Florida Firefighters Say EMS System`s Too Slow

Pinellas County's emergency medical services system is supposed to do two things: Quickly get the sick and injured to the hospital and swiftly get firefighter/paramedics back on the street.

But it's not working that way, many firefighters say.

They charge the system is designed with built-in hurdles that delay medical care and waste their time.

"The system's failing," Seminole District fire Chief Rick Koda said. "You've got a delay in patient care. You've got a delay in patient transport."

The solution, say the county's Fire Chiefs Association and many firefighters, is to let firefighters take people to the hospital. Koda has submitted one plan to the county. Palm Harbor firefighter Scott Sanford and Lealman fire Capt. Jim Millican have submitted another. The county has rejected both as well as earlier proposals submitted by others in the fire service.

Pinellas County Administrator Bob LaSala said staff members analyzed both plans and found that neither would do the job as well as the current system or save money. "There's the end of the conversation," LaSala said. "They can't do it better, cheaper, faster."

LaSala declined to comment about the contention that the current system has a flaw that delays access to doctor and hospital care.

"That's a technical question that I don't feel able to answer," he said. LaSala said county staff members would study the issue.

The firefighters' criticisms come as county officials are looking for ways to hold down costs of the EMS system and its $106 million budget. LaSala has suggested a new funding strategy, but the structure of the system has not been an issue.

Some fire chiefs and many frontline emergency responders say it should be. The system, they say, does a good job, but should be better at quickly getting patients to hospitals that can provide specialized care.

Pinellas' two-level EMS system has firefighter/paramedics responding first to medical emergencies, then handing off the patient to a Sunstar ambulance crew that arrives later. Both crews have similar training. The handoff is supposed to get the firefighters back on the street faster and make them available for other emergencies rather than being tied up at the hospital.

It's that handoff that many in the system see as the problem.

Their argument goes this way:

Patients who are suffering from extreme medical emergencies such as heart attacks and strokes should get to a hospital as soon as possible. But under the current system, the patient and firefighters wait for Sunstar to arrive. There's another delay while the firefighters tell the ambulance paramedics what's happening.

Firefighters say this also raises the potential for miscommunications between crews. They point to a redundancy in treatment and the collection of information as the ambulance paramedic asks questions the firefighters have already asked and performs tests the firefighters have already performed.

The delay becomes even more unnecessary, they say, if a firefighter goes in the ambulance to the hospital to help care for a critically ill patient. It happened in about 6 percent of all Sunstar transports in 2010, which may not sound like a lot but amounts to 5,879 times that firefighters helped transport patients.

The firefighters' contention distorts what actually happens on the ground, said Craig Hare, Pinellas County's EMS division manager. The implication is that the Sunstar crew stands around doing nothing until the patient is loaded in the ambulance. Actually, Hare said, both the firefighter and Sunstar paramedics treat the patient, so the handoff is not as cut and dried as it might appear.

Besides, Hare said, patient handoffs are customary whether it be from the ambulance paramedic to the hospital or an emergency room nurse to a floor nurse.

"You're going to have handoffs in medicine," Hare said.

Palm Harbor fire Chief Jim Angle said he's not sure if the system's design has a major flaw but conceded he has seen the delays. Angle said he believes the systemic delays are more pronounced at the other end of the spectrum - in emergencies that aren't life-threatening.

In an emergency, Sunstar must arrive within 12 minutes 90 percent of the time. But, for less severe calls, Sunstar can take up to 20 minutes to arrive. The fire crew, on the other hand, has to arrive within 7½ minutes 90 percent of the time for most calls.

That can leave the firefighters explaining to patients why they have to wait for an ambulance rather than immediately ride to the hospital in the transport-ready fire rescue truck that's sitting in front of their house.

That's not getting firefighters back on the street quickly, Sanford said.

"We're wasting time. This person needs to go to the hospital," Koda said.

Speed is important when it comes to critical care, said Chris Granger, a North Carolina cardiologist who works with the American Heart Association.

"One of the treatments (in heart attacks) is time," Granger said. "Part of the treatment is timeliness because every minute one has a blocked artery, there's more muscle that's dying."

Dr. Laurie Romig, the county's medical director who oversees the EMS system, agreed on the need for speed when someone is having a heart attack.

The more quickly blood flow is re-established, the better for the patient, Romig said.

Andrew Bern, a Florida doctor on the board of directors of the American Academy of Emergency Medicine, said, "What firefighters are saying is true to a point. All of the things they say theoretically are true."

But, he said, other factors can delay care.

"That's the downside they're not talking about," Bern said. The Pinellas system is working, he said. "Don't try to fix something that's not broken."

Frontline firefighters say the system may not be broken, but that it is flawed and could do a better job of patient care. To bolster their point, they point to cases like a recent one in Pinellas Park. Firefighters arrived to find a motorcyclist lying in the street bleeding from a head wound. The Pinellas Park paramedics treated her, then held a tarp over her head to protect her from a rainstorm until Sunstar arrived seven minutes after firefighters arrived. It took another seven minutes to get the patient in the ambulance and trade information before the crew could leave for Northside Hospital.

That wouldn't happen with firefighter transport, Koda said. "We wouldn't be waiting. We'd be gone."