8. Discussion and possible approval of the proposed revised Regional Emergency Medical Services Authority (dba REMSA Health), Amended and Restated Franchise Agreement for Ambulance Service, effective July 1, 2026. (FOR POSSIBLE ACTION)
Staff Representative: Dr. Chad Kingsley
I am writing in strong support of REMSA Health’s franchise extension.
I serve as president of the Academy of International Mobile Healthcare Integration (AIMHI) which represents high-performance EMS agencies across the U.S. and internationally. Member organizations, including REMSA Health, combine evidence-based clinical practice, transparency, accountability, and close government oversight to deliver exceptional patient care with demonstrable cost efficiency.
REMSA Health exemplifies the principles that AIMHI exists to promote.
History matters in decisions such as this. The franchise model adopted by local governments, including the DBOH, aimed to correct failures of fragmented EMS. The results in Washoe County are evident in system performance, community trust, and clinical outcomes. REMSA’s longevity is not accidental. It's proof of a stable, clinically sophisticated, and highly accountable, mature and reliable EMS system and reflects sustained investment in medical oversight, quality assurance, workforce development and community integration.
Clinically, REMSA is consistent with the best EMS systems in the nation. Dual, local, practicing medical directors ensure real-time clinical relevance and strong hospital integration. REMSA’s commitment to accreditation demonstrates a willingness to subject itself to rigorous external review. Further, REMSA conducts clinical review on 100 percent of high-risk/high-impact clinical events, and maintains a structured, data-driven dispatch review process.
Strong EMS systems do not exist in isolation. They require thoughtful governance, collaboration with public health and elected leadership, and a culture of transparency. REMSA’s current executive team demonstrates a clear commitment to partnership, open communication and doing what is right for patients and the community – regardless of jurisdictional boundaries.
From AIMHI’s perspective, and based on decades of national and international EMS system experience, REMSA represents exactly the kind of EMS organization that local governments should seek to preserve and support.
I respectfully urge you to approve REMSA’s franchise extension. Thank you for the ability to comment & for your stewardship of public health and EMS.
My name is Brad Kitts and I am part of the leadership team of Battle Born Medevac. We are an Air Ambulance provider with our primary receiving facility area being Reno. Additionally, I have served on the flight line in Northern Nevada for more than a decade and have utilized REMSA ground ambulances to complete transports to Reno area hospitals many times.
The nature of 911 systems is that requests for service is variable and unpredictable. Do to this variability, it is not possible to meet the demand 100% of the time. I have personally experienced delays in transport due to ambulance availability more than once prior to the start of Battle Born Medevac. As part of the leadership team for Battle Born Medevac, I have identified 2 specific examples of delay in transport since 2024. I believe there are several more instances but I cannot prove it with the data available.
Currently we have access to multiple ambulance providers and I believe more resources allows for this demand to met and prevent delaying transport. Battle Born Medevac primarily utilizes REMSA and Technical Medical to complete our Air Ambulance Airport transfers. I believe both services are excellent and provide professional medical crew and clean functional equipment. As mentioned previously, the history of delays from REMSA is the reason for opposing this agenda item.
I oppose the following language to give REMSA the sole right the air ambulance airport transfers:
“Section 2.1 (a) REMSA Health has exclusive market rights to provide ground ambulance transportation associated with air ambulance transports or air transfers that originate outside of the Franchise Service Area and terminate within the Franchise Service Area which require ground ambulance transportation in the Franchise Service Area;”
I am strongly in support of renewing REMSA’s franchise.
During my husband Allen Hauth’s most recent transport to the ER, the response time was remarkably fast. The EMTs / paramedics who cared for him were gentle, efficient, professional, and genuinely compassionate. What stood out just as much as their medical skill was the way they treated ME at such an emotional time. They spoke to me with calm reassurance, explained what was happening, and made sure I felt supported rather than helpless on the sidelines. Their kindness steadied me when I needed it most.
I know they face intense pressures and encounter difficult situations every day, yet they continue to serve with admirable professionalism and humanity. Their dedication deserves recognition and continued support.
I am grateful and thankful!
Susan Hauth
Dear Chair and Members of the Board,
I am a retired fire chief with over 37 years of experience in the Fire/EMS service. I am writing in support of the REMSA Health Franchise Agreement listed as Agenda Item #8 on today’s agenda.
REMSA Health has served as the primary emergency medical services provider in Washoe County since 1986, delivering essential prehospital care to residents and visitors across Northern Nevada. In 2025, REMSA responded to 97,143 emergency incidents, underscoring the importance of a stable, well coordinated EMS system.
Beyond 911 response, REMSA provided 64 Tactical Medical responses supporting local law enforcement, responded to 81 Search and Rescue calls, and covered approximately 1,300 special event shifts throughout Washoe County, ensuring public safety at community events.
Over 30 years ago, REMSA adopted the High-Performance EMS model, emphasizing data driven operations, clinical quality review, and continuous improvement to deliver high quality, cutting edge emergency medical care. Adopting the High-Performance EMS model ensures that REMSA stays on the cutting edge of patient care and EMS technologies.
Since 1986 REMSA had integrated itself into the community and has strong and proven partnerships with fire departments, law enforcement agencies, public health, and of course the hospitals and care facilities in the Washoe County region. REMSA also plays a significant role in community education and prevention, teaching CPR to 12,621 community members and installing 952 car seats for new families in 2025.
Approval of the franchise agreement will provide continuity, accountability, and the operational stability necessary to maintain and enhance emergency medical services aligned with public health goals. For these reasons, I respectfully support approval of the REMSA Health Franchise Agreement.
Thank you for your consideration.
Sincerely,
Sean Slamon
I am writing to express my support to extend the franchise agreement, allowing REMSA Health to continue serving as the exclusive emergency medical services transport provider in Washoe County. As the Operations Coordinator of the Washoe County Nevada Cares Campus and Our Place (the homeless shelters in Washoe County), I’ve seen firsthand the invaluable impact the REMSA staff and teams have on the unhoused community we serve. Extending the agreement would continue the consistent response to emergency medical incidents and, ultimately, would continue to serve our community.
