Safety, Wellness, and Youth Committee Memorandum
TO: SAFETY, WELLENESS, AND YOUTH COMMITTEE DATE: APRIL 17, 2024 FROM: FIRE DEPARTMENT WARDS: ALL
SUBJECT: UPDATE ON THE STATUS OF THE AMERICAN MEDICAL RESPONSE OPERATIONAL AGREEMENT AND AMBULANCE COMPLIANCE METRICS INCLUDING RESPONSE TIMES ISSUE:
Provide an update to the Safety, Wellness, and Youth Committee on American Medical Response’s (AMR) Operational Contract and review of compliance metrics including response times. In response to the pending franchise extension, the Safety, Wellness, and Youth Committee asked the Fire Department to provide an update on the American Medical Response (AMR) Operational Contract negotiations and response times.
RECOMMENDATIONS:
That the Safety, Wellness, and Youth Committee:
Consider the information contained in this report regarding an update on the proposed Operational contract with AMR; and Consider the information contained in this report regarding AMR’s compliance metrics including response times.
LEGISLATIVE HISTORY:
The Emergent Medical Transport Franchise is covered under Chapter 5.66 of the Riverside Municipal Code (RMC), which identifies the rules, laws, and processes that the City Council has identified as standards to operate ambulatory services within the City, such as franchise/permit fees, application process, service requirements, mutual aid requirements, personnel, and fee structure. The Fire Chief, or designee, is the controller of the ambulance franchise and has the responsibility under the RMC to act as the ambulance franchise “Administrator”.
BACKGROUND:
The County of Riverside Department of Public Health is the local Emergency Medical Services Agency (REMSA) for the area that includes the City of Riverside. In 2015, the County of Riverside and American Medical Response Ambulance Service (AMR) agreed to the exclusive emergency ambulance service for the entire County of Riverside. Working with REMSA, the City of Riverside entered into a Franchise Agreement on November 8, 2018, for ambulance service within the City of Riverside that expired on November 8, 2023.
The Riverside Municipal Code requires that emergency ambulance providers operate under a franchise model with the City of Riverside. On October 9, 2018, the City adopted Ordinance No. 7440, granting AMR an exclusive franchise to operate authorized ambulance services on City streets, subject to the terms of the ordinance, for a term of five years expiring on June 30, 2023. The term of the ordinance can be extended by resolution of the City Council for a period up to three years, for a total term not to exceed the City Charter limitations for franchises, which is thirty-five years. (RMC Section 5.66.020, 5.66.090, City Charter Section 1302.) The City of Riverside has historically used the same ambulance provider that Riverside County Emergency Medical Services Agency (REMSA) has contracted with for 9-1-1 Advance Life Support Services. The City of Riverside has retained the administration of our Emergency Medical Services (EMS), which is required under the Health & Safety Code 1797.201, to allow the City of Riverside the flexibility to administer franchise agreements and ambulance permits in accordance with the Riverside Municipal Code 5.66 “Ambulances.” This structure allows the City the flexibility needed to ensure our residents consistently receive the services they expect in a timely manner. The previous two franchises and operational agreements were executed with five-year terms from 2010 to 2018. In 2018, a new franchise ordinance and operational agreement were executed, with the term of service from 2018 to 2023.
On September 20, 2023, the Fire Department requested the Safety, Wellness, Youth Committee extend the Franchise agreement to allow time to negotiate a new ambulance operational agreement with American Medical Response (AMR).
In response to the extension request, the Safety, Wellness, and Youth Committee asked the Fire Department to provide an update on American Medical Response (AMR) operational contract and response times within six (6) months.
On November 8, 2023, the City of Riverside Council approved an extension of the Ambulance Franchise for one year. The operational contract was also extended for six (6) months, with the option for the City Manager to extend another six (6) months to allow time to negotiate a new agreement with AMR.
DISCUSSION:
AMR Operational Contract Update:
The AMR operational contract is currently in the final stages of negotiations between the City of Riverside and AMR with the expectation that staff will have a contract renewal by May Some highlights of changes to the pending agreement are as follows:
Term: The new Franchise and Operational Contract will be in effect for three (3) years from the date of signing.
Ambulance Deployment:
2018 Operational contract: AMR's deployment model is called "System Status." The model is based on meeting response times of 90%. Ambulances are not in fixed locations and move according to the Emergency Medical System's needs. No ambulances are dedicated to the City of Riverside. 2024 Operational contract: AMR will continue with "System Status" and will now station ambulances in the City of Riverside Fire Stations. Fire Station 1, Fire Station 3, Fire Station 5, and Fire Station 12 will now house ambulances. These units are not dedicated to the City of Riverside but will help provide a more consistent response from AMR with ambulances in the City of Riverside.
Tier Dispatch: The City of Riverside Fire Department will begin Tier Dispatching. Tier Dispatching allows the Fire Department Dispatch to respond to the right resource to the 911 incident. Tiered Dispatching will implement different response configurations: the Fire Department and AMR responding with lights and sirens (code 3) and the fire Department and AMR responding without lights and sirens (code 2).
CAD-to-CAD: The City of Riverside and AMR will coordinate a CAD-to-CAD data transfer to help with the Fire Department and AMR ambulance information exchange.
First Watch: AMR will feed response data to First Watch Online Compliance Utility Module (OCU) and any associated response dashboards to help the City of Riverside monitor compliance and quickly address any issues.
