Palm Coast Mayor Jon Netts was in a scrappy mood Tuesday when talk turned to ambulance services in the city and the county. He has no qualms about the services themselves. He considers them “top notch.” But he has a problem about the delivery system. He considers it inefficient. He loathes the fact that the county talks all the revenue from ambulance services. The county provides those services, while the city adds EMTs to the mix at most calls.
Maybe it was hunger pains—the meeting was over three hours old and pizza was waiting. Maybe it was the prospect of a meeting that had another few hours to run. More likely, it was part of Netts’s on-and-off campaign to change the way the county and Palm Coast have doubled-up, in his view, on EMS services, with the county refusing to let the city run its own calls (though it’s not that simple). Council members each in turn today were discussing what goals they have in mind during a strategic overview. Netts brought up his old EMS bugaboo.
“The vast, overwhelming majority of responses that the fire department makes are EMS calls, not fires,” he said, correctly: well over 90 percent—and usually close to 95 percent—of calls are for emergency medical services. Fires are comparatively extremely rare: fire trucks get called out, but the majority of those fire runs turn out empty. “We are spending a significant amount of money to supplement a service that Flagler County has determined that they, and they alone will provide.” Netts added: “Long-term, it’s not a viable situation. If the county is going to provide EMS services, then let them provide all the EMS services. We’re providing I think more than what needs to be provided.”
Typically, a 911 call goes to the county’s dispatch center (staffed by sheriff’s office employees). A dispatcher will send the closest ambulance and a fire truck to the address making the call. The ambulance is always that of Flagler County Fire Rescue—the county’s EMNS service. The fire truck is usually Palm Coast’s, or Flagler Beach, if the call is in that city, or, if it’s in the unincorporated part of the county, then a county fire truck. Residents often wonder: why the ambulance and the truck? Why two separate agencies?
The county in the past has considered consolidated services, which would have the county provide all services—fire and EMS. In 2011, the then-union leaders of both the city’s fire department and the county’s put forth just such a plan. The plan got a considerable public response, suggesting there was room for discussion. But the plan fell flat when the politicians heard of it. Cities recoil at the notion: witness how Flagler Beach did so last year, even though its finances invited at least consideration of consolidated services. There’s historically been little interest on the Palm Coast council for consolidation.
Netts concedes that two people can’t alone respond to an EMS call, “so you’ve got to have other personnel on the scene. Do they have to be trained to that same extent, do they have to be paramedics, would EMT’s be just as well.”
Netts, who just last month proposed, his tongue not entirely in his cheek, that the county owes the city a fire truck, took City Manager Jim Landon somewhat by surprise today. Landon said the discussions he’s been having focus on data: where the responses to calls are taking place, how efficient are they, how to make them more efficient, where to locate a fire station in the future when that needs arise. He was not prepared to question the overall structure of the system, and strained on several occasions today to rein in the mayor’s caustic broadsides at the county, which didn’t stop.
“We’re called first responders, we’re supposed to be the ones that get there, get first, when it comes to EMS—not fire, but EMS,” Landon said.
“Why are we supposed to be the first responders?” Netts asked.
“That is our system, is that we respond to the call then the county brings the transport in,” Landon said. “There’s times when the county gets there before we do, and we don’t respond at all, depending on where it is. You’re saying change that process.”
“I think if we’re going to have a shared system, which is what we have, then we ought to share the revenues,” the mayor said.
Ambulance fees bring in between $2.5 million and $3.2 million a year. But the county also pays for the $1.2 million annual cost of the county’s 800 megahertz emergency communications system. A separate funding stream—about $37,000 a month, derived from a 40-cent tax on phone lines—pays for the 911 operation, with some left-over for capital improvements.
“Our relationship between the two fire departments, not to mention the county itself , has not always been the most congenial and cooperative, so how are you facilitating that?” council member Bill McGuire asked the city manager. At that point, Landon summoned Mike Beadle, the city’s fire chief.
Beadle focused on the data. “In past it’s always been well, you didn’t ask us, you didn’t use our data, you skewed the numbers, you played games with all the numbers. We’re not playing numbers with anybody’s data,” he said. “It’s all the same data that’s being collected through the computer of automated dispatch center, better known as the CAD,” or computer assisted dispatching. Beadle has been analyzing that data to see whether calls are meeting their target consistently—responding in six minutes or less, wherever the calls come from. But there are limitations. Dispatching has not yet graduated to medical dispatching, which entails a quick seven-question determination of what to send. “Right now, ‘Well, I think they’re having a heart attack,’ they send the world,’” Beadle said.
So multi-units can end up converging on the same address, duplicating services.
Netts wnet back to the charge: “Why are we sending a fire truck on an EMS call?”
“Our paramedics are dually certified,” Beadle said. “It used to be that they could ride in an ambulance, and a lot of the ambulance people couldn’t ride in a fire truck. But those days are gone. There’s more bang for your buck, if you will, if you have cross- or dual certified people.”
“You’ve got a fire truck, why not pit four people on the fire truck instead of sending more units?”
Beadle agreed, but again said there are no black and white answers right now, prompting McGuire again to question whether there are inefficiencies. This time the city manager intervened.
“We could operate EMS and fire service in the entire county a lot more efficiently than we do now,” Landon said.
“Correct,” Beadle said.
But the immediate aim is to channel the data into a plan to be more cot-effective.
Netts again: “Why can’t the city run its own ambulances?”
“Because the overhead costs the last time we looked at it would be $3.5 million, the start-up costs, that we will never recoup,” Beadle said.
Netts: “How many ambulances does the county currently have in Palm Coast?”
Netts: “You’re going to spend $3.5 million on two ambulances? It’s even worse than your fire trucks.”
Beadle: “I guess I should just take that and go.
Netts: “I think so. I’ve made my point, I hope.”
Beadle: “And you have. You have.”
But Netts wasn’t done. “How much rent do we get from the county when they put their ambulances in our fire houses? How much? How much?”
He asked knowing the answer, of course. The county doesn’t pay to put its ambulances in city fire houses, because it does so as a joint service, not by favor from the city.
Council member Steven Nobile contributed just five words to the discussion: “It’s a stupid system.”
The county, Landon said, is not participating in the city’s analysis, though it’s aware of it. “They said yes, they’re willing to sit down at the table with us,” Landon said. “Now, what the results of that are, sitting down is one thing. Working together on some solutions, we’re going to have to hope for the best.”
Still not done—he had one more trap to spring—Netts asked the fire chief: “Mike, if I gave you $3.5 million, could you start your own ambulance service?”
“Absolutely,” Beadle said.
“No, you could not,” Netts snapped back, “you know very well you’d need a certificate of need from the county, and they have refused to provide one to us.” Netts claims the late Ralph Carter, when he was a council member, asked for such a certificate from the county (though Carter alone could not have done so). “And I remember the chairman of the county commission going across the table shaking his finger, don’t you dare, that’s county province exclusively.”
And like a first responder declaring a scene safe again, Landon announced the pizza had arrived, stopping the discussion cold.
— Pierre Tristam (@PierreTristam) April 28, 2015