TO: HONORABLE MAYOR FROM: Robert Sapien, Jr.
AND CITY COUNCIL
SUBJECT: SANTA CLARA COUNTY 9-1-1 DATE: October 4, 2023
AMBULANCE SERVICES
STUDY SESSION
Approved Date
10/10/2023
PURPOSE
The purpose of the Santa Clara County 9-1-1 Ambulance Services Study Session is to provide the City Council with an overview of Emergency Medical Services (EMS) operations within Santa Clara County (County) with a focus on 9-1-1 ambulance services and possible future service models.
OUTCOME
The City Council will gain a common understanding of the County EMS System, 9-1-1 ambulance services, system revenues, and service model trends in the State of California.
BACKGROUND
The end of the current agreement between Rural/Metro of California, Inc. (Rural/Metro) and the County opens an infrequent opportunity for EMS system reforms that could result in improved system performance, efficiencies through operational integration, and greater sustainability through improved cost recovery. City staff recommended this Study Session to present to the City Council EMS system elements and challenges in advance of this opportunity for reforms which could include expanded City EMS services.
The County EMS System includes advanced life support (ALS) first responder services provided by fire agencies and 9-1-1 ALS ambulance services that are currently provided by a single private (for profit) provider. Services and performance requirements are specified by the agreements between each provider agency and the County. The current 9-1-1 EMS provider agreements were executed on July 1, 2011, and were extended, and/or amended, through June 30, 2024. The EMS agreement between the private firm Rural/Metro and the County will expire on June 30, 2024 – however, this agreement includes an option to extend for one additional three-year period.
STUDY SESSION: 10/16/23
HONORABLE MAYOR AND CITY COUNCIL
October 4, 2023
Subject: Santa Clara County 9-1-1 Ambulance Services Study Session
On March 14, 2023, the County Board of Supervisors adopted a written policy (Resolution BOS- 2023-391) regarding ambulance services contracts pursuant to Health and Safety Code Section 1797.230 Assembly Bill. This resolution stated the County Emergency Medical Services Agency (County EMSA) intends “to issue a competitive bid process through a request for proposals from ambulance providers interested in contracting with the County to provide pre-hospital emergency services within Santa Clara County”. The Eighth Amendment to the EMS Agreement between the County and Rural/Metro extended the original agreement to June 30, 2024, with the County reserving the right to extend the agreement for an additional three-year period. The County has yet to release the intended request for proposals (RFP). Because of the scope and complexity of this procurement, the Fire Department (Department) believes it is most likely that the County will extend the agreement through June 30, 2027.
ANALYSIS
Introduction
In October 2021, the County EMSA convened a stakeholder group for a series of meetings facilitated by a consultant to “assess the County’s current model for the provision of emergency ambulance services and to identify action-oriented solutions that will improve the system to best serve people within the County.” Participating stakeholders included staff from the County Services Agency, County 9-1-1 Communications, County Procurement, and representatives from area hospitals, County Administration, law enforcement, City Managers, and fire South County region. The stakeholder group’s evaluation focused on four ambulance service models including private ambulance, public “third service”, “Alliance” public/private, and the public fire department model. The County EMS Stakeholder Group Final Report 2 was completed in
October 2022.
On April 20, 2023, the Department provided its Annual Fire Department Emergency Medical Services Report
3 to the Public Safety, Finance and Strategic Support Committee detailing EMS activities for Fiscal Year 2021-2022.
1BOS-2023-39 Adopt Resolution making certain findings and adopting a written policy regarding ambulance services contracts pursuant to Health and Safety Code section 1797.230 (Assembly Bill 389). (Office of the County Executive) - The County of Santa Clara, California (iqm2.com) 2SCC_EMS Stakeholder Emergency Ambulance System Report Oct 2022.pdf (sccgov.org) 3https://sanjose.legistar.com/View.ashx?M=F&ID=11900852&GUID=8035EC5B-8E51-4E17-8649-390263F4A951
HONORABLE MAYOR AND CITY COUNCIL
October 4, 2023
Subject: Santa Clara County 9-1-1 Ambulance Services Study Session
EMS Services in Santa Clara County
County 9-1-1 Ambulance Services Model
California Health and Safety Code § Division 2.5 authorizes each county to establish a Local Emergency Medical Services Agency to oversee the delivery of EMS within that geographic area
4, allowing for local control of EMS delivery including ambulance transport.
