City Council discusses proposed ambulance service standards

The St. George City Council discussing proposed ambulance standards, St. George, Utah, April 24, 2014 | Photo by Mori Kessler, St. George News

ST. GEORGE – During a work meeting Thursday night the St. George City Council discussed a draft of its pending standard of care agreement between the city and its current – and potentially any future – ambulance service providers.

A standard of care agreement includes a list of standards and protocols created by a municipality for an ambulance service to follow. It also measures the ambulance service’s performance in relation to items like personnel training, equipment and vehicle maintenance and response time.

“This is what we want,” City Manager Gary Esplin said.

If the ambulance service does not meet the requirements set forth by the city, it can find itself facing potential penalization, or even replacement.

Points of the proposed standard of care agreement

City Attorney Shawn Guzman went over the proposed agreement, stopping at parts to allow the City Council to discuss certain aspects of the agreement and recommended revisions and additions along the way.

Among the points discussed to be required in the city’s standard of care agreement were the following:

An operations manager/supervisor overseeing the ambulance service must be readily available on a 24-hour basis and shall also be locally accessible (not based out of the county, for example). 

Ambulance crews shall update the St. George Communications Center (dispatch) first, before contacting any in-company dispatch center, regarding their operational status and location. This shall be done so the dispatch center has accurate knowledge of where an ambulance is in the city at any given time so they can better respond to and monitor an emergency situation.

“If they’re not going through dispatch, where are they?” Esplin said.

Cindy Flowers, the dispatch center manager, said that if an ambulance provider has its people call an in-house dispatch center before contacting the Communications Center, her department cannot provide the city with accurate time response information needed for performance evaluation.

In relation to response times, the city is also considering implementing a standard response time of 8 minutes to 90 percent of all priority-one emergency calls. Guzman said the city also maintains the right to make determinations on what an acceptable response time is based on conditions at the time as well.

The time response standard the city is considering is based on the industry-wide recommendation recognized in the National Fire Protection Agency, St. George Fire Chief Robert Stoker said.

A record of ambulance response times shall be provided to the city from the St. George Communications Center for review. However, Flowers said that their numbers would be invalid if the ambulance provider doesn’t keep the dispatch center updated on where its people are and what their units are doing at all times.

On matters of review, the ambulance provider will provide monthly data to the city for review to ensure compliance with the city’s standard of care ordinance. The city itself shall also maintain a review committee that will evaluate the ambulance provider’s overall performance on an annual basis, or as needed, depending on the circumstances.

Requiring a minimum of four ambulances with Advance Life Support-trained staff stationed throughout St. George at any given time was also discussed.

Should an ambulance provider violate the standard of care agreement, the city may: issue a written warning, initiate a probation period up to 12 months, or revoke the ambulance provider’s city business license. Under state law, an ambulance provider is required to have a business license from the city it operates in.

If the city deems necessary, it may issue an RFP, or request for proposal, which is an open call to other 911 ambulance providers to submit proposals to become the city’s next 911 emergency transport sercice.

“These standards can be met by anyone,” Councilwoman Michele Randall said.

At times during the discussion the mayor and council members sought Randall’s opinion on aspects of the agreement due to her background. Before running for public office, Randall was one of the owners of Dixie Ambulance Service. Dixie Ambulance Service closed it doors just over a year ago after the state Bureau of Emergency Medical Services awarded 911-transport licenses previously held by the local ambulance provider to Salt Lake City-based Gold Cross Ambulance Service.

Moving forward

The city did not vote to approve the standard of care agreement as it is still being reviewed and revised. Once a final version is produced, the agreement, being a proposed city ordinance, will be subject to public hearing at a future date.

The latest version of the draft will be sent to Gold Cross Ambulance Service and BEMS for review. Mayor Jon Pike suggested the agreement be addressed again on May 21, which will allow the current ambulance provider and the state agency time to go over the latest draft.

Absent at the work meeting during the discussion of the standard of care agreement was any representative of Gold Cross Ambulance.


The City of St. George did not have a standard of care agreement between itself and Dixie Ambulance Service when it covered the city. However, as the dispute between the local ambulance service and Salt Lake City-based Gold Cross Ambulance Service began to ramp up in late 2012, city officials began to give the measure more consideration.

Though the city opted not to officially pick sides and left it to BEMS to determine which ambulance service would best serve the city, it nonetheless raised a concern that BEMS may have been deficient in some of its own duties related to the matter.

Gold Cross Ambulance Service

Gold Cross Ambulance Service was not represented at the work meeting Thursday.  St. George News requested comment from the company on the proposed standards ordinance but no response has been received as this report is published.


Email: [email protected]

Twitter: @MoriKessler

Copyright St. George News, LLC, 2014, all rights reserved.

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  • Scotty April 26, 2014 at 8:12 am

    As Gold Cross was railroaded out of town, I’m sure they have no desire in returning. Too bad the council couldn’t step up before changing services. I would be surprised if any other service would even consider coming to St. George due to city politics.