The unhoused in our region face significant barriers to accessing healthcare, and the need for consistent care is required. The REMSA team has been crucial in bridging healthcare gaps, offering rapid response, coordinating medical treatment, and collaborating to ensure unhoused individuals are not bouncing back and forth between medical facilities, the streets, and the shelters. The REMSA staff display empathy, compassion, and understanding to those who may be overlooked by traditional healthcare systems. The REMSA collaboration efforts have increased communication between emergency shelter staff and healthcare system staff. The REMSA team has helped improve access to healthcare and the health of clients staying at the Nevada Cares Campus and Our Place.
It has been a privilege to collaborate with REMSA staff. Their skills, dedication, and compassion have been vital to improving the healthcare of the unhoused. If this agreement is continued, the stakeholder relationships REMSA helped develop and maintain will play an important role in shaping future healthcare for underserved communities in our region.
I strongly support the extension of the franchise agreement, allowing REMSA Health to continue serving as the exclusive emergency medical services transport provider in Washoe County and believe it will have a lasting, positive impact on our community. Thank you for your consideration.
Sincerely,
Sabrina Sweet, Human Services Coordinator
Washoe County Human Services Agency, Division of Housing and Homeless Services
I have been a resident of Washoe County for 43 years. The majority of this time I was employed by hospitals (Emeregency and ambulatory care) and private businesses. I always had an Excellent relationship with REMSA.
I remember when there were 2 Ambulance services, MEDIC1 and AIDS.
The professionalism and caring response is always amazing.
I have also been on the receiving end of REMSA.
REMSA is an integral part of our community. Th
I am an actively working emergency physician in California, who was born and raised in Reno. My mom, who still lives in Reno, recently had a life threatening medical emergency in a third world country and I needed to get her home safely. I was in contact with many different organizations in order to do this and had to coordinate her arrival back home. This included safe medical transport from the airport to the hospital for further care. The time window for her transport out of that country was somewhat uncertain due to geopolitical unrest in that country. Once she was able to get out and airborne I would have 24 hours to set up the ground transport from the airport to the hospital. I had contacted REMSA for transport from the airport to the hospital. This was not something routinely done by the staff I initially spoke with, and so was forwarded to the administrative staff directly to help. Coordinating this required multiple phone conversations to keep everyone updated based on the status of the flight so they could have an ambulance there ready and waiting. All of my interactions with REMSA were fantastic and they made the process seamless. There was an ambulance waiting at the airport when my mom landed in Reno. The REMSA crew transported my mom and the air ambulance medical team to the hospital without incident. I was in contact with REMSA that whole day updating the arrival time with them and everything went perfectly. In a world that is getting more distant, less personal and with many intermediaries it was so refreshing to work and interact directly with those at REMSA, from the dispatch to administration, in such a personal way. This is how things used to work years ago and to still have a business model like this is remarkable. Reno is fortunate to have REMSA, not all EMS services are like this, speaking from experience. I write this in support for REMSA to keep their extension. They have been the main EMS service in Reno since I can recall and they have that native hometown Nevadan hospitality that Reno should be proud of. Please don't let that go.
As a proud resident of Washoe County, I highly support the revision of the REMSA franchise agreement. Before my father passed from cancer, there were numerous times we needed emergency assistance to get him from his home to the hospital. REMSA was there for the last time he needed to be transported from one hospital to where he received his final care. The REMSA staff was there for him each time and were beyond gentle and helpful for all of those times.
In addition to the care REMSA gave my father, they also were very responsive to the needs of the other family members who needed care and transport to the hospital.
Finally, but as important as the care that was given my father and other family members, I worked many years at a Memory Care facility in Sparks. Many times a week we would need to call REMSA to come and give care and transport our residents. The REMSA crew was always prompt to respond to our calls, and were very respectful of the resident's needs, while they were preparing them for transport to the hospital. I can't express how important their service was to me both personally, and professionally, and I HIGHLY recommend renewing their franchise agreement to service Washoe County.
Good afternoon, Chair Reese and members of the District Board of Health. For the record, my name is Cora Case. I am the district board of health’s financial appointee to the REMSA Health board of directors.
I am writing to respectfully express my strong support for REMSA Health and its continued role as Washoe County’s exclusive provider of emergency and nonemergency medical transport.
As this body’s financial appointee, it is my responsibility to ensure that REMSA Health, a 501 (c)(3) nonprofit organization, is financially secure and making business decisions in the best interest of the public trust that the District Board of Health has placed in it.
Without hesitation, I can affirm that REMSA Health is financially stable and well-positioned for long-term fiscal health. Through inclusion in its franchise reports, annual third-party audits of our financial statements, as well as Community Investment Fund and average bill audits and the public availability of its Form 990 document, REMSA Health is committed to a level of transparency and accountability that reflects how it upholds and delivers on the promise it has made to the citizens of Washoe County.
REMSA Health’s executive leadership delicately and successfully balances being responsible stewards of its limited healthcare revenue with raising funds to offset reimbursement shortfalls and still reliably invests in employees, technology and infrastructure that creates the REMSA Health safety net that this community relies on so heavily.
Thank you.
Cora Case, PhD
REMSA Health Board Finance Chair
On February 5, 2022, my son was injured during an ArenaCross event and required emergency medical care and transport. Although his most visible injury was a severely fractured arm, he began experiencing worsening dizziness, shortness of breath, and abdominal pain while awaiting transport. When the next ambulance arrived, the responding REMSA Health paramedic immediately recognized the seriousness of his condition, took control of the scene, and initiated rapid transport to the trauma center. She provided prompt stabilization, pain management, and calm, professional reassurance to my son and our family during a frightening situation.
Upon arrival at the trauma center, my son was diagnosed with multiple complex arm fractures, bilateral pulmonary contusions with a partial pneumothorax, and a grade 5 liver laceration. His injuries were life-threatening, and it is my sincere belief that the paramedic’s clinical judgment, experience, and adherence to established protocols played a critical role in his outcome. One misstep during those early moments could have had devastating consequences.
While my son remembers little from that night, he does remember the paramedic who cared for him and how safe she made him feel. That sense of trust left a lasting impression on our entire family.
Today, my son is healthy, thriving, and pursuing his future, something we do not take for granted. Our experience reinforced the importance of high-quality, well-coordinated emergency medical services.
REMSA Health has served Northern Nevada for decades with consistent, professional, and highly skilled prehospital care. The organization’s commitment to clinical excellence, accountability, and patient-centered service is evident in critical emergencies and everyday calls alike.
