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HomeMy WebLinkAbout11/14/1995, 2 - AMBULANCE CONTRACT STUDY SESSION MEEnNG DATE: mollo IIPn1D 1 city of San 1UlS OBISpo 11 N�MB5 aiis COUNCIL AGENDA REPORT we FROM: Robert F. Neumann, Fire Chief SUBJECT: Ambulance Contract Study Session CAO RECOAE%IENDATION By motion, receive a report regarding alternatives for ambulance operations within the City of San Luis Obispo and direct staff to further develop Alternatives 3 and 4 and return to City Council with further information. REPORT IN BRIEF For at least seven years now, cities and districts throughout the County have been at odds with the current ambulance system. Concerns include: lack of local control, standardization of care, duplication of service, definitions of service levels and a process for change. This county is not unique in this venture. Currently, cities and counties throughout the state are litigating the issue of providing pre-hospital care.and ambulance transportation. . It is important to note that San Luis Obispo is currently served by a very professional and well-run private provider. The entire pre-hospital care system as we know it, is changing. The future focus will be on trying to limit costs while still providing safe professional care. An expansion of the role of paramedics, both public and private, has been on-going for quite some time and is certain to continue in the future. Some Fire Departments, with little modification of existing personnel, are expanding their roles in the pre-hospital medical care system. Local cities and fire districts have been involved in long and drawn-out negotiations with the County and the private providers defining their role in the pre-hospital system. These discussions have resulted in the development of a new contract. The following summarizes the proposed contract and discusses a number of alternatives that are available to the Council. DISCUSSION Working cooperatively, the Fire Chiefs, County administrative staff and private providers have managed to negotiate a tentative agreement. The significant areas are: • New ambulance zones have been created and the resources that must be provided in those specific areas have been defined. Ambulance station locations and the number of units assigned are now finalized. • Contract language has been developed that meets all the legal requirements for public and private interests. Issues such as emergency take-over, dispatch funding, support of the Critical Incident Stress Team, training, and equipment requirements have been resolved. • It has been established that fire agencies are an integral component in the system. This is based upon two separate levels that fire service personnel provide: Emergency Medical Technicians with defibrillator capability (EMT-D) or Emergency Medical Technician- Paramedics (EMT-P). We have created a funding mechanism to reimburse these services. city of San tui s OBISPO' i COUNCIL AGENDA REPORT The following chart outlines what various agencies in the central zone, which includes the area from Avila Beach to the Cuesta ridge north to Cayucos, could hope to expect. It should be noted that these are very narrowly-defined direct costs and do not reflect all costs associated with pre-hospital care. Staff does not necessarily agree that this is adequate funding. It is simply what we have been able to negotiate to date. The return rates in Chart #1 are based on the following cost figures: EMT-D Training Costs = $150/Yr. Per Person EMT-D Equipment Costs = $1,500/Yr. EMT-P Training Costs = $1,500/Yr. Per Person EMT-P Equipment Costs = $3,500/Yr. EMT-P Incentive = .$4,500/Yr. Per Person Based on the negotiated rate, the City Fire Department would have a one-time expense of $3,000 (to equip an existing fire apparatus as a back-up transportation unit) and would qualify for a return of$107,500 per year. CENTRAL ZONE DEPARTMENT # OF EMT-D #OF EMT-P TRAINING EQUIPMENT EMT-P TOTAL EMPLOYEES/ EMPLOYEES/ COSTS/YR. COSTS/YR. INCENTIVE PIECES OF PIECES OF EQUIPMENT EQUIPMENT Avila Beach 10/1 0 $1,500 $1,500 0 $3,000 Cambria F.D. 0 0 0 0 0 0 Cayucos F.D. 11/1 0 $1,650 $1,500 0 $3,150 Morro Bay 0 7/2 $10,500 $7,000 $31,500 $49,000 San Luis Obispo 0 15/5 $22,500 $17,500 $67,500 $107,500 SLO Co. Avila 16/1 0 $2,400 $1,500 0 $3,900 SLO Co 16/1 0 $2,400 $1,500 0 $3,900 Morro/Tom SLO Co. Airport 16/1 0 $2,400 $1,500 0 $3,900 South Bay 0 6/2 $9,000 $7,000 $27,000 $43,000 ZONE TOTAL 69/5 28/9 $52,350 $39,000 $126,000 $217,350 ACTION NEEDED A decision must be made pertaining to pre-hospital care and patient transport. Four alternatives are presented here for Council's review. city of San WIS OBISPO COUNCIL AGENDA REPORT ALTERNATIVE #1 Delete Emergency Medical Service From The Current Fire Department Program. When the Fire Department was first established, the sole purpose was to combat unwanted fires. Over the years, the fire service has evolved into a multi-functional organization. As a response to the needs and expectations of the citizens of San Luis Obispo, emergency medical service became an important part of our department's mission in the early 70's. We have progressed- into providing Advanced Life Support (AIS) capabilities, more commonly known as "paramedic", from our engine companies. This alternative would"take us back to our original sole