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PSA Minutes 03/13/2013COLLIER COUNTY PUBLIC SAFETY AUTHORITY (PSA) March 13, 2013 10:00 a.m. Growth Management Division - Planning and Regulation 2800 North Horseshoe Drive Naples, Florida MEMBERS PRESENT: Chairman Reg A. Buxton Chief Michael D. Murphy Todd Lupton Dr. Jeffrey A. Panozzo Dr. Todd Bethel Justin Gibson Captain Robert Montagano Phillip C. Dutcher David Mennini Chief Walter Kopka Bobby Allen Dr. Robert B. Tober This cause came on to be heard at the time and place aforesaid, when and where the following proceedings were reported by: Terri L. Lewis, Court Reporter and Notary Public Gregory Court Reporting Service, Inc. 2650 Airport Road South Naples, FL 34112 COLLIER COUNTY PUBLIC SAFETY AUTHORITY (PSA) AGENDA March 13, 2013 — Wednesday 10:00 am Growth Management Division - Planning and Regulation 2800 North Horseshoe Drive Conf Room 609/610 1. CALL TO ORDER AND PLEDGE OF ALLEGIANCE 2. AGENDA AND MINUTES a. Approval of Today's Agenda b. Approval of Minutes from the January 16`h PSA Meeting 3. OLD BUSINESS a. Changes to the Ordinance b. Changes to the Bylaws 4. NEW BUSINESS a. Elect new Hospital Administrator representative for PRPR b. Report from the Medical Director's Subcommittee c. Report from the Community Education and Awareness Working Group i. Appoint new member to sit as Chair d. Report from the Clinical Coordination Working Group e. Goals of the PSA f. Problems Facing PSA g. Medical Director Executive Summary 5. STAFF REPORTS 6. PUBLIC COMMENT a. Captain Roy Arigo i. Smart 911 Presentation 7. BOARD MEMBER DISCUSSION 8. ESTABLISH NEXT MEETING DATE a. May 15, 2013 9. ADJOURNMENT PROCEEDINGS CHAIRMAN BUXTON: Call the meeting to order of the PSA. If you'll rise for the Pledge of Allegiance, please. (The Pledge of Allegiance was recited in unison.) CHAIRMAN BUXTON: Everyone has the minutes. Anything need to be changed? If not, I move for approval for the minutes from the last meeting. CHIEF KOPKA: Mr. Chairman? CHAIRMAN BUXTON: Yes. CHIEF KOPKA: On Page 3 -- you're referring to the January 16th minutes? CHAIRMAN BUXTON: Right. CHIEF KOPKA: Page 3, Section D, PSA ordinance revision. CHAIRMAN BUXTON: Okay. CHIEF KOPKA: I did not make that motion. I believe it was Chief Murphy, if I remember correctly. CHIEF MURPHY: Yes. CHAIRMAN BUXTON: Everybody agrees? CHIEF KOPKA: As a matter of fact, I remember because I voted against it, so I wouldn't have made that motion. CHAIRMAN BUXTON: Change the minutes to reflect that, please. Anything else? (No response.) CHAIRMAN BUXTON: Motion to approve the minutes? CHIEF KOPKA: Second. CHAIRMAN BUXTON: All in favor? Aye. CHIEF MURPHY: Aye. MR. LUPTON: Aye. DR. PANOZZO: Aye. DR. BETHEL: Aye. MR. GIBSON: Aye. DR. TOBER: Aye. MR. ALLEN: Aye. CHIEF KOPKA: Aye. MR. MENNINI: Aye. MR. DUTCHER: Aye. CAPTAIN MONTAGANO: Aye. CHAIRMAN BUXTON: All against? (No response.) CHAIRMAN BUXTON: Passed; thank you. DR. PANOZZO: Mr. Chair? CHAIRMAN BUXTON: Yes. DR. PANOZZO: I just wanted to take a moment, if we can, just to mention one of Naples' finest. It was reported in the news this morning one of our Naples citizens, a soldier, was killed in Afghanistan recently. He was Staff Sergeant Marc Scialdo, and this was confirmed by NBC -2 that he was one of five Americans killed in a helicopter crash on one of the deadliest days in Afghanistan. And I just wanted, if we could, if it was appropriate -- if you feel it appropriate, just to take a moment of silence. CHAIRMAN BUXTON: Absolutely. Let us take a moment of silence on that. (A moment of silence was taken.) CHAIRMAN BUXTON: Thank you, everyone. As we sit here in what we think is important -- and somebody gave his life so we could do what we do here. So that's tough stuff. Thank you very much for bringing that up. Okay. Old business, change in the ordinance. CHIEF KOPKA: Did we approve today's agenda? CHAIRMAN BUXTON: I'm sorry. I apologize. Approval of today's agenda? Do I have a motion to? CHIEF KOPKA: Yes, sir. CHAIRMAN BUXTON: Second? MR. DUTCHER: Second. CHAIRMAN BUXTON: All in favor? Aye. CHIEF MURPHY: Aye. MR. LUPTON: Aye. DR. PANOZZO: Aye. DR. BETHEL: Aye. MR. GIBSON: Aye. DR. TOBER: Aye. MR. ALLEN: Aye. CHIEF KOPKA: Aye. MR. MENNINI: Aye. MR. DUTCHER: Aye. CAPTAIN MONTAGANO: Aye. CHAIRMAN BUXTON: Thank you. All right. Let us digress just one second here. Over the last week, there's been a lot of communications going on in the community and among people and everything like that, and I think it's important that we take five minutes here. And Scott Teach from the County Attorney's Office is going to take just a short two, three minutes and go over our responsibilities as members here, and who we talk to, how we talk to, what we do; do we email? Do we call? Do we put up billboards? Whatever. Everybody probably knows that, and sometimes we get carried away. But anyway, just give Scott a couple minutes here to do his dog- and -pony show with a small pony. MR. TEACH: Good morning, gentlemen. Yesterday I spoke with the chairman, and because you're a group that meets so infrequently, it's probably good that we meet now and then to remind everybody that -- UNIDENTIFIED SPEAKER: You need to use the mike. MR. TEACH: I talk pretty loud, so I thought I could -- CHIEF KOPKA: Good try. MR. TEACH: Sorry you're facing my back. But in any event, I thought that it might be a good idea to just run through the fact that this is a board that's subject to the Sunshine Laws and that you -all need to be aware and careful about engaging in any communication outside of these meetings. And I would encourage you that the best way to prevent any issues regarding any subject matter that may be coming before this board for future discussion is that if you have a question or if you have an issue, you can always contact our office to see how it is appropriate to communicate, but go through your staff liaison. If there's an email that you think would be helpful which is informational -- for example, if there's a study from another jurisdiction and you think that it would benefit all the members, send it to your liaison. Your liaison will contact our office and they'll ask us, is this something that can be put forward and emailed out to all the members. And if it's just an informational thing, doesn't have any commentary or express an opinion that you might debate or discuss in a future meeting, we would probably say that's fine. But it would have to go out to all the members. It can't go out to three or four or anything like that. So just to guard against any potential that there could be an infraction or a violation of the Sunshine Law, you know, we strongly encourage you to work through your liaison. I'm not saying that anything has happened. I'm just -- this is a reminder. That's why we're doing this. But it's important to know that, because I don't want to see any -- I don't want to see any of your names in the paper on any single issue. And, really, that's why I'm here today is just to remind everybody that you have to be careful. And I understand that, especially interagency, the way this board is configured, you