When the fire chief asked if anyone in the room had fallen before, a few in the gray- and white-haired crowd raised their hands.
One woman lost her footing as she was answering the phone. Another saw a palmetto bug, sprayed it with repellent, then slipped, the floor slick with bug spray.
Sam Jeffers, 83, had just mowed his lawn in Palm Harbor when his toes curled beneath his feet. He fell on his knees, then back the other way, breaking his hip. A man who had once spent his weekends running 10Ks had to move into The Fountains at Boca Ciega Bay, a senior living community in South Pasadena.
Jeffers was attending a fall prevention class last month at the Fountains taught by Fire Chief Dave Mixson and Lori Collins, a public educator and 911 database analyst from Pinellas County. It was the first step in an effort by the county and local fire departments to cut down on a dramatic rise in 911 calls, the majority from medical issues.
From 2014 to 2015, medical calls that resulted in a response jumped 7 percent, and another 6.5 percent the following year, the highest rates in at least a decade. And growth appears to be continuing. As of Nov. 30, the 165,143 dispatched calls are on pace to surpass last year’s 175,528.
Meanwhile, population has grown less than 1 percent annually. Census data shows a projected increase of about 5 percent between April 2010 and July 2016. EMS demand rose by about 27 percent between the same years.
So, what gives?
"If I could tell you why, I would be a genius," said Jim Fogarty, director of the county’s safety and emergency services bureau.
He and others have some leads as to why. The population is aging. People are relying on EMS as their primary source of health care rather than for true emergencies. The opioid crisis. Agencies cut educators during the recession, slashing prevention efforts. More tourism.
"There’s no fingerprints on the knife from any one driver," said Ian Womack, rescue chief for St. Petersburg Fire Rescue.
Fogarty, who tackled a similar challenge in his old job in King County, Washington, and his staff are trying to pin it down further. While working on prevention efforts such as the class at the Fountains, officials will be examining call data from different angles to pin down other potential solutions.
Officials picked the Fountains as a starting point for a reason. Medical and fire personnel ran calls to the senior living community at 1255 Pasadena Ave. S more than any other address last year: 920 times, only 14 of which were for fire-related issues.
Falls made up 261 of those responses and 25,883 responses countywide last year, second only to "sick person.’’ Starting with fall prevention seemed "like the low-hanging fruit," Mixson said.
"It just seemed like a no-brainer we could make a difference with this," he said.
Mixson attributed the facility’s call volume to its size. The community is made up of two towers with 524 independent living apartments and a skilled nursing facility with 109 units called The Springs at Boca Ciega Bay. Unlike facilities that encompass multiple addresses, the Fountains and the Springs are under one address.
The facility tries to avoid calling 911, said Suzanne Burtzlaff, executive director of the Fountains. The independent living side has nurses on staff Monday through Friday during the day.
Burtzlaff has noticed that residents are often wary of reporting a first fall, which increases their chances of falling again. They fear losing their ability to drive, their mobility, their independence.
But, she said, "if they would have alerted us of it, we could have been proactive."
In line with the county trend, dispatches to the Fountains have increased over the years, up from 775 in 2012. There have been 872 as of Nov. 30 this year. The rise baffled Burtzlaff and her staff, but she said they plan to look into it further.
It was a similar case for Brookdale Pinecrest at 1150 Eighth Ave. SW, Largo, the other senior community in the top five. It saw a rise from 423 in 2012 to 600 last year with 580 as of Nov. 30. The facility has 318 independent living beds and 108 assisted living and memory care beds, said executive director Karen McFarlin.
Unlike the Fountains, Pinecrest doesn’t have a medical staff for its independent living residents, she said. The assisted living portion expanded in late 2015, which she said could have driven some of the increase.
The Society of St. Vincent de Paul Center of Hope saw a huge increase that launched it to the second spot last year with 732 runs. In 2014 it was only 175. According to the website, the center has 50 single rooms for transitional living and 10 double rooms for emergency shelter.
St. Vincent representatives did not return requests for comment.
Another homeless shelter, Pinellas Safe Harbor, has been a heavy user of the system since it opened in 2011 and source of contention among the Sheriff’s Office, the county and Largo Fire Rescue, which runs calls there.
Sheriff Bob Gualtieri said it’s to be expected when you put a bunch of "very vulnerable people with extensive medical needs" together in one place.
Plus, he said, many call 911 on their own, which is beyond the shelter’s control. The calls there fluctuated over the last five years but didn’t match the consistent increase seen countywide.
Last year, the county opened Bayside Health Clinic next door to Safe Harbor to serve in part the roughly 400 people in the shelter. That’s exactly the kind of intervention Largo Fire Chief Shelby Willis wants to see more of to address the population’s health needs.
"Somewhere along the way, we have to bring the medical care to them," she said. "It has to be continuous."
Fire departments have been forced to get creative while costs increase. The county has two contracts for EMS, one with Paramedics Plus, which provides Sunstar ambulances for hospital transport and is funded by ambulance user fees, and the other with the 18 fire departments that provide EMS that’s funded by a property tax.
The total cost of both contracts have spiked between fiscal years 2013 and 2017, from about $78.2 million to about $99 million, or by 27 percent, according to Jodie Sechler, director of ambulance billing and financial services. In comparison the rise in the prior five years was about 4 percent.
St. Petersburg Fire Rescue added two vehicles in January to run medical calls downtown during the busiest times. The SUVs with medical equipment, called peak load units, have cut down on the workload for the busiest areas, Womack said.
And at a cost of about $419,000, they’re more than $300,000 cheaper than a 24-hour rescue vehicle. Clearwater Fire & Rescue is adding one as well.
"It’s just the most effective and efficient way to handle growth," Womack said.
But the deeper challenge comes in nailing down the root causes for why people are relying on the EMS system more than they used to.
"We have a lot of work to do," Fogarty said.
Contact Kathryn Varn at (727) 893-8913 or [email protected] Follow @kathrynvarn.