For these reasons, I strongly support extending the franchise agreement for our local ambulance service. Continuity in emergency medical services matters, and our community benefits from an experienced provider with proven systems, deep local knowledge, and a demonstrated commitment to saving lives. I respectfully urge the Board of Health to support the extension of the REMSA franchise agreement.
The support of the revised REMSA franchise agreement is beneficial for our community because it stands to strengthen emergency medical service delivery across Washoe County. The agreement modernizes governance, reinforces accountability, and ensures long-term service reliability for residents, visitors, and regional partners. The public benefits from updated performance standards, enhanced system readiness for high demand events, disasters, and population growth which is critical to our expanding community. Additionally, the amended agreement provides for greater transparency and assurance that public expectations are being met. A key factor that should be highlighted is that this agreement aligns ambulance rates, cost recovery and system investments more clearly, without burdening or creating additional financial risk to consumers.
Let's also consider the pros of a single system model that ensures equal service to all parts of the county, including rural and lower population areas. Competitive markets tend to lean into higher profit areas leaving gaps in coverage for all county citizens. Fragmented provider competition can also create delays due to duplication whereas a centralized dispatch and deployment plan produce consistent response performance. Finally, the benefits of a regulated franchise system establish transparent performance standards, oversight, and enforcement tools that are harder to impose on multiple private companies. A regulated franchise model is self-sustaining and avoids cost shifting, billing inflation, and financial instability that occur in competitive markets.
The benefits of supporting the amended franchise agreement preserves a well-established EMS system that is better equipped to serve all areas of Washoe County and does not promote a profit-driven model that can compromise coverage, quality and long-term sustainability.
As the volunteer president of REMSA Health’s Board—and the hospital appointed consumer representative—I serve with a board made up entirely of volunteers appointed by the DBOH or representing our region’s three hospital systems. That blend of clinical expertise, operational insight, and fiduciary responsibility ensures strong, balanced governance focused solely on providing exceptional EMS care in the best interest of the people of Washoe County.
Because REMSA Health is a community owned, private nonprofit, every dollar we earn is reinvested locally and goes directly into employee wages and benefits, mission critical equipment, and the community programs that keep our region safer and healthier. In the last eight years, REMSA Health has invested more than $31.5 million in capital projects and equipment to care for our colleagues, neighbors, friends, and families. We are not funded by a distant corporation or private equity group—our providers don’t come to work to make investors wealthy; they come to work to make their community healthy.
Nearly 40 years ago, Washoe County and the cities of Reno and Sparks, along with the local hospitals, worked with this Board to establish a unified health district and an exclusive franchise model. That decision created accountability, performance standards, and layers of independent review—all at no cost to taxpayers.
And today, the model continues to work. REMSA Health remains a high performing emergency and non-emergency medical transport, dispatch and education organization that delivers equal, consistent care across the county, maintains required accreditations, meets contract based performance standards, and reinvests all revenue back into the community.
As a nonprofit powered by people who live, work, learn, and raise their families here, we are proud—and honored—to be entrusted with providing emergency medical services for Washoe County. I respectfully urge you to approve the extension of the franchise agreement.
A resident for over 50 yrs, I am in strong support of REMSA & the continuation of its franchise agreement. For decades, thousands have experienced REMSA’s care firsthand, & those experiences consistently reflect rapid response, clinical expertise, & compassionate service. These are are not abstract claims—they are the real experiences of people whose lives were saved or stabilized in their worst moments. Some concerns raised in opposition deserve acknowledgment, but they require clarification: 1.Isolated delays do not define system performance. Any EMS system will have rare delays during simultaneous high‑acuity incidents & hospital offload congestion. These outliers do not reflect REMSA’s overall performance, which consistently meets or exceeds contractual standards. 2.The unified system is intentional—for patient safety. Washoe County adopted an integrated EMS model because fragmented, multi‑agency response previously created inconsistent care, unequal standards, and unregulated costs. A single system with unified protocols, centralized dispatch, medical direction, and transparent oversight prevents those issues from returning. 3.Air medical concerns misinterpret both law and practice. Nothing in the agreement prevents hospitals or flight providers from meeting EMTALA obligations or using the nearest appropriate resource when required. REMSA has coordinated effectively with air medical partners for decades. 4. Accountability is increased, not reduced. Updated performance metrics, penalties, & oversight mechanisms strengthen transparency. The Community Fund ensures that any fines directly support patient‑focused improvements. 5.Antitrust concerns are not supported. Local governments have clear legal authority to structure EMS systems to protect public health & safety. Washoe County has done this for nearly 40 yrs without legal challenge. Residents trust REMSA because they have witnessed the quality of its care. REMSA is nationally accredited, physician‑directed, and fully self‑funded with no tax dollars. For these reasons, I urge you to approve the franchise agreement so REMSA can continue providing the unified, accountable, high‑quality emergency care our community depends on.Thank you for your consideration.
I strongly support the extension of REMSA’s franchise agreement, allowing REMSA Health to continue serving as the exclusive emergency medical services transport provider in Washoe County. In my work partnering with REMSA on a community-based falls prevention project, I have seen firsthand their professionalism, responsiveness, and commitment to collaboration that improves outcomes for older adults and other vulnerable residents. REMSA is a trusted partner that plays a critical role in the health and safety of our community, and continuity of their services is vital for effective emergency response and prevention efforts.
Hello, I am a proud resident of Washoe County. I have used REMSA’s services multiple times over the years for myself and my husband. The crews have always responded quickly and gone above and beyond to care for us. There is no one better equipped to provide emergency medical services to our community. Their expertise, compassion and professionalism surpass what any other agency could ever offer. Years ago, we signed up for their membership program - another generous resource this organization offers to our community. This has given our family tremendous peace of mind. It is clear REMSA genuinely cares about their patients and is an irreplaceable resource for us all.
I respectfully urge you to approve the extension of REMSA’s franchise agreement so the team that does it best can continue serving us.
My family and I are forever grateful to REMSA. Thank you all.
Greetings...
Please, please, please approve the proposed revised REMSA Health and Restated Franchise Agreement for Ambulance Service. We desperatey need this ambulance service and all that it provides. I have had to use the ambulance service quite a few times in recent years. In October of 2025 I took a bad fall and needed REMSA badly. The response was quick, the paramedics were professional, courteous, helpful, caring and provided safe transport of me to the hospital. Had they not been there, I really think I could've died. Each time that I have used REMSA they have been nothing less than a Godsend for me. Please, please approve this franchise so that we can maintain this most vital service for our community.
