Preparedness

Volusia County, Fla., Looks to Put $5M into Ambulance System

County officials unveiled a plan this week to enhance the EVAC system with seven more ambulances and 28 emergency medical technicians and paramedics, plus new technology.

by Dustin Wyatt, The News-Journal, Daytona Beach, Fla. / February 8, 2019

(TNS) - Overhauling an ambulance system that's been chronically understaffed even as demand for the service has soared could cost Volusia County more than $5 million — and may even require a property tax increase.

County officials unveiled a plan this week to enhance the EVAC system with seven more ambulances and 28 emergency medical technicians and paramedics, plus new technology and nurse triage positions to field non-emergency calls. To help pay for it, the county may need to boost property taxes by an average of $5.25 per household, enough to generate $2.1 million toward the bill.

"There is a price tag. ... We are being asked to upgrade a lot of things," County Manager George Recktenwald said at Tuesday's County Council meeting. "At the end of the day, we are going to have to make some decisions budgetarily."

The system drew heavy fire last year. Believing Volusia ambulances weren't responding fast enough to calls, Port Orange voted last year to buy its own and hire four people to staff it — at an annual cost of $425,000. Councilwoman Heather Post has given several examples at council meetings and on her Facebook page of occasions when wait times or transport times exceeded 30 minutes.

The criticism prompted Recktenwald and other top managers to hold a series of meetings with EMS personnel to pore over data and assess needs. The recommendations that resulted from those meetings were part of a lengthy staff presentation at Tuesday's meetings. Among the takeaways:

The county has typically been short eight or nine paramedics since taking over EVAC in 2011, said Public Protection Director Joe Pozzo, who has issued an edict requiring all full-time positions be filled by Feb. 15.

County ambulances spend a lot of time when they are unable to respond to emergency calls because they occupied transferring patients between hospitals. Such calls happen on average 14 times a day and typically take up to two hours. County staff recommends adding two ambulances and eight paramedics to focus on this function.

The county's system is bogged down by 911 calls for non-emergency situations. To combat this, staff recommended putting a nurse in the county's communications center to triage calls and seek other alternatives to ensure that the emergency system is reserved for true emergencies.

In addition to those issues, a News-Journal analysis published Sunday found that the ambulance system is also hindered by bed delays at over-crowded emergency rooms. The number of times ambulances had to wait outside a hospital for more than 30 minutes increased 72 percent over a six-year period, costing the system an average of five and a half hours per day.

Council members commended staff on the presentation as they now set about the task of determining the best course of action before the next budget is adopted in September. The county has recommended rolling out the changes in phases over the next three years, with four ambulances added this year; two more next year along with the triage program, and a seventh new ambulance in 2021.

"What I want is the outcomes for the residents," said County Chair Ed Kelley, adding that he'd like to see the nurse triage rolled out this year. "I think if money wasn't an issue, we'd say do it all yesterday. But we have to face the realities and make the decision. ... It's incumbent upon us to provide the level of service that we know and feel our residents deserve."

Councilman Ben Johnson agreed.

"This is about saving lives," said the former sheriff. "We have to step up to the plate. We have to do that even if we have to cut (money) from somewhere else in the future in order to do it."

Said Billie Wheeler: "This is our number one priority: our citizens' safety. It is time to move forward."

Post said the county should have made improving its EMS system a priority before taking on other initiatives — like a years-long goal to get debt-free in its general fund.

"The work that has been done over the past several months on this has been amazing," she said. "But the point is that there have been deficiencies that have gone on for several years that have been brought to our attention. This is what's in front of us. It's our responsibility to provide adequate public safety service to the citizens of Volusia County. Obviously, I'm mindful of the price tag, but also I'm a little irritated for council to go-to-zero budget when there are critical needs not being addressed. I don't find that acceptable either."

Councilwoman Deb Denys shared a story of a bad experience she had in January when her husband thought he was having a heart attack. After an EMS crew arrived in New Smyrna Beach with no response time problems, Denys requested a transport to Halifax Hospital in Daytona Beach. She was told that EMS crews weren't allowed to transfer patients to hospitals outside a 12-mile radius.

Even after telling the paramedic team that she was a councilwoman, her request was denied and Denys wound up having to drive her husband to Halifax Health without an ambulance. Later, the county's medical director Peter Springer called and apologized, telling Denys that the county is supposed to send patients to whichever hospital they prefer.

"If I can't navigate the system on a transport issue, how are our senior citizens or a young mother with a child (going to) know what their rights are?" she said, asking the county to do better at ensuring the right information gets to patients.

"A million dollars isn't going to fix that," she added.

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