For the first time since 2015, when Riverside County awarded the emergency ambulance service contract to American Medical Response (AMR), the county’s Emergency Medical Services (EMS) Agency has denied AMR’s request to extend the contract’s expiration date.

Each year, AMR submits an annual report that EMS uses to review compliance with the contract and whether it should be extended. In January 2015, the board awarded a five-year contract, from July 1, 2015 to June 30, 2020. Provisions allow for extending the contract’s length one year at a time. For the first six years, AMR received the annual permissible extension. The current expiration date is June 30, 2026.

However, based on AMR’s performance from July 1, 2021 through June 2022, the county did not grant AMR’s request for another year’s extension.

In his March 14 letter to AMR, EMS Administrator Dan Bates identified four areas that did not comply with the current contract or fell short of requirements. AMR and the county will work to find solutions in order to improve the current performance.

“We did find areas of noncompliance in both minimum and enhanced service,” EMS Director Bruce Barton told the board of supervisors last week.

Four specific areas were identified as failing to comply satisfactorily with the contract. The first was response times, which are critical in potential life-threatening events.

According to the county report, AMR did not meet either its minimum or enhanced response time performance requirements for the months of February, March, April, May and June 2022.

For the two years from July 2020 through June 2022, AMR made 2,716 transports in the Mountain Plateau Zone, which includes all of the Hill neighborhoods. The average number of monthly patient tranports was 113 and ranged from a low of 87 in March 2022 to a high of 155 in June 2022.

During that period, AMR responded within requirements for more than 90% of the monthly transports. But every month were some late responses.

Besides late responses, AMR would frequently respond with a basic life support (BLS) ambulance, when the contract requires advanced life support responses.

Barton, board Chair Kevin Jeffries (District 1) and Jeremy Schumaker, AMR’s regional director of operations, all agreed that the COVID-19 pandemic was a substantial contributor to AMR’s problems.

Jeffries explained the problem and its consequences in his latest constituent newsletter. “This staffing shortage has sometimes resulted in delayed emergency responses, or occasional ambulances being sent with no paramedic on board, requiring the firefighter paramedic on the fire engine to ride to the hospital with the patient –—thereby putting the fire engine out of service.”

Also, hospital shortages exacerbate the lack of ambulances and the use of fire engines to transport patients. “On top of that, a few of the 17 hospitals across the county have their own emergency room staffing limitations, which in turn delays the admittance of the patient, which then keeps the patient in the ambulance with the firefighter paramedic until admitted by the hospital,” Jeffries added.

“The COVID-19 pandemic was a significant impact on emergency medical services in Riverside County,” Shumaker told the board. “Our staffing shortages hurt our performance profoundly … It’s a national shortage of professionals, mostly paramedics, due to schools being closed, less enrollment and more leaving the profession.”

AMR is taking steps to address its staffing such as offering hiring bonuses, paying for paramedic education and others to mitigate the staffing problems, Shumaker said. Consequently, he believes response times are beginning to improve and the county will see significant improvement in the coming months.

However, AMR competes with other ambulance carriers and, even, fire departments throughout the nation, for a diminished pool of paramedics.

While Jeffries acknowledged how COVID had devastating effects on all aspects of health care, including emergency services, he averred that everybody struggled.

“But AMR was still sending only BLS ambulances on some emergency calls,” he said to Shumaker. “AMR hasn’t been able to figure out how to get back to normal operations. That’s unacceptable.

“There’s got to be a sense of urgency to get AMR back to full adequate staffing because of the impact on fire engines, which are out of service because their paramedic is doing your job,” Jeffries implored Schumaker. “When will that change?”

Other identified problems were failure to submit monthly compliance reports within 15 days of the end of each month. The fiscal year 2021-22 annual report was incomplete when submitted, including omission of data for five months.

EMS is working with AMR and expects changes. EMS will return to the board before the end of 2023 with its review of AMR’s performance in 2022-23.

“If we continue to see performance like the 21-22 year, we’ll come with a different conversation and we’ll be prepared to do that,” Barton informed the board.

Also in the future is the preparation of the next EMS Strategic Plan, Barton added. EMS is currently reviewing bids from six vendors to help with its next Strategic Plan update.

“We have serious questions to ask and answer moving forward post-COVID,” he declared. “Can we improve the resiliency of our system? Does it make sense to continue with the current model? What will we do to move our system to the next level?”