The County EMSA provides services through contracted agencies including fire departments that provide first responder ALS (Paramedic-level) and basic life support (BLS) (Emergency Medical Technician-level) response. ALS 9-1-1 ambulance services are provided by a private firm, Rural/Metro servicing an exclusive operating area (EOA) that includes Mountain View, Santa Clara, Cupertino, Milpitas, Sunnyvale, Los Altos, Los Altos Hills, Campbell, Los Gatos, Monte Sereno, Saratoga, San José, Morgan Hill, Gilroy, and all areas outside organized cities including Moffett Field/NASA/AMES and unincorporated County areas not covered by legally organized cities or fire districts. The County’s EOA does not include the City of Palo Alto or parcels known as “Stanford Lands” where ambulance services are provided by the Palo Alto Fire Department.
County agreements with provider agencies specify various performance requirements including response times. First responder agreements with the County require 8-minute response time performance 90% of the time when responding with lights and sirens to urban areas. The ambulance provider agreement with the County requires response times under 12-minutes, 90% of the time when responding with lights and sirens (Code 3) to urban areas. Response time underperformance by first responder agencies result in liquidated damages deducted from first responder funding. The ambulance provider incurs fines for response time underperformance.
Other unmet performance requirements specified in EMS agreements can also result in liquidated damages or fines.
EMS Agreement Between Rural/Metro of California, Inc., and the County
On July 1, 2011, the County and Rural/Metro EMS Agreement for the provision of ALS Emergency Ambulance Service in the County EOA became effective
5. This initial agreement to
provide ALS ambulance transport services had a five-year term with the County holding an option to extend the agreement for two additional three-year periods.
4https://leginfo.legislature.ca.gov/faces/codes_displayexpandedbranch.xhtml?tocCode=HSC&division=2.5.&title=& #content_anchor
5https://emsagency.sccgov.org/sites/g/files/exjcpb266/files/general/2022%20- %200707%20%20EOA%20Agreement-Amendments-Exhibits%20RMetro.pdf
HONORABLE MAYOR AND CITY COUNCIL
October 4, 2023
Subject: Santa Clara County 9-1-1 Ambulance Services Study Session
On September 23, 2014, the County Board of Supervisors “directed the Administration to begin developing options for the County in light of Rural/Metro’s bankruptcy filing and prior to contract defaults”. On October 6, 2015, the County Board of Supervisors convened a meeting and presented the following options:
• Option 1: Extend the existing contract with Rural/Metro without a current modification to terms.
• Option 2: Extend the existing contract with Rural/Metro and implement some modifications.
• Option 3: Issue a new RFP and explore a new contract.
For Option 1, County Administration offered the following assessment:
The 9-1-1 ambulance transport business has undergone considerable consolidation in the last few years. As part of that market consolidation, Rural/Metro is in the process of being acquired by American Medical Response (AMR). AMR, for its part, must ensure to the County that it stands ready to perform the balance of Rural/Metro’s contractual obligations as a pre-condition to the County approval of AMR’s acquisition of Rural/Metro (and the County’s existing 9-1-1 ambulance transport contract). If AMR satisfies the County that it stands ready to perform and will perform the balance of Rural/Metro’s contractual obligations, the Board may wish to consider extending the current contract with Rural/Metro by way of exercising the first three year option. The option to extend must be exercised by the County no less than sixty days prior to June 30, 2016.
