Inter-Departmental Correspondence


Health System



February 13, 2009


March 3, 2009







Honorable Board of Supervisors



Jean S. Fraser, Chief, Health System


Brian J. Zamora, Director, Community Health Division


Barbara Pletz, Emergency Medical Services Administrator



Agreement with American Medical Response West, a California corporation for countywide emergency ambulance service



Adopt a Resolution authorizing the President of the Board to execute an Agreement with American Medical Response West for countywide emergency ambulance service for the term of July 1, 2009 through June 30, 2014.



Commitment: Ensure basic health and safety for all.

Goal 7: Maintain and enhance the public safety of all residents and visitors.


This Agreement contributes to this commitment and goal by providing coordinated emergency medical response services to the citizens of the County.


Performance Measure:


FY 2007-08

FY 2008-09

Percent compliance with ambulance response time standards.





On September 30, 2008, your Board authorized the Health System to enter into negotiations with American Medical Response West (AMR), for the provision of county-wide emergency ambulance service. This action followed a three-year Emergency Medical Services system redesign process and subsequent Request for Proposals (RFP) process.


AMR is the current ambulance provider. Its current contract includes both emergency ambulance and paramedic first response provided by the San Mateo County Emergency Medical Services Group (JPA) as a subcontractor to AMR. At the JPA’s request, the new contract does not identify the JPA as a subcontractor and the JPA will separately contract with AMR for paramedic first response services.


The RFP specified that the ambulance response time standard would be longer (12:59 minutes) than the California standard of 8 minutes because the fire service paramedic first responder would be shorter than 8 minutes. Further, the RFP provided that the ambulance provider’s cost savings associated with the longer response time standard could be available to offset the JPA’s costs in providing paramedic first response rather than an EMT level response. The negotiated new Agreement with AMR provides an annual subsidy of $3,743,540 to the JPA.


The RFP requested that proposers include automatic vehicle location (AVL) and global positioning satellite equipment for its ambulances that would be integrated with the County’s computer aided dispatch (CAD). Unfortunately the cost to integrate with present CAD is cost prohibitive ($500,000 - $750,000) especially when considering that this CAD will likely need replacement within the next few years. As an alternative AMR may use AVL/GPS equipment that is digitally displayed in the dispatch center but not integrated within the CAD.


The Agreement maintains the current ambulance response time standards and also mandates ambulance staffing levels (unit hours). A number of upgrades to the current system are included and are described in the Executive Summary.


The patient fees have been capped at the present level through June 2010. An annual increase is permitted based upon the San Francisco Bay Area Consumer Price Index. However, the July 2010 increase will be based on a CPI of at least 3.25% in order to accommodate the final year of special Centers of Medicare and Medicaid Services (CMS) ambulance rate adjustments.


The Agreement has been presented to and reviewed by your Board’s Housing, Health and Human Services Committee. The Agreement has been reviewed and approved by the Information Services Department, County Counsel, and Risk Management.



The term of the Agreement is July 1, 2009 through June 30, 2014. There is no cost to the County associated with this Agreement. The Contractor will be paying the County for a number of services it provides to AMR. The annual amounts for these services include: PSC Dispatch, $787,000; Radio System Maintenance, $103,582; EMS Agency Oversight, $336,061; and Injury Prevention Coordinator, $75,866.