Local government and emergency medical service systems.

• Author: Yard, Mary Julianne
• Position: Florida

Emergency medical services is one of the essential public safety functions for which local government has responsibility. The basic purpose of any emergency medical services system is to reduce the incidence of injury and death resulting from emergency situations. The EMS system rapidly responds to emergency requests with personnel medically trained to treat and stabilize the patient at the emergency scene and to transport the patient safely to a hospital. The minimum components which make up an EMS system are a dispatch System, rapid response vehicles, transport vehicles, qualified personnel, and overall medical supervision of the system.

How these components are organized and who will be the provider of each component are key questions for local government. The answers to these questions will involve the local government lawyer in a wide variety of legal issues. Once the system is in place and operating, the issues arising from day-to-day operations will be even more varied. Using Pinellas County as an example, this article presents an overview of some of the issues raised, first, in establishing a comprehensive EMS system, and, second, in the ongoing administration and operation of such a system.

Establishing the System

Pinellas County created a countywide emergency medical services system in 1988. The authority to create a countywide system has been granted by a special act of the Florida Legislature.[1] With 24 municipalities within its boundaries, the county wanted to avoid any threat to patient care which might result from different levels of services provided by various jurisdictions.

The special act also created a dependent special district, known as the Pinellas County Emergency Medical Services Authority, the governing body of which is the board of county commissioners. The authority is vested with a number of powers, including the power to set uniform standards and levels of service for the system. The authority also serves as a vehicle for receiving and expending the dedicated ad valorem tax also authorized by the special act. Under the Pinellas County structure, revenues from the EMS ad valorem tax are used to pay the first responders (discussed below) while ambulance fees are used to pay the transport contractor (also discussed below).

Having dealt with the issues of countywide authority and of funding for the system, the county then addressed the questions of how the system would be structured and who would be providing the key services in the system. These key services are dispatch, first response, ambulance transport, and medical direction. These key services are provided by qualified personnel.

* Dispatch

Dispatch in Pinellas County is now provided by one centralized public service answering point. Prior to creation of the comprehensive system, however, the dispatch function had been performed by law enforcement, either the sheriff or multiple municipal police agencies. Pinellas County gradually consolidated this function into one county 911 center. This consolidation has resulted both in operational efficiencies and savings to the county and, hence, to taxpayers.

* First Response

First response refers to the component of an EMS system that arrives first at the scene of the emergency and manages the scene until transport arrives. In general, first response may be provided solely by fire departments, or it may be provided by so-called "civilian" personnel that is not fire department-based. Such personnel may be public employees or employees of a private company.

At the time Pinellas County structured its current system, the municipal fire departments had been providing first responder services for a number of years. The special act mandated that the authority continue to contract with those fire departments for first responder services. Thus, no consideration was given to the possibility of privatizing this particular service.

Pinellas County, through the authority, now contracts with 18 fire departments...