New EMS Plan Aims to Ease Workload of Pinellas Fire Departments

New priority dispatch protocol would eliminate the need for area departments to respond to thousands of calls

LARGO — During the more than 25 years Largo Fire Rescue Chief Chad Pittman has been a first responder, he has heard the topic of priority dispatching come and go several times.

Concerns about call volume have mounted, however. So, after about three years of discussions and research, Pittman said several Pinellas County fire departments are finally willing to give it a try and forging ahead with a plan that would change the way calls are dispatched and could drastically reduce the workload of departments already stretched thin.

If implemented in the next couple of months, Pittman said the ALS Growth Management Agreement between agencies and the county EMS Authority would eliminate the need for fire departments to respond to approximately 12,500 minor calls for falls or sick persons systemwide, instead sending only a Sunstar Paramedics ambulance.

“Our overall goal is to improve the availability of Fire Rescue resources for those true emergencies – the life-threatening events,” Pittman told Largo city commissioners Feb. 5. “So, if we don’t have a unit on … the falls or the sick person, they are available to respond to one of those emergencies.”

Those two types of calls add up for the county’s largest departments.

According to 2017 data, the new approach would eliminate 2,500 responses each year for Largo (an 8.5 percent reduction of its 29,500 annual calls), 4,800 for St. Petersburg, 2,300 for Clearwater and 1,100 for Seminole.

Other agencies also interested in the program are East Lake, Lealman, Pinellas Suncoast, Safety Harbor and Oldsmar.

Currently, even non-emergency 911 calls, such as a sprained ankle, require both EMS and ambulance responses, consisting of four to six personnel.

Using a set of standardized protocols to triage patients via the telephone, the new method would allow dispatchers to downgrade calls for sick persons or falls and send only an ambulance.

“The first thing the dispatcher checks off is is the patient awake and alert? And if the first answer is no, the fire department goes right away,” Largo Deputy Fire Chief Joe Pennino said. “So, it’s until they get to the end to really figure out that this is definitely not a severe priority where they send Sunstar only.”

John Carroll, a former Largo police chief, was among several city commissioners who praised the approach and approved the agreement with the county.

“I think this is fantastic,” he said. “I know how much work has gone into this and I really appreciate the effort. I know in the law enforcement side, we have done some sort of priority dispatching for a long time.”

St. Petersburg Fire Rescue Chief Ian Womack made the same point when presenting the plan to the St. Pete City Council on Feb. 7.

“If you have somebody crawling through your window and you call 911, you’ll get a police officer very quickly,” he said. “If the neighbors are just making too much noise and you call 911, you’ll get an officer when they can get you one.”

Which leads to the downside to priority dispatching: it will take about five minutes longer for ambulances to respond to downgraded calls.

Using 2017 data, the average first responder response time is 5 minutes, 5 seconds. Under the new plan, the average time it would take for an ambulance to arrive would be 10 minutes, 26 seconds.

However, if dispatchers determine that an ambulance can’t arrive within 20 minutes, then a first responder will be sent immediately. Ambulances also can request assistance if necessary.

Womack pointed out that neighboring counties have already implemented priority dispatching. Hillsborough County and the city of Tampa, for example, do not respond to such calls at all, referring them to a private third party that has a 60-minute window to respond.

“Most of the major metros and … your largest counties in the state have gone to this,” he said.

“We are not the tip of the spear on this. You try to continue to answer all of those calls as long as you can, and we’re getting to a point where our resources are getting stretched. The workload on our personnel is getting excessive and we’re no longer able to answer every call in the exact same fashion. So, we rode it as long as we could. A lot of our other partnering agencies, larger counties, larger municipalities, they just got to that fork in the road before we did.”

Not sold yet

St. Pete city leaders were far more guarded than their Largo counterparts when hearing about the plan.  

Councilor Ed Montanari requested the topic be further discussed in March because he was worried about dispatchers downgrading responses.

“Public safety is job one, and I’m concerned about the time that somebody doesn’t get the service they need,” he said. “And I don’t want to go forward at this point with a change that may affect the public safety without making sure we’re doing the right thing.”

Womack and St. Pete Fire Rescue Chief James Large said that was one of the concerns addressed by a data-driven focus group, which has been a collaborative between fire chiefs and county staff to evaluate the response time performance and workload of ALS first responder units.

“What we discovered was the rate that we were over-resourcing these non-emergency calls and missing a more emergent call was happening five times more often than we were under-resourcing a more emergent call,” Womack said.

“This is the smaller piece of the risk assumption.”

Womack said all the calls also will get a clinical review from the EMS medical director to make sure they were dispatched correctly.

Councilors Brandi Gabbard and Charlie Gerdes also called for more discussion and wanted to hear firsthand that Sunstar would be up to the task of servicing these calls independently.

“I want to get some sense of being able to sleep at night that the Sunstar folks aren’t going to be overwhelmed No. 1,” Gerdes said, “and No. 2, aren’t going to go, ‘Oh my God, I’m looking for another job because I don’t want to do this.’”

Large said the concerns were valid, but he wouldn’t have brought it up if he thought for a second that it would hinder public safety.

“This program works all over the nation, not just in Florida,” he said. “It’s been working for years. We did a lot of homework on it. We’re not throwing something out there that is not going to work. … We’re not just coming up here and throwing something up because it sounds like a good idea. That’s not how we work.”  

Do fewer calls mean fewer dollars?

Fire chiefs had their own concerns when developing the program because county funding of units is tied to call volume. Therefore, fewer calls could mean less cash.

Womack said that was the thought when St. Pete opposed the idea in 2008.

“At that time, what the county was trying to do was simply reduce our call volume to then come and leverage resources away from the fire department,” he said. “So, it was a little bit of a sordid purpose. It wasn’t a pure motive in implementing the medical priority dispatch system.”

Womack said the relationship with the county EMS Authority has improved exponentially since then, so the new agreement includes a list of “foundational units” that must continue to be funded in order to maintain public health, safety and welfare.

“The whole goal here is to reduce the workload on our personnel,” Large added. “They are getting beat up day in, day out. … And the only solution that I continue to hear is let’s throw some more money, some more people at it. I’m all for that. Bring it. Give us as many people as you want, as many stations as you want. I don’t think it’s going to happen. So, we’re doing the best we can with what we have.”