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Ambulance RFP: Frequently Asked Questions

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Published on April 16, 2019. Last modified on August 01, 2019

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Monterey County 2019 Ambulance RFP Information 

The Monterey County Emergency Medical Services Agency oversees ambulance contracts for Monterey County.  The agency is required to design an RFP (Request For Proposal) to select a company to provide ambulance services. 

Creating an RFP is a long process which includes collecting and encouraging input from responder agencies and the public and oversight by state and county authorities. The Monterey County RFP Process has been:

  • Endorsed by the Monterey County Emergency Medical Care Committee on September 13, 2017
  • Approved by the Monterey County Board of Supervisors on October 10, 2017
  • Reviewed and approved by the California Emergency Medical Services Authority, the state agency responsible for approving Emergency Medical Services/Ambulance RFPs
  • Managed by the Monterey County Contracts and Purchasing Department
  • Reviewed by the Monterey County Counsel’s Office

At the end of the process, the Monterey County Board of Supervisors can either approve or reject the proposed contract. Before the RFP was released in January, extensive efforts were made to get public and stakeholder input:

  • EMS System stakeholders and the public were encouraged and invited to attend five bilingual hearings, one in each Supervisorial District.  
  • In 2017, the EMS Agency’s consultants interviewed 63 EMS System Stakeholders, including every fire chief in Monterey County, every member of the Board of Supervisors and medical and community leaders.
  • Stakeholders, such as the Monterey County Fire Chiefs Association, submitted written recommendations regarding the RFP. The EMS Agency studied each recommendation and incorporated some into the RFP.
  • An EMS System Strategic Plan was created at collaborative two-day Strategic Planning Workshops.
  • EMS Stakeholders and RFP Bidders commented directly on the RFP during the Bidders’ Conference comment period. The EMS Agency responded in writing and incorporated some comments into the RFP.
System Assessment • Input Details



Agencies and entities that have participated in the long RFP process are now suggesting the process be paused. Here are some facts about the RFP and ambulance service residents should know. The Monterey County 2019 Ambulance RFP:

 WILL

 WONT

  • Drive a higher level of emergency medical services by encouraging the deployment of ambulances in a more equitable, need-based manner, based on call history.
  • Add life-saving pre-arrival and safety instructions by dispatchers to help until rescuers arrive
  • Add EMT—staffed ambulances for non- critical calls
  • Maintain ambulance response for Carmel Valley Fire District and Carmel-by-the-Sea.
  • Penalize ambulance contractor if it fails to respond in a timely manner.
  • Change mutual aid, closest ambulance options or fire department responses
  • Prevent fire agencies from responding to medical calls
  • Remove paramedics from ambulances responding to critical calls
  • Change response requirements for ambulances to remote areas of the county.
  • Increase waits for an ambulance no matter where you live.
 


Want more information?  Check out the more detailed Frequently Asked Questions below.

 



 

FREQUENTLY ASKED QUESTIONS

What does RFP mean? What is an RFP?

RFP is short for Request For Proposal.

 

Have the public and EMS System stakeholders been provided with opportunity for input into the RFP?

Yes, the public and especially EMS System stakeholders have been provided with numerous opportunities for input during the EMS System Assessment, Strategic Planning, and RFP process.

The EMS Agency and their consultants conducted five bilingual public hearings, one in each Supervisorial District. EMS System stakeholders were invited to attend these public hearings, which received media coverage, and were told that “information gathered at these meetings will help us design the RFP (Request For Proposals) for the next ambulance contract.” The EMS Agency’s consultants interviewed 63 EMS System Stakeholders, including every fire chief in Monterey County, every member of the Board of Supervisors and Emergency Medical Care Committee, ambulance management and labor, and other hospital, city and county leaders. Some stakeholders, such as the Monterey County Fire Chiefs Association, submitted written recommendations regarding the RFP. The EMS Agency studied each recommendation and incorporated some recommendations into the RFP.

EMS System Stakeholders also created an EMS System Strategic Plan at a collaborative two-day Strategic Planning Workshop. Unfortunately, few stakeholders attended these meetings. Both the EMCC and the Board of Supervisors received and accepted both the EMS System Assessment Report and EMS System Strategic Plan.