come -- you might come across each other doing business, and that's a little bit different. If you're not discussing legitimate matters that are going to be a topic for discussion among your board and you're just talking about doing business and if it's protocols and you're just clarifying things that are in the ordinary course of business, you gentlemen are all professionals, and you can use best professional judgment and respond and interact accordingly as you're required to do so by your jobs. And that's really all I wanted to say today is just sort of a reminder. CHAIRMAN BUXTON: Thank you very much. We appreciate it. I'm sure everyone heard it. Thank you. All right. Let's go to changes in the ordinance. CHIEF KOPKA: I'll take that. We did need to clean up those minutes so we could add that to the documentation going to the County Attorney's Office for a change in the ordinance and the relative COPCN ordinance, but that will be submitted along with the minutes. CHAIRMAN BUXTON: We're fine then. Okay. Change to the bylaws. CHIEF KOPKA: Same applies. It will all be submitted together. CHAIRMAN BUXTON: All right. New business. Elect a new hospital administrator representing for this Physicians Regional. Do you have one? MR. LUPTON: I do want to recommend Joe Bernard, who's assistant COO for Physicians Regional. He has had a distinguished career, military career, retired lieutenant colonel with the Marine Corps as a fighter pilot and actually a pilot for Marine 1 for President Clinton. He's a very smart, honorable man. I recommend him for vote to take my place when I leave this weekend. CHAIRMAN BUXTON: Okay. Discussion? CHIEF KOPKA: Sad to see you go. MR. LUPTON: Thank you. CHAIRMAN BUXTON: I happened to have spent some time with the gentleman. He's pretty sharp. Motion to accept? MR. DUTCHER: So moved. CHAIRMAN BUXTON: Second? CHIEF MURPHY: Second. CHAIRMAN BUXTON: Okay. All in favor? Aye. CHIEF MURPHY: Aye. MR. LUPTON: Aye. DR. PANOZZO: Aye. DR. BETHEL: Aye. MR. GIBSON: Aye. DR. TOBER: Aye. MR. ALLEN: Aye. CHIEF KOPKA: Aye. MR. MENNINI: Aye. MR. DUTCHER: Aye. CAPTAIN MONTAGANO: Aye. CHAIRMAN BUXTON: Thank you. We're going to be out of here in two minutes, guys. This is -- something's wrong here. CHIEF MURPHY: Back to the County Commission agenda. How does that get moved to the County Commission agenda? CHIEF KOPKA: We'll process it through the County Attorney's Office as a change in the ordinance. CHAIRMAN BUXTON: Thank you. All right. Report for the medical director subcommittee. DR. TOBER: On our last subcommittee meeting, we discussed some issues on certain protocols. We had some subsequent meetings between the two neurology groups, and we are going to further discuss that today at today's medical subcommittee meeting. CHAIRMAN BUXTON: Okay. Any questions from anyone? (No response.) CHAIRMAN BUXTON: Report of the Community Education and Awareness Working Group. The minutes from that are not in the packet, and I apologize for that. We'll make sure that you get to see those. We met. Actually, we met twice since the last meeting. We've done a few things. There are -- and I'll pass these around. There's a Smart 911 and then the new Intelligent 911 article in this. That's probably the first thing that we've done from that. We have two members of that committee here. They're both citizens not on board -- or three. I'm sorry. I will ask them if they have anything that they thought I missed or anything that the group needs to know. Mr. Page? MR. PAGE: No. I was wondering if you're going to continue to chair that or -- CHAIRMAN BUXTON: No, I'm not. I'm going to -- that's my next thing is I'm going to ask someone to step up and chair that. Pretty soon we're going to have too much cross - pollination here and, you know, there needs to be some freedom of that person to do things. Mr. Burke? MR. BURKE: No, I have nothing. CHAIRMAN BUXTON: Okay. George? MR. DANZ: For the record, can you put in what publication that article's in? CHAIRMAN BUXTON: Life in Naples magazine. MR. DANZ: Thank you. CHAIRMAN BUXTON: Now, I'm looking for someone who wants to do something that's hard -- not that hard, but -- and gets very low pay for it, that would be to chair that subcommittee of communication and community awareness. And I see they fight to get their hands up. Okay. Is it possible to have this committee without a PSA board member on it? CHIEF KOPKA: It's my understanding that all subcommittees need to have a person from the -- CHAIRMAN BUXTON: Okay. That's what I thought. I just was looking for clarification on that. Okay. Did anybody miss the meeting today? That's usually a good way to get appointed, if you don't show up. DR. PANOZZO: What are the obligations of that? CHAIRMAN BUXTON: Well, the obligations are is that they meet -- they meet about once a month, and they get together and they discuss ways to get things about the PSA out, things we can do. You know, we put something on Collier's website. They came up with these two articles which are in the magazine, you know, those kind of things like that. It's a pretty rowdy group of guys, actually. Does that mean you volunteer? DR. PANOZZO: No, sir. CHAIRMAN BUXTON: Oh, okay. All right. Before that committee meets again, we will come up with, via by draft or lottery, someone to chair it. Thank you. Report from the Clinical Coordination Workers Group. CHIEF KOPKA: Mr. Chairman, I'll take that -- CHAIRMAN BUXTON: Got it. CHIEF KOPKA: -- as chairman. We had a productive meeting. We had four members from the PSA, a couple staff members there as well. It divided it into two different topics. One was the possibility to link information from the EMS database with either the paramedics' impression of what was wrong with the patient, linking that with the hospital outcome, whether that be discharge outcome, admissions, diagnosis, and from there to look at the data and determine if there are any trends or what our paramedics are encountering and what the true outcome of the patient is. That was one portion of it. And I'll refer to Mr. Dutcher. He was going to look into some legal or admin aspects of that. And if you wanted to let us know what you found out about that. MR. DUTCHER: Yeah. We consulted our legal, and I think there's some issues with HIPAA. Even though the paramedics are part of the process, we -- our attorneys are still researching to see if providing that additional information back as a follow -up is a violation of HIPAA or whatever. But, you know, we're -- we think that's a good thing to do if we can legally make it happen. CHAIRMAN BUXTON: Okay. CHIEF KOPKA: We plan to meet again next month, middle of next month, and hopefully by then we'll -- MR. DUTCHER: Yeah, I'll have something by then. CHIEF KOPKA: -- have some more information. I've done some research on how other EMS agencies do it, and the ones that are hospital based, it's very easy, because it's all under one entity. I haven't found any other third -party or any other services that transfer that information like I asked, but I haven't been digging too deep. The other aspect was getting the information back to the