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County Takes Dim, Caustic View of Palm Coast’s “Efficiency” Push in Ambulance Services

| March 25, 2016

flagler county fire rescue.

Palm Coast would rather not use its more expensive fire trucks on medical calls. The county has no objections. But the county wonders why that’s its problem. (© FlaglerLive)

The Flagler County Commission can’t understand what exactly Palm Coast government is after regarding ambulance service in the city, nor are commissioners interested in doing the city’s job, if the city is looking to lower its costs.

That’s the essence of a brief commission discussion earlier this week in answer to the city’s recent moves intended to urge the county to work jointly toward what Palm Coast Mayor Jon Netts terms “increasing the efficiency of our emergency medical services.” Netts used those words in a letter to Commission Chairman Barbara Revels, asking for a joint meeting between the two governments to discuss the possibilities.

The commission agreed to a meeting, though not before its new public safety emergency manager, Stephen Garten, whom the county administration just hired as a replacement for Kevin Guthrie, has had time to familiarize himself with the issue. The joint meeting between the two governments will take place sometime in May.

But both sides have already staked out their positions, leaving little doubt as to what Palm Coast is looking for, and little doubt as to what the county is not willing to concede. The tone of the commission’s discussion on the issue Monday said it all: commissioners and County Administrator Craig Coffey were more frustrated with, than welcoming of, the city’s proposal.

To briefly understand the issue: Palm Coast’s firefighters are also paramedics, but they don’t provide ambulance, or rescue, transportation. That’s the county’s responsibility. By law, the county decides who transports, and whether other local governments may have permission to have their own rescues. Palm Coast would like to have its own. But the county is not granting it that authority, precisely because—in the county’s view—it would be inefficient. And because there are no complaints, in the city or the county, regarding ambulance services: they garner the highest marks in satisfaction from residents year after year in Palm Coast’s surveys.


The County doesn’t want to do Palm Coast’s job.


But in Palm Coast, whenever a county rescue is out on a call, it’s accompanied by a Palm Coast fire truck. City council members say that can be expensive and redundant. They want to cut costs, because they run a much more expensive fire department than the county does (even though the city has fewer firefighters) and they want to save money.

The plan they came up with centers on actually increasing the number of rescues in the city by two, and reducing the number of times a city fire truck goes out. The two approaches are not co-dependent: one can happen without the other (as the county keeps telling the city). In other words, even today, the city does not have to send out its big, expensive fire trucks on every call, if it chooses to send out smaller “jump trucks” or, if the dispatch center declares the emergency less than critical, just a county ambulance will do.

But the city also doesn’t want to give up its turf—if not its bragging—rights: it wants that city presence at most calls. It just doesn’t want it to be as costly. The county says that’s the city’s problem, not the county’s. And county officials, particularly fire officials, have been displeased with the city’s proposal of adding two rescues at city fire stations, when those rescues would actually be county equipment, when the county does not have two rescues to spare for full-time duty (it has four back-up rescues for its seven full-time units, but the back-ups are no longer fit for 24-hour duty). The city is discussing possibly buying its own ambulances—at least one, if not two—even if it doesn’t have the authority to carry patients. That would relieve the county of having to provide its own back-ups. But the county sees that as unnecessary, too, if not as a ploy to add pressure on the county to let the city enter the ambulance business.

The county is also not keen on splitting or diluting its teams to the point of having a county and city paramedic on an ambulance, exposing the two governments to tricky liability issues, chain of command issues, morale issues and the like. To the county, the system is working. Why fix it?

County Fire Chief Don Petito has one proposal to save money: consolidate. That is, merge some or all the city’s and county’s operations. But to Palm Coast, whose sense of identity—and obsession with “branding”—rises taller than the tallest church steeple in town, that’s sacrilege. The county’s and city’s firefighters unions had once favor consolidation, but they no longer do. (A previous version of this story had incorrectly stated that they still did.) There is no interest on the current council for consolidation, though three of the five current members of the council will be gone by November.