Contract Financials:
AMR will pay the City of Riverside one hundred and sixty-five thousand, two hundred and twenty-four dollars, and eleven cents ($165,224.11) per month. The fee shall increase by 3% annually.
AMR will pay $1,800.00 per month per Fire Station for using the City of Riverside four Fire Stations.
AMR will pay $30,000 annually to reimburse the City of Riverside for equipment that supports the restocking of EMS supplies.
AMR will pay one hundred and forty-four thousand, eight hundred and twenty-one dollars, and thirty-five cents ($144,821.35) per year for a Dispatch Emergency Medical Dispatch Coordinator.
Contract Penalties:
AMR ALS ambulances shall arrive on scene in eleven (11) minutes and fifty-nine (59) seconds or less; at least ninety percent (90%) of the time or fees will be assessed.
AMR BLS ambulances shall arrive on scene in twenty (20) minutes and fifty-nine (59) seconds or less, at least ninety percent (90%) of the time, or fees will be assessed.
Three hundred sixty dollars ($360.00) for the ambulance crew's failure to report their arrival at the scene, and the at-scene time is not verifiable by other reliable means.
Five hundred dollars ($500.00) for any incident when ARM refers a call to a Basic Life Support Unit (BLS), except expressly permitted by the City in the RFD EMD MPDS PROTOCOL MATRIX-City of Riverside.
AMR’s Compliance and Response Times:
Riverside County Emergency Medical Services Agency (REMSA) annually provides an update on American Medical Response’s (AMR) response times for the County of Riverside, according to the 2015 Ground Advanced Life Support Emergency Ambulance Services contract. The City of Riverside response area is identified as the “Riverside City Subzone.” AMR’s performance is evaluated by its response time of (11) eleven minutes and (59) seconds at least ninety percent (90%) of the time within the Riverside City zone.
REMSA provides an AMR Compliance Summary by fiscal year. The report highlights compliance from July 1, 2022, to June 30, 2023. AMR’s response times are not reported directly to the Riverside Fire Department. All response data is adjudicated by REMSA and provided in an AMR Compliance Summary, which is completed annually. The report identified the following.
1. AMR Response time and overall performance in the Riverside City Subzone:
Within the Riverside Zone, AMR did not meet the ninety percent (90%) adjusted compliance with the delay response exemptions for March, April, and May of 2023.
March 2023
April 2023
May 2023
Total EMS Responses
3058
3001
3098
90% Response Compliant
2752
2701
2788
10% Response Non-Compliant
306
300
310
AMR was not compliant with the ALS mandate, sending BLS ambulances to Advanced Life Support Agreement (ALS) level calls outside the current 2018 ALS First Responder Agreement (AMR & City of Riverside). A Basic Life Support ambulance responded to two incidents in 2023.
2. Riverside County EMS Agency (REMSA) was unable to grant AMR the request for annual renewal for the following reasons.
During this performance period, AMR has failed to meet the required compliance thresholds of ninety-one (91%) in all EMS zones and subzones for more than nine (9) nonconsecutive months of the performance period.
AMR has been unable to consistently meet the requirements of the ALS mandate requiring BLS resources to respond to incidents. This is not in compliance with section 3.1.3 ALS mandate of the contract.
Breach of Contract Notification: AMR was notified that they were in breach of contract for not meeting ninety percent (90%) adjusted compliance and for not meeting the ALS mandate.
AMR Compliance Reports
Starting February 27, 2024, Fire is receiving AMR’s Response Time Compliance Summary through First Watch. First Watch is a data analytics software solution that is used to monitor and report response times for emergency responses. The City of Riverside has recently approved the acquisition of First Watch to help with identifying and quickly addressing response issue with the ambulance service.
Northwest – Riverside City Zone for February 2024
Total Volume
RAW Gross Exceptions
RAW Compliance
Exemptions Requested
Exemptions Approved
Chargeable Late Responses
Compliance
Contract Comp%
2454
280
88.59%
54 54
189
92.30%
90.0%
STRATEGIC PLAN ALIGNMENT:
The item contributes to Strategic Priority No. 2, Community Well-Being, and Goal No. 2.6 – Strengthen community preparedness for emergencies to ensure effective response and recovery.
This item aligns with each of the five Cross-Cutting Threads as follows:
Community Trust – Providing AMR’s response times information allows for transparency on how the Riverside Emergency Medical System is operating.
Equity – All City of Riverside citizens deserve a timely 911 response when people are faced with an emergency.
Fiscal Responsibility – The Riverside Fire Department is a prudent steward of public funds and ensures that relationships between public and private partnerships are leveraged.
Innovation – Riverside is inventive and timely in meeting the community’s changing needs by evaluating the Emergency Medical System and identifying improvements when possible.
Sustainability & Resiliency – Riverside is committed to meeting the needs of the present without compromising the needs of the future and ensuring the City’s capacity to provide emergency services to the community.
FISCAL IMPACT:
There is no fiscal impact associated with this update.
Prepared by: Steve McKinster, Deputy Fire Chief
Approved by: Michael D. Moore, Fire Chief
Certified as to availability
of funds: Kristie Thomas, Finance Director/Assistant Chief Financial Officer Approved by: Mike Futrell, City Manager Approved as to form: Phaedra A. Norton, City Attorney
Attachments:
2022 2023 AMR Annual Response Time Report
2022 2023 AMR Compliance Review Matrix
2022 2023 AMR Executive Summary 11012023
AMR Response ● Page 2