Sincerely,
George C. Bratiotis
Dear Members of the Board, This agenda item represents significant changes in the Washoe County Ambulance Franchise to include language that attempts to further restrict the market to competitors, in an EMS system that is already scarce with resources, and without proper public process. Additionally, the attempt to change the Term of the Ambulance Franchise to "Perpetual" may be contrary to State and Federal Anti-Trust regulations. The attempt to do so without proper public process gives the appearance of conspiratorial and anti-competitive behavior. Other major changes include a new performance measurement scheme that will decrease the required P-1 response time requirement to 89% in Zone A, as long as the contractor is 90% in Zones B,C and D. REMSA already posts a consistent 90% compliance for Zone A, the lowest allowable under the current contract. On any given month, that could mean up to 900 responses across all Priorities are not responded to within the time standard. What's the rush?! Why is the DBOH in a hurry to make these changes? REMSA has four years left on their current contract. If Franchise changes are necessary, why not provide for an appropriate amount of Public Process. Allow the community stakeholders and subject matter experts the opportunity to properly evaluate these changes. Additionally, some of these changes may violate Federal and State Laws: The Airline Deregulation Act of 1978 preempts interference with Price, Route and Service of an Air Carrier, Federal and State Anti-Trust laws may disallow a private services contract or Franchise with a perpetual Term. When ambulances from REMSA are not available and patients must wait at sending facilities, Hospitals are obligated to source other services to satisfy appropriate transport requires un the Emergency Medical Treatment and Labor Act (EMTALA). Not having other providers to source impact patient care negatively. To avoid the appearance of anti-competitive behavior and to ensure all Federal and State Laws will not be violated, changes to the Franchise must be undertaken with extreme caution to ensure the best outcomes for patients and allow the Free Market to add supply of Resources. Not doing so will have dire consequences. -Aaron A.
Dear Chairman Reese and Members of the Northern Nevada Public Health Board,
I would like to express my strong support for REMSA Health and the continuation of its franchise agreement.
In 2020, my husband experienced a medical emergency, and REMSA paramedics were the first to arrive. Although my husband ultimately did not survive, I will always be grateful for the professionalism, compassion, and expertise demonstrated by the paramedics who cared for him.
That was one of the worst moments of my life, and they treated my husband with dignity and cared for our family with respect during an incredibly painful time. While the outcome was not what we hoped for, the quality of care they provided mattered deeply and will always stay with me.
Emergency medical services are something you seldom think about until you need them and when you do, having a skilled, well-trained, reliable system in place makes all the difference. REMSA Health provides that level of care to our community and my experience is a powerful reminder of the importance of having dedicated emergency medical professionals available when families need them most.
I urge you to consider the real human impact of this decision and to continue supporting REMSA Health and the essential work they do every day.
Before 1986, ambulance service in Washoe County was fragmented and unsafe – marked by poor patient care, slow response times, inadequate equipment, no accountability, and high, unregulated transport costs. There were no formal standards for clinical care, response times, or rate setting to ensure patient safety.
To correct this, the Cities of Reno and Sparks and Washoe County used Nevada law to form a regional health authority. Under Nevada Revised Statutes, local governments may create a district board of health by interlocal agreement; Reno, Sparks, and Washoe County did so, establishing the Washoe County District Board of Health as the regional public health governance body.
In 1986, the District Board of Health (DBOH) exercised authority granted to counties and cities under Nevada statutes to limit competition in ambulance service in order to ensure adequate, economical, and efficient patient care. Acting through the newly formed health district, the Board incorporated the Regional Emergency Medical Services Authority (REMSA) and awarded an exclusive franchise for ambulance services. That action was memorialized by a DBOH resolution in October of 1986, and a Memorandum of Understanding in May of 1987 – establishing REMSA as the county’s EMS authority and creating a single, accountable system.
This structure brought strict response time and performance requirements, average bill costs monitored and set by the DBOH, and multiple layers of independent oversight, including the DBOH itself and nationally recognized accreditation bodies. Later franchise updates have continued that oversight framework and performance-based accountability.
Nearly forty years later, the result is a high performance, high value EMS system that provides equal standards of care across Washoe County – without taxpayer subsidy—and remains aligned with the community’s needs and patient safety. The model works because the DBOH created clear authority, unified standards, and robust accountability from day one.
I would urge the board to approve the proposed franchise agreement.
Sincerely,
Louis Test
REMSA Health Board of Directors
This communication is to express my strong support for REMSA Health and its continued role as Washoe County’s exclusive emergency medical services provider. For four decades, REMSA has delivered a high-performing, community-focused EMS system that stands as a national model of excellence.
One of REMSA’s most significant contributions to public safety is its regional emergency communications division. For more than 22 years, REMSA has continually maintained its status as an Accredited Center of Excellence (ACE) from the International Academies of Emergency Dispatch for its medical dispatch center, a distinction requiring rigorous compliance to a 20-point assessment every three years. In 2024, REMSA Health became Washoe County’s first, and remains its only, emergency fire dispatch ACE.
Every REMSA dispatcher holds EMT or paramedic certification, ensuring that emergency calls are managed by professionals with clinical experience. This level of training and accountability is rare and reflects REMSA’s dedication to patient care and operational excellence. Dispatch quality is continuously monitored through systematic reviews including 80 percent random selection and 20 percent focused audits driven by monthly quality improvement themes. These processes guarantee accuracy, consistency, and adherence to nationally recognized protocols. More importantly, that assures those calling for assistance are receiving potentially lifesaving interventions at the second the telephone is answered.
REMSA Health is a private, nonprofit organization that responds to more than 92,000 calls annually at no cost to taxpayers. It is entirely self-sustaining through user fees and philanthropic support, reinvesting revenue back into the community.
It is respectfully urged that you approve REMSA Health’s franchise extension. Doing so will preserve a nationally recognized EMS model that delivers exceptional care and dispatch excellence to the citizens of Washoe County and the patients it serves.
Thank you for your leadership and commitment to the health and safety of Washoe County residents. Please contact me with any questions.
