The ongoing “conversation” concerning the ambulance service contract in Santa Barbara County is boiling down to whether there are enough ambulances to meet standard response times or not.
I think many observers agree that the wait times for ambulance service can be excessive.
But who is responsible for this anomaly?
The current provider, American Medical Response responded favorably to a Request for Proposal including the level of service (response time) requested in the RFP issued by the county Emergency Medical Services Agency (EMSA).
The EMSA apparently determined the service level provided in the contract was adequate, and AMR management says they currently and in the future meet contract requirements.
The Santa Barbara County Fire Chiefs Association says the current level of service isn’t adequate. So, the Board of Supervisors invalidated the EMSA award of a new contract to AMR and instead began a process to have the County Fire Department develop a government run ambulance program.
In 2021 the governor signed into law AB 389, which “provides counties and fire agencies new contracting options” for ambulance service.
Response times are very important when providing emergency medical/fire services; the National Fire Protection Association (NFPA) established nationwide consensus standards, NFPA Standard 1710, for those services.
For example, a fire engine with four members is expected to arrive at a medical or fire emergency four minutes after dispatch 90 percent of the time.
Staffing for basic life support responses is two members with basic (AED-qualified) first responder skills and for advance life support (eg. cardiac arrest, major traumatic injury) two paramedic qualified personnel on scene within eight minutes.
In most fire stations in our county there are only three members on each engine, so the fire departments in Lompoc and the county fail to meet the staffing standard. Why? Because elected officials haven’t provided proper funding for minimum staffing levels.
Currently, there are no paramedic positions in the Lompoc Fire Department, and only one typically responds in an AMR or county ambulance.
Rural areas such as the eastern part of the county have longer response time standards.
The Lompoc 2030 General Plan states: “The first fire department response units capable of initiating effective incident intervention shall arrive at a priority emergency within six minutes 20 seconds from receipt of the call at the dispatch center, 90 percent of the time.”
This is consistent with the national standard when call receipt and dispatch times are included; but the City Council hasn’t followed up to see if this timeline is being met and the staffing levels don’t meet NFPA Standard 1710 requirements.
The term “surge capacity” is being used to justify a significant increase in the number of ambulances. That is a legitimate concern; however, surges, or the need for multiple ambulances in one area, can occur without notice.
For example, in Lompoc during the week of July 20-26 there were 56 medical responses, and the Fire Department had 18 concurrent calls for service, meaning all fire equipment and/or ambulances were committed to multiple incidents and not available for other calls.
When the fire chiefs and elected officials recently stood in front of the county building to draw attention to ambulance service response times, shouldn’t they also reflect on the root causes?
First, did the EMSA ask for additional ambulances to improve response times in the initial RFP so there would be an adequate level of service 24/365?
Second, both the fire service and the elected officials should broaden their focus to reflect on the big picture of emergency service response times and adequate staffing for both medical and fire responses.
Lastly, did the BOS adopt a written policy, as required by AB 389 in 2021, to include new contracting options for ambulance service before issuing the initial RFP?
The ambulance service contract issue is still being litigated, and we won’t have a definitive answer on which agency will provide it for several months.
One thing is certain though, a lot of money has already been spent and a lot more will be spent before this is over.
If the county prevails in the court case, the key question, which will remain unanswered until a substantial period has passed is, Ddid a fire department-provided ambulance service improve response time to meet the national standard”?
References:
Fire Chiefs Urge County to Change Ambulance Model as Lawsuit Continues | Local News | Noozhawk
FD staff/response times; English_Version_- NFPA_1710_standards_DFSR_Summary_2022_new.pdf (iaff.org)
NFPA 1710 Requirements Fact Sheet
AB 389, new contracting options: https://wlelaw.com/wp-content/uploads/2021/10/WLE-AB-389-Legal-Alert.pdf
