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January 18, 2022
ITEM TITLE
Ambulance Transport System Purchase: Approve the Purchase of Two (2) Additional Ambulances and Required Outfitting
Report Number: 22-0027
Location: No specific geographic location
Department: Fire
Environmental Notice: This activity is not a “Project” as defined under Section 15378 of the California Environmental Quality Act State Guidelines; therefore, pursuant to State Guidelines Section 15060(c)(3) no environmental review is required.
Recommended Action
Adopt the resolutions to purchase two (2) additional ambulances through Republic EVS, and purchase required outfitting from Stryker Gurney Systems and Motorola for necessary ambulance outfitting.
SUMMARY
To accomplish the financial and operational goals for the Ambulance Transport Program, the Fire Department needed to develop a detailed plan based on historical and predicted calls for service. The department evaluated CAD data from the previous ten (10) years to identify patterns and locations for calls for service in the City of Chula Vista. Data was then entered into performance prediction software to understand what pattern of staffing and locations would best serve the response needs throughout the City.
The conclusions drawn from this data modeling indicated that the City of Chula Vista would need a total of eight (8) ambulances to provide the maximum level of performance and cost effectiveness, six (6) of those would be staffed 24 hours daily and two would be staffed 12 hours daily during the peak demand period. The city response fleet would then be combined with two (2) additional 24-hour ambulances located in contract jurisdictions of the City of Imperial Beach and the Bonita Sunnyside Fire Protection District, which will create a network of ten (10) ambulances servi cing the areas. Since the original inception of the 10 -unit response network, the department has converted one of the two 12-hour units to be kept in service 24 hours daily. In addition, at the time, the department calculated that a reserve fleet of three apparatus would be sufficient for preventative maintenance and unexpected repairs, bringing the transport fleet to 13 total ambulances.
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With almost nine months of operations, the Ambulance Transport Program has identified the need to purchase two additional ambulances to increase our reserve fleet. Our current system design runs ten (10) ambulances for daily operations, with three (3) ambulances available as reserves. The increase in fleet resources is not intended to add more operational ambulances to th e system, but rather to provide a more sustainable and redundant fleet to maintain service levels. In comparison, our fire engine fleet currently has nine (9) in-service for daily operations, with five (5) engines available as reserves.
As of the end of FY21 that Transport has drawn down approximately $3,200,000 of the originally approved $4,881,000 loan from Measure A for system startup costs. The Fire Department has determined the need to utilize the remaining Measure A loan funds to purchase the additional two (2) ambulances to add to our fleet.
ENVIRONMENTAL REVIEW
The Director of Development Services has reviewed the proposed activity for compliance with the California Environmental Quality Act (CEQA) and has determined that the activity is not a "Project" as defined under Section 15378 of the State CEQA Guidelines because the proposal consists of a governmental plan of action related to the City's preparedness in the event of a natural or manmade disaster and which will not result in direct or indirect significant physical impacts on the environment. Therefore, pursuant to Section 15060 (c)(3) of the State CEQA Guidelines the activity is not subject to CEQA. Thus, no environmental review is necessary.
BOARD/COMMISSION/COMMITTEE RECOMMENDATION
Not Applicable.
DISCUSSION
With nearly nine months of operations, the Ambulance Transport Program has identified the need to purchase two additional ambulances to increase our reserve fleet. Our current system design runs ten (10) ambulances for daily operations, with three (3) ambulances available as reserves. This need is not intended to add more operational ambulances to the system, but rather to provide a more sustainable and redundant fleet to maintain service levels. In comparison, our fire engine fleet currently has nine (9) in-service for daily operations, with five (5) engines available as reserves. Several factors have led the department to this conclusion.
Periodic Maintenance/Minor Repairs
There have been several occasions where two ambulances are out of service for maintenance needs, so two of three reserves are put into service. This leaves one ambulance in reserve status to be placed into service in case of an unanticipated failure. Additionally, we have had two occasions where thre e ambulances have been out of service leaving no reserves to place in service in case of an unanticipated failure. During the system design the department recommended the purchase of 13 ambulances to keep startup costs as low as possible. This decision w as made begin operations and reassess the system needs after a few months in operation.
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Major Repairs
In addition to the above maintenance and repair, the potential of a vehicle accident causing an ambulance to be put out of service for a prolonged peri od is a potential problem. This scenario nearly came true on Monday, August 16, 2021 when M39 was returning to quarters and was driving southbound on I805 at Imperial Avenue returning from transporting a patient to a San Diego based Hospital. The crew sustained a front tire blow -out while traveling at freeway speeds. The driver performed excellent and controlled the vehicle safely to the shoulder of the freeway. The tire was changed on the freeway and M39 was able to go back into service. Blowouts like this commonly end with body damage due to the damaged tire tread contacting the front fender. If that where the case, the vehicle would most likely be out of service for several weeks and reduce our reserve capacity by 33%.
