El Paso County Emergency Services Agency seeking proposals for

Colorado Springs and El Paso County might soon have a new ambulance service.

Since 1995, the joint city-county committee, the El Paso County Emergency Services Agency has used American Medical Response to serve the area's emergency medical needs.

During the years that the contract has been in force, the company has received its fair share of criticism. Critics complain that response standards are not strong enough and that the local governments could save money by operating a publicly funded ambulance service in conjunction with fire departments.

For example, prior to 1985, the Phoenix Fire Department relied on private ambulance companies to transport its patients. At that time, seven ambulance companies participated in a rotational dispatch policy. Average response times approached 20 minutes and a 10 minute response time was met only 50 percent of the time.

Going public

The City of Phoenix decided to change to a single transportation service. The Phoenix Fire Department was permitted to compete in the bidding process for this service and won the contract. In November 1985, Phoenix Fire Department Emergency Transportation Services was implemented. The service maintains a response time of less than 10 minutes 92 percent of the time with "most" response times within 5 minutes.

The direct cost for emergency ambulance service in Phoenix is about $7.7 million per year. Cash receipts total more than $12 million, making it a strong profit center for the fire department.

According to El Paso County Commissioner Sallie Clark, who is chairwoman of the ESA, there's no indication that the Colorado Springs Fire Department will bid for the local contract, despite its potential profitability.

In November 2004, City Council asked the Fire Department to develop a proposal to assume responsibility for ambulance service within the city. That proposal never got beyond preliminary stages, when council members balked at the costs of such an operation.

The request to the fire department was driven by Clark and City Councilwoman Margaret Radford.

"There have been extensive discussions in the past, but I think it's kind of a dead issue now," Clark said. "I don't think that council wants to make the kind of start-up investment that the contract would require."

That investment would be substantial. AMR has a minimum of nine and a maximum of 17 ambulances on call, depending on time of day, weather, season and other factors.

That would suggest that the city would have to purchase at least 20 ambulances, and hire scores of paramedics, dispatchers, administrators and other support personnel. Given the city's budget problems, such a commitment seems unlikely.

Problems, deficits

And not every city that has made ambulance service a public responsibility has fared well. In Lincoln, Neb., the city loaned the fire department $1 million in 2001 to take over ambulance transport.

The venture has not exactly been a resounding success. Six years later, the department still owes the city $642,000, and has often been enmeshed in labor disputes.

When the Lincoln switched from a private to public ambulance provider, the city was promised faster, better and cheaper service. But in 2005, fire Chief Mike Spadt admitted that "We're not making ends meet."

The ambulance service lost $500,000 during that fiscal year, leading to an emergency loan from the city and a 22 percent rate increase the next year.

Hybrid model

Pueblo, following the model of many cities, neither operates its own ambulance service nor has a contract with an exclusive provider. There are five ambulance services operating about 20 ambulances in Pueblo County. They are licensed by the County Health Department.

The barriers to entry are low. Applicants need only pay a $100 fee, provide proof of insurance, submit to a vehicle inspection and prove that their personnel are appropriately qualified.

Request for proposals

The ESA board is preparing to issue a request for proposals, which will form the basis of a new contract, whether with AMR or another ambulance service.

So far, only Rural Metro Corp., one of the country's largest providers, has expressed interest in competing with AMR for the contract.

According to David Patterson, the manager of the Colorado division of Rural Metro, the interest is "very strong. We're very interested."

"Of course," he said, "A lot depends on the RFP. We'd hope that it would offer a level playing field for all of the potential providers. But Colorado Springs is a wonderful community, with a lot of potential for good partnerships, and we'd love the opportunity to enter the market."

Rural Metro provides ambulance service to the metro Denver area, including Denver, Aurora, and Adams, Arapahoe, Douglas and Jefferson counties. The company, which has 7,800 employees and annual revenue of more than $500 million, provides services to more than 400 communities.

Changing expectations

Clark was specific about changes that the board would like to see in a future contract.