These non-emergency calls may include ground transportation or rides to and from a medical facility. State law already sets minimum requirements for such operations in Alaska, and a hospital could contact a private ambulance company directly for non-life-threatening services.

David Farris, director of ground operations for LifeMed Alaska, said Monday the order sets guidelines and expectations comparable to those of the Municipality of Anchorage.

“This ordinance appears to provide a structured framework for any private ambulance service to come and provide non-emergency transportation in the area,” Farris said.

LifeMed provides air and ground medical transportation within the state, including emergency air medical services to Seattle from Anchorage. LifeMed CEO Grace Greene told the board Oct. 19 that her company averages about 80 flights out of Fairbanks and 59 ground transports to and from Fairbanks Memorial Hospital.

Greene also expressed support for the new framework, noting that LifeMed’s ground ambulance can help meet a community need and relieve pressure from an already overburdened FFD ambulance call volume.

Coccaro, the fire chief, has advocated for the framework since its introduction in 2023 with the support of himself and then-Fire Chief Scott Raygor. Coccaro, whose background includes extensive ambulance experience, said the framework protects patients and hospitals and gives all private ambulance companies a level playing field.

“I believe in the regulation of emergency medical services because the patient does not decide who picks them up. It is therefore our duty to ensure that there is a high level of care and an expected level of quality for our citizens ” Coccaro said Monday.

The order creates a three-tier licensing system for interested businesses. Each level sets its standards, with the underlying theme that ambulances must be in good condition and operated by qualified and trained personnel.

The lowest level, a Type 3 license, allows private ambulances to transport previously assessed patients requiring only basic life support or those accompanied by a medical escort team. A Level 2 license confers this authority to those previously assessed in need of an advanced life support system. A Type 1 license holder may transport previously assessed critical care patients and urgent hospital-to-hospital transfers.

Coccaro clarified that the new regulations only affect non-emergency medical transfers, such as hospital-to-hospital, airport or home-to-hospital transfers for patients already being evaluated by a doctor or health care professional.

“This is a normal structure for non-emergency private ambulance transportation in many jurisdictions,” Coccaro said. He said the Fairbanks version came about years ago as a result of conversations between companies like LifeMed and the fire department.

Emergency interventions are defined as medically unevaluated patients and conditions that “could reasonably result in loss of limb or life or could if not treated immediately.”

Private companies would be prohibited from providing emergency transportation within city limits unless there is a major emergency disaster such as an earthquake.

LifeMed’s Farris recommended removing some provisions, such as having the Fairbanks Emergency Communications Center send private ambulance calls within city limits. He said companies like LifeMed can send their ambulances for non-emergency calls.

“We believe this would place additional strain on the current dispatch center,” Farris said. “Private ambulance companies are fully capable of interacting with the various facilities that use the companies for transportation. There is no need to place this burden on the dispatch center.

The FECC has faced a chronic staffing shortage for years, particularly among qualified dispatchers. It takes at least seven months to train a dispatcher, who must learn the policies, regulations and procedures of the 22 agencies the center dispatches for in Fairbanks’ North Star Borough, Nenana, Delta Junction and Denali Borough.

Some council members initially proposed removing this provision, as well as sections requiring private ambulance companies to submit quarterly reports on data such as the number and types of transport trips, vehicle inspections and trips on site.

“To me, it (the reports) seems like unnecessary paperwork,” said council member Jerry Cleworth.

Coccarro, the fire chief, said neighboring fire departments that provide ambulance transportation already meet standards of care for emergency transportation. FNSB ambulance service contracts, which are separate from fire service contracts, have several standards.

Proposed changes to remove sections requiring FECC to send private ambulances within city limits and quarterly reports remained intact. Kristi Merideth, FECC dispatch manager, said while it might present some challenges, her staff can adjust to calls as needed.

“I hope that one day, when many companies in town are trying to get the same deal, we will know what the call volume is so that we, as a regulator, can make a decision at the same time. “The future of what we want this program to look like,” Coccaro said.

“We are the obstacle”

Cleworth was in favor of delaying the ordinance until the city receives clarification on how it defines a mutual aid agreement for ambulance services. Mutual aid agreements allow partner agencies, such as other fire departments, to respond to fire and emergency calls in neighboring jurisdictions.

“To me, it’s a convoluted mess unless you define what mutual aid is,” Cleworth said.

He added that he feared excessive regulation of the private sector without defining other boundaries.

“To me, this is a double standard that we need to address,” Cleworth said.

Cleworth noted that recent information highlighted whether there was a written EMS mutual aid agreement with neighboring FNSB fire departments. He added that in his 30 years on and off on the council, he believed such agreements existed.

Most city council members and city staff disagreed.

“These people (LifeMed) are trying to get something off the ground and now we become an obstacle,” said board member John Ringstad. “I don’t think we should delay this any longer.”

He added that if the city continues to delay adopting new regulations, private companies may decide not to “invest significant time, manpower and money” in such operations.

“Give them the guidelines and let them go,” he said, adding that the board can refine the pieces that aren’t working later.

Chief of Staff Michael Sanders agreed, referring to local meetings between LifeMed and medical providers.

“We are the obstacle in this whole debacle,” he said. “That’s what the hospital wants. LifeMed wants that.

Licensing and regulatory requirements will be implemented on January 1, 2025.