Nice to see a community seeking proposals for evidence-based innovation in their EMS system!
Change Sought for County Ambulance Response System
By Larry Altman
January 25, 2024
REGIONAL — Alameda County officials have opened the bidding process for a new ambulance service contract, asking prospective providers to create a system that would make it unnecessary to transport all patients to emergency rooms.
The idea, said Lauri McFadden, emergency medical services (EMS) director for the county, is to eliminate the “one size fits all approach,” where every patient who calls 911 is taken to a hospital, even if that is not required.
McFadden called the idea a “significant shift in how we’re approaching 911 ambulance response.” Residents in Livermore, Pleasanton, Dublin and Sunol all receive ambulance service through the county’s contract, currently with Falck Northern California.
“The new system is designed to deliver the right care at the right place based on the patient’s acuity, which can mean that in some low-acuity cases patients will receive medical and other treatment at places other than the county’s emergency rooms,” McFadden told The Independent. “The county hopes this will help reduce the impact of the time ambulances must wait between calls.”
McFadden said the new approach will enable health professionals to provide necessary care, whether in a hospital emergency room, at the scene, or by connecting the patient to other care outside the emergency response system.
Patients not needing hospitalization could be connected to a care provider on the phone or referred to a service that would deploy mental health providers.
“Our goal is really to be able to offer the appropriate level of care for each unique call,” McFadden said.
According to the county’s “Request for Proposal (RFP)” issued Jan. 11 to open the bidding process for a new ambulance service contract, the EMS system will “appropriately prioritize” lower acuity 911 calls where a life is not threatened.
“Not all EMS callers are necessarily patients who require EMS,” the document says. “Many 911 calls involve situations that are not life threatening and do not require an immediate EMS response or indeed any emergency response at all.”
The change would free up ambulances for true emergencies, it says.
During the last year, Livermore and Pleasanton officials have criticized Falck Northern California for delays in responding to calls to assist Livermore Pleasanton Fire Department. According to LPFD data, Falck failed to meet expected response times 7.2% of the time on calls requiring a priority response — those with lights and sirens — from May to September.
Livermore City Manager Marianna Marysheva and Pleasanton City Manager Gerry Beaudin recently wrote a letter to Falck officials to express their concerns and met with them as well.
The issue of response times is occurring at the same time the county opened the process for other EMS companies to bid for the contract. Falck’s contract expires in 2025. In a statement to The Independent, the city managers did not directly comment on whether they believe the change in policy would improve emergency response times.
“The cities of Livermore and Pleasanton receive EMS service through a contract with Alameda County,” Marysheva and Beaudin said in a statement. “The county received input from partner cities in the development of the RFP that includes a system redesign for all emergency medical response/transport. The cities are looking forward to service improvements through this new contract. “
Potential providers have until August to submit their applications. Whoever wins the job, which would be determined by the Board of Supervisors, would take over service between April and July 2026.
McFadden said in most cases, ambulance providers bill a patient’s insurance for the cost of transport. Not requiring a trip to the emergency room could save the patient money.
“While cost savings to the consumer may certainly be a byproduct of the RFP, it was not a driving factor in its design.”
McFadden called the system design change unique in California. She said it was developed through a multiyear process that included public meetings.