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Santa Rosa fire department crews respond to an average of 33 medical emergency calls every day of the year ? all without directly charging those they help.

But the cash-strapped city may give households and businesses a choice: either a modest insurance-like monthly fee or face a $350 service charge when city paramedics show up at the door to save a life.

?I wish I could say it would sail right through and people would applaud the idea but I doubt that will be the case. Bringing any fee forward in such bad economic times will be controversial,? said Fire Chief Bruce Varner.

Deputy Fire Chief Mark McCormick said residents and business owners likely will contend they already pay property and sales taxes to fund the system.

Those two major sources of funding, however, have declined significantly, leaving the city facing a projected $23 million deficit during the budget year that starts July 1.

?This will help fill that gap,? McCormick said.

The proposal, to be discussed at a City Council study session Tuesday, calls for a voluntary program that would levy a $3- or $4-a-month emergency medical response fee on willing households and businesses.

Those who sign up would be exempt from paying the $350 it costs the city to send a paramedic-staffed fire engine crew to provide basic life-saving services to anyone living at or visiting that address.

?If you look at our nearly $30 million budget,? McCormick said of the fire department, ?about 65 percent of the calls we get are emergency medical calls.?

In 2007, the department fielded 714 fire-related calls and 12,128 calls for medical assistance. There were more than 5,000 other types of calls, including for hazardous material situations and false alarms.

McCormick said the fee has been under study for several years but is being pushed now because of the city?s mounting budget deficit. The City Council has authorized the elimination of 85 staff positions and $14.2 million worth of cuts, including the closure of one of the city?s 10 fire stations on a rotating daily basis.

Another $8.7 million in proposed cuts, mostly in the police department, and the rotating closure of a second fire station, remain in play. While those cost-cutting measures will be reviewed by the council at its March 24 meeting, the council will discuss numerous revenue-raising ideas during its study session Tuesday.

The emergency response fee is the only revenue proposal of six being considered that does not require voter approval.

<NO1><NO>The other five, and money they would generate annually, are: a quarter-sales tax measure ($7 million), a $50 parcel tax ($2.5 million), an increase in the hotel room bed tax to 12 percent from 9 percent ($1.2 million), and adjustments in business license fees and the utility users tax ($500,000 each).

City officials in the past have rejected putting measures such as the business license and utility fees on the ballot because the potential revenue is such a small share of what they said the city needs.

Council members have also voiced concerns about voter receptivity to an additional sales tax increase in light of the state Legislature?s recent decision to boost the state sales tax by 1-cent starting in April. They also cite the recent controversy over the council?s decision to redirect Measure O sales tax revenues to stave off police department layoffs rather than expand the department as voters had been promised.

In addition, city voters in 2000 rejected an increase in the hotel room occupancy tax.

McCormick said the emergency response fee, which would be included in monthly utility bills, is not unprecedented. He said at least 15 cities, mostly in Southern California, have the voluntary fee program in place.

The city of Sonoma adopted the fee in 1991 and, according to a report compiled by McCormick, now has 26 percent of the city?s homeowners enrolled.

<NO1><NO><NO1><NO>McCormick estimates a combination of the fee and the service charge that would be paid by those who do not sign up would generate about $1.5 million a year for Santa Rosa, about what is raised in Corona, a similar-sized city in Southern California.

McCormick said paramedics aboard city fire engines are the first to arrive to emergency calls 75 percent of the time.<NO1><NO>

The role of the city paramedics is to stabilize the patient and assess their condition in preparation for the arrival of the ambulance crew.

Under state law, cities are prohibited from charging for anything but basic life support, McCormick said. ?Basic life support means CPR, patient assessment, stopping bleeding, providing oxygen, caring for shock,? he said.

?When you get there you have four to six minutes to make a difference in a person who stops breathing,? McCormick said of the city?s response time goal. ?People?s lives every day get saved by early intervention and we make a difference,? he said.

He said the $350 fee would not be levied if the city crew does not provide medical assistance when called.

?Lots of times elderly people will fall out of bed. If they?re not hurt and they simply need help getting back in bed, there?s no charge,? he said.

Varner said the revenue would go into the general fund, the part of the city?s budget that finances nearly a dozen departments including police, fire, planning, park and recreation and public works.

Varner said he did not know if the money would be used to offset the daily closure of a second city fire station set to begin July 1, a move estimated to save the city $1.1 million a year.

?The ultimate use of the funds is the council?s decision,? he said.

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