Off Deadline: Approaching 40 years, Palo Alto paramedics program may charge fees | May 16, 2014 | Palo Alto Weekly | Palo Alto Online |

Palo Alto Weekly

Spectrum - May 16, 2014

Off Deadline: Approaching 40 years, Palo Alto paramedics program may charge fees

by Jay Thorwaldson

This fall, the Palo Alto Fire Department's paramedics program — officially the Emergency Medical Service (EMS) — will observe its 40th anniversary.

And maybe launch hefty cost-recovery fees.

The growth of the program is actually changing the focus of the entire department into something that could be called a "fire and medical services" department, or some catchier name. Could one say it's a case of a little paramedics program that ate the fire department?

The nature of calls reflects that: Of more than 8,100 total calls (including many false alarms and a few major fires), about 4,700 were EMS calls.

Of those 4,700, the city was able to charge an EMS treat-and-transport fee for about 3,500, roughly 75 percent. The others were for first-responder or no-transport calls, hence no charge.

Non-residents accounted for about 40 percent of those calls in 2013, Fire Chief Eric Nickel reported.

The paramedic program's fourth-decade birthday will fall in a year that is seeing perhaps the greatest change in health care (emergency and otherwise) in American history. The changes began with the World War II discovery of penicillin and modern treatment systems, and continued in the 1970s-1980s era of expensive, high-tech imaging and treatment equipment.

But with Obamacare rolling out, emphasizing more cost-effective ways of delivering care, there is an emerging opportunity for some cost recovery for non-transport paramedic care, Chief Nickel believes.

He raised the fee question May 6 in a brief report to the City Council, seeking an OK to conduct a public-outreach program for a "First Responder Fee" and a "Treat and No Transport Fee." He will report back to the council with specifics about fees and potential revenues.

An initial estimate of the size of the fees puts them into the $350 to $450 range, but most or all of that might be covered by a person's health insurance, Nickel said.

The plan evoked a barrage of online Town Square forum posts raising objections about double-taxation and asking if the city would soon be charging for fire, rescue and other emergency calls — the dread "camel's nose under the tent" phenomenon. Other questions relate to what happens if someone can't afford the fee and doesn't have insurance, and whether such a fee might discourage someone from calling for help when they really need it.

In terms of non-medical calls, the lack of a ready reimbursement source is a disincentive, unless the city could tap into homeowner's or renter's policies — not considered likely. And a fire or emergency response often provides protection for a neighborhood or broader community, while a medical response primarily benefits an individual, Nickel said.

The city's paramedics program is highly regarded by most residents and seems to have an excellent reputation beyond Palo Alto. Yet, expectedly, it is the target of citizen complaints about high firefighter salaries. Nickel said a comparison to other departments shows Palo Alto salaries are a bit on the low side. And he cites intensive mandated training of about 300 hours per firefighter per year, including 24 hours of EMT training for all firefighters — resulting in (when combined with police) a highly trained "standing army ready to respond at a moment's notice" to emergencies.

Palo Alto's paramedics program can claim credit for saving an uncountable number of lives due to quick-response times, high levels of training and close coordination with first-on-the-scene fire engine companies.

The program currently operates three paramedics ambulances in addition to eight first-responder vehicles (six fire engines, a ladder truck and a seasonal engine in the foothills), all staffed by paramedics or emergency medical technicians (EMTs).

Because it was one of the first fire-department-based programs with transport, it is able to serve as an "ambulance" transport service in addition to on-the-scene treatment of illnesses, accidents and injuries.

In Palo Alto a base-rate fee of $1,725 is charged for transport, but as a bundled price. Other services may have lower base rates but itemize just about every piece of equipment or bandage used to get to about the same level, Nickel said.

That's comparable to other transport fees in Santa Clara County, which funds paramedics programs in other fire departments.

Palo Alto does not charge for calls that do not need transport or when transport is refused.

Other departments do. Berkeley, San Francisco, Alameda County and the Novato Fire District in the Bay Area charge such fees, along with the 16 cities and county areas that comprise the Sacramento Metro Fire Department, Nickel noted.

In Santa Clara County, World Metro Ambulance is the current contractor with exclusive operating rights under a system mandated statewide in June 1980.

But Palo Alto's service level is significantly faster than the countywide service is able to achieve, Nickel noted, citing an 8-minute-or-less response in 90 percent of the calls compared to 12 minutes countywide.

The evolution of the Palo Alto Fire Department toward a possible new name got a big push in October 2012, when two consulting firms issued a report with 48 recommendations for improving operations. The city had recently hired six new paramedics and added a second full-time ambulance to its fleet (in addition to a half-time ambulance staffed by firefighters working overtime), reflecting a radical increase in medical-service calls.

I have a personal interest, albeit historical, in the subject of ambulances and emergency responses. After months of research I put together a five-part series for the erstwhile Palo Alto Times, which ran in early October 1971.

The series detailed a lack of training and high turnover in the private ambulance firms, with double-sourced examples. One hospital official said he had advised his daughters that if he had a heart attack or other crisis to drive him to the hospital rather than call an ambulance.

It was thanks to one Palo Alto resident, the late Joe Carleton, that the paramedics program emerged three years later. Based on the series, Carleton lobbied city officials hard, and the program resulted. He later was involved in donating engines and a paramedics van to Palo Alto's sister city, Oaxaca, Mexico, acts worthy of recognition in their own right.

Former Weekly Editor Jay Thorwaldson can be emailed at and/or He also writes periodic blogs at


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