’s about 700 runs per unit annually. By contrast, Tower’s entire ambulance service receives an average of about 450 runs per year. Divided by three ambulances, that’s just 150 runs per unit. At that rate, it takes Tower nearly five years to put as many runs on an ambulance as Virginia does in a single year.
How were the specifications developed? The rig that Mr. Altenburg wants is a departure from previous ambulance purchases. Mr. Altenburg argues that purchasing a high-end ambulance box, rather than the lower-cost versions the service has bought in the past, may save money in the end by allowing the service to remount the box on a new chassis when the original chassis is worn out. Mr. Altenburg’s plan may or may not work out. Constant updates in the standards of the emergency services suggests that by the time such a remount is in order, the expensive ambulance box will be outdated regardless of its condition.
Before making such dramatic and costly change, the service would be best served by more thoughtful consideration. It’s routine for emergency services to establish a committee to review and talk through the pros and cons of such major decisions. It appears that did not happen in this case. Indeed, the latest purchase request had all the hallmarks of a rush job, timed to allow the city council to finalize the purchase before the new mayor and city council could take office.
There has certainly been no suggestion that the service is in desperate need of a new vehicle. Indeed, one of three rigs has been sitting outside, unused and covered in snow, for weeks. Clearly, the service is operating successfully with the two other ambulances. Given that there is no urgency to the purchase, and that the fate of the service’s POC staffing looks increasingly tenuous financially, there is good reason for the city council to take time for a more careful look.