A special MEETING of the board of county commissioners
APRIL 9, 2018
The Lake County Board of County Commissioners met in a special Lake Emergency Medical Services transition session on Monday, April 9, 2018 at 1:00 p.m., at the Clermont Performing Arts Center, 3700 U.S. Highway 27, Clermont, FL. Commissioners present at the meeting were: Leslie Campione, Vice Chairman; Sean Parks; and Josh Blake. Others present were: Jeff Cole, County Manager; John Molenda, Assistant County Manager; Jerry Smith, Executive Director, Lake Emergency Medical Services; Darren Gray, Clermont City Manager; Carle Bishop, Clermont Fire Chief; Ray Goodgame, Clermont City Councilman; and Josh Pearson, Administrative Specialist, Board Support.
Mr. Jim Purvis, a resident of Clermont, welcomed guests to the presentation.
presentation of lake emergency medical services transition
Commr. Campione introduced the present officials. She stated that this was a great opportunity to answer citizen questions and explain the recent improvements to Lake Emergency Medical Services (EMS). She mentioned concerns about an ambulance that had been stationed at Fire Station 2 in Clermont, which had been moved to another station to create space at Station 2 for additional personnel. She elaborated that the ambulance was temporarily moved to Fire Rescue Station 109, and that this was never intended to be a permanent change. She specified that Station 109 would be used as a home base for the ambulance to pick up supplies and equipment, and that the ambulance would typically be moving through the city on calls. She said that there had been discussions with the City of Clermont about housing an ambulance at the Clermont Performing Arts Center in order to more effectively service the U.S. 27 corridor. She commented that the greatest EMS system is one that is continually evaluating data, including the time required to process an initial 911 call, dispatch the first responders, and arrive on scene with a paramedic. She mentioned that once a paramedic arrives, a decision can be made whether to transport the patient to an emergency facility, and said that data should also be collected on how long it takes for an ambulance to arrive once emergency transport is required. She stated that the EMS system in Lake County utilizes a nationally recognized model that uses fire trucks certified for advance life support (ALS) to arrive first at a scene. She specified that fire trucks and ambulances have the same medical equipment, use the same protocols and are under the same medical director. She said that the system is designed to allow ambulances on their way to a call to be slowed down if the patient is stabilized in order to minimize the risk of road accidents. She said that Lake EMS’ goal was to provide a high quality of medical care and professionalism to patients throughout Lake County. She commented that studies and operational audits in recent years have led to the recommendation of bringing Lake EMS under the umbrella of Lake County government. She said that previously Lake EMS operated as a quasi-governmental entity under a separate Lake EMS Board consisting of the Board of County Commissioners (BCC), three elected city officials, and one Chief Executive Officer from a Lake County hospital. She said that the organization had its own personnel for the services of information technology, human resources and procurement, and that bringing Lake EMS into county government would enable utilizing those departments that were already in place at the county. She indicated that an additional benefit of transitioning Lake EMS was affording Florida Retirement System (FRS) benefits to Lake EMS employees, and explained that FRS benefits could reduce employee turnover and lengthen employment terms. She said, even after transitioning Lake EMS employees into the FRS, that the County would be able to save approximately $500,000. She elaborated that this saving did not involve reducing any of Lake EMS’ workforce, and that service would be enhanced by reinvesting the savings into Lake EMS. She commended Clermont’s fire department for its funding, staff, training, response times and providing a paramedic on every fire truck.
Mr. John Molenda, Assistant County Manager, stated that the purpose of Lake EMS is to provide countywide medical services, and said that the presentation would include the background of Lake EMS, an overview of the system, and community specific information.