purpose, combating unwanted fires. The department currently responds to approximately 2,400 calls a year,-approximately 70% of which are medical aids. Pros The City could realize cost savings, no longer having to provide for training and certification of paramedics. We would not have to maintain advanced life support equipment and supplies. The Department would increase its readiness for fire suppression. Engine companies would not be tied-up at routine medical calls and would be capable of responding to fire emergencies with less potential for delay. The Fire Department would have one primary mission. It is easier to accomplish a single goal such as fire suppression. When you have a multi-functional organization, priorities are often conflicting. There would be elimination of competition with private enterprise. The current dual-response system o both private and public agencies would end. Private enterprise would take complete control and responsibility of all facets of pre-hospital care within the City. Cons The potential for loss-of--life would increase due to reduced emergency medical (EMS) response. Eliminating the current level of care provided by ALS engine companies would significantly delay delivery of critical medical treatment to our citizens. There would be a reduction in the established level of service. The City currently has fire stations strategically located throughout the community to provide fire protection rapidly and efficiently. Our current level of service provides ALS within 4-6 minutes throughout the city. There is no higher level of service available. If we were to reduce or eliminate EMS from our mission, the standard response time for providing care would be substantially increased, resulting in greater mortality and exacerbation of injury and illness. Eliminating this service would be an inefficient use of the department's existing personnel and equipment. The amount of personnel currently assigned to emergency response is minimal. We have taken advantage of our successful fire prevention program to reduce the amount of fires. This has given us time to focus on other area of emergency response. Emergency medical service has been determined to be a high priority based on the fact that the vast majority of 911 calls are medical in nature. The Fire Department is able to respond to the medical needs of our citizens with the current level of staffing, and should not reduce the number of personnel due to the potential for disaster. ����►► �NNIp�p �Ul city of San LUIS OBISpo li;% COUNCIL AGENDA REPORT ALTERNATIVE #2 Private Provider-Based Transportation With Cost Reimbursement To The Hue Department (Support The New Contract). This is the most basic of the cost-recovery proposals. No additional personnel or equipment would be added to the system. Pros The City would be reimbursed approximately $107,500 a year by accepting the contract as currently negotiated. While it does not bring total cost recovery, it would offset some of the operating costs. Other cities throughout the County would be receiving similar treatment. While the proposed contract is not ideal, there seems to be a general consensus among the private providers, County administrative staff and the Pure Chiefs that the contract, as developed, would be acceptable. While the return will not be as much as we would want, the new contract, which we expect to cover a period of 3-5 years, establishes three important principles which we believe are more important at this time than just the fiscal impact: • Establishes a major role for cities in setting pre-hospital emergency care standards • Eliminates a number of deficiencies and results in an improved service delivery system. • Establishes cost recovery as an integral part of the system. Cons It only reimburses a portion of the true costs of the City's involvement in pre-hospital emergency care. With EMS calls rising to 70% of the emergency-related calls, it could be argued that the cost for . delivering ALS to the citizens.of San Luis Obispo is much greater, and total reimbursement should be the goal. The City would be locked in to $107,500 per year for the life of the contract. A greater reimbursement amount would require renegotiation, pitting the City Fire Department against other providers. It does not resolve duplication of service issues. Both public and private agencies would still continue to respond to the same incident, needed or not. ALTERNATIVE #3 Fire Department Based Transportation System. It would be possible for the Fire Department to operate its own emergency ambulance system. This - would require augmentation to the existing Fire Department staff to provide the best EMS delivery and transport system possible. Pros Improved program efficiency. This alterative would provide for a fourth 3-person ALS engine company capable of delivering paramedic level-of-care within four minutes inside the City limits. Presently we can only staff three engine companies with 3 personnel. Medical studies have shown the key to successful resuscitation of cardiac arrest victims is the arrival of ALS care within 4-6 minutes. By adding a third-person to the fourth engine company, fire suppression efforts would be improved, '����►► ���IIB�pn ��a�JN City of San Luis OBISPO i COUNCIL AGENDA REPORT and staffing levels would be adequate