COUNTY OF SAN MATEO

Inter-Departmental Correspondence

Health Services Agency

DATE:

July 14, 2003

BOARD MEETING DATE:

August 5, 2003

TO:

Honorable Board of Supervisors

FROM:

Margaret Taylor, Director of Health Services

Barbara Pletz, EMS Administrator

SUBJECT:

Menlo Park Fire Protection District Request For Waiver of Ambulance Mileage Limitation

Recommendation

Adopt a resolution authorizing the President of the Board to execute an amendment to the agreement with American Medical Response West for Countywide Advanced Life Support First Response and Emergency Ambulance Service to increase the allowable mileage limitation for ambulances and create a waiver process.

Background

The Countywide Advanced Life Support First Response and Emergency Ambulance Service agreement between American Medical Response West (AMR) and the County requires the Contractor to remove ambulances from primary service at 175,000 miles and completely from service at 250,000. Primary services means that the vehicle is routinely used to provide ambulance service. The 175,000 limit was used for two reasons (1) according to AMR the 175,000 mile limit was the standard contained in AMR San Francisco Bay Area contracts and (2) the 175,000 limit was included in AMR's response to the County's Request for Proposals.

The Menlo Park Fire Protection District (MPFPD) is part of the San Mateo County Prehospital Emergency Medical Services Group ("JPA") which is a subcontractor of AMR. Four JPA fire service agencies staff ambulances for AMR; Menlo Park, Woodside, and Half Moon Bay Fire Protection Districts and the City of Pacifica. Standard AMR ambulances are Type II (van type vehicle). The Menlo Park and Woodside Fire Protection Districts chose to have AMR supply them with Type III ambulances (a modular vehicle) and agreed to pay AMR the difference in the cost ($31,377 per vehicle). A Type III ambulance is longer and has a wider patient compartment than the Type II vehicle. There is no other real difference in the quality of the two vehicles.

In December AMR alerted the EMS Program that the MPFPD Type III ambulance was nearing the mileage limit and that replacement plans were underway. In May, MPFPD provided an inspection report of this ambulance performed by a local mechanic indicating that six items need services or repair. Repairs were made, but as of June 30, 2003, MPFPD'S vehicle mileage exceeded 199,000 miles.

Health Services has informed AMR and MPFPD that the MPFPD ambulance must meet the mileage limit contained in the contract. Currently MPFPD is using one of AMR's Type II ambulances, so that it will be in compliance with the agreement, at no cost to MPFPD or AMR. AMR is willing continue to provide the MPFPD with an ambulance meeting the contract requirements throughout the term of the agreement.

Discussion

MPFPD has requested a waiver of the 175,000 mileage limit and indicates that it is prepared to move forward on purchasing a replacement ambulance. Because this issue may arise again when the Woodside Fire Protection District's (WFPD) Type III ambulance approaches the mileage limit, AMR has requested that the Countywide Advanced Life Support agreement be amended to provide a 250,000 mileage limitation for all ambulances.

We have surveyed five Bay Area Counties regarding their ambulance mileage limits. The two counties with fire service-based 9-1-1 ambulance service had no mileage limits for their vehicles. Of the three other counties, all with AMR as their provider, Santa Clara and Alameda have mileage limits of 175,000 miles, and Contra Costa has six years or 275,000 miles.

The proposed contract amendment extends the mileage limitation for all AMR primary service ambulances to 200,000 miles and shortens the time period between major vehicle maintenance for ambulances with an excess of 175,000 miles.

While Health Services believes that extending the mileage limit to 200,000 will not endanger patients, we do not believe there is a basis to generally extend the limit beyond that mileage. However, if a need arises to exceed the 200,000 mile limit for a specific vehicle, we recommend a waiver process to extend this limit up to 225,000 miles. Any request for a waiver would be submitted through AMR, the Contractor. The waiver would be contingent upon the submission of a current mechanical inspection performed by a mechanic approved by the Director of Health Services or her designee. The waiver would be further contingent on the submission of monthly mechanical inspections by an approved mechanic demonstrating the vehicle's roadworthiness, safety status, and compliance with the mechanical specifications contained in the agreement.

We believe increasing the mileage limit to 225,000 miles, through the proposed waiver process, allows MPFPD and WFPD sufficient time to secure the needed funding, manufacture, and delivery of new Type III ambulances.

Fiscal Impact

There is no cost to the County or to AMR associated with this contract amendment.