paramedics. Paramedics will deliver the patient to the hospital and really have no feedback on what happens to that patient. They may talk to staff afterwards or, you know, inquire about the outcome of the patient. Obviously, on cardiac arrests and Phoenix awards they're notified. On trauma -alert patients, those are QA'd 100 percent of the time; that feedback is always done, but on 98 percent of the other patients the feedback isn't provided to the paramedics. And I'll let Chief Murphy jump in if you want to give your aspect of how you think that could happen and if you found anything more about that.. CHIEF MURPHY: I have not found any additional information on that. The issue really is is that we have a lot of paramedics out in the field who go to a call, they can't find out what happened to that patient unless they happen to be visiting the ER, walk through the ER, see the patient there, and it really does impact their serviceability, plus the issue of, just on a general - information basis, I did a good job, I did something, I need to correct something, similar to what we just talked about in patient outcome, which is at the discharge stage. But I will do some more research in reference to that to see if there are any systems. But that tied into two other things that we were talking about. One was that we were going to ascertain if the sheriff -- because we do have Smart 911 data that is downloaded directly to the paramedics and is up on a platform for so many minutes. EMS was going to ascertain if that data can actually be downloaded directly into a field on the field reports so that it can be kept on the field reports and through the computer system they use. And the other part was the hospital doesn't have that information which could benefit everybody in long term so that CCSO was going to check or the dispatcher was going to check with the hospitals and see if there was a way of transferring or opening up that field of data through Password or something to the ER physicians who are treating these people, because with that 45- minute window, it's a limited amount of time and, therefore, if they get to the hospital, they may not be able to access the information which had other information the hospital may wish or desire. And then one other piece of information, there was a subsequent meeting that night where I had done some reviews on hospital systems, and there are systems in the United States that actually -- where hospitals will actually dump patient data into one main secure system so that it's -- if a patient ends up in Hospital XYZ, the access of information for treatment of that patient or -- could come back through this main database, and how do you share that information? Can it be done under HIPAA? Is it protected under HIPAA? But more important was, as we were discussing it, is not only that is EMS is a component of that, and if there is a patient who has a doctor locally or -- and this information is available that an EMS individual responding to a call might be able to access that for the purposes of transport or to make sure they go to the correct facility or the right treatment is given to them. And I know there was going to be a meeting that evening actually between the two hospitals about information sharing and data sharing, but there are systems and technology out there that can make that happen. And, again, we just -- we were looking at the aspect -- or I look at the aspect that EMS is a component of the entire healthcare through that patient, and we just wanted to try to make sure that our paramedics and stuff had adequate information. MR. DUTCHER: Yeah. Just to comment again. You know, both healthcare systems in this community and, frankly, around the country are developing what's known as a health information exchange. So it's a database of information about all patients treated in those facilities, and the intent really is to coordinate care amongst the many healthcare providers, including the initiation at the paramedic level all the way through hospitalization, follow through for post -acute care, and even into the ambulatory settings of physician offices and other ambulatory providers in the community to just better coordinate care through information. And so it seems logical that if there was a way, without violating the HIPAA rules, that this information was available to all the different participants, it really should be a benefit to everybody and, most specifically, the patients. And there are some systems -- the ones that I'm aware of -- I think, Walter, are similar to you that -- where the hospital runs its own emergency services. And obviously it's their data, so they do have access to it, but -- CHIEF MURPHY: Yeah. There were two systems that I found in the United States that I brought articles from that -- where the hospitals had agreed to share this information and dump it into a central database or make it available through a central database for patient outcome. MR. DUTCHER: Yeah. On the other hand, as healthcare systems develop these databases, it's very, very -- we're all very concerned that we don't violate HIPAA. There's a case up in New York right now where -- or in New England, Boston, where a bunch of patients' information got out and, you know, there's a $50 million class- action suit against one hospital up there right now for violating patient information. So we've just got to be careful about it. DR. PANOZZO: Mr. Chair? CHAIRMAN BUXTON: Yes. DR. PANOZZO: There are some other ways you can -- to do this. One is that the system entertains a contract with the hospitals that -- specifically regarding HIPAA. And we do this with teaching -- many of the teaching -- for example, at NCH we have a PA program. It's a very robust program, and we have PAs come through all the time, and they have -- they follow -- at NCH they get HIPAA trained by the NCH personnel in HR. They sign a contract with the hospital, and they're vigorously monitored. And so there is -- there are some solutions to this. So I ask us to -- this group and members that are on this committee -- First off, Walter, when are you meeting again? CHIEF KOPKA: Middle of next month. I think it's the second Wednesday or third Wednesday of March. We'll send it out to the group that anybody can participate. DR. PANOZZO: I'll make sure that's disseminated to the group. I'd ask you to challenge yourselves to look at that, because I think it would be a huge benefit for the medics, in general, for training purposes, QA, and there are ways around it, but it has to be watched very closely, obviously, because there's a significant risk that you could get exposed to there. But with close monitoring and so on, it can work. CHAIRMAN BUXTON: Okay. Thank you. Thank you. Yes, Doctor? DR. TOBER: Reg, right now, you know, what happens in EMS is that we -- and mostly me -- laboriously pull records out of Power Chart to determine outcomes so that we can use these as teaching cases in our in- services. And what happens is, after we pull the case we de- identify the patient so there's no medical record number, there's no name, and in that way