Meeting minutes reflected the County Board of Supervisors direction that the Office of the County Executive work towards preserving the ability to keep the existing contract; developing an RFP at some point in the future; and exploring the feasibility of a public/private partnership; and direction to report back no later than January 2016.
On February 9, 2016, the County exercised its first option to extend the agreement with Rural/Metro for three years to June 30, 2019. On February 12, 2018, the County released its RFP for Emergency Ambulance Services, 9-1-1 Emergency Response, 7-Digit Emergency Response, ALS Ambulance, and Standby Service with Transportation Authorization for the County’s Exclusive Operating Areas (Excluding the City of Palo Alto and “Stanford Lands” parcels). The solicitation resulted in a single bidder that was determined to be unresponsive.
Subsequently, the County exercised its second option to extend the agreement with Rural/Metro for three years to June 30, 2022.
The Eighth Amendment to the EMS Agreement between Rural/Metro and the County was effective and retroactive to July 1, 2020, extending the terms of the EMS Agreement until June 30 , 2024, with the County holding an option to extend for one additional three-year period to June 30, 2027.
HONORABLE MAYOR AND CITY COUNCIL
October 4, 2023
Subject: Santa Clara County 9-1-1 Ambulance Services Study Session
9-1-1 EMS Provider Agreement Between City of San José and the County
The Department provides first-responder patient care through an agreement with the County under the 9-1-1 Emergency Medical Services Provider Agreement between City of San José and the County EMS Agency (911 EMS Provider Agreement)
6. Through this agreement, the City of
San José is authorized to provide ALS/Paramedic-level services within the County EMSA. This agreement went into effect on July 1, 2011, for a five-year period with the County holding the right to extend the term for two additional three year periods if desired by the City of San José.
Either party reserves the right to terminate the agreement without cause with at least 180 calendar days of written notice. The current 9-1-1 EMS Provider Agreement is set to expire on June 30, 2025.
Annex A of the agreement authorizes the Department to provide ambulance transport services on a limited basis to augment the services provided by Rural/Metro. The Department deploys three rescue medics (ambulances) staffed with a single fire engineer and firefighter/paramedic, equipped to provide routine emergency medical response and patient transport as part of the 9-1- 1 EMS Provider Agreement in four specific scenarios:
• Immediate lifesaving transportation is required.
• Material failure of the contracted ambulance provider when emergency transport is required.
• Delays with the contracted ambulance provider when emergency transport is required.
• Emergent needs requiring approval from the County EMS Agency Duty Chief.
Annex B of the agreement includes a provision for “First Responder Funding” that is contingent on the performance criteria of the EMS Resource Management (Category A) requiring Emergency Medical Dispatch and Medical Priority Dispatch System, and Response Time Performance (Category B). The Department’s Fire Communications Division’s operational procedures conform to the Category A requirements. From 2012 through 2016, the Department’s performance fell below the 8-minutes, 90% of the time standard due primarily to decreased resourcing post-Great Recession, increased call volume, high traffic congestion, dispatch and response practices, and response time reporting procedure deficiencies. As a result of the underperformance, the City of San José was declared to be in material breach of the agreement, and First Responder Funding was terminated. The Department developed a comprehensive work plan to address response time performance, rectifying its performance and again qualifying for First Responder Funding. To date, the Department has met response time performance requirements specified in Annex B, Category B for over 60 consecutive months.
6https://emsagency.sccgov.org/sites/g/files/exjcpb266/files/General/CityofSanJoseEMSAgreementAmendments2018 1231.pdf
HONORABLE MAYOR AND CITY COUNCIL
October 4, 2023
Subject: Santa Clara County 9-1-1 Ambulance Services Study Session
Emergency call volume has continued to rise over the term of the agreement, increasing over
48.5% from to 73,327 in FY 2011-2012 to 109,136 in FY 2022-2023. This was principally driven by “Medical Only” responses which increased by more than 44% in that period from 46,893 in FY 2011-2012 to 67,752 in FY 2022-2023 representing approximately 58% of the additional calls.