EMS Stakeholders and RFP Bidders commented directly on the RFP during the Bidders’ Conference comment period. The EMS Agency responded in writing to each of more than 240 comments received, including comments from the Monterey County Fire Chiefs’ Association, the Monterey Regional Fire District, and AMR. The EMS Agency incorporated some of those comments into the RFP. The public and especially EMS System stakeholders have had many opportunities for input during the EMS System Assessment, Strategic Planning, and RFP process.

 

Does the RFP affect ambulance service in Monterey County?

This RFP will drive a higher level of emergency medical services by encouraging the deployment of ambulances in a more equitable manner, based on call history. The specific number of ambulances deployed, and the location of those ambulances will be determined by the Contractor; however, the new ambulance zones counts previously uncounted populations, including the homeless, undocumented, and those on transportation corridors. Because the ambulances will be placed where calls will occur, many callers will receive an ambulance quicker than they do now.

The RFP assures that patient care can be started sooner by fully instituting the Medical Priority Dispatch System. A trained and certified Emergency Medical Dispatcher will immediately tell you how to provide life- saving medical treatment, such as CPR, first aid or child birth instructions, before the arrival of first responders and ambulance personnel. This is a significant improvement over the current system.

 

Is mutual aid allowed in the RFP?

Yes, the RFP allows mutual aid to augment the contracted ambulance provider. The RFP will provide more ambulances in the Carmel Highlands and Mouth of the Valley Area. While the Contractor will be responsible to provide service in these areas, the Carmel by the Sea and Monterey Regional Fire District ambulances will be allowed to augment the system through mutual aid, should they voluntarily choose to enter into mutual aid agreements. This allows the Carmel by the Sea and Monterey Regional Fire District ambulances to remain more available to serve their ambulance response zones, resulting in additional ambulance coverage, beyond what is available today.

 

Who is involved in selecting an ambulance provider?

Under state law, the Monterey County EMS Agency is responsible to design an RFP to provide ambulance services. The EMS Agency is using an RFP process consistent with state law and county ordinance. This process was endorsed by the Monterey County Emergency Medical Care Committee on September 13, 2017 and approved by the Monterey County Board of Supervisors in an ordinance change on October 10, 2017. The RFP was reviewed in detail and approved by the California Emergency Medical Services Authority, the state agency responsible for approving Emergency Medical Services RFPs. While this RFP process is being led by the Monterey County EMS Agency, it is conducted by the Monterey County Contracts and Purchasing Department and is overseen by the Monterey County Counsel’s Office and the California EMS Authority. At the end of the process, the Monterey County Board of Supervisors will vote to either approve or reject the proposed contract.

 

Does the new RFP allow the closest ambulance to be sent to a medical emergency in the Cachagua area?

Yes, it does. The Contractor can enter into a mutual aid agreement with the Monterey County Regional Fire District to have the District serve the Cachagua area, exactly like they do now. The County will also continue to pay $100,000 annually to support service in the Cachagua area and other remote or “peripheral” areas.

 

Does the new RFP change the fire department response?

No. Fire departments will continue to be notified of the call at same time as the ambulance as the ambulance provider. That fire department will determine whether they respond and whether they will use red lights and sirens. However, the new RFP assures that every caller to 9-1-1 for a medical emergency receives life-saving pre-arrival and safety instructions to help until rescuers arrive. This is an improvement over the current system.

 

Will fire agencies be prevented from responding to medical calls?

No. The RFP does not restrict fire departments in any way from responding to medical calls.

 

Does the new RFP remove paramedics from ambulances?

No. Paramedics are not being removed from ambulances. Every critical medical emergency will receive a paramedic-staffed ambulance. The new contract merely allows EMT-staffed ambulances to be used on interfacility transports and non-critical low-acuity calls. This is safely done in many other EMS systems and will save users hundreds of dollars, without sacrificing safety or quality of care.

 

Will fire departments and ambulances be delayed on 9-1-1 calls in rural areas?

No. In all areas of Monterey County, a fire department and the closest appropriate ambulance will be immediately dispatched to every 9-1-1 medical call. Additionally, the new RFP assures that every caller to 9-1-1 for a medical emergency receives life-saving pre-arrival and safety instructions to help until rescuers arrive. This is an improvement over the current system.

 

Will a paramedic be sent to my call for a heart attack, stroke or other critical medical emergency?

Yes, the closest paramedic-staffed ambulance and a fire department first responder will be dispatched to all critical medical emergencies, just like today. You will also receive life-saving pre-arrival and safety instructions to help until rescuers arrive. This is an improvement over the current system.

