TAMRMS#: B06
9.4
REQUEST FOR DECISION
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Ground Ambulance Contract
Presented by: Diane McMordie, Managing Director, Corporate and Emergency Services/CFO & Dan Lemieux, Director, Fire and Emergency Medical Services
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RECOMMENDED MOTION(S)
recommendation
1. That Council move in camera to discuss a matter pursuant to sections 26(1)(a) (disclosure harmful to intergovernmental relations), 29(1)(a), 29(1)(c), 29(1)(d), 29 (1)(g) (advice from officials), 30(1)(c) (disclosure harmful to economic and other interests of a public body), and 32(1)(a) (privileged information) of the Access to Information Act.
2. That Administration notify EHS that St. Albert will not renew its contract for provision of EMS ground ambulance services.
3. That St. Albert will maintain Medical First Response with the service standard to be brought back for Council decision by the end of Q4 2026.
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SUMMARY
Based on the analysis completed by City Administration, it is recommended that the City discontinue the provision of ambulance service on behalf of the Province. While an integrated model has provided a valuable service to the community and region, to date this has been done on a close to cost-neutral basis, something that is no longer available as part of a new contract with EHS.
To continue to provide this service, the City would be required to take on additional costs moving forward without adequate reimbursement from the Province, to deliver a service that is Provincial responsibility.
Administration recommends maintaining the continuation of Medical First Response (MFR) capabilities, with further analysis to take place prior to end of year to evaluate how the service is being delivered to the community, and various service standards that may be available to Council related to MFR.
ALIGNMENT TO COUNCIL DIRECTION OR MANDATORY STATUTORY PROVISION
On May 7, 2024 Council passed the following motion:
AR-24-212
That the CAO be authorized to execute an agreement between the City of St. Albert and Alberta Health Services for the continued provision of EMS ground ambulance services for a term of up to 5 years, including renewals, on terms and conditions acceptable to the CAO.
Alberta Emergency Health Services Act, Ground Ambulance Regulation 110/2020
City Council Policy C-PS-1 Provision of Emergency Services (2003)
Fire Services Bylaw 21/2002
BACKGROUND AND DISCUSSION
Background on Integrated Fire-EMS
The City of St. Albert has delivered pre-hospital care to residents and neighbouring communities since 1977, and specifically through an Integrated Fire-Ground Ambulance (EMS) Service since 2009. Since 2009, when the Government of Alberta centralized ambulance service throughout Alberta, the City of St. Albert has been funded by the Government of Alberta to varying degrees (formerly Alberta Health Services, or AHS, now Emergency Health Services, EHS) to operate an integrated ambulance service.
St. Albert has provided integrated Fire/EMS service since its first contract with AHS (now EHS). This has enabled cross-trained firefighter-paramedics to operate on both fire apparatus and ambulances. This model enhances operational flexibility and supports Advanced Life Support (ALS) Medical First Response (MFR) from fire apparatus, providing a high level of pre-hospital care across the community.
Prior to 2009, ground ambulance within St. Albert was a municipal responsibility, until the Provincial Government assumed control through new legislation and introduced a “borderless” dispatch system. When this occurred, St. Albert Council chose to provide an integrated Fire-EMS Service, as a service provider for AHS from 2009 onwards. Since then, the City has been contracted by AHS to administer this service, which has been subsidized by the City of St Albert to varying degrees.
The AHS “borderless” dispatch system means that the closest ambulance is dispatched to active incidents. St Albert Fire ambulances are regularly dispatched outside the community and the City has no control over those situations.
The City of St. Albert provides two ambulances under contract with EHS. There have been instances where a request for a third ambulance on a temporary “surge” basis has come to the City, which we have been able to support. These ambulances are considered part of the overall system of borderless ambulance coverage in the area and are not specific to the City of St. Albert, although stationed here.
In 2025, St. Albert’s two ambulances were dispatched just over 6,000 times, with 63% of calls within St. Albert, and the remaining 37% of calls going to neighbouring communities (primarily Edmonton). In 2025, EMS accounted for nearly 63% of all responses by St. Albert Fire Services (SAFS).
In total, there are seven municipalities in Alberta that currently provide an Integrated Fire/EMS Service: Wood Buffalo, Spruce Grove, St. Albert, Strathcona County, Leduc, Red Deer, and Lethbridge. These communities are colloquially known as the Integrated 7 (or I-7). An Integrated Fire-EMS Service is where Integrated Fire Services operate Emergency Medical Services (ground ambulances) and cross-train firefighters and paramedics so that each can provide mutual support with fire and advanced life support.