EMS System Models
“Alliance” Model
In the “Alliance” model, the EMS agency delegates service provision to a local fire district(s) 7 or
fire department through a competitive bid process. This designee then subcontracts transport services to a private ambulance provider and coordinates services based on geographic regions, as seen in Contra Costa
8, San Diego9, and Sonoma10 Counties. It is also understood that Alameda, Solano, and San Bernardino Counties have all undergone the competitive RFP process and the following agencies were awarded a contract for service using the “Alliance” ambulance model:
• Santa Barbara County Fire Department
• Sonoma County Fire District
• CONFIRE EMS: Joint Powers Agreement of 11 fire departments in San Bernardino County
On October 4, 2021, Governor Newsom signed into law Assembly Bill 389 11, the first
amendment to California’s Prehospital Emergency Medical Care Personnel Act (“EMS Act”) specifically addressing emergency ambulance service contracting. The new law, which became effective on January 1, 2022, represents a significant departure from existing practice and creates new contracting options and opportunities for California counties and fire agencies.
Assembly Bill 389 approves the “Alliance” model of emergency ambulance services delivery by authorizing counties to contract with fire agencies that will provide emergency ambulance services, in whole or in part, through written subcontracts with private providers. The main strength of this model is its ability to access the advantages of both public and private systems.
This public-private model can leverage the purchasing power of a private firm, while also
7Fire Districts are designated special districts that governed independently from a city or county government and typically provide broader fire prevention and fire suppression services to rural and/or unincorporated areas within municipalities.
8https://cchealth.org/ems/pdf/sysplanupd17.pdf
9https://www.sandiegouniontribune.com/news/politics/story/2023-04-17/falck-deal-alliance-model-san-diego- ambulance
10https://sonomacounty.ca.gov/sonoma-county-supervisors-award-ambulance-contract-to-sonoma-county-fire- district
11https://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=202120220AB389
HONORABLE MAYOR AND CITY COUNCIL
October 4, 2023
Subject: Santa Clara County 9-1-1 Ambulance Services Study Session
accessing funding only available to public entities. Other strengths of this type of model include increased resources, clear and streamlined chain of command, and better performance.
Exclusive Operating Area – Private Provider
As seen in the current County Private Provider model, a for-profit corporation is selected in a competitive bid process that is awarded to the most qualified bidder with the lowest price.
Public – Third Service
The Public - Third Service model, based on the model currently used in Austin, Texas, creates a standalone department within the same agency that is dedicated to emergency ambulance services (in addition to law enforcement and fire departments).
Public – Fire Based
In a Public - Fire Based model, the fire department provides EMS services, delivering initial medical response, as well as hospital transport. This model mirrors the operations found in the City and County of San Francisco, California.
EMS Trends
Beginning in June 2022, the Department experienced a dramatic increase in situations where either no ambulances were available to respond to a medical emergency and/or only a BLS-level ambulance was available. The Department (and other first responder agencies) responded by increasing the frequency of rescue medic transports and by sending firefighter/paramedics on BLS ambulances with patients requiring ALS care.
The County EMSA monitors EMS system stability. When ambulance levels are low, Standard Dispatch Orders (SDOs) are activated countywide to create surge capacity and/or alter ambulance dispatch protocols to reserve ambulances for the most serious emergencies. SDOs may be executed by the County EMS Agency, County Communications Watch Commander, and authorized agents of the County EMS Agency
12. Four of the 30 distinct SDOs increased in
frequency over the past two years including SDO 3, SDO 10, SDO 11, and SDO 17 as defined below:
• SDO 3: Dispatch BLS Ambulances to “ALPHA” and/or “OMEGA” EMS Events. If available and in-lieu of an ALS ambulance, attached BLS Ambulances to all “ALPHA” and/or “OMEGA” level of responses (even if an ALS ambulance is closer). Once attached to an event, the BLS ambulance shall remain on the event even if a closer ALS ambulance becomes available. If the response is upgraded prior to the arrival of the BLS
12https://emsagency.sccgov.org/sites/g/files/exjcpb266/files/prehospital-care-policy- 900/919%20SDO%20Order%20Form%202022_07_13.pdf
HONORABLE MAYOR AND CITY COUNCIL
October 4, 2023
Subject: Santa Clara County 9-1-1 Ambulance Services Study Session
ambulance and an ALS ambulance has a shorter estimated time of arrival than the BLS ambulance, reassign the response to the ALS ambulance.