This example of a near miss is a factor that has emerged that demonstrates to the department that even when our personnel are doing the right things, they represent opportunities for accidents to occur, and different outcomes could have greatly impacted the system’s ability to operate effectively.
Call Volume
Since April 9, 2021, compliance system wide (Bonita, Chula Vista, and Imperial Beach) has been approximately 95%. However, despite monthly fluctuation December compliance is 0.1% higher than April with increase to both call volume and daily transports. The department is analyzing the compliance trend and we have found that incident and transport volumes are on an upward trend, both increasing almost 6%.
The ATS was designed to operate with an average of 48 transports per day. To date, since April 9, 2021 the average transports per day is 52.6 equating to more than an 8% increase in transport volume when compared to the original system design forecast. This is just shy of an additional four transports per day.
However, looking back at July-August, the average transports per day has risen to 54.8 and August alone was at 57.4. For perspective, the capacity of a 12-hour shift ambulance at the high end is four transports per day with three being optimal.
It has become obvious through analyzing the past nine months, the system incident and transport volumes will fluctuate. The department has also reviewed the past five years of data from our previous transport contractor and found that incident and transport volume has consistent ly increased approximately 4% per year. Actual and historical data shows the system will need to be in position to expand to keep up with volume increases. Increasing reserve ambulance capacity is the least impactful method to do this.
Specifically, by ensuring system unit hours are always maintained at existing levels by having ready reserves available to go into service when needed for maintenance or repair. And by allowing the addition of unit hours during peak volume times/events.
The ATS design was based on FY21/22 call volume at an average of 48 transports per day. Transports per day based on the systems known payor mix generates the reliable revenue to cover operating expenses and payments for startup cost loans. If the average transport per day increases, so does revenue which is intended to be reinvested back into the system and/or paydown startup cost debt. After nearly nine months of operations, the daily transport average for December MTD is up to 54.3 with no single month falling below 50 per day. August has been our busiest month to date with approximately a 10% increase in call and transport volumes when compared to July and even higher increases compared to April, May, and June. These are the trends that any system will experience; however, we need to be able to react to these fluctuations.
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Our intended response to situations like these would be to add temporary unit hours to the system by placing reserve ambulances into service with overtime staffing to ease increased call and transport volumes to maintain compliance. This situation coupled with our reserve fleet size (currently three reserve ambulances) is driving our recommendation to increase to five total reserve ambulances.
Ambulance Ordering
As the department has evaluated the need to increase our reserve capacity, the manufacturer of our current ambulance fleet was contacted to determine ordering process and lead time. The same group purchasing contract is still available and was validated by purchasing.
The manufacturer was contacted regarding lead time for ambulance purchases. They informed us that their lead time to build an ambulance is approximately five to six months. This timeframe begins once a purchase order is received, and they receive the commerci al truck chassis from Ford. Currently, Ford releases commercial truck chassis on a demand basis and their ability to manufacture while working through the impacts of COVID. This release time is not scheduled and is a moving target for clients such as us. The current estimated availability of commercial truck chassis was January of this year. These commercial truck chassis still have not been delivered as of the date of this staff report. Considering the manufacturer lead time combined with Ford’s chassis deliver would put delivery to the City between June and July 2022. In addition, payment is not due until delivery to the City.
Mutual Aid
When the ATS becomes overloaded, we do in fact rely on mutual aid from other agencies to assist with covering calls for service in our service area. However, what the department has found is that when we are overloaded, so are our partner agencies. This is typically due to patient care transfer delays to the hospital Emergency Departments.
Our goal is to balance the number of ATS unit hours against the incident and transport volume in the service area. If we can do this consistently, mutual aid requests are minimized so that we do not over tax our neighboring agencies. This in turn equates to more support from our neighboring agencies when we have a need. This is the mindset that we use when mutual aid requests are made to us to support them. During April and May we found a disproportionate number of mutual aid requests between our ATS and the City of San Diego tran sport contractor. Specifically, we were providing three times the number of mutual aid responses to San Diego. This resulted in us reaching out to San Diego Fire-Rescue to discuss. Their contractor has made corrections to better balance this in June and July.
Mutual aid with the new City of San Diego Fire-Rescue ambulance contractor, which took over November 27, 2021, has not improved the situation described in the previous paragraph. After the new contractor’s first 30 days in service the following rat ios were found; arrivals 10:1 and transports 13:1. We are proactively meeting with San Diego Fire-Rescue and their contractor; however, we are not seeing improvement thus far.
