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Home My WebLink About9/15/2026 Item 6h, Strommen Kris Strommen <kris@SLA.MD> Sent:Tuesday, September 26 PM To:E-mail Council Website Subject:Public Comment: City Council Meeting September 15, 2026 – Agenda Item 6h Attachments:SLO_Council_Email_of_Facts.pdf; SLO_Zone_Performance_Summary (4).pdf Honorable Mayor and Members of the City Council, Please ﬁnd attached my comments, factual data, and performance summary regarding agenda item 6h for tonight's City Council meeting on September 15, 2026. Thank you for your time and consideration. Respectfully, Kris Strommen Operations Manager San Luis Ambulance 805-543-2626 Kris@sla.md 3546 S. Higuera Street San Luis Obispo, CA 93401 This message may contain conﬁdential or proprietary information and is intended solely for the individual(s) it addresses. If you are not a named addressee, you should not disseminate, distribute, or copy this e-mail or act upon the information. Please notify the sender immediately by e-mail if you have received this e-mail by mistake and delete this e-mail from your system. 1 To: emailcouncil@slocity.org Subject: Public Comment for September 15, 2026 City Council Meeting — Item 6h Dear Mayor and Members of the San Luis Obispo City Council, My name is Kris Strommen, and I serve as Operations Manager at San Luis Ambulance. I am writing to provide the Council with factual information relevant to Item 6h — the resolution supporting the City of Paso Robles's bid for the San Luis Obispo County ambulance services contract — ahead of tonight's meeting. 1. San Luis Ambulance Pays for its Dispatch Services San Luis Ambulance has a contractual agreement with the County and pays for its dispatch services through the San Luis Obispo County Sheriff's Department. Dispatching is therefore already a contracted and paid-for component of the EMS system. 2. San Luis Ambulance Is Held to a 90% Response-Time Standard We would ask the Council to review the official EMSA response -time data for the San Luis Obispo response zone. San Luis Ambulance is currently averaging approximately 94.2% compliance in the San Luis Obispo zone over the last 25 months, exceeding the 90% c ompliance standard established by the County contract. In July 2026, the most recent audited month, compliance was 95.1%. San Luis Ambulance is evaluated across 25 separate response zones throughout the County. 3. The Response-Time Standard Is Applied at the Zone Level Some of the 25 zones have relatively low call volumes , approximately 30 calls per month in some areas. At that volume, just a few late responses can have a significant effect on the monthly compliance percentage. For example, if a zone has 30 calls in a month, four calls that do not meet the required response time would bring that zone below the 90% compliance standard. Over the past two years, San Luis Ambulance has experienced periods of increased call volume in other zones that resulted in late responses and contractual penalties. These situations demonstrate how quickly an isolated surge in demand can affect complianc e in a particular zone, even while the overall system continues to perform at a high level. 4. Not Every Late Response Is the Result of an Ambulance Deployment Problem Some responses involve patients who require transportation to a hospital for further evaluation but are not experiencing a life-threatening emergency. At times, a fire department may continue to send an ambulance response at a higher emergency priority eve n when the patient's condition is stable. This can result in an ambulance responding under emergency conditions to a lower -acuity patient while other patients may be waiting for an appropriate emergency resource. This creates a system-level concern: the ambulance provider can be held accountable for the response time even when the circumstances contributing to that response are outside the ambulance provider's control. 5. San Luis Ambulance Has Worked to Add Additional Resources During the last contract negotiation, San Luis Ambulance proposed adding BLS ambulance s to the system to handle appropriate non-emergency and lower-acuity transports while preserving ALS resources for higher-acuity calls. The implementation of that resource was delayed for approximately two years while the County's rate review process was co mpleted. San Luis Ambulance has therefore been actively working to identify and implement resources that can improve system efficiency and protect emergency response capacity. 6. Hospital Offload Delays Also Affect Ambulance Availability Hospital offload delays are another significant factor affecting ambulance availability and response times. It is not uncommon for an ambulance crew to spend an hour or more at a hospital waiting to transfer care of a patient to a hospital bed. During that time, the ambulance and crew are unavailable to respond to another emergency. San Luis Ambulance has no ability to control hospital bed availability or the time required for a hospital to accept a patient from an ambulance. 