City of Piedmont
COUNCIL AGENDA REPORT
DATE: July 1, 2024
TO: Mayor and Council
FROM: Rosanna Bayon Moore, City Administrator
SUBJECT: Consideration of Extension of Emergency Medical Services Agreements for First Responder Advanced Life Support (FRALS) Services and Ambulance Transport Services between the County of Alameda and the City of Piedmont.
RECOMMENDATION
Approve the extensions of Emergency Medical Services agreements for First Responder Advanced Life Support (FRALS) Services and Ambulance Transport Services between the County of Alameda and the City of Piedmont.
EXECUTIVE SUMMARY
The Piedmont Fire Department provides First Responder Advanced Life Support (FRALS) and Advanced Life Support ambulance transport services with medical oversight and quality control from the Alameda County Emergency Medical Services (EMS) Agency. Piedmont performs its duties in alignment with the County, and, at the same time, delivers services with some degree of independence from the countywide EMS system. Piedmont Fire is required to maintain formal agreements with the County detailing certain provisions of FRALS and Ambulance Transport Services. These agreements extend the existing contracts for two years with minor amendments.
BACKGROUND
Alameda County EMS System
The Alameda County EMS is a regional system overseen by the Alameda County Local Emergency Medical Services Agency (LEMSA). The LEMSA contracts with private ambulance providers to deliver emergency and non-emergency ground transportation within the county. In addition, four cities, Alameda, Albany, Berkeley, and Piedmont provide ambulance transport services through their fire departments, independent of the County system but with mandated medical oversight, protocols, and quality assurance by the LEMSA. The Piedmont Fire Department also provides First Responder Advanced Life Support (FRALS) services on its fire engine and truck. Both capabilities are highly coveted in the fire and emergency service industry because they increase the survivability of patients and improve patient outcomes.
The City of Piedmont Ambulance Transport Service
The City of Piedmont maintains its own ambulance transport service, utilizing Piedmont Fire Department personnel for emergency response and patient care. This service operates under the umbrella of LEMSA protocols and quality standards.
Benefits of Piedmont's Separate Ambulance Transport Service • Faster Response Times: Having a dedicated ambulance stationed within Piedmont allows for more rapid response times compared to relying solely on a regional system. Alameda County’s contracted ambulance transport provider has a tiered response requirement that allows them to arrive on scene between 10 to 40 minutes after the 9-1-1 call is answered by the dispatcher depending on how urgent the dispatcher decides the 9-1-1 call is. In Piedmont, we value all 9-1- 1 calls equally and respond accordingly. In the past year, the City ambulance has arrived on scene an average of 3:05 (minutes:seconds) after being dispatched and 7:04 after the initial call was answered, outperforming our contractual requirements and most importantly providing rapid and reliable emergency medical care to all residents who need it. • Local Expertise: Piedmont Fire Department personnel are highly familiar with the City's geography and potential challenges, leading to improved response and on-site care. • Community Control: The City maintains direct control over service standards, staffing levels, and resource allocation for its ambulance service.
• Efficient Staffing: Piedmont’s transport paramedics are fully trained firefighters and can operate as either or both in any emergency situation.
The City of Piedmont First Responder Advanced Life Support Service (FRALS) • Faster Care on Scene: Piedmont’s firefighters are active, engage throughout the community during shifts and perform department business in between responding to emergencies. Staffing the fire engine and truck with paramedic firefighters means Piedmonters quickly receive the highest level of care available regardless of which apparatus first arrives to the emergency. • Staffing Flexibility: Piedmont Fire is a lean and nimble department. Having paramedic firefighters on first responder units increases flexibility to move staff to and from the ambulance to make sure there is always advanced medical care on every call. • Necessary Critical Resource: Emergency departments have large teams dedicated to caring for the sickest patients. Advanced medical emergencies in the field may also require a larger response team, in addition to the one or two paramedics on an ambulance. First responder paramedics provide critical skills and personnel to manage complicated calls in the field, often augmenting personnel in the ambulance to assist delivering care to the Emergency Department of local hospitals.
The City of Piedmont and Alameda County EMS Agency
While Piedmont has a separate ambulance and FRALS services, it still interacts with the LEMSA in several ways:
• Standardized Care: Piedmont adheres to the LEMSA's established protocols and training standards, ensuring consistency in patient care across the county. • Resource Sharing: Collaboration with the LEMSA allows Piedmont to access additional resources when needed, such as during mass casualty incidents.
There are two Agreements with Alameda County affecting ALS capabilities provided by the Piedmont Fire Department. These Agreements are referred to as the FRALS and Ambulance Agenda Report Page 2
Transport Services Agreements. It is a long-standing value of the Piedmont Fire Department to have provide these additional services to the community to deliver the highest level of service possible.
FISCAL IMPACT
Each year, Alameda County approves a maximum fee schedule for ambulance transport providers in the County based on their contracted private provider’s rates. Our contract allows Piedmont to charge rates up to that amount and the City typically adopts these fees at the next scheduled budget cycle. Adopted as part of the new budget, the fee schedule increases July 1 as illustrated in this chart:
FY 2023/2024 FY 2024/2025
DESCRIPTION Fee Fee
Base Rate $3,331.40 $3,664.87
Mileage $75.17 $82.69
Oxygen $248.88 $273.79
Treatment/Non-Transport $668.13 $735.01
Once ambulance transport services are delivered, the City solely invoices the insurance carriers for Piedmont residents. The City does not further pursue Piedmont residents for any out of pocket expenses that are not recovered from insurance carriers.
