The Orange County Health Care Agency’s plan for selecting ambulances for 911 calls in 19 cities drops previous, specific experience requirements and reduces municipal control, records show.

The agency’s proposal, scheduled for consideration Tuesday morning by the Board of Supervisors, has eliminated the extensive experience standard required by the Orange County Fire Authority — the joint powers authority that in prior years with its partner cities selected ambulance firms to transport paramedic patients to hospitals.

The Health Care Agency’s plan also would consolidate the 19 cities — which previously could select an ambulance firm for their individual municipality — into five zones of multiple cities. The new proposal calls for one ambulance firm to be selected to exclusively provide transportation for Fire Authority paramedics in an entire zone.

Concerns about the new methods for selecting the ambulance firms for new, three-year contracts has swirled or weeks as details of the plan were tightly held.

“The process is scary,” said Trish Kelley, Mission Viejo’s mayor and a member of the Fire Authority’s board. She noted that cities could lose the ability to control the number of ambulances on duty for their residents.

“And if you reduce the requirement for experience, that is scary,” added Kelley. “We want efficiency, but we also want good service to keep our residents safe.”

Dr. Samuel Stratton, the county medical director for emergency-disaster services, couldn’t be reached for comment Monday.

Proposed geographical zones are closely aligned to the boundaries of the five supervisorial districts, which city officials see as a further loss of control.

Because of a lack of information, some city officials want to delay the process and extend the current ambulance firms’ contracts beyond their Sept. 1 expiration.

But that has been legally discouraged by state officials, who stepped in earlier this year and ordered the Health Care Agency to take over the ambulance selection process from the Fire Authority.

The state Emergency Medical Services Authority near Sacramento determined that the Health Care Agency was giving too much responsibility to the Fire Authority, thereby violating legal requirements for ensuring quality emergency systems.

On Monday, municipal city managers were talking to each other trying to understand the selection proposal after the county sent two different drafts out on March 23 and 24. The second is said to be the one under consideration by the supervisors.

Jill Ingram, Seal Beach’s city manager who heads a Fire Authority technical advisory panel monitoring ambulance services, said the time line is “very aggressive” to conduct a proper, legal request for proposals, especially given the continual problems obtaining information.

For instance, county supervisors had the Health Care Agency hold three workshops on March 11 through 13 for city officials and others. But municipal officials learned the ambulance selection proposal wouldn’t be released then, so few attended.

Thereafter, Mark A. Refowitz, the Health Care Agency’s director, wrote a memo that “participation of city managers was lower than expected.” City managers then took umbrage at that.

On March 13, Refowitz wrote to the supervisors that the ambulance selection proposal would be publicly released on March 26.

But it wasn’t released that day, with an agency spokeswoman saying it didn’t have to be until March 28. On March 26, an early draft was sent to cities. Then on March 27, a new draft was dispatched.

The current 53-page draft of the request for proposals describes the new ambulance zones, the schedule for the process and technical details, such as communication and computer requirements.

In past Fire Authority selection processes, there was an initial phase when the bidding firms’ financial strength was checked. That also has been eliminated by the county, which apparently plans to examine firm finances as a part of its overall review.

To be eligible to bid under the previous Fire Authority requirements, officials said, an ambulance company had to have one of two levels of experience: Either it had to have been a contracted ambulance provider in the Orange County paramedic system for at least three consecutive years during the last five years, or it had to have at least five years experience within the last 10 years in a 911 paramedic system comparable to Orange County’s.

Those specifications are not in the proposal before the county supervisors today, several officials noted.

The schedule described by officials and documents is as follows:

After supervisors consider the draft Tuesday, with an April 4 deadline for the public to respond. The proposal again would go to the supervisors April 8 for final approval. The county’s selection plan then must be submitted to the state for approval.

Assuming it is approved, the ambulance selection process will open April 25. There will be a bidders conference May 6. All bids must be submitted electronically by 4 p.m. May 23. The review, decision and contractual process is to be done before Sept. 1.

The five zones where a winning ambulance firm will respond with Fire Authority paramedics on 911 calls are:

Zone A — Placentia and Yorba Linda.

Zone B — Cypress, La Palma, Los Alamitos, Seal Beach and Stanton.

Zone C —  Irvine, Tustin and Villa Park.

Zone D — Laguna Hills, Laguna Nigel, Aliso Viejo, Laguna Woods and Dana Point.

Zone E — San Juan Capistrano, Rancho Santa Margarita, Mission Viejo and Lake Forest.

The 13 county unincorporated regions near these zones also will be included in the contracts.

Rex Dalton is a San Diego-based journalist who has written for the San Diego Union-Tribune and the journal Nature. You can reach him directly at

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