Title
Approve and authorize the Director of Health Services or designee to execute the Agreement for Advanced Life Support and Basic Life Support Ambulance Services, Interfacility and Critical Care Transport, Standby, and Communication Services for the Exclusive Operating Area for the County of Monterey between the County of Monterey and American Medical Response West for the period from the date the Agreement is signed by all parties through January 31, 2032.
Report
RECOMMENDATION:
It is recommended that the Board of Supervisors:
Approve and authorize the Director of Health Services or designee to execute the Agreement for Advanced Life Support and Basic Life Support Ambulance Services, Interfacility and Critical Care Transport, and Standby Services for the Exclusive Operating Area for the County of Monterey between the County of Monterey and American Medical Response West for the period from the date the Agreement is signed by all parties through January 31, 2032.
SUMMARY/DISCUSSION:
The Emergency Medical Services (EMS) Agency is a Bureau within the County of Monterey Health Department and is designated by the Board of Supervisors as the lead agency that oversees the delivery of emergency medical services within the County of Monterey. The role of the County of Monterey EMS Agency is defined by California statue to plan, implement, and evaluate the EMS System. One component of the EMS Agency’s responsibilities is the establishment of the County of Monterey Exclusive Operating Area (EOA) and contracting for the provision of ambulance services within the EOA.
The current agreement for ambulance services will expire on January 31, 2026. To maintain the EOA, the EMS Agency must periodically conduct a competitive request for proposals (RFP) process for the right to provide ambulance services within the EOA. The RFP process is regulated by not only the County of Monterey’s Contracts and Purchasing Department and Office of County Counsel, but also by the State of California’s Emergency Medical Services Authority (EMSA). Compliance with EMSA’s requirements helps secure antitrust immunity for the County of Monterey.
To permit sufficient time to conduct the RPF process and provide for a safe and organized transition of the provision of ambulance services, the EMS Agency began its work on efforts related to the release of an RFP in early 2024. The construction of the RFP was vital to ensure the continued delivery of cost effective and clinically sound care to residents and visitors.
In addition to the knowledge and experience gained while overseeing the current and past agreements for ambulance services, the EMS Agency undertook the following while preparing the RFP:
• Released a SWOT (Strengths, Weakness, Opportunities, and Threats) Analysis Survey that sought input from stakeholders on the state of the EMS System.
• Held virtual and in-person meetings throughout Monterey County to allow stakeholders to provide feedback directly to EMS Agency staff.
• Sought input and guidance from the County of Monterey Contracts and Purchasing Department and Office of County Counsel.
• Released a draft RFP Scope of Work for public comment and feedback.
• Accepted written public comments on the draft RFP Scope of Work and held additional general public and stakeholder meetings to receive verbal comments and feedback.
• Conducted focused meetings with various stakeholder groups to allow feedback on specific topics such as behavioral health patient needs, interfacility transfers, and critical care transports.
• Revised the draft Scope of Work and other RFP documents to incorporate stakeholder input.
• Worked with EMSA to obtain review and approval of the RFP.
Contracts and Purchasing released the resulting RFP to potential proposers on January 30, 2025. Interested proposers attended a mandatory Pre-Proposers’ Conference and were able to submit written questions about the RFP to the EMS Agency. The EMS Agency responded to the questions submitted and made clarifying changes to the RFP. County Counsel, Contracts and Purchasing, and EMSA reviewed the responses and draft changes prior to release. Proposals were due on April 22, 2025. The EMS Agency received two responsive proposals. A review panel composed of representatives from key stakeholder groups including the public reviewed the written proposals and attended oral presentations from the proposers. The Review Panel members completed scoring the proposals by May 8, 2025. On May 12, 2025, Contracts and Purchasing notified the proposer with the highest score (AMR) of the tentative intent to award. The EMS Agency promptly entered into discussions and contract negotiations with AMR.
The Agreement resulting from this procurement process incorporates several significant enhancements to the County of Monterey EMS System including:
• Increasing ambulance unit hours to help ensure that ambulances are available to respond to requests for service in a timely manner.
• Investing in upgrades to the Contractor’s fleet of ambulances and durable medical equipment. This investment will bring state of the art patient care resources and introduce new Type III ambulances with larger patient compartments to the EMS System.
• Adding a number of Basic Life Support (BLS) ambulances to respond to lower acuity requests for services, thus helping keep Advanced Life Support (ALS) ambulances available to respond to patients with higher clinical acuity needs.
• Implementing a “9-1-1 Nurse Navigation Line” to refer patients who call 9-1-1 with lower acuity illnesses/injuries to a telemedicine nurse who can assess their medical needs, determine an appropriate plan of care, and refer patients to local resources potentially eliminating the need for a visit to the emergency department and saving the patient a costly trip to the emergency room and making ambulances available for patients with higher acuity medical needs.
• Initiating a Critical Care Transport (CCT) Paramedic program. This program will allow specially trained and equipped Paramedics to manage the transport of a subset of patients without the need for a nurse. This helps to maintain nurse availability for those patients requiring more complex care and monitoring.
• Developing and instituting a “Clinical Scorecard” containing evidence-based standards related to the care and treatment delivered to measure and monitor the provision of appropriate clinical care to those utilizing the Contractor’s services. Historically, ambulance service provider performance was evaluated based on response time compliance. The addition of clinical metrics ensures not only the timely arrival of an ambulance, but also the delivery of high-quality care once the ambulance arrives.
This work supports the following County of Monterey Health Department 2025-2028 Strategic Plan Goal(s): “Build Community Power and Partner’s Capacity to Increase Equity and Improve Health”, “Provide Exceptional Person-Centered Care through Accessible, Community-Focused Health Services”, and “Deepen Organizational Effectiveness and Support Long-Term Sustainability”; it is in support of one or more of the ten essential public health services, specifically: 7. Link people to needed personal health services and assure the provision of health care when otherwise unavailable and 9. Evaluate effectiveness, accessibility, and quality of personal and population-based health services.
OTHER AGENCY INVOLVEMENT:
No other agencies are involved in the proposed Board action.
FINANCING:
There is no financial impact resulting from this Board action.
BOARD OF SUPERVISORS STRATEGIC INITIATIVES:
Check the related Board of Supervisors Strategic Initiatives:
☐ Economic Development:
• Through collaboration, strengthen economic development to ensure a diversified and healthy economy.
☐ Administration:
• Promote an organization that practices efficient and effective resource management and is recognized for responsiveness, strong customer orientation, accountability and transparency.
☒ Health & Human Services:
• Improve health and quality of life through County supported policies, programs, and services, promoting access to equitable opportunities for healthy choices and healthy environments in collaboration with communities.
☐ Infrastructure:
• Plan and develop a sustainable, physical infrastructure that improves the quality of life for County residents and supports economic development results.
☐ Public Safety:
• Create a safe environment for people to achieve their potential, leading businesses and communities to thrive and grow by reducing violent crimes as well as crimes in general.
Prepared by: Debra Hopgood, Management Analyst III, 755-4920
Approved by: Elsa Jimenez, Director of Health Service, 755-4526
Attachments:
Board Report
Agreement