we can use them as teaching cases. But we haven't been able to progress beyond the manual pulling of an individual chart when we know that there's an interesting outcome either positive or negative based on that patient. CHAIRMAN BUXTON: Okay. Thank you. Thank you for that. Walter? CHIEF KOPKA: We'll notice everybody on the next meeting. CHAIRMAN BUXTON: Okay. CHIEF KOPKA: Middle of next month. CHAIRMAN BUXTON: Great input, everyone. Thank you. I'm sure you saw me on the phone. I'll relay what that was. That was the County Manager's Office. I don't know if anyone watched the BCC meeting yesterday. Within two weeks we will be charged by the commissioners to look at applicants for the medical director's position. They're going to advertise for that. I just tell you that because I just got that information. And as soon as I get further information, I will disperse it quickly to everyone. Goals of the PSA. We are surrounded on this table by very smart people who are all very successful at what they do, but we have not yet put together, nor have we had a meeting to do that, where are we going, what are we doing, how are we going to get there, and what do we hope to be there (sic) when we get there? So we need to -- we need to do that quickly as more and more things are thrust upon us. This will be the third one of these, call it what you want, blue ribbon, green ribbon, whatever committees, and they all had good ideas, and they all went away, and they never got to the goal that they had to get to. This committee will get where we need to go, where the public wants us to go, and where what's best for the public to get -- for us to be there. There's always obstacles in our way. There are obstacles in the other people's way. We are an advisory committee, which means, supposedly, unless we're asked, we don't say anything. Well, maybe we can say a little more than that. But it's important that we act unified and professional as we go forward with these different items and that the public comes to see us as a shepherd of their views and a shepherd of their care. And we've got to do that. We've got to do that, people. We've got to do it. I know we got off the track there, but we're only as good as where we want to go and how we want to get there. So what needs to happen -- and I'll get -- I'll get with some people, but we need to get a committee together, or we can pull a whole general meeting, but we need to decide exactly where we want to go, how do we want to get there, and what good are we going to do once we get there. Problems of the PSA. CHIEF MURPHY: I have a question in reference to that. CHAIRMAN BUXTON: Yeah. Go ahead, Mike, Chief. CHIEF MURPHY: I'm not sure of -- does the county -- do county departments have goals and objectives, a template that they use for -- or is it a mission or -- and, again, I just -- CHIEF KOPKA: Are you referring to EMS in particular or -- CHIEF MURPHY: County departments or EMS. I mean, is there a sheet or a format that you use that says, this is the goal, this is the objectives, this is the performance, this is the task, this is the requirement, a standard -- CHIEF KOPKA: Are you looking for a format to use for the committee? CHIEF MURPHY: Yes. CHAIRMAN BUXTON: Road map, I guess, yeah. We wouldn't start out going to -- way, way to Iowa without a road map, and we've got to have one. CHIEF KOPKA: I would use the governing document for us, which is the ordinance, and work from it, because it's pretty detailed on what the goals and objectives of this committee are supposed to be. I use it as a template and work from that. CHAIRMAN BUXTON: Okay. CHIEF MURPHY: Right, and that part I understand. But I guess my question is that when you do goal setting or you do strategic planning, you usually have a form, and if the form says we're to listen to cases involving discipline and that's one of the objectives in the ordinance, you would list that at the top, and then you would have assignments, you would have performance objectives, what are the requirements of time, when do you think that project is going to be complete, just like the three projects we're working on. Each one of those would be a subgoal of that. But there's usually a form you fill out, and I guess I'm familiar with that from strategic planning. And all I'm asking -- I'm suggesting if the county has a strategic planning document or form they use, since we're a county group, if we were to get that, we could transfer those goals directly into there and send that blank document out to the group here, and if they see things that they feel are important, they could list the goal that they would like to see and then bring us all back together, let's say, in May, first meeting in May, as a workshop of strategic planning with a facilitator, and let's go through it and try to keep it in perspective. CHIEF KOPKA: I guess I'm not sure what document you're referring to. But if you're familiar with it, I welcome you to submit it to the group and go from there. CHIEF MURPHY: Okay. And I'm not aware -- and, again, I know I asked about the county, but I will find it. I have documents that outline that, goals, objectives, performance, data, times, et cetera, of strategic planning, or if the hospitals have one, I just want to use a form that we're familiar with or the agency we're working for is familiar with, that's all. So I can do some research. CHAIRMAN BUXTON: Great, thank you. DR. PANOZZO: And I'll send it. CHAIRMAN BUXTON: second. I want to break protocol just one Mr. Summers, you've been waving your hand back there, director of EOC. I know you're not trying to fly, so you must have something important to say. MR. SUMMERS: I'll take the mike, because Kady keeps reminding us to get to the microphone. Dan Summers, director of the Bureau of Emergency Services and Emergency Management. Just wanted to let you be aware in terms of the facilitation and long -range and short -range planning, we're aware that our cooperative extension, University of Florida office, has, in fact, a trained facilitator program that they offer, and I believe it's much more competitive in rate as opposed to hiring an outside firm to come in and do that. And I think if you would like for us to put us in contact with one of these trained facilitators that is out of our university cooperative extension -- CHAIRMAN BUXTON: We can charge that back to your department? MR. SUMMERS: Well, I think it -- no, I think it's very reasonable. I think it's very reasonable -- CHAIRMAN BUXTON: Great idea. MR. SUMMERS: -- and I think we would be willing to do that. I think the other part of that is that you've got a -- I want to say an academic environment, if you will, to take us through goals and objectives and an exercise to have group participation, certainly a neutral party when you go to the cooperative extension opportunities and something that would be of value to do in a public venue. So I just wanted to let you know that we know that that resource is out there. And if it's something, Mr. Chair, that you'd like for us to bring back some more information to you -- CHAIRMAN BUXTON: Please