Mr. Jerry Smith, Executive Director, Lake Emergency Medical Services, said that Lake EMS currently operated 22 ambulances, and stated that Lake EMS provides these items to the county: pre-hospital transport for the sick and injured; a consolidated communications center that provides dispatch service for 12 of the 13 fire departments in Lake County; a unified medical director that was on staff at the University of Florida Medical School, is board certified in emergency room medicine, and had completed a fellowship for emergency medical services; consolidated logistics supplies for fire departments; and regulatory compliance and quality assurance, due to Lake EMS being regulated as a healthcare provider. He indicated that Lake EMS affords these services to fire departments within the county: payment for state vehicle permitting; dispatch services at no cost; medication and oxygen replacement; controlled substance services; bio waste disposal; ongoing training; payment for the medical side of an online training platform for firefighters, paramedics, and emergency medical technicians (EMTs) that is certified by the medical director; and mobile data terminals (MDTs) utilized in the cabs of emergency vehicles that are linked to the Lake EMS dispatch center and provide a one button push feature to notify Lake EMS that units are responding, without adding radio traffic. He added that fire departments also benefit from these Lake EMS services: regulatory compliance; equipment retrieval from hospitals and decontamination of that equipment; assistance with equipment purchasing through the County obtaining a lower price for items such as cardiac monitors and blood pressure cuffs, and requiring vendors to sell items at that same price to fire service partners; the replacement of disposable medical supplies; and loaning of the County’s spare equipment to fire departments. He indicated that he had served as part of Lake County since 1989, and that there had been many changes throughout Lake EMS’ history.
Mr. Molenda stated that a consultant studied Lake EMS to ensure current operations were functioning as intended and to suggest potential improvements. He elaborated that a 21 month study began in March 2016, and said the consultant presented three alternatives that identified efficiencies, improvements and savings, and considered the organizational structure of Lake EMS. He opined that the recommended alternative of transitioning Lake EMS into the County as the Office of Emergency Medical Services was best for the employees, the system and the municipalities, and would allow Lake EMS to make its administrative and financial functions more efficient without changing the operational side. He relayed that, after selecting this alternative, the County reached out to municipalities, hospitals, educational facilities, the Sheriff’s Office, other law enforcement, elected officials and the Lake EMS Board to ensure that the transition would be acceptable to them. He noted that discussions with these entities were positive, and that the County received helpful input from Fire Chiefs and elected officials. He said that on February 13, 2018, the transition was brought before and approved by the BCC in a unanimous vote for a final transition anticipated by February 2019. He elaborated that these administrative changes provided cost savings that could be invested back into Lake EMS, and that the organization could save a total of $500,000 in the first year of the transition as a result of eliminating services that were duplicated between the County and Lake EMS. He said that Lake EMS met with fire departments monthly to discuss data and organizational changes, and also noted that operating Lake EMS under the County could increase collaboration, increase consistency, reduce workloads and liability, and improve service delivery and emergency response. He also noted that the transition would lead to safety, supervision and service, enabled by the County’s ability to train together with municipal fire departments at fire stations closer to employees. He indicated that the transition would assist in disaster preparedness, stating that the consultant recommended more effectively activating, staffing, and housing personnel that are hired to assist with disasters. He stated that there would be no reduction in units, and that service delivery would increase as a result of the transition. He mentioned that the savings would offset existing service costs and establish an operational pooled cash budget to ensure that the money is kept within Lake EMS, and said that there would be no changes in funding or increases in billing for fire departments. He commented that Lake EMS’ computer aided dispatch (CAD) uses a nationally recognized software model that dispatches units based on the location and circumstances of the call, and that the model considers factors such as unit locations and availability to create an ideal level of service. He also mentioned enhancements to these categories: priority dispatch that uses both a fire truck and ambulance which provides adequate personnel to respond to medical calls; zone coverage deployment; specialized units; child immunizations; critical care units to provide higher levels of care once a patient reaches a hospital; reduced employee turnover through FRS benefits; improved response times; collaboration with the Office of Building Services to help identify growth; elder affairs support; addressing child abuse and neglect through first responders that can identify these cases; and citizen training for first aid and cardiopulmonary resuscitation (CPR). He read the first statement of the First Response Agreement that the County has with city fire departments as follows: “Whereas, the City is a municipal corporation which operates a fire department and desires to provide first response advance life support (ALS) services on a regular basis…”, and said that the contract provides for the fire department arriving first at the scene of an emergency call. He added that the