EMS, Politics and the Great Urban Sprawl


 
 

Howard Rodenberg, MD, MPH, Dip(FM) | | Wednesday, September 19, 2007


It s July in Daytona Beach, and there are a lot of hot issues out there for us locals. One is the heat itself, more oppressive this summer than the last. (We tend to chalk it up to the warm breeze of election rhetoric, a high-pressure system dominated by our own vice president s note that the use of an old Anglo-Saxon verb meaning to plant in describing a senatorial colleague was OK because it made the Veep feel better. ) Another is the argument down at the Speedway over the $50 million infield expansion to develop a more family-friendly environment (translated as Pay $65 to see the garages but they are pretty cool). Then there s the fate of the proposed International Swimming Hall of Fame down on the beachside that may move here from Ft. Lauderdale, but nobody knows why Ft. Lauderdale wants it to go. Personally, I m distressed that the Rotary Club of Daytona Beach, average member age of 10 (in dog years), always sings God Bless America instead of catering to a younger crowd and giving Paradise by the Dashboard Light a try. Of course, this last one may just be me.

(Speaking of civic clubs, one of my Health Department staffers notes on his resume that he is a member of the Loyal Order of the Moose. This raises two questions. First, what exactly is it that a moose is loyal to? Other moose? A favorite place to rut? Flying squirrels? The other issue is that I never know what to call groups of plural moose. If a single moose is a moose, and a group of moose are also moose, than what is a congregation of several groups of moose? Meese? These things keep me up at night. Yes, I need a life.)

One of our other issues on the board is something called urban growth boundaries. As you might guess, growth is a critical issue in Florida. Much of the state has been effectively paved over, disrupting the natural balance of our ecosystem. Uncontrolled development taxes our limited remaining natural resources and poses serious problems with drainage, sewage treatment and freshwater recharge. Much of our development is focused on communities for older people who have little incentive to contribute to the tax base of their part-time or retirement homes (their view, and I sort of understand this, is that they gave at the office during their working lives). This reluctance to raise taxes or fund bonds means that the city is unable to keep up with the cost of services required by these developments. In order to enhance the tax base, cities and counties allow unchecked development in the hope of gaining new revenues, and the process starts to snowball out of control.

Although we see this problem starting in Volusia County, our leadership has been aggressive in addressing these issues and in preserving natural areas when possible. There are programs in place called Volusia ECHO and Volusia Forever that seek to purchase and preserve environmentally and culturally sensitive lands. In addition, we have a large state forest within our midst, and several wonderful state and county parks. I think we can be proud of our efforts to preserve our region, especially when compared with the 1,000 square mile parking lot we call South Florida. But in some areas you can see the sprawl starting to occur, with huge developments hiding behind small gates off two lane roads. If the process is not controlled, the day will come when we could look like Hernando County. Ten years ago, it was a small rural county on the west coast of Florida. Now it s no more than a suburb of Tampa 50 miles to the south, and along every two-lane road is the identical collection of chain stores, gas stations and strip malls. The only way you d know you were in Florida is when you pass the Weeki Wachee Springs, and even then you d be hard pressed to find a real native mermaid.

Of course, you re reading this to find out what it has to do with EMS. And just as you ve heard that all politics are local, I ask you to consider that all politics are also EMS.

Urban growth boundaries are a specific case in point. They re all about space, and space is time travel time, to be exact. And travel time response time has proven to be the most single critical factor influencing EMS outcomes.

Uncontrolled growth leads to increased response times and less efficacious EMS. More space, especially with expansion of city limits, means more geographic area for a service to cover. If the boundaries of a city expand, and the population rises with it, so do the support services required. In theory, this might mean more jobs for paramedics and firefighters. This is a good thing, right? And won t you decrease response times to these new areas by building new facilities and adding more staff?

You certainly would in a perfect world. However, that s not exactly where we live. Someone has got to support the new infrastructure. And while many developers do pay up-front impact fees for the capital needs of a community (more sewers, etc.), the provision of EMS, fire, and law enforcement services require ongoing annual infusions of funds for salaries and supplies. Although property taxes are designed to fill the bill, I don t know of any municipality that has unlimited funds and a generous disposition. And I ve never lived in a city where taxpayers will gleefully open their wallets for a load of new bills, nor seen a retirement community that is glad to pay for new schools. (I think that s especially noticeable here in Florida, where residents may live only part time and feel much more connected with their previous homes.)

Something has to give, and the response to growth becomes a game of political football. Do you have less LEA coverage? Do you increase response times with fewer EMS units on the streets or staff one less fire station? Do you opt to maintain these public services and ax the Parks Department or the Housing Authority (which often serves core city neighborhoods rather than those in planned developments)? Even if EMS wins, another city service loses, and the quality of life for the whole community suffers.

I truly wish I had a magic answer to this issue. Personally, I know that I want my son to still be able to see some of the real, Ponce-de-Leon Florida. I want to be able to buy 20 acres of land, build a house, sit on the porch looking for a Florida panther and pretend that most of the world is passing me by. I want a balanced ecosystem and to see us all live within our natural limits. I ll put solar collectors on the roof. I want people who move here to contribute to the community rather than simply taking from it. All of my desires are complicated by the realization that as a long-term immigrant from the Plains, I m likely part of the problem.

I do think that as a public health professional, urban growth boundaries offer a wonderful opportunity to ask developers to work within current limits and neighborhoods. The limits will force schools, shops and businesses to be closer to homes, and revised code requirements for street lighting, housing density, zoning, sidewalks and bike paths may promote physical activity, healthier lifestyles and a renewed sense of community. That s not a bad deal for EMS, either.

The key message here is that when local politics come knocking at your door, recognize that everything affects EMS in some way. As part of the community, you re affected by everyone and everything in it. Advocating those positions good for EMS and the community as a whole enhances the value of EMS to your residents and policymakers. Being active in your community is the difference between working at a job and being a professional.


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Related Topics: Provider Wellness and Safety, Legal and Ethical, Operations and Protcols

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