By Gary Pinnell
Highlands Today
SEBRING, Fla. — Firefighters wouldn’t allow EMTs to share a building while a new EMS facility is being built. Many fire stations are unclean and in disrepair. A lack of trust, communication and coordination exists among the 10 volunteer fire departments and the county’s paid fire chief. Fourteen percent of the county’s fire trucks should be taken out of service.
These are a few of the findings from a $42,600 report on fire and EMS departments from Fitch & Associates of Platte City, Missouri, commissioned last year by Highlands County.
The needs assessment is for fire and EMS services within the unincorporated county, where 78 percent of the population resides. The study did not include the cities of Sebring and Avon Park.
The study made 33 recommendations to improve fire and EMS services, so commissioners will make life-and-death decisions on April 5 when they analyze the Fitch Report at an April 5 meeting.
Priority 1, the Fitch Report said, is that EMS service delivery “is stressed to continue to have units available to cover both the geographic responsibilities of the county and the demand for services.”
Most of Highlands County’s population lives from north of Avon Park to south of Lake Placid. However, that U.S. 27 corridor is a fraction of county’s total geographic area, which extends east to the Air Force Bombing Range and Okeechobee, and south to Venus.
“The time from when the units are enroute to an incident until they arrive on scene is 10 minutes or less 90 percent of the time, and can be maintained with six fixed facilities. However,” the report said, “in order to maintain reasonable availability to cover the geographic areas, three additional units are needed to cover the demand for services.
“This would indicate that a total of nine ambulances are necessary to maintain a 10-minute travel time and cover the demand for services,” Fitch said. “Placing a 12-hour ambulance in service rather than a full 24-hour truck is an efficient solution.”
Key data points not currently utilized within the Computer Aided Dispatch system would benefit the County and EMS Department, Fitch said.
“First, the dispatch center does not capture the individual unit responses past the first arriving unit. For example, when multiple units are sent to an incident, only the first arriving unit has the elements of time associated with the record in the system. This limitation does not allow the system to evaluate the individual performance for the second unit and beyond such as response time and time on task.”
Sheriff Susan Benton disagreed. “Much of what the consultants said in their report is inaccurate. They were only evaluating from raw data, they did not really look at the CAD reports. We do collect what they are asking for; however, it was not in a data format that we were able to provide them.”
“We track each of the units, and when we are in live CAD or call history, we simply click on unit times and the following is what we see,” said Shane Smith, 911 PST Training Coordinator for the sheriff’s office, pulling one example. “This is just for one call that was an auto accident. Notice all the different unit call numbers, and then in the description it tells you dispatch, enroute, cancelled and so on.”
“Second, the dispatch center places the ambulances ‘available’ upon arrival at the hospital,” Fitch wrote. “System inefficiencies may be present as the units are potentially subject to another call where they may be delayed responding and the EMS management has no manner to monitor the impact of emergency receiving facility delays on the EMS system. Hospital delays can inadvertently cause the county to fund additional units to overcome the inefficiencies introduced into the system, but the current system does not afford EMS management the capability of evaluating the impact through the CAD records. Similarly, the individual unit performance cannot be monitored, potentially introducing inefficiencies into the system.”
Smith disagreed: “We change the unit’s assignment when they get to the hospital. This makes it easier for the dispatcher to see where the units are.”
“Third, the dispatch center does not create a call disposition data element in the CAD for EMS calls that would indicate whether the call resulted in a patient transportation to the hospital. In other words, the CAD system does not identify if the EMS call resulted in a patient transport, accepted a refusal on scene, or was cancelled,” the report said.
Smith disagreed again: “If EMS transports a patient from a call, when the call is closed, the second disposition code is an ‘O,’ which means ‘transport to medical facility/detox/jail.’ If they do not transport, or patient refuses services, the second disposition code is an ‘L,’ which means assistance rendered. If they have refused service, we put a note in the CAD. It is just PRS, meaning patient refused service.”
“While the limitations of the current CAD system have been identified, it is important to clarify that the dispatch center is capturing these call elements at the individual incident level, as the dispatcher types them into a text or narrative area for call note taking,” the report said.
“Finally, it would be beneficial to the system to fully implement Automatic Vehicle Locator technologies in the EMS system to better ensure that the closest and most appropriate apparatus is assigned to each request for service.”
“All the EMS units have computers and they do use their GPS,” Smith said. “We track them just like the deputies on the maps.”
EMS and the fire department don’t play well together, the report noted.
“An obvious example is the plan to build an EMS station across the street or adjacent to an existing fire station… The parties could not agree to allow the EMS department to occupy during the demolition and construction of the new facility, let alone co-locate.”