7. Existing Oversight Performance is reviewed on an ongoing basis by County officials, City Managers, and Fire Chiefs as part of contract review and renewal. Oversight of San Luis Ambulance's operations includes the County EMSA, the Contract Subcommittee, and APOC. 8. Open Questions on the Proposed Alliance Model The staff report for Item 6h lists no fiscal impact for tonight's vote; however, we would ask the Council to consider that this vote represents an in -principle commitment to a new operating model and lead agency (Paso Robles) before cost information is available. Last week, Morro Bay's City Council was presented with a startup-cost estimate of approximately $850,000 for this same model. We would ask that San Luis Obispo be given the same level of cost information before this Council lends its support. 9. Sonoma County Ambulance Service Model Deficit (Similar arrangement to what is being considered in San Luis Obispo County) The Sonoma County Fire District (SCFD) is projecting a 6% budget deficit for its regional ambulance service, with current-year expenses exceeding $42 million against $40 million in revenue. This financial strain comes less than three years after SCFD won the exclusive operating contract by underbidding the private incumbent, American Medical Response (AMR). To close the $2.5 million operational gap, SCFD has formally requested a two-phase 16.36% ambulance rate increase. We raise this example because it illustrates a real -world outcome of the type of model being proposed here: an agency wins a contract on the strength of a lower bid, and within a few years is requesting a significant rate increase to remain solvent. We wou ld ask the Council to consider this precedent when weighing assurances that the proposed Alliance model will not require additional cost to sustain. Why the Model Is Failing Financially: • The Forced Wage Trap: Before exiting, the private incumbent, American Medical Response, raised employee pay. By contract, the public district was legally required to match these salaries, which significantly affected the district's original budget projections. • The 80% Reimbursement Ceiling: Approximately 80% of patients use Medicare or Medi-Cal. These government reimbursement rates are fixed and do not cover actual operating costs, meaning the majority of revenue cannot be adjusted to offset a shortfall. • The Burden on Residents: Because public insurance rates are locked, the proposed 16.36% rate increase falls on privately insured and self-pay residents, increasing local out-of-pocket costs for those patients. 10. The California Quality Assurance Fee (QAF) Model and Local Sustainability The California Quality Assurance Fee (QAF) model does not generate net zero for San Luis Ambulance, and comes out almost even due to the region's relatively low Medi-Cal patient volume. The state levies a flat, mandatory fee on every emergency transport regardless of how a patient pays. Because local government-reimbursement matches are comparatively low in this region, the oper ator pays significantly more into the program upfront than it recovers back through those matches. Rather than functioning as a source of additional revenue, the QAF system operates as a neutral figure to San Luis Ambulance in San Luis Obispo County. This leaves the operator reliant on commercial insurance reimbursement rates to remain financially sustainable — a factor we believe is relevant for the Council to consider when assessing the long-term sustainability of any EMS operating model, public or private, in this county. 11. The Larger System Needs to Be Considered Response-time compliance is an important measure of EMS performance, and San Luis Ambulance supports maintaining high standards. However, response times are influenced by the entire EMS system — including dispatch, fire department response decisions, call volume, resource availability, hospital offload times, and other factors outside the ambulance provider's direct control. San Luis Ambulance currently operates under a system in which it can be financially penalized for response -time failures even when contributing factors are outside of its control. We respectfully ask the Council to weigh this full record carefully, and to request specific answers on cost, performance standards, and oversight structure for the proposed Alliance model before voting to support it. Thank you for your time and your service to this community. Sincerely, Kris Strommen Kris Strommen, Operations Manager, San Luis Ambualnce Jul - 2 4 Aug - 2 4 Sep - 2 4 Oct - 2 4 Nov - 2 4 Dec - 2 4 Jan - 2 5 Feb - 2 5 Mar - 2 5 Apr - 2 5 May - 2 5 Jun - 2 5 Jul - 2 5 Aug - 2 5 Sep - 2 5 Oct - 2 5 Nov - 2 5 Dec - 2 5 Jan - 2 6 Feb - 2 6 Mar - 2 6 Apr - 2 6 May - 2 6 Jun - 2 6 Jul - 2 6 90% 92% 94% 96% 98% 100% 90% contract minimum Monthly Response-Time Compliance City of San Luis Obispo San Luis Ambulance City of San Luis Obispo Zone Performance Submitted for Item 6h San Luis Obispo City Council, September 15, 2026 94.2% 25-Month Average Compliance Rate 95.1% Most Recent Month (July 2026) 0 Months Below 90% Standard Green markers = most recent three audited months (May July 2026). San Luis Obispo has not fallen below the County's 90% contract minimum in any of the last 25 months. Submitted by Kris Strommen, Operations Manager, San Luis Ambulance | Source: County-audited monthly response-time data