If its managers had to pick one word to describe Nature Coast EMS, that word would most likely be “focused.”
That attribute is what Director Teresa Burgess says has enabled the almost six-year-old service to become what it is today: a lean, highly efficient company focused on patient care.
She said the model of a nonprofit foundation whose company works for the county commission on contract to deliver emergency medical services has worked well for the county. The nonprofit, stand-alone model allows managers and personnel to focus only on providing the best patient care for the lowest possible cost, she said.
After the county took over the ambulance service from Citrus Memorial Hospital years ago, and eventually decided that it couldn’t effectively run the EMS in a cost-efficient manner, it tried going to a private service, only to have that service pull out, leaving the county commission with the problem of what to do next.
It chose the nonprofit foundation model used in Volusia County, which had been successful during a time when most counties were struggling with how to fund EMS systems facing sharply escalating costs.
Looking back on the past six years of the Nature Coast EMS’s life, Burgess said she’d have to characterize that time as a process of growth toward a maturity that is now exemplified by respect by employees for themselves, their peers and their performance, as well as their organization. In short, the organization has developed a justifiable pride in itself, she said, in regard to its standards and performance.
And that evolved, even as the service’s workers unionized.
Burgess said that the number of calls for service has increased from 13,699 in 2001, the company’s first full year, to 17,503 in 2005. As of the end of last month, the service had racked up 17,759 calls so far for this year.
But the interesting thing, she said, is that the transports to the hospital, which generally take about an hour of a crew’s time, have gone up from 10,689 to only 11,8816 between 2001 and 2005. Nature Coast managers analyze the calls and transports to try to understand what drives then and the demographics behind them.
Burgess said they don’t automatically equate increased population with the need for more trucks and personnel, but look for the key factors that actually affect service. Being a stand-alone service and driven by cost efficiency, she said, allows — and demands — they evaluate it in such a business fashion, though without the profit motive.
For instance, she said, there are seven units on duty around the county 24 hours a day, and that has remained the same since Nature Coast took over the operation from the private operator. The only change was initially making the seventh unit active 24 hours a day instead of just during the day.
But the point is, she said, that the same number of units have served the county since 2001 as the service’s response time has been going down — even though the number of calls has gone up. The service is under contract to maintain a 7 minute and 30 seconds countywide average response time. The national average time for city areas ranges from 6 to 9 minutes and for rural areas ranges from 12 to 15 minutes.
Initially, the average countywide response time for the service was 7 minutes and 27 or 28 seconds, she said. The service has slowly whittled that down.
The countywide response for last month was 7 minutes and 10 seconds. For August, it had been 7 minutes and 3 seconds.
When some have said the service should add ambulances to keep up with the growing population, Burgess said she has responded that such action is not yet justified by the statistics.
The kind of improvements the service makes that allow that determination also demand flexibility and innovation, she said, which is exactly the way the business model should drive the service.
Depending on the calls for service, the units may be moved around to strategic locations on a given day to better cover areas and to minimize the response times when some crews are on calls. Obviously, the closest ambulances are dispatched first to the most serious calls, in particular the life-threatening ones.
The service looks first at those critical calls, calls on which the response times have an impact on patient outcome. In September, eight cardiac arrest calls had an average response time of 7 minutes even, and seven cardiac alert calls had an average time of 9 minutes and 15 seconds. There were 24 trauma alert calls, and those had an average response time of 6 minutes and 50 seconds. There were 13 stroke alert calls and those had an average response time of 8 minutes and 43 seconds.
The service averaged 32 transports to the hospital per day. That averages five transports per 24-hour shift for the seven ambulances constantly in service.
From the beginning, the county has had to subsidize the service, but Burgess said the goal is to reduce that, and she noted the success in doing so is another important measure of the service’s success.
In 2001, the EMS budget was $3.3 million, with the county kicking in 1.05 million, which was 32 percent of the budget.
By the 2007, however, with a $5.54-million budget, Nature Coast was getting only $651,808 in subsidy, or 12 percent of its budget from taxpayers. Burgess said she thinks that speaks for itself, although the ultimate goal is zero subsidy, she said.
The chairman of the county commission agrees with Burgess’ appraisal of the service’s success in the past six years.
Gary Bartell said, “As far as I am concerned, the entire program, from EMS workers to the board of directors, has been nothing but professional from the start. It’s been a good partnership.” He said what few problems there have been have been handled in the highest professional manner.
The commission has discussed, but so far rejected, combining the fire and EMS services in the county, and Burgess said the model in use is the best for both the patients and taxpayers.
Bartell agreed that experience has proven the county picked the right model with the nonprofit foundation, and keeping the service separate has allowed it to focus on what it does best in the most cost-efficient manner.
Paramedic Russ Schlenker said he had been with the county’s emergency medical services in its various forms during the past 27 years. He agrees with Burgess’ assessment of Nature Coast’s successes, and added that in relation to things like the new emergency treatment protocols and state-of-the-art equipment, such as the AutoPulse just deployed (see accompanying story), “This is a very progressive service for a mid-sized county.”
Though he has been a part of it, Nature Coast Operations Director Wayne Martin is still amazed. “In just six years, if you can go from concept initialization to setting such standards, to me, that’s incredible.”
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