AMR Is Out, CONFIRE Is In: How Your City’s Ambulance System Actually Works

What changed when CONFIRE replaced AMR, and how does your city’s ambulance system work now?

On October 1, 2026, CONFIRE EMS & Mobile Health officially launched across much of San Bernardino County, replacing American Medical Response after more than 40 years. But coverage varies by city, and understanding how your local system actually works matters more than the headlines suggest.

*Information as of October 2026; litigation and service details may change. This article is general information, not legal, medical, or insurance advice. In an emergency, always call 911.*

Why This Matters for Rancho Cucamonga Right Now

If you live in Rancho Cucamonga, you may have heard about the ambulance switch and wondered what it means for your neighborhood. Here is the short version: the San Bernardino County Board of Supervisors ended its decades-long relationship with AMR and awarded a new ambulance contract to CONFIRE, a joint powers authority made up of local fire agencies, including Rancho Cucamonga Fire. CONFIRE has partnered with Priority Ambulance, reported to be the nation’s second-largest ambulance provider, to staff and operate ambulance units across the county’s contracted service areas. You still call 911 the same way. But what happens after that call connects is different now, and the details vary depending on whether your city runs its own fire department ambulances or relies on the county contract. We covered exactly how 911 works in Rancho Cucamonga in Part 1 of this series, and we break down the system design (in-house ambulances, mutual aid, contracted units) in Part 3.

AMR’s 40-Year Run in San Bernardino County

To understand the switch, you need to understand what came before it. American Medical Response of Inland Empire, through its predecessor companies, provided Advanced Life Support emergency ambulance services under contract with San Bernardino County since the late 1970s. AMR had been a grandfathered Advanced Life Support ambulance transport provider under California Health and Safety Code Section 1797.224, meaning that for most of those four-plus decades, the contract was simply rolled over rather than competitively bid. The San Bernardino County Sentinel described this as a “grandfathered process.”

That arrangement made AMR the exclusive provider across much of the county, including areas like Chino Valley, for more than 40 years. It was the status quo for generations of residents. Eventually, the county decided the era of automatic renewals needed to end.

How Ambulance Contracts Work in San Bernardino County

San Bernardino County does not operate as a single ambulance zone. The county is divided into 26 ambulance operating areas to ensure appropriate coverage and regulation of services, and in 19 of those operating areas, ambulance providers require a contract with the county.

The agency overseeing those contracts is ICEMA, the Inland Counties Emergency Medical Agency. ICEMA is a joint powers authority responsible for administering emergency medical services in San Bernardino County and two other counties. The Emergency Medical Services Systems Act grants authority to agencies like ICEMA to implement and oversee plans based on public and private agreements to meet community needs.

What does that mean for you practically? It means your ambulance service is governed by a patchwork of contracts, operating zones, and local fire department agreements. Some cities run their own ambulances through their fire departments. Others rely entirely on whoever holds the county contract. And mutual aid agreements connect the pieces when one agency’s units are committed on other calls. We explain this layered structure in detail in Part 3 of this series.

The 2022 Bid and a Near-Tie Score

In December 2022, San Bernardino County and ICEMA released a Request for Proposal to select an ambulance provider for a designated geographic area covering multiple exclusive operating areas within the county. AMR and CONFIRE were the only two agencies that responded.

The results were remarkably close. An independent evaluation committee scored AMR at 1,519 and CONFIRE at 1,515, as reported by Champion Newspapers and the San Bernardino County Sentinel. The county emphasized that the score differential was a mere quarter of one percent. Based on that negligible difference, the county declared the competition essentially a wash. It then notified both AMR and CONFIRE to enter into contract negotiations, with final contract approval resting with the Board of Supervisors.

That decision set off a chain of events that would take nearly two years to resolve.

Why the County Chose CONFIRE

In December 2023, the San Bernardino County Board of Supervisors voted unanimously to cut ties with AMR and sign a contract with CONFIRE, according to reporting from the San Bernardino Sun via EMS1. The board cited several reasons for its decision. According to court records, CONFIRE presented a better value by being eligible for supplemental state funding, promising faster response times, and improving public safety through closer integration with fire services. County officials also emphasized the benefit of partnering with a public agency already embedded in local fire coordination.

AMR’s stated position was direct. In public statements and court filings, AMR argued that the county had awarded the contract to the lower-scoring proposer and that the state-approved RFP mandated the highest-scoring bidder receive the contract. AMR stated that despite what it characterized as its status as the winning bidder, the county had notified both bidders that draft contracts from both would be presented to the Board of Supervisors.

Both sides’ positions are documented in court records and news accounts. We present them here as stated. The legal system, not us, determined the outcome.

Who Is CONFIRE?

