County advances draft EMS RFP to modernize ambulance system, adds clinical performance focus

Nick Clay, director of the county EMS Agency, updated the committee on the draft ambulance RFP and system redesign, saying staff paused to address stakeholder concerns and that response-time monitoring has resumed and is being posted online. The draft RFP would add clinical performance measures to contractual requirements, expand data transparency and create additional remedies beyond liquidated damages to enforce provider performance.

"We are not just ambulance drivers — we are EMS clinicians," Dr. Nicole Darcy, the EMS medical director, said while listing clinical interventions the county plans to require contractors to track and deliver (early aspirin for suspected cardiac events, rapid ECG, appropriate trauma and stroke routing). Clay and Dr. Darcy also described harm-reduction steps such as rolling out paramedic administration of buprenorphine and expanding naloxone availability.

Clay summarized outreach: the draft RFP was publicly posted for three weeks (350 providers notified); 15 submissions were received and staff met in-depth with the Fire Chiefs Association. Changes under discussion include shifting from five to six response zones to better reflect population growth and call volumes, adopting a tiered response model so lower-acuity calls receive lower-acuity resources, and creating root-cause analysis processes to supplement liquidated-damage remedies.

The committee discussed subcontracting arrangements with local fire departments and how to standardize minimum requirements while preserving local operational flexibility. Clay warned the state review (required for the EMS plan and RFP) typically takes at least six months; subsequent procurement and negotiations could take around seven months, and operationalizing a new provider could require a one-year ramp and about 70 ambulances. Staff plan to bring an update to the full board on August 25 and continue engagement with city and fire partners.

The committee voted to receive the EMS update; supervisors requested more concrete subcontract language and examples from other counties and asked staff to continue stakeholder work before finalizing the RFP.