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Along the far reaches of the rugged North Coast, the “golden hour” isn’t about spectacular sunsets or other whimsical seaside moments.

It is the 60-minute span from the time when a person needs emergency medical attention until they arrive at a hospital. Get the patient there within that period, and they have a better chance of surviving.

It’s often a matter of life and death.

Now, the ability to do that through a robust system of air ambulances is being challenged. A primary funding source derived from a $4 fee on traffic tickets is set to expire Dec. 31. And legislation meant to extend it appears hopelessly stalled.

“We’re very concerned,” said Eric Freed, vice president for operations of Santa Rosa-based REACH Air Medical Services, which stands to lose millions of dollars and could close bases. “This affects many people, not just in the rural areas but in urban areas as well.”

REACH, which counts pediatric and neonatal transport among its main services, relies on funding through the Emergency Medical Air Transportation Act. The fee on traffic tickets, established in 2010, generates $8 million statewide and allows the state to receive a like amount of federal matching money, backfilling gaps between Medi-Cal reimbursement rates and the actual costs of services.

Without this money or a replacement source of funding, air ambulance companies would suffer a financial hit and likely have to pull back services.

“It’s a very expensive operation,” Freed said. “It’s a flying ICU with pilots and nurses ... operating 24-7.”

Emergency responders along the more than 50-mile Sonoma County Coast said any reduction would be devastating.

The Sheriff’s Office, Cal Fire and the CHP fly rescue helicopters in the area but none offer the level of medical expertise of dedicated air ambulances like REACH and CalStar, which was acquired last year by the holding company that owns REACH.

“They have saved a lot of lives because they are able to respond to us,” said Cal Fire Engineer David Levin, whose station in The Sea Ranch is a two-hour drive from major hospitals in Santa Rosa. “They are really a big part of how we take care of medical emergencies because we are so far away.”

Earlier this year, Assemblyman Jim Wood, D-Healdsburg, wrote a bill to extend the $4 fee past Dec. 31. However, the bill died in the appropriations committee. Bipartisan opposition stems in part from a push to reduce the escalating cost of traffic tickets, a financial burden that is believed to hurt the poor disproportionately.

Lawmakers pursued a separate effort to include the fee in the state budget but it was rejected by Gov. Jerry Brown.

“I get it,” said Wood, whose district stretches from Santa Rosa to the Oregon border and includes Trinity County. “People are concerned tickets are too expensive, and we keep adding to them. We just haven’t been able to find another funding source.”

Wood noted a connection between the fee and air ambulances. Many flights are ferrying car crash victims from remote parts of his district to medical care. Without the money, Wood believes service would be curtailed to concentrate on more centralized calls.

California temporary cultivation licenses issued as of March 15:

(Multiple licenses may be held by a single entity)

532 Santa Barbara County

491 Humboldt County

349 Mendocino County

263 Monterey County

158 Calaveras County

116 Los Angeles County

105 Trinity County

105 Riverside County

59 Sacramento County

58 Sonoma County

51 Yolo County

51 Alameda County

34 San Bernardino County

27 Santa Cruz County

25 Santa Clara County

20 Stanislaus County

11 San Francisco County

5 Shasta County

4 San Diego County

4 Lake County

5 San Luis Obispo

3 San Benito County

3 Contra Costa County

3 Kern County

2 Colusa County

1 Madera County

1 Solano County

1 El Dorado County

1 Fresno County

1 Siskiyou County

1 Tulare County

“This literally is the difference between life and death for people, especially in rural areas,” Wood said.

But there is hope.

Proponents may try to insert the fee in other legislation before the year’s end. It is supported by groups including the California Children’s Hospital Association, the California League of Cities and the California Fire Chiefs Association.

“It is our hope that the Legislature extends funding for these vital services before we have to consider specific steps to address the shortfall, which is why the industry is working to find an appropriate legislative solution,” said Marissa Currie, an industry spokeswoman.

You can reach Staff Writer Paul Payne at 707-568-5312 or paul.payne@pressdemocrat.com.

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