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Two hours of debate about emergency medical services — some of it pointed, spirited and wearing — climaxed a long day for the Volusia County Council Aug. 17.

Many of the issues are still unfinished business.

Although many changes in the county’s EMS system have taken place over the past two years, more work remains, according to county leaders.

Besides the increase in emergency calls that comes with a growing population, the people charged with responding to critical health needs are grappling with the challenges of the ongoing pandemic and shortages of personnel and equipment.

“We don’t have enough ambulances, and we don’t have enough paramedics,” Public Protection Director Joe Pozzo told the County Council.

There are 55 ambulances in the county’s EMS fleet.

As for paramedics, the EMS has 74, and there are 19 vacant positions. The County Council recently approved a $4,500 signing bonus for new hires.

There is no shortage of emergency medical technicians, however. The county EMS has 84 authorized positions for EMTs, and all of those slots are filled.

“EMTs we don’t seem to have a problem recruiting,” Pozzo said.

Paramedics have a higher level of training than EMTs, and can deliver more advanced treatments. They are also paid more.

Every county firefighter is an EMT, but only a few firefighters are paramedics.

On any given day, 28 EMTs are in service on the roads or awaiting dispatch, Pozzo said.
The workload is daunting. The county’s EMS — formerly known as EVAC — transported some 5,000 patients to hospitals during July.

The call volumes have risen and continue to rise, Pozzo said.

County EMS crews responded to 59,202 calls to 911 during the 2020 calendar year, or an average of 162 calls per day.

COVID calls

On each call, the trained responders are possibly putting themselves in harm’s way.

“They are treating COVID patients, picking them up and taking them to the hospital, ” Pozzo said. “EMS — they are really on the front lines every day.”

COVID patients are in addition to the standard calls for heart attacks, strokes, household accidents, elderly falls, car wrecks and such — which are increasing as Volusia County’s population grows.

“There’s a great demand right now,” Pozzo said.

Asked what is typically the busiest time of day for EMS, Pozzo replied, “Between 7 a.m. and 1 a.m.”

Trying to keep the promises to serve all

The strain is such that Pozzo said he had to move units from one short-covered part of the county to other short-covered areas. The need to cover a wide geographic area with an already stretched-thin first-responder service set off a sharp exchange between Pozzo and Council Member Heather Post.

“There are areas of the county that are far-removed from the urban centers,” Post said, referring specifically to Ormond-by-the-Sea, also known as the North Peninsula, where a county ambulance had been on standby. “That ambulance is no longer up there.”

“It’s a double-edged sword,” Pozzo responded. “We’re also under pressure to meet response time. We’re under great demand right now.”

Pozzo said the EMS goal for a life-threatening emergency in an urban area is 8 minutes 59 seconds, while the goal for a similar incident in a rural setting is 17 minutes, 59 seconds.

Post said she had talked with constituents who waited for an ambulance for six hours. She asked Pozzo why he had not informed her and fellow council members about the staffing changes and repositioning of ambulances.

“I’m not OK with that,” Post added.

We are short of paramedics,” Pozzo stressed. “There are operational decisions that have to be made. There are things in emergency services that we have to make decisions on.”
“Still, not notifying council … is not appropriate,” Post said. “I would expect that council be told.”

“We’re in the middle of a pandemic,” Pozzo reminded the County Council, noting the need for quick action.

County Manager George Recktenwald, who served as public-protection director on his way up the county government’s career ladder, weighed in.

“There are command decisions that are made all day long,” Recktenwald said. “They are the professionals.”

“What we’ve got here is a failure to communicate,” County Chair Jeff Brower said, using a line from the 1967 film Cool Hand Luke.

“You need to respect us enough to come to us,” Brower told Pozzo. “We want to be responsible to the people of this county.”

Brower agreed Pozzo must “have the freedom to make decisions” on where to place his EMS resources, but he called for keeping the council aware of changes that may affect their neighbors.

“It’s not acceptable to hear from the public, ‘Why did you take my ambulance away?’” he told Pozzo.

“Desperate times require desperate measures,” Council Member Danny Robins said, entering the verbal fray.

“You have my support,” Robins told Pozzo.

“We’re hearing from the public that they’re scared to death … hearing that there’s no ambulance in Ormond-by-the-Sea,” Brower said.

From order to disorder

A parliamentary free-for-all erupted, as Post continued talking to Pozzo.

“Point of order!” Robins demanded, calling for an end to the debate.

“It’s gone on long enough,” Council Member Ben Johnson chimed in.