Ground ambulance is a Provincial responsibility that is provided by these municipalities via contract with EHS.
The provision of pre-hospital care is identified in the City of St. Albert’s Service Level Inventory. To provide this service, the City maintains our ambulance fleet with the necessary equipment, while over 80 firefighters are registered paramedics with the Alberta College of Paramedics. When a paramedic is not assigned to an ambulance, their medical skills are utilized on MFR response.
Emergency Medical Care in St. Albert is delivered through the following high-level process flow:
The City currently has MFR capabilities in addition to our ambulance contract. In other words, responders are trained to provide immediate, on-scene life support and medical aid to patients until an ambulance arrives for transport. Staff can respond to medical calls from a fire pump truck with ALS capabilities. A municipality can choose to commit this level of response with additional financial support (i.e. medical supplies, equipment, etc.) provided by EHS. During discussions with EHS, the City asked and received confirmation that in the event the City chose not to renew a contract for ambulance, the City can still maintain MFR/ALS response capabilities.
In 2025, MFR accounted for nearly 25% of all SAFS responses.
Current State: EHS Conditions for Contract Extension
EHS, a Provincial Health Corporation, was established on June 1, 2025 and operates under the responsibility of the Minister of Hospital and Surgical Health Services, Acute Care. The organization is mandated to deliver emergency health services within the acute care sector across Alberta, including ground ambulance services and interfacility transfers. These services are delivered directly by EHS and through contracted services providers, like St. Albert.
EHS currently manages 30 EMS contracts across the Province, 29 of which are set to expire on September 30, 2026, including the contract with the City of St. Albert.
On March 13, 2026 EHS informed the City that with the expiry of the contract approaching, it would be willing to negotiate a new long-term contract with the City. However, EHS made it clear that it would only enter “sole-source” negotiations with the City if the City agreed to costing based upon EHS’ benchmark (the funding standard set by EHS), and that the City would cover any gap between the funding provided by EHS’ amount and St. Albert’s actual costs to provide the service.
EHS initially gave the City until March 31, 2026 to provide a written response on if St. Albert would cover any funding gap or not. Advocacy efforts by Council and Administration, alongside the other Integrated Fire/EMS communities, led to this deadline being extended to May 31, 2026. The revised timeline has allowed Administration to complete a financial and service-level analysis to present options for Council’s consideration.
EHS has indicated that should the City not be willing to fund the costs above the EHS benchmark, or should an agreement not be reached, formal notice would be issued to initiate the transition to an alternate EMS service delivery provider (either EHS direct delivery, or private contractor with EHS). EHS has communicated that “Resourcing for the new agreement will remain unchanged from current service provision. This is inclusive of number of ambulances, shift modelling, and level of service. Future resource changes will occur as a result of resource planning and in coordination with the appropriate parties.”
Analysis
Given the position provided by EHS to Integrated Fire/EMS communities, City Administration believes there are three general options St. Albert City Council could consider moving forward.
These include:
- Option 1: New Contract to Maintain Integrated Fire/EMS at increased cost to the City of St. Albert
• Under this scenario, higher and increasing municipal subsidization for ground ambulance services will occur, which includes 40% of calls outside of the City.
• Current staffing costs, inflation and union rates are higher than the EHS benchmark costs, which would result in increased City costs immediately and increasing over time.
• Two ground ambulances will continue to be delivered by St. Albert Fire Services (SAFS).
• No change to MFR program.
• SAFS staff will remain trained as both firefighters and paramedics.
- Option 2: Maintain Medical First Response (MFR) and Divest Ambulance
• Under this scenario, there would be reduced staffing, equipment and fleet costs (some costs would be immediate actual savings, others are future cost avoidance). There would be decreased future staffing requirements, managed primarily through attrition.
• Effective September 2027 (subject to completion of transition plan between St. Albert and EHS), ground ambulance services in St. Albert would be provided by EHS.
• No change to MFR program (although there is potential to see increased call demand based upon ambulance availability).
• SAFS staff will remain trained as both firefighters and paramedics.
- Option 3: Divest MFR & Ambulance
• Under this scenario, there would be reduced staffing, equipment and fleet costs. There would be decreased future staffing requirements, which would be managed primarily through attrition.
• Effective September 2027 (subject to completion of transition plan between St. Albert and EHS), ground ambulance services in St. Albert would be provided by EHS.
• MFR would be discontinued, likely resulting in a negative impact on health outcomes in the community and broader healthcare system.
