TO: Mayor and City Council
THROUGH: Krishna Namburi, City Manager
FROM: David Gerboth, Fire Chief
SUBJECT:
title
Salem Fire Department. Mid-Year Update on Reintegration of Ambulance Services.
Ward(s): All Wards
Councilor(s): All Councilors
Neighborhood(s): All Neighborhoods
Result Area(s): Safe and Healthy Community
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SUMMARY:
summary
In July 2025, the Salem Fire Department resumed responsibility for ambulance transport services within the City of Salem under the Ambulance Operator Model. This staff report provides a mid-year update on system performance, call volume, financial activity, and future system planning. The system remains operational and stable. Results show consistent service delivery, acceptable performance outcomes, and clear areas for refinement as the program matures.
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ISSUE:
Information Only.
RECOMMENDATION:
recommendation
Information Only.
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FACTS AND FINDINGS:
Call Volume: Since resuming ambulance transport operations in July 2025, Salem Fire has experienced call demand that slightly exceeds initial projections for a city of Salem’s size. The system was originally planned around an average of 54 transports per day, or approximately 19,710 transports for the fiscal year. Over the last six months, we have averaged 55.77 transports per day, for a total of approximately 20,357. This represents a 3.28 percent increase over initial expectations. While the increased volume is favorable from a revenue standpoint, it also places additional operational demand on the workforce.
Marion and Polk County Ambulance Service Area response time compliance is 90.3% over the past six months, despite sustained increases in call volume reflecting ongoing growth in EMS demand.
Financials: Financial activity to date for the first six months reflects the early and transitional phase of system deployment. Revenue collection, expenditures, and receivables remain generally consistent with expectations that serve a high Medicare and Medicaid population. Total revenue through December 2025 totals $28.1 million. While revenue performance is trending as anticipated, personnel and operating costs are still being closely monitored. Write-offs and reimbursement limitations remain inherent to the EMS reimbursement environment.
The current payor mix reflects the system's public nature. Medicare represents 51.4 percent of transports, followed by Medicaid at 25.1 percent. Insurance accounts for 12.7 percent, patient responsibility represents 7.9 percent, and other sources account for 2.9 percent.
Personnel Services and Materials and Services expenditures total approximately $14.7 million through December 2025, representing 25.10% of the approved $58.9 million budget, with a current cash balance of $945,629. This spending level reflects the early phase of ambulance service deployment and remains within overall expectations for the first six months of service. Personnel Services expenditures total $3,461,916.28, representing 32.42% of total costs, including $527,847.50 in overtime charged to the EMS Fund and an estimated $532,433.43 associated with dual-role staffing impacts. Materials and Services expenditures total $10,945,784.40, representing 23.93% of total costs, and align with operational startup, fleet operations, medical supplies, and contractual support needs typical of a newly deployed ambulance service.
Ground Emergency Medical Transport revenue has not yet been received for the current fiscal year. At this time, the State has not provided updated estimates or timelines for GEMT reimbursement. Staff continue to coordinate with state partners and will report back to Council as information becomes available and revenue projections can be refined.
Future of the System: The ambulance service remains in a phase of continual operational evaluation. Key focus areas moving forward include refining deployment models, securing additional equipment needs, and ongoing financial monitoring. In a following staff report this evening, the city requested authorization to add two single-role paramedics and two single-role EMTs to offset overtime impacts associated with expanding an ambulance unit from peak-hour coverage to a 24-hour deployment. As call volume and operational needs continue to increase, further staffing adjustments may be necessary to maintain service reliability and workforce sustainability.
The department continues to closely monitor unit-hour utilization, aiming to keep it below 0.5. This threshold is intended to prevent sustained overuse of resources and ensure crews are not continuously taxed across a 24-hour operational period. Staff will continue to monitor this as the system progresses toward long-term sustainability.
BACKGROUND:
The City of Salem resumed ambulance transport operations under the Salem Fire Department's oversight in July 2025, following two decades of contracted private ambulance service. This transition followed a comprehensive EMS Valuation and Optimization Study recommending the Ambulance Operator Model as a financially sustainable and operationally effective approach. The mid-year update confirms the system is functioning as designed while highlighting areas requiring continued monitoring and adjustment.
DAVID GERBOTH
FIRE CHIEF
Attachments:
1. None