- February 7, 2025
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Concerns about how the Volusia County's EVAC ambulance system is being run has led some cities to seek alternative routes to providing service to people in both emergency and non-emergency situations. Ambulances can vary when it comes to the what parts of the county units are coming from, meaning an emergency in Port Orange may have to wait on an ambulance coming form DeLand.
County and city officials have continued to discuss what measures can be taken to ensure EMS services respond to the needed locations while limiting the amount of non-emergency calls that wouldn't normally require an ambulance.
Last fiscal year in the city of Port Orange, EVAC arrived with 15 minutes of Port Orange Fire 98.5% of the time, within 10 minutes 95.4% of the time and arrived ahead of the fire department 31.5% of the time, according to data from the county.
"The two-tiered EMS system employed throughout the county ensures that a patient has the same level of trained medical professionals taking care of them throughout the call," Deputy County Manager George Recktenwald wrote in an email, adding that , "care given and valuable information obtained in the field by properly trained and licensed paramedics is a vital first step and has proven to improve the long term outcomes of patients."
More 911 calls
An increased call volume that has stretched the abilities of first responders who are being used as medical providers has become part of the issue to provide timely responses, according to Holly Hill Fire Chief and Volusia County Fire Chiefs' Association President Jim Bland.
Bland noted that in Holly Hill, the department was running approximately 3,000 calls on six stations each year in 1988 when he first started. Now, he said there are seven stations with less people trying to run around 24,000 calls throughout the year.
"Availability is pretty spotty. It's been going on for quite awhile," Bland said.
According to Port Orange Fire Chief Ken Fustin, there has been no significant increase in the number of field units Volusia County EMS has made available for response after taking over EVAC in 2011-2012. Fustin recommended that the county add additional response units to the daily ambulance rotation.
Ormond Beach Fire Chief Bob Mandarino said that the last time he had requested availability, the county provided information that showed appropriate response times. However, Mandarino said this is not the case with what he is seeing out in the field.
“We’re similar to Port Orange where we’re experiencing delays,” Mandarino said. “You can just throw more units out on the road, but there’s a huge cost associated with that.”
Non-emergency calls
In addition to call volume, Fustin noted that available resources are also struggling due to an increased population and individuals who are calling 911 for non-emergency situations and a ride to the hospital for non-medical related issues, such as food or a shower. Bland also explained many non-emergency calls, such as a stubbed toe, that have hindered ambulance service could easily be solved by having a friend or family member drive the individual to the hospital.
"All participants in the pre-hospital care business need to be utilized to their greatest extent possible," Fustin wrote in an email. "That is currently not being done, because of economic reasons and not quality of patient care reasons."
During an Eggs and Issues meeting, Volusia County Manager Jim Dinneen said county officials are pushing to find other ways for people to get emergency services while at the same time freeing up EMS services from responding to non-emergency situations. According to Dinneen, of the 92,000 calls that the county received last year, real emergencies amounted to about 1%, with around 100 of those calls being life or death situations.
"The big issue we have with a lot of people is ... they get older and they don't have a support system," Dinneen said. "A lot of people, because they're incapable of gettingt themselves to the doctor or not capable of taking their medicine, what happens is they allow themselves to get into a position where they call ambulance."
Triage
Addressing how important the calls are could potentially help place ambulances where they are most needed. Dinneen said officials are trying to implement triage to understand what situations are immediate emergencies.
Fustin is advocating a nurse triage position funded and filled at the county 911 center. According to Fustin, that role has been cut from the county budget in previous attempts. Through this position, medical calls would be screened. Fustin wrote that a triage of the medical calls could reduce the unnecessary utilization of field based EMS and fire units.
"Often times, both fire units and EVAC are sent because there are no other resources available that can be sent to these types of repetitive calls," Fustin wrote.
PLUS Program
Some cities, such as South Daytona, have bought an ambulance to help with the number of calls coming in. Through this PLUS ambulance program, cities buy, maintain and staff an additional ambulance that can be used for calls if no other county ambulance is available.
However, while the program does provide additional means of transportation, the process to allow a city-owned ambulance transport has made some people hesitant to adopt this.
According to Port Orange City Councilman Scott Stiltner a city ambulance cannot immediately be sent out to a call, even if that EMS service is the closest. Instead, the county has a period of time to try and send out EVAC. If none can take the call, then the city's ambulance is given the green light to go to where the call came from.
"Police and EMS fire services predominately use what is known as closest unit response unit methodology, meaning the closest unit to that emergency responds," Stiltner said. "If you have an ambulance sitting in your bay, owned and payed for by municipalities, in the contract you have to wait for the county to get an ambulance in route."
Fustin wrote that the county should ease the restrictions and limitations placed on the municipal fire department based PLUS units. This would allow the PLUS units to be sent when they are closer to a call.
Through South Daytona's PLUS lprogram, 131 transports were made between Oct. 1 2016 and Sept. 30, 2017.
South Daytona City Manager Joseph Yarbrough said that the use of the ambulance, purchased in 2011, has grown in regards to the number of transports.
However, this last fiscal year the city spent $46,000 for the service but was only reimbursed around $20,000 as the billing is made through the county and not all patients pay their transport fees.
However, Yarbrough is confident in the city’s decision to have the program.
“It just made sense. We have service areas in the city and outside. We need to answer these calls in a timely manner,” Yarbrough said. “It’s a high level service.”
Response Initiative
In April 2016, the Volusia County Fire Chiefs Association met with the county Medical Director in an attempt to establish a “right sized” response initiative. According to Fustin, the majority of what the fire chiefs recommended has yet to be enacted for was reject by the county.
"To my knowledge, the only thing that has been done as a result of those discussions was to stop sending fire department resources to medical calls at care facilities having on-site trained medical personnel, like Doctor’s offices, clinics, hospitals (yes I said hospitals) and assisted living facilities.
Other initiatives have included taxi voucher and modified release program to assist in speeding up the return service times for fire units with the goal to increase ambulance availability. Bland said this proposal was brought to the county and has been started in Daytona Beach and Holly Hill.
The program is in its early stages of development with April 2018 as the target to go live. According to Fustin, this is nearly two years after being discussed.
Bland said finding alternative methods of transportation could also help with charges those patients will receive. He noted that a patient being taken from Holly Hill to Halifax Hospital with no treatment can be charged around $600, a cost that is not always covered by Medicare or Medicade.
"We're having incremental success," Bland said. "The emergency medical system is totally broken, not just in Volusia County but in this country."
