Santa Barbara County Fire Chief Mark Hartwig.
Santa Barbara County Fire Chief Mark Hartwig speaks about why his agency should take over the ambulance contract during the county Board of Supervisors meeting on Sept. 19 in Santa Maria. (Janene Scully / Noozhawk photo)

The Santa Barbara County Board of Supervisors on Tuesday approved permits for the county Fire Department to take over ambulance services beginning in March.

The board also voted to deny American Medical Response’s application.

AMR — whose longtime contract to provide emergency medical services in the county expires early next year — and the Santa Barbara County Fire Department competed for the upcoming contracts.

Both entities submitted proposals last year and then, after the board moved to a non-exclusive contract system, submitted permit applications.

The county Emergency Medical Services Agency reviewed applications for the three types of permits providing ambulance services — emergency medical calls; interfacility transports and special event standbys; and critical-care transport.

The county Fire Department submitted applications for all three permits, while AMR submitted an application only for the emergency medical calls permit.

Mike Sanders, regional director for AMR Santa Barbara and Ventura, said that in order to provide services for the critical-care transport and interfacility transports and special event standbys permits, AMR would need all three permits, and it did not want to risk getting those two permits but not getting the emergency medical calls permit.

“We’ve been in this county for over five decades,” Sanders said. “AMR is the incumbent provider in Santa Barbara with an unblemished history of providing great service. Approved and published compliance records show AMR has never been out of compliance.”

Sanders said AMR has more than 150 experienced paramedics, EMTs and other emergency medical services personnel who are familiar with providing ambulance transport in Santa Barbara, and that it already has a fleet of ambulances being used in the county.

Santa Barbara County Supervisors, from left, Joan Hartmann, Laura Capps, chairman Das Williams and Steve Laganino listen to comments about the ambulance contract during the Board of Supervisors meeting on Tuesday. Not pictured is Supervisor Bob Nelson. (Janene Scully / Noozhawk photo)

“Our plan to improve critical emergency medical services to the people of Santa Barbara County is built on four pillars — innovation, integration, clinical commitment and financial strength,” county Fire Chief Mark Hartwig told the board. “We’re here for one reason — we’re here to improve the emergency medical care for the people that live, that work and that visit this beautiful county.”

The county Fire Department already has purchased 35 ambulances, before having a contract, so the organization could be competitive in the bidding process.

Supervisor Bob Nelson said he felt AMR’s application was incomplete and “failed to address integration, service to rural areas, community benefit and paramedicine.”

Other members of the board agreed that the current system “lacks visibility and integration.”

Nelson originally proposed delaying a decision on AMR’s permit application, allowing AMR to resubmit it, but he and the rest of the board later decided to deny the application.

Hartwig emphasized that the county Fire Department would provide a system for transparency and for people to know how many ambulances are on duty and where they are located — something AMR does not provide.

“I don’t think I’ve ever felt quite this intense about the life-and-death consequences of the decision we make here today, and it really does go to the public health and safety of our citizens,” Supervisor Joan Hartmann said.

“Our job as a board isn’t really to determine deployment … but I fervently believe that when it comes to public health and safety, we all deserve transparency and visibility into such a critical system as ambulance services, and we don’t have that now.

“I don’t know what will happen in the future, but for right now I think we have a far superior proposal by (county) fire.”

Supervisor Das Williams also pointed out that county fire personnel are typically already first on the scene of a large percentage of calls.

Mike Sanders, regional director for American Medical Response Santa Barbara and Ventura.
Mike Sanders, regional director for American Medical Response Santa Barbara and Ventura, talks about his agency’s proposal to continue providing ambulance services in Santa Barbara County. (Janene Scully / Noozhawk photo)

The supervisors voted unanimously to approve the three county Fire Department permits, and voted 4-1, with Steve Lavagnino dissenting, to deny AMR’s application. Lavagnino said he had concerns about legal liability in denying a qualified applicant’s permit.

The denial findings stated, “AMR’s proposal lacks sufficient detail regarding how AMR proposes to serve remote areas of the county, most notably the Cuyama Valley, while meeting LEMSA response time requirements.

“Additionally, AMR’s proposal demonstrates relatively few community benefits, such as a paramedicine program or an alternate destination program. It does not propose or demonstrate innovative improvements for promoting system integration, including integration with existing ALS/BLS resources.

“It also fails to demonstrate how it would integrate with the (interfacility transfer and critical care) permit providers to ensure a cohesive system.”

Next steps in the emergency medical services permitting process involve the county Fire Department meeting with LEMSA to begin agreement discussions, as well as conferring with local hospitals to ensure interfacility transfer needs are met.

The new emergency medical services contract is scheduled to start March 1, 2024.