On a snowy February afternoon, a well-used vehicle in Pittsburgh’s ambulance fleet was parked in a garage attached to the Training Division of the city’s Bureau of Emergency Medical Services. Its interior was barren, stripped of the life-saving medical equipment that used to line its shelves. The vinyl on a paramedic’s seat — antimicrobial and fluid-resistant to keep blood-borne pathogens from spreading — was peeling away, exposing the yellow upholstery foam.
The ambulance, known as Medic 20, is a backup for other “frontline” vehicles in the fleet: Purchased a decade ago, it can still be dispatched to the scene of a medical emergency if a truck in better shape isn’t available. Its total usage — which factors in engine operation — is roughly the same as 300,000 miles, said EMS Deputy Chief Jeffrey Tremel, who took this reporter inside its patient compartment during a tour of the Strip District facility.
Tremel said the truck should have been decommissioned long ago — ideally after five years. It “blew an engine” six months ago, which cost $50,000 to replace. It can cost a city more money to maintain an aging ambulance than buying a new one, according to a report by Cleveland’s EMS union.
As the fleet’s condition worsened over the years, EMS crew “had no choice” but to run older trucks that can still pass a safety inspection. “But there’s no air-conditioning, right? There’s no heat,” said Jon Atkinson, president of the Fraternal Association of Professional Paramedics Local 1, the union for city paramedics. Some even fashioned makeshift ducts from dryer vents or “vomit bags taped together” to funnel warm or cool air “from [an HVAC system that only works in] the cab to the back of the truck,” or vice versa.
Atkinson said these conditions are bad for the crew’s morale and bad for patients, but “you just have to deal with it.”
Maybe not for much longer, thanks to a surprise gift from Pittsburgh’s largest nonprofit, which will speed up replacement of the EMS fleet, likely lead to better public health outcomes and possibly kick off a new era of partnership between the city and tax-exempt corporations here, said multiple stakeholders with knowledge of the deal.
During a Jan. 29 press conference — less than a month after he was sworn in — Mayor Corey O’Connor announced that UPMC had donated $10 million to the city for nine new ambulances and one rescue truck. The gift marks a swift reversal from the health care giant’s at-times frosty relationship with former Mayor Ed Gainey, who mounted legal challenges to the tax-exempt status of scores of UPMC properties, among other attempts to make good on his pledge to force the city’s large nonprofits “pay their fair share.” Other large nonprofits have yet to commit to similar arrangements.
EMS infrastructure is critically strained across the country, said Leonard Weiss, a UPMC emergency medicine doctor who also serves as medical director for the city’s Department of Public Safety. Paramedics and emergency medical technicians are using outdated, high-mileage vehicles in the field — where a few minutes of delay can mean the difference between life and death. And research shows a growing population of older adults — who need more emergency care than other age groups — will keep increasing demand. While Pittsburgh is no different, officials hope UPMC’s donation will help ease that burden and could lead to better patient outcomes in the short term.
“Our response is directly related to the equipment that we are using, and we want to be able to depend on that without fail,” said Weiss, also an associate professor of emergency medicine at the University of Pittsburgh. He expects EMS crews will reach people “more efficiently” and “more effectively” as the new vehicles roll out.
‘The death wobble’ and other vehicle malfunctions
EMS staff were initially stunned by news of UPMC’s gift, which they learned of the day O’Connor announced it. Their surprise gave way to joy and excitement.
Atkinson said his reaction included colorful language he didn’t want a reporter to publish. Then he asked the mayor’s team, “How’d you guys do that?” It was the kind of transformative funding EMS brass had tried to get for years.
In July 2024, Tremel and EMS Chief Amera Gilchrist appealed to the city’s Equipment Leasing Authority (ELA) Board, which decides how to spend the city’s limited budget for vehicles across departments. Just before wrapping up a presentation about the dire condition of their fleet, they played a news clip about a tragedy in Alabama. After their ambulance broke down, paramedics there had to unload a 2-year-old patient — found unconscious in a pool — and push the gurney on foot. The child was pronounced dead at the hospital.