“Has anybody specified what the problem is that we’re trying to fix?” Commissioner Frank Meeker asked. Meeker served on the city council for several years. The city fire department grew significantly on his watch. “Because I thought the only issue was, they don’t like taking large $800,000 to $1 million-dollar fire trucks out on emergency calls. I thought that was the only issue, really. How do you save money and not use those vehicles. I’m not sure why we’re involved in that discussion.”

“We’ve tried to explain that, we’ve presented our ideas. They were dismissed quickly,” Coffey said.

Revels was planning to respond to the mayor’s letter, but with the understanding that a top item on the agenda for that joint meeting would be: “What is the problem we are trying to fix.”

nate mclaughlin

Flagler County Commissioner Nate McLaughlin.(© FlaglerLive)

“I was approached by Mr. McGuire,” Commissioner Nate McLaughlin said, referring to City Councilman Bill McGuire, “who wanted some help cutting costs with his fire department. We talked about consolidation, we talked about sending smaller trucks, but I’m kind of with the board here on: what’s the problem we’re trying to fix, and if they want to save money, I can’t do that for them.”

“They created a situation, they need to fix it,” Commissioner George Hanns said.

Coffey and Petito had both been surprised by the city council’s March 15 workshop when the city’s proposal was put forth: neither had been invited to the meeting or alerted about its substance. “We wish would have got called to even come to a workshop to discuss it,” Coffey said. “It would have made a lot more sense to us, because we could have handled some of these issues in front of them many, many months ago.”

“Maybe we need to start checking their agenda,” Meeker said sardonically.

“I volunteered to go to their mayors’ gatherings, and no invitation yet,” Revels said, referring to the quarterly meeting of the Flagler League of Cities headed by Netts. She’s not alone: That meeting is never noticed on any of the various cities’ websites, and repeated requests, even from media, to be provided notices about them have gone unheeded.

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18 Responses for “County Takes Dim, Caustic View of Palm Coast’s “Efficiency” Push in Ambulance Services”

  1. Mark says:

    Money, money, money. How about some common sense?

  2. Old Fire Guy says:

    I would like to explain a few things to the taxpayers of Flagler County and the City of Palm Coast. First of all, if anyone thinks the County makes money from ambulance transports they are very misinformed. I know for a fact that the collection rate is very low and there is a reason for that. The County is the primary responder and is required to transport all calls for service even if the callers have no way to pay the charges. The County can send bills until they run out of paper, but can’t make them pay. Many patients are from out-of-town and when Flagler County bills their insurance company they find the money went to pay the hospital and there is no money to pay the transport bill.
    There are some questions about Palm Coast staff driving County ambulances. This doesn’t happen, because Chief Beadle will not let his staff drive county ambulances. His reason is because this would be too much of a liability.
    Some people think Palm Coast should take over the County, because that is what Jacksonville and Miami did. These people must not have been there when that took place. I can’t speak for Miami, but Jacksonville taxes doubled in the first one and a half years of consolidation. So if you are concerned about your taxes you might want to reexamine that thought. Palm Coast Fire has a budget of 7.75 million and has a staff of 58. They also have 5 ALS engines and two aerial apparatus. Flagler County Fire Rescue has a budget of 8.85 million and a staff of 89. It has a Technical Rescue Team, that is state recognized, as well as 7 full time ALS transports, 4 ALS engines, Wildfire Team and a Water Rescue Team. I will not go into all the spare apparatus, but they also have mass casualty equipment, technical rescue equipment as well as 2 volunteer fire stations, a fire training tower that is state approved, a wildland fire equipment trailer, 4 tankers, and 4 attack trucks. If you still think you over pay your taxes you need to speak with the County Fire Chief. Flagler County does not have fancy stations and they cut their budget to the bone. It actually would make more sense to turn all of Palm Coast’s Fire and EMS services over to Flagler County.
    The busiest station in the county, Station 92 runs many calls into the City and can beat Station 25 on Belle Terre to most of the calls South of SR 100 even though it is Station 25’s zone. The zone was setup because the station was placed in the wrong place when it was built. Palm Coast didn’t want the citizens to be upset about the poor planning. Station 92 at the airport is a ¼ mile closer to the intersection of SR 100 and Belle Terre than Station 25. The County is first in, to the Target shopping center, Chevrolet dealer on SR 100, but the City benefitted from all the impact fees for all the buildings that have been built along that stretch. Once again, the County serves that area and doesn’t complain even thought they did not benefit from the impact fees.

