The Santa Barbara County Board of Supervisors appeared ready Tuesday to issue a request for proposals from companies interesting in providing ambulance services after hearing a report on the first phase of a study analyzing the existing emergency medical services system.
But staff convinced the board to wait until phases two and three are complete, which they said will provide the data needed for the board to decide whether to issue an RFP or renegotiate a new contract with American Medical Response, the current ambulance service provider.
Instead, supervisors voted 5-0 to extend AMR’s contract another 18 months, rather than the year staff had requested, which will provide time for staff to boil down the results of the entire report and prepare a recommendation to the board.
The vote also included a directive for the staff to return as soon as possible with information from the study being conducted by consultant Fitch & Associates regarding whether an RFP or renegotiated contract is needed.
Ultimately, the goal is to improve the health of all the various county populations and provide them with equal access to emergency care, according to a report from Van Do-Reynoso, director of the Public Health Department, and Nicholas Clay, director of the Emergency Medical Services Agency
That would be accomplished by improving the system’s quality and safety as well as the provider’s experience, all while getting the biggest bang for the public health buck, according to the report.
“This set of circumstances — it is what it is, and I don’t think it’s going to change,” 4th District Supervisor Peter Adam said after hearing the report. “I don’t see any choice but to go out for an RFP. … You just keep kicking the can down the road. We’re being told a lot of things are bad, something’s wrong with the system.”
First District Supervisor Das Williams agreed: “I am with you 100%. We need to look at all options. The only to do that is the RFP process. That’s why I advocated for 18 months.”
But staff advised the board to wait, especially since making that decision wasn’t a part of the agenda item.
“In fairness to that process, we need to let the process complete,” Clay said, adding there are some risks in the RFP process that need to be evaluated.
“This is an area that is appealed and litigated frequently,” noted County Counsel Michael Ghizzoni.
Fifth District Supervisor and Board Chairman Steve Lavagnino noted the consultant and staff have not finished collecting information and it would probably be wiser to wait, “even though we all want to move fast.”
In the first phase of the study, Fitch & Associates looked at the emergency medical system, the local emergency medical system agency — in this case, the Public Health Department — and the ambulance agreement.
A number of successes were found for each of the three areas.
For example, the emergency medical service system has an “outstanding” cardiac arrest case management program, with a survival rate of 41% compared to the national average of 32%.
New leadership has brought changes and improvements to the EMS agency, which has provided law enforcement with training in the use of automatic electronic defibrillators that have saved the lives of many county residents.
AMR has a 92.32% rate of compliance in response to nearly 17,000 calls, maintaining obligations despite economic challenges while contributing $3.4 million to the emergency medical service system each year.
But the study also found a host of challenges in each of the three areas.
Two of the challenges for the system is an increasing number of patients with complex mental health issues but without enough nearby beds to accept them and a need to improve coordination between social and support services.
The local EMS agency has outdated advanced life support agreements with fire departments, which provide basic life support services but feel underrepresented, and staffing limitations have an effect on regulatory oversight.
AMR’s contractual staffing requirements for paramedics limits the service’s flexibility, its financial obligations to the system increases at an annual rate that exceeds the rate funds are collected from patients and staff recruitment hasn’t always kept pace with attrition.
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