A special MEETING of the board of county commissioners
APRIL 5, 2018
The Lake County Board of County Commissioners met in a special Lake Emergency Medical Services transition session on Thursday, April 5, 2018 at 9:30 a.m., in the Summit Greens Clubhouse, 1190 Summit Greens Blvd, Clermont, FL. Commissioners present at the meeting were: Leslie Campione, Vice Chairman; and Sean Parks. Others present were: Jeff Cole, County Manager; John Molenda, Assistant County Manager; Jerry Smith, Executive Director, Lake Emergency Medical Services; Ray Goodgame, Clermont City Councilman; and Josh Pearson, Administrative Specialist, Board Support.
welcome and presentation overview
Mr. Frank Costanzo, President of the Summit Greens Residents’ Association, welcomed guests to the presentation. He stated that Mr. Bill Shell, Chairman of the Summit Greens Safety and Security Committee, would be chairing the activity. Mr. Shell introduced the officials present, and said that the presentation would be followed by official comments and citizen questions.
presentation of lake emergency medical services transition
Commr. Campione stated that this was a great opportunity to answer citizen questions and explain the recent changes to Lake Emergency Medical Services (EMS). She indicated an intent for the County to provide emergency response times that are equal to or better than the national average, and said the organization should have the ability to adapt to changing conditions, such as road changes, new emergency facilities, and other factors that affect emergency response and patient transport times. She opined that the greatest Emergency Medical Services (EMS) system is one that is continually evaluating data, including the time required to process an initial 911 call, dispatch the first responders, arrive on scene with a paramedic, and arrive on scene with an emergency transport. She stated that the EMS system in Lake County utilizes a nationally recognized model that combines fire departments and ambulances to provide the best possible response times, and that once a paramedic arrives, a decision can be made whether to transport the patient to an emergency facility. She added that the County cooperates with each city to assist with funding to hire and train paramedics, and that the County also helps cities obtain supplies for emergency vehicles. She elaborated that ambulances and fire trucks carry the same medical equipment because fire trucks are often able to arrive on scene more quickly than an ambulance. She clarified that fire trucks and ambulances currently operate under separate agencies, but cooperate under the same emergency medical system. She said that Lake EMS has a medical director that oversees training and ensures that the protocols for paramedics are identical throughout the county. She reiterated that Lake EMS’ goal was to provide response times that meet or positively exceed national benchmarks, and to perform those tasks with a high degree of professionalism. She reported that Lake EMS had undergone a number of operational audits in previous years, and that a consulting firm had been hired to conduct studies and evaluate the system with the goal of finding potential efficiencies. She commented that Lake EMS had been reviewing if response times were being measured accurately, and what benchmarks should be used in urban, suburban and rural areas. She mentioned that the consultant recommended transitioning Lake EMS into an agency directly under county government to save money, as it was not previously considered a county department, and mentioned that there had been a separate Lake EMS Board that oversaw the EMS system, consisting of five County Commissioners and three elected officials from different cities in Lake County, along with one Chief Executive Officer from a Lake County hospital. She elaborated that this transition would allow Lake EMS to utilize county infrastructure already in place, such as procurement services, information technology and human resources, and that financial savings could be put back into Lake EMS, rather than other county entities such as the General Fund. 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 noted that the consultant also made recommendations about deployment practices to improve response times, and she concluded by commending Clermont’s fire department for its funding and staff.
Mr. John Molenda stated that the purpose of Lake EMS is to provide countywide medical services. He said that the presentation would include the background of Lake EMS, an overview of the system, and community specific information.
Mr. Jerry Smith said that Lake EMS currently operated 22 ambulances, 14 of which provided 24 hour coverage, with the other eight operating 13 hours per day. He elaborated that all 22 ambulances are typically on the road between 11:30 a.m. and 8:00 p.m. because this strategy matches Lake EMS’ emergency call volume and ensures that overstaffing is avoided. He emphasized that the first response provided by the County’s fire service partners is vital to Lake EMS, and stated that Lake EMS provides these items to the county: pre-hospital transport for the sick and injured; a consolidated communications center that enables 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 such as bandages and electrocardiogram (EKG) monitors; and loaning of the County’s spare equipment to fire departments. He indicated that he had served as part of Lake EMS since 1989, and that there had been many changes throughout its history. He elaborated that it is more common in modern times for EMTs to successfully treat a citizen for cardiac arrest, and that considerable progress is being made to ensure that patients survive these incidents. He commented that Lake EMS’ partnership with fire services is critical to help citizens receive care more quickly.
