The fire truck speeds down the street, lights flashing and siren blaring when needed, to a call for medical help at Safe Harbor, the sheriff's homeless shelter.
The emergency turns out to be a boil on a man's rear end. He's taken to a hospital in an ambulance.
The run to Safe Harbor is virtually a daily happening for the firefighter-paramedics from Largo Fire Station 40. They spend so much at the shelter that Largo officials have asked the county for more money from the emergency medical service fund to better cover the costs of serving Safe Harbor and the surrounding area.
The fact is, the homeless shelter has been one of the biggest users of the EMS since it opened in 2011. That year, Safe Harbor topped the list of the single most frequent users of the system with 537 calls. In 2012, it was second with 603 calls. Last year, it was third with 545. And, in the first quarter this year, it's again third with 161.
"I'm happy to run the calls, we just want to be funded for them," Largo fire Chief Shelby Willis said.
And, she said, Sheriff Bob Gualtieri should shoulder some of the burden because it's his shelter.
Pinellas County has turned down Largo's request for more money. Officials say Engine 40's overall workload isn't high enough to qualify for additional funding. Gualtieri said he's not responsible for the increased workload. EMS, he said, is a countywide system and the homeless at Safe Harbor would be using the system no matter where they were.
"Those are the same people who would be served elsewhere. Are they more centralized now? Yes," Gualtieri said. "What does it matter whether it's St. Pete running that call in downtown St. Pete or it's Largo running that call?"
It matters, Willis said, because the main burden is falling on one Largo station. When Engine 40 is at Safe Harbor, it's not available for fire or other medical calls. While those other calls will be answered, help comes from farther away so patients have a longer wait.
And, it matters, she added, because taxpayers aren't seeing the true costs of Safe Harbor.
That's not true, Gualtieri said. The situation, he said, actually illustrates the sum of the cost of homelessness and how medical care is provided.
"It's a bigger problem than just whether Largo is burdened by it," Gualtieri said. "The silver lining, if you will, is it allows people to see what a significant problem this is and the cost."
Safe Harbor, 14840 49th St. N, opened in January 2011 as a jail diversion program. Gualtieri billed the shelter as a cost-effective alternative to jailing the homeless. It costs less, he said, to shelter the chronically homeless and keep them out of the criminal justice system. The facility can house more than 250 men and women.
Its $1.8 million startup costs came from federal funds, grants and contributions from cities such as St. Petersburg. Its annual budget of about $1.6 million comes from Gualtieri's department and donations from cities, civic groups and citizens. Largo, the sheriff said, provides no funds to the operation. Instead, Largo officials said they saw the EMS service as an "in-kind" donation to the shelter.
The reasons for the calls vary from the life-threatening — heart attacks, chest pains, seizures — to the mundane — alcohol-related, coughs, generalized anxiety.
"I've heard this from Largo … about the increased calls for service," Gualtieri said. "It's the nature of the population. You're dealing with a population that has significant acute health problems."
But Safe Harbor seems to place higher demands on the EMS system than other homeless programs. The other homeless shelter in the most recent list of top 20 single users of the EMS system is Pinellas Hope. That shelter, in unincorporated Pinellas Park, is run by Catholic Charities of the Diocese of St. Petersburg. It houses more than 250 men and women.
In 2011-12, it was 49th on the list of the single most frequent users with 145 calls. Last year, it rose to 11th place with 356 calls. For the first quarter this year, it was No. 6 with 106 calls.
Pinellas Suncoast Fire and Rescue Chief Bert Polk is familiar with the situation at Safe Harbor. Polk, who heads up the county's Fire Chiefs Association, says it's a topic that often comes up at the group's meetings. While there's been discussion, he said, no one seems to have calculated the numbers or economic impact.
Gualtieri does not provide full-time medical care at Safe Harbor. The county's mobile medical unit comes a few times a week. (Gualtieri's office does pay for medical care and ambulance fees for jail inmates. The jail also has full-time medical staff.)
Severe or not, nearly all of those who call for help are taken to a hospital — 94 percent in 2013 and about 91 percent in the first quarter of this year. The average retail bill for an ambulance ride in Pinellas is $642.94, according to the county. That makes the cost for ambulance rides alone about $329,828 in 2013.
"We don't pay that," Gualtieri said. "That's up to Sunstar (the county's ambulance service) to determine how they collect that payment … or if they write it off."
The county, under the Sunstar name, sends out bills for ambulance service. Most are paid by the federal and state tax funded Medicare and Medicaid programs. The rest is paid by private insurers or out of pocket. If the user can't pay, the county absorbs the loss.
That's just for the ambulance portion of the service. As Polk said, apparently no one has figured the costs of the first responder side of the equation. But, a quick estimate can be made.
The first responders — the firefighter/paramedics who answer the calls — are paid from a countywide property tax. Dividing the total amount of property tax money that is earmarked for the fire departments — currently about $46.6 million — by the total number of emergency medical calls the department answered during the 2013 calendar year — 147,359 — gives a rough idea of the cost per call to taxpayers for fire paramedic services. That works out to about $316.
So, for the 545 medical calls firefighters ran to Safe Harbor last year, taxpayers shelled out an estimated $172,220.
If the costs of the first responders are added to the ambulance costs, the estimated total cost of Safe Harbor to Pinellas' EMS system was about $502,048 in 2013.
Gualtieri agreed the EMS system shouldn't be used as a primary care provider. But he doesn't have an answer.
"Nobody's come up with a better solution," he said.
Perhaps it's time, Polk said, for a small group of those most affected to sit down and try to come up with a better way of handling the demand and the costs. That could provide a blueprint for similar situations elsewhere in Pinellas where agencies or others are using 9-1-1 as the primary health care provider.
Information in this report comes from pcsoweb.com and pinellascounty.org. Anne Lindberg can be reached at firstname.lastname@example.org or (727) 893-8450. Follow @alindbergtimes on Twitter.