Some Sumter County residents recently have faced long delays of an hour or more waiting for an ambulance.
The ambulance service, operated by Advanced Medical Response (AMR), a private contractor, is at a crisis point.
Commissioners will meet May 18 to hear options from County Administrator Bradley Arnold for improving or modifying the service.
Basically, commissioners have three choices to address the crisis:
• They can work with AMR to improve response times, possibly by offering more oversight and resources.
• They can terminate the AMR contract either for lack of performance or when it expires at the end of next year and hire another provider.
• They can scrap the private provider system and replace it with a public firefighter-based system.
Rapid population grown in The Villages make ending the ambulance response crisis in Sumter County critical.
AMR has been called the McDonalds of the private ambulance world because it is the largest company of its kind.
It was founded in 1991 by Paul Verrochi, who followed an expansion strategy used by Waste Management to dominate the garbage industry. Two decades later, when it bid on the first Sumter County contract in 2011, the company had nearly 20,000 employees and 4,000 air and ground vehicles. When it was acquired by Global Medical Response in 2018, the company had an estimated 29,000 employees.
AMR’s aggressive billing and collection practices have generated a lot of social media complaints nationally. A woman in Buffalo, N.Y., complained she was billed $2,200 for an ambulance ride of 600 feet.
When San Diego officials voted less than two weeks ago to replace AMR with another provider, many of the 150 speakers at a public hearing complained about poor response times.
Christine Kennedy, operations manager for Sumter County AMR and wife of Sumter County Deputy Administrator Stephen Kennedy, and the national AMR media staff did not respond to questions or interview requests by Villages-News.com. Stephen Kennedy used to serve as the county’s public safety director and he has managed the contract with AMR.
In March, Sumter County AMR was selected for a five-year federal program called Emergency Triage, Treat and Transport that will allow Medicare recipients to be treated at the scene or transported to a hospital or other facility.
The program would provide payment for treated and released patients, increasing the flexibility of medical care. In addition to a county subsidy, the company is paid for transport by insurance companies or individuals.
Sumter County AMR was among 62 AMR locations of 205 total providers selected for the program.
Arnold may propose that UF Health, which now owns the hospitals in The Villages and Leesburg, play a greater role in supervising the AMR operation.
Or UF Health could be a key player to bring a new private ambulance provider into the county.
Firefighters fear that Arnold also will propose that they stop responding to many medical calls.
Sumter County pays AMR $1.278 million during the current fiscal year for ambulance services. The company also provides emergency dispatching of firefighters and ambulances.
Reducing the practice of having firefighters respond to medical calls would save money for the county. But it also would reduce the quality of emergency care because most firefighters are EMTs or paramedics who often arrive well before ambulances and can begin treatment immediately..
Firefighters probably still would be asked to respond to some medical calls, such as traffic accidents.
Implementing this plan would be difficult and risky without an efficient and reliable ambulance service. It also could mean reduction in the number of professional firefighters and, in the most extreme case, return to a volunteer force.
Based purely on statistics, the proposal seems to make sense. In 2019, Sumter County had 385 fires and 15,233 rescue EMS calls, according to the annual Florida Fire Incident Report. Safer building construction and smoke detectors have reduced the number of fire calls significantly over the past few decades.
Another issue that can cause ambulance delays is off-loading of patients at the hospital. The law requires that a patent is transferred from an ambulance to a medical provider of equal status at the hospital, which makes it easier to maintain treatment. That means a paramedic must transfer a patient to someone with at least the status of a registered nurse. Sometimes there are delays in finding the appropriate person for a patient transfer.
Dumping the private provider system in favor of a firefighter-based approach would be costly. Former Sumter County Fire Chief William Gulbrandsen estimated it would take at least $300,000 to buy and equip an ambulance, or at least $6 million for a fleet of 20 ambulances.
He said the best way to finance this cost would be impact fees and federal grants so current property taxpayers don’t bear the burden.
Hernando County is among the counties ringing Sumter County that use a firefighter-based ambulance service. With cross-staffed ambulances, the county is rated in the top 3 percent of fire and ambulance services in the nation.
Like Sumter County, Hernando County Fire Chief Scott Hechler said the model evolved over many years and involved the merger of several smaller departments. The system relies on fire engine companies equipped to offer advanced life support (ALS).
“Having 13 ALS engines allows us 13 more units that can respond quickly to medical emergencies and establish advanced medical care with the same capabilities and training as the rescue and maintain that care until a rescue unit arrives,” he said. “Most ALS emergencies require more than two responders and we send an engine and a rescue on most serious medical responses as every second counts in EMS.”
Hechler said other rural counties use private ambulances and firefighters equipped for basic, not advanced, life support but that the Hernando County model works for him.