  3. confidential says:

    That FCBOCC says that the current County Ambulance and EMS is running smooth and good doesn’t mean is true. Ask the western Flagler County residents how long they have waited for an ambulance with emergency heart attacks or accident injuries before the county EMS ambulance services arrived? Why..? because the ambulances were out transporting hospital non emergency patients to different locations “for county revenue” That is the truth. That is why Coffey and his minions BOCC want to have total control of the City of PC EMS ambulance as well, for revenue other than service the taxpayers already footing the bill. Palm Coast residents should not be subject to that soon to be lack of service. Lets do not forget for how long was the French lady alive on a trench after she was hit by the former School Board member wife Fisher after 911 calls were placed and of course she died. I want my EMS ambulance service under city control as well as the emergency call service so many times down lately under Coffey control. I already pay too much to this county of my home taxes for the maybe 28% of services county provides. Pass some of my overpaid taxes to our city and maybe that will stop them from buying derelict real estate from their buddies.

  4. Kyle Berryhill says:

    While the Palm Coast Professional Firefighters have the utmost respect for Flaglerlive’s reporting in general, and on the 2+2 issue in particular, I feel compelled to clarify our position with regards to consolidation. We are 100% AGAINST consolidation with the county. In Flaglerlive’s defense our previous leadership came out in favor of consolidation in response to a city proposal to close down Fire Station 22 on Clubhouse and Palm Coast Parkway. Our position changed some time ago and remains AGAINST consolidation.nIn the last two months County Administartor Coffey proposed shutting down the Matanzas and Palm Harbor stations at a County Commission meeting and privately to city administration. City firefighters are proud that our admin forcefully rebuffed removing the protection from these areas. City firefighters work hand in hand with county firefighters and these men and women are our friends and brothers. Out union however believes that we don’t need to be managed by Adminstrator Coffey. If Palm Coast City Council wants to inquire about increasing county services for the city residents who pay for them I can fully support that request. When they try to diminish the work of the brave men and women I have the privilege of serving with as duplicitous or unnecessary, it shows me they are out of their depth wrt to emergency service provision. Thank you Flaglerlive for continuing to report on these issues and thank you to the 80,000 Palm Coast residents we have the privilege to serve. Please contact your city and county representatives and tell them to quit playing games with your emergency service protection.

    Kyle Berryhill
    Palm Coast Professional Firefighters

  5. confidential says:

    Yes Mr. Berryhill, no consolidation please, thank you. There is a very important reason why in the late nineties Palmcoasters decided to incorporate, simply because the county was taking our taxpayers monies and was not providing our services. They still excel at that but at least not in full capacity as they did before 1999. I can attest to that as I reside in Palm Coast since 1991. I had several years enduring the county rule over our heads and the lack of proper services paid and non rendered
    In this context of course, I respectfully disagree with Old Fire Guy.

  6. Will says:

    Why is the County so interested in running City services? Don’t they have enough to worry about? They just can’t stand the idea that the City can take care of itself much better than the County could ever hope to do. What the City is proposing does not hurt the citizens in the rest of the County. In fact, neighbors of Palm Coast are more likely to get quick help from the City than they could get from the County.

  7. PJ says:

    PC getting their own does not reduce what the PC taxpayer will pay. PC residents are still paying the same tax rate for County services I did not see anywhere in the article that would reduce the rate for efficiency.

    Is the service from the County that questionable that we need now a Palm Coast EMS?

    Can anyone really clarify is the http://www.Flaglerlive.com article said no complaints?

    However, I do HAVE a suggestion!

