Salem took over ambulance transport in July 2025 after years of relying on a private provider. Full first-year results are still pending, but early operating and financial data show a system handling more demand than originally projected.
More than a year after Salem made one of the biggest changes to its emergency medical system in decades, early results show the city is transporting more patients than expected while continuing to expand staffing to keep pace with demand.
The Salem Fire Department became the city’s sole ambulance provider July 1, 2025, ending roughly two decades in which ambulance transportation was handled primarily by a private contractor.
The change followed concerns about service reliability. The city said former provider Falck Ambulance Northwest had been unable to consistently provide required service hours, forcing Salem firefighters to fill coverage gaps. From 2021 until the transition, Salem reported spending about $3.3 million in overtime related to those gaps.
Salem also expected a public ambulance system to open new reimbursement opportunities, including federal Ground Emergency Medical Transport funding available to public agencies.
Demand quickly exceeded the city’s initial forecast.
In its most detailed operational update, released in January, Salem reported averaging 55.77 ambulance transports per day during the system’s first six months, about 3.3% above its original projection of 54 daily transports.
Despite the higher workload, the city said ambulance response-time compliance remained above 90% in both Marion and Polk counties.
The increased volume also prompted the City Council to approve four additional full-time EMS positions. The positions, estimated to cost $643,984 annually, allowed Salem Fire to convert an ambulance previously operating during peak hours into a 24-hour unit. The city said additional transport revenue and reduced overtime were expected to offset the expense.
Financial reports also show how dramatically ambulance operations have expanded the city’s Emergency Services Fund.
Through March 31, the fund reported about $40.3 million in resources and $27.9 million in expenditures. Resources were more than five times higher than during the same period a year earlier, an increase the city attributed primarily to launching municipal ambulance transport.
Those figures should not be treated as ambulance profit. The Emergency Services Fund includes beginning fund balance and an internal startup loan from the Building and Safety Fund, in addition to ambulance-related revenue and expenses.
That distinction matters as Salem evaluates whether bringing ambulance service in-house is financially sustainable over the long term.
The early indicators show demand above projections and response-time standards continuing to be met, but a complete assessment will require the city’s final first-year numbers—including actual transport collections, reimbursement levels, overtime expenses and total operating costs.
