National City City Council
March 17, 2026

Public Provider Ground
Emergency Medical Transport
March 17, 2026
1 History of Ambulance Services in National City
• City-operated Police Department ambulances documented as early as 1936 • Ambulance ordinances adopted in 1966 and 1973
• Long history of City regulation and contracted transport services • 90-year record of continuous ground ambulance service • Current AMR contract expires August 31, 2026
EMS Demand in the National City Operational Area
• Average 8,605 ambulance responses annually (2020–2024) • 8,487 responses in 2025
• 8,600 - 8,800 projected annual responses moving forward • Stable and predictable demand trend
• Demand indicates need for:
• 3 - 5 ambulances daytime
• 2 - 3 ambulances overnight
Ground Emergency Medical Transport System
Design
• Proposed design balances coverage and efficiency
• Three (3) 24-hour frontline ambulances
• Two (2) ready-reserve ambulances
• Single-role Paramedic , Single-role EMT staffing model • 18 new FTEs on a three-platoon schedule
Station Deployment & Resiliency
• One 24-hour ambulance at each fire station
• Adds a 24-hour unit at Station 33
• Improves response times and system resiliency
• Supports disaster and surge response
Operational System Costs (Preliminary)
• Fire Battalion Chief and EMS leadership support
• Ongoing costs include:
• Staffing and benefits
• Supplies and fleet maintenance
• Medical billing services
• Estimated annual cost: $5.5–$6.0 million
Operational Cost Recovery (Preliminary)
• Cost recovery driven by:
• Number of transports
• Payer mix
• Collection rates
• Approximately 8,500–8,800 responses annually
• Third-party EMS billing provider
• Conservative assumptions used
• Program designed to operate as an enterprise account, not reliant on the General Fund Financial Sustainability
• Transport revenue expected to support:
• Annual operating expenses
• Repayment of startup costs
• Fleet and equipment reserves
• System designed to be sustainable, not profit-driven
• Predictable and insulated from contract volatility
Buildout & Operation Timeline
• Phased and deliberate implementation
• Planned transition extension with current provider
• Ensures uninterrupted service during system buildout
• Manages risk, staffing, and capital costs
• Council direction gates each phase
Phase 1: Staffing and Classification
Development
• Establish Paramedic and EMT classifications
• Meet-and-confer and recruitment
Phase 2: Startup Financing & Foundational
Agreements
• Identify financing options for startup costs
• Develop repayment strategy tied to revenue
• Initiate agreements for:
• Billing
• Supplies and pharmaceuticals
• Continuity of service
Phase 3: Fleet and Equipment Procurement
• Procure:
• 3 frontline ambulances
• 2 reserve units
• Vehicle upfitting and inspections
Phase 4: Budget Finalization and Billing
Development
• Finalize budget and billing systems
• Complete ePCR and billing integration
Phase 5: Training, System Testing, and
Operational Activation
• Conduct training and system testing
• Activate service only when fully ready
Grant Funding Opportunities
• Actively pursuing:
• State grants
• Federal grants
• Regional funding
• Offsets:
• Fleet
• Equipment
• Training
• System development
Conclusion & Council Direction
• Ambulance transport is a core City service
• Data supports a City operated, sustainable model
• No immediate budget action requested
• Council approval requested to initiate phased implementation activities