    PC get one ambulance for the most northern Firehouse and one for the southern Firehouse. Since all your Firefighters are Paramedic also, you can send the ambulance rather a 800k-1m firetruck out on a County 911 Dispatched ambulance call.
    No need to discuss this with the County because it is just another back up to the County at our expense. Ask the taxpayer in referendum……PJ

  8. YankeeExPat says:

    Happy Easter Fellow Palm Coasters!………, Beware of the Killer Rabbit!

    https://www.youtube.com/watch?v=XcxKIJTb3Hg

  9. JR says:

    Why is there constant friction between Palm Coast and the County. For years every potential issue that can be manipulated and politicized has been and continues to be. Why? Who needs this constant bickering and consternation. Do you? Isn’t your stress level high enough? It seems at the root of all of the hard feelings lies a highly overpaid, over zealous and opinionated City Manager. A city manager serves at the pleasure of the commission. It has long been time to replace the source. $250,000 in combined salary for one man who argues with everyone is a joke. Wake up PC. Elect those who work together. Not apart.

  10. Ex-Volunteer says:

    These smaller medic trucks that everyone is talking about, um, didnt the city already have 3 of them? Lets see Medic 21, 22, 25. Where did they go?? Oh wait I know Medic 25 is still at station 25 , but isnt staffed every shift , Medic 22 was given to the fire dept mechanic to use and they removed the EMS box from it, and Medic 21 is now a Technical rescue unit , full of wood….

    What a waste of money right there..

  11. Laughable says:

    Is anyone else reading what I am? “The city council members say it’s expensive and redundant”.. Only to be followed by saying “the city doesn’t want to give up its turf-if not its bragging rights, it wants city presence at most calls”…. So is it more about saving money or turf wars? Ol fire guy has some statistics in his comment, maybe some of you need to read those and let them sink in a little.. The city has 30 less personnel and their budget is not far off from the counties!!! Maybe we need to step back and start asking the city questions instead of trying to involve the county in problems we have CLEARLY created within the city!! Hell maybe another aerial apparatus is next in line for all these single story residential structures, logical!! And I think that’s exactly where a lot of the city’s problems begin, LOGIC!!!

  12. Former Flagler Lawman says:

    I have worked for FCSO for many years and it seemed as Palm Coast was always gripping about something. They were never happy with what they had and at one time wanted their own police department until they found out the start up costs. Get rid of the city manager already!

  13. Frank Meeker says:

    [Note: For a more easily readable version of this comment (the text below does not reproduce the tables and lay-out that Meeker had in his original text), see the pdf here.]