do. MR. SUMMERS: -- then I think that might be a route for us. It's very hard in this environment with the time constraints that we all have, but if you want to have a facilitator that might get us jump started, I'll be glad to put you in touch with them. CHAIRMAN BUXTON: I appreciate that. Please do. CHIEF MURPHY: I like that -- and we had done that, and on day one a number of government agencies in this county spent the time with them, and it was phenomenal. It was an excellent, excellent product. So I would recommend we go that route. Would you need a motion? CHAIRMAN BUXTON: Do we have a motion for that? CHIEF MURPHY: I'll make a motion. CHAIRMAN BUXTON: Do we have a second? CHIEF KOPKA: Second. CHAIRMAN BUXTON: All in favor? Aye. CHIEF MURPHY: Aye. MR. LUPTON: Aye. DR. PANOZZO: Aye. DR. BETHEL: Aye. MR. GIBSON: Aye. DR. TOBER: Aye. MR. ALLEN: Aye. CHIEF KOPKA: Aye. MR. MENNINI: Aye. MR. DUTCHER: Aye. CAPTAIN MONTAGANO: Aye. CHAIRMAN BUXTON: Thank you very much. I'll digress just one second here. In the minutes of the last meeting we were asked by the CCSO, Sheriff Rambosk, to send a letter, after listening to his presentation, to the BCC saying that the PSA had looked at what he'd presented to us and that we thought it was valuable and that we supported what he had to say. Now, that letter has been written. Did everyone get a copy? Everyone should have a copy of it. DR. PANOZZO: Just one second. CHAIRMAN BUXTON: I will remind everyone -- or not remind, well I will remind everyone that we voted 15 -0 to write this letter and send it to him. DR. PANOZZO: Was that emailed to us? MS. FRANCO: No. I just put it on there. CHAIRMAN BUXTON: Any questions or objections to the letter? (No response.) CHAIRMAN BUXTON: Motion to -- that we send it? CHIEF MURPHY: Motion to approve. DR. TOBER: Second. CHAIRMAN BUXTON: Thank you. All in favor? Aye. CHIEF MURPHY: Aye. MR. LUPTON: Aye. DR. PANOZZO: Aye. DR. BETHEL: Aye. MR. GIBSON: Aye. DR. TOBER: Aye. MR. ALLEN: Aye. CHIEF KOPKA: Aye. MR. MENNINI: Aye. MR. DUTCHER: Aye. CAPTAIN MONTAGANO: Aye. CHAIRMAN BUXTON: Opposed? (No response.) CHAIRMAN BUXTON: Thank you. Okay. On the next item, medical director executive summary, I have been advised by the county attorney to ask this group to ask for an indefinite continuance of that. This group will decide whether they do that or not. DR. TOBER: I don't understand the question. CHAIRMAN BUXTON: The medical director's executive summary. The attorney said that he would ask that we continue that, in other words, not discuss it today. But it is our choice whether we do that or not. CHIEF KOPKA: Mr. Chairman? CHAIRMAN BUXTON: Yes. CHIEF KOPKA: I don't have an issue with discussing it, but like you said earlier, the board has made a decision to post this position, that the applications would come back to this committee for review with a ranking of them from 1 to 10, and the applications would go back to the Board of County Commissioners. So that wheel's already been set in motion, but I'm not objecting to discussing anything at this time. CHAIRMAN BUXTON: Any dissention? Dr. Tober, your report, please. DR. TOBER: I don't know -- which report are you referring to now? CHAIRMAN BUXTON: Well, it says the medical executive summary. Part G on the agenda, sir. DR. TOBER: I don't have any specific report on this subject. You know, this is politics at its worst in Collier County, and that's what we're up against, and we'll do what we do. CHAIRMAN BUXTON: And quite well, I might say. Staff report? DR. PANOZZO: Excuse me? CHAIRMAN BUXTON: Oh, I'm sorry. DR. PANOZZO: Can you help me here? I'm not sure what the meaning politics at its finest is, in fact, what the executive summary point is right now. Can we clarify this previous discussion, Dr. Tober? DR. TOBER: I don't know what the executive summary point is either right now. I didn't bring this up. I didn't come here with an intention to discuss this, because it's not my idea. CHAIRMAN BUXTON: Okay. DR. PANOZZO: But the politics at its finest, can you clarify what that means, that statement? DR. TOBER: I think that this all emanated from special interests and things being done that circle around this entire meaning of this PSA and what the Blue Ribbon Committee wanted us to do in the first place. I think that's pretty clear, Jeff. DR. PANOZZO: What's "this "? DR. TOBER: Reg, you decide what you want to do here, because we could fence on this all day. CHAIRMAN BUXTON: Yeah, and we probably can. I guess, Jeff, tell me -- you know -- DR. PANOZZO: What are we talking about? CHAIRMAN BUXTON: Well, we're talking -- you're talking -- you mean Dr. Tober's statement? DR. PANOZZO: Well, this is a -- this is an item on the agenda. It says medical director -- CHAIRMAN BUXTON: Okay. This was not an item that I put on the agenda. DR. TOBER: I didn't either. MS. FRANCO: You asked me to put it on the agenda, about your letter. DR. PANOZZO: I'm just asking -- DR. TOBER: Oh, I guess it refers to the -- CHAIRMAN BUXTON: Okay. We're going to get this answered right now. DR. TOBER: -- letter that went to -- I'm sorry. I misunderstood what this was. CHAIRMAN BUXTON: Okay. No problem. DR. TOBER: It refers to the letter that my attorney sent to the Board of Collier County Commission, that letter. CHAIRMAN BUXTON: Okay. DR. TOBER: And did you -all get a copy of that? CHAIRMAN BUXTON: Yes, yes. All right. Everybody clear now? DR. PANOZZO: That's what this is? CHAIRMAN BUXTON: Yes. DR. PANOZZO: Okay. CHAIRMAN BUXTON: Okay, all right. DR. PANOZZO: And the clarification about the politics part? DR. TOBER: I think that politics played a large role in the entire evolution of events here. You don't? DR. PANOZZO: I'm asking you the question, Dr. Tober. DR. TOBER: I said -- I already answered you. Yes, I do. DR. PANOZZO: And you're talking about the -- I mean, we're -- this is the PSA, right? We're -- this is a meeting of the PSA. DR. TOBER: I'm not talking about the politics in the PSA. I'm talking about the politics that led to the writing of the letter that was sent to the board by my attorney. DR. PANOZZO: Yeah. I'm going to just remind the chair and the members of this committee, the essential aspect of our position, every one of us, be it medical, paramedical, administrative, or whatever it might be, is not politics. It's patient care and patient care for our community. CHAIRMAN BUXTON: I agree, I agree, and I don't think anybody here has ever said that it's not. The question was asked, referral of what it came from, and that was it. It has nothing to do with PSA is politics. This has got to do with politics. DR. TOBER: That's correct. DR. PANOZZO: That's the point; that's the point. CHAIRMAN BUXTON: Okay. Staff reports? CHIEF KOPKA: Mr. Chairman, just a few points of interest here. First, our MedFlight program did apply for accreditation this past month, which many of you probably have gone through an accreditation process. It's quite a grueling process. Anybody who comes in and looks at all of your procedures and documents, it's a bit nerve - wracking at times, but it's nice to have a fresh outside perspective. We'll know sometime mid