National City Fire Department
Ambulance Transport Services
September 15, 2026
1 Phased Implementation
• PHASE 1: STARTUP FINANCING & FOUNDATIONAL AGREEMENTS
• PHASE 2: STAFFING AND CLASSIFICATION DEVELOPMENT
• PHASE 3: FLEET AND EQUIPMENT PROCUREMENT
• PHASE 4: BUDGET FINALIZATION AND BILLING DEVELOPMENT
• PHASE 5: TRAINING, SYSTEM TESTING, AND OPERATIONAL ACTIVATION 2 Phase 1: Startup Financing & Foundational
Agreements
STARTUP FINANCING
• Evaluated financing alternatives to support ATS implementation • Developed a revenue supported repayment strategy
• Presenting recommended inter-fund financing structure for council consideration
FOUNDATIONAL AGREEMENTS
Continuity of Service
• AMR services agreement amended through August 31, 2027, ensuring continuity of ambulance transport services
EMS Billing & Collection Services
• Vendor proposal under development
• Anticipated return to Council for approval in Fall 2026 Total Startup Funding and Operational Costs
ESTIMATED STARTUP FUNDING NEED: $6.0-$6.5 MILLION
FY27 | IMPLEMENTATION & STARTUP
• Approximately $3.5-$4.0 million in startup expenditures. • Includes ambulance acquisition, medical equipment, communications systems, facility improvements, personnel recruitment and training, supplies, and working capital.
FY28 | OPERATIONAL READINESS & CASH FLOW:
• Approximately $2.5 million in implementation and operational expenditures • Provides operational cash flow support during service startup and revenue stabilization 4 Recommended Funding Strategy & Source
INTERNAL FINANCING
Staff evaluated both external and internal financing alternatives to support establishment of the Ambulance Transport Services (ATS) Program. Based on that analysis and council direction, staff recommends an internal financing approach.
INTER-FUND LOAN:
• Inter-fund loan from the Sewer Service Fund to the Ambulance Transport Services Enterprise Fund.
• Amount not to exceed $6.5 million.
RATIONALE:
This approach provides the greatest flexibility, simplifies implementation, avoids higher external borrowing costs, and ensures consistent funding across both fiscal years, while maintaining full City control over repayment terms.
5 Inter-Fund Loan Structure
FUNDING SOURCE: Sewer Service Fund
BORROWING FUND: Ambulance Transport Services Enterprise Fund LOAN AMOUNT: Not to exceed $6.5 million
DRAW PERIOD: Funds advanced on an as-needed basis during implementation and through the first twelve (12) months of ATS operations
INTEREST RATE: Interest accrues only on funds advanced. Interest calculated quarterly using the interest rate earned through investments in the Local Agency Investment Fund (LAIF)
REPAYMENT: Final loan balance determined at the end of the draw period. Repaid over ten (10) years through annual installment from net revenues of the Ambulance Transport Services Enterprise Fund
6 Sewer Service Fund Financing Rationale
WHY USE THE SEWER SERVICE FUND?
• Sufficient reserves available to support temporary financing • Avoids higher-cost external borrowing
• Planned sewer utility operations and capital improvement projects will continue as previously programmed
• Loan repaid with interest from future Ambulance Transport Services net revenues LEGAL COMPLIANCE:
• Temporary inter-fund loan, not a permanent transfer
• Sewer Service Fund remains dedicated to sewer utility purposes • Reserves remain available for sewer operations and capital needs • ATS Enterprise Fund repays all principal and accrued interest • The Sewer Service Fund will earn the same return it would have earned if the funds had remained invested
7 Immediate Impacts and Timeline
ESTABLISHMENT AND FUNDING OF ATS ENTERPRISE FUND
• Establishes a dedicated Enterprise Fund with transparent financial reporting and operational accountability
• Captures ambulance transport revenue and reinvests it into local emergency medical services, equipment and operations
• Provides greater visibility into program performance, operational costs, and long-term financial sustainability
• Supports the City's efforts to address structural budget challenges by creating a revenue-supported service model that reduces long-term General Fund exposure to EMS-related costs 8 Immediate Impacts and Timeline
FALL 2026
• Procurement of ambulances, medical equipment, and supporting systems through successive Council actions
• Council consideration of EMS classifications following Human Resources review LATE 2026 - EARLY 2027
• Council consideration of EMS billing and collection services agreement • Finalize foundational agreements, supplies, and pharmaceutical procurement • Continue coordination with San Diego County EMS and regional transport providers FEBRUARY - MARCH 2027
• Begin recruitment for EMT, Paramedic, and Assistant EMS Coordinator positions SPRING - SUMMER 2027
• Employee onboarding, training, testing, and system integration 9 Conclusion & Council Action Requested
RECOMMENDED ACTION
Adopt a Resolution authorizing an inter-fund loan from the Sewer Service Fund to the Ambulance Transport Services Enterprise Fund in an amount not to exceed $6.5 million to support implementation of the City's in-house Ambulance Transport Services Program.
Purpose
• Fund startup costs, operational readiness, and program activation. • Provide implementation funding and support through the first twelve months of operations. • Allow ATS revenues to be established before repayment begins. • Establish a repayment structure funded by net revenues of the ATS Enterprise Fund.