    • Joyce Kuzmanic April 26, 2014 at 10:05 am

      Scotty, Gold Cross is the current ambulance service provider for St. George. I wonder if you mean their predecessor, Dixie Ambulance Service?
      Joyce Kuzmanic
      Editor in Chief

  • Figures April 26, 2014 at 10:28 am

    We should’ve known this would happen when michelle randall (former owners wife of dixie ambulance) met with the city counsel. She is probably the one who called the metting. She is soooo bitter!

    • Observer April 26, 2014 at 10:50 pm

      You wouldn’t be bitter if a government agency took away your business? I think Michelle is handling what happened in an appropriate fashion – Changing things from the inside out. She was fairly voted into office and has been using her expertise in the emergency medical field to help create standards of care.

      Had the city had these standards in place 10 years ago like they should have, there would not have been millions of dollars wasted on fees for the two year legal battle.

      By saying she is bitter, I assume you mean that as a compliment. I think what happened with the state and city governments was a shame and she is doing something about it. Cut her some slack.

      As a local resident, I appreciate standards of care. If I dial 911, I know I will get the same care, regardless of the paramedic or ambulance that shows up. This also holds the ambulance company accountable for their actions.

  • Tony April 26, 2014 at 10:48 am

    It’s michelle randall

  • spectator in the cheap seats April 26, 2014 at 11:56 am

    The Randalls should know by experience ,that any qualified ambulance company can meet the standards set by any State /County /Local Governments . The problem exists with the provider and if they want to stay current with the requirements ,including staff training , equipment updates , etc. For a provider NOT to reinvest back in the company ( proper training for the staff ; equipment updates ; etc. ) is foolish , and will only cause the company to throw in the towel .

  • Garth April 26, 2014 at 12:02 pm

    St George Fire should just take it over. They go to every call anyways and with no compensation. Then we could be done with this conversation.

  • elliemae100 April 26, 2014 at 12:55 pm

    Yes – we should seek the opinion of the woman whose campaign platform was to defeat the “good ol’ boys” on the Council who had failed to support her company. Rather than to ask Michelle Randall as to what standards she believes are important (i.e. removing hundreds of thousands of dollars from Dixie Ambulance, effectively leaving it insolvent), they might wish to use as a basis the BEMS report that described in detail what Dixie’s failures were. These failures included meeting the State Administrative Rules of providing two paramedics on each ambulance, developing & implementing a preventive maintenance program for both equipment and the ambulances, and failing to have written protocols.
    Asking Michelle Randall for her opinion as to what she believes the minimum standards might be is laughable, considering that Dixie Ambulance failed to meet the State’s minimum standards in its operations and the owners are solely responsible for the demise of their company.
    Let us not forget that even though the owners of Dixie continued to assert that the company was providing good service in the area, when Dixie failed, they bailed on all of Washington County with a few days notice after they lost the contract. If Michelle makes suggestions that aren’t taken, will she quit the council in the same way Dixie walked away from all of Washington County? Will she blame everyone else like Dixie did (the State for not monitoring them, the City for not fighting for them, etc)?
    Seeking the opinion of Michelle Randall as to proper procedures of operation seems disingenuous as least and smacks of a conflict of interest at best.
    I have a suggestion: the council should either consult with the company that is finally providing excellent service in our community, or read the following document as to the proper standards of care for an EMS provider in Utah:

    • Happy, happy, happy April 26, 2014 at 3:24 pm

      Ellemae you are a troll who needs to leave the bridge you hide under and jump from it. If you are so bitter and angry about the ambulance service issue why don’t you and the people go vote during the city council elections? Oh wait the people did!

      • elliemae100 April 27, 2014 at 5:43 pm

        I raised points that were verifiable (as opposed to calling me a “troll” as if that negates my argument). I’m not “bitter and angry” about the ambulance service issue – but I do question why the council would seek the opinion of a person whose company refused to comply with minimum standards of care yet complained bitterly when the City Council accepted the recommendations made by BEMS.
        I don’t believe that name calling is productive to this issue – but I would like to point out that you certainly aren’t “happy, happy, happy” when someone disagrees with your rather narrow point of view. Read the report (linked above) and then make a salient argument as to why the city council should seek the counsel of someone whose company operated outside of best practices and who removed hundreds of thousands of dollars of profits while the employees worked 2-3 jobs to make ends meet. A person whose company provided benefits for the owners but not the employees – and who had every opportunity to comply with state rules, yet instead chose to complain that the city didn’t fight hard enough for them. The Randalls and the Millers reaped the benefits of the efforts of their employees.
        In order to set minimum standards of care, the city council could have invited Gold Cross representatives or someone from the state BEMS to contribute to this discussion. If they truly wanted to set minimum standards, all they needed to do was read the report about Dixie Ambulance and do the opposite of what Dixie Ambulance did.
        Again, calling me a “troll” doesn’t change the truth. You have no idea whether I vote, or whether I contributed in any way to the elective process. I guess that, when you have no substantive argument, it’s best to hurl insults. We’re not in high school any longer, and this tactic displays your inability to effectively communicate your position. If you have one, that is.

