Category: Gateway Ambulance

Your questions about Gateway Ambulance

Earlier I published an analysis of our contract with Gateway Ambulance (…/lets-talk-gateway-ambulance-caf021ccff…). A lot of neighbors raised great questions and important additions. This post follows up to offer more depth on some of the topics I’ve heard many neighbors ask to learn more about.

My original analysis started from the question, “How did we know things were working *before* Gateway?” That question didn’t lead to the data, but to our Fire Chief, who has always personally heard almost every single emergency call on his radio. Our Fire Chief said that for now, Gateway has performed comparably to what we had before.

The biggest problems with our contract are long-term. One of the main reasons for outsourcing ambulance service was that our City was unable to collect on more than $1 million of unpaid ambulance bills. Ambulance service was losing the city money at a dangerous rate. When a private company collects less than they were expecting, they can only (1) cut service or (2) over-charge those who are able to pay. Our contract did not put in place effective mechanisms to detect these problems early and exit the contract if things start to go wrong. Also, we should have negotiated for less than a 5-year term, to have the flexibility to address problems moving forward.

We can point our political process toward solutions. We did need to reform our old ambulance system to improve public safety. However, outsourcing was not the only way to achieve that outcome, and above all we needed an inclusive discussion about the best way to make the reforms. Instead, we had one solution rushed through without citizen engagement. When things went wrong, our government did not respond. Our neighbors brought serious concerns about failures with Gateway. Just because a system is working on average, that does not mean that things do not go wrong. There should have been a thorough investigation to bring clarity, closure, and make sure public safety is protected better in future.

We also need a government that takes action. With the switch to Gateway, we lost our cooperative EMS agreements with nearby cities. But with negotiation, we can still re-establish them.


Here are answers to some of the questions raised about the last post. This does not address every aspect of this complicated issue, but offers short summaries and policy ideas for neighbors interested in engaging more. Please reach out if you’d like to talk further!

What does U City’s data show?

U City’s data show that Gateway is faster. To be clear: Gateway does not drive faster, but its drivers can wait for calls behind the wheel of the ambulance instead of in a fire station, allowing them to start driving sooner. Read more:…/learn-more-u-citys-ambulance-data-fa6b…

How do the qualifications of Gateway medics compare to our firefighters? Gateway’s medics pass the same state certification exams that our firefighters do. However, that does not mean Gateway medics are using that training with the professionalism our residents deserve on-scene. We should establish a system to follow-up with residents who use ambulance service, and study the quality of care they receive. Read more:

Was fatigue really a problem for our ambulance drivers? Yes. Before our contract with Gateway, U City ambulance drivers were working 48-hour shifts. That is standard for firefighters, but there are many more ambulance calls than fires. The data shows—and our Fire Chief confirms—that the 48-hour shifts were exhausting for our ambulance drivers. Changing to 12-hour shifts was an important improvement to public safety. Read more:

Where did this data come from? This data has been publicly available for a while. The response times were sunshined and published on Nextdoor months ago. The only new piece of data here was the geographic data of where calls were coming in from, used to create a map of U City ambulance calls. Several residents asked to learn more about the team involved in the work, you can read bios here:

Finally, read here to learn why Gateway’s data is different from U City’s, and what we can do to get reliable data:…/learn-more-why-are-gateways-and-u-city…

Let’s Talk: Gateway Ambulance

Click here to read my accompanying analysis of the ambulance data:


In August 2015, University City’s City Council approved a contract to have Gateway Ambulance, a private company, provide our emergency medical services. Previously, ambulance service was provided by our Fire Department.

The conclusions you will read in this analysis are based on (1) data analysis conducted by a team of Stanford-trained data scientists, and even more importantly by (2) conversations about Gateway ambulance with as broad a range of individuals as possible, including the City Manager, Paulette Carr (a councilmember who opposed privatization), Greg Pace (a citizen consultant who supported it), the Gateway director and ambulance drivers, and our own Fire Chief.


In the back-and-forth on City Council, our representatives completely lost sight of the issue. We had real opportunities to make progress, improve public services, and have a conversation that would reflect our community’s values.

1.) We needed to change our ambulance system to improve response times. Simple changes could improve public safety.

  • Previously, our firefighters waited for ambulance calls in the fire station. They worked exhausting 48 hour shifts. It took about 90 seconds on average just leave the station, get to the ambulance, and start driving. We needed to change the system.
  • Our ambulances should be located closest to where people need them, not wherever we happened to have land for a fire station.
  • Our ambulance drivers should wait for calls inside the ambulance. That way when a resident calls they can start driving immediately. Before, drivers had to wait inside the fire station.

2.) The contract with Gateway achieved those changes. But because the contract was pushed through without a transparent democratic process, it cannot reflect our community’s values.

  • There were many other ways to improve ambulance response times. Changing our fire department’s policies could achieve the same outcome.
  • Many of the residents I speak with are deeply concerned about having a private company manage a public service, even a company that hires union workers. And research suggests they are right to be concerned.
  • Our city manager entered us into a 5-year contract without establishing clear reporting on performance for our citizens, and without clear mechanisms to let us leave the contract if Gateway fails.

3.) The pendulum politics on City Council hurt our city’s reputation but took us nowhere. This issue was used to further personal agendas, but the facts needed to make sense of it were distorted and left out.

  • Everyone involved was trying to either make themselves look good, or make the “other side” look bad. We needed to be looking for solutions.

The data shows that ambulance calls come around the clock, meaning that it is crucial for drivers to have a chance to rest. Click this link to see the data:
  • Our representatives got us lots of bad publicity. But they did not get us the facts. When I talked to our Fire Chief, I was surprised to learn that before the Gateway contract, our least-senior firefighters were assigned to drive the ambulances on exhausting 48-hour shifts.
  • I also learned that no U City firefighters lost their jobs. Three empty positions now no longer need to be filled, but no one was fired. The firefighters’ Union pushed back because this meant 3 fewer jobs for its members throughout the region, but no U. City firefighters lost their jobs.After a minor court dispute the city is on track to save an estimated half million dollars every year.
  • All this information matters to our residents, and it was left out of the conversation.
Previously, we had to position our ambulances wherever we had land for a fire station. We needed reforms to give us flexibility to put our ambulances wherever they could respond to calls most quickly. Click here to see the data and learn more:

Let’s talk about solutions

The political infighting damaged our community’s reputation. It ultimately led us nowhere, and did not even bring out the facts we need to make a rational decision about the issue. There were opportunities to make great progress for our community.

  1. Bringing the issue back into focus, it is clear that we needed to reform our ambulance service. The map above shows the location of ambulance calls in U City. We now have flexibility to place our ambulances wherever they are most effective, and keep improving their location in the future.
  2. We needed a true democratic process to represent all the values of our community. Trustworthy service, return on taxpayer dollars, and the intrinsic value of keeping service in-house all need to be balanced and brought into the conversation.
  3. We need to talk and work together. We have a vibrant, diverse community. That needs to be the focus of our policy-making, not personal political agendas.