It’s rush hour when a middle-aged man walking down East Santa Clara Street collapses with a stroke. A few minutes later, a firefighter trained as a paramedic gets on scene. The firefighter takes the patient’s vitals, gives him an IV and stabilizes him. But he can’t take the man to a hospital — only the county’s ambulance provider can.

The firefighter waits. Five, ten, fifteen minutes go by. The firefighter gets a new call, but can’t respond until the ambulance is there. The firefighter must wait until the ambulance gets there to call the hospital to prepare for a patient in need of medical treatment for a stroke.

As emergency first responders, fire departments handle emergency calls like this every day, as well as calls that deal with hazardous situations, such as car accidents, chemical spills and general rescue. In Santa Clara County, an ambulance provider works with first responder agencies, such as fire departments, to supply emergency response services and ambulance transports.

But now, a new amendment to Santa Clara County’s ambulance agreement has sparked concern from firefighters and San Jose and Santa Clara county officials, who fear changes to the ambulance provider’s response times will provide no incentive to arrive to the emergency any faster once they are late, potentially stranding firefighters on scene longer.

American Medical Response, which operates Rural Metro — the current contractor and sole bidder — added a seventh amendment to an existing contract with the county that was approved in June at a Board of Supervisors meeting.

The changes mainly affect AMR’s operations — the county’s ambulance provider for nearly ten years — but hardly change fire departments’ protocols across the county. All changes go into effect July 1.

The amendment changes the fee for when AMR is late. In Santa Clara County, fire departments and AMR have to respond to an emergency within a certain time limit — 8 minutes for fire departments and 12 minutes for AMR — called a “response time clock.” The “clock” for both agencies starts ticking as soon as they get a call.

Before the approved changes, AMR kept racking up late fees for each additional minute that they were late to a scene. Now, they’ll only be charged a flat $250 fee, regardless of how late they are. That means AMR can respond five to twenty minutes late on any given scene with no additional financial penalties.

“Once the response time clock has stopped, Rural/Metro has no incentive to arrive timely, but first responders remain obligated to stay on-scene until the arrival of the ambulance,” said city manager Dave Sykes in a statement. “This would prevent first responders from being released and available to respond to other calls.”

Santa Clara County Board President Joe Simitian — the sole supervisor to vote no — said the rates for a missed call used to run up to more than $15,000. The longer the delay, the greater the damages would be.

“The $250 fee used to run up to as much as $15,000 per call on a graduated basis,” said Simitian. “Under the new amendment, that provision is erased.”

But that change barely scratches the surface. County officials worry that the $250 fee per missed call can be waived, as long as response times are met at the countywide level.

Under the contract, both agencies have to meet their response times at least 90 percent of the time. According to Miguel Marquez, chief operating officer of the county of Santa Clara, anything below a 90 percent response time rate per zone will have significant penalties — $10,000 for each percentage point. But there are changes for AMR.

In the past, AMR was required to respond to emergencies within 12 minutes, 90 percent of the time within certain parts of the county — now they have to meet that threshold countywide. And as long as the countywide average of 92 percent is met, AMR’s $250 late fee can be waived.

“If the numbers are right countywide — the $250 fee goes away,” Simitian said.

Once a first responder is late to a call, the initial $250 late call fee does not rack up additional financial penalties.

But some officials said that financial penalties are not the reason why the ambulance provider gets to a call on time and that AMR has consistently met response times in the past.

“Financial penalties are paid many months later,” said county executive Jeff Smith. “It’s not the penalty that’s effective in motivating response times but the regulation because it affects the paramedic.”

“If a particular ambulance, paramedic, or location is consistently late, they can lose their license,” added Smith.

Still, some supervisors said they felt “boxed in” to approve the amendment. The supervisors had 60 days to make a decision, if they didn’t approve it and without other bidders, some worried the county wouldn’t have an ambulance provider starting July 1.

“Approving the seventh amendment when the process to get here was so flawed is frustrating and feels disrespectful to our first responder partners who had minimal opportunity to weigh in on the changes on the contract of which may impact them directly,” said Supervisor Susan Ellenberg.

Higher costs for patients

Amid all the changes, patients who call an ambulance for help will see higher bills.

Starting on July 1, patients will pay $85 more for transports, going from $1,710 to $1,795. The mileage rate — the number of miles an ambulance is driven to get a patient to a hospital — will also increase from $47 to $49.77. The increases will continue each year and are based on the county’s Consumer Price Index.

“The impact (on patients) depends on insurance,” said Sharon Henry, chief operating officer of AMR. “An increase in rates doesn’t impact anyone on Medicare, Medical, or non payers. Costs shifted–like most of healthcare–to private insurance.”

“The city is against the approval,” continued Sykes in the statement. “Contrary to the information provided in the agenda packet, approval of the seventh amendment is not necessary for the extension of the existing contract. The changes proposed in the seventh amendment would conflict with the city-county agreement and create a disincentive for timely ambulance arrival that would negatively impact the city’s first responder resources.”

San Jose Fire Chief Robert Sapien said he’s concerned that the suggested changes might have a negative consequence.

“I don’t know how that will impact our resources and that concerns me simply because we haven’t had a chance to evaluate the impacts,” Sapien said.

Sapien added that first responder agencies, such as fire departments, need to be involved in the contract negotiations to design a system that best serves all Santa Clara County communities.

The contract and changes were approved on June 4 and will remain in effect until June 2022.

Contact Nadia Lopez at [email protected] or follow @n_llopez on Twitter.