April whether that accreditation has been approved or not. As you probably already know, our ambulance services was accredited back in August/September of last year. We are only 152 accredited ambulance companies in the nation. About 13,000 accredited -- or 13,000 EMS providers, and there's only about 152 of those accredited, and there's only about 10 accredited in the state. So we're very -- certainly very proud of that as an organization -- CHAIRMAN BUXTON: You should be, you should be. CHIEF KOPKA: -- and hope that we're able to obtain the MedFlight accreditation as well. We did add two additional seasonal ambulances, as we generally do this time of the year. Our call volume can nearly double at times. So adding those additional resources makes a -- that makes a difference for us. CHAIRMAN BUXTON: If I may ask you a question? CHIEF KOPKA: Yes, sir. CHAIRMAN BUXTON: When you add the two ambulances, are you hiring extra people, are we paying overtime, or are you just moving personnel around to do that? CHIEF KOPKA: It's a combination of overtime and job bank staff. Job bank staff are personnel that provide a schedule of when they can work, and they're utilized accordingly. And then, obviously, overtime staff as well. That's budgeted. It's tough to hire staff for two or three months out of the year, so overtime staff has increased. CHAIRMAN BUXTON: Sounds like a great program. CHIEF KOPKA: The job bank staff is a fantastic program. It's a great farm to get EMTs and paramedics into our program to see that they -- CHAIRMAN BUXTON: Our system. CHIEF KOPKA: -- like our system and we like them. It works out very well. CHAIRMAN BUXTON: Excellent, excellent. CHIEF KOPKA: The last item I have to report on, if you didn't see the board meeting yesterday, are the preemption devices. Direction was given to transportation department to add the preemption devices to all of the intersections in Collier County. Right now about half of them have the preemption device. Our -- is everybody familiar with it before I continue to talk about it? No. The preemption device is a receiver at an intersection which, when emergency vehicles approach that intersection with lights on, it activates the light to becoming a green light, and it turns all other lights red. The newest thing they've added to that device is another light at the intersection, which is a white light, and that's important. That white light let's the responders know that all other lights are red, and it also lets the individuals sitting at the intersection wondering why all lights are red know that there's an emergency vehicle approaching. And very few intersections have that white light. But in the next few years, or whatever time period transportation determines, all the intersections will have the preemption device as well as the white light, so that's important for emergency responders. CHIEF MURPHY: I would just ask if your transportation department could talk to our city. We. installed them in all of our traffic lights, the city did, except for one. And if they could, perhaps, work with them and -- if they're doing a general bid or whatever. But I know your units are impacted, but we installed them for everybody, and we just have one traffic light left, so -- CHIEF KOPKA: Chief, do you know which intersection that was? CHIEF MURPHY: I want to say Kendall Drive, I believe, is the right one. DR. PANOZZO: Chief, I just had a couple comments from some of the things you mentioned. Number one, is it the OptiCon or something similar to the OptiCon? CHIEF KOPKA: Yes, it's OptiCon. DR. PANOZZO: So there's going to be a public, you know, message so that people -- so that the public knows what those -- a lot of people still see it and say, what's that all about? And so is there going to be a public message delivered? CHIEF KOPKA: Yes. I can get with transportation and either have them send one out as to the process, or we can do a combined press release on it. DR. PANOZZO: And then -- yeah, I mean, I would advise that. I've been in systems where -- years ago we used the OptiCon. It was successful, but the public needs to know what's going on. And one of the problems is, people are just smacking the brakes when they see the white light, and -- just kind of letting them know what's going on, because they see everyone braking suddenly. But it's definitely a helpful tool. CHIEF KOPKA: Yes. DR. PANOZZO: Hugely helpful. I've been -- I actually have responded to a number of calls with the fire department, and it's just amazing how we can get through this traffic, especially this time of year. The other is I wanted to congratulate you on the accreditation in both the helicopter and the ground units and also mention the extra ambulances that you have. I can tell you, because I'm online -- and I think Dr. Bethel, being in the ED, knows that we see a lot of those units coming through constantly on a daily basis, and many of them are fatigued, and so that relief for the members in the street, I'm sure, is well taken and well appreciated by them. Good job. CHIEF KOPKA: Thank you. CHAIRMAN BUXTON: Anything else? CHIEF KOPKA: That's it, sir. CHAIRMAN BUXTON: Any other staff? (No response.) CHAIRMAN BUXTON: Public comments? CHIEF KOPKA: Captain, you're up. CAPTAIN ARIGO: Am I public comment? CHIEF KOPKA: Yeah. CHAIRMAN BUXTON: No, no. Well, I mean, I thought the public was the public, and then the captain's on the agenda. I apologize. I just want to make sure that the public doesn't want to say anything. All right, Captain; you're up. CAPTAIN ARIGO: Sorry that this is not set up. What I was going to talk about real quickly is Smart 911, which, when I look around the room, 90 percent of you, 85 percent of you, are familiar with Smart 911. And I just have some brochures just to pass out. And just kind of to remind you what 911 is, Smart 911 is -- if I could take a moment to attach this. It's only a two- minute video, and I think it will give us a good idea what we're talking about. For those of you not familiar with it, Smart 911 is a process that an individual signs up for and puts their personal information in. Just about any kind of information that they would like to put in can go in there, from pictures of your family pets to your medical history, to any family issues that you want to share with emergency responders. The good thing about it is -- or one of the many good things about it is that it's maintained by the individual so they have to track of all the information that goes in there, and they are prompted every six months to update that information. If they do not update the information, then they will not be registered any longer. So, basically, kind of guaranteeing us that when we get out there on the scene we're going to have updated information. It's not going to be old information. It should be released within the last six months. So if we could just play -- I'll just play this real quickly, and then -- oh, the sound might be a problem. DR. TOBER: Put the microphone next to your speaker. (The video was played as follows:) "No one anticipates an emergency. The fact is, over 300 million 