Fla. County Agencies Feuding Over EMS Dispatch Policy

Jan. 13--Not every 911 call means an adrenaline-charged dash through red lights to save lives. Sometimes the "emergency" is merely someone with constipation, a sore elbow or hiccups that won't stop.

For those calls, first responders are told not to bother turning on their flashing lights and sirens.

Regardless of how minor an emergency is, though, firefighters and a Sunstar ambulance are dispatched to almost all of the 140,000 medical-emergency calls received each year in Pinellas County. Firefighters trained as paramedics provide immediate treatment, and the ambulance transports patients to the hospital.

That could soon change if Pinellas County commissioners on Tuesday approve a change to 911 dispatch policies. Under that proposal, only ambulances would be sent to about 14,000 low-priority calls classified as "falls" and "sick persons."

The move has sparked a firestorm of criticism from local municipalities, with at least one threatening to sue the county. Some fire district leaders have also been critical, warning that distressed 911 callers will go longer without critical medical attention.

At least seven Pinellas cities, including St. Petersburg, and at least four fire districts approved resolutions opposing the EMS changes, known as Phase III.

St. Petersburg Mayor Bill Foster has accused the county of going back on an agreement reached last year to delay changes until the completion of a major study of the county's EMS system, due this summer.

"Everybody is playing nicely in the sandbox. Why screw it up now?" Foster said. "We can't prevent it. But the moment they implement Phase III, we will file a notice of our intent to sue."

County officials have long warned that EMS costs must be reduced. But finding a solution acceptable to the county's 18 separate fire districts won't likely be easy.

The county this year will pay roughly $45 million to fire departments across Pinellas to double as medical first responders. Every fire vehicle dispatched on a call includes at least one firefighter cross-trained as a paramedic. The money also pays for medical equipment and supplies.

Of the 14,000 low-priority calls received each year, about 70 percent end up with a patient being taken to the hospital. County officials say sending two emergency vehicles for those minor medical issues is a waste of taxpayer dollars, especially at a time when budgets are being squeezed.

"This issue is the fiscal cliff for Pinellas County," said County Commissioner Janet Long. "We have put in place a Rolls-Royce service."

But local fire chiefs question whether the change will save money, given that on-duty firefighters are still being paid, whether they're running calls or sitting around the fire station.

They also warn that residents could be put at risk if they have to wait longer for medical care. The average response time from a 911 call to a fire truck's arrival is 41/2 minutes, compared with 10 minutes for an ambulance.

Even if fire trucks keep their sirens silenced, they still typically arrive in little more than seven minutes.

Although 911 dispatchers do a good job, callers don't always know what's wrong with them, Palm Harbor Fire Chief James Angle said. People who call 911 because of a fall, for example, may not realize they became dizzy because of a low heart rate or cardiac event.

"Without looking up an EKG, how could you ever make that decision?" he said. "We would rather err on the side of caution and go to every call and see what treatment is needed."

When fielding 911 medical calls, dispatchers enter information from callers into a computer system that prompts them to ask questions so they can accurately classify whether the call is critical and give first responders details before they arrive.

Under the proposed change, only an ambulance would be dispatched to residents complaining of symptoms such as nausea, sleeplessness, earaches and other mild ailments. The same service would be provided to victims of falls who call more than six hours after or if their injuries are limited to their limbs.

The proposed changes have been approved by the county's medical director and the EMS Medical Control Board, made up of emergency physicians and hospital administrators, said Bruce Moeller, the county's public safety director. The EMS Advisory Council, which includes elected officials, nurses and residents, also approved it.

The approach the county is advocating is no different than what happens at hospital emergency rooms, where doctors prioritize which patients get treated first, he said.

"You don't go to the hospital with a cut finger and get taken in and seen right away," Moeller said. "That's triage; that's what we're doing here."

But fire chiefs counter that the county's proposal introduces an unnecessary delay that could be costly.

Under the proposed change, an accident victim could be across from a fire station but would have to wait for an ambulance, according to Doug Lewis, the fire chief for the city of Pinellas Park. For elderly people, especially during Florida's brutal summers, every second can be crucial, he said.

"It's a potential of people being put at risk," Lewis said. "It happens occasionally (that) we're given one type of call. We respond without a siren, and you get there and find out it's a more serious injury."

But county officials point to an in-house study of dispatchers' performance that awarded them a 98 percent accuracy rating, which exceeds the National Academy of Emergency Dispatch standards, according to a county memo.

Moeller said he has not calculated how much the proposed changes would save but says responding to fewer calls would save fire districts fuel costs and reduce wear and tear on equipment.

Reducing call volumes could mean even bigger savings for the county because fire districts will go longer without adding additional trucks, he said.

The county spends about $472,000 a year to equip fire trucks to provide medical first response. When the number of medical calls for one response unit exceeds more than 10 a day, the county may also have to pay for an additional fire truck, which costs upward of $500,000.

"The public is smart enough to get it that you don't need two units on every one of these calls; you don't need it on a stubbed toe," Moeller said. "The real saving is we're building capacity back into the system."

Although county officials may be looking to reduce costs, area fire chiefs may want to maintain the status quo because reducing the number of calls firefighters respond to ultimately could spark debate about staffing levels.

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