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 was conducted, beginning in March 2016. He said the consultant presented three alternatives that identified efficiencies, improvements and savings, and considered the organizational structure of Lake EMS. He relayed that the consultant looked at the employment model and response times, and there were a few changes made to the methodology of analyzing these factors. He clarified that most of the proposed changes were on the administrative side of Lake EMS, rather than the operational side, and 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. 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 Board of County Commissioners (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. He also noted that operating EMS under the County could increase collaboration, reduce workloads and liability, and improve service delivery and emergency response. He specified that the County’s dispatch center was located next to the Sheriff’s Office to ensure that emergency calls are processed quickly by the appropriate unit. He said that changing the name that dispatchers answer with from “Lake Emergency Medical Services Communications” to “Public Safety Communications” had already reduced confusion, led to improvements in call volumes, and raised customer satisfaction. He also noted that the transition would lead to increased 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 activating, staffing, and housing personnel proactively, and collectively purchasing and reimbursing items for disaster relief. He stated that there would be no reduction in units, and that service delivery would increase as a result of the transition. He commented that the $500,000 savings would be used to enhance existing Lake EMS services without changing them, and that effective administrative practices would enable improving the operational side of the organization to meet growth and other changes in the county. 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. He also mentioned enhancements to these categories: zone coverage deployment; specialized units, such as those that can transport contaminated patients; 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; 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 advanced 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 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 noted questions about dispatch practices, and said that advances in technology have positively affected deployment. 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 there were currently 22 EMS call stations and 46 fire stations in the county. He noted that the number of medical calls exceeded those for fire emergencies, but commented that the greater number of fire stations was due to those units being used as first responders. He mentioned that the number of reported fires had been decreasing due to fire prevention and improved building codes, though medical calls had risen; therefore, utilizing fire units for medical calls was cost effective. He 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 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 the nearby Clermont 3 unit used a 24 hour schedule and was recently moved to Fire Station 1 at the end of 2014. He added that this change was due to an expanse of staffing by the Clermont Fire Department, and that Station 1 provided additional space. He clarified that the same ALS care was being provided by both the first responder and the ambulance, and he noted that near the Kings Ridge community, another unit was temporarily moved from Fire Rescue Station 109 to another station on Lakeshore Drive. 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. He mentioned that the 13 hour ambulance at Fire Station 3 was stationed there due to nearby call volumes, and called attention to the considerable number of hours each day that an ambulance is waiting to be deployed from South Lake Hospital. He relayed that the consultant 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 posts would be located in Groveland, Clermont and Four Corners, with two ambulances each and varying hours of operation. He elaborated that the use of posts was one of the cost savings and efficiencies identified by the consultant, and would allow Lake EMS to be more efficient with citizens’ tax dollars while maintaining partnerships with municipal fire departments for first response units. He clarified that this strategy may change over time due to periodic review with staff and examinations of data. He gave a recent example of changing the unit hours of the ambulance at Fire Station 3 based on call data, and stated that there are data thresholds used to determine when additional units need to be added. He displayed a chart showing EMS response times for Summit Greens, noting that Lake EMS ambulances typically arrived approximately three minutes later to calls than the Clermont Fire Department in Fiscal Year (FY) 2015. He commented that this was a significant increase when compared to the previous FY; however, this was a countywide occurrence. He explained that in FY 2015, there was an 11 percent increase in ambulance transports, and that this was much higher than the average increase of calls per year is five percent. He said that this increase allowed for the funding for additional transports, but that response times increased due to the higher number of transports reducing overall unit availability. He noted that, while Lake EMS response times increased, Clermont Fire Department response times remained stable during this time, and explained that the FY 2017 average Lake EMS response time of approximately two minutes was sufficient to allow first responders to investigate the scene. He also showed a similar chart for the City of Clermont, stating that medical calls had increased, and reiterated that resources would be placed according to call volumes. He mentioned that South Lake County comprises about 45 percent of Lake EMS’ call volume and approximately 46 percent of its resources.