911 calls are made annually. And what would happen if you or a family member dialed 911 but couldn't tell them what was wrong or where you were? The truth is, ending up in this situation is easier than you think. Seconds count and pressure is high. You may not be able to think clearly, and if you have a blocked airway from allergies or are having a heart attack, you may not be able to communicate critical information, like your location, your name, or if you have children or pets present who may be in danger. When you reach 911, all they know about you is your number and a general idea of your location. But now there's a service being used by millions across America that can save lives by giving you a secure way to automatically communicate critical information to 911 operators, even if you can't tell them yourself. Smart 911 is a nationwide service that allows you to create a private safety profile that delivers potentially lifesaving information about you or your family directly to emergency responders, including police, ambulance, and fire personnel in the event you dial 911. With a Smart 911 profile, when you place an emergency call, the system instantly transmits the information you specified directly to the dispatcher's screen along with your number. You can share as much or as little information with 911 as you choose. You can even upload pictures of your family for more rapid response in Amber alert situations. Your profile is owned only by you, and you can change or update it at any time. As a nationwide system provided by your community at no cost, all information is held securely in a database vault, and the only time it's ever released is when you call 911, when every second counts. Make sure that when emergency strikes, you're more than just a number on a screen with Smart 911. Peace of mind that someone will be there when you need them most is only a click away. It takes less than five minutes. It's free, private, and secure." (The video concluded.) CAPTAIN ARIGO: Well, that's kind of it. Get that information out. What happens is, in the communications center -- I don't know if you're familiar with exactly what goes on in there, but there are actually six monitors that the dispatcher and call takers monitor and they watch continuously. One of those monitors, when a 911 call comes in and it is a Smart 911 call, will flash and open up and start providing the information to the dispatcher. That information will be immediately available. The dispatch -- or the call taker will be looking at that to see if it's relevant to the call. If it's someone calling in about a parking complaint, naturally, we're not going to be taking that information about people's medical history and dispatching it over the radio. So it is not dissimilar to something that we have, which is a premise information that is on there currently now that we maintain that we could have information for the emergency responders. So the push is to get more people involved. We are only getting about one call a day that is a Smart 911 call. One of the drawbacks about a Smart 911 call is that it has to be made from the phone that's registered. Now, you can register more than one phone, but the call has to come from the phone that is registered. So if you have Smart 911 information and you fall out at Publix and someone calls to help you, that information won't be available. It has to be from your phone and a phone number that is registered to you. And there are agencies nationwide that have Smart 911. So you could be in California, you could be up in Illinois, wherever it might be, and that information would still come into the communications center if they're members of Smart 911. DR. TOBER: Captain Arigo, if somebody calls 911 from their cell -phone because they're trying to rescue somebody and they identify the patient's name, can you cross - reference the Smart 11 (sic) -- or Smart 911, or is that information locked out because it wasn't their telephone? CAPTAIN ARIGO: No, it's locked out. It's only accessed and made available from their telephone. So there's a lot of security. It can't be searched by law enforcement. No one can use it for any other purpose other than when you call from your phone. DR. TOBER: So, really, from a public- education standpoint, well- intentioned people trying to help someone should call 911 from that patient's cell phone? CAPTAIN ARIGO: If they can. DR. TOBER: If they can. CAPTAIN ARIGO: Yes, that would be ideal. Because that would make the information come up. DR. TOBER: Right. CHIEF KOPKA: Mr. Chairman? CHAIRMAN BUXTON: Yes. CHIEF KOPKA: Captain, is Smart 911 activated if they call the 252 -9300 number? CAPTAIN ARIGO: No, only when they dial 911. CHIEF KOPKA: Okay. All right. Is that information on Smart 911 just at the in- taker's screen, or does that go to Control North and Control South as well? CAPTAIN ARIGO: What we do is we send the code to Control North and Control South, and the dispatcher at that location can access the information also. CHIEF KOPKA: Okay. Will that -- if time allows, will that information be provided to the responders as an update, again, depending on call volume and many other factors -- but if Control North and South has that, can that be provided to the responders if it's relevant to the call? CAPTAIN ARIGO: Yes, yes. And hopefully the in -take personnel who are looking at it will -- once they usually finish the emergency part of the call, usually our responders will not be there yet, they can look in -- put that information into the call and get a verbal update as well. Additionally, we're pushing that number out to the units who have MDTs so that they can go to the Internet and pull the information up themselves. And that will also provide them with a picture. If they pull it up on the Internet, they can actually see any of the pictures that are in there if they're identifying who the person is when they get there. CHIEF KOPKA: It is a great program. If you haven't registered, you should. My mother, who's 79 years old, did it. And if she can do it, anybody can do it. CAPTAIN ARIGO: Yeah, it's pretty simple. You just follow the steps and go right through it. CHAIRMAN BUXTON: Any more questions for the captain? MR. ALLEN: Yes. Captain, are there multiple -- you said you could have multiple telephone numbers for one profile, but are there multiple profiles for one telephone number? CAPTAIN ARIGO: Yes. MR. ALLEN: So if I called when my wife was having a problem, they could pull up her profile? CAPTAIN ARIGO: Yes. You can put any member of your family's profile in there as well. And you can put pictures. In fact, we just pulled up one the other day. One of the young ladies had her dad -- she lives with her dad -- had her dad's picture, and all his information came up as well as her information. CHIEF MURPHY: The other question we had -- did have, and I don't remember the answer, is could you share that -- if the hospital, the receiving hospital gets that patient, can you send them a link that they're able to access that? And that was the piece of information you were going to try to find out