Public Safety Committee
March 14, 2023
AGENDA REPORT
TO: Harold Duffey FROM: Reginald Freeman
Interim City Administrator Fire Chief
SUBJECT: Letter of Intent with Alameda County DATE: March 1, 2023
City Administrator Approval Date:
RECOMMENDATION
Staff Recommends the City Council Adopt A Resolution Authorizing The City Administrator To Enter Into A Letter Of Intent With Alameda County Fire Department To Negotiate The Terms Of A Proposal For Ambulance Services And / Or Emergency Medical Services To Be Provided In Alameda County
EXECUTIVE SUMMARY
The Alameda County Fire Department wishes to partner with the City of Oakland’s Fire Department (“City”) and other Fire Departments within Alameda County to develop a new model and conceptual understanding for ambulance services that will address current issues with response times and financial feasibility.
This report seeks to provide justification for the City to enter into a Letter of Intent with Alameda County Fire Department to negotiate the terms of a proposal for ambulance services and / or emergency medical services to be provided In Alameda County
BACKGROUND / LEGISLATIVE HISTORY
Alameda County Emergency Services Agency awarded an ambulance contract to Falck USA starting in 2019, after being selected by the county through a Request for Proposal (RFP) process in December 2018. Others bidding for the contract were Paramedics Plus, which had been carrying out ambulance service in Alameda County since 2011, and American Medical Response West, which, at the time, provided the service in Contra Costa County.
In April 2019 after concerns about the financial and operational viability of the current private ambulance provider model in use, the Alameda County Board of Supervisors convened an Emergency Medical Services (“EMS”) re-design Task Force (“Task Force”). Under the current contract, Falck has exclusive rights to provide emergency service in all areas of Alameda County, except for the cities of Alameda, Albany, Berkeley, and Piedmont which provide their own ambulances. In the current contract, they serve the cities of Oakland, Emeryville, San Leandro, Hayward, Fremont, Newark, Union City, Dublin, Pleasanton, Livermore and unincorporated Castro Valley and the Lawrence-Livermore Laboratories.
Mar 2, 2023
Harold Duffy, Interim City Administrator
Subject: Letter of Interest with Alameda County
Date: March 1, 2023 Page 2
Public Safety Committee
March 14, 2023
This contract is for an advanced life support (ALS) ambulance system. The contract is overseen by the county’s Emergency Medical Services Agency. As Falck's current contract comes to an end in mid-2024, Alameda County Fire Department has announced its plans to bid on the contract when the request for proposals is released around June. The RFP process will be led by the Alameda County Health Care Services Agency.
The Task Force ultimately expressed overarching support for development of a new Fire Based EMS delivery system. The premise for the Alameda County proposal is that the fire service is known for its rapid mobilization. Firefighters are the nation’s first responders and fire-based EMS routinely get to the scene faster. A comprehensive response within time limits set by the emergency medical community should be the goal for other EMS providers. It is already routine for the fire service.
ANALYSIS AND POLICY ALTERNATIVES
Falck's response time is one of the main factors for the county assessing its options of moving forward with a different company.
In an open letter Sept. 17, 2021. Oakland Fire Chief Reginald Freeman requested an investigation into Falck's response times, contending there had been 462 delayed responses between July 1 and August 17, 2021 — an average of 11 per day.
"Falck Ambulance has consistently not been providing reliable emergency transportation within the city limits of Oakland," Freeman said. "Our residents and visitors deserve to have the best services which includes their loved one(s) being transported to the hospital in an expeditious, safe and orderly manner when there is a medical emergency."
In October 2021, Alameda County EMS chief Lauri McFadden sent Falck a letter notifying the company its response times have been out of compliance and must improve.
"These performance shortfalls represent an unacceptable progression of Falck's poor response- time trends, which the EMS Agency has been raising with Falck with increasing alarm and to which Falck has responded with a disappointing lack of urgency," McFadden wrote.
At multiple points during the contract term, Falck has had difficulty in meeting its contractual obligations primarily related to ambulance response times. Falck was out of compliance in October, November, and December of 2021, such that Alameda County placed Falck on a monitored performance improvement plan intended to improve response times.