to allow for further annexations and/or growth. Safety would be enhanced by eliminating the second engine response to ALS calls in the district presently covered with a 2-person engine company. Provides the citizens with a paramedic ambulance staffed 24 hours per day. This ambulance could assist with other Fire Department duties when not involved in patient transport. The apprentice program funded by this alternative would supply the EMT drivers for the ambulance service. It would also provide candidates with both EMS and Fire Suppression experience making it very attractive to persons seeking a fire service career, as well as a hiring pool for future City firefighters. Apprentice programs can also assist the City with its affirmative action policies. The City of Huntington Beach has successfully initiated a similar program. Anticipated return of$114,700 to the General Fund after paying the costs of providing the service. (Further discussion/cost analysis to follow.) Cons There is a possibility of creating conflict between the City, the County, and the private providers. Private providers could argue that the loss of income would necessitate higher fees in the unincorporated area. However, the private provider, based on City participation, would no longer be required to staff the zone with the same level of resources. The City would have to agree to respond anywhere in the zone for mutual aid purposes. They would also have to agree to move out of the zone on limited occasions. The County would need to agree that the mutual aid was reciprocal, so that in times of system overload, adequate resources would respond to the City. The City may incur significant litigation costs to challenges made by the private providers. Current litigation has ruled in favor of local/public control. A decision filed October 17, 1995, by the 4th Appellate District of the California Court of Appeals ruled that State law for emergency medical care does not pre-empt the City's right to provide pre-hospital emergency services (County of San Bernardino vs. City of San Bernardino). Discussion/Cost Analysis The following is a preliminary cost breakdown of how a Fire Department based EMS delivery and transportation system would look. Expenses (Annual (Basis) Staffing Firefighter/Paramedic Position (3.3)* $237,600 Apprentice Program 752000 Accounting Assistant Position (1/2 Time Billing/Collections Agent) 18,000 Sub-Total 330,600 * In order to staff one position per shift, it is necessary to fund at a factor of 3.3 to compensate for holiday, vacation time, etc. 111121111 city of san LUIS OBISp0 mewsCOUNCIL AGENDA REPORT AmbulanceSupplies Equipment & Contingencies Ambulance (5 Yr. Life) $129000 Fuel and Maintenance 2,000 Medical Supplies ** 11000 Office Equipment/Supplies 2,000 Contingencies (10%) $339000 Subs-Total 50,000 TOTAL EXPENSES $3809600 ** These are direct costs for safety equipment essential for increased Paramedic service. The Department is currently spending $8,100 on medical equipment and supplies. The required $1,000 would be in addition to the existing accounts. The City's current liability insurance carrier has indicated that no increase in insurance premiums would result from the additional transportation capabilities due to the fact that current practice finds Firefighters assisting in the ambulance already. Revenue Source The department responds to approximately 1,600 emergency medical calls a year. In 1994, there were 1,100 transports resulting from these calls. Projected transports in 1995 are 1,150 and 1,200 for 1996. (Inter-facility transfers are not included in these numbers.) . The new ambulance rate is expected to be somewhere in the neighborhood of$575 a call, with an additional revenue source of$60 for the use of oxygen and $15 per transport for infectious disease control. The average total, we could expect to bill for a call would be approximately $635. A realistic collection rate should be about 65-70%. This is based upon the experience of similarly- sized and socio-economically based communities; Petaluma and Napa. At the collection rate of 65%, a total of$495,300 could be expected for transports in 1996. REVENUE (1,200 calls x $635 x Collection Factor of .65) $4959300 PROGRAM COSTS 3809600 NET RETURN TO THE GENERAL FUND $114,700 Additional Revenue Possibilities Public agencies offering ambulance transportation can offer a membership program to residents. Customers appreciate coverage of all ambulance related "out of pocket" expenses and relief from dealing with their insurance companies. Public providers benefit from added revenue and very effective public relations. Based on the experience of agencies throughout the State that have membership programs, our City could realize between $30,000 and $60,000 of additional revenue in the first year. Another benefit of far greater value is public relations. Cities and service districts have found that their residents' awareness and appreciation of emergency-response service greatly increases. An additional indirect revenue benefit happens when members and non-members alike tend to utilize the ambulance service more often. Examples of cities with programs in place include Arcadia and Sonoma. —CD city of San Luis OBISPO COUNCIL AGENDA REPORT ALTERNATIVE #4 Partnership Between City Fire Department And Private Ambulance