Revenue per transport averaged $934.42 in Fiscal Year 22/23 and totaled over $366,000 in revenue. The FRALS and Ambulance Transport Services Agreements provide the City with the basis for fees charged. These contract extensions also include provisions for billing the Treatment/Non-Transport fee when using a Telehealth service to discuss options with the patient and paramedics. While Piedmont does not currently work with such a service, launching a program to do so would be the only financial impact of these contract extensions.
By: Fire Chief Dave Brannigan
ATTACHMENTS
A) 2024 City of Piedmont First Fire Ambulance Transport Services Amendment B) 2024 City of Piedmont First FRALS Amendment
Agenda Report Page 3
FIRST AMENDMENT TO AGREEMENT
This First Amendment (“Amendment”) to the Emergency Medical Services Ambulance Transport Services Agreement (“Agreement”), made and entered into on July 1, 2019, is made by the County of Alameda (“County”) and the City of Piedmont (“Contractor”).
For valuable consideration, the receipt and sufficiency of which is hereby acknowledged, County and Contractor agree to amend the Agreement in the following respects:
1. Section 2.1 of the Agreement, concerning the term, shall be deleted and replaced with the following language:
2.1 This Agreement is for the provision of 911 emergency medical ground ambulance response and transportation at a paramedic Advanced Life Support (“ALS”) level of service, and where specified in this Agreement, Basic Life Support (“BLS”) level of service for the time period July 1, 2019 through June 30, 2026. The EMS Agency may terminate this Agreement earlier if the County enters into a new 9-1-1 ambulance service provider contract at the conclusion of the competitive procurement for such services issued on January 11, 2024, and the successful bidder commences services before June 30, 2026.
2. Telehealth User Fees
In furtherance of pilot telehealth programs, Contractor may assess a User Fee at the Treat, Nontransport rate for referrals to telemedicine providers approved by the EMS Agency Director. This authorization will continue with its 9-1-1 ambulance services, whether as a pilot or as a permanent program.
Exhibit G definition of “Treat, Non-transport rate” shall be amended to read:
“* Treat, Non-transport rate applies to patients who receive a treatment intervention (such as 50% Dextrose) and subsequently refuse transport. Assessment (vital signs, EKG, etc.) does not constitute treatment interventions. The Treat, Non-Transport rate also applies to patients who receive treatment via referral to EMS Agency Director-approved telehealth providers under Contractor’s pilot or permanent telehealth program.”
3. Except as expressly modified by this First Amendment, all of the terms and conditions of the Agreement, are and remain in full force and effect.
Attachment A Agenda Report Page 4
IN WITNESS WHEREOF, the parties hereto have executed this First Amendment to the Agreement on the date(s) referenced below.
COUNTY OF ALAMEDA CITY OF PIEDMONT
By:______________________________
Signature
By:_____________________________
Signature
Name: Name: Rosanna Bayon Moore
Title: Title: City Administrator
Date:___________________________ Date:___________________________ Approved as to Form:
DONNA R. ZIEGLER, County Counsel
By:________________________________
K. Scott Dickey, Assistant County Counsel
By signing above, signatory warrants and
represents that he/she executed this First
Amendment in his/her authorized capacity
and that by his/her signature on this First
Amendment, he/she or the entity upon
behalf of which he/she acted, executed
this First Amendment.
Attachment A Agenda Report Page 5
FIRST AMENDMENT TO AGREEMENT
This First Amendment (“Amendment”) to the Emergency Medical Services First Responder Advanced Life Support Services Agreement (“Agreement”), made and entered into on July 1, 2019, is made by the County of Alameda (“County”) and the City of Piedmont (“Contractor”).
For valuable consideration, the receipt and sufficiency of which is hereby acknowledged, County and Contractor agree to amend the Agreement in the following respects:
1. Section 2.1 of the Agreement, concerning the term, shall be deleted and replaced with the following language:
2.1 The term of the agreement shall be July 1, 2019 through June 30, 2026. The EMS Agency may terminate this Agreement earlier if the County enters into a new 9-1-1 ambulance service provider contract at the conclusion of the competitive procurement for such services issued on January 11, 2024, and the successful bidder commences services before June 30, 2026.
2. Telehealth User Fees
In furtherance of pilot telehealth programs, Contractor may assess a User Fee at the Treat, Nontransport rate for referrals to telemedicine providers approved by the EMS Agency Director. The rate shall be equivalent to the rate authorized for the 9-1-1 Ambulance Service Providers. This authorization will continue, in alignment with 9-1-1 ambulance services, whether as a pilot or as a permanent program.
3. Except as expressly modified by this First Amendment, all of the terms and conditions of the Agreement, are and remain in full force and effect.
Attachment B Agenda Report Page 6
IN WITNESS WHEREOF, the parties hereto have executed this First Amendment to the Agreement on the date(s) referenced below.
COUNTY OF ALAMEDA CITY OF PIEDMONT
By:______________________________
Signature
By:_____________________________
Signature
Name: Name: Rosanna Bayon Moore
Title: Title: City Administrator
Date:___________________________ Date:___________________________ Approved as to Form:
DONNA R. ZIEGLER, County Counsel
By:________________________________
K. Scott Dickey, Assistant County Counsel
By signing above, signatory warrants and
represents that he/she executed this First
Amendment in his/her authorized capacity
and that by his/her signature on this First
Amendment, he/she or the entity upon
behalf of which he/she acted, executed
this First Amendment.
Attachment B Agenda Report Page 7