an answer to maybe, or can -- CAPTAIN ARIGO: We don't have access to ship it to the hospital, because it would be going kind of like via our system. So if an ambulance arrived at the hospital and they had the link and they had a computer, they could open it up and give it to the hospital, but they would not -- if the hospital logged on and took that link number and put it in, then they would be able to look at the information. CHIEF MURPHY: And I guess -- I don't want to say they have an MDT assigned to the ER, but if they had a specific computer that it could be sent to, or an MDT assigned to the ER that it was sent to, could they use it? CAPTAIN ARIGO: We don't even have MDTs in all the units yet. DR. PANOZZO: Does that information go into the CAD? Is that where it goes? No, it doesn't. CAPTAIN ARIGO: No. CHIEF KOPKA: I think what we're trying to get at is how long is that information available for? CAPTAIN ARIGO: Forty -five minutes. CHIEF KOPKA: After the call is closed out or from the time the call started? CAPTAIN ARIGO: From the time the call comes in, it's available for 45 minutes. CHIEF KOPKA: Could the hospitals be given a user name and password? The 45 minutes isn't a lot of time, especially by the time they transport from Marco or Immokalee, that time will have expired. But either if that time can be extended and/or -- CAPTAIN ARIGO: The problem would be that it's for emergency medical response personnel. There's a lot of other information on there that the average person might not want to share with people in the hospital that they would have access to. I mean, there's a different -- there's a different level of security for fire, EMS, and law enforcement personnel. And there's information in there regarding -- people can put in there how many weapons they have in the house, where their child -- what room their child sleeps in, anything, anything, if they've been a victim of domestic violence in the past, who the domestic violence subject is, they've been the victim of sexual assault in the past, whatever they want to put in there, and that information would -- I'm not sure all that information would be appropriate for the hospital or people at the hospital to see. CHAIRMAN BUXTON: Doctor? DR. TOBER: Todd put his hand up first, and then I'll ask. CHAIRMAN BUXTON: Oh, I'm sorry. DR. BETHEL: I guess my question would be, it's the 911 dispatcher that purviews that information and decides this is relevant to the call, provides that information to other agencies there, for example, a paramedic. Would it be reasonable for that paramedic to then just pass along that information to the hospital at the time the patient arrives? I mean, especially if it's something like this person has a peanut allergy, this person has a history of -- you know, something that would be relevant. I don't know that we need a separate computer to log onto and look that up. It seems like something that we could still transfer from, you know, EMS to, you know, ER pretty readily just verbally. DR. TOBER: That's exactly what I was going to say, so I totally agree with you. Paramedic's going to glean what information is relevant for that call and transmit that probably verbally to the ER. CHAIRMAN BUXTON: Any other questions for the captain? Yes, George. MR. DANZ: Mr. Chairman, I've got a question. If Jim falls down in the street and I call in and I've got a do- not - resuscitate on my Smart 911, how is this distinguished to make sure that they don't apply my do- not - resuscitate to Jim? CHAIRMAN BUXTON: Jim needs to find new friends. DR. TOBER: You're going to clarify that when you call in that it's not you who is the patient. You're calling in for a -- you're a bystander watching somebody else fall. MR. GIBSON: But doesn't that document need to be present anyway, physically, for us to not provide care? So it's kind of a moot point. MR. DANZ: Yeah, but I'm talking about any type of medical condition. I mean, it could be any other medical condition. CHAIRMAN BUXTON: Anything else you want to share with us, Captain? CAPTAIN ARIGO: I do have a question about preempting and the lights. We talked about emergency vehicles, but we -- I am assuming we are still excluding law enforcement vehicles? The only emergency vehicles that preempt the lights now are fire and EMS. CHIEF KOPKA: I speak for EMS. I think EMS, all ambulances have them, yes. I can't speak for fire, and I can't speak for the Sheriffs Office. DR. TOBER: Captain, so the police vehicles do not -- CAPTAIN ARIGO: Preempt the lights, no. DR. TOBER: -- preempt? Even if you're in hot pursuit, you've got to just lead the way through? CAPTAIN ARIGO: And I'm not sure where that decision comes from. It doesn't come from the Sheriffs Office. CHIEF MURPHY: I will -- I believe Marco Island PD units do have preemption devices on their units, just for your information. You might check with Captain Baird (phonetic). And so far they haven't hit any of our fire trucks or other vehicles, knock on wood. CAPTAIN ARIGO: Law enforcement, I know that their philosophy has been in the past that there are too many law enforcement emergency responses so that the lights in the county would be out of whack all the time. CHIEF KOPKA: And it does, it does throw that off cycle. CAPTAIN ARIGO: Yeah. It takes -- and I'm not sure, but -- and like, 15 minutes or so to get -- there's a time period to get back on cycle. Maybe it might be 5 minutes. CHAIRMAN BUXTON: Thank you, Captain. We appreciate it. CAPTAIN ARIGO: All right. Thank you. CHAIRMAN BUXTON: Board member discussion? (No response.) CHAIRMAN BUXTON: We're a chatty group today. Next meeting date -- DR. BETHEL: Sir? CHAIRMAN BUXTON: Sorry, sir. DR. BETHEL: Just I have a question. Back when you were talking about new businesses and you wanted to discuss the goals of the PSA. CHAIRMAN BUXTON: Yes. DR. BETHEL: We kind of bring that topic up. What is a good way to get that information? Like, if we have some ideas or we're not at the meeting, we email them to Maria? CHAIRMAN BUXTON: Yes. DR. BETHEL: Will she send that to everybody? Is that -- CHAIRMAN BUXTON: I believe she can do that, yes. Am I correct, Maria, you can do that? MS. FRANCO: (Nods head.) CHAIRMAN BUXTON: Okay. As of now, the next meeting date is May 15, 2013. DR. PANOZZO: Where's it going to -- we're meeting here? CHAIRMAN BUXTON: Yeah, here, please. Thank you all. Have a great day. MR. GIBSON: Motion to adjourn. CHAIRMAN BUXTON: Motion to adjourn. Is there one? CHIEF KOPKA: Second. CHAIRMAN BUXTON: Second? All in favor? Aye. CHIEF MURPHY: Aye. MR. LUPTON Aye. DR. PANOZZO: Aye. DR. BETHEL: Aye. MR. GIBSON: Aye. DR. TOBER: Aye. MR. ALLEN: Aye. CHIEF KOPKA: Aye. MR. MENNINI: Aye. MR. DUTCHER: Aye. CAPTAIN MONTAGANO: Aye. There being no further business for the good of the County, the meeting was adjourned by order of the Chair at 11:02 a.m. PUBLIC SAFETY AIT,°IOITY REG A. BUXTON; CHAIRMAN ATTEST DWIGHT E. BROCK, CLERK These mi tes approved by the Board on 1 0 as presented as corrected TRANSCRIPT PREPARED ON BEHALF OF GREGORY COURT REPORTING SERVICE, INC., BY TERRI LEWIS, COURT REPORTER AND NOTARY PUBLIC. or