Board approves draft RFP for exclusive ambulance service; county will submit plan to state EMS authority

The Contra Costa County Board of Supervisors on Feb. 4 approved in concept a draft request for proposals for exclusive emergency ambulance service covering specified Emergency Response Areas in the county and authorized staff to submit the document to the California Emergency Medical Services Authority for required review.

Marshall Bennett of County Health presented the RFP, which proposes a contract term of up to 10 years with a mechanism for annual contract fees and performance oversight. Bennett told the board the RFP is informed by the county EMS system board’s prior work and that the draft had undergone a four‑week public comment period that produced 94 comments and about 62 substantive revisions.

Highlights of the RFP

Bennett said the RFP emphasizes an integrated response model—911 dispatch triage, paramedic and EMT ambulance response, and expanded clinical and operational quality‑improvement measures. It includes response‑time requirements and targeted clinical performance measures designed to promote equitable patient care across the county. The document also includes a placeholder annual contract fee to enable county budget planning; staff said a final fee schedule would be set using the finalized 2025‑26 budget before finalizing a contract.

County and fire partners’ concerns

Local fire leaders and ambulance providers praised revisions but urged further adjustment to how hospitals and ambulance providers handle ambulance‑patient off‑load time (APOT). Chief Louis Brochard asked that the RFP avoid placing responsibility for hospital off‑load delays solely on the ambulance contractor and recommended the county position the LEMSA (local EMS agency) to lead coordination on APOT issues with hospitals and regional partners.

"APOT is a complex statewide issue," Chief Brochard said. "We urge the board to consider a revision to this section where the LEMSA is the actual responsible party for resolving APOT, not the provider." County counsel and staff said they would review the language and consider clarifying roles and coordination expectations.

Board action and next steps

The board voted 4‑0 to approve the draft RFP for submission to the California EMS Authority, with staff directed to finalize the RFP and fee schedule for state review and subsequent contract negotiation. County staff indicated they would return with a finalized contract following state review and legal review and would continue dialogue on APOT language and enforcement mechanisms that do not unduly penalize an ambulance provider when hospitals cause delays.

Quotes in this article are taken from the Feb. 4, 2025 meeting transcript.