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Pinellas County seeks to scale back response on less urgent EMS calls

Pinellas commissioners are poised to change the county's emergency medical services dispatch system to make it more efficient by sending fewer paramedics to certain calls.

What won't change is who gets an ambulance ride to the emergency room. Those include people who are itching, have hiccups, can't sleep or feel nervous. In short, just about anyone who wants an ambulance ride to the emergency room will get one, just as they do today.

Those rides are often paid for by taxpayers through the state and federally funded Medicaid and Medicare programs.

The new system would kick in next year if the County Commission approves the move.

Under the current system, both a fire vehicle with two to four firefighter-paramedics and an ambulance with two more paramedics are sent to most 911 calls asking for medical help. The firefighters are sent to provide immediate help. The ambulance is sent to take the patient to the hospital.

Under the proposed change, firefighters would no longer be automatically sent to two categories of calls: "falls" and "sick persons." The county would send only an ambulance and would not tell local firefighters someone in their area wants help.

It's a change that Pinellas officials say would save money and improve service because it would leave firefighters available for more serious calls. The change is also designed to help correct a public perception that the EMS system is inefficient because too many people are sent to handle minor complaints.

Craig Hare, who oversees the EMS system, said it's not unusual for a caller to ask the 911 dispatcher, "Why are you sending a fire truck? I'm just calling for an ambulance to take me to the hospital."

The change would affect about 14,000 EMS calls a year, or about 10 percent of the 140,000 emergency medical calls the system handles each year. Those categories were chosen because they're not true life-and-death emergencies but most — 71.5 percent — end with the caller being taken to the hospital. Among the complaints that fall into those broad categories: boils, sore throat and transportation only.

Some people have no way to get to the hospital or can't afford a cab ride, but some "do in fact call the ambulance for no reason," said Dr. David Bowden, medical director for the Pinellas EMS system.

Bowden added, "If the patient says in fact, I want to go to the hospital, they are being transported. … Whether that's abusive or not, I'll leave that to the public to decide."

Part of the problem stems from callers who have no insurance or other means to pay for medical care. Some use the EMS system as their primary care. Some blame lies with the design of the system, which mandates a response to all calls no matter how trivial they might sound on the phone.

"We're not going to not respond," said Bruce Moeller, the county's public safety director.

And a paramedic on the scene can't refuse transport even if he believes a hospital visit is unnecessary.

"Even if their issue is 'I need to go to the hospital,' we are not going to debate that. We will take them to the hospital and let them get that care if that's what they believe they need," Moeller said.

Hare said the eventual solution might be to create some system of community paramedicine. But that's down the line, he said. The more immediate solution is to send fewer people to low-level calls.

That's a concept most in Pinellas' EMS community seem to embrace. But some dispute the way the county's going about it.

Some cities and fire districts say they believe firefighters should go to the calls because that's what taxpayers expect from their local governments. And, they say, there's "zero savings" because the firefighters are being paid whether they respond or not.

"These are our residents," East Lake fire commissioner Mark Weinkrantz said. "These are people we're responsible for."

Anne Lindberg can be reached at alindberg@tampabay.com or (727) 893-8450.

New EMS plans

Pinellas County officials have suggested changing the EMS dispatch system to send only an ambulance to calls that fall into two broad categories, "falls" and "sick persons."

They say there is no need to send firefighter-paramedics and ambulance paramedics to those calls because they're not true emergencies and most callers end up taking an ambulance ride to the hospital anyway.

Below is a list of some of the specific ailments that are included in the "falls" and "sick persons" categories.

• Falls (that do not involve injury to a "dangerous body area")*

• Falls (that happened more than six hours before the call to 911)*

• No priority symptoms (such as heart pains, or symptoms of a stroke)*

• General weakness

• Boils

• Can't sleep

• Constipation

• Cut-off ring request

• Earache

• Hiccups

• Itching

• Sore throat

• Toothache

*These three complaints make up about 80 percent, or 11,200, of the 14,000 calls in these categories.

Source: Pinellas County Emergency Medical Services



Pinellas County seeks to scale back response on less urgent EMS calls 12/07/12 [Last modified: Friday, December 7, 2012 11:48pm]
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