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
Dear Chairman Reese and Members of the Northern Nevada Public Health Board,
About nine months ago, I had a heart attack, and REMSA showed up for me on one of the worst days of my life. From the moment they arrived, I felt calm, cared for, and in capable hands. Their quick actions and professionalism quite literally saved my life.
I will always be grateful to the REMSA team who took care of me that day. I’m here today because of what they did, and I want you to know how much that means to me.
About a month or so ago a little girl about two years old, goes to the urgent care out in the North valleys next to Raley's because she can’t breathe. The staff states the little girl needs to go to the hospital immediately. They call Remsa and they put her on oxygen, hold her hand and give her a teddy bear while they wait for Remsa to show up. Close to 2 hours later Remsa finally shows up with red lights only on for one block. The little girl finally makes it to Renown and her breathing issues are addressed. That little girl is my granddaughter. I am all too familiar with the time because we were extremely concerned and we were watching the clock, In addition I was sitting in the parking lot waiting to take her mom’s car to Renown with my wife for my daughter. But instead of immediately taking the car to Renown, we had to sit and wait for up to two hours. It was not a holiday, it was not during rush-hour, it was in the evening, yes. But there was nothing out of the ordinary about this day or I should say evening. Giving Remsa exclusive rights to do as they please is completely unacceptable in my book. The Urgent Care would not let my daughter take my granddaughter to the hospital. They told her they have to wait! What if my granddaughter would’ve died? Then what? Why can’t we entertain other services in a scenario like this? I do not and I cannot support an exclusive Remsa contract given this scenario and the fact that this is being played out all over town according to numerous people that I have told the story to. I would really appreciate you looking out for the residence of Washoe County and look at another plan that includes other providers so somebody’s grandchild doesn’t get killed. It is not right that we are required to sit and wait for Remsa to show up especially when there could’ve been another service provider that may have saved some time. There should be other options. Giving one company the ability to write their own contract, be their own judge and their own jury and render their own verdict exclusivity is not the right choice. The residence of Washoe County are counting on you to look out for our best interest. Not Remsa’s! It's time to look out for us, your loved one could be next.
REMSA has lost sight of ‘Grandma Smith’ They have lost their focus on doing what is right for the patient and are solely concerned on protecting their own management and pocketbook - while touting being ‘Not for Profit’. Perpetual from Merriam Webster “eternal”. This just reeks of stagnation, not innovation. One of REMSA’s claimed ‘pillars’ is Innovation; according to Merriam Webster “a new idea, method, or device”. There is nothing new about what REMSA did, will do or has done. For example, in recent years when they were in jeopardy of not meeting compliance, they would take crews from other areas and move them to the area in jeopardy. This isn’t fixing the problem. When crews were working to unionize, REMSA offered raises and better schedules. The result of those ‘changes’ were browned out shifts, and when they got really desperate they would throw gift cards and money at staff that was already burned out in order to fill seats. This wasn’t just limited to ground operations, this was company wide. Let me ask you this, if you or a loved one was in need of an emergent transfer from one facility to another, would you be ok with allowing REMSA to be 30 minutes late - with NO repercussions? REMSA wants to be able to do these transfers when they feel like doing it. Who benefits from this Community Investment Fund? As it’s worded the community benefits, REMSA is essentially the sole beneficiary of this supposed fund. If they are paying a penalty - it should be a penalty, and not just a twisted way to move the money around. The citizens and visitors of Washoe County and surrounding areas deserve better, and frankly should EXPECT better. They should demand accountability, not just smoke in mirrors, not robbing peter to pay paul, actually taking steps to rectify deficiencies and not just put a band aid on the situation until the heat is off. REMSA has become so comfortable that they believe that they are untouchable. When other companies move in they resort to sending cease and desist letters to the competition.
One of the most fundamental ethical principles in healthcare is beneficence and nonmaleficence. These principles ensure healthcare providers act in the best interest of the patient and to "do no harm." This proposal is in direct contradiction to both. I was born and raised and currently reside in Washoe County. As a Nevadan, I am shocked at the audacity of this proposal. I am also a helicopter flight nurse for Battle Born Medevac, based in Yerington and Carson City. We serve the residents of rural Northern Nevada, reaching as far as Winnemucca, Battle Mountain, Austin, Tonopah and even into isolated regions of California like Bishop and Mammoth. We are one of many aviation emergency medical services that brings patients to Reno for definitive care. We are frequently required to land at KRNO in order to complete the last leg of our transport by ground for many various reasons including occupied helipads at the receiving facility or the lack of a helipad altogether. We depend on our local ambulance partners rapid availability to complete these transfers in a timely manner. Allowing REMSA to monopolize these transfers from airport to hospital is a huge disservice to the residents of Northern Nevada and will lead to increased out-of-hospital time. Increased out-of-hospital time is linked to lower survival rates and increased morbidity and mortality. Not only is REMSA demanding total control of these transfers, they are anticipating availability issues, adding verbiage that would allow them to be late by up to 30 minutes without penalty. Frankly, the thought of sitting on a tarmac, performing CPR in a helicopter, exposed to the elements with limited resources, waiting for up to 30 minutes for a REMSA ambulance to arrive when there is another ambulance service available right around the corner seems absolutely absurd. If there's anything the residents of Northern Nevada need, its access to more EMS and healthcare services, not less. This proposal shows a complete disregard for the health of Nevadans and is more about profits. I hope you see this proposal for what it is, an obvious attempt to bully and strong-arm the competition out of the way. Competition and diversity drive innovation and quality.