“She said, ‘This could be us today, right now,’” Atkinson recounted, noting Gilchrist told the board she was trying to prevent a similar tragedy here. Despite pleas from EMS leadership, he said limited funding precluded the leasing authority from buying meaningful numbers of new ambulances. Tremel said it recently approved the purchase of three trucks. The current fleet includes 13 medic units, four “basic life support” (BLS) ambulances, two heavy rescue trucks and a vehicle for river rescues.
“As you can see from the video, it’s scary and unsafe.”Jon Atkinson
Meanwhile, vehicles were breaking down en route, requiring EMS to immediately dispatch another to the scene. Due to good contingency planning and sheer luck, none of the incidents so far have “had a negative impact” on a patient, said Atkinson. (Tremel confirmed his account.)
But the aging fleet has created more occupational hazards for crew members, who already experience them at a higher rate than the general worker population. Atkinson shared photos and videos with Public Source that show EMS trucks malfunctioning in the field.
One video shows a crew member gripping the steering wheel to maintain control as it violently shakes while the unit travels along a highway. “Got it?” the driver calls out to his partner before the camera pans to a mounted laptop showing real-time information about 911 calls as it rattles against the dashboard.
The crew calls it “the death wobble, ”Atkinson wrote in a text, explaining how an issue with the truck’s front suspension causes the steering wheel to shake at highway speeds. They’ve experienced this phenomenon in several vehicles. “As you can see from the video, it’s scary and unsafe,” he said.
Another video shows puffs of smoke spurting from a truck’s tailpipe, seen by a crew member in a side mirror’s reflection. And photos show that a wheel fell off Medic 20 as the crew member who was driving it pulled into EMS’ Homewood station in 2022.
‘You catch more flies with honey’
Atkinson said the closest call happened in Carrick as paramedics rushed to treat a patient in his forties, who was in cardiac arrest. As they arrived at the scene, a warning light flashed on the dashboard, signaling a possible issue with the engine’s cooling system. They immediately requested a second unit — which arrived as they were administering aid — to take the patient to a hospital.
The patient died, but not due to the vehicle issue, Tremel said. He credited the crew for “noticing [the problem] right away,” calling for backup and getting the patient care without delay.
O’Connor hammered Gainey over the incident during an April mayoral primary debate on WTAE.
“Right now, we have ambulances that break down to and from calls,” he told viewers. “We had an ambulance break down Friday taking somebody for a cardiac arrest to the hospital.” He later told TribLive, “It’s putting people’s lives at risk.”
A Gainey campaign staffer disputed O’Connor’s statement, pointing out the ambulance was still operational, which was confirmed by the Department of Public Safety.
“It makes sense that he’d try to spin an ambulance running low on coolant as the failing of a mayor who had the highest year of vehicle investment and made unprecedented strides in public safety,” Emilia Rowland, then a spokesperson for the campaign, told the Trib.
Even as Gainey’s campaign touted his vehicle investment achievements, Atkinson said the former mayor didn’t heed paramedics’ concerns about the aging fleet.
“The relationship that this union has had with Ed Gainey was almost non-existent. Four years of him being the mayor, I never had a phone number,” he said, noting the union endorsed O’Connor over the incumbent last year.
Gainey didn’t return a phone call and text requesting a response to the union’s criticism.
Asked if O’Connor — a former city councilor and county controller — was more accessible, Atkinson said, “I’ve had Corey’s phone number for 15 years.” He described how the union began meeting with the new mayor and his campaign staff before he was elected. “The [poor condition of the] fleet was probably the biggest conversation that we had.”
During the press conference, Atkinson got an answer to his question about how O’Connor’s team was able to secure UPMC’s donation.
O’Connor said he was looking for conversations and partnerships with large nonprofits, Atkinson recounted. “You catch more flies with honey than vinegar,” Atkinson added, referring to Gainey’s combative remarks about the health care giant as he tried to force it to pay taxes on some of its property.
“I think that Corey and his administration have shown in a month that a different approach yields results,” he added.
Molly Onufer, a spokesperson for the mayor’s office, wrote that O’Connor is having “ongoing conversations with many private partners about partnership opportunities.” She didn’t provide specifics in response to a question about his approach to working with the city’s large nonprofits.