• SAFS will transition to fire-only service over time and cease to fund the certification of paramedics.
A summary of the three options available is provided below:
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|
Option 1: Accept EHS |
Option 2: Maintain MFR + Divest EMS |
Option 3: Stop MFR + Divest EMS |
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Ground ambulance delivered by |
City |
EHS or contractor |
EHS or contractor |
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MFR maintained |
Yes |
Yes |
No |
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FTEs required (including dispatch) |
130 |
110 |
110 |
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2027 cost impact |
$1.76 M |
$0.79 M |
$0.4 M |
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Tax impact equivalent 2027 |
1.2% |
0.5% |
0.3% |
STAKEHOLDER COMMUNICATIONS OR ENGAGEMENT
Since receipt of notification from EHS on March 13th, the City has maintained communications with other municipalities that provide an Integrated Fire/EMS service, as well as EHS and the Ministry of Hospital and Surgical Health Services. A verbal update can be provided on this, as the situation continues to unfold.
The Mayors of Lethbridge, Red Deer, Leduc, Spruce Grove, Strathcona County and St. Albert co-signed a letter to the Minister on March 31 and had a meeting on the topic on April 15, 2026.
At the time of writing this report, the other municipal Councils have made decisions on the matter as follows:
- May 4: City of Leduc passed the following motions:
o That City Council direct Administration to notify EHS that the City will not enter into negotiations for a new EMS contract; and
o Begin the transition out of delivering EMS and move towards staffing engines with a minimum of one primary care paramedic, with the expectation that Administration will return to Council if there are any unanticipated barriers to this delivery option.
- May 11: City of Spruce Grove
o That the City of Spruce Grove inform EHS they will not be entering into a new ambulance service contract following the expiry of the existing contract.
o That the City further informs EHS of the City’s desire to continue providing MFR as part of that program in partnership with EHS.
o That Administration be directed to put forward a business case for enhancement of the MFR Program for consideration during the 2027-29 Budget and Fiscal Plan.
- May 12: Strathcona County provided direction to accept the EHS contract proposal to maintain ground ambulance services, at increased costs to the municipality. The following motions were passed:
o That Administration take the necessary steps to accept the ambulance services contract with Alberta Emergency Health Services as outlined in Option 1 of the May 12, 2026 Community Services report; and
o That the 2026 Emergency Services Operating Budget be increased by $575,000 to fund Option 1, with funding from Municipal Reserves.
- May 12: City of Lethbridge provided direction to:
o Strategically notify EHS that the City of Lethbridge does not agree in advance to cover any additional costs associated with a new EMS Ground Ambulance Agreement while preserving the City’s right to participate in further negotiations and/or a request for proposals process.
- May 12: City of Red Deer Council directed Administration to continue delivering ambulance services through The City’s integrated Fire and EMS model, including the municipal tax funding support (1.7 per cent) required to maintain the service.
Fire Leadership has also maintained communications with the Union Executive on this topic.
Subject to Council’s decision, a news release, public and staff messaging will be implemented reflecting Council’s decision.
IMPACTS OF RECOMMENDATION(S)
Financial:
Due to the loss of the EHS contract value of $4.62 M, and that some additional costs will need to be incurred to maintain MFR, and that total wage and benefit savings, as well as ancillary savings only amount to $3.83 M due to fixed costs of operating an integrated service, a resulting impact of $0.79 M is projected to be experienced by the City. This amount is equivalent to a 0.5% property tax increase.
Compliance & Legal:
This option returns this risk to the Provincial Government, who maintains responsibility for ambulance service provision through the Alberta Emergency Health Services Act, Ground Ambulance Regulation 110/2020.
Council would need to update Council Policy C-PS-1 Provision of Emergency Services (2003) in the future to be reflective of no longer providing this service, as well as the Fire Services Bylaw 21/2002.
Program or Service:
Under this scenario, EHS would become responsible for ground ambulance service provision in St. Albert effective September 2027, subject to the negotiation of a transition plan with EHS, per the current contract.
EHS has expressed City residents will see “no disruption or degradation of service” associated with EHS providing this service on a go-forward basis instead of the City.
From a City perspective, there are many unknowns related to the provision of EMS by the Province, compounded in the absence of data being shared by EHS. While EHS has stated there will be “no disruption or degradation of service,” there is the potential for this service-level to change in the future, based upon future EHS resource planning. It is our estimation that in 2025, a non-SAFS ambulance responded to 37% of medical calls where ambulance was required within the municipality.
