Manatee fire districts look to enhance medical service

When Tom Sousa became the chief of West Manatee Fire Rescue in spring 2015, he wanted to evaluate the service being provided to ensure it was the best it could be.

He found two areas of improvement for the district, which serves West Bradenton and Anna Maria Island. One was increasing the staff at the Holmes Beach fire station; the other was upgrading the firefighters from EMTs to paramedics.

With 60 to 70 percent of West Manatee’s calls being EMS calls, the district wanted to be able to provide non-transport Advanced Life Support since at times the fire district arrives on scene before the ambulance.

When the fire district responds to a call today, they are able to provide a basic level of medical care. But after proper training to become a paramedic, they would be able to perform an advanced level of care, including advanced airway procedures, administering medications, chest decompression and heart monitoring.

“We are putting a safety net in for the current EMS system,” Sousa said. “What we are trying to do is save more lives by getting there quicker. That’s the goal.”

But a Manatee County ordinance does not allow independent fire districts to operate under the county’s current ALS license. So the discussion of allowing the fire districts to provide this added service has not been successful — until now. The county commission voted last week to have county staff draft language that would “allow the independent fire districts to obtain a Certificate of Public Convenience and Necessity for non-transport ALS services,” documents show.

“We believe this will be a great value to the community,” Sousa said. “It will supplement the current service that is provided by Manatee County, which is excellent service, and it will guarantee that a person within our district will receive a paramedic in a timely manner, either us through a fire engine or Manatee County EMS.

The fire district sees this as most advantageous for Anna Maria Island residents and visitors. With the fire station on Holmes Beach and only one medic transport unit on the island, Sousa said this will be especially helpful. There is also Squad 4, which is the county’s Quick Response Unit offering ALS, on the island.

“When that unit transports off the island, our fire engine will still be on the island and will be staffed with a paramedic. So in the event someone calls for a medical assistance and that transport unit isn’t available, our fire engine will be able to respond with the paramedic, and they will be able to initiate advanced care once they arrive on scene,” he said.

For Bob Smith, the county’s public safety director, the biggest benefit from this would be having additional trained personnel on the scene of an incident. Manatee County has only 19 full-time transport ambulances.

“Any time you can add a higher level of service to the community it’s a good thing,” he said. “Obviously having additional highly trained personnel on the scene of an incident can always be of help.”

West Manatee already moving forward

Eight firefighter/EMTs at the West Manatee fire district recently started training to become paramedics. Once they become paramedics by next February, the fire district will have at least 13 individuals able to provide ALS.

By then, Sousa expects that the district will be able to start providing the non-transport ALS.

“We are going to wait until we have adequate staff to staff all units 24 hours, seven days a week,” Sousa said.

The fire districts would be responsible for any costs associated with the additional service, Smith said.

“The county wouldn’t fund any part of it,” he said.

The proposed change in ordinance will make sure the fire districts bear the costs, adhere to the county’s medical director protocols and remain only non-transport, Smith said.

“Once it is amended with that built in, it will come before the board for final approval and process to get those districts up and running,” he said.

For West Manatee Fire Rescue, Sousa estimates it will cost $200,000 in start-up costs,with an annual recurring cost around $100,000.

“The money is there,” he said of the district’s budget.

Statewide effort on hold

With roots in public safety as a volunteer firefighter, Rep. Jim Boyd, R-Bradenton, has been watching the debate unfold in Manatee County.

Since it “has been going on kind of slowly,” Boyd has a draft bill that would allow fire districts to allow non-transport ALS on a statewide basis. But if the Manatee County Commission takes action to allow this locally, Boyd said he won’t proceed at this time.

“If it gets approved, then no reason for me to pursue on the statewide basis,” he said. “Right now, I really was trying to help constituents in Manatee County to enjoy a higher level of first responder care on medical emergency, where a paramedic could add a lot to a bad situation from an ALS point of service.”

If the commission doesn’t consider amending the ordinance in March, he said, “there’s time to pursue on statewide level.”

“I cannot imagine why it would be something we wouldn’t want to do,” he said. “It made great sense to me. I really care about our community. I think it just makes great sense for our constituents. There is no reason for me not to try to make it happen.”

Once West Manatee Fire Rescue begins offering non-transport ALS, Boyd said he imagines that there may be broader interest around the state.

“My overarching desire is to allow fire departments that can and have structure to do it to provide that ALS,” Boyd said.

Other Manatee fire districts interested

While West Manatee Fire Rescue has been spearheading the effort, there are at least two other fire districts in Manatee County in support of the initiative to provide non-transport ALS.

Coming from Sarasota County, which has a fully consolidated fire department where everyone is cross-trained as a firefighter and paramedic, Southern Manatee Fire Rescue Chief Brian Gorski said he supports it 100 percent.

“It’s needed and the reason is that EMS is so busy,” Gorski said. “They are out of zone a lot of times.”

Sometimes the fire engine arrives on scene a couple minutes before the ambulance, Gorski said.

“Those minutes can mean a lot to someone’s life if having a heart attack, stroke or a trauma patient,” he said.

North River Fire Department Chief Michael Rampino, who is also supportive of the efforts, agrees.

“A benefit would be in the event an ambulance is tied up on another call, we can start ALS prior to the ambulance’s arrival,” he said. “At least that person is getting medical care. That’s truly a benefit right there. It’s better service delivery to our customer.”

A couple times every day, the fire district arrives on scene before EMS, Rampino said.

“Even if we get there a minute before them, every minute takes its toll,” he said. “I really don’t see a downside to it.”

Should the ordinance be changed, Gorski said Southern Manatee, which already has some firefighter/paramedics, would begin the process to slowly add non-transport ALS.

For North River, Rampino said it would take time to implement it.

“It is something we are looking to do down the road,” he said. “We don’t have the funds to do it immediately.”

While the fire districts are supportive of the non-transport ALS, they aren’t interested in doing transport.

“We are absolutely not interested in transporting patients to the hospital,” Rampino said.

This story was originally published February 11, 2017 at 12:00 PM with the headline "Manatee fire districts look to enhance medical service."