Consolidated Fire Agencies, commonly known as CONFIRE, is a joint powers authority located in San Bernardino County that provides emergency communications and medical services to its member agencies. CONFIRE is a coalition of approximately 15 fire agencies, including the Chino Valley Fire District and Rancho Cucamonga Fire, according to reporting from the San Bernardino County Sentinel (February 2024).

For Rancho Cucamonga residents, this connection is worth noting. Your local fire department is already a member agency within the CONFIRE system. That existing relationship is part of what the county cited as a reason for choosing CONFIRE: the integration between fire response and ambulance transport was already built into the organizational structure.

Our founder’s background in emergency medicine gives us a particular appreciation for why this kind of integration matters in practice. When fire and ambulance services share dispatch infrastructure, the coordination during a real emergency call can be more seamless.

Two Years in Court

AMR did not accept the Board of Supervisors’ decision quietly. What followed was a multi-year legal battle across state and federal courts.

• AMR filed state and federal lawsuits challenging the contract award, arguing the county violated its own RFP process by selecting the lower-scoring bidder
• A Superior Court injunction temporarily blocked the transition, which had originally been scheduled for October 2024
• The state Court of Appeal issued a significant ruling finding that the county was not required to negotiate exclusively with the highest-scoring proposer and had discretion to award based on “greatest value,” per Champion Newspapers reporting
• A May ruling allowed CONFIRE to proceed toward the October 2026 launch
• A final pre-launch challenge was resolved, clearing the path for the October 1, 2026 start date

Every litigation milestone above is sourced from court records and local news reporting. As of October 2026, we recommend checking with county sources for the most current litigation status, as additional proceedings may be pending.

October 1, 2026: The Switch in Rancho Cucamonga and Beyond

On October 1, 2026, CONFIRE EMS and Mobile Health officially launched, replacing AMR across the county’s contracted service areas. Priority Ambulance, described as the nation’s second-largest ambulance provider, serves as CONFIRE’s private partner. According to Victor Valley News, the partnership covers emergency 911 response, interfacility transport, and critical care transport.

For you as a Rancho Cucamonga resident, the most important thing to know is this: you still call 911 the exact same way. The dispatch system, the fire engine that shows up first, the paramedics who assess you on scene: that infrastructure has not changed. What has changed is the ambulance unit that transports you to the hospital in contracted service areas now comes through CONFIRE and Priority Ambulance rather than AMR.

How Your City’s Ambulance System Actually Works

Here is where it gets practical. Not every city in the county relies on the CONFIRE/Priority contract the same way. Based on local field knowledge and available reporting, here is how coverage breaks down:

Cities With Fire Department In-House Ambulances

• Rancho Cucamonga Fire operates its own in-house ambulances
• San Bernardino County Fire operates in-house ambulance units
• Rialto Fire runs its own ambulance service
• Ontario Fire operates in-house ambulances
• Chino Valley Fire District (serving Chino Hills and Chino) runs its own ambulances

How CONFIRE/Priority Fits In

Even in cities with in-house fire ambulances, CONFIRE EMS and Priority Ambulance play a role. Reported CONFIRE/Priority service areas include Apple Valley, Chino, Colton, Loma Linda, Montclair, Ontario, Rancho Cucamonga, Redlands, Rialto, County Fire areas, Victorville, and Yucaipa [VERIFY with official county sources for the complete list]. In areas with in-house ambulances, CONFIRE/Priority may serve in a transport or mutual aid capacity when local units are committed on other calls.

Mutual Aid: Connecting the Pieces

When a fire department’s own ambulances are all committed and another call comes in, the department requests mutual aid. This brings in the next available unit, whether that is a neighboring fire department’s ambulance or a CONFIRE/Priority unit. This system is designed so that no call goes unanswered because one agency happens to be stretched thin at that moment.

The exact roles (primary response versus transport versus mutual aid) can differ by city and by agreement. We will continue to track these details as the new system settles in, and we cover the mutual aid structure more thoroughly in Part 3 of this series.

What Residents Will Notice, Including Bills

What Looks Different

You may notice new ambulance markings and uniforms in your area. The vehicles that respond under the county contract now carry CONFIRE EMS and Priority Ambulance branding rather than AMR logos. If you call 911 in Rancho Cucamonga, the fire engine and paramedics that arrive first will look exactly the same as before.

Billing Changes

According to reporting from the Daily Bulletin, the reported maximum ALS emergency base charge rises from $2,681.04 to $4,791.02 under the new contract. County officials have stated that these figures represent caps, not necessarily what patients will pay. Your actual cost depends on your insurance coverage, whether the call qualifies as an emergency, and other factors. If you have questions about a specific bill, contact your insurance provider and the ambulance service directly.

What to Watch Next

The new system is just days old as of this writing. Several things are worth monitoring.

