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It appears that the needed support from the various communities to continue with a fully staffed volunteer ambulance service in the Sebastian area is not forthcoming and consideration of a paid service in this response area is appropriate and necessary. ALTERNATIVES AND ANALYSIS There appears to have been a considerable drop in the availability of EMS staff in that documents reflect during July, 1988, during investigation of the request for renewal of the Certificate of Public Convenience and Necessity, Fellsmere was covering 26 out of 28 shifts or 92 percent of the total shifts in the North County area. The agenda item recommending renewal of the Certificate of Public Convenience and Necessity alluded to staffing problems although the Squads were actively recruiting new personnel for training and paying the tuition for those who would commit to the in-depth training. It was also noted in the agenda item that only a small portion of the populace of the Sebastian area had volunteered their time and talents to the EMS service. It was anticipated that with quality leadership and positive publicity, adequate staffing could be achieved in a reasonable time period. It is unfortunate that adequate staffing has not been achieved as of the date of this memorandum and full staffing with volunteers is not anticipated. The agenda item of August 16, 1988, also recommended a review of the staffing and response profile within a six month period. That report was to a large degree contained in the proposal approved by the Board of County Commissioners on December 20, 1988, in which the County became the single focus of management for the EMS system and responsibility for the operational control of the system was delegated to the Department of Emergency Management Services. The proposal alluded to staffing problems within the North County area and it was noted that hopefully, with a county operated system, volunteers would come forward to receive training and assist in staffing the various shifts. What did occur was that the former Squad Chief was relegated to pulling double shifts for six days a week over ten hours a day until the demand took its toll on her and she unexpectedly walked out without notice on March 24, 1989. However, this type of behavior is cause for concern now in terms of what will occur the next time when an emotional issue surfaces. On April 11, 1989, the Fellsmere Volunteer Ambulance Service Board of Directors voted to reject her resignation and requested that she return to the helm of the Squad as a paid employee at the rate of $25,000 per year plus fringe benefits which will require approximately $33,250.00 in funds. The Indian River County ALS is the EMS ALS licensee for the County wide EMS system. As such, Chapter 401, Florida Statutes, Administrative Rule 10D-66, and Indian River County Ordinance #87-66, as amended, must be followed to the letter. Failure to adhere to the above referenced authorities subject the County to severe penalties and fines. The Fellsmere Volunteer Ambulance Service has not totally adhered to the letter of the law and while this may have occurred unintentionally, had an inspection been accomplished by HRS in the recent period of time, it is felt certain fines could have and would have been levied against the County. What has happened in the past on several occasions as relate to the Sebastian Volunteer Ambulance Squad cannot be allowed to repeat itself again. It is time that this service location be stabilized on a permanent basis and that can be done only with paid professional emergency medical services staff. Therefore, it appears that the following options are available to the Board of County Commissioners: 1. Continue to permit the Fellsmere Volunteer Ambulance Service to operate with less than required staffing and pay paramedics overtime to staff the shifts not covered by volunteers. 49 APR 18 1989 ROOK 76 f'aGE 638