        • Truth April 28, 2014 at 10:52 am

          Oh Ellie. Your writing style resembles much of a senator. Anyways, I having worked for both companies now have something to say. I made 13.61 at Dixie ambulance. I make 13.67 at gold cross. Your argument is pathetic for the shear fact that you know nothing of EMS, how corrupt gold cross is and as far as working 2 jobs to make ends meet. We all still do that because of the so called better pay. You think the owners of gold cross aren’t taking millions? Maybe all that money they promised us, you know the 15 or 16 dollars is going to the legal battles we have. If you are just someone from the outside Ellie the shut your mouth because you have no idea how both companies are from reading a PDF unlike me who has worked at both companies, but maybe you are part of the legal council of gold cross (Steve) and trying to defend your big mistake and eventual demise of your political advances.

          • elliemae100 May 3, 2014 at 3:53 am

            Thank you for comparing my writing style to that of a State Senator. I don’t know the State Senator, never met him, and am not an “outsider.” It doesn’t offend me that those people who disagree with me have nothing more to say than that they suspect I have ties to Gold Cross. I don’t – but again, thank you for presenting your narrow view that the Washington County Public School System couldn’t possibly have provided my primary education.
            I do have extensive knowledge of EMS. I also have the ability to read, and to research these issues. Yes, Gold Cross is making profits but the company is viable (unlike Dixie, where the owners removed all of the profits). My point is that Dixie failed at its mission and when it was called on it, then complained bitterly that the City didn’t support it. Michelle Randall ran a failed company – that the city council would ask her opinion about these issues yet not seek the counsel of the company who meets the state’s minimum requirements shows that the “good ol’ boy system” our elected representatives ran against is alive and well.
            “Shiny new leased rigs and WELL MAINTAINED equipment certainly does equate to better patient care, as does the current company’s ability to follow the rules set forth by BEMS. And I would hope that the professionals at the local ER would be busy caring for patients and not “rolling their eyes.”
            Nothing has changed in St. George, where I’ve lived most of my life, was educated and raised my family.

    • Observer April 27, 2014 at 12:22 am

      “finally providing excellent service in our community”??? You’re joking right? Shiny new leased rigs and equipment does not equate to better patient care. Your comment is inflammatory and ignorant.

    • ELLIE IS STEVE April 27, 2014 at 11:53 am

      Read the PDF. It says Gold Cross will have 4, 2 paramedic staffed ambulances 24/7 for St. George City. I’m not seeing anywhere in the ordinance or Gold Cross’ promise to “provide better care” that differs. Maybe Dixie Ambulance was doing the right job when Gold Cross’ “analyst” decided they needed better care. Well Gold Cross shot themselves in the foot it looks like promising things that are losing them money. Seems they can’t pay Steve off anymore. Going back to “providing excellent care” how many lawsuits did Dixie Ambulance have compared to Gold Cross’ current legal situations? Pathetic if you think they are providing excellent patient care. Go sit in the ER for 12 hours and watch the staff roll there eyes when those monkeys come in.

  • Maggie April 26, 2014 at 6:49 pm

    I am surprised how little people know, and yet they comment. Sad!
    The council, it appears wants to be sure we have good ambulance service, Mrs Randall is no part of that service ,but she does know the lingo and understands what it takes to meet the needs being discussed, since she was elected to city council does it not make sense to utilize her talents?
    If you feel the previous ambulance company did not meet these needs, isn’t it important that council avoids this problem with Gold Cross? Besides ,we were told that Gold Cross was an excellent ambulance provider, better than the one we had. Perhaps we are just getting everything in writing so both sides are aware of expectations on both sides. I am surprised a rep from Gold Cross was not there to have input . I think that would have been important to them so that they, not Mrs Randall would have to clarify info.

  • ArmyVet April 27, 2014 at 9:54 am

    Interesting no representation from Gold Cross was present, considering their legal counsel, Mr Steve Urqhart (State Senator from Washington County) lives just down the street. I’m sure he has plenty to say about the situation. Huge conflict of interest there, don’t you think?

  • COMBAT VET AND CONSERVATIVE April 28, 2014 at 9:35 am

    Just a thought. I frequent the Habitat for Humanity Re Store located just off Riverside Drive. In the past 2 months that I have visited the Re Store, I have noticed that a Gold Cross ambulance is ALWAYS parked in the Re Store parking lot. Is this a strategic location for the ambulance? I have observed the ambulance personnel either eating and/or sleeping in the ambulance while parked under the shade tree near the driveway approach to the lot. I wonder if they had to conform to the new proposed guidelines, would we still continue to see this ambulance parked in the Re Store parking lot? And if it is a strategically located position, who decided that an industrial location would be best? Sure would like to know from Gold Cross execs if they would publicly address this. Gold Cross?????

  • An angry resident May 2, 2014 at 11:07 pm

    With further regard to the “ambulance situation” , I am hoping that this topic can be discussed at a Town Hall type meeting. Early last year when the so-called discussions re Dixie vs Gold Gross were in discussion of Dixie’s inadequate response, I fully investigated the topic. What I learned was that the Fire Chief was upset with the fact that I had gathered actual facts and figures and it was strongly suggested that I not collect further information. By the way, why is it that the owner of Gold Cross is NEVER reachable. It is time to let the residents have their say.

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