At least three of the seven county commissioners say Pinellas firefighters should be allowed to take emergency patients to the hospital.
None of the three - Norm Roche, Nancy Bostock and Ken Welch - want to immediately and completely transform the county's emergency medical services system. Instead, all visualize some variation of a hybrid system that would include transport by both the private company that currently provides ambulance service and firefighter-paramedics who are now prohibited from transporting patients.
Their comments come at a time when County Administrator Bob LaSala has said he plans to ask for a property tax increase to pay for an expected shortfall in the estimated $103 million EMS budget for the coming fiscal year. That after increasing the EMS tax 46 percent this year.
It also comes as county, city and fire officials have been squabbling about the best way to control costs. LaSala has suggested a plan to cut funding for personnel and emergency vehicles in the 18 fire departments that provide EMS service. Some firefighters and city officials say the answer lies in allowing firefighters to transport patients to the hospital. A study expected to kick off later this year is designed to answer that question. But Roche said he doesn't need another study done.
"We know fire transport works," Roche told an audience of about 20 during a coffee klatsch in Palm Harbor on Friday. Firefighters "should be able to transport. I think it's a better way."
LaSala could not be reached for comment.
Roche was reacting in part to a recent experience with Pinellas' dual-response EMS system, which has firefighter-paramedics respond to most emergency calls to provide immediate treatment. Patients needing to go to a hospital are taken there by Paramedics Plus, a private, for-profit company based in Texas, that contracts with the county to operate under the name Sunstar. The system is set up so firefighters arrive first in most cases while the ambulance gets there shortly after.
Roche said a neighbor recently needed help. Firefighters arrived quickly, then everyone stood around waiting for the ambulance to arrive. The ambulance had done nothing wrong, Roche said, it was merely performing according to the system.
"It was ridiculous," Roche said. If the firefighters are there and determine someone needs to go to a hospital, he said, they should be able to immediately take the patient.
"If the paramedics determine the person should go, you go," he said.
Under the system Roche envisions, firefighters would transport only emergency cases. Non-emergency transports - from a nursing home to a hospital and back, for example - would continue to be handled by the private company.
Mark Postma, Paramedics Plus vice president and Sunstar chief operating officer, declined to comment.
Roche said he would not simply change the transport system but would include it in talks about consolidating the county's 18 fire departments into larger blocks and eventually into one.
Welch envisions a different type of system, at least to start with. Not all the departments want to transport or have the equipment to do so, he said. He suggested the best way to start changing the system is to allow those departments that want to transport to do so. But the fees for the transport, which now go to the county, which pays Paramedics Plus, would go to Pinellas and stay there. The city or fire district would not receive any of the fees. Like Roche, he would allow firefighters to transport only emergency cases.
The county would benefit in several ways, he said. One is that it would keep some of the money that is now flowing into the private company. Another is that the county will get more use out of equipment and personnel that are already in place.
"It's a different mix, but it lets us use those resources more effectively and save money," Welch said. "We're already paying for those firefighters and infrastructure."
Bostock said, "I'm definitely interested in moving toward some fire transport."
She agreed with Welch in saying that existing personnel and equipment that the county is "already paying for" could be used more efficiently.
But Welch's suggestion, she said, is a "very good and very obvious step one."
The next step, she said, is to more efficiently use personnel who are already in place, even if it means buying more vehicles.
"I think that might be the key to finding some savings," Bostock said.