    Well,…I wasn’t going to weigh in on this subject although I’ve found the discussion interesting and informative from some. I’ve been dealing with this issue since 2010 from both sides of the coin, city and county and I’ll share with you my views, which of course may not necessarily be the views of any of the city council or the rest of the county commission. While my numbers in this first section may be a bit off since I collected them, they should still be reasonably close for comparison, so let’s get some numbers out on the table based on research I’ve been doing on this subject going back a ways.
    1. Staffing Costs
    i. County Staffing Cost
    ii. County EMS/PM 42K Total Staff 89
    1. Budget Break Down
    a. 7.1 personnel,
    b. operating $880K,
    c. capital, $673K
    d. totals 8.6 million
    2. Cost per employee $96.6K
    iii. City EMS/PM 39K Total Staff 58
    1. Budget Break Down
    a. 5.3 million personnel,
    b. 2.1 operating (because they place capital purchases in operating),
    c. totals 7.4 million
    2. Cost per employee $127.6K
    My take away on this subject? This shows that Palm Coast residents pay $31K more per employee than the county pays for individuals with identical training, although I could put together an argument that says the county provides even more training with Life Flight Medics and Swift Water Rescue to name just two but the reality is both departments have highly dedicated, well trained and caring people there to save a life. There’s more.
    a. Here’s another interesting nugget. Palm Coast crews arrived first 28.5% (Which means the county got there first 71.5% of the time I guess, but this statistic is basically meaningless). They arrived within a minute of the county 22.2% (before or after wasn’t stated in the data I reviewed), and behind the county rescue 1.7% of the time.
    b. Almost half the calls cancel an ambulance or a fire engine.
    c. (So almost 4000 of the at that time reported 8,252 calls are cancelled at the git go)
    In my opinion, these kinds of numbers are used to try and justify a fire budget that exceeds 7 million/year, but handles roughly 6 fires per year. Statistically, you would conclude that each fire costs the city over 1 million to put out. The real work as we all know is in the emergency services area of BLS (Basic Life Support) and ALS (Advanced Life Support).
    I wanted to get you some facts, not my facts, but facts presented to us when I was back on City Council regarding the 2010 Fire State Location Study. Hopefully, my formatting will hold up after uploading to Flaglerlive’s website. Before we start, let me say that we have fantastic emergency services personnel at the city and county level. The questions basically are two.
    1)should the city take on transport responsibilities or not, and if not, and
    2)is there a way to save money by not sending out expensive fire engines costing 700K to 1 million on each call out?
    The answer to the second question is yes, there is a way, but the county commission doesn’t need to be part of that discussion. That is a decision for the city council. As to transport, the city has been touting they will make 1 million dollars per year if the county would just give up transport within the city and therefore it makes financial sense for them to take on this function.
    Rubbish.
    That sounds to me like “I want the city’s thumb on anything going on in the city even if it costs the tax payer a bunch extra to do it”.
    That’s what happened with law enforcement in the city. We wanted a higher level of service above and beyond what the sheriff was providing within the city, and struck a deal at that time that went something like 21 additional deputies for 2.7 million,…I really don’t remember the exact numbers but that’s reasonably on the dart board of the cost. If was that or start our own police department and that cost was considerably more. Considerably.
    Something to keep in mind here. If the city were to take over transport, it would, or at least should operate as an Enterprise Fund, self supporting, self run and sustainable. Can’t be done for reasons I’ll go into in a moment. What follows is information provided us when I was on city council at one of the workshops, and the data came directly from the 2010 Fire State Location Study.
    On Page 62 is a discussion called “Estimated Revenues from EMS Transport”. On Page 67 is a chart the should yank anybody up real short if they were to propose the City taking on transport. Remember, this is basically another “Enterprise Fund”. The City already loses money on two of their other enterprise funds, the Palm Harbor Golf Course, and The Palm Coast Tennis Center, but their losses pale compared to what EMS transport within the city would lose.
    The reason is collections are never at 100% of what is billed.
    The collection numbers (also called the billing recovery rate) for Flagler is 52%, St. Johns is 65%, and Duval County is 57%. Now we can have some fun here just to see how much money the citizens of Palm Coast would lose per year based on these numbers and data from the 2010 study discussing “revenues” on page 67. It looks exactly like what I’m providing below, except where the 2010 study used numbers of 50%, 60% and 70% “revenues under various collection rates”, I got the actual data from Duval, St. Johns and Flagler, and used those collection rates in my calculations. I then placed the data in a table for easy understanding and comparison (which didn’t make it through the upload, sorry, I’ve adjusted as I could).

    Revenues Estimated Revenue Comments
    2009 Est. EMS Related Calls for service 5100 Total Calls
    Minus Cancelled calls
    No Transports 587 Some calls don’t need
    transport
    Transports 4513 Billing will be based on
    this number
    Avg. Billing Rate $448.43 Billing rate used back
    in the 2010 study.
    Probably higher now
    Sub-total $2,023,764.59 This is what you would
    hope to collect back to
    offset your costs
    Billing Charge Deduct $18/bill ($81,234.00) Already a deduct from
    what you hope to collect
    Net Possible Recovery $1,942,530.59 What you could
    possibly hope to collect
    at a 100% collection
    rate (which doesn’t
    exist except in a
    fictional theoretical
    alternate universe)

    Real World Recovery
    based on Real World
    Collection Rates Rate Amount typically recovered Comments (or how
    after incurring a “net much can a Palm
    possible recovery” Coast Tax payer expect
    to lose per year)

