Pace of Ambo Transition Concerns San Diego Leaders

The San Diego Union-Tribune

The company scheduled to become San Diego's new ambulance provider over Thanksgiving weekend is struggling to hire paramedics and secure new ambulances, prompting city officials to express concerns about the transition.

Falck, a Danish company that handles ambulance service in many cities around the world, is scheduled to replace longtime city ambulance provider American Medical Response at 8 a.m. Nov. 27, Fire Chief Colin Stowell said.

The takeover will come at the end of a six-month transition period the City Council approved last spring, when it chose Falck over AMR as San Diego's ambulance provider based on promises of better service and response times.

None of the areas where Falck is falling short of city expectations would put lives in danger, Stowell said. But the slow progress on some priorities has raised concerns about stability during the transition and shifted the city's Fire-Rescue Department into a proactive posture.

"We have cited some concerns, and we want to make sure we are seeing progress in some areas, but we are still 10 weeks away from the go-live date, so I think a lot of these things can be accomplished," Stowell said.

Stowell said Falck's inability to hire enough paramedics, while understandable in an extremely tight labor market, is likely to delay Falck fulfilling its promise to increase overall ambulance hours by 20 percent over what AMR provided — 1,008 daily hours vs. 840 daily hours.

Falck also is struggling to fulfill a promise to have its entire fleet of 66 ambulances be brand-new vehicles immediately. Because of a pandemic-related microchip shortage, acquiring any type of new vehicle has been a challenge recently.

Falck has secured 34 new ambulances, which meets its contractual agreement that at least half its ambulances be brand new. The other 32 new ambulances are expected to arrive at a rate of about two per week, so the fleet likely won't be all new ambulances until next spring, Stowell said.

On hiring, Stowell said Falck has managed to hire many of the paramedics and emergency medical technicians currently handling city of San Diego work for AMR, which was expected.

But he said the increase in ambulance hours promised by Falck requires an increase in staffing at a time when there is an overall shortage of emergency workers.

In addition, Stowell said, AMR has prioritized retaining its San Diego paramedics so they can transition to the company's operations elsewhere in the region after Falck takes city operations over.

Stowell said Falck has hired 115 of the 148 paramedics the company needs, which he characterized as a significant shortfall. Stowell praised Falck for offering $12,000 paramedic signing bonuses, but he said that hasn't been enough.

Falck also needs to increase the number of emergency medical technicians it has hired from 129 to 192, but Stowell said that gap would be easier to close because lower qualifications make EMTs relatively easier to find.

Falck also has missed deadlines for acquiring needed supplies and for hiring people into leadership positions for its San Diego operations, but Stowell stressed that none of the company's failures threaten lives so far.

"Fire had very aggressive expectations that Falck would get some things accomplished maybe even earlier than probably necessary," he said. "We like things done earlier, not last minute."

He also said city officials understand the staffing and vehicle acquisition challenges created by the pandemic. And Stowell praised Falck for signing a lease on a new Kearny Mesa headquarters, spending $20 million on cardiac monitors and making key decisions about employee uniforms, training and the outward appearance of its ambulances.

Falck said in an emailed statement that the company is making steady progress despite challenges outside its control. The company also expressed confidence.

"Falck has many years of experience around the world transitioning new systems, and we understand the complexities involved in this process," the statement said. "We remain confident that given some flexibility around non-critical elements of the system, we will provide the city of San Diego a smooth transition and the high-quality emergency medical services that every San Diegan deserves."

Stowell said another challenge facing Falck has come from  AMR declining to train new Falck paramedics during the transition. While not contractually required of AMR, Stowell said city officials had hoped for such cooperation.

Instead, the new workers are being trained by city firefighters, who will familiarize them with patient documentation and procedures at local hospitals, just not from an ambulance perspective, Stowell said.
In an emailed statement, AMR said it was unable to train Falck employees because the company is committed to other local training programs.

Stowell also said AMR fell out of compliance with the company's response-time requirements in the southern part of the city during August. Stowell said the company is still providing enough staff and ambulances, blaming the non-compliance on unusually long waits during hospital drop-offs because of the pandemic.

"We continue to experience significant delays at local hospitals largely due to the surge of the Delta variant which has impacted response times throughout San Diego," AMR said in its statement.

Stowell is scheduled to present his concerns Wednesday to the City Council's public safety committee, which is scheduled to get additional updates on the ambulance transition during its October and November meetings.

This story originally appeared in San Diego Union-Tribune.