The fact that this is even proposed and considered for an agenda item is very concerning to me as a resident of Washoe County. Sec 2.1 includes air transfers in the new franchise agreement. This is in direct violation of the Airline Deregulation Act. It is also a direct disservice to air providers in the area. It was not unusual to spend 30+ minutes at the airport waiting for an ambulance for a critically ill patient. That changed about a year ago with the introduction of a competitor to REMSA (Technical Medical LLC). The district should encourage competition and provide additional resources, not restrict them under an arbitrary monopoly. Sec 2.5 allows for REMSA to renew the contract "in perpetuity". This is blatantly illegal and also the antithesis of encouraging competition and high performance. Sec 7.4.3 allows REMSA to be up to 30 MINUTES LATE for air transfers, with no penalty. This is frankly absurd. Air Medical companies only transport the most critically ill & time sensitive patients. For these patients, minutes are the difference between life and death. To allow for REMSA to be 30 minutes late is absurd. Not only are they trying to monopolize against the competition, but they are also trying to decrease expectations while removing options. This is such a blatant slap in the face to the community. To top it all off, REMSA's proposed fine structure involves them "donating" $5000 to a community fund (Sec 7.4.5). These funds are then used to fund "approved items". The best part about these "approved" tasks/items/causes is that they are all services directly provided by REMSA. The proposed fine structure essentially allows REMSA to self-fund non-revenue tasks through "fines". I am impressed by how one-sided this agreement is. If I were the CEO/Board at REMSA, I would love this. All the benefits, all the service area, all the volume, all the financial incentive- all with no possible accountability. I urge the district to reject this entire proposal with prejudice. It is an offensive proposal that shorts the citizens of Washoe County, handcuffs the air medical providers who provide service to the rural areas, and insults the intelligence of the board members it is presented to. Thank you
Dear Chairman Reese and Members of the Northern Nevada Public Health Board,
About nine months ago, I had a heart attack, and REMSA showed up for me on one of the worst days of my life. From the moment they arrived, I felt calm, cared for, and in capable hands. Their quick actions and professionalism quite literally saved my life.
I will always be grateful to the REMSA team who took care of me that day. I’m here today because of what they did, and I want you to know how much that means to me.
Thank you for taking the time to hear my support.
Warm regards,
Peter Lissner
About a month or so ago a little girl about two years old, goes to the urgent care out in the North valleys next to Raley's because she can’t breathe. The staff states the little girl needs to go to the hospital immediately. They call Remsa and they put her on oxygen, hold her hand and give her a teddy bear while they wait for Remsa to show up. Close to 2 hours later Remsa finally shows up with red lights only on for one block. The little girl finally makes it to Renown and her breathing issues are addressed. That little girl is my granddaughter. I am all too familiar with the time because we were extremely concerned and we were watching the clock, In addition I was sitting in the parking lot waiting to take her mom’s car to Renown with my wife for my daughter. But instead of immediately taking the car to Renown, we had to sit and wait for up to two hours. It was not a holiday, it was not during rush-hour, it was in the evening, yes. But there was nothing out of the ordinary about this day or I should say evening. Giving Remsa exclusive rights to do as they please is completely unacceptable in my book. The Urgent Care would not let my daughter take my granddaughter to the hospital. They told her they have to wait! What if my granddaughter would’ve died? Then what? Why can’t we entertain other services in a scenario like this? I do not and I cannot support an exclusive Remsa contract given this scenario and the fact that this is being played out all over town according to numerous people that I have told the story to. I would really appreciate you looking out for the residence of Washoe County and look at another plan that includes other providers so somebody’s grandchild doesn’t get killed. It is not right that we are required to sit and wait for Remsa to show up especially when there could’ve been another service provider that may have saved some time. There should be other options. Giving one company the ability to write their own contract, be their own judge and their own jury and render their own verdict exclusivity is not the right choice. The residence of Washoe County are counting on you to look out for our best interest. Not Remsa’s! It's time to look out for us, your loved one could be next.