• SDO 10: Place All Available EOA and Non-EOA Ambulances in Services. Place all available EOA ambulances and non-EOA ambulances in service. Notify each private ambulance dispatch center to place all available units into service and immediately make them available for 9-1-1 system response. Dispatchers shall attach BLS ambulances to any appropriate event. Once attached to an event, the BLS ambulance shall not be cancelled because of ALS ambulance availability.
• SDO 11: Notify Fire Departments with permitted ambulances that unrestricted use of fire-based ambulances have been authorized within their jurisdiction (Non-systemwide use). Each fire service jurisdiction may use their fire-based ambulance units in the most effective method as determined by their jurisdiction. This shall include responding to events that require ambulance transportation within their local jurisdiction. Response to and transport of all levels of triaged and non-triaged (Code 2 and Code 3) events occurring within their jurisdiction is authorized. Upon receiving notification from a public safety answering point that a fire department emergency ambulance has been dispatched to an event, County Communications will inform the public safety answering point that an ambulance will not be dispatched to the event, unless a need for multiple ambulances exists. If an ambulance has already been attached to the event, it will be canceled.
• SDO 17:
Automatic Ambulance Dispatches are Suspended Until a First Response Unit Arrives on-the-scene and verifies that a Patient Needing Emergency Transport Exists.
Ambulances shall only be sent to calls for services when a patient has been identified and is in need of emergency transportation by ambulance.
Table 4 below displays the monthly average of SDO 10 and SDO 11 activation increases of over 1,992% over a 38-month period from FY 2020-2021 to FY 2023-2024. SDO 3 is excluded because it has been activated on an ongoing basis since June of 2022.
Table 4: Cumulative Annual and Monthly Average SDO 10 and 11 Activation Minutes
Fiscal Year
Cumulative Annual SDO 10 and
11 Activation Minutes
Monthly Average SDO 10 and
11 Activation Minutes
2020-2021 4,919 410
2021-2022 8,895 741
2022-2023 49,575 4,131
2023-2024 17,155* 8,578
*FY 2023-2024 displays year-to-date data through August 2023.
HONORABLE MAYOR AND CITY COUNCIL
October 4, 2023
Subject: Santa Clara County 9-1-1 Ambulance Services Study Session
In extreme circumstances, County EMSA will activate SDO 17 where no ambulances are assigned to EMS incidents. Once first responders arrive on scene, they can provide updates including communicating the need for an ambulance response, however ambulances may be unavailable or significantly delayed. Table 5 reflects SDO 17 increases in minutes over a 38- month period from FY 2020-2021 to FY 2023-2024.
Table 5: Cumulative Annual and Monthly Average SDO 17 Activation Minutes
Fiscal Year
Cumulative Annual SDO 17
Activation Minutes
Monthly Average SDO 17
Activation Minutes
2020-2021 0 0
2021-2022 104 17
2022-2023 3,117 260
2023-2024 1,128* 564
*FY 2023-2024 displays year-to-date data through August 2023.
In FY 2022-2023, resource constraints regarding the lack of available ambulances resulted in over 700 Department rescue medic transports and 800 instances where Firefighter/Paramedics rode in Rural/Metro ambulances to maintain ALS patient care. As seen in Chart 1 below, the added strain on the Department’s resources is reflected in diminished response time performance when SDOs are activated.
