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San Diego Fire-Rescue moving forward with plans to manage EMS system

San Diego Fire-Rescue is moving forward with taking over provider responsibilities for San Diego’s emergency medical services (EMS). It means the city of San Diego’s current ambulance contractor, Falck, will no longer be in control of billing or where ambulances are stationed. The move comes after Falck continued not to meet contractual obligations for paramedic staffing levels.

The step would allow the city to bring in a secondary provider to backfill any missing hours.

“The fire department would manage the system,” said San Diego Fire-Rescue Chief Colin Stowell. “We are going to dictate how many hours, the deployment models, the days, the scheduling — all of that. All we would be contracting with the private providers only for the ambulance, supplies and the personnel on those ambulances.”


Stowell said it would be a significant change, but one he has seen be successful in other cities. Since Falck took over the 9-1-1 contract in Nov. 2021 they have yet to meet their full staffing requirement. Falck promised 900 monthly median paramedic hours for advanced life support (ALS) ambulances. Data from the fire department shows Falck had 794 hours in October, 771 in November and 792 in December.

“We’ve kind of plateaued right now,” Stowell said. “We’re still below the contract obligations — Falck is not putting enough unit hours out in the streets — but we have not seen a dip over the last three or six months.”

The new system to stabilize those hours is called an alliance model. Falck would still be the main provider, but another company would be brought in to make up any missing hours. This step would also mean the city is now on the hook for collecting transport fees and ambulance providers would be paid a set-rate. Falck would also not be required to pay $9 million in annual fees to the city.

“The risk certainly does come back to the city,” Stowell said. With transport reimbursement rates higher for public agencies under Medicare and Medicaid, Stowell hopes to see the EMS system break even or become profitable.

“We will hopefully be able to generate enough revenue to not only pay for the unit-hours — as well as the oversight part of it — but to bring in additional revenue that we can now reinvest back into the system to continue to build up the number of hours that we want to see,” Stowell said.


Falck San Diego’s managing director Jeff Behm said the alliance model is a win-win — more ambulances will be on the streets and the workload would be spread out among first responders.

“I think that is something we feel confident in and as long as we’re continuing to work collectively and collaboratively with the fire department — we think it’s going to be a great success,” Behm said.

The new system would take a few months to set up. In the meantime, the requirement would be to have Falck subcontract any missing paramedic hours to another provider.

“You wouldn't think that you would do this,” Behm said. “Those are your competitors — but you get into a market where you’re short staffed and you have demand and you’re trying to reach it and so you have to work together.”

All of these changes require approval from the San Diego City Council, an amendment to the contract with Falck is expected to be presented to the council's public safety committee next month.

Falck officials said their staffing is improving thanks to a sign-on bonus and they have announced a tentative agreement with existing employees to raise wages over the next three years. A representative from the San Diego Association of Prehospital Professionals, which represents Falck employees, said under the tentative agreement paramedics and emergency medical technicians (EMTs) would see a 9% raise in the first year, followed by 4% in the second and third years.

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