Fitch also noted a “fragmented system design,” calling it “a challenge of the general effectiveness in oversight.”
“Fitch would need to further clarify,” the county’s Emergency Operations Director Tim Eures said. He did not think “this is specifically between (himself) and the volunteers, but more so the system that has 10 separate funding levels that creates the fragmentation.”
Fitch “observed an overall lack of trust, communication and coordination across the system.” Is that lack of trust in Eures?
“Fitch would need to explain the opinion,” said Eures, who would not consent to an interview. He answered written questions submitted through County Public Information Officer Gloria Rybinski.
“Fire Services relation with the volunteers, from our perspective, has been one that works with mutual respect and trust,” Eures emailed. “As with any team effort, we may not always agree, but we continue to work together to find a common, positive outcome. “
The county funds up to eight firefighters at four of the fire districts. “However, only two of the departments have hired and expended the funds.” Fitch added: “While these personnel are county employees, there is some ambiguity as to whom they report: to the Fire Services Director or the (volunteer) Fire Chief.”
Eures, who is also the fire services director, said two paid firefighters are funded by Highlands Lakes Fire District, and two by Desoto City Fire District.
Taxes fund the fire stations, fire apparatus, and equipment. However, “differing views exist” between the ten volunteer fire districts and the county, Fitch said. “The net result of the system ambiguity is that many of the fire stations were in ill repair, and routine care and cleanliness has been grossly neglected.”
Fitch recommended establishing “clear lines of authority on all aspects of fire service.”
“Fitch would need to further clarify this point,” Eures said. His answers to nine other questions were, “Fitch recommendations, at this point a comment ... will be speculation.”
“Due to the challenges of a somewhat fragmented fire service delivery model, the county is challenged to maintain accountability of services and cost controls from a system perspective,” Fitch said.
Because Highlands County has 10 fire districts with 220 volunteers and 60 EMTs, and they operate independently, some districts have accumulated excess fire engines, tankers, brush trucks, and self-contained breathing apparatuses.
“One fire district may be replacing a 10-year-old piece of apparatus while another fire district is still using apparatus that is 20 or more years old,” Fitch said. “Forty-six percent of the fire fleet is out of compliance for front line service, according to National Fire Protection Associations, and 14 percent should be taken out of service immediately.”
“Three percent of SCBA should be taken out of service immediately and nearly 42 percent of the SCBA are 14 years old or older approaching their useful life. Best practice is to replace SCBA every 10 years.”
Eures’ answer: “Fitch is to update this information.”
Fitch also complimented Jimmy Branca. “The fire prevention office is well performing and efficient… While the public education program is performing well, the staff may benefit from developing a process for identifying at risk or target populations in order to prioritize efforts.”
“The report was very important,” said County Commissioner Don Elwell, who persuaded other commissioners to commission the report. “We have not done a report like this at least 20 years. We need an understanding of what we need to do.”
The takeaway lessons of the report are the current levels of the EMS and fire services, Elwell said.
“And the difficulties with the volunteer system,” Elwell said. “There are inherent challenges on the fire side. EMS is working very well, but they are undermanned. They could use a ninth ambulance.”
Commissioners will discuss the best way to look at a hybrid system of paid and volunteer firefighters, Elwell said. “How much better would it be than what we have right now? If you live in downtown Sebring, your level of service is pretty darn good. If you live in Lorida and Spring Lake, you’re much farther away. The outlying areas have far less of a chance.”
“What we’re looking for on April 5 is the opening workshop,” Elwell said. “And we will honor the volunteers. At no point does any solution fail to include our volunteer firefighters. We’re not trying to eliminate that. We’re trying to improve.”
Other Findings
Also, Fitch recommended, create a consolidated, countywide, volunteer fire service, and create a partially consolidated fire and EMS, and create fully consolidated fire and EMS service.
None of the rural fire departments currently provide EMS services, said Eures. “First responder only for vehicle accidents or cardiac issues or any request from EMS to respond.”
The approximate cost of paying 20 full time firefighters per year is about $880,000, Eures said, plus $80,000 for gear.
Mondays, Tuesdays and Fridays are the busiest days for EMS.
If EMS raises transport and mileage rates to 150 percent of Medicare cost, the county will raise more money. EMS Interim Director James Duppenthaler said his office already bills at that level.
Evaluate the fire services system to define lines of authority, accountability and responsibility for management, training and certification, facilities, apparatus, and equipment between the county and the fire districts.
When rebuilding or replacing fire stations, the county is encouraged to design fire stations to house 24-hour personnel.
Create a volunteer battalion chief position that reports directly to the operations chief to ensure that the volunteer chiefs have appropriate representation and participation in the staff and management decisions.
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