Palm Coast Floats New Rescue System in Name Of “Efficiency,” But County Sees Many Flaws

For almost a year, Palm Coast—and particularly Mayor Jon Netts—has been on a mission to change the way ambulance services are provided in the city. The city has not put forth a plan to do just that. But it’ll go nowhere unless county government agrees. And county government, along with the firefighters’ unions of both city and county departments, are opposed.

Netts, following on the city manager’s recommendation, is asking for a joint meeting of the city council and county commission.  “We have to have the county at the table at this point,” City Manager Jim Landon said.

But with so much resistance in the ranks, financial numbers that don’t favor the county—whose fire chief sees the plan as a subsidy of city services—little political will in an election year, the city’s push may not go much further than talk.

“It’s kind of a manufactured problem,” says Stephen Palmer, president of the county’s firefighters union, which represents some 80 firefighters. “There’s no problem. They want to increase the rescues in the city of Palm Coast, and they’re doing it at the expense of the safety of our firefighters. It’s not a necessity, they want to increase their level, which is fine, but do it the proper way, get extra, manpower and put it up.”

By doing it at the expense of firefighters’ safety, Palmer means that Palm Coast’s plan would dilute the presence of firefighters on fire trucks from three to two in many cases—on fire calls, anyway. And he notes, as city council members acknowledge, that there is currently no issue with getting ambulances to patients anywhere in the city: even City Manager Jim Landon acknowledges there are no problems at that end. Residents consistently give fire rescue services some of the highest marks of any local government service in the city’s annual survey.

Palm Coast Deputy Fire Chief Jerry Forte, who put the city’s new plan together, says that happens even now, and the dilution would affect less than 2 percent of all calls, since less than 2 percent of emergency calls involve fires.

“The firefighter in me 20 years ago would have looked at this and said this is crazy. But I’m in a different position now,” Forte said. The needs of the community are overwhelmingly medical-related, and that’s where the focus of services should be.  “My concern is what’s going  to happen in next 15 years because by doing this concept, we’re going to bring two agencies further together, they’re going to operate more effectively, we’re going to bring the zones closer together.”

A county responsibility

Palm Coast itself doesn’t ambulance those services per se. Flagler County Fire Rescue, a county government service, provides the ambulances, with a Palm Coast fire truck usually responding to a call as well. Palm Coast’s firefighters can provide what’s called advanced life support to patients, and routinely do. But by law they may not transport patients to a hospital. That’s the county’s responsibility. It’s also up to the county to decide whether the city may or may not do such transports, so even if Palm Coast wanted to have its own ambulances, it still could not transport patients without the county’s permission. The county is not about to grant that permission.

But as Emergency Medical Services are a joint city-county operation in Palm Coast, fire trucks continue to accompany ambulances. Netts considers that a duplication of services. Palm Coast would rather not use its fire trucks so often, particularly since because less than 2 percent of all calls for service involve actual fires.

And at least half the medical calls don’t involve the sort of emergencies that require more than two paramedics: sprains, broken bones, fevers, panic attacks, that sort of thing. So they can be taken care of with just an ambulance, or at least a crew of two. Additional paramedics are necessary with more serious medical issues or when the patient may be heavier, and requires more than two pairs of arms to maneuver.

The heart of the Forte plan has to do with adding two more ambulances to the city’s fire stations, bringing the total of ambulances running in the city and the county to nine, up from seven.

The city has five fire stations: Station 25 on Belle Terre Parkway near Royal Palms Parkway (which averages 4.8 medical calls a day), Station 21, behind Kohl’s (6.4 calls a day), Station 22 across from the community center (3.2 calls), Station 24 at Palm Harbor (2.5 calls), and Station 23, north of the Indian Trails Sports Complex (2 calls a day). Stations 21 and 22 now have permanently stationed county ambulances.

The Forte plan would take two of the county’s four back-up ambulances and put them in service: one at Station 23 and one at Station 24, thus effectively “doubling” ambulances in the city.

“To me, four ambulances in Palm Coast is twice as good as two,” Netts says.

The Forte plan would also in some cases have a city firefighter and a county firefighter on the same county ambulance, while reducing the personnel on some fire trucks from three to two, to enable the personnel manning the additional rescue units.

In essence, at Stations 21, 22, 24 and 25, one county paramedic and one city firefighter would respond to non-emergency medical calls together, leaving two firefighters  at the station in case another call comes in in the same response area. If the station receives a call for a critical emergency, all four personnel go out—ambulance and fire truck—and the patient is driven to the hospital, with the city firefighter driving the ambulance and the county paramedic performing the medical services. Should a third paramedic be required in the ambulance, the fire engine would then be out of service, even if another call came in at the same time.