Another concept to keep in mind regarding mutual aid, is that our agreements are not binding. This is the norm with these agreements as these transport systems typically have compliance-based contracts in place.
This is the constant motivation for each agency to provide the best balance possible of ambulance system unit hours and incident/transport volume. This provides the greatest control over service performance and cost recovery for expenses.
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Amphitheater
The Department has recently begun service delivery for the Amphitheatre to provide medical services during events. These even ts require a minimum of one ambulance on site for these services, but the number of ambulances and resources needed on site can increase depending on the size of the event.
Delivering this service is important for several reasons. The most important, is to ensure these events are safe for those in attendance; but more importantly, if these events are properly provided for, they will not impact daily ATS operations. If they are not properly provided for, any additional calls for service will become the burden of ATS daily operations. Typically, these events occur during our ATS peak volume times and even one call for service from the amphitheater could have a significant and negative impact on our ability to make response times. With the City maintaining these services, we can have the greatest amount of control of this exposure and risk.
Ambulances
The process of selecting a vendor for purchasing ambulances involved soliciting preliminary quotes from three separate vendors that are currently listed on th e Houston Galveston Area Council (HGAC); Medix Specialty Vehicles, Frazer, and Braun Northwest. The request was for a diesel chassis greater than one ton, Type I ambulance, and the installation of customer specific equipment as part of the manufacturing process.
Medix was the most responsive vendor with the best cost per unit.
HGAC conducted a competitive solicitation for ambulances and Medix/Southwest Ambulances was chosen to be the lowest most responsible and responsive bidder. To procure these vehicles, the Purchasing Agent has determined that the award of this contract is consistent with Section 2.56.140 of the Chula Vista Municipal Code Cooperative Purchasing Agreements. The HGAC award to Medix/Southwest Ambulances under contract AM10-18 was competitively bid and complies with the City of Chula Vista procurement policy.
The City of Chula is a current member of HGAC, member number 17-6246. (Attachment #1).
Gurney System
After detailed research of the two gurney systems in the marketplace, the fire depar tment determined the most functional and safe gurney system is the system produced by Stryker. A preliminary quote was requested per the Savvik RFB 2019 -05. Savvik conducted a competitive solicitation for gurney equipment.
Stryker Medical responded to the RFB. To procure this gurney equipment, the Purchasing Agent has determined that the award of this contract is consistent with Section 2.56.140 of the Chula Vista Municipal Code Cooperative Purchasing Agreements. The Stryker Medical bid under Savvik RFB 20 19-05 was competitively bid and complies with the City of Chula Vista procurement policy. (Attachment #2).
Motorola Radio Communications Equipment
Motorola radio equipment is required for all 13 ambulances being purchased to provide transport services.
The equipment includes mobile radios, portable radios, accessories, and installation of the equipment. The radio equipment is purchased via a sole source agreement per City of Chula Vista Resolution 2011 -131. (Attachment #3 & #4).
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The above items are shown b elow as updated quotes we received from each of the vendors described. The total estimated cost of the two (2) additional ambulances is $609,755, broken down below.
As previously discussed, the Fire Department has currently utilized $3,200,000 of our $4,881,000 loan from Measure A. The purchase of the two ambulances with the Measure A loan will bring our total loan utilization up to $3,810,000, leaving $1,071,000 of the total loan to utilize if additional start up needs are identified.
DECISION-MAKER CONFLICT
Staff has reviewed the decision contemplated by this action and has determined that it is not site-specific and consequently, the real property holdings of the City Council members do not create a disqualifying real property-related financial conflict of interest under the Political Reform Act (Cal. Gov't Code § 87100, et seq.).
Staff is not independently aware, and has not been informed by any City Council member, of any other fact that may constitute a basis for a decision-maker conflict of interest in this matter.
CURRENT-YEAR FISCAL IMPACT
There are no General fund costs associated with this action. Staff will return to Council for approval of any future associated costs as necessary. The Fire Department would be utilizing an estimated $609,755 of our previously approved Measure A loan to purchase the two (2) additional ambulances.
ONGOING FISCAL IMPACT
No projected negative impact to the general fund. The ongoing maintenance and fuel costs associated with these ambulances would be paid for out of the Ambulance Transport Program budget. Due to our consistent increased call volume, it has been determined t hat the ATS budget can sustain the additional ongoing maintenance costs.
ATTACHMENTS
Attachment #1 REPUBLICEVS Purchase Agreement
Attachment #2 Stryker Medical Purchase Agreement
Attachment #3 Motorola Solutions Purchase Agreement
Attachment #4 City of Chula Vista Resolution 2011-131 Sole Source Resolution Staff Contact: Emily Folker, Raymond Smith, Harry Muns