Santa Barbara County 4th District Supervisor Bob Nelson shared his recent experience calling 911 as an example of the need for changes to a county ordinance governing ambulance services.
“Last Friday [June 2] I was at the scene of someone overdosing and was able to call 911 and had AMR [American Medical Response] and County Fire arrive at the same time,” Nelson said during the June 6 Board of Supervisors meeting. “They worked together well, but it highlighted that we were sending two sets of resources to the same place at the same time.”
To help combat duplicated services and costs and to provide a streamlined medical response, the supervisors unanimously approved making changes to the Santa Barbara County Code—steering away from the current exclusive model where one agency provides emergency medical services to the county.
The decision to create a permitting process for a nonexclusive ambulance service system for the entire county comes after a meeting in April where supervisors voted to allow its contract with its current exclusive provider, American Medical Response (AMR), to expire in March 2024 and begin a nonexclusive system, according to the April 4 staff report.
Staff told supervisors on June 6 that establishing a permitting process is the best way to begin.
“This will allow for tiered response in the 911 system, ensuring the right resource is dispatched to the right patient, while maximizing the resource availability for the IFT [Interfacility Transports] market,” according to the staff report.
Public Health Director Mouhanad Hammami presented three permits that agencies could apply for: emergency medical calls; interfacility transport and special events transport; or critical care transport.
“The permit process establishes who can provide ambulance services and at what level,” Hammami said during the meeting. “Someone can have a permit for all three levels and provide that, but if they only hold one level, then they can only provide that one level.”
All agencies must apply for a permit and go through a review from an Emergency Medical Care Committee then receive final approval from the Board of Supervisors. AMR can also apply for permits to provide services and can select which permits it would like to receive, Hammami said.
Agencies can later enter into contracts with the Local Emergency Management Services Agency and should start services on March 1, 2024, the last day of AMR’s contract, he said.
“We are so focused on who is providing what; meanwhile, the answer should be who is showing up and how are we serving the public,” Hammami said.
Andy Caldwell, executive director of the Coalition of Labor, Agriculture, and Business (COLAB), said during public comment that his organization “doesn’t have a horse in this race,” but that the county should honor its contract with AMR and not switch to a nonexclusive model because of a lack of research.
“Since you changed your mind, there has not been one cintella of independent evaluation and analysis as to whether or not to support two nonexclusive ambulance contract providers or more than two,” Caldwell said. “How in the heck did you go through all of that process to exclusive, change your mind to nonexclusive, and not one bit of analysis—fiscal or otherwise—determine whether or not the redundancy would end up with these providers having nonbillable hours?”
Caldwell added that COLAB would like to see a financial or independent analysis before issuing any contracts “that literally mean life and death to county residents.”
Supervisor Nelson said that Caldwell’s statements were untrue and that the board relied on extensive analysis to make its decision.
“I think that no one is more acutely aware that this is a matter of life and death and that we’re concerned [with] the health and safety of our residents and not taking this lightly,” Nelson said. “We’ve done some really innovative things in this county, and I trust, with the decisions being made, we are going to end up leading to better patient success and public safety in general.”
The item will return to the Board of Supervisors on June 20 for a final reading and adoption of the ordinance.
—Taylor O’Connor
This article appears in Jun 15-25, 2023.