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Change Viewed In Florida EMS Dispatching

Some people could wait longer for help under a proposal that would change the way Pinellas County dispatches its emergency medical personnel.

The change, which affects only calls about emergencies that aren't life-threatening - could be a first step to a total revamp of Pinellas' EMS response system.

The system, known as priority dispatch, is designed in part to cut down on the duplication in services that is a hallmark of Pinellas' EMS system. But it's unclear whether the move will save any money. Pinellas has not analyzed the possible savings, said Craig Hare, the county's EMS division manager.

When someone calls 911 for a medical emergency under the current system, paramedics from one of the county's 18 fire departments are sent. Also sent are paramedics in a Sunstar ambulance. Under the proposal, which is expected to kick in around Dec. 1, some callers would see only the firefighter/paramedics; others would see only ambulance paramedics; and most would continue to see both.

The change would affect an estimated 10,000 calls, or about 7 percent of the 141,726 EMS calls the county expects this year. The affected calls are those in which there is no life-threatening emergency. That would be determined by the 911 operator, who would ask a series of questions designed to find out exactly what is wrong. This already happens, but the questions would become more detailed. The remaining 93 percent of the calls would continue to be answered by firefighters and Sunstar.

County staff members analyzed emergency medical calls and identified two groups among the non-life-threatening emergencies, Hare said. One was a set of calls that do not usually result in transportation to a hospital. The other was a set of calls in which there is a high likelihood that the person will go to the hospital. The staff made its recommendations based on that data. Cities and fire chiefs have agreed to participate.

Callers from doctors' offices, nursing homes or adult living facilities, and patients who otherwise have a medical professional present and are complaining of nonlife-threatening symptoms would be sent only an ambulance. Some of these callers could wait longer for help. Firefighter/paramedics respond to medical calls in 4½ minutes on average and are required to arrive within 7½ minutes at least 90 percent of the time. The Sunstar ambulances, however, have an average response time countywide of 10 minutes and are required to answer the call within 20 minutes at least 90 percent of the time.

If the dispatcher thought an ambulance was necessary, one would be sent. And if a firefighter/paramedic on scene believed an ambulance was necessary, Sunstar would be called.

The decision to use priority transport is a way to manage the increased call volume expected with an aging population, Largo fire Chief Mike Wallace said.

"We are going to be seeing increased call volume. The way to manage that is send the right unit to the right call," he said. "There are ways to do that safely and responsibly." But Wallace said he expects to see no real monetary savings from the change. Firefighters and ambulances are going to be there whether they're responding to calls or not. And they have to be paid.

"We're a fixed cost. By sending or not sending, you're not saving anything," Wallace said. Priority dispatch "doesn't save any money. It's just common sense. "

County EMS officials say they would like to expand the concept of priority dispatch to all calls, but some stumbling blocks will make the process slow if they don't derail it altogether.

Fire chiefs, for example, are reluctant to keep their paramedics just sitting around when someone needs help, even if that person's life is not in danger.

Also problematic are the thousands of calls when both law enforcement and EMS go to a scene. Many times EMS is not needed or the paramedics hang around until the police clear the scene. That could be done more efficiently if the 911 operator asked more questions, Hare said.

But the idea of having the 911 operator ask even more questions worries some law enforcement personnel, such as Pinellas County's Chief Deputy Bob Gualtieri, because the questions could delay police response.


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