Surge is EMS concern in Manatee County

Since he is chief of operations with Manatee County Emergency Medical Services, it isn't surprising Larry Luh is direct when he speaks.

Luh was discussing the county's current plight, where EMS ambulances get so tied up that slower response times could threaten the safety of county residents.

"We are looking for alternatives to 'You call ... we haul,'" Luh said.

Indeed, "You call ... we haul" might be a blunt, politically incorrect term, but it adequately describes the EMS department's policy since 1972 when the Board of Commissioners took it over. Each and every call for help has been treated as a life-and-death situation.

With the county experiencing a surge in population that is expected to continue, the EMS command staff of 12 supervisors meets on a weekly basis with one of the main topics being how to serve that expanding public with a limited number of emergency room options for drop-offs. "You call ... we haul" is not working anymore.

During the current Season, the county's EMS teams are facing what they call "surge" situations at an alarming rate. EMS employs one ambulance for every 19,000 residents in the county.

"Surge is our internal word," said Manatee County EMS Chief Paul DiCicco. "On a good day, we operate 20 to 21 ambulances, and one or two quick-response vehicles. So picture when these units get so tied up that we drop to six available units to cover 746 square miles. When we get to six, that's surge."

When EMS, which has a budget of approximately $16 million, goes into surge, the six or fewer remaining units have to be positioned at strategic points in the county for coverage. If it appears the surge will last for more than an hour or two, West-Coast Southern Medical Service can be hired for additional ambulance coverage. DiCicco said that is an expensive proposition.

So what are the answers?

DiCicco explained he doesn't feel simply adding more ambulances and EMTs and paramedics (the county has 144 EMTs and paramedics) will solve the problem, which is more about ambulances being stuck in a holding pattern because they can't drop off patients. He said at times, county EMS ambulances have been backed up five or six deep at a hospital.

Like EMS with surge, the hospitals have their own internal terms. If a hospital gets so backed up that it can't admit more patients, it can go into "Diversion" when EMS ambulances might be told to take patients elsewhere. It all adds up to extra transport time.

"Last week, there was a big accident on (U.S.) 41," DiCicco said. "That one took four ambulances. It taxes our resources."

Throw in a few other accidents and full emergency rooms, and it leaves EMS heads seeking answers.

More emergency room space would be welcome and Bradenton's Blake Medical Center is planning an emergency room expansion.

Randy Currin, the CEO of Blake Medical Center, said the extra population during Season can tie up the emergency room at his hospital.

"It can be a struggle, whether that means resources, assets or people," Currin said. "When your area has an increase in population for certain times, that is not easy to deal with. People have to be registered and triaged, determined to be urgent or emergent based on need. We want to treat everyone as timely as we can."

Currin said people never are turned away when they come to the emergency room, but the hospital does consider diverting ambulances when four or five already are waiting in the parking lot.

Lakewood Ranch Medical Center hasn't been in a diversion situation for 18 months, and CEO Andy Guz is hoping that trend continues. A $28.5 million expansion will help.

"We didn't expand our emergency room, per se," Guz said. "But we are doing a few things. We know EMS' time and resources are valuable, and we know we need to be as efficient as possible getting them back on the road. So for us, it's not so much about ER space, but upgrading our imaging equipment and processing our regular walk-in patients."

The expansion, simply put, allows Lakewood Ranch Medical Center to process patients faster.

"The average turnover time (to accept EMS patients) for us is nine to 10 minutes," Guz said.

Blake and Manatee Memorial also try to admit patients as quickly as possible, however, the area population explosion is overwhelming resources.

"To give you perspective, there are more beds at Sarasota Memorial (839) than in Manatee County combined (822)," DiCicco said. "During Season, if we get a wave of the flu or allergies, what typically happens is the ER ends up in holding patients because there is no availability upstairs (in terms of beds)."

The EMS paramedics and EMTs called the time at the hospital "wall time," because they line up patients against a wall of the hospital and wait for them to be admitted.

"This Season, we have had some bumps," DiCicco said. "We know about the increase in volume."

With new hospitals unlikely in the county in the near future, EMS is turning to the public for help.

The plea is to use available resources before calling for an ambulance.

District Chief Mark Regis urges the public to use the Community Paramedic at 744-3951 when it's not an emergency situation. The Department of Public Safety program is intended to help patients manage chronic health problems before they become emergencies.

In Sparks, Nev., 96% of 911 medical calls are sent to a nurse who can weed out non-emergencies. Whether a nurse could have a similar effect in the county's dispatch center will be investigated.

DiCicco said EMS has refined its public relations team.

"We go out to communities and teach people about the appropriate use of 911," he said.

Regis said over the next three weeks, EMS will give 12 such presentations.

"This is the first full year we've done it," he said. "We have to educate people better."

Other changes should help as well. DiCicco said EMS is adopting a new system through Medicare (ET3) that would allow EMS to provide treatment in place using a qualified health care practitioner, either by remaining on the scene or by taking treatment advice by remote connection using telehealth technology.

DiCicco also said it was important to note all three hospitals have been meeting over the last month to discuss surge and to find ways to eliminate Diversion.

"We are working on communication," DiCicco said.