Keep Control of Ambulance Stock

Most of us have been on an ambulance that was overstocked. Just how many supplies does one need to work a plane crash? The only things you typically require more of than you carry are blankets and body bags; yet I’ve worked with many partners who believed more is always better. Of course there are situations that warrant stashing away an item or two that isn’t on the checklist. But they tend to be the exception. 

Is More Better?

We must look at overstocking ambulances as a whole and consider how it can impact an agency and its personnel. How often do your personnel inspect ambulances? How long does it take to really go through an ambulance and check the equipment, supplies, and even date-check items at least once a month? How long does it take to find an item in a crowded compartment? This should be food for thought.

Look at it from another angle: How many items on your ambulances go out of date before you use them? How much equipment and supplies do you carry beyond what’s required? Have you ever wondered about the cost of those extra supplies and equipment? How much is tied up in excess that could be used to stock another ambulance?

Unnecessary equipment and supplies are extravagances that are compounded as the supply cache at your agency must stock extra items to replace expiring items. Look at the typical costs tied up with what I’d consider unnecessary equipment:

• Endotracheal tube: $2.70 (one)
• Pack of 4x4 gauze pads: $3
• Combat gauze: $55
• Chest seals: $8
• QuikClot: $62
• Combat Application Tourniquet: $37
• SAM splints $5
• X-Collars: $22
• Board splints: $6
• Sager splints: $370
• Pro splints: $10
• Epinephrine preloads: $10
• Epinephrine ampules: $28
• EpiPen (generic): $350
• Narcan preload: $51
• Bag-valve mask: $14
• King airway kit: $53
• IV start pack: $4
• Amiodarone: $10
• Normal saline IV bag: $5
• Nasal cannulas: $1.31
• IV catheters: $2.95 each

These amounts are typically small, and thus we do not consider the sum of their combined costs when we look at the total overstock on an ambulance. It’s not unusual to find at least $1,500 worth of extra supplies and equipment on ambulances when the hierarchy of an organization does not strive to manage its inventory and cash flow. Even the typical ambulance service that orders supplies routinely has been known to inadvertently overstock items to the point where whole lots of an item expire before they can be used.

Some of these cases are the nature of beast. Items may be required by a regulatory body but seldom used. At other times it can result from not studying use patterns within the call history to more strategically order supplies without an abundance of stock held in cache.

Managing Your Inventory

Hospital systems have been able to manage their inventories more economically using just-in-time order processing, in which they no longer sit on stockpiles. The pitfalls can be substantial—they may occasionally run out of an item—but with proper planning and suitable supply chains, associated risks can be mitigated. Some groups have developed supply sharing options to mitigate the burdens associated with minimum quantities required in certain circumstances.

Keeping an eye on the amount of stock both in reserve and on-board ambulances will help an agency manage its supplies and cash flow while also keeping the workflow of field personnel to a more reasonable level. It is much easier for a crew to clean and inspect an ambulance that’s not overstocked. It’s also easier for a crew and others on scene to locate items when they are not obscured by overstock.

I have personally damaged (and witnessed others damage) soft goods by opening the wrong item when searching for something in a similar package due to overstocking in boxes, bags, and cabinets on both ambulances and rescue vehicles. How much waste are we causing by inadvertent opening of supplies in situations like this across our fleets? As most agencies have no concrete numbers, we can only guess. Yet often we do not take this into account, as we simply look at this as the cost of doing business without trying to curtail these trends.

Get a Handle On It

If we are to free enough of our cash flow from operational costs to allow us to provide raises to personnel, we must hold one another more accountable and seek methods to curtail the waste we are causing ourselves as providers and managers. We must get a handle on our expenses. Though some agencies manage these costs with mitigation, others have not been able to implement these changes to levels that can make a difference within their organizations. It takes both a mind-set and a purpose to realize change. Fundamental change is a system approach that must be a coordinated effort from all levels—providers, supervisors, managers, and supply officers. Everyone must be involved.

We must choose our stock levels appropriately for our situation. Most jurisdictions have some level of regulatory requirements for minimum stock; additionally agencies will require stock to meet their protocols and operational requirements as well. Other than that, everything else is fluff and overstock. Sure, we want to have a few extra sheets and nasal cannulas for the transports we make routinely each day, along with extra electrodes and maybe a few IV setups. But limits must be established. 

If an agency requires the minimum and then pads their required numbers to allow for those other instances to continue operations without having to restock after every call, do the personnel on the ambulance also pad those numbers so they aren’t below required stock levels? We can always make allowances, but have to keep ourselves in check so we don’t escalate. 

Evolve and Innovate

Have we always done things this way, so we continue to do things this way? We can learn from one another. Some jurisdictions are dealing with duplication by centralizing both supplies and equipment within ambulances. The crew works out of a large rolling case, similar to modern luggage, that can be locked into place within the ambulance. Crews also work out of these cases during transport, as everything is still readily accessible. The need for cabinetry and extra equipment is greatly reduced, as is the need for duplication within other bags and compartments. 

Should we look at similar scenarios in our departments? It could depend on your geography and your demographics. A critical care transport service wouldn’t necessarily require field-ready gear in bags, nor would a neonatal transport service require adult gear in carry-in bags. There is always room to evaluate how we do things. 

Evolution can be a good thing and make operations a bit easier for our personnel once they grow comfortable with new methods. But it will take buy-in from stakeholders across the board to make change happen, along with time to accept and tweak our methods to allow for oversights.  

John M. Dabbs is an EMS consultant and investigator for the Tennessee Office of EMS.