    Flagler %52 $1,010,115.91 Lose almost 1 million (0.93)
    having spent 1.94 million
    Duval %65 $1,262,644.88 Lose almost 0.7 million 0.68)
    having spent 1.94 million
    St. Johns %57 $1,107,242.44 Lose well over ¾ of a million (0.84)
    having spent 1.94 million

    What is my take away? Using Flagler numbers, I see another Enterprise fund that loses almost 1 million/year for the citizens of Palm Coast. How is this a deal? The county provides our service knowing up front we’ll lose money every year. It’s one of those 25 or so services we discuss at budget time every year and as you can see from the opening discussion, we take those costs very seriously, and provide a very quality service at a much lower cost than is provided by the city. I’m not saying the city is a bad operation, in fact far from it. The city is a great operation, make no mistake. But I would argue the quality of the service between the two is very strong, but not necessarily $31K per employee stronger. Others have been going around using the “Amount typically recovered after incurring a cost” numbers, but stating, “if we take over transport, we’ll make over a million per year”! Whoowho! They neglect to say that to get there they spent over 2 million first and will operate at a loss as explained under “Comments (or how much can a Palm Coast Tax payer expect to lose per year)”.

    FOREVER.

    I would add that the report, also on page 67 agrees with this analysis when it states, “An important consideration in evaluating EMS revenues is the billing recovery rate (the amount actually paid as a percentage of billed amounts). The project team typically observes recovery rates around 50%”.

    NFPA, the National Fire Protection Association uses (for municipalities) a turn out in 1 minute, 4 minutes or less for arrival at a fire. For BLS (basic life support), a turnout of 1 minute, and 4 minutes or less for the arrival of BLS. For ALS (advanced life support), it’s a turnout of 1 minute, and ALS started within 7 minutes.

    At the county level, we meet that 8-minute mark for ALS. In fact, we beat it.

    If a fire department does it, Fire Department ALS recommends an 8-minute window. If there is a problem, it would be that based on our population, the layout of the roads, and possibly some fire stations located in the wrong place, it is tough for the City to meet the 5-minute standard especially when trying to maneuver big trucks through Palm Coast traffic. That is no reflection on the quality of the city troops. They are doing the best they can under the kind of adverse conditions just mentioned but it has to be even tougher with those big fire trucks and with wear and tear, cost more. The solution? One to consider is using smaller, less expensive trucks, and again, that is not a decision the county needs to be involved in. That’s it. Hope this helps the discussion.

    Frank J. Meeker, District 2
    Flagler County Board of County Commissioners

  14. YankeeExPat says:

    Thank You Mr. Meeker for the specific information that you have provided. Very often citizens are uniformed as to how the Sausage is made in regards to governance of Public services. I would ask if as a suggestion if as a weekly if not monthly written contribution from any or all members of City and County government as to our local issues. For those of us that cannot attend council meetings this is greatly appreciated.

  15. just me says:

    Thanks Mr Meeker The city of PC is using common core math on us all. They say they will take in 1 MILLION $ a year on the service. Sounds great to the average joe BUT they TOTALLY leave out that they must spend an additional 2 MILLION to get 1 in return.

  16. Ron says:

    Commissioner Meeker hit it on the head.

    My question for the PC council. Why would you send out an Engine company to a EMS run when there is an EMS ambulance in route?

    That is a complete waste of resources. Stop this practice now.

  17. Laughable says:

    FACTS….. That’ll shut them up!

  18. GoGators says:

    Mr. Meeker is on point. To the questions regarding why multiple responding units. An ambulance is staffed with two people. If a critical call requires extra hands. I don’t think you all would want only one paramedic in the back of an ambulance to do CPR on a loved one. Usually you would have one person driving, one person doing chest compressions. And the other rescuer breathing for the patient and also administering medication as well as administering a defibrillation if so is indicated. Two responders at times is only needed, for example, a patient ran out of pain medications and wants to go to the hospital to get more. Or maybe a person says they are having back pain and their family member doesn’t want to take them to the hospital themselves and calls 911. Or someone is having the flu and wants to go to the hospital by ambulance. That would require only 2 rescuers. The more critical the call. The more responders needed.

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