Chart 1: Unadjusted Late Responses versus SDO Activation Minutes
0 2,000
4,000
6,000
8,000
10,000
12,000
0 200
400
600
800
1,000
Cumulative Minutes
Late Repsonses
MonthYear
Unadjusted Late Responses SDO 10, 11, & 17 Cumulative Mins. Trend Progression (Linear)
HONORABLE MAYOR AND CITY COUNCIL
October 4, 2023
Subject: Santa Clara County 9-1-1 Ambulance Services Study Session
EMS System Revenues and Sustainability
Ambulance services are typically delivered on a fee for service basis. County ambulance billing and user fees are specified in the agreement between Rural/Metro and the County including ambulance user fees including ALS or BLS ambulance service, mileage, staff time, and fees for disposable supplies and medications. Table 1 below shows a fictitious ambulance service billing scenario based on billing rates as of July 1, 2022.
Table 1: Fictitious Ambulance Service Billing
Service Level Price Basis
Advanced Life Support (1) $2,055.53 ALS 1 Emergency
Mileage $697.90 10 miles
Paramedic $130.06 1 hour
EMT $86.71 1 hour
EKG Monitor 12-Lead $172.59 1
Razor, Disposable $1.59 1
Intravenous Start Kit $72.62 1
Non-Rebreather Mask $19.98 1
Temperature Measurement $30.67
Pulse Oximetry $76.30
Normal Saline $179.23 1 (1,000 cc)
Total $3,523.18
There are four categories of payers; the ratio of payers is often referred to as the payer mix or payable cost centers. These cost centers consist of Medicare, Medi-Cal (both Fee for Service and managed care), private pay (uninsured), and commercial insurances. Understanding a service area payer mix will aid in estimating system revenues.
In an EOA, the percentage of each of these payer categories varies widely depending on the demographics of that EOA. An EOA with a very high percentage of working age adults and higher percentage of larger businesses will have a higher percentage of commercial insurance payers, while an area consisting of a large population of senior citizens (age 65 and older) will have a higher rate of Medicare payers.
In 2015, the Department engaged with the consulting firm, AP Triton, to conduct a Santa Clara County Ambulance Service Feasibility Study. Table 2 below represents AP Triton’s estimate for the County.
HONORABLE MAYOR AND CITY COUNCIL
October 4, 2023
Subject: Santa Clara County 9-1-1 Ambulance Services Study Session
Table 2: Reported Payer Mix and Collection Rate from Rural Metro in 2014
Cost Center Payer Mix Collection Rate
Medicare/Medicare HMO 34% 85%
Medi-Cal/Medi-Cal HMO 23.3% 92%
Commercially Insured 21.1% 80%
Private Pay/Non-Insured/Other 21.6% 3%
Public Provider Ground Emergency Medical Transport (PP-GEMT) Intergovernmental Transfer (IGT) Program
The PP-GEMT IGT Program, established in accordance with Assembly Bill 1705 13 and recently
implemented in January 2023 by the Department of Health Care Services (DHCS), provides eligible public providers of ground emergency medical transports with supplemental reimbursement through add-on payments. Under the PP-GEMT IGT Program, ambulance bills for patients enrolled in Medi-Cal are paid a base rate of $118.20, plus the new add-on amount of $946.92, for a total reimbursement of $1,065.12. There is a Medi-Cal IGT fee of $361.00 for the PP-GEMT program, making for a typical reimbursement of approximately $700.00 per transport above funding allocated to the provide provider.
These figures are summarized in Table 3. Funding for the new PP-GEMT IGT Program’s add-on payments is made from Federal Centers for Medicare and Medicaid Services funds matched with local funds. The State of California will not allow State general funds to be used, therefore the program requires public ambulance providers to voluntarily provide the State with the matching amount needed through an IGT. DHCS then uses the non-federal funds to draw down the available matching federal funds and uses the combined amount to pay the add-on amount per transport.
