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Carmel council directs staff to contract ambulance operations to Monterey Fire to maintain medic coverage
Summary
After reviewing options to keep available paramedic service and protect the city's paramedic provider status, the Carmel-by-the-Sea City Council voted unanimously to pursue a 5‑year contract with Monterey Fire to manage ambulance operations; the city will retain ambulance ownership and billing.
The Carmel-by-the-Sea City Council voted May 6 to direct staff to pursue a contract with the Monterey Fire Department for ambulance administration and operations, a move staff and council said will lower the risk of losing the city's paramedic provider status and improve medic-level coverage.
Staff explained the city has traditionally operated its own ambulance but has struggled in recent years to staff paramedic positions reliably. County regulators recently notified the city it risked failing to meet obligations tied to its paramedic/provider agreement—often referred to in the discussion as “201 rights”—because intermittent staffing shortfalls had forced the city to take the ambulance out of service at times.
Brandon (city staff) summarized three options: keep the existing model with no changes (staff said it meets neither goal of service improvement nor protecting the provider agreement), enhance the city-run model with additional hires and new on-site supervision (estimated at roughly $2.95 million total annual cost), or enter a contractual staffing and management arrangement with Monterey Fire (staff-recommended, estimated roughly $2.40 million total under the presented assumptions). Under the Monterey proposal, the ambulance would remain city-owned, Carmel would continue to manage billing and collect revenues, and Monterey would provide day-to-day staffing, training and administration; Carmel employees assigned to ambulance service would be offered transfer opportunities under the plan.
Monterey Fire Chief Daniel Miller and Carmel Chief Tomasi answered council questions about paramedic staffing and response. Miller explained the operational difference between EMTs and paramedics: paramedics have additional training and can deliver advanced prehospital care, including IV medications, cardiac monitoring and advanced airway management. Councilmembers and speakers from Carmel Fire Ambulance Association and city residents urged the council to preserve the medic-level service that improves patient outcomes.
Councilmember Hans Booter moved to direct staff to proceed with an agreement to contract ambulance services with Monterey Fire as recommended by the ambulance ad hoc committee; the motion was seconded and passed on a unanimous roll-call vote: Councilmember Barron, Councilmember Booter, Mayor Pro Tem Delves, Councilmember Jermaugh and Mayor Dale Byrne voting yes.
Staff will return with a draft contract and outline of operational transition steps. The council asked staff to include details on cost, performance measures, revenue-billing responsibilities and transition timelines when the contract returns for final approval.
