If you're seriously injured and need immediate medical transportation to a hospital, waiting 20 to 40 minutes could be the difference between life and death.

But Livermore-Pleasanton Fire Department firefighter and union president Joe McThorn told the Weekly that this month he witnessed it happen first-hand -- and that it hasn't been the first time.

"I just got off a four-day stretch at work," he said. "Five of the calls I was on, actually six, had over 20-minute responses from Falck ambulance and two that were over 40 minutes. These were seriously injured people and sick people and this has become the norm."

European-based ambulance company Falck, through its local branch Falck Northern California, is the current ambulance contractor that provides transportation services to many of the cities in Alameda County -- excluding Berkeley, Alameda, Albany and Piedmont, which use their own fire departments for emergency transportation.

The for-profit ambulance company, which began working under the county in 2019, provides 911 emergency services under the authority and contract award of the Alameda County Fire Department's Board of Supervisors.

That includes Livermore and Pleasanton, which are part of the county's exclusive operating area (EOA).

The primary day-to-day governing body for the contract is Alameda County Emergency Medical Services, which falls within the Alameda County Health Department. The Alameda County Fire Department is a separate department that provides service to unincorporated Alameda County and multiple other jurisdictions through contract

As Falck's current contract comes to an end in mid-2024, the county fire department has announced its plans to bid the EOA when the request for proposals is released around June. The RFP process will be led by the Alameda County Health Care Services Agency.

What that means for LPFD is that it gives the department's joint powers authority the chance to discuss with the county fire department, whether there are ways LPFD can partner with the county in providing 911 services, should they be awarded the bid.

That led to both Pleasanton and Livermore city managers, who both serve as joint executive directors for the LPFD, to seek their respective council approval in executing a joint letter of intent to negotiate the terms of a proposal for the request proposal.

The Pleasanton City Council approved its letter of intent during its consent calendar on Jan. 17, and Livermore was presented with a similar resolution before its City Council on Monday as part of its consent calendar as well.

Falck's response time was also one of the main factors listed in the Pleasanton City Council staff agenda report for why the county is assessing its options of moving forward with a different company.

"For a variety of reasons ... at multiple points during the contract term, Falck has had difficulty in meeting its contractual obligations primarily related to ambulance response times," according to the staff report. "Falck was out of compliance in October, November and December of 2021, such that Alameda County placed Falck on a monitored performance improvement plan intended to improve response times."

McThorn, president of the International Association of Firefighters Local 1974, which represents firefighters working for the LPFD, said that even though Falck has made some effort in improving, the county deserves better.

"Falck has implemented some changes," McThorn said. "They hired non-union workers from out of state to come in and supplement the shortage on the staffing. That was a mild mild improvement, it still did not meet the true contractual agreements."

He said that with the letter of intent, he hopes LPFD can have a chance to take matters into their own hands.

"What we want to do with a letter of intent is partner with Alameda County Fire, which is a bigger agency, and then contract with them (so) that we have our own ambulances in Livermore and Pleasanton that just cover our communities," McThorn said. "Hayward and Fremont want to do the same."

But unfortunately, according to LPFD Fire Chief Joe Testa, that is unlikely to happen.

"I do not anticipate Alameda County to break up their EOA allowing cities to bid for services. As such, the LPFD (Joint Powers Authority) and the cities of Livermore and Pleasanton are not preparing to respond to the RFP," Testa said.

He said that in addition to finding ways to partner up with the county fire department in its future contract, LPFD is also working with Falck to find ways to improve services within the current contract.

But as fire chiefs, fire departments and local firefighter unions in Alameda County work on overall improvements to the entire emergency response systems, they are not sure whether Falck will bid on the county's next contract and the new model that will come with it.

"This new model would generally look similar to the model in Contra Costa County, whereby the county fire department contracts with a private ambulance provider (not yet identified) to provide primary response service to cities within the county," according to the staff report. "This model would be more financially viable than the current model because cost recovery rates for public entities are higher (statutorily) than for private providers."

But McThorn said he still strongly believes that LPFD should subcontract ambulance services.

He said that the department has been asking Alameda County Board of Supervisors and the Alameda County Emergency Medical Services Agency to consider that possibility for many years but have been met with denials and no responses to information requests.

But according to Jerri Randrup, communications director for the Alameda County Health Care Services Agency, that wouldn't be allowed per state regulations.

"It's important to note that state law and the regulations of the California Emergency Medical Services Authority provide that a local EMS Agency (LEMSA) can operate an Exclusive Operating Area -- where a single provider is responsible for ambulance services for the area -- in the interest of the local system of care and per state-directed procurement requirements," Randrup said in an email to the Weekly.

"By conferring exclusive authority to provide ambulance transport services within the Exclusive Operating Area the LEMSA can compel the selected ambulance provider to serve all territory within the area, including distant rural and lower income areas where disproportionate access to health care is largely observed," Randrup added. "Allowing Livermore Pleasanton Fire Department to operate EMS ambulance transport in their areas violates the exclusivity conferred on Falck and is inconsistent with the County's commitment to maintaining ambulance services that provide equitable service levels to all residents."

In all, it remains unclear how negotiations between LPFD and ACFD to refine the bid proposal and the terms and conditions of local participation in the model will look like. But however it plays out, McThorn said all he wants is to provide the appropriate emergency services that residents in Pleasanton and Livermore deserve.

"Livermore-Pleasanton, Hayward, Fremont, Alameda County, Oakland and the other agencies have never failed to respond and be there within a reasonable time and our communities deserve that," McThorn said. "So that's all we want to do."