The City will maintain MFR, and SAFS staff will remain trained as both firefighters and paramedics. This type of service provision model, where firefighters provide MFR but not ambulance exists in other Alberta municipalities, including Calgary, Edmonton, Airdrie, Grande Prairie, Cochrane, Fort Saskatchewan, and others.
Organizational:
Under this scenario, the long-term FTE requirement for SAFS is 110, and given the growth the City is experiencing and planned completion of Fire Hall 4, staffing reductions can be achieved primarily through attrition.
From a future staffing attraction and retention perspective, it may become easier to attract and retain firefighters under this service model.
Should the City instead complete a contract extension and then be faced with a similar decision again in 5-10 years, this is not likely to be the case, and layoffs would result.
ALIGNMENT TO PRIORITIES IN COUNCIL’S STRATEGIC PLAN
None at this time.
ALIGNMENT TO LEVELS OF SERVICE DELIVERY
1.3.1 Emergency Medical Services
Provision of response and medical care to ill and injured persons.
IMPACTS OF ALTERNATIVES CONSIDERED
If Council does not wish to support the recommendation, the following alternatives could be considered:
ALTERNATIVE 1: City Council could direct Administration to notify EHS of the City’s intent to continue to provide EMS, at an increased cost to the City.
Financial:
Due to the decreased EHS contract value of $0.9 M plus future staffing requirements for Fire Hall 4 of $0.85 M that is required under this scenario, the net City impact is $1.76 M, equivalent to a 1.2% property tax increase.
Over time, it is projected that the City’s expenses to deliver ambulance service will likely grow approximately 3% per year, but the City’s commensurate receipt of contract revenue from the Province will likely only grow at 1.5% per year, thereby resulting in an ongoing impact to City finances and a growing gap between the City’s costs to administer the service on behalf of the Province, and what the City collects in commensurate revenue from the Province.
Compliance & Legal:
Should Council proceed with this option, City Administration would return for Council for approval prior to ratification of the new ambulance contract with EHS.
Program or Service:
Status quo would be maintained under this scenario: two ground ambulances would continue to be delivered by SAFS, and there would be no change to MFR. There is the potential risk that SAFS will continue to respond to a growing number of calls outside of St. Albert (in 2025, 37% of calls occurred outside of St. Albert).
Organizational:
Should Council proceed with this option, City Administration would engage in negotiations with EHS on a long-term contract renewal.
ALTERNATIVE 2: City Council could direct Administration to notify EHS that St. Albert will not renew its contract for provision of EMS ground ambulance services, and direct Administration to cease the MFR program.
Financial:
Due to the loss of the EHS contract value of $4.62 M, and that total wage and benefit savings, as well as ancillary savings only amount to $4.2 M due to fixed costs of operating an integrated service, a resulting impact of $0.4 M is projected to be experienced by the City. This amount is equivalent to a 0.3% property tax increase.
Compliance & Legal:
This option returns this risk to the Provincial Government, who maintains responsibility for ambulance service provision through the Alberta Emergency Health Services Act, Ground Ambulance Regulation 110/2020.
Council would need to update Council Policy C-PS-1 Provision of Emergency Services (2003) in the future to be reflective of no longer providing this service, as well as the Fire Services Bylaw 21/2002.
Program or Service:
Under this scenario, EHS would become responsible for ground ambulance service provision in St. Albert effective September 2027, subject to the negotiation of a transition plan with EHS, per the current contract.
EHS has expressed City residents will see “no disruption or degradation of service.”
From a City perspective, there are many unknowns related to the provision of EMS by the Province, compounded in the absence of data being shared by EHS. For instance, EHS ambulances currently respond to medical events in the City, when they are the closest ambulance; however, we do not have that information provided to us to share.
With the removal of an MFR program, Administration would predict a negative impact on health outcomes in the community and the broader healthcare system.
This direction would mean the elimination of the Service Level, 1.3.1 Emergency Medical Services: Provision of response and medical care to ill and injured persons.
Organizational:
Under this scenario, the long-term FTE requirement for SAFS is 110, and given the growth the City is experiencing and planned completion of Fire Hall 4, staffing reductions can be achieved primarily through attrition.
From a future staffing attraction and retention perspective, it may become easier to attract and retain firefighters under this service model.
SAFS would transition to a fire-only service over time, and the City would cease to fund the certification of paramedics.
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Report Date: May 19, 2026
Author(s): Dan Lemieux, Trevor Duley
Department: Fire and Emergency Medical Services
Managing Director: Diane McMordie
Chief Administrative Officer: William Fletcher