fire department first stabilizes the patient, with the ambulance later serving as the transport method. He explained that the first response from the fire department maximizes the use of personnel and paramedics through strategic locations of fire stations, resulting in the fastest possible response times. He commented that fire stations in the county are located according to nearby call volume, and that data is continually examined to ensure that fire stations are located in the proper areas. He noted that both the ambulance and fire truck carry the same equipment and personnel, with the primary difference being the ambulance’s transport capabilities. He said that Lake EMS uses a model that keeps ambulances on the street to more quickly arrive on scene if called, though noted that fire trucks are housed in hardened stations that are more likely to be located near calls. He stated that every ambulance and fire truck carries an EMT, certified for basic life support (BLS), and that paramedics who are certified for ALS, are carried by every ambulance and certain fire trucks. He commented that in the event that all EMS units in an area are depleted, the CAD system will move other units to that location, and that the CAD’s operations are based on call data. He explained that the Lake EMS dispatch center receives emergency calls, that dispatchers follow guidelines to ensure they are asking the proper questions, and that dispatchers will relay the call to the appropriate agency while they are still communicating with the caller by phone. He elaborated that the dispatcher will continue gathering information which is then forwarded to fire trucks and ambulances as they are being deployed, and said that the fire truck will generally arrive first at a scene and begin administering care to the patient, such as intravenous (IV) drug therapy and cardiac monitoring. He elaborated that the ambulance will arrive after treatment begins and will transport the patient; however, an ambulance may cancel its arrival due to first responders informing the crew that the patient does not want or need to be transported to a hospital. He said that, in these situations, the ambulance may divert away from the call if it is no longer needed, and that ambulances may also slow down while travelling to a scene if the first responders report the patient to be in stable condition. He said that slowing an ambulance down reduces the chance of a road accident or frees the crew to be deployed on another call, though this can negatively impact ambulance response times. He displayed a map showing the locations of the 46 total fire stations in Lake County, noting 24 county fire stations, 18 city/town fire stations, one station that the county shares with the City of Clermont, and three volunteer city/town fire stations equipped with BLS. He also displayed a map detailing deployment for EMS ambulances, stating that they are not at fixed locations, but rather they move around between hospitals, fire stations, and roads. He commented that there were a high number of ambulances at South Lake Hospital in the City of Clermont that are not assigned to the area, due to repeatedly transporting patients to that hospital throughout the day. He said that eight of Lake County’s ambulances deploy during a 13 hour period of peak demand to save costs, and that this system was based on a nationwide model. He specified that emergency calls begin to be received in higher volumes at 7:00 a.m., with call volumes beginning to lower at around 8:00 p.m. to 10:00 p.m., and that eight ambulances operate on a 13 hour schedule due to this call pattern. He commented that transitioning a 13 hour ambulance to provide 24 hour service would be ineffective, due to call data suggesting that the ambulance would not be responding to calls for a significant amount of time.
Mr. Smith showed a chart displaying the hours of operation for EMS units in South Lake County, mentioning that an ambulance housed near the Kings Ridge community was temporarily moved to Fire Rescue Station 109. He reiterated that this would be a temporary move, and said that Lake EMS was looking for a way to move the ambulance back to an area near U.S. 27 in Clermont; however, there are zoning issues with housing ambulances for parking areas, unit security, and vehicle entrances and exits that need to be considered. He called attention to the considerable number of hours each day that an ambulance is waiting to be deployed from South Lake Hospital, due to ambulances transporting there from countywide locations. He elaborated that the CAD system used automatic vehicle locators on every fire truck and ambulance to send the closest units to a call. He said that Lake EMS added an additional 13 hour ambulance in South Lake County in 2015 after experiencing an annual increase in transport rates of 11 percent, which was much higher than the average increase of about five percent. He relayed that the consultant also discussed moving ambulances from traditional fire stations to a post system throughout Lake County, and that this plan would carry forward the current total of six ambulances for South Lake County. He specified that the ambulance posts could be moved throughout the county based on growth and call data. He displayed a chart showing EMS response times for Kings Ridge, noting that there was not a significant time difference between the arrivals of the fire truck and ambulance. He also commented that response times had positively increased after 2015. He mentioned that there was currently an average of less than one call per day in Kings Ridge, but asked citizens to notify Lake EMS about issues with response times, recalling an incident with an ambulance being unable to access Kings Ridge’s gate. He said that the number of transports was also higher for the City of Clermont in 2015, though they had been improving over time due to Lake EMS’ additional resources. He stated that Lake EMS and the fire departments were interdependent, and each made the other more effective.