Provider. This alternative would have staff explore the possibility of sub-contracting with the private. ambulance provider for a variety of services. The City would have to retain control of emergency ambulance operations within the City limits for this alternative to be viable. There are many negotiable services such as staffing, billing, equipment, supplies, vehicles and housing that could be explored prior to implementation. The private provider would retain authority for inter-facility patient transfers. Pros It may be advantageous to develop sub-contracts with the private company. The City could use this "partnership" to respond to any charges that it was interfering with private enterprise, yet still take advantage of a number of the pros outlined in Alternative 3, the Fire-Based Transportation system. The ambulance company would still be able to recover costs, and continue to collect charges for the financially lucrative inter-facility transports. The ambulance company would also be able to reduce expenditures by possibly housing an ambulance inside a fire station. If a contract was acceptable to the private provider, a potentially expensive and protracted legal battle could be avoided. The City could reduce its costs by allowing the private provider to do the billing. They have an effective and efficient billing .system currently in place. The cost breakdown is similar to the all Fire-Department based transport system described in Alternative 3. Cons The City's major interest is community welfare and cost-recovery. A private provider, while sharing these concerns, also needs to show a profit. This is the basis for conflict between the two entities. The City would have a smaller return from the ALS service which could have a negative financial impact on the long-term stability of the program. Without an agreed-upon deadline, protracted negotiations could significantly impact the implementation of the County-wide ambulance contract. The role of the Fire Department in emergency transport will always be subject to negotiation. If the private provider changes, new agreements would have to be made. This results in uncertainty and instability surrounding such a vital program. FISCAL IMPACT The 1995-97 Financial Plan projected Paramedic revenues at $150,000 annually. The proposed contract specifies reimbursement of$107,500 annually. °`►�� ��NIQpfIP lI city of san WI S OBISPO Eiis COUNCIL AG- EIYDA REPOFRT CONCLUSION All parties agree that the current system has many inequities. Staff recommends that we further develop Alternatives 3.and 4 in order for the City to reaffirm and maintain a position of local control. We believe this to be important as the.prehospital .care system of the future is most likely to expand at the most basic levels, that of field and/or home care. Fire service resources, which are already in place, can be cost-effectively utilized to fill this expanding need.. ATTACEMENTS Council Agenda Report dated 911.5/92. r ►l city of San WIS OBISPO WMIRGM COUNCIL. AGENDA REPORT FROM: Robert F. Neumann, Fire Chief SUBJECT: Confirmation of the City of San Luis Obispo intent to negotiate a new agreement in the County for the regulation of ambulance services. CAO RECOMMENDATION: Adopt a resolution requesting the County to negotiate a new ambulance agreement between the cities and the county and designating the City Managers/Fire Chiefs Committee on ambulance as the bargaining group for the cities. HISTORY: Prior to 1976, an organized approach for the delivery of ambulance service to the citizens of San Luis Obispo County did not exist. Various cities and districts had individual contractual agreements with ambulance providers and most of the unincorporated areas of the county were served on a first- come, first-serve basis. At the urging of the Grand Jury, the County of San Luis Obispo developed a system known as the EMRM (Emergency Medical Response Manual) that provided various zones in the county and allowed for the Board of Supervisors to establish rates. In 1976, the seven cities in the County contractually agreed to allow the County to regulate ambulance services via the EMRM. The provisions of this agreement called for automatic renewal every five years unless a city gave one (1) year notice prior to renewal time. In May of 1990, the seven cities all notified the Board of Supervisors that they were no longer happy with the current EMRM system and wished it to be reworked when the contract came due at May of 1991. The cities took this step at the urging of the Fire Chiefs Association based on a number of problems and concerns that had developed since the inception of the EMRM. Major points include: • No local control • Levels of service not well defined. • Standards of care not established • No input/process for change • Duplication of service All City contracts with the County were terminated by May, 1991. With this contract termination of the seven County cities and the realization on the part of the County that the entire EMRM was outdated, the County Health Director commenced a study to analyze the local situation. Concurrently, the City Managers established a committee to review ambulance service and emergency medical service as it pertains to cities. This Sub-Committee, consisting of two City Managers and two Fire Chiefs developed