I am writing in strong support of REMSA Health’s franchise extension.
I serve as president of the Academy of International Mobile Healthcare Integration (AIMHI) which represents high-performance EMS agencies across the U.S. and internationally. Member organizations, including REMSA Health, combine evidence-based clinical practice, transparency, accountability, and close government oversight to deliver exceptional patient care with demonstrable cost efficiency.
REMSA Health exemplifies the principles that AIMHI exists to promote.
History matters in decisions such as this. The franchise model adopted by local governments, including the DBOH, aimed to correct failures of fragmented EMS. The results in Washoe County are evident in system performance, community trust, and clinical outcomes. REMSA’s longevity is not accidental. It's proof of a stable, clinically sophisticated, and highly accountable, mature and reliable EMS system and reflects sustained investment in medical oversight, quality assurance, workforce development and community integration.
Clinically, REMSA is consistent with the best EMS systems in the nation. Dual, local, practicing medical directors ensure real-time clinical relevance and strong hospital integration. REMSA’s commitment to accreditation demonstrates a willingness to subject itself to rigorous external review. Further, REMSA conducts clinical review on 100 percent of high-risk/high-impact clinical events, and maintains a structured, data-driven dispatch review process.
Strong EMS systems do not exist in isolation. They require thoughtful governance, collaboration with public health and elected leadership, and a culture of transparency. REMSA’s current executive team demonstrates a clear commitment to partnership, open communication and doing what is right for patients and the community – regardless of jurisdictional boundaries.
From AIMHI’s perspective, and based on decades of national and international EMS system experience, REMSA represents exactly the kind of EMS organization that local governments should seek to preserve and support.
I respectfully urge you to approve REMSA’s franchise extension. Thank you for the ability to comment & for your stewardship of public health and EMS.
Dear Members of the Board,
My name is Brad Kitts and I am part of the leadership team of Battle Born Medevac. We are an Air Ambulance provider with our primary receiving facility area being Reno. Additionally, I have served on the flight line in Northern Nevada for more than a decade and have utilized REMSA ground ambulances to complete transports to Reno area hospitals many times.
The nature of 911 systems is that requests for service is variable and unpredictable. Do to this variability, it is not possible to meet the demand 100% of the time. I have personally experienced delays in transport due to ambulance availability more than once prior to the start of Battle Born Medevac. As part of the leadership team for Battle Born Medevac, I have identified 2 specific examples of delay in transport since 2024. I believe there are several more instances but I cannot prove it with the data available.
Currently we have access to multiple ambulance providers and I believe more resources allows for this demand to met and prevent delaying transport. Battle Born Medevac primarily utilizes REMSA and Technical Medical to complete our Air Ambulance Airport transfers. I believe both services are excellent and provide professional medical crew and clean functional equipment. As mentioned previously, the history of delays from REMSA is the reason for opposing this agenda item.
I oppose the following language to give REMSA the sole right the air ambulance airport transfers:
“Section 2.1 (a) REMSA Health has exclusive market rights to provide ground ambulance transportation associated with air ambulance transports or air transfers that originate outside of the Franchise Service Area and terminate within the Franchise Service Area which require ground ambulance transportation in the Franchise Service Area;”
Thank you for your consideration,
Brad Kitts
I am strongly in support of renewing REMSA’s franchise.
During my husband Allen Hauth’s most recent transport to the ER, the response time was remarkably fast. The EMTs / paramedics who cared for him were gentle, efficient, professional, and genuinely compassionate. What stood out just as much as their medical skill was the way they treated ME at such an emotional time. They spoke to me with calm reassurance, explained what was happening, and made sure I felt supported rather than helpless on the sidelines. Their kindness steadied me when I needed it most.
I know they face intense pressures and encounter difficult situations every day, yet they continue to serve with admirable professionalism and humanity. Their dedication deserves recognition and continued support.
I am grateful and thankful!
Susan Hauth
Dear Chair and Members of the Board,
I am a retired fire chief with over 37 years of experience in the Fire/EMS service. I am writing in support of the REMSA Health Franchise Agreement listed as Agenda Item #8 on today’s agenda.
REMSA Health has served as the primary emergency medical services provider in Washoe County since 1986, delivering essential prehospital care to residents and visitors across Northern Nevada. In 2025, REMSA responded to 97,143 emergency incidents, underscoring the importance of a stable, well coordinated EMS system.
Beyond 911 response, REMSA provided 64 Tactical Medical responses supporting local law enforcement, responded to 81 Search and Rescue calls, and covered approximately 1,300 special event shifts throughout Washoe County, ensuring public safety at community events.
Over 30 years ago, REMSA adopted the High-Performance EMS model, emphasizing data driven operations, clinical quality review, and continuous improvement to deliver high quality, cutting edge emergency medical care. Adopting the High-Performance EMS model ensures that REMSA stays on the cutting edge of patient care and EMS technologies.
Since 1986 REMSA had integrated itself into the community and has strong and proven partnerships with fire departments, law enforcement agencies, public health, and of course the hospitals and care facilities in the Washoe County region. REMSA also plays a significant role in community education and prevention, teaching CPR to 12,621 community members and installing 952 car seats for new families in 2025.
Approval of the franchise agreement will provide continuity, accountability, and the operational stability necessary to maintain and enhance emergency medical services aligned with public health goals. For these reasons, I respectfully support approval of the REMSA Health Franchise Agreement.
Thank you for your consideration.
Sincerely,
Sean Slamon
Washoe County District Board of Health (DBOH)
To whom it may concern:
I am writing to express my support to extend the franchise agreement, allowing REMSA Health to continue serving as the exclusive emergency medical services transport provider in Washoe County. As the Operations Coordinator of the Washoe County Nevada Cares Campus and Our Place (the homeless shelters in Washoe County), I’ve seen firsthand the invaluable impact the REMSA staff and teams have on the unhoused community we serve. Extending the agreement would continue the consistent response to emergency medical incidents and, ultimately, would continue to serve our community.
The unhoused in our region face significant barriers to accessing healthcare, and the need for consistent care is required. The REMSA team has been crucial in bridging healthcare gaps, offering rapid response, coordinating medical treatment, and collaborating to ensure unhoused individuals are not bouncing back and forth between medical facilities, the streets, and the shelters. The REMSA staff display empathy, compassion, and understanding to those who may be overlooked by traditional healthcare systems. The REMSA collaboration efforts have increased communication between emergency shelter staff and healthcare system staff. The REMSA team has helped improve access to healthcare and the health of clients staying at the Nevada Cares Campus and Our Place.