• Litigation status. While the courts cleared the way for the October 1 launch, additional proceedings may be pending. Check county sources for updates
• Performance reporting. The county contract includes service standards. How CONFIRE and Priority Ambulance perform against those benchmarks will become public over time
• Billing transparency. Residents should watch for clear communication about costs, especially the difference between published rate caps and actual patient responsibility
• Mutual aid coordination. How smoothly in-house fire ambulances and CONFIRE/Priority units work together during high-call-volume periods will be an important indicator

We are not making predictions about service quality in either direction. The system is new, and the data will tell the story.

Frequently Asked Questions

Why did San Bernardino County drop AMR?

The county’s Board of Supervisors voted unanimously in December 2023 to award the ambulance contract to CONFIRE after a competitive RFP process. The county cited CONFIRE’s eligibility for supplemental state funding, promised faster response times, and closer integration with existing fire services as reasons for the decision. AMR has publicly disputed the decision, and litigation followed.

What is CONFIRE?

CONFIRE, or Consolidated Fire Agencies, is a joint powers authority of approximately 15 fire agencies in San Bernardino County. It provides emergency communications and medical services to its member agencies, including Rancho Cucamonga Fire and the Chino Valley Fire District. CONFIRE EMS and Mobile Health is the entity now operating ambulance services under the county contract.

Who is Priority Ambulance?

Priority Ambulance is CONFIRE’s private partner in delivering ambulance services under the new county contract. It has been described as the nation’s second-largest ambulance provider. Together with CONFIRE, Priority Ambulance covers 911 emergency response, interfacility transport, and critical care transport in the county’s contracted service areas.

Did AMR win its lawsuit?

AMR filed state and federal lawsuits challenging the contract award. While AMR secured a temporary injunction that delayed the original October 2024 launch, the state Court of Appeal ultimately ruled that the county had discretion to award the contract based on “greatest value” and was not required to select the highest-scoring proposer. The October 1, 2026 launch proceeded. Check with county sources for the most current litigation status.

Which cities have their own fire department ambulances?

Based on local field knowledge, Rancho Cucamonga Fire, San Bernardino County Fire, Rialto Fire, Ontario Fire, and the Chino Valley Fire District (serving Chino and Chino Hills) operate their own in-house ambulances. These departments run their own units alongside the CONFIRE/Priority system, with mutual aid agreements connecting them.

Which areas does CONFIRE EMS serve?

Reported CONFIRE/Priority service areas include Apple Valley, Chino, Colton, Loma Linda, Montclair, Ontario, Rancho Cucamonga, Redlands, Rialto, County Fire areas, Victorville, and Yucaipa [VERIFY with official county sources for the full list]. In some of these areas, fire departments also operate in-house ambulances, and the CONFIRE/Priority role may involve transport or mutual aid.

What is mutual aid?

Mutual aid is the system that allows fire departments and ambulance providers to assist each other when one agency’s units are already committed on other calls. If all of Rancho Cucamonga Fire’s ambulances are out on calls, mutual aid brings in the next available unit from a neighboring agency or from the CONFIRE/Priority system.

Will ambulance bills go up?

The reported maximum ALS emergency base charge under the new contract rises from $2,681.04 to $4,791.02, per the Daily Bulletin. County officials have stated these are rate caps, not what patients necessarily pay. Your actual cost depends on insurance coverage and the specifics of the call. Contact your insurer and the ambulance service with questions about a specific bill.

Do I still call 911 the same way?

Yes. Nothing about how you request emergency medical help has changed. Dial 911, and the dispatch system will send the appropriate fire and ambulance units to your location.

Does this affect home values in Rancho Cucamonga?

Emergency services quality is one of many factors that contribute to how buyers evaluate a community. With Rancho Cucamonga Fire continuing to operate its own in-house ambulances and now having the additional CONFIRE/Priority system as a mutual aid resource, the city’s emergency medical infrastructure remains robust. Learn more about what makes Rancho Cucamonga an attractive community, or if you are curious about what your home is worth in Rancho Cucamonga given current conditions, we are always happy to run a complimentary market analysis.

The Bottom Line

The AMR-to-CONFIRE transition is the biggest change to ambulance service in San Bernardino County in over 40 years. For Rancho Cucamonga residents, the fundamentals have not changed: your fire department still runs its own ambulances, you still call 911 the same way, and mutual aid ensures backup when units are committed. What has changed is the contracted provider behind the system. Whether you are a longtime homeowner, someone who recently inherited a property in Rancho Cucamonga, or a buyer evaluating this community, knowing how your city’s emergency services actually work is part of understanding where you live.

Have questions about life in the Inland Empire or your next move? Let’s talk. Whether you are buying, selling, or just planning ahead, we will give you honest advice and a clear plan.

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