All across the country, smaller communities often acquire fire apparatus and ambulances second-hand, from larger communities. This is an economic reality, and typically the small communities do an excellent job of making do with something less than the absolute latest and greatest.
This is true here in New Jersey as well, where the fire company in a very small town not far from the offices of the Badge Company of New Jersey just put its second used ambulance into service.
"This is like a retirement home for ambulances," the Fire Chief quipped, but with wise budgeting and wise spending the community was able to refurbish the ambulance to the extent that it can scarcely be distinguished from a new one.