It has been a privilege to collaborate with REMSA staff. Their skills, dedication, and compassion have been vital to improving the healthcare of the unhoused. If this agreement is continued, the stakeholder relationships REMSA helped develop and maintain will play an important role in shaping future healthcare for underserved communities in our region.
I strongly support the extension of the franchise agreement, allowing REMSA Health to continue serving as the exclusive emergency medical services transport provider in Washoe County and believe it will have a lasting, positive impact on our community. Thank you for your consideration.
Sincerely,
Sabrina Sweet, Human Services Coordinator
Washoe County Human Services Agency, Division of Housing and Homeless Services
I have been a resident of Washoe County for 43 years. The majority of this time I was employed by hospitals (Emeregency and ambulatory care) and private businesses. I always had an Excellent relationship with REMSA.
I remember when there were 2 Ambulance services, MEDIC1 and AIDS.
The professionalism and caring response is always amazing.
I have also been on the receiving end of REMSA.
REMSA is an integral part of our community. Th
I am an actively working emergency physician in California, who was born and raised in Reno. My mom, who still lives in Reno, recently had a life threatening medical emergency in a third world country and I needed to get her home safely. I was in contact with many different organizations in order to do this and had to coordinate her arrival back home. This included safe medical transport from the airport to the hospital for further care. The time window for her transport out of that country was somewhat uncertain due to geopolitical unrest in that country. Once she was able to get out and airborne I would have 24 hours to set up the ground transport from the airport to the hospital. I had contacted REMSA for transport from the airport to the hospital. This was not something routinely done by the staff I initially spoke with, and so was forwarded to the administrative staff directly to help. Coordinating this required multiple phone conversations to keep everyone updated based on the status of the flight so they could have an ambulance there ready and waiting. All of my interactions with REMSA were fantastic and they made the process seamless. There was an ambulance waiting at the airport when my mom landed in Reno. The REMSA crew transported my mom and the air ambulance medical team to the hospital without incident. I was in contact with REMSA that whole day updating the arrival time with them and everything went perfectly. In a world that is getting more distant, less personal and with many intermediaries it was so refreshing to work and interact directly with those at REMSA, from the dispatch to administration, in such a personal way. This is how things used to work years ago and to still have a business model like this is remarkable. Reno is fortunate to have REMSA, not all EMS services are like this, speaking from experience. I write this in support for REMSA to keep their extension. They have been the main EMS service in Reno since I can recall and they have that native hometown Nevadan hospitality that Reno should be proud of. Please don't let that go.
As a proud resident of Washoe County, I highly support the revision of the REMSA franchise agreement. Before my father passed from cancer, there were numerous times we needed emergency assistance to get him from his home to the hospital. REMSA was there for the last time he needed to be transported from one hospital to where he received his final care. The REMSA staff was there for him each time and were beyond gentle and helpful for all of those times.
In addition to the care REMSA gave my father, they also were very responsive to the needs of the other family members who needed care and transport to the hospital.
Finally, but as important as the care that was given my father and other family members, I worked many years at a Memory Care facility in Sparks. Many times a week we would need to call REMSA to come and give care and transport our residents. The REMSA crew was always prompt to respond to our calls, and were very respectful of the resident's needs, while they were preparing them for transport to the hospital. I can't express how important their service was to me both personally, and professionally, and I HIGHLY recommend renewing their franchise agreement to service Washoe County.
Good afternoon, Chair Reese and members of the District Board of Health. For the record, my name is Cora Case. I am the district board of health’s financial appointee to the REMSA Health board of directors.
I am writing to respectfully express my strong support for REMSA Health and its continued role as Washoe County’s exclusive provider of emergency and nonemergency medical transport.
As this body’s financial appointee, it is my responsibility to ensure that REMSA Health, a 501 (c)(3) nonprofit organization, is financially secure and making business decisions in the best interest of the public trust that the District Board of Health has placed in it.
Without hesitation, I can affirm that REMSA Health is financially stable and well-positioned for long-term fiscal health. Through inclusion in its franchise reports, annual third-party audits of our financial statements, as well as Community Investment Fund and average bill audits and the public availability of its Form 990 document, REMSA Health is committed to a level of transparency and accountability that reflects how it upholds and delivers on the promise it has made to the citizens of Washoe County.
REMSA Health’s executive leadership delicately and successfully balances being responsible stewards of its limited healthcare revenue with raising funds to offset reimbursement shortfalls and still reliably invests in employees, technology and infrastructure that creates the REMSA Health safety net that this community relies on so heavily.
Thank you.
Cora Case, PhD
REMSA Health Board Finance Chair
On February 5, 2022, my son was injured during an ArenaCross event and required emergency medical care and transport. Although his most visible injury was a severely fractured arm, he began experiencing worsening dizziness, shortness of breath, and abdominal pain while awaiting transport. When the next ambulance arrived, the responding REMSA Health paramedic immediately recognized the seriousness of his condition, took control of the scene, and initiated rapid transport to the trauma center. She provided prompt stabilization, pain management, and calm, professional reassurance to my son and our family during a frightening situation.
Upon arrival at the trauma center, my son was diagnosed with multiple complex arm fractures, bilateral pulmonary contusions with a partial pneumothorax, and a grade 5 liver laceration. His injuries were life-threatening, and it is my sincere belief that the paramedic’s clinical judgment, experience, and adherence to established protocols played a critical role in his outcome. One misstep during those early moments could have had devastating consequences.
While my son remembers little from that night, he does remember the paramedic who cared for him and how safe she made him feel. That sense of trust left a lasting impression on our entire family.
Today, my son is healthy, thriving, and pursuing his future, something we do not take for granted. Our experience reinforced the importance of high-quality, well-coordinated emergency medical services.
REMSA Health has served Northern Nevada for decades with consistent, professional, and highly skilled prehospital care. The organization’s commitment to clinical excellence, accountability, and patient-centered service is evident in critical emergencies and everyday calls alike.
