AGENDA CAPTION:
Title
Receive a report on the San Marcos Emergency Medical Services (EMS) Feasibility Study, and provide direction to the City Manager.
Body
Meeting date: January 20, 2026
Department: City Manager’s Office
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Background Information:
The City initiated an Emergency Medical Services (EMS) Feasibility Study to identify a cost-effective and financially sustainable approach to providing Advanced Life Support (ALS) emergency medical transport services while maintaining service reliability, public accountability, and operational control. This evaluation was undertaken in response to increasing medical call volumes, sustained population growth, and recent changes in regional EMS participation that have shifted greater financial responsibility to the City.
Emergency medical services represent one of the most significant and rapidly growing cost drivers within the City’s public safety operations. Medical calls comprise the majority of emergency responses and are projected to continue increasing steadily over the next 15 years. Without a delivery model that provides strong cost controls and budget predictability, rising demand will place increasing pressure on staffing levels, fleet replacement schedules, and operating expenses, creating long-term financial risk for the City.
The feasibility study evaluated three operationally viable service delivery models: continuation of a City-only regional EMS model, integration of EMS services into the Fire Department, and establishment of a standalone, City-operated EMS department. While each option can provide emergency medical services, the analysis identified meaningful differences in long-term cost control, administrative efficiency, governance stability, and financial risk.
Establishing a City-operated EMS department provides the City with the greatest ability to directly manage costs, improve financial transparency, and reduce long-term uncertainty. Under this model, all EMS revenues and expenditures are consolidated within the City’s budget, eliminating reliance on external governance structures and improving oversight of staffing, deployment strategies, and capital investments. This structure allows resources to be scaled incrementally based on measured demand rather than contractual or interlocal obligations, reducing the likelihood of sudden or unplanned cost increases.
From a financial perspective, a City-operated EMS department offers several advantages. Staffing levels, compensation structures, and deployment models are determined by the City and adjusted through the annual budget process, providing predictable operating costs. Consolidation under City management reduces administrative duplication and associated professional service expenses. Patient transport revenues flow directly to the City, improving transparency and allowing for more accurate revenue forecasting. Capital replacement schedules and fleet expansion can be phased strategically, lowering long-term financial risk and avoiding large, unanticipated expenditures.
The recommended service model is based on operating six ALS transport units, 24 hours per day, supported by a lean supervisory and administrative structure. Financial projections indicate this deployment level is sufficient to meet current service demand while avoiding overstaffing, excessive unit utilization, and overtime pressures that would otherwise drive future expansion costs.
While the standalone EMS department option requires the most extended implementation period, estimated within approximately 21 months, this transition timeline allows for phased implementation that maintains uninterrupted service delivery while minimizing financial and operational risk. Although startup complexity and upfront costs are higher than other options, these short-term challenges are offset by improved long-term governance stability, financial control, and operational focus specific to emergency medical services.
Integrating EMS into the Fire Department was also evaluated as a viable alternative. This option represents lowest-risk implementation path, as it leverages existing City infrastructure, leadership, labor agreements, and support services, thereby reducing duplication and facilitating a smoother transition. However, long-term cost projections for this model are higher than those of a standalone EMS department, and integration introduces competing operational priorities that may limit cost optimization and financial flexibility over time.
Based on current system performance, projected service demand, financial modeling, and comparative review of peer agencies, the study recommends that the City establish a standalone, City-operated Emergency Medical Services Department to provide Advanced Life Support emergency medical transport services. This model best aligns with the City’s objectives of direct accountability, long-term financial sustainability, governance stability, and the ability to scale services responsibly in response to continued community growth and evolving regional service relationships. On September 16, 2025, Council adopted a tax rate of 65.15 cents, which provided an additional $2million in funding for EMS services.
Lastly, the City Manager’s Office has engaged in ongoing coordination with ESD9 and other relevant stakeholders to incorporate their input and address any EMS-related matters, with the objective of ensuring continued delivery of high-quality emergency medical services during ESD9’s transition to a standalone model.
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Recommendation:
Staff recommends establishing a standalone, City operated EMS Department.