Santa Barbara County Fire Beats out AMR for Countywide Ambulance Service Contract

The County of Santa Barbara will have a new ambulance service come March, which will be fairly indistinguishable from the paramedics who now respond to 9-1-1 calls: the men and women of the County Fire Department. What will be lacking is American Medical Response, or AMR, which on Tuesday lost the new contract for emergency ambulance service countywide next year.

By a flip of a coin, AMR went first to argue why it should have the new contract and not County Fire. Chief Mark Hartwig won the toss and deferred to AMR’s Mike Sanders, who had to defend his company’s meager contract application to county supervisors looking for more from a corporation that had held for 50 years a contract with life-or-death consequences, as more than one supervisor pointed out.

Supervisor Joan Hartmann recalled how last Christmas, her husband had awakened confused and unable to walk. They’d gone to Cottage Hospital in Santa Ynez, where he was diagnosed with sepsis and needed a transfer to Santa Barbara. But it was nine hours before an AMR ambulance was available. “When they arrived, the AMR personnel were absolutely fabulous,” Hartmann said, “but even if it is a holiday, there’s a reasonable expectation of a greater demand and more overtime. Should there be more ambulances in the system?”

Hartmann put that question to Sanders: How many ambulances were staffed right now? And, as AMR considers the information proprietary, he replied that the information was available on the PulsePoint map. That map, however, shows current incidents and emergencies, not what’s available.

Supervisor Steve Lavagnino struggled with another issue regarding the contract, which is worth an estimated $1 billion: AMR had come out on top in an earlier Request for Proposal, though that contract was never finalized. What legal pitfalls would the county face in now denying AMR the original contract? And what happens if AMR employees just walked off the job?

Hartmann laid out the many ways the ambulance company had failed to complete the application, which was for a new contract that countenanced two or more suppliers, rather than one, as the original contract had. Not only was there no information on the number of ambulances staffed at any one time — “We all deserve transparency in critical systems like ambulance services,” Hartmann said — but the company said little about what new innovations it would bring to the program.

On the other hand, Chief Hartwig made County Fire’s pitch to partner with Behavioral Wellness to bring vulnerable patients to a crisis center or sobering center if need be, rather than an ER. He noted the 37 fire stations around the county that could house ambulance services — AMR has six. In answer to Lavagnino’s concern about hard-to-keep employees, Hartwig said the county was preparing a letter inviting AMR’s emergency medical techs and paramedics into the “fire family” within the next five months and nine days.

“It’s an awkward situation,” Hartwig acknowledged. “We know the employees at AMR. We depend on them today and they’re all strongly involved members of the community,” he said, adding that recruitment workshops were in place. “Their workforce is our workforce, and we want them to be part of the County Fire family.”

For Supervisor Bob Nelson — who recalled losing his father to cardiac arrest as a boy and watching him be carried away in an ambulance — AMR’s history with the county deserved an attempt to keep them viable for the next round; perhaps they’d improve their application? But when it came to a final vote, it was clear that AMR had lost Nelson’s support. The company had failed to include Cuyama, Orcutt, Gaviota, Tepusquet, and Sisquoc as locations for 24-hour service units. “The planned lack of coverage of rural areas is a big part of my decision to deny,” Nelson said. He made the motion, which was voted in, 4-1, with Lavagnino opposed. County Fire was voted in unanimously.

The next step in the protracted process is for County Fire to enter negotiations with LEMSA, or the Local Emergency Medical Services Authority, which is out of County Public Health, to finalize a contract for services.