For these reasons, I strongly support extending the franchise agreement for our local ambulance service. Continuity in emergency medical services matters, and our community benefits from an experienced provider with proven systems, deep local knowledge, and a demonstrated commitment to saving lives. I respectfully urge the Board of Health to support the extension of the REMSA franchise agreement.
The support of the revised REMSA franchise agreement is beneficial for our community because it stands to strengthen emergency medical service delivery across Washoe County. The agreement modernizes governance, reinforces accountability, and ensures long-term service reliability for residents, visitors, and regional partners. The public benefits from updated performance standards, enhanced system readiness for high demand events, disasters, and population growth which is critical to our expanding community. Additionally, the amended agreement provides for greater transparency and assurance that public expectations are being met. A key factor that should be highlighted is that this agreement aligns ambulance rates, cost recovery and system investments more clearly, without burdening or creating additional financial risk to consumers.
Let's also consider the pros of a single system model that ensures equal service to all parts of the county, including rural and lower population areas. Competitive markets tend to lean into higher profit areas leaving gaps in coverage for all county citizens. Fragmented provider competition can also create delays due to duplication whereas a centralized dispatch and deployment plan produce consistent response performance. Finally, the benefits of a regulated franchise system establish transparent performance standards, oversight, and enforcement tools that are harder to impose on multiple private companies. A regulated franchise model is self-sustaining and avoids cost shifting, billing inflation, and financial instability that occur in competitive markets.
The benefits of supporting the amended franchise agreement preserves a well-established EMS system that is better equipped to serve all areas of Washoe County and does not promote a profit-driven model that can compromise coverage, quality and long-term sustainability.
As the volunteer president of REMSA Health’s Board—and the hospital appointed consumer representative—I serve with a board made up entirely of volunteers appointed by the DBOH or representing our region’s three hospital systems. That blend of clinical expertise, operational insight, and fiduciary responsibility ensures strong, balanced governance focused solely on providing exceptional EMS care in the best interest of the people of Washoe County.
Because REMSA Health is a community owned, private nonprofit, every dollar we earn is reinvested locally and goes directly into employee wages and benefits, mission critical equipment, and the community programs that keep our region safer and healthier. In the last eight years, REMSA Health has invested more than $31.5 million in capital projects and equipment to care for our colleagues, neighbors, friends, and families. We are not funded by a distant corporation or private equity group—our providers don’t come to work to make investors wealthy; they come to work to make their community healthy.
Nearly 40 years ago, Washoe County and the cities of Reno and Sparks, along with the local hospitals, worked with this Board to establish a unified health district and an exclusive franchise model. That decision created accountability, performance standards, and layers of independent review—all at no cost to taxpayers.
And today, the model continues to work. REMSA Health remains a high performing emergency and non-emergency medical transport, dispatch and education organization that delivers equal, consistent care across the county, maintains required accreditations, meets contract based performance standards, and reinvests all revenue back into the community.
As a nonprofit powered by people who live, work, learn, and raise their families here, we are proud—and honored—to be entrusted with providing emergency medical services for Washoe County. I respectfully urge you to approve the extension of the franchise agreement.
Thank you,
Shirley Folkins-Roberts
A resident for over 50 yrs, I am in strong support of REMSA & the continuation of its franchise agreement. For decades, thousands have experienced REMSA’s care firsthand, & those experiences consistently reflect rapid response, clinical expertise, & compassionate service. These are are not abstract claims—they are the real experiences of people whose lives were saved or stabilized in their worst moments. Some concerns raised in opposition deserve acknowledgment, but they require clarification: 1.Isolated delays do not define system performance. Any EMS system will have rare delays during simultaneous high‑acuity incidents & hospital offload congestion. These outliers do not reflect REMSA’s overall performance, which consistently meets or exceeds contractual standards. 2.The unified system is intentional—for patient safety. Washoe County adopted an integrated EMS model because fragmented, multi‑agency response previously created inconsistent care, unequal standards, and unregulated costs. A single system with unified protocols, centralized dispatch, medical direction, and transparent oversight prevents those issues from returning. 3.Air medical concerns misinterpret both law and practice. Nothing in the agreement prevents hospitals or flight providers from meeting EMTALA obligations or using the nearest appropriate resource when required. REMSA has coordinated effectively with air medical partners for decades. 4. Accountability is increased, not reduced. Updated performance metrics, penalties, & oversight mechanisms strengthen transparency. The Community Fund ensures that any fines directly support patient‑focused improvements. 5.Antitrust concerns are not supported. Local governments have clear legal authority to structure EMS systems to protect public health & safety. Washoe County has done this for nearly 40 yrs without legal challenge. Residents trust REMSA because they have witnessed the quality of its care. REMSA is nationally accredited, physician‑directed, and fully self‑funded with no tax dollars. For these reasons, I urge you to approve the franchise agreement so REMSA can continue providing the unified, accountable, high‑quality emergency care our community depends on.Thank you for your consideration.
I strongly support the extension of REMSA’s franchise agreement, allowing REMSA Health to continue serving as the exclusive emergency medical services transport provider in Washoe County. In my work partnering with REMSA on a community-based falls prevention project, I have seen firsthand their professionalism, responsiveness, and commitment to collaboration that improves outcomes for older adults and other vulnerable residents. REMSA is a trusted partner that plays a critical role in the health and safety of our community, and continuity of their services is vital for effective emergency response and prevention efforts.
Hello, I am a proud resident of Washoe County. I have used REMSA’s services multiple times over the years for myself and my husband. The crews have always responded quickly and gone above and beyond to care for us. There is no one better equipped to provide emergency medical services to our community. Their expertise, compassion and professionalism surpass what any other agency could ever offer. Years ago, we signed up for their membership program - another generous resource this organization offers to our community. This has given our family tremendous peace of mind. It is clear REMSA genuinely cares about their patients and is an irreplaceable resource for us all.
I respectfully urge you to approve the extension of REMSA’s franchise agreement so the team that does it best can continue serving us.
My family and I are forever grateful to REMSA. Thank you all.
Greetings...
Please, please, please approve the proposed revised REMSA Health and Restated Franchise Agreement for Ambulance Service. We desperatey need this ambulance service and all that it provides. I have had to use the ambulance service quite a few times in recent years. In October of 2025 I took a bad fall and needed REMSA badly. The response was quick, the paramedics were professional, courteous, helpful, caring and provided safe transport of me to the hospital. Had they not been there, I really think I could've died. Each time that I have used REMSA they have been nothing less than a Godsend for me. Please, please approve this franchise so that we can maintain this most vital service for our community.
