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To shorten response times and ensure trained personnel are available in life-threatening situations, Volusia County’s Emergency Medical Services is making changes.

Emergency Medical Services operates the county’s EVAC ambulances.

“It’s a very large system … driven by demand,” county Public Protection Director Joe Pozzo said.

How large?

Pozzo cited figures from the 2017-18 fiscal year: EVAC responded to 78,300 calls. Of those, 51,073 resulted in taking someone to a hospital.

With the blessing of the County Council, the system will buy more vehicles, hire more medics, and set up units to handle transporting patients from one hospital to another. Such runs are known as inter-facility transfers.

Setting aside ambulances and crews for those transfers will free up other EVAC units to scramble to emergencies, the county said.

Under the current circumstances, quite frequently, EVAC crews that take a patient to a hospital must remain there for hours, while physicians decide whether to admit the patient and determine whether a bed is available. EVAC logs an average of 14 inter-facility transfers each day, and those delays at hospitals mean the ambulance and its crew are out of service as 911 operators field other emergency calls.

With the changes, a nurse-triage unit will be available to advise ambulance crews on the severity of the emergencies of patients awaiting transport or en route to a hospital.

Investing in emergencies

“We’re going to make more investment in assets and people,” County Manager George Recktenwald said.

That investment involves purchasing four new ambulances and hiring 16 employees: eight paramedics and eight emergency-medical technicians. All of the new hires will be assigned to inter-facility transfers.

County officials are also considering the need to increase the emergency workers’ wages and benefits.

“Paramedics are in high demand,” Recktenwald said. “Someone could call into the office and say, ‘I’m taking a job somewhere else.’”

Pozzo added, “We’re down three EMTs [emergency-medical technicians] now.”

The new vehicles, which will be ready in approximately six months, will cost about $915,000, while the new hires will cost almost $980,000 annually. They will join the more than 160 front-line responders already on EVAC’s roster. The estimated annual cost to keep the new ambulances on the roads is $236,000.

“There is a price tag,” Recktenwald noted. “There will be an ongoing cost.”

The higher cost may show up on tax bills — unless county residents and visitors become better educated about when to call 911 and when not to. Pozzo said the education piece of the new EMS effort will not discourage people from calling for help if they really fear a medical crisis.

“If in doubt, call 911,” he said.

The nurse-triage asset will also guide emergency-medical personnel in determining which cases are real emergencies and which are less acute. This sorting is supposed to make certain the actual life-threatening cases are handled as quickly as possible, while offering alternative steps for less-critical patients.

“Many people use the emergency room as a doctor’s office,” Pozzo said, echoing a complaint often spoken for years at meetings of the West Volusia Hospital Authority when dealing with rising indigent-care bills.

Getting there sooner

The EMS changes are also supposed to cut response time. In the 2017-18 fiscal year, the average length of time between a 911 call and EVAC’s arrival was seven minutes and 23 seconds in an urban area. The average response time in a rural area was 14 minutes and 36 seconds.

“If you fall out of a tree in Pierson, it’s probably going to take longer,” Recktenwald said.

EVAC’s revised budget for the 2018-19 fiscal year, which began Oct. 1, totals $25.2 million, and the projected budget for the 2019-20 fiscal year is almost $2 million more. Fees patients pay account for almost two-thirds; EVAC also relies on a $5.9 million subsidy from the ounty’s general fund.

‘It’s a national problem’

On his way up the county government’s career ladder, County Manager Recktenwald served for a time as the director of Public Protection. He knows what EMS providers deal with daily.

He also understands that the costs of maintaining and running ambulances are going up because more people are moving into Florida. On top of that, many of the new settlers are graying, and that usually means more health problems.

“We have an aging population. We have a lot of assisted-living facilities,” Recktenwald said, adding that it’s true across the nation.

All of the changes coming to EVAC are supposed to make certain the critical emergency resources are available when and where they are most needed.

While the additional emergency-medical personnel — including the triage nurses — and vehicles will help keep pace with the growing demand, EMS officials say they must “educate” the public better about when to use the EMS system, and that involves knowing what is an emergency and what is not.

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