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18 APRIL 2016 | EMSWORLD.com Squeezing Out the Lemons! Finally, combine the assembled data into one place to compare and contrast avail- ability and cost. Vehicles on top of the list are the most dependable, have the lowest costs and highest availability, and are able to support the operational need. Those on the bottom provide little or no operational sup- port. The decision is then whether to replace the vehicles that are draining resources or find the causes for the issues and make the necessary adjustments. Mileage and time alone do not provide enough data to make solid fleet decisions. You may discover that the oldest, highest-mile vehicle ends up being the most reliable workhorse of the fleet. Using all three data sets (vehicle avail- ability, repair cost and breakdowns) to set a base point and data collection to determine replacement is the most efficient process. Deciding on Your Next Purchase Fleet selection should be based on environ- mental, as well as operational, conditions. The continental U.S. has a range of terrain and environments that spans from Arctic to desert and mountain to plains—one size does not fit all. To clarify vehicle types: Type I: These are pickup-truck style or the heavy-duty/AD medium-duty truck chassis. These will have a clinical box module on the original chassis construction with various options for seating and equipment storage design. A larger version on a truck chassis is known as a Type I HD–heavy-duty. Type II: Van, sprinter or transit style. These vehicles are always purchased new and usually have less equipment storage space compared to other types. They are typically more fuel efficient and less costly on maintenance due to total weight. Type III: As with the Type I, these consist of a van-style form and clinical box mounted on the rear chassis. They are usually smaller and more maneuverable compared to the Type I and HD/AD. They come in a range of main dealer chassis and are diesel with DEF (diesel exhaust fluid), gasoline engine and now the potential for CNG (compressed natural gas). W h y M a i n t e n a n ce M a t t e r s Preventive maintenance is a great way to ensure the patient never has to wait any longer than is necessary for the ambulance, or wait on the side of the road for a replace- ment vehicle to arrive. Data is as much a key requirement in caring for vehicles as a tool box full of wrenches. Having comprehensive vehicle records is essential and, in most states, is a permitting requirement. It is certainly a "must have" to attract any form of formal accreditation such as CAAS (Commission on Accreditation of Ambulance Services). Vehicle records and their absolute maintenance provide evidence of failures and the frequency of those events and may well lead to clues about particular vehicle brands or engine types. Comparison and contrast of all vehicle data reveals trends and provide insight to key equipment types as well as informing maintenance or replacement programs. Understanding when key components break on any particular type of equipment allows that piece or part to be serviced or replaced before it critically fails on the street on a call. Establishing a mean time between failures (MTBF) chart for key equipment and abiding by it will ensure that unscheduled maintenance remains at a minimum. The term "unscheduled maintenance" is another code word for cash hemorrhage—if a truck and its crew have to leave the street with zero notice then unit hours (EMS currency) are wasted, the net effect being that there is one less vehicle available on the street when the carefully constructed data-driven demand analysis says you need them. Poor maintenance potentially equates to poor patient service. There are many types of maintenance tracking systems in the marketplace, but consideration should be give to systems that capture: » Assets: Your vehicles by their VIN and type. » Retired Assets: Having data on old vehicles and vehi- cle types allows for comparative analysis against new or updated units. » Work Orders: Key information that shows who did the work (it may be possible to benchmark and performance- manage mechanical output as one mechanic may fare better at one repair versus another). Also a record of parts used on every truck allows for cost-benefit analysis of the relative worth of a vehicle, particularly as they near end of life and determinations need to be made over disposal or continued service. » Preventive Maintenance: Again the simple mantra of a good PM program is to "catch it before it fails." It is the public health program for vehicles. A sufficient under- standing of other fleet metrics will allow the timing and intensity of servicing to be adjusted to ensure a cost- effective level of treatment. » Inventory: Understanding inventory by both what is on the shelves and what has been fitted to the vehicle is important. As with all logistic principles, understanding throughput informs stock control and how much fast- moving items are required on the shelf and how much is required to be readily available elsewhere for rapid delivery.