a proposal that addressed local and fire service concerns and presented it to the County Health Director and County Administration in January of 1991. city of San Luis OBISPO COUNCIL AGENDA REPORT DISCUSSION: The City Managers Sub-Committee has had numerous meetings with both County administrative staff and the County Health Director. The group was making significant headway through the spring of 1992. However, negotiations have completely stalemated with no recent movement. As late as mid-June, both County administrative staff and the Sub-Committee were optimistic that County Counsel would bring a draft ordinance forward. However, as of this date, no such draft has been developed. With the current negotiations at a stalemate and with the supplemental documentation from the Grand Jury, now it is time for the seven Cities in the county to reaffirm their commitment to the formation of a Joint Powers Agency. This action will allow maximum input, local control, better coordination and system operation and program administration of a more effective ambulance system. In order to accomplish this, staff recommends that the attached resolution, which is being brought before the other seven cities within the county, be passed. The Fire Chiefs hope that the increased awareness of this issue will force the Board of Supervisors to take favorable action. In July of 1992, the Grand Jury released a report that was very critical of the current system. A short summary: • The county-wide 9-1-1 system of ambulance dispatch is inadequate and needs reworking. • The County has been lax in its oversight responsibilities and the EMRM (ambulance contracts) is out of date and needs immediate review. • Emergency/non-emergency ambulance service need to be separated and/or held to different criteria. • Ambulance response times in urban areas are unacceptable. • Ambulance rates are the third highest in the state without any compelling reason. It recommends: • The County should consider a competitive bidding process for ambulance services. • Cities, which perform Paramedic service, should be compensated for those services. • The County should establish a fair rate of return for ambulance service providers. • The County should rework the current EMRM. ��LD N city Of San LUIS OBISPO RRaZe COUNCIL AGENDA REPORT ALTERNATIVES: 1. Abandon current Sub-Committee negotiations and allow each agency to operate independently in negotiations with the County Health Director and administrative staff. Pro - This alternative provides an opportunity to improve service levels and design specific emergency medical services based on local needs and desires. Each city would maintain the ability to contract with the County for delivering all Ambulance/EMS services. The local agency may provide more ambulance units if an increased level of service is desired and if it is willing to assume the additional cost. Con - Operating independently, a cost-effective, efficient system will not be developed. The coordination of mutual aid, large scale emergency/disaster situations all require a county-wide effort. There is no assurance the County will cooperate with individual cities. 2. Continue with the current negotiations in hopes of reaching eventual accord with the County. Pro - The method is easily continued. No expense has or is to be incurred. Con - The County currently is under no pressure to move at anything other than its own pace which to this point is unacceptably slow. 3. Adopt the proposed resolution which urges the County to negotiate in good faith with the cities. Pro - This alternative would force the County to deal with a more formal/united group of cities. It maximizes local control and allows the cities to jointly coordinate medical response, system operations and program administration. JPA's have proven effective in dealing with medical insurance and similar benefits and could potentially do the same for EMS. Con - The JPA could require some staff time to develop and implement. The cities establishment of a JPA may require some financial commitment. RECOMMENDATION: Adopt the proposed resolution which urges the County to negotiate in good faith with the cities (Alternative 3). �ii� � �►� � city of san tins osIspo COUNCIL AGENDA REPORT FISCAL E14PACT: Other than staff time, no outlay will be required in the onset. Long term fiscal requirements, depending upon the system design, may be more significant. However, provisions in the contract would provide for a funding source. NOV-14-95 TUE 1 : 20 PM SAN LUIS AMBULANCE HQ FAX NO, 8n55460885 P. 2 F OUNCIL O CDD DIR MEETING AGENDA I 0 ❑ DIR 9 ITEM.# W (B'FIRECHIEF DATE//-/ TTORNEY 0 PW DIR LERWORK3 O POLICE CHF eAGW TEAM ❑ REG DIR t(3 C READ IP an Luis Ambulance SErvicE, Inc. F.O. BOX 954.569 HIGUERA STREET,SUITE'X+" •SAN WIS OBISPO CA 93406.8051543-2626• FAX 805/546-0885 FACT SHEET R19GF% 1Vr: D NOV 1. 4 1995 SERVICECITY CLERK SAN LUIS OBISPO.CA. San Luis Ambulance Service, Inc. is the largest paramedic ambulance provider in San Luis Obispo County for 911 emergency medical services. SLAS has a history of service to the community. From 1945 to 1995, SLAS is celebrating 50 years of dedication to providing state-of-the-art pre-hospital care and ambulance service. SLAS is a privately owned service receiving no tax subsidies. Only those individuals who use the service, pay for it . SLAS has not received a rate increase for the past five years . During this five year period, SLAS has been working in good faith with SLO County with only a year-to-year temporary contract in place. Paramedic ambulances respond to approximately 10, 000 calls annually from five strategically located stations covering 75k of San Luis Obispo County. 