With only 18 ambulances serving Manatee County, EMS seeks more in county budget

June 10--MANATEE -- Manatee County Emergency Medical Services has only 18 ambulances responsible for transporting those in need to area hospitals -- not enough, officials warn, as Manatee County and the number of EMS calls continue to grow.

Officials voiced a critical need for additional ambulances in Tuesday's county budget hearings. In May, the center received 1,200 more calls than in May 2014.

They also point specifically to the Parrish area, where the closest ambulance is at U.S. 301 in Palmetto/Ellenton.

"Parrish and that area of the county is going through substantial growth," said Bob Smith, public safety director. "Ten to 15 minutes is a long time for someone not breathing."

With a large number of new developments approved in the Parrish area, the public safety department is seeking one more ambulance, which would be the county's 19th, to reduce response times to

that area. The department's total budget request is $20.6 million.

The ambulance and the associated required staff of seven would cost $944,355 in the upcoming year and $526,030 the following year.

County administrator Ed Hunzeker has not included funding for the ambulance service in his recommended 2015-16 $550 million budget, but county commissioners "flagged" the request Tuesday for more discussion July 30.

Smith said impact fees could cover the cost of the ambulance -- about $325,00 for the physical vehicle and $100,00 for the necessary equipment.

"EMS (budget) requests are all to address growth," Smith told the commission.

Manatee County EMS is the only ambulance provider in the county with the exception of Longboat Key.

"We have an obligation, in my opinion, to provide these services in the Urban Service Boundary," Commission Chairwoman Betsy Benac said Tuesday. "We have to provide services in the areas we approved development."

The average response time in Manatee County is 7.47 minutes, which is under the current industry standard to be on the scene within eight minutes. But those numbers do not "truly show the difference from areas like Parrish vs. Bradenton," said Stephen Krivjanik, EMS division chief.

The county separates these times by using a model titled Urban vs. Rural to get a "more accurate picture of our true response ability," Krivjanik said.

In May, the rural average time was 10.87 minutes and the urban average time was 6.74 minutes. But some rural response times are more than 15 minutes, Krivjanik noted.

The increased EMS calls correlate to more residents requiring the county's existing ambulances to be transported to one of the area hospitals. If all of the county's 18 ambulances are in use, the county has contracts with the surrounding counties including Sarasota, Hillsborough and Pinellas for assistance, Krivjanik said. Manatee provides the same for those counties as needed.

Compounding the issue, Krivjanik said, ambulances often get stacked at area hospitals during peak season, because it takes longer to transfer the patient from EMS to the Emergency Room staff.

"It is not an unusual occurrence and unfortunately it could last hours," Smith said.

This isn't a new problem for the county, and county officials said Tuesday that they've been working with the hospitals to reduce this.

Melissa Morgan, a Blake Medical Center spokeswoman, said Blake officials and county emergency personnel met recently to discuss the stacking situation.

"Blake meets with EMS leadership regularly and this has been a topic of discussion," Morgan said. "We are always looking for ways to improve the care and access to care for our patients, the community and the emergency responders that care for them."

Manatee Memorial representatives did not return calls or emails from the Herald seeking comment Tuesday.

"When these units are stacked at our hospitals, that's even fewer units we have available to respond to a call volume that is already increasing," Smith said.

Benac questioned the hospital's role in addressing the issue since it is a "cost to the county to provide the additional ambulances."

"We need to ask what they are envisioning to solve this problem," Benac said.

In Manatee County, the average turnaround times is 24.57 minutes, according to Krivjanik. This is an average time waiting for a patient bed and transfer of patient care, Krivjanik said, and some are "way faster and some extreme cases hours long."

At 15 minutes, the county's excessive delay protocol kicks in when the dispatcher begins asking the medic if the patient has been transferred. At 30 minutes, the division contacts the hospital and will "try to work with them to free up patient bed space," Krivjanik said.

During the public safety department budget presentation Tuesday, Smith showed a photograph of an incident when half of the county's ambulance fleet was outside the hospital waiting for patient care transfer.

"We've had quite a bit of success and we have some work left to do, but we are well on our way to addressing it," Smith said.

The county has a surge plan in place to send other staff to the hospitals so ambulances can get back on the road, Smith said.

Half of the fleet at the hospitals at a given time is not the norm for the county, as on a normal average day they may have one or two units at a hospital offloading and cleaning up, Krivjanik said. This occurred during season, but each year's peak period becomes the following year's "normal," he added.

"The hospitals have been working very closely with us to fix this program and we are partners with them on these issues," he said. Commissioner Carol Whitmore stressed that this isn't a new problem.

"This is a problem chronic with all the hospitals," said Whitmore, a registered nurse. "The nurse has to accept, touch and feel the patient. That happens every day."

Commissioner Vanessa Baugh, who represents Myakka City, said that area is also growing. In the public safety department's budget, they are requesting an additional Advanced Life Support unit in Myakka City, which Hunzeker has not recommended for funding. These units can identify emergency situations, provide first aid and transport the patient to a hospital if necessary.

"Myakka has really been on their own in quite a number of ways," Baugh said. "I think we need to look at whether or not this is something that is needed in the area. We have really not stood by Myakka, in my opinion, as we should have."

Benac responded that Parrish was set out in the Comprehensive Plan as a growth area rather than Myakka.

"It's our responsibility to provide for all residents of Manatee County," Baugh said.

Claire Aronson, Manatee County reporter, can be reached at 941-745-7024. Follow her on Twitter @Claire_Aronson.

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