Palm Coast’s rosy assumptions

The city says all that can be done without added cost or added personnel, either to the city or to the county. County Fire Chief Don Petito disputes the city’s rosy view on many counts.

First, while the county does have four back-up ambulances in addition to the seven it has in full service at the moment, the four ambulances are not designed to be running calls 24 hours a day. They each have around 200,000 miles on them. One of them is frequently used to back up any of the current seven that may need to go out of service for repairs or maintenance. That would still be necessary under any plan. And while the county can put back-up ambulances in service during emergencies, Petito says the service would be limited.

If the city wants two additional ambulances at its stations, it would sooner or later amount to an additional cost of two ambulances, with each ambulance costing in the range of $200,000. That’s the upfront cost. Maintaining an ambulance doesn’t come cheap, Petito says, and those costs would be new and recurring—and the county would be paying those costs.

Second, the county has always disputed—if not resented—the city’s characterization of EMS service as amounting to just two ambulances in the city. For example, Palm Coast never includes the county’s airport fire station (and ambulance) in its calculations, because the airport is technically not city territory, but to the county, the airport station—the busiest in the county or the city, running close to nine calls per day—is very much part of city coverage. In addition, the county is constantly shifting ambulances from one station to another—From Flagler Beach into  Palm Coast, for example, or from Espanola, or the Hammock—to ensure that once an ambulance in the city is out on a call, that area of the city still has ambulance coverage in case another call comes in. As the county sees it, there is a seven-ambulance coverage system in place now that primarily benefits Palm Coast, where most of the calls are concentrated.

Third, the county has concerns about supervision and liability, should the Forte plan entail a county and a city employee on the same truck. Who would be responsible, for example, when a city employee operating a county truck gets into a wreck?

Resistance to change

Forte sees the resistance as primarily resistance to change, which can be worked out. In his presentation to the city council earlier this month, the plan, he and other city officials said, did not generate outright opposition from the county.

Yet no sooner did the council open the floor to public comment than Kyle Berryhill, who heads the city’s firefighters’ union, made it immediately clear that the union was opposed. He elaborated in an interview. “One of the stated goals of the plan, or what started down this rabbit hole,” Berryhill said, “is to reduce the miles on the fire trucks. I just think that’s a fallacy that does anything with regards to savings. Fire trucks are expensive when you buy them, but fire departments are much more expensive. If you’re trying to go on less call, that doesn’t make any sense to me from a return-on-investment perspective.”

“Buying more little trucks and switching back and forth versus buying a big truck every 10, 5, 20 years, I don’t see a savings there,” Berryhill said. He complimented the city for including various points of view, his and his county colleagues’ included, but he said, referring to the effects of the proposal on firefighting practices, “now we’re talking about making a fundamental change to a practice that’s safe.”

Forte said he expected some resistance. “I don’t expect firefighters who have been doing this for a long time to understand. In the long run I think they could,” he said. “For the governing boards to come together and discuss this at large and come up with one direction would be great to move forward.”

But Petito and both union presidents say the city is pushing a plan for efficiency without providing hard data that shows how such efficiencies will actually make a difference in terms of firetruck usage, for example. And the city is doing so while county and 911 reforms are, in fact, instituting changes that can make tangible improvements in efficiency.

Current improvements

Two such changes: the county just signed an agreement with Florida Hospital Flagler that significantly reduces the hospital’s needs for county ambulances to provide patient transports to other hospitals. The county used to provide that service. Now the hospital is contracting with a private provider to do so. That frees up more county ambulances to remain in service in the county and the city.

More significantly on a day-to-day basis, the 911 system is moving toward what’s called Emergency Medical Dispatching, which will enable the dispatcher to determine in a matter of seconds whether a medical call is critical or not, and whether an ambulance and a firetruck need to respond to that call or whether an ambulance alone can do so. That will improve efficiency vastly, Petito said—and should be given time to work before the structure of ambulance and firefighter services is altered, as the city proposes.

What surprises Petito is that city officials at the council meeting were willing to go so far as to buy one or two ambulances if it came to that, even though the city could still not transport patients. They could, however, respond to calls with the ambulances. With two additional ambulances in the city’s inventory, that would then enable the city to further pressure the county to go along with its plan. But Petito said Daytona Beach tried doing just as much, without success. The end result is ambulances sitting idle more often than they need to, which goes against the claim of efficiency.

But in the end, no matter what the city proposes or buys, it’s still entirely up to the county to decide whether to go along. And for now, little appears to favor a county move in that direction.

The Jerry Forte Plan.

Click to access ems-efficiencies.pdf