Mr. Molenda said he appreciated the opportunity to educate citizens about Lake EMS, and praised the service that it delivers. He added that sometimes ambulances may not leave scenes with lights and sirens enabled, in order to decrease the risk of an accident.
Commr. Campione added that Lake EMS considers roads under construction, road congestion, and newly completed roads when evaluating data and communicating with its partners. She said that because of the depth of Lake EMS resources, ambulances can be strategically located throughout the county to address needs.
Commr. Parks thanked the audience for attending, and also thanked Mr. Goodgame and Mr. Purvis. He commented that he would not want to see an inefficient emergency system, and said that the transition of Lake EMS into county government was focused on improving efficiency. He commented that he was pleased with the possibility of the ambulance temporarily stationed at Fire Rescue Station 109 moving to the Clermont Performing Arts Center, and mentioned an interest in citizen questions.
Mr. Ray Goodgame, Clermont City Councilman, recalled questions from the previous meeting about dialing 911 for cell phones, and a website that could assist Lake EMS in this situations. He said that even though the City of Clermont has grown considerably, the City had three ambulances in 2008, and that no ambulances had to be added since.
Commr. Blake said that the transition was an issue to the residents of Kings Ridge, and commended County staff for the job they do.
Mr. Goodgame thanked Mr. Mark Johnson, Minneola City Manager, for attending the meeting.
Commr. Campione noted that dialing 911 on a cell phone that does not have a Lake County area code would direct the call to Lake EMS based on cell towers. She added that the website Smart911.com, also accessible from the County website, can be used by citizens to provide Lake EMS with more accurate personal information when calling 911, such as hearing or vision impairment and location information. She also mentioned that AlertLake service on the County website can allow citizens to obtain emergency information.
citizen questions and comments
A citizen asked about moving the ambulance that was temporarily housed at Fire Rescue Station 109 to a different location, and about the percentage of time that Lake EMS ambulances spend on the road compared to waiting at a station.
Mr. Darren Gray, Clermont City Manager, said that different city facilities had been considered for the ambulance, and the issue would be discussed at a City Council Workshop on April 11, 2018.
Mr. Smith replied that the ambulance temporarily located at Fire Rescue Station 109 was typically running calls for approximately 11 hours per day out of a 24 hour shift, and the ambulance was very busy.
A citizen inquired about increasing numbers of emergency calls in the Kings Ridge community.
Mr. Smith said that in FY 2017, there was an average of approximately one call per day in Kings Ridge. He added that monitoring call data at the subdivision level is helpful.
Mr. Molenda said that Lake EMS does not operate based on the previous year’s minimum data for call volume, and instead attempts to prepare for surges in calls. He stated that the Clermont Fire Department is also prepared for high volumes of calls.
A citizen asked if impact fees would be used to fund new emergency equipment, salaries and pensions, and if citizens should expect increased taxes during the transition.
Commr. Campione responded that impact fees can only be used for certain types of services, such as construction. She added that Lake EMS’ goal was not to increase taxes, and that the organization was continually evaluating revenues and additional services.
Commr. Parks indicated that the savings achieved as a result of the transition could be used to improve the system, and reiterated that there was no intent to raise taxes.