 

Are the requirements of the RFP too stringent?

No. The requirements of the RFP hold the Contractor accountable to provide fast, safe, high-quality ambulance service. The fine structure penalizes the Contractor if they fail to provide fast, safe, high quality ambulance service to the people of Monterey County. The RFP also has other important requirements that improve the EMS System, including more training for paramedics and EMTs, improved medical disaster capabilities, important fatigue prevention measures, and provisions for equity throughout the county.

 

Will the closest available ambulance be dispatched to my life-threatening medical emergency?

Yes. The closest ambulance will be dispatched to my life-threatening medical emergency, based on approved mutual aid agreements.

 

Why are Basic Life Support Ambulances, staffed with Emergency Medical Technicians, allowed in the new RFP?

EMT staffed ambulances will be allowed to only respond to basic interfacility transfers and low acuity 9-1-1 calls, such as a call for foot pain or a cold. EMT ambulances will not be used for critical medical emergencies. EMT ambulances will provide safe, clinically-competent care, and save the user hundreds of dollars of unnecessary ambulance charges, which may be denied by an insurance, unless the use of the ambulance is medically necessary.

 

What does a Red Area with “as soon as possible” mean on an RFP map?

Like the current contract, the new RFP has red areas. Like the current contract, because of the remote area and extremely low ambulance call volume, red areas do not carry a financial penalty. However, these areas are treated like all other areas of the County: When you call 9-1-1 for a medical emergency, a fire department first responder and an ambulance will be dispatched and respond immediately.

 

I live in an Orange Area. Will I have to wait 16 minutes for an ambulance in an emergency?

RFP maps do not show how long it will take for an ambulance to arrive. The colored maps are based on historical call volume and location. The time measure shows the contractually-specified point at which the ambulance provider will be fined for a late response. Regardless of where you live in Monterey County, when you dial 9-1-1 for a medical emergency, a fire department first responder and an ambulance will be dispatched and respond immediately.

 

Will I have to wait longer for an ambulance?

No, the RFP design and maps compel the ambulance provider to place ambulances where the calls occur thereby reducing the overall response to calls.

 

Will it take longer for an ambulance to get to my home?

No. Regardless of where you are in Monterey County, fire department first responders and an ambulance will immediately be dispatched and respond. This process is the same for all areas. The RFP design and maps compel the ambulance provider to place ambulances where the calls occur thereby reducing the overall response to calls.

 

I live in the City of Carmel-by-the Sea. Will I be able to use the same ambulance as I do today?

There is no change in ambulance response for the City of Carmel-by-the-Sea. The Carmel-by-the-Sea ambulance will continue to serve the City of Carmel-by-the-Sea. The RFP Contractor will serve the Carmel Highlands and Mouth of the Valley Area. While the Contractor will be responsible to provide service in these areas, the Carmel by the Sea and Monterey Regional Fire District ambulances will be allowed to augment the system through mutual aid, should they voluntarily choose to enter into mutual aid agreements.

 

I live in the Carmel Valley Fire Protection District. Will I be able to use the same ambulance as I do today?

There is no change in ambulance response for the Carmel Valley Fire Protection District area. The Monterey Regional Fire District will continue to serve the Carmel Valley Fire Protection District area. The RFP Contractor will serve the Carmel Highlands and Mouth of the Valley Area. While the Contractor will be responsible to provide service in these areas, the Carmel by the Sea and Monterey Regional Fire District ambulances will be allowed to augment the system through mutual aid, should they voluntarily choose to enter into mutual aid agreements.

 

What happens if the current contract with AMR expires without a new contract in place?

The current contract with AMR expires on January 31, 2020. As stated by the California EMS Authority, in their letter to the EMS Agency of April 11, 2019, if a new contract is not in place by January 31, 2020, on February 1, 2020, the Monterey County ambulance response zone will become “non-exclusive.” This means that anyone wanting to provide ambulance service could do so. The contract-based standards for response times, clinical quality, paramedic training, and safety would end. Ambulances providers would rush to serve urban and suburban areas with high call volumes and people with high-paying private medical insurance. Ambulance providers would not want to serve rural areas with low call volumes or areas with people with poorly-paying medical insurance. Having an open ambulance system in Monterey County would constitute a preventable threat to public health and safety.