I have 3 different roadside assistance programs and still carry a spare. The e450 Vegas uses 16" van type wheels so I have no issue with Lugs. I also carry a jack, breaker bar and a length of aluminum pipe.
If we are on vacation somewhere peaceful, I would wait for roadside assistance. If we are in nasty area or on a tight schedule, I will change myself. I also carry an air compressor and tire plugs.
Most of my racing pals also carry spares for same reason.
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