'there are two stations in San Luis Obispo, and one in Morro Bay, Atascadero and Paso Robles. Of the estimated 10, 000 calls a year, approximately 28% will involve patient treatment but no transportation, and therefore, no charge. Of the estimated 72% of calls involving patient transports, the overall collection rate will average 68%. - Working closely with the hospital base station medical staff, SLAS paramedics and EMT' s assess and stabilize the patient for transport . Patient care is continued from initial response and assessment through initiation of emergency department treatment. In addition to emergency medical care, SLAS provides local patient transfers, as well as out-of-town transfers to major metropolitan medical centers. STAFF SLAS employs 32 full-time and 15 part-time employees. There are 5 SLAS paramedics who have been with the company longer than ten years. There are 18 employees from the field and office staff who have been with the company longer than five years . "Serving Since 1945" WE ADHERE 70 THE HIGH STANDARDS AND ARE MEMBERS OF THE CALIFORNIA AMBULANCE ASSOCIAMON NOV-14-95 TUE 1 :20 PM SAN LUIS AMBULANCE HQ FA'X N0, 8055460885 P. 3 The professional SLAS field staff spend hundreds of hours in extensive emergency medical training. Continuing medical education is an ongoing commitment, ensuring the highest quality of training at the EMT and Paramedic level. - Medical professionals in the SLAB business office are available to assist with insurance billing and answer questions regarding the patient' s prehospital services. EQUMMENT - Top-of-the-line ambulances are continually upgraded to keep pace with the newest technology in advanced life support equipment . State-of-the-art cardiac defibrillator/monitors guarantee cardiac and chest trauma patients the most advanced life support care available. A double radio system and cellular phones equipped in each ambulance ensures there will be no compromise in communications capabilities during an emergency. An ambulance stands ready at each of the five stations on a 24-hour basis, with extra vehicles equipped for emergency back-up. CONEMXTNrrY SERVICE It is the philosophy of SLAS that the opportunity to serve the community is an honor. Many local organizations, both public and private, are supported by SLAS with financial donations or donations of service. SLAS interfaces with various public agencies including SLO County Emergency Medical Services Agecny (EMSA) and local fire departments. Medical equipment is donated to these agencies on a regular basis as updated equipment is provided for SLAS staff . Backboards, portable suction units, defibrillator batteries and other medical supplies have been donated to allow these public agencies that are restricted by budget constraints to remain active in the pre-hospital setting. This practice also guarantees that a continuity of equipment is available for patients, ensuring a smooth patient transfer between erall the public providers and the private ambulance company. The benefit to the entire pre-hospital care system is an enhancement of the level of care provided to all patients. NOV-14-95 TUE 1 : 21 PM SAN LUIS AMBULANCE HQ FAX NO. 8055460885 P. 4 Standby time and equipment are donated to many community and nonprofit organizations such as high school sporting events and community athletic activities, that benefit the entire county of San Luis Obispo. In addition, SLAS is proud of its support of the following organizations: Boy Scouts of America, Hospice, YMCA, Council on Child Abuse, American Red Cross, SLO County Sheriff Department, Cal Poly, Cuesta College, Hotline, Special Olympics, Tri-Counties Blood Bank, Beach Cities Little League and various local charity golf tournaments. NOV-14-95 TUE 1 : 22 PM SIN LUIS AMBULANCE HQ FAX N0, 8055460885 P. 5 San Luis Ambulance Service, Inc. PO BOX 954 .569 HIGUERA STREET,SUITE'A' •SAN LUIS OBISPO CA 93406. 80.51543.2626 • FAX 806/846-0885 MISSION STATEMENT San Luis AmbulanceService, Inc. is a privately owned paramedic ambulance service, dedicated to provide sate-of-the-art prd-hospital care and ambulance service. We are : Committed to providing prompt, safe, efficient and courteous ambulance service for all incapacitated persons who require ambulance transportation. Dedicated to the preservation of life and to the reduction of pain and suffering of the ill and injured. Committed to providing the most well equipped ambulances available, including the most advanced life-saving technology and medical supplies . Committed to providing the finest Paramedics and Emergency Medical Technicians trained, licensed and certified as professional health care providers in the State of California, as well as San. Luis Obispo County. Committed to the assistance of our patients with any questions or problems they may have during the billing process. "Serving Since 1645" WE ADHERE 70 THE HIGH STANDARDS AND ARE MEMBERS OF THE CALIFORNIA AMBULANCE ASSOCIATION