Sincerely,
George C. Bratiotis
Dear Members of the Board, This agenda item represents significant changes in the Washoe County Ambulance Franchise to include language that attempts to further restrict the market to competitors, in an EMS system that is already scarce with resources, and without proper public process. Additionally, the attempt to change the Term of the Ambulance Franchise to "Perpetual" may be contrary to State and Federal Anti-Trust regulations. The attempt to do so without proper public process gives the appearance of conspiratorial and anti-competitive behavior. Other major changes include a new performance measurement scheme that will decrease the required P-1 response time requirement to 89% in Zone A, as long as the contractor is 90% in Zones B,C and D. REMSA already posts a consistent 90% compliance for Zone A, the lowest allowable under the current contract. On any given month, that could mean up to 900 responses across all Priorities are not responded to within the time standard. What's the rush?! Why is the DBOH in a hurry to make these changes? REMSA has four years left on their current contract. If Franchise changes are necessary, why not provide for an appropriate amount of Public Process. Allow the community stakeholders and subject matter experts the opportunity to properly evaluate these changes. Additionally, some of these changes may violate Federal and State Laws: The Airline Deregulation Act of 1978 preempts interference with Price, Route and Service of an Air Carrier, Federal and State Anti-Trust laws may disallow a private services contract or Franchise with a perpetual Term. When ambulances from REMSA are not available and patients must wait at sending facilities, Hospitals are obligated to source other services to satisfy appropriate transport requires un the Emergency Medical Treatment and Labor Act (EMTALA). Not having other providers to source impact patient care negatively. To avoid the appearance of anti-competitive behavior and to ensure all Federal and State Laws will not be violated, changes to the Franchise must be undertaken with extreme caution to ensure the best outcomes for patients and allow the Free Market to add supply of Resources. Not doing so will have dire consequences. -Aaron A.
Dear Chairman Reese and Members of the Northern Nevada Public Health Board,
I would like to express my strong support for REMSA Health and the continuation of its franchise agreement.
In 2020, my husband experienced a medical emergency, and REMSA paramedics were the first to arrive. Although my husband ultimately did not survive, I will always be grateful for the professionalism, compassion, and expertise demonstrated by the paramedics who cared for him.
That was one of the worst moments of my life, and they treated my husband with dignity and cared for our family with respect during an incredibly painful time. While the outcome was not what we hoped for, the quality of care they provided mattered deeply and will always stay with me.
Emergency medical services are something you seldom think about until you need them and when you do, having a skilled, well-trained, reliable system in place makes all the difference. REMSA Health provides that level of care to our community and my experience is a powerful reminder of the importance of having dedicated emergency medical professionals available when families need them most.
I urge you to consider the real human impact of this decision and to continue supporting REMSA Health and the essential work they do every day.
Sincerely,
Nicole Price
Before 1986, ambulance service in Washoe County was fragmented and unsafe – marked by poor patient care, slow response times, inadequate equipment, no accountability, and high, unregulated transport costs. There were no formal standards for clinical care, response times, or rate setting to ensure patient safety.
To correct this, the Cities of Reno and Sparks and Washoe County used Nevada law to form a regional health authority. Under Nevada Revised Statutes, local governments may create a district board of health by interlocal agreement; Reno, Sparks, and Washoe County did so, establishing the Washoe County District Board of Health as the regional public health governance body.
In 1986, the District Board of Health (DBOH) exercised authority granted to counties and cities under Nevada statutes to limit competition in ambulance service in order to ensure adequate, economical, and efficient patient care. Acting through the newly formed health district, the Board incorporated the Regional Emergency Medical Services Authority (REMSA) and awarded an exclusive franchise for ambulance services. That action was memorialized by a DBOH resolution in October of 1986, and a Memorandum of Understanding in May of 1987 – establishing REMSA as the county’s EMS authority and creating a single, accountable system.
This structure brought strict response time and performance requirements, average bill costs monitored and set by the DBOH, and multiple layers of independent oversight, including the DBOH itself and nationally recognized accreditation bodies. Later franchise updates have continued that oversight framework and performance-based accountability.
Nearly forty years later, the result is a high performance, high value EMS system that provides equal standards of care across Washoe County – without taxpayer subsidy—and remains aligned with the community’s needs and patient safety. The model works because the DBOH created clear authority, unified standards, and robust accountability from day one.
I would urge the board to approve the proposed franchise agreement.
Sincerely,
Louis Test
REMSA Health Board of Directors
Dear Members of the District Board of Health,
This communication is to express my strong support for REMSA Health and its continued role as Washoe County’s exclusive emergency medical services provider. For four decades, REMSA has delivered a high-performing, community-focused EMS system that stands as a national model of excellence.
One of REMSA’s most significant contributions to public safety is its regional emergency communications division. For more than 22 years, REMSA has continually maintained its status as an Accredited Center of Excellence (ACE) from the International Academies of Emergency Dispatch for its medical dispatch center, a distinction requiring rigorous compliance to a 20-point assessment every three years. In 2024, REMSA Health became Washoe County’s first, and remains its only, emergency fire dispatch ACE.
Every REMSA dispatcher holds EMT or paramedic certification, ensuring that emergency calls are managed by professionals with clinical experience. This level of training and accountability is rare and reflects REMSA’s dedication to patient care and operational excellence. Dispatch quality is continuously monitored through systematic reviews including 80 percent random selection and 20 percent focused audits driven by monthly quality improvement themes. These processes guarantee accuracy, consistency, and adherence to nationally recognized protocols. More importantly, that assures those calling for assistance are receiving potentially lifesaving interventions at the second the telephone is answered.
REMSA Health is a private, nonprofit organization that responds to more than 92,000 calls annually at no cost to taxpayers. It is entirely self-sustaining through user fees and philanthropic support, reinvesting revenue back into the community.
It is respectfully urged that you approve REMSA Health’s franchise extension. Doing so will preserve a nationally recognized EMS model that delivers exceptional care and dispatch excellence to the citizens of Washoe County and the patients it serves.
Thank you for your leadership and commitment to the health and safety of Washoe County residents. Please contact me with any questions.
Sincerely,
Jerry Overton
President, IAED