American Medical Response has asked a judge to block San Bernardino County from swapping out its ambulance provider this week, filing a request for a temporary restraining order just days before the county's planned midnight changeover to CONFIRE. The company argues the switch, set to take effect as Sept. 30 turns into Oct. 1, could put patients and workers at risk if it goes forward as scheduled.
AMR filed its request on Sept. 25, and a hearing is scheduled for Tuesday in Rancho Cucamonga, according to the Daily Bulletin. In its filing, AMR argued the provider change “presents a very real risk of substantial irreparable harm to AMR, its employees, and most importantly the citizens of the county.” The company also warned that transitions in emergency medical services can increase ambulance response times, and that increased response times paired with inadequate staffing during a mass casualty incident can have catastrophic impacts, per the filing.
County officials, meanwhile, are pushing back hard on the idea that the switch will disrupt care. Lauren Howland, a spokesperson quoted in the same report, said the county is “fully confident in their operational readiness.” Daniel Muñoz, an administrator with the Inland Counties Emergency Medical Agency, which oversees the county's EMS system, put it even more plainly: “From the public's perspective, it should be a seamless transition.” ICEMA has been working with both CONFIRE and AMR on the handoff, according to the report.
A Long Legal Road to This Week's Deadline
The fight over who answers 911 calls in much of San Bernardino County goes back to December 2023, when the county Board of Supervisors voted to end its contract with AMR and instead award a five-year ambulance-service deal to CONFIRE, the Consolidated Fire Agencies, set to begin in October 2024, according to the Press-Enterprise. That vote came despite AMR narrowly edging out CONFIRE in the underlying bid competition, scoring 1,519 points to CONFIRE's 1,515, the outlet reported.
Three months after the board's vote, AMR sued the county, alleging the board had not followed the federal and state legal process for awarding the contract, per the Daily Bulletin's account. That lawsuit dragged on and delayed the originally planned October 2024 changeover; the litigation is still ongoing. A court lifted an injunction that had been blocking CONFIRE's takeover of ambulance services in May, clearing the way for the county to set this week's new deadline.
What Actually Changes for Patients — and What Doesn't
Company officials say the mechanics of the handoff itself are designed to be nearly invisible to the public. Trevor Leja said AMR ambulance workers will return their vehicles, change shirts and board CONFIRE ambulances at midnight, according to the Daily Bulletin's report, and the vast majority of AMR's roughly county workforce is expected to become CONFIRE employees at the moment of the switch. The physical appearance of the ambulances will be the only thing that looks different to the public, though workers will wear new uniforms.
CONFIRE, for its part, says on its website that “patients should expect uninterrupted ambulance service throughout implementation,” and that it retained Priority Ambulance through a formal request-for-proposal process to handle the bulk of its ambulance transportation needs. CONFIRE has described itself as a joint operation encompassing 15 fire departments, including the Apple Valley Fire Protection District, Chino Valley Independent Fire District, Colton Fire Department, Loma Linda Fire Department and Montclair Fire Department. The organization uses a single coordinated dispatch center and a shared communication system across its member departments, which officials say lets those departments assist each other more easily during periods of high demand, per the Daily Bulletin. CONFIRE has also used a nurse telephone-advice line for lower-priority calls since 2020, according to a separate San Bernardino Sun report. In its December 2023 press release, the county said consolidating basic and advanced life support and medical transport services under one system was expected to ensure continuity of care and improve performance during disasters.
A Steep Rate Hike Lands the Same Day
Layered onto the provider fight is a substantial jump in the maximum charge for the most serious ambulance calls. Global Medical Response has reported that the Advanced Life Support emergency base charge will rise to $4,791.02 on Oct. 1 — an increase of nearly 79% over the current rate of $2,681.04, per the Daily Bulletin's reporting. Notably, CONFIRE's own submitted rate during the original bidding process was $3,552.19, lower than the figure now set to take effect. The county spokesperson said those figures are maximum caps, not the rates paid by patients and their insurance providers.
AMR has operated in San Bernardino County since the late 1970s and describes itself as providing ambulance service across 40 states and the District of Columbia. Whether that decades-long local run continues past this week now rests with the outcome of Tuesday's hearing in Rancho Cucamonga, where a judge will weigh AMR's request against the county and CONFIRE's insistence that the switch is ready to go.