Extended ambulance response times impact operations that extend beyond Falck. Most medical calls result in the dispatch of a fire department unit in addition to the ambulance crew. Fire crews are committed to those incidents until patient care can be transferred to Falck paramedics and EMT.
Shifting this response model to be overseen by the Alameda County Fire Department will allow local departments the ability to work directly with their colleagues in the fire service and Harold Duffy, Interim City Administrator
Subject: Letter of Interest with Alameda County
Date: March 1, 2023 Page 3
Public Safety Committee
March 14, 2023
implement a level of coordination that is committed to meeting response time mandates, reflects existing community needs, and better manages resources.
As communities evaluate their present emergency medical care needs, they may focus exclusively on patient transportation issues. Most research, however, has demonstrated that rapid, on-scene medical intervention produces the best patient outcomes. The fire service is best positioned to deliver this critical care, as well as rapid patient transport. Fire-based Emergency Medical Services (EMS) provides a comprehensive approach to emergency care, with trained personnel capable of handling any complication. The bottom line – a better chance for patient survival – is the true measure of quality for any pre-hospital emergency medical system.
Working with Alameda County Fire at this stage of the process will ensure that the needs of Oakland Fire and the diverse community it serves are heard and incorporated into a potential submission.
A proposal from Alameda County Fire Department to over ambulance services and emergency medical services would generally look like the model in Contra Costa County, whereby the County Fire Department contracts with a private ambulance provider (not yet identified) to provide primary response service to cities within in the County.
Adoption of this resolution advances the citywide priorities of Holistic Community Safety, and Responsive and Trustworthy Government.
Explaining the Letter of Intent
The Alameda County Fire Department (ACFD) recently released a Request for Proposals (RFP) for private ambulance providers to develop a proposal that would be submitted to Alameda County in the summer of 2023 as a competitive bid for ambulance services in the County. With the Letter of Intent in place, cities and/or fire departments within Alameda County have an opportunity to come together in negotiations with ACFD to refine this proposal and provide critical input on the terms and conditions of City participation in the model. Upon finalizing the new partnership model, OFD staff will return to City Council and present further details regarding the City’s anticipated obligations and commitments.
The Letter of Intent will allow Oakland to be a partner in a process whereby the Alameda County reimagines how its residents and businesses are served when it comes to emergency response and transport services.
FISCAL IMPACT
There is no fiscal impact related to the adoption of this resolution.
Harold Duffy, Interim City Administrator
Subject: Letter of Interest with Alameda County
Date: March 1, 2023 Page 4
Public Safety Committee
March 14, 2023
PUBLIC OUTREACH / INTEREST
No outreach was deemed necessary for the proposed action to enter into a letter of intent.
However, Oakland Fire will conduct outreach to Oakland residents to learn about how EMS services in Oakland can be improved under a new system.
COORDINATION
The Office of the City Attorney was consulted in the preparation of this report.
SUSTAINABLE OPPORTUNITIES
Economic: There is no economic impact for the city to enter into a letter of intent with Alameda County Fire, as this is a preliminary stage in the RFP process.
Environmental: There are no environmental opportunities or direct impacts associated with this report.
Race and Equity: For a city like Oakland, where a large portion of the population faces high concentrations of health disparities, poor health care options, low economic opportunity and high rates of violent crime, EMS response services is a critical component and can have a significant role in survival rate of patients. Thus, any efforts to enhance this critical service would be a benefit to populations such as East and West Oakland and other historically underserved areas of Oakland.
Harold Duffy, Interim City Administrator
Subject: Letter of Interest with Alameda County
Date: March 1, 2023 Page 5
Publ
ic Safety Committee
March 14, 2023
ACTION REQUESTED OF THE CITY COUNCIL
St
aff Recommends the City Council Adopt A Resolution Authorizing The City Administrator To Enter Into A Letter Of Intent With Alameda County Fire Department To Negotiate The Terms Of A Proposal For Ambulance Services And / Or Emergency Medical Services To Be Provided In Alameda County
For ques
tions regarding this report, please contact Michael Hunt, at (510) 238-6353.
Res
pectfully submitted,
Regi
nald D. Freeman
Fire Chief