Mr. Molenda said he appreciated the opportunity to speak, and praised the service that Lake EMS delivers. He commented that there are daily changes within the organization, and Lake EMS meets monthly with Fire Chiefs to ensure that service is properly delivered. He stated that it can be challenging to communicate changes, such as using a mechanical chest compression system that can perform CPR on patients in place of an ambulance crew member, but that this scenario may lead to hiring fewer personnel in that role. He said he appreciated the chance to explain why changes within the organization occur, and indicated an intent to provide the best possible service. He commended the City of Clermont for providing some of the best response times on a national basis, and added that Lake EMS’ response times are also above the national average. He mentioned that the Clermont Fire Department was recently accredited and that Lake EMS is proud to partner with them.
Commr. Parks thanked the audience for coming out, stating that there was a high level of concern for the community. He commented that every second matters, and that he wants to have the best emergency response system possible. He indicated a desire to listen to the community’s concerns, and stressed the importance of intergovernmental coordination between cities and the County.
Mr. Ray Goodgame, Clermont City Councilman, said that Lake EMS provides a great service, and praised Fire Station 3’s service to the growing area near County Road (C.R.) 455. He mentioned that Hartle Road would soon be connected to Hartwood Marsh Road, and that this growth would change traffic patterns for ambulances and fire trucks in the city. He said that the Lake-Sumter Metropolitan Planning Organization (MPO) was attempting to have the road completed as quickly as possible, along with construction on Hooks Street from North Hancock Road to C.R. 455. He said that fire services and Lake EMS act as insurance policies for the County, and asked what it would require to become the best EMS provider in the nation. He concluded by praising Lake EMS’ efforts to service the county.
Mr. Shell thanked the County staff for their presentation and clarifying issues with Lake EMS.
citizen questions and comments
A citizen praised a Lake EMS paramedic that helped save his life during a heart attack, and said that he wanted to see an emphasis on transporting victims during emergencies.
Mr. Carle Bishop, Clermont Fire Chief, thanked the County staff for explaining how Lake EMS operates, and opined that citizens have a higher chance of surviving a cardiac incident in Clermont than anywhere else. He said that the City’s fire staff is well trained, continually monitors service and response times, and was currently looking at implementing a new fire station to house ambulances close to where calls occur. He said that the fire department cooperates well with Lake EMS, and mentioned how the joint fire station between the City of Clermont and the County helps save costs.
A citizen asked about the location of Fire Stations 1 and 2.
Mr. Bishop said that Fire Station 1 was the headquarters station for Clermont, and was located east of Fifth Street on U.S. 50. He elaborated that Fire Station 2 is located near the back entrance of the Kings Ridge subdivision.
Many citizens inquired about what happens if 911 is dialed on a cell phone, particularly if the cell phone does not have a Lake County area code.
Mr. Smith stated that all 911 calls in the County are sent to the Sheriff’s Office in Tavares, which has a one button transfer to the Lake EMS dispatch center. He added that if the caller was unable to talk on the phone, then their location could be triangulated through cell towers. He said that the first question asked by an emergency dispatcher is where the emergency is located. He mentioned that landline calls automatically populate information to Lake EMS’ CAD system, and that cell phone users can input their information on Smart911.com to allow address information to populate in a similar way; however, this may cause confusion if 911 is dialed from a cell phone in a location that is away from home. He stated that the question of the patient’s location is always asked, including for landline calls.