“I’ve sat here for 20 minutes watching this county employee being beaten up. It’s a witch hunt,” Robins said.

Robins said the County Council was getting into the details of day-to-day operations, matters that should be left to the staff, as overseen by Recktenwald.

“This has been going on for almost an hour on this topic,” Vice Chair Billie Wheeler said, via a remote televideo connection. “I’ve not heard from the citizens that they are fearful. … I’m really very uncomfortable with badgering our employees that way.”

Council members began talking over one another, as Post pressed her point.

“I’m trying to get the council to understand what’s occurring,” she began.

Council Member Fred Lowry called for a vote on cutting off the debate, as Post continued talking.

Wheeler, meanwhile, asked County Attorney Mike Dyer to intervene.

“We’re neglecting our duties here,” Robins said.

When Brower at last called for a vote to end the debate on the movement of ambulances within the county, Post was the lone dissenter.

The verbal storm subsided, but tensions remained.

If we’ve got $$$, should we spend it?

When the council discussed how to end the shortage of paramedics and ambulances, Post called for using more of the funds Volusia County is to receive under the American Rescue Plan Act to address the shortages.

Under the $1.9 trillion coronavirus stimulus bill, the county is to receive $107 million, and has tentatively decided to spend $3.6 million for three EMS respite centers, where ambulance crews could clean up and relax after especially difficult or traumatic calls. One such respite center is to be located in DeLand, and the other two are to be built on the east side.

Post proposed allocating more of the ARPA funds for paramedics and ambulances to cover the shortages. Johnson opposed that idea, noting the ARPA funds are “one-time money.”
Using the coronavirus money now would create a problem when those funds are gone and the need remains, he said.

When that happens, “You either drastically shut down county governments in other places or drastically raise taxes,” Johnson said.

To be continued …

The county’s medical-rescue safety net will doubtless generate more debate. Another key component of the system is the EMS capability of the county’s Fire Services. Each county firefighter is certified as either an EMT or a paramedic.

Volusia County has a two-tier emergency-response system. When the county’s emergency-dispatch center receives a 911 call, the dispatcher alerts the fire department for the jurisdiction where the emergency is located, and also alerts the county’s EMS.

If the firefighters arrive on the scene first and determine a medical emergency exists, they will render first aid and stabilize the patient or patients. The county’s EMS crew may arrive shortly thereafter.

If the situation warrants, one of the agencies may transport the patient to a hospital.
Within the past few years, EVAC — now known as Volusia County EMS — had a virtual monopoly on hospital transports. As the county grew and more people began needing immediate emergency-room care, some fire departments, notably Deltona’s, moved to do what they had previously been forbidden to do: take patients to hospitals.

Although EMS’s monopoly is not as solid as it once was, the practice of scrambling both fire/rescue personnel and EMS to an emergency remains.

To be clear, Fire Services is altogether separate from the county’s EMS, even though the front-line personnel of each of the agencies have similar medical training and skills. In fact, Pozzo said, many of Volusia County EMS’s paramedics have left to join Fire Services because the agency offers higher pay.

The numbers tell the story

59,201
The number of calls for help responded to during 2020 by Volusia Emergency Medical Services.

16,972
The number of distress calls answered by Volusia County Fire Services during the 2020 calendar year.

Almost 9
Volusia County Emergency Medical Services’ response-time goal is 8 minutes, 59 seconds in urban areas, for time-sensitive 911 calls. The average actual response time in urban areas is 6 minutes, 12 seconds.

Almost 18
Volusia County Emergency Medical Services’ response-time goal is 17 minutes, 59 seconds in rural areas, for time-sensitive 911 calls. The average actual response time in rural areas is 9 minutes, 48 seconds.

84
The number of emergency medical technicians working for Volusia County Emergency Medical Services. The agency has 74 paramedics. There are 19 openings for paramedics, and none for EMTs.

99
The number of paramedics working for Volusia County Fire Services. There are no vacancies.

19.99
Bottom-tier pay for an employee of Volusia County Emergency Medical Services. The pay range is from $19.99 to $33.80 per hour. For Volusia County Fire Services, the pay range is from $13.44 to $25.94. All firefighters are trained as EMTs; a few are also paramedics.

12
Hours in a shift for employees of Volusia County Emergency Medical Services. Fire Services employees work 24 hour shifts, followed by 48 hours off.

37.5
In millions, the proposed budget for the 2021-22 fiscal year for Volusia County Emergency Medical Services. The Fire Services proposed budget is $57.2 million.

SOURCE: Volusia County Public Protection

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