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New emergency medical services deal could mean more ambulances for San Diego

San Diego city officials took the first step Friday to increase the number of ambulances on the streets. KPBS Health Reporter Matt Hoffman says the move comes after months of negotiating.

A plan to increase the number of ambulances in the city of San Diego got its first approval Friday. The San Diego City Council's Public Safety Committee voted to move forward an agreement for Falck, the city's ambulance provider, to subcontract missing hours to another provider.

Falck is supposed to provide 900 advanced-life-support-ambulance hours every day, but it has failed to consistently hit that number. Data from the fire department show Falck had a daily average of 794 hours in October, 771 in November and 792 in December of last year. That has driven up response times and frustrated city council members who have been asking Falck to deliver what it promised. Pending full city council approval, it would be able to contract out any missing hours to another ambulance provider. 

"Our community needs to be able to rely on ambulances," said San Diego Fire-Rescue Chief Colin Stowell. "When you call 911 you should expect to get a fire engine and an ambulance there for a medical emergency and right now there’s time when it’s either delayed or times when there’s not one immediately available."


Stowell said ambulances are answering calls, just not as quickly as he would like. In some instances, it has meant fire trucks taking patients to hospitals. Stowell said amending Falck's contract to allow them to subcontract could quickly add up to 10 more 12-hour shift ambulance crews every day in the city.

"Response times should actually come down," Stowell said. "They should be quicker."

Since Falck took over ambulance services in late 2021, it has been fined about $3 million for delayed response times. The company has faced staffing shortages, which leaders point to as a nationwide trend impacting emergency medical services. To address this, Falck implemented a $50,000 sign-on bonus late last year for new paramedics.

If this framework is approved, Falck would subcontract with its market competitor — American Medical Response (AMR) — for 120 hours a day or more. Falck's Chief Commercial Officer Troy Hagen said it's the best way forward.

"The market has changed," Hagen said. "The labor force, especially in health care, is extremely challenged with the shortages that are post-COVID. So the more that we can pool those resources together, I think the more successful we’ll be."


Under this proposed agreement, Falck would not face fines if it maintains a daily average of 780 advanced-life-support-ambulance hours, while subcontracting out what it can to another provider.

Falck won San Diego’s ambulance contract because it promised more ambulances than competitor AMR. On Friday Councilmember Raul Campillo expressed reluctance in his vote in favor of the contract amendment. Campillo said if the city didn't need additional ambulances and paramedics, he wouldn't feel comfortable, "letting Falck even start to wiggle off the hook.”

“It really bothers me to see bad faith on the part of applicants,” Campillo said during the Public Safety Committee meeting. “They might not intentionally do something in bad faith, but we need realistic goals so that the contracting process is fair to all applicants and the city doesn’t have to waste the amount of time that the fire department’s had to put ... to fix this.”

Hagen said a lot has changed since Falck submitted its bid in 2020 and there have been market challenges.

“We have to come up with new creative solutions,” Hagen said. “It’s not about getting back to what was in 2020, it’s about moving forward and trying to figure out, 'how do we tackle these problems in this new world.'”

This contract amendment is the first step in a move for the San Diego-Fire Rescue department to take more control over emergency medical services. The city would assume more risk in doing so. It would be responsible for billing patient transport fees while paying Falck and AMR a set rate for its ambulances and first responders. Falck would also not be required to pay the $9 million in annual fees to the city that are part of the current contract. The fire chief called this proposed change the 'alliance model.'

"Under the alliance model they’re going to be under — the oversight of a public agency, the fire department," Stowell said. "We do not have profit shares, we don’t have shareholders to report to. Our number one goal is to provide the best service to the communities, increase the number of ambulances out there."

The city taking over provider responsibilities also means it could see higher reimbursement rates for patient transports under Medi-Cal and Medicare, something Stowell thinks would make the system break even or become profitable.

But what Stowell and others have been concerned about is existing Falck paramedics and Emergency Medical Technicians (EMTs) being overworked or burnt out due to staffing shortages.

Tony Sorci leads the union representing Falck paramedics, the San Diego Association of PreHospital Professionals. He said call volume has been high, and if a system is not fully staffed, "you end up in a situation where there’s such a greater demand on the individual unit crew and it creates horrendous working conditions for them."

Sorci said the subcontracting amendment not only adds more ambulances, it also helps retain and attract new staff. If it is approved by the full council, paramedics will see raises under a new bargaining agreement.

"It’s exciting," Sorci said. "I’m getting calls from people that used to work here 10 or 15 years ago and they want to come back."

The the city council is set to vote on the agreement to allow Falck to subcontract to AMR in May. The larger proposal to have more control over the emergency medical services system could be presented to the public safety committee in August.

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