Mr. Molenda added that the Smart911.com service can be accessed from the County’s website, and provides services beyond identifying a citizen’s location. He elaborated that Smart911.com can provide Lake EMS with information such as if an animal is present at the location, and if the patient requires special needs due to conditions such as hearing or vision impairment; however, in the event that a citizen cannot open a door, firefighters are trained to break through locked doors while causing minimal damage. He added that Lake County partners with surrounding counties, and that crossing county lines can lead to emergency calls being received by other counties. He mentioned that cell towers will attempt to direct calls to the closest dispatch center. He explained that many one button transfers are used to direct calls to the correct location, though said it is possible that units may be sent from multiple cities if a call is made when close to county lines.
A citizen opined that other states use per capita data for districts when gathering information for fire departments and ambulances, and asked how the aging population in Lake County affects data gathering.
Mr. Molenda replied that data gathering was not limited to call volumes and locations, and that Lake EMS uses countywide data. He said that Lake EMS benchmarks itself against the response times of surrounding counties, and the County examines nationwide trends and local growth patterns. He explained that Lake EMS currently uses a one year plan, a five year plan, and a 20-30 year plan that are all modified over time.
Commr. Campione stated that the County conducts per capita analyses for all of its different functions to benchmark effectiveness, and that looking at other counties can help determine if the appropriate amount of resources is being put into different areas of government.
A citizen said that many Summit Greens residents live alone, and asked if wearable emergency devices should be utilized when other citizens are not nearby to help.
Mr. Molenda replied that Lake EMS needs emergency information as quickly as possible, and suggested that citizens should assist each other. He added that fire departments often engage in fire prevention activities with communities, and relayed that any method of quickly making a call to Lake EMS is helpful.
A citizen asked if every fire truck carries an EMT and paramedic, and if fire trucks can transport patients.
Commr. Campione replied that every ALS certified fire truck has a paramedic, and that every fire truck in Clermont meets this certification.
Mr. Molenda said that fire trucks cannot transport patients because they do not have the capacity to house a stretcher. He elaborated that ambulances are dispatched such that there should never be a significant delay before one arrives. He specified that ambulances arriving late to a scene are often because they are intentionally slowed down, and that the extensive amount of equipment carried by fire trucks prevents them from carrying patients.
Commr. Campione noted that computer software is effective at continually evaluating and arranging vehicle locations to ensure fast response times.
The citizen also asked if the Lake EMS transition would cause any delays in the time that it takes an ambulance to transport a patient to a hospital.
Mr. Molenda commented that the goal of the transition was to improve transport times, though noted that anomalies can occur due to train crossings, road accidents, or other calls that requires assistance. He also said that effectiveness can be reduced due to surges in illnesses, such as during flu season, though reiterated that Clermont’s response times are favorable when compared to the national average.
A resident of Kings Ridge indicated concerns with the Lake EMS transition, growth in the area, moving an ambulance to a station on Lakeshore Drive, and an incident where an ambulance could not access the gated community of Kings Ridge.
Mr. Molenda said that the transition had only begun about a month prior, and that most of the current changes were administrative. He clarified that the current EMS delivery was unchanged, with no further intentions to change it. He said that the movement of the ambulance previously stationed at Fire Rescue Station 109 was temporary, and stated that the county’s growth has also led to the Clermont Fire Department’s growth. He reiterated that the Clermont Fire Department needed a location to house additional personnel, and that call data revealed that the ambulance was not at Station 109 very often. He added that where the ambulance initially begins service from is a minor issue due to the current system being based on posts, and that he was primarily concerned with response times. He indicated that a long response time where an ambulance could not access a gated community could have been due to a gate malfunction or personnel errors, and that efforts are made to cooperate with gated communities. He also reiterated that ambulances may be slowed down if the patient is stabilized, so that road accidents are minimized.
Mr. Goodgame said that the Clermont Performing Arts Center would be allowing room for Lake EMS vehicles, and opined that the City of Clermont should have been better informed about the ambulance moving.
A citizen indicated concerns with the Lake EMS transition, and commented that communication between Lake EMS and the City is important.
Commr. Parks asked staff to provide more specific details about the ambulance’s temporary relocation during the next Lake EMS transition meeting on April 9, 2018.
Mr. Costanzo thanked the audience for attending.
There being no further business, the meeting was adjourned at 11:20 a.m.
timothy i. sullivan, chairman
NEIL KELLY, CLERK