Tuolumne County Ambulance Services

The County of Tuolumne, through its Health and Human Services Agency, Emergency Medical Services (EMS) Agency, hereinafter referred to as “County,” is requesting proposals from qualified organizations to provide personnel and management to operate the Tuolumne County Ambulance Service (TCAS). The County is authorized to plan and implement an EMS system as provided under California Health and Safety Code, Section 1797.200 et seq. TCAS serves as the provider of ground ambulance services for the County.

The County intends to award one contract to a successful applicant to provide personnel and management for operating TCAS subject to the performance standards and other specifications herein. California and federal laws provide specific employment restrictions for retirees and/or current County employees that desire to contract with the County.

For CalPERS retirees: if the work performed by an employee of the contractor is the same or similar to work performed as an active employee or is work that is performed by active employees, it is most likely subject to the California Public Employee’s Retirement System (CalPERS) retired annuitant restrictions, meaning the inclusion of said individual(s) is disallowed and the person cannot work within the County.

For current County employees: California and federal law prohibit a current employee from contracting with its employer while being an active employee. If an employee is interested in becoming an independent contractor, the employee must consider separation from employment with the County, however, should the employee retire, he/she may be subject to the CalPERS retired annuitant laws. Should a current County employee respond to an RFP while in active employment status, the employee must separate from employment prior to award of the contract.

No County time is allowed to be used to prepare for or work on a response to a County RFP.

The County is a rural, "foothill" county located in the central eastern section of California, covering a large geographical area of 2,235 square miles. The population is most heavily concentrated along the Highway 108 corridor, with significant differences in climate zones and ease of transportation access. Based on the U.S. Census Bureau, the population was 55,620 in 2020. The primary service area represents all incorporated and unincorporated areas of the County as detailed in this RFP.

TCAS provides emergency and non-emergency medical transport services within the County, excluding the portion within Yosemite National Park. On occasion, TCAS provides mutual aid outside the County as requested. TCAS has served this community for over 35 years through a public/private partnership with an ambulance company, responsible for ambulance staffing and daily operations since 1987. The contracted provider employs approximately 60 full-time and part-time paramedics and Emergency Medical Technicians (EMTs), responding to approximately 8,200 calls per year. These include Advanced Life Support (ALS), Basic Life Support (BLS), Critical Care Transport (CCT), and non-transport responses. CCT is performed using an ALS or BLS ambulance and critical care staff from the local hospital or in partnership with the air ambulance provider; there is no expectation that the Contractor will provide nurses.

Currently, there are six (6) ALS ambulances available 24/7, stationed in Jamestown, Sonora, East Sonora, Soulsbyville/Mono Vista, and Groveland. The Groveland ambulance is maintained through a special tax that South County voters have supported for the last 35 years. This funding supports a 24/7 ALS ambulance service in Groveland where there is insufficient transport revenue to cover its expense. The County maintains a reserve fleet of ambulances used for covering maintenance needs as well as non-emergency transfers, extended fire standbys, special events, and can be called into active duty during periods of high call volume. In addition, County-provided safety cars have been used on occasion for appropriate behavioral health transfers, but are not included in this contract at this time. For reference, please see the map below for the five stations within the County:

In fiscal year 2024-25, TCAS completed 8,259 calls for service. For comparison, see the table below for call volume over the last four years. The decrease in call volume is related to the outsourcing of BLS interfacility transports (IFT) to a BLS ambulance service.

A high percentage of BLS IFT involves behavioral health patients. Due to the increasing volume of these calls over the years, a significant portion has been sub-contracted to a private ambulance provider, which reduced the County's transport volume and associated revenue. In 2024, there were 155 BLS behavioral health transports.

EMS dispatch services in the County are coordinated through a funded partnership with the County Sheriff’s Department, which operates the County’s central dispatch center. In 2019, the County implemented Emergency Medical Dispatch (EMD). All dispatchers are certified in EMD, enabling them to assess the nature and severity of medical emergencies, prioritize calls, and determine the appropriate level of response.

To support the financial sustainability of the EMS system, the County employs fiscal technicians who manage medical and ambulance billing (e.g., standby, special events, etc.) and oversee reimbursements through the Ambulance Enterprise Fund. This fund not only covers dispatch-related expenses but also supports vehicle purchases and maintenance, equipment needs, provider contracts, ambulance station acquisition and maintenance, and other operational costs.