What’s behind UPMC’s decision to give?
UPMC’s gift raised some eyebrows after its battles with Gainey and longstanding position that it would participate in a program that equitably includes the region’s other large nonprofits.
Asked why it gave the city such a large sum under a new mayor, a UPMC executive said O’Connor’s team shared their “priority list for action” shortly after he was sworn in. Their desire for new ambulances aligned with the healthcare giant’s own agenda.
UPMC wanted “to help in the area that overlaps directly with what we do, [which is] serving the community in their times of health need,” Chief Medical Officer Donald Yealy said during an interview. Donating $10 million to upgrade the EMS fleet was a “natural, no-strings” decision that “has zero to do with property taxes or other issues that people may bring in.”
Yealy is a 40-year veteran emergency medicine physician and chair of Pitt’s Department of Emergency Medicine. He said he has a personal stake in the issue because he spent his career “in very close contact with the paramedics and EMTs in the city.” If their ability to do their jobs “is impaired, we don’t get the opportunity on the hospital and post-hospital side to do the very best that we can for people.”
Yealy pointed out that UPMC’s contributions to EMS didn’t just start under the O’Connor administration. He said its involvement pre-dates the bureau and UPMC itself, stretching back to the days of the Freedom House Ambulance Service, which pioneered paramedic training and ambulance design in 1967, and set the standard for providing emergency care while transporting a patient to a hospital. Its all-Black team of paramedics from the Hill District trained at and operated out of Mercy and Presbyterian hospitals, both now part of the UPMC network.
An advocate was skeptical of the health care giant’s motivations, pointing to the muscle it’s flexed in past dealings with the city as the largest landowner and employer here.
“They’ve used their resources and power to try to get their way … and bulldoze anyone” in their path, said Alex Wallach Hanson, executive director of Pittsburgh United, a coalition of grassroots groups working to improve quality of life in the city. While UPMC’s property is mostly tax-exempt, city property tax rates on homeowners will spike by 20% this year — a drastic measure by City Council to fill up to a $30 million hole in the budget.
But this one-off contribution does set “an important precedent of UPMC giving cash directly to the city,” he added, urging the O’Connor administration to do more to get the city’s big five nonprofits to shell out $40 million per year.
A 2022 report by the city and county controllers found that if UPMC, Highmark and the Allegheny Health Network, the University of Pittsburgh, Carnegie Mellon University and Duquesne University were not tax-exempt, they would have to pay the city $34.5 million in property taxes.
Seven new vehicles in the fleet by December
O’Connor announced UPMC’s gift in the aftermath of Pittsburgh’s biggest snowfall in 16 years. The storm took out nearly half the city’s roughly 80 snowplows — another aging fleet operated by the Department of Public Works. He said the amount originally budgeted for EMS vehicles — more expensive than snowplows — will now be used to buy 35 new vehicles for snow removal.
EMS was due to get just three more units by December. UPMC’s donation bumped that number up to seven “brand new” vehicles this year and more in early 2027, depending on how quickly the vendor can build them, Tremel said. “It’s actually going to be very quick and timely.”
The new rescue truck will be on the streets by June, he added. Atkinson, who works on one of these units, said they can be mistaken for fire trucks and are equipped with the Jaws of Life and other tools to extricate victims from accident sites.
Weiss, the Department of Public Safety’s chief medical officer, hopes to integrate telemedical services into emergency care in the trucks. That would allow the crew to transmit a patient’s “critical vital signs and data to our physicians over a network so we can understand what’s going on even earlier than we might see them.”
It’s hard to imagine that kind of tech in Medic 20 — the old truck parked in the Training Academy’s garage. Asked what will happen to it after the new vehicles roll out, Tremel said it will be decommissioned. He’s unsure of what the city will do with it afterward, but said it could be sold for parts. Or it will meet its fate in “the junk yard.”
Venuri Siriwardane is the health and mental health reporter at Pittsburgh’s Public Source. She can be reached at venuri@publicsource.org or on Bluesky @venuri.bsky.social.
The Jewish Healthcare Foundation has contributed funding to Public Source’s health care reporting.
This story was fact-checked by Rich Lord.
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