Mr. Gray also said that City taxes would not be raised, and noted that the Clermont Fire Department would always arrive quickly to scenes and be equipped with ALS.
A citizen asked if a fire truck could ever transport a patient to the hospital.
Mr. Molenda said it is unlikely that an ambulance would be unable to respond, explaining that agreements were in place with other counties to use their services in the event that Lake EMS is unavailable to respond. He indicated that fire trucks provide both a fire service and medical component, though they lack a compartment to transport a patient in. He said that ambulances are primarily used to transport patients to a hospital, whereas the fire truck’s role is to provide a multitude of services including stabilizing patients.
A citizen commented that the Clermont Fire Department has a rare accreditation.
Mr. Carle Bishop, Clermont Fire Chief, replied that the Clermont Fire Department recently completed a three year accreditation process that was reviewed by other fire departments and fire chiefs around the world. He added that there were currently only 179 non-Department of Defense fire stations to hold that accreditation worldwide, and he thanked his staff for their help in the process. He indicated that his fire department has a positive working relationship with Lake EMS, and that patient chances of survival were high in South Lake County.
Mr. Smith commented that there was a high chance of reviving patients after a cardiac arrest in Lake County.
A citizen asked about relocating the temporarily moved ambulance to a nearby fire department, rather than the Clermont Performing Arts Center.
Mr. Bishop replied that increases in fire station personnel created a need for more space, and that the ambulance was initially moved due to a grant that allowed Clermont to hire more firefighters for its station near Kings Ridge. He indicated confidence that the ambulance would be relocated to the area, and emphasized that there would be no change in service.
A concerned citizen asked if the Lake EMS transition would cause a perceived reduction in service to Kings Ridge, and if the new growth north of Summit Greens would lead to Fire Station 3’s ambulance returning to its previous 24 hour service.
Mr. Smith responded that there would be no reduction in service, and said that call data is examined on a weekly and monthly basis. He explained that Lake County’s demographics were different than surrounding counties due to its aging population, and that Lake EMS considers these needs while also providing a financially responsible service.
Commr. Campione said that Lake EMS’ first operational audit examined how to measure response times and what benchmarks should be used for urban, suburban and rural areas. She commented that the possibility for more units would be evaluated in order to meet or exceed national benchmarks.
A citizen commented that more effective communication may have avoided the confusion about temporarily moving the ambulance to Fire Rescue Station 109.
A citizen that was involved with a firefighter’s union asked if the time that ambulances are considered available at South Lake Hospital includes when they are offloading a patient. He also inquired about long ambulance response times on some calls that he experienced, stemming from ambulances being called from cities that were not nearby.
Mr. Smith replied that ambulances are considered to be available immediately after the patient is off the stretcher. He added that slow ambulance response times may occur because they are slowed down intentionally due to the patient being stabilized; however, high demand for service in Lake County will likely indicate similar demand in other counties, so response times may be higher due to demand.
Mr. Molenda said that ambulances housed at certain cities may not actually arrive to each call from those cities, as they move around while deployed. He urged the citizen to alert Lake EMS about issues as they occur, citing an example of a reported problem with entering a gated community being addressed on the following day.
Mr. Goodgame said that Lake EMS had been properly explained at the current meeting, though suggested that further improvements could be made with ambulance turnaround times at hospitals. He asked about how much Municipal Service Taxing Unit (MSTU) funding was being collected from Clermont when compared to the cost of services that the City was receiving from Lake EMS, and if the City could be provided reports showing how much funding it was receiving.
Commr. Parks said that Clermont was being fairly compensated for its taxes.
A citizen asked if being transported to a hospital by an ambulance or helicopter would allow that patient to be seen by medical staff immediately, as opposed to having to wait in an emergency room.
Mr. Smith clarified that a patient may not be seen immediately if they are delivered to a hospital by an ambulance.
Mr. Purvis thanked the audience for attending.
There being no further business, the meeting was adjourned at 2:50 p.m.
timothy i. sullivan, chairman
NEIL KELLY, CLERK