Abuse of 911 system raises cost of 'free' service

ST. PETERSBURG — A man at a bus shelter drank 10 beers and had a stomachache.

A barber felt nervous and wondered if it was his blood pressure medication.

A homeless guy needed a trip to the hospital — his fourth in three days.

It was a typically frantic Friday night for the firefighters of downtown St. Petersburg's Station 5 as they hopped from one medical call to the next — at a cost of more than $300 a trip.

In the heated national debate over health care reform, this is the public option no one talks about: Health care by firefighter. Each year, an estimated tens of millions of local tax dollars are spent in the Tampa Bay area on calls that are anything but emergencies.

It is a huge but hidden expense that costs local governments nationwide billions of dollars a year. Firefighters now spend far more time on medical calls than fighting fires. Sometimes it's a heart attack or a shooting, but more often it's someone wanting an aspirin or a ride to the hospital to get out of the rain.

"We've become the indigent care provider for the city," said St. Petersburg Fire Rescue Chief James Large. It's worse during tough economic times, when unemployment is high and fewer people can afford doctor's visits.

For those who take advantage of the system, it's free.

For everyone else, it's anything but.

St. Petersburg Fire Rescue responded to 47,006 calls last year — 85 percent of them medical. Officials estimate about 35 percent of those were life-threatening situations, and an additional 25 percent came in as potentially life-threatening calls.

The rest? Stubbed toes, common colds, panic attacks and everything in between. In many of the cases, the caller could have visited a clinic, gone to a drugstore or waited in an emergency room for treatment.

The same is true in Tampa. Last year, firefighters there responded to 66,422 calls, 84 percent of which were medical.

And it's not just the Tampa Bay area.

Nationwide, firefighter medical calls have tripled since 1980, according to the National Fire Protection Association. Actual fire calls, meanwhile, fell 56 percent from 1977 to 2007, thanks to better building codes and firefighting technology.

"The 'fire department' has become a catchall phrase for something we rarely do anymore," said Lt. Jake Nyhart of St. Petersburg Fire Rescue. "I think our profession is becoming something so different than what it once was, I'd like to see them come up with a new title for us."

Calculating the actual cost of firefighter medical care is tricky, and each fire department uses its own formula. Some simply divide their total budget by the number of calls received. Others have more complicated formulas.

St. Petersburg estimates the average rescue call costs tax­payers $332, which includes staff time, equipment, fuel and vehicle wear-and-tear. In Tampa, the cost per call is about $218. In large county departments, the cost can be more.

Taking someone to a hospital is even more expensive, with the average ambulance trip costing around $400 to $500.

Local governments typically won't bill someone when firefighters respond to a 911 call, but will for an ambulance ride. Collecting is a challenge, though. Pinellas County (which also serves St. Petersburg) gets about 65 percent of its bills paid, which is considered high compared to other areas. The rest is covered by taxpayers.

"It is a well-known belief within EMS and fire departments that socioeconomic class has a lot to do with call volume," said Seminole Fire Department EMS Chief Terry Tokarz. "From people who are homeless to people without health insurance or with Medicare or Medicaid. People call 911 and get taken to the ERs, thinking it's a free clinic."

But when call volume goes up, response time increases .

"People don't realize the impact they're having when they're tying us up with social service calls," Nyhart said.

It takes St. Petersburg firefighters about 30 seconds longer to respond to medical calls than it did 20 years ago. For someone choking or having a heart attack, those seconds can mean the difference between life or death.

• • •

Station 5 fire rescue workers Jeremy Wert and Ed Hintz heard their alarm sound over the station loudspeakers. They grabbed a fax in the garage with basic facts: Address, man injured.

They scrambled into their red rescue ambulance, turned on the flashing lights, rushed to Central Avenue and jumped out of the truck with their first aid equipment.

They found a familiar face — Ronald Miller, a 59-year-old homeless man and frequent subject of emergency calls. He was drunk and fallen down and was making a scene. Wert knew Miller well enough that he didn't need to ask his birth date or social security number.

