by Jacob Espinoza

On July 1, 2025, the Salem Fire Department took over ambulance service from Falck Northwest, a private company that had held the contract for a decade. A year later, the fire chief says ambulances are available far more often, the system is (almost) paying for itself, and the city hasn't had to lean on neighboring departments nearly as much. That matters to you because when you call 911 for a medical emergency, this is the system that answers.

Jenn Hays and I sat down with Fire Chief David Gerboth and Deputy Chief Steven Boughey, who oversees emergency medical service, on this week's episode of the What's Happening Salem podcast.

Listen to the full episode here.

If a friend forwarded this email to you…

Salem had contracted out ambulance service since 2005. Falck took over in 2015 under a contract requiring 1,030 hours of ambulance coverage each week. Gerboth said that number "wildly fluctuated" in reality, with coverage sometimes dropping to half of the requirement.

Starting in 2021, Salem Fire began staffing its own backup ambulances to fill the gaps. In 2024, the Salem City Council voted unanimously to bring the whole service in-house.

The goal, Gerboth said, was consistency. "It is a life and death service," he said. "And so that was critically important."

Fire departments track something called "Level Zero," the moments when every ambulance in the city is busy, meaning none are free to respond to a new call.

Before the takeover, Salem sometimes spent more than 200 hours a month in Level Zero. That's over six hours a day. In the first year under Salem Fire, Gerboth said, Level Zero averaged 23 minutes a day. That's often a minute here and a minute there rather than one long stretch.

A few other numbers the chiefs shared:

These are the city's own figures. The full one-year report, slides and data are posted with the City Council agendas. Read the August council information report here.

The ambulance service runs on what patients and insurers pay for transports, and that money sits in its own account. Gerboth said it doesn't pull from the city's general fund that pays for parks, police or other fire services.

Rates are set by Marion County based on the city's recommendation. Gerboth said Clackamas County's rates run about $1,500 more per transport.

That doesn't mean every bill gets paid in full. Medicare and Medicaid pay fixed rates, so a transport billed at $2,000 might bring in $550, and the city can't charge the patient the difference. Gerboth said only about 5% of transports involve someone with no insurance coverage at all, and the city has a hardship program for people who can't pay.

Could a shortfall ever land on taxpayers? "Ultimately it could happen," Gerboth said, adding that keeping the system efficient enough to avoid it is the department's job.

Not yet. At least, not when you count the cash that has come in. I got these numbers from the fire department's one-year report to the City Council on Aug. 10 (Here is the link, pages 50-72). I did some of the math myself.

First, the money coming in. From July 2025 through June 2026, Salem Fire sent out $54.1 million in ambulance bills. But it will never get most of that because more than $29 million was written off and wiped off the books.

Other things to consider. Medicare and Medicaid pay set amounts, often far less than the bill. The city can't charge patients the difference. Other bills just never get paid. In its first year, the city collected $10.6 million. It is still owed $13.9 million.

Next, the money that is going out. Paying the crews cost $8.7 million. That includes about $1.4 million in overtime. The city also counts the wiped-off bills as a cost. Take those out, and everything else costs about $4.9 million. Add it up, and the system spent about $13.6 million. That's about $3 million more than it took in.

But that's not the whole story. Medicare, Medicaid and insurance companies often pay months after a ride. So the first four months brought in very little. Since then, the city has collected about $1.2 million a month. At that rate, it would bring in about $15 million a year.

How does that compare to the plan? In March 2024, then-Fire Chief Mike Niblock told the council the system would cost about $10 million a year to run and bring in about $12 million from bills, KGW reported at the time. Money from bills is now on pace to beat that. But costs ran higher. The system spent about $13.6 million in year one.

The plan also counted on extra state money for Medicaid patients. A study the city paid for put that money at about $4.4 million. The city now expects about $1.5 million. None of it has come in yet. The report said it should arrive in August. I asked Salem Fire whether the payment came in, but hadn't heard back by the time this newsletter went out.

In the report, Gerboth said the money coming in, the money going out and the money still owed are about what the department expected. He said that's normal when so many patients are on Medicare and Medicaid.

The same day the city took over, it sued Falck for nearly $7 million, saying the company didn't meet the terms of its contract. Falck has called the claims meritless and, in a later court filing, accused the fire department of taking calls to boost its own revenue, according to Salem Reporter's coverage.

Gerboth said it's still an open lawsuit and declined to say more beyond that the city feels the contract wasn't upheld.

Not every 911 call needs a trip to the emergency room. Boughey estimated 35% to 40% of transports nationally could be handled another way. Many involve mental health, addiction or housing challenges.

That's where REACH comes in. It's a crisis team pairing a fire department paramedic and EMT with a mental health worker from Marion County. Instead of taking someone to the ER, they can take them straight to the county's crisis center or connect them with other help.

Early results: among the city's 100 most frequent 911 callers, those REACH has worked with are calling 20% less. And 30% of REACH transports go somewhere other than the ER. The city has committed funding through June 2027, the county through the end of this year, and the department has applied for grants to keep the program going.

So, was it the right call? I asked both chiefs. Boughey's answer: "A hundred percent." Beyond the numbers, he pointed to the people. Ambulance crews are now city employees who train alongside firefighters and work out of fire stations instead of waiting in parking lots between calls.

Boughey said the department wants more homegrown Salem and Marion County residents on its ambulances. All it takes to start is a high school diploma and an EMT basic certificate, which you can get at Chemeketa Community College. Gerboth said starting pay for EMTs is about $23 an hour plus benefits.

Listen to the full conversation.