Table 3: PP-GEMT IGT Add-On Amount by Type of Procedure
Procedure
Code
Procedure Code Description Current Fee
Schedule
Rate14
Medi-Cal PP-
GEMT IGT
Add-on
Resulting
Payment
Amount
A0225 Neonatal Emergency Transport $179.92 $946.92 $1,126.84 A0427 ALS 1-Emergency $118.20 $946.92 $1,065.12
A0429 BLS-Emergency $118.20 $946.92 $1,065.12
A0433 ALS 2 $118.20 $946.92 $1,065.12
A0434 Specialty Care Transport $118.20 $646.9215 $765.12
13https://leginfo.legislature.ca.gov/faces/billTextClient.xhtml?bill_id=201920200AB1705 14Reflects the base rates associated with each of the presented codes that are also subject to further adjustments pursuant to the State Plan.
15The estimated Medi-Cal PP-GEMT IGT Add-on amount of $649.92 deducts $300.00 per transport fee to administer the PP-GEMT IGT Program.
HONORABLE MAYOR AND CITY COUNCIL
October 4, 2023
Subject: Santa Clara County 9-1-1 Ambulance Services Study Session
The PP-GEMT IGT Program is anticipated to provide a reimbursement of an additional $765.12 per Medi-Cal transport. This enhanced reimbursement is funded with Federal Centers for Medicare and Medicaid Services funds that are matched by voluntary contributions from participating public providers of ground emergency medical transport. The DHCS has advised that, “if DHCS determines that the projected amount of voluntary contributions is not sufficient to support implementation of the Program, the Program would not be continued in future rating periods. If the Program ends, public GEMT providers would revert to reimbursement under existing programs, including the GEMT Certified Public Expenditure Supplemental Payment Program and the GEMT Quality Assurance Fee Program
16.”
Next Steps and Closing
The Department plays a critical role in the County’s EMS system. In 2021, the Department responded to 73,403 EMS responses, almost 57% of the County ambulance provider’s 125,918 responses countywide. Increasing call volume and recent increases in rescue medic transports and paramedic escorts has added burden to Department resources. The current EMS ambulance model does not result in effective operational coordination between Rural/Metro managers and the Department. County EMSA holds regulatory responsibilities but also operational control of EMS. This means that the first responder agencies and the ambulance provider have little opportunity to coordinate effective resource deployment. This arrangement is particularly limiting as the ambulance provider struggles to deploy sufficient ALS ambulances. System revenues are not programmed to sufficiently support the Department’s commitment to the EMS system. The Department estimates that the cost to operate ALS-level EMS services in FY 2022- 2023 was approximately $6.8 million with only $2.9 million realized in first responder funding, a cost recovery rate of approximately 43%.
As the County prepares to release its RFP for 9-1-1 ambulance services, the Department must identify options for improved cost recovery and operational integration. This includes close evaluation of models gaining prominence in California such as, the “Alliance” model and first responder fees. As communicated to the City Council in the September 8, 2023, information memorandum: Fire Department Evaluating Options for Integrated First Responder and 9-1-1 Ambulance Services
17, the Department released an RFP to assess the viability of an “Alliance” model where the City could become the countywide 9-1-1 ambulance service provider.
Ultimately, the Department seeks a path to providing adequate and sustainable EMS resource levels throughout the County that are operationally integrated with fire agencies and that do not compromise fire agency response other emergencies.
16https://www.dhcs.ca.gov/provgovpart/Documents/PPGEMT-IGT-FAQs-.pdf 17https://www.sanjoseca.gov/home/showpublisheddocument/104830/638297894315800000
HONORABLE MAYOR AND CITY COUNCIL
October 4, 2023
Subject: Santa Clara County 9-1-1 Ambulance Services Study Session
COORDINATION
This memorandum has been coordinated with the City Attorney’s Office.
ROBERT SAPIEN, JR.
Fire Chief, Fire Department
For questions, please contact Robert Sapien, Jr., Fire Chief, at [email protected] or
(408) 794-6952.