The firefighters turned Miller over to a county ambulance, which took him to a hospital.

Most 911 systems operate the same way: An operator receives the call, determines the type of emergency and passes the information to the right fire station. The station gets the call and sends either a rescue truck, a fire engine, or both. As the crew head to the address, more information streams to computers inside the trucks.

The information, though, is often minimal and cryptic, and firefighters and paramedics don't know how serious a situation is until they get there. "Shortness of breath," "chest pains," and "seizure" are common complaints, but they often serve as catchalls for myriad conditions.

But they don't say no very often.

If you call 911 because your toilet is overflowing, the fire department will come. Call 911 because you're lonely, the fire department comes. If you call 911 but call back to say you changed your mind, it's too late.

The fire department will come.

"We err on the side of responding," Nyhart said. "That one time you miss a real call and someone dies, you're liable."

Every firefighter has rushed to a reported medical emergency only to find an elderly person who needs help into bed. Or a young mother whose baby won't stop crying until the firefighter shows her how to burp the child.

"Those are the calls you don't mind," said paramedic Jim Cunning­ham of St. Petersburg Fire Rescue Station 11. "It's the callers who are between 20 to 45, able-bodied, but don't want to pay for a cab to go to the doctor. It's the ones who call because they need an aspirin for a headache. Those are the kind of people that tax the system."

Firefighter Burner Lindsey remembered a call from about 10 years ago. Dispatchers could give only a couple clues from the caller about a possible hernia and an inability to lift 30 pounds.

Burner and his partner rushed to the home of a man and his bedridden elderly mother. The man said he was recovering from a hernia operation and his mother needed her pillow adjusted.

"We were like, 'Man,' " Lindsey said, " 'you can't even fluff your mom's pillow?' "

• • •

Firefighters say they face a perplexing dilemma. They don't like dealing with frivolous calls, but they also don't want to discourage people from calling for help when they need it.

But can the average person decide if something is an emergency or not?

Children are taught at an early age to call 911 if there's trouble. When people call the county health department or a social service office, they are often greeted with a message to hang up and call 911 if it's an emergency. The general message to the public has always been to call 911 for whatever ails.

Before the economy soured, that was fine with fire departments.

"Quite frankly, in my mind, it was a means to put tax dollars into good use," said Seminole's Tokarz. "You're paying for those guys to be there, put 'em to work."

"Unfortunately, as the economy has changed, my opinion is we start looking at areas of how can we save. It costs money for someone who stubs their toe."

Tampa Fire Rescue spokesman Capt. Bill Wade says fire rescue medical services cost "pennies to the dollar" compared to traditional medical services from a doctor's office. But it's still wasteful to throw equipment and staff designed to handle worst-case scenarios at complaints most people wouldn't bother taking to a doctor.

Lake-Sumter Emergency Medical Services has launched a campaign called "When to Call 911" (www.whentocall911.com), though it's also aimed at teaching people when not to call 911. Among the non-emergencies listed: Emotional upsets, minor cuts and routine medical check-ups.

"Years ago, we did a terrific job of getting the word out that, 'Hey, you have a problem, call 911,'" said Lake-Sumter Emergency Medical Services director Jim Judge said. "Now we have to educate people on making the right call."

Many rescue agencies across the country link to Lake-Sumter's "When to Call 911" Web site, and Lake-Sumter has spent money on posters, flyers and billboards along major state roads.

The St. Petersburg fire department is intrigued by Lake-Sumter's campaign. But Steven Knight, who heads St. Petersburg's rescue division, wonders what kind of effect such a message will have.

He has heard of cases where city or county agencies placed 911 education billboards around town, only to find themselves suddenly handling a surge in 911 calls.

The 911 awareness campaigns, it seems, just mean more publicity for 911.

Emily Nipps can be reached at nipps@sptimes.com or (727) 893-8452.