REMSA has lost sight of ‘Grandma Smith’ They have lost their focus on doing what is right for the patient and are solely concerned on protecting their own management and pocketbook - while touting being ‘Not for Profit’. Perpetual from Merriam Webster “eternal”. This just reeks of stagnation, not innovation. One of REMSA’s claimed ‘pillars’ is Innovation; according to Merriam Webster “a new idea, method, or device”. There is nothing new about what REMSA did, will do or has done. For example, in recent years when they were in jeopardy of not meeting compliance, they would take crews from other areas and move them to the area in jeopardy. This isn’t fixing the problem. When crews were working to unionize, REMSA offered raises and better schedules. The result of those ‘changes’ were browned out shifts, and when they got really desperate they would throw gift cards and money at staff that was already burned out in order to fill seats. This wasn’t just limited to ground operations, this was company wide. Let me ask you this, if you or a loved one was in need of an emergent transfer from one facility to another, would you be ok with allowing REMSA to be 30 minutes late - with NO repercussions? REMSA wants to be able to do these transfers when they feel like doing it. Who benefits from this Community Investment Fund? As it’s worded the community benefits, REMSA is essentially the sole beneficiary of this supposed fund. If they are paying a penalty - it should be a penalty, and not just a twisted way to move the money around. The citizens and visitors of Washoe County and surrounding areas deserve better, and frankly should EXPECT better. They should demand accountability, not just smoke in mirrors, not robbing peter to pay paul, actually taking steps to rectify deficiencies and not just put a band aid on the situation until the heat is off. REMSA has become so comfortable that they believe that they are untouchable. When other companies move in they resort to sending cease and desist letters to the competition.
One of the most fundamental ethical principles in healthcare is beneficence and nonmaleficence. These principles ensure healthcare providers act in the best interest of the patient and to "do no harm." This proposal is in direct contradiction to both. I was born and raised and currently reside in Washoe County. As a Nevadan, I am shocked at the audacity of this proposal. I am also a helicopter flight nurse for Battle Born Medevac, based in Yerington and Carson City. We serve the residents of rural Northern Nevada, reaching as far as Winnemucca, Battle Mountain, Austin, Tonopah and even into isolated regions of California like Bishop and Mammoth. We are one of many aviation emergency medical services that brings patients to Reno for definitive care. We are frequently required to land at KRNO in order to complete the last leg of our transport by ground for many various reasons including occupied helipads at the receiving facility or the lack of a helipad altogether. We depend on our local ambulance partners rapid availability to complete these transfers in a timely manner. Allowing REMSA to monopolize these transfers from airport to hospital is a huge disservice to the residents of Northern Nevada and will lead to increased out-of-hospital time. Increased out-of-hospital time is linked to lower survival rates and increased morbidity and mortality. Not only is REMSA demanding total control of these transfers, they are anticipating availability issues, adding verbiage that would allow them to be late by up to 30 minutes without penalty. Frankly, the thought of sitting on a tarmac, performing CPR in a helicopter, exposed to the elements with limited resources, waiting for up to 30 minutes for a REMSA ambulance to arrive when there is another ambulance service available right around the corner seems absolutely absurd. If there's anything the residents of Northern Nevada need, its access to more EMS and healthcare services, not less. This proposal shows a complete disregard for the health of Nevadans and is more about profits. I hope you see this proposal for what it is, an obvious attempt to bully and strong-arm the competition out of the way. Competition and diversity drive innovation and quality.
The fact that this is even proposed and considered for an agenda item is very concerning to me as a resident of Washoe County. Sec 2.1 includes air transfers in the new franchise agreement. This is in direct violation of the Airline Deregulation Act. It is also a direct disservice to air providers in the area. It was not unusual to spend 30+ minutes at the airport waiting for an ambulance for a critically ill patient. That changed about a year ago with the introduction of a competitor to REMSA (Technical Medical LLC). The district should encourage competition and provide additional resources, not restrict them under an arbitrary monopoly. Sec 2.5 allows for REMSA to renew the contract "in perpetuity". This is blatantly illegal and also the antithesis of encouraging competition and high performance. Sec 7.4.3 allows REMSA to be up to 30 MINUTES LATE for air transfers, with no penalty. This is frankly absurd. Air Medical companies only transport the most critically ill & time sensitive patients. For these patients, minutes are the difference between life and death. To allow for REMSA to be 30 minutes late is absurd. Not only are they trying to monopolize against the competition, but they are also trying to decrease expectations while removing options. This is such a blatant slap in the face to the community. To top it all off, REMSA's proposed fine structure involves them "donating" $5000 to a community fund (Sec 7.4.5). These funds are then used to fund "approved items". The best part about these "approved" tasks/items/causes is that they are all services directly provided by REMSA. The proposed fine structure essentially allows REMSA to self-fund non-revenue tasks through "fines". I am impressed by how one-sided this agreement is. If I were the CEO/Board at REMSA, I would love this. All the benefits, all the service area, all the volume, all the financial incentive- all with no possible accountability. I urge the district to reject this entire proposal with prejudice. It is an offensive proposal that shorts the citizens of Washoe County, handcuffs the air medical providers who provide service to the rural areas, and insults the intelligence of the board members it is presented to. Thank you