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County moving forward with EMS changes
Staff prepares to take plan to 18 service providers
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Lt. Scott Sanford with Palm Harbor Fire Rescue tells Pinellas County Commissioners that he is glad Fitch and Associates proved that fire departments could provide transport service during an Aug. 1 work session.
CLEARWATER – Pinellas County Commissioners gave staff direction Aug. 1 to move forward with a consultant’s plan that could help contain costs for emergency medical services.

Unlike many previous meetings on ways to balance the EMS fund, the room wasn’t packed with fire chiefs, firefighters and paramedics opposed to a consultant’s findings and recommendations. The Thursday morning meeting concluded in about an hour.

“This is a very important day,” Commission Chair Ken Welch said at the beginning of the work session.

He said the work done by the consultant, Fitch and Associates, was a “good process” toward a “necessary discussion.”

“That doesn’t mean we’ll agree on everything in the report, but it does give us enough information to make decisions.”

He said the consultant’s conclusion that Pinellas County had the finest EMS system in the United States – maybe the world - was good news. He also said it was time to move forward to “maintain the excellence of the system in an affordable way.”

Robert Polk with Pinellas Suncoast Fire Rescue and president of the Pinellas County Fire Chiefs Association, outlined the areas in which the association agreed with the Fitch report, which he described as the “most comprehensive set of data we’ve ever had.”

He complimented Fitch for its “interesting use of the data,” which consisted of EMS calls from the year 2011, and said the association also agreed with Fitch’s conclusion that the county’s system was one of the most sophisticated in the United States.

The association agrees with Fitch in its opinion that the plan proposed in a 2011 study by consultant Mic Gunderson, one of the principals with Integral Performance Solutions, was in theory achievable, but not implementable. The county’s system is not in such “disrepair to need such a move,” he said.

The association agreed with Fitch that using Sunstar instead of fire department first responders for low-level emergency calls would not save money. He also agreed with the findings that a centralized system created efficiencies.

However, he said, “Surge capacity must be present” in the system to ensure response to disasters. He also pointed out that fire departments and districts contribute to the system by providing equipment and personnel that “doesn’t cost the county a dime.”

He said for the first time, in 2014, the firefighters' contracts for EMS would be less than the contract with Paramedics Plus, a private company that provides ambulance service under the county’s Sunstar brand. He cautioned that any changes made to the system would be complex and time consuming.

“This report provides a positive framework for dialogue and potential savings and long-term savings enhancements,” he said.

Lt. Scott Sanford with Palm Harbor Fire Rescue said he was glad that Fitch had demonstrated that a plan he co-authored with Capt. Jim Millican with Lealman Fire Rescue would work. The plan advocates ambulance transport by local fire departments instead of private ambulance service. However, he wasn’t happy with the revisions made in the plan to address excessive workload, which Fitch said was a problem with the Sanford-Millican plan. Adding in units to balance workload made fire department transport too expensive to implement.

“It’s somewhat of a relief to find closure on this,” he said. “This is a life and death decision we’re passing on to you.”

Lealman Fire and Rescue Chief Rick Graham said the Fitch report showed the county’s system was “effective and efficient.” He objected to the notion that the system had “excess” capacity as opposed to “reserve” capacity. Reserve capacity is required, he said. He gave the example of recent thunderstorms as proof of its need.

“It’s the difference between life and death. It’s safety,” he said.

Graham is not sure that the CARES plan recommended by Fitch is something that can be implemented immediately.

“It’s a good platform,” he said.

The CARES plan calls for a reduction in EMS staff during nighttime hours.

John Klinefelter, president of the Clearwater Firefighter’s Association, talked about problems with the IPS and Fitch study, saying neither had been fully vetted. He objected to the county’s move on priority dispatch. He said the CARES plan, cutting 10 hours from midnight to 7 a.m., did not ensure enough firefighters were on duty to respond at all times.

“It’s not just about medical, it’s also about fire,” he said.

He said if the county did not fund personnel for those 10 hours, cities and fire districts would have to fund their own units. He said one-third of Clearwater’s units were funded by the city now. He said if the county made cuts, they would have to do more with their advance life support engines, which could influence the level of service on Clearwater Beach.

“It’s a huge cost shift to the cities and fire districts,” he said.

Thus far, municipalities and fire districts have been silent in terms of a formal response to Fitch’s report and the CARES plan. Commissioner Chair Ken Welch said the response had been favorable in conversations with some fire chiefs.

The commission directed staff to begin conversations with all interested parties as soon as possible to begin work toward implementing any possible cost savings from Fitch’s plan. While the consensus was to push ahead sooner rather than later, commissioners realize it could take two to three years. Meanwhile, millage rates may have to be increased to pay for costs.

The commission agreed that "boundaries" of the discussion should center on the CARES plan, reduction of staffing for 10 hours between midnight and 7 a.m., addressing excess capacity, long-term financial sustainability and protecting the level of service.

Commissioners also asked for a status report on phase 3 priority dispatch. The commission had voted to implement phase 3 on June 1. Phase 3 calls for Sunstar to respond to low-level emergency calls instead of fire department first responders.

The Fitch report recommends the opposite approach – response by fire personnel instead of the private ambulance provider. County Administrator Bob LaSala said the decision would be up to the EMS medical director and Medical Control Board, but staff supports Fitch’s recommendation. He said that Phase 3 was not in effect at this time.

Welch asked if the medical control board was still planning to move ahead with eliminating response to certain calls, such as hiccups. Bruce Moeller, director of Public Safety Services, said that plan was still undecided.

Commissioner Susan Latvala commented on the results of the Fitch study.

“We’re now in a better place. There’s more consensus in the community,” she said. “We need a system that will sustain us in the future while maintaining the most clinically sophisticated system that we have and addressing excess capacity.”

Commissioner Karen Seel, along with other commissioners, thanked Sanford and Millican for their contribution toward solving the EMS issue.

“But we still have a long-term sustainability issue. That’s still the elephant in the room,” she said.
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