Carmel council authorizes staff to pursue ambulance contract with Monterey Fire amid staffing risks

The Carmel-by-the-Sea City Council voted unanimously to direct staff to proceed with contracting ambulance services to the City of Monterey, following staff warnings that the city's current staffing and management model creates a measurable risk of losing paramedic licensure (referred to in the meeting as "201 rights").

Brandon (staff) summarized the background: the city has operated an ambulance service in one form or another for roughly 90 years, but state-era licensing and reporting requirements — and the administrative burden of meeting those standards — have made management complex. Brandon said the city had experienced staffing problems that led to roughly 30 days of ambulance outages over the prior 12 months. He presented three options and recommended a five-year contract with Monterey Fire. "This service model would allow for there to be two firefighters on the ambulance that were both qualified EMT and paramedic," Brandon said, describing the proposed change as an enhancement that would reduce shutdowns.

Monterey Fire Chief Matthew Miller explained the operational difference between EMTs and paramedics during council discussion: "An EMT is basic life support level and a paramedic is advanced life support... a paramedic can actually push drugs. They can read a manual defibrillator for heart rhythms. They can use narcotics for pain management. They can start IVs. They can do airways. So the difference is when we arrive at the scene of a patient... a paramedic can actually start doing life-saving work." Chief Miller and Carmel Chief Tomasi both addressed the council about the logistics of joint staffing and training with Monterey.

Staff presented cost estimates: the city’s current baseline cost to operate its ambulance was presented at about $2,140,000; Option 1 (contract with Monterey Fire) was estimated at $2,403,000; Option 2 (enhance and keep city management) was estimated near $2,950,000; Option 3 (minimal change plus paramedic on the engine) would add about $70,000 to current baseline. Staff recommended Option 1 as the best way to retain the city's paramedic provider status and improve service reliability.

Public comment included firefighters and resident speakers who supported the merger; Matt Knighton, a Carmel firefighter-paramedic, told council the merger would be “seamless” and praised the operations and oversight Monterey would provide. Several council members said the contract preserves the city's ability to recover the ambulance in the future because the city would retain its 201 rights in the proposed agreement; others emphasized staff should pursue better billing and revenue capture and asked staff to return with a plan to refine transport billing and revenue opportunities.

On a motion to direct staff to proceed with an agreement to contract ambulance services with Monterey Fire (Option 1), the council voted by roll call: Council member Barron — yes; Council member Bueter — yes; Mayor Pro Tem Delves — yes; Council member Grama — yes; Mayor Byrne — yes. Motion carried unanimously. Staff will draft the specific contract terms, including performance and reporting expectations, and return to the council for approval.