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After more than 40 years, AMR out as ambulance provider in Calif. county

The board’s action is intended to “revolutionize the delivery of emergency medical care and transportation in most of San Bernardino County”

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Photo/Alistair Fernandez, Wikimedia Commons, CC BY-SA 3.0

By Beau Yarbrough
San Bernardino County Sun, Calif.

SAN BERNARDINO, Calif. — After more than four decades, San Bernardino County will be replacing its ambulance service provider next year.

At its meeting Tuesday, Dec. 5 , the Board of Supervisors voted 5-0 to sign a five-year contract for ambulance service in much of the county with Consolidated Fire Agencies (CONFIRE), starting October 2024 . CONFIRE is a joint operation of 15 fire departments.

“I think both agencies have a lot to be proud of, and it’s very, very difficult” to choose between them, First District Supervisor Paul Cook said before the vote, according to a recording of the meeting.

The board’s action is intended to “revolutionize the delivery of emergency medical care and transportation in most of San Bernardino County,” according to a county news release.

That means ending the contract with the private ambulance company American Medical Response, or AMR, which has operated in the county since the late 1970s.

“Consolidating basic and advanced life support and medical transport services with the agencies that already provide critical emergency medical services is expected to ensure continuity of care and enhance performance during disasters, especially when mutual aid between agencies is necessary,” the county said in its news release.

“We appreciate the service AMR has provided to county residents for many years,” county CEO Luther Snoke is quoted as saying in the release. “This was a very difficult decision for the board. We are looking forward to a smooth transition and providing the best level of service to those who rely on us in the community.”

The new CONFIRE contract doesn’t cost the county anything, according to county spokesperson David Wert . Ambulance services are charged to patients and their insurance companies and the county charges the ambulance contractor for the expenses involved in monitoring the contract, estimated at $1.8 million the first year, with annual adjustments for inflation after that.

The board’s decision was strictly about which ambulance provider is able to operate in most of the county, officials said.

AMR expressed its “surprise” at the board’s decision in a news release after the meeting Tuesday.

“AMR submitted a superior proposal that was awarded more points than any other proposal,” the company said in its release, “while providing significantly more system ambulances per day to the residents of San Bernardino .”

That’s not the whole story, according to the county. In a presentation made to the board on Tuesday, it was noted that there was less than a quarter of 1% difference between the total scores submitted by the four people evaluating the proposals and that three of four evaluators scored CONFIRE higher.

“This has been something in probably my nine years that’s been on our minds for a long time: Do we go (out for bid) for an ambulance or not,” Fourth District Supervisor Curt Hagman said before the vote.

The mutual aid agreements signed by local fire and police departments provide “seamless coordination of services,” he said, which Hagman finds important.

Elected officials, AMR employees, firefighters and members of the public gave supervisors an earful during a more than two-and-a-half hour meeting Tuesday.

“Our county’s vast geography, encompassing more than 20,000 square miles, demands a tailored approach to emergency response,” Victorville Mayor Debra Jones told the board. “CONFIRE’s deep understanding of our diverse communities, coupled with its reputation as a trusted public agency, squarely positions it to meet the unique needs of our residents.”

“AMR has rightfully earned the (contract) by one distinction alone: merit,” AMR paramedic Ed Zubia told the board. “CONFIRE’s proposal ... provides no assurances to our current employees, no honoring of prior contractual agreements. It’s also threatening our very own jobs.”

Tony Myrell , chairperson of the board of directors at Community Hospital of San Bernardino , supported CONFIRE’s contract, noting various fire departments can fill in for one another when local staff or equipment is in use elsewhere.

“Having alternative (ambulance) providers in the CONFIRE model makes perfect sense,” Myrell said.

According to AMR, however, the Board of Supervisors’ decision ignores state law.

“Given the circumstances, AMR is left with no choice but to explore all available options, including legal recourse, in response to the board’s actions,” Mike Rice , vice president of operations for AMR, is quoted as saying in the company’s news release.

“The decision made by the county Board of Supervisors does not align with the best interests of the community and the patients of this community,” Rice said. “The proposal selected by the board puts 29 fewer ambulances a day on the road that what AMR proposed. The community, and our hard-working employees will be negatively impacted by the decision today.”

Colorado -based American Medical Response provides ambulance service in 40 states and the District of Columbia .


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