Productivity Committee EMSAC Subcommittee Minutes 08/28/2008 EMERGENCY MEDICAL SERVICES ADVISORY COUNCIL (EMSAC)
SUB-COMMITTEE AND PRODUCTIVITY COMMITTEE SUB-COMMITTEE
Friday August 28,2008
COLLIER COUNTY EMS HEADQUARTERS
2705 South Horseshoe Drive,Naples, Fl 34104
9:30 A.M.
EMSAC District 1—Victoria DiNardo, Present
EMSAC District 4—Nancy Lascheid, Present
Productivity Committee—Janet Vasey, Chairman, Present
Productivity Committee—Steve Harrison, Present
Productivity Committee—Joe Swaja, Present
Productivity Committee—Gina Downs, Present
Staff Present:
Jeff Page, Chief
Dan Bowman, Deputy Chief
Artie Bay, Operations Analyst
Dave Stedman, Database Administrator
Jennifer Florin,Administrative Assistant
Audience Present:
No audience present
Meeting was called to order by Chairman Janet Vasey.
Motion to adopt to agenda; passed unanimously
Motion to adopt minutes from July 31-d; passed unanimously
Janet asked that one change be made to the August 8th minutes. On the second paragraph
of the 5th page she asked that it be clarified the "fire consolidation study". Motion to
adopt minutes with the addition;passed unanimously.
Wrap-Up Master Plan Issues
Janet asked if anyone had anything additional to add before we got into the draft final
report. Chief Page stated that Dr. Tober read the draft report and subsequently had a
phone conversation with Janet on it. He has also asked that we provide the group with
some data on the ALS engine program and the training requirements. Chief Page stated
that one of the reasons this is coming up now is that just recently we held a testing for the
City of Naples paramedics. This test was specifically geared to test their knowledge and
make sure they were at least on an intermediate level in regards to their training. The
reason the City was chosen was because none of their medics have sat before Dr. Tober
for certification. Chief Page stated that this test was both written and practical. Only 2 of
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their 14 medics passed the test. This means that they cannot man their own ALS engine
and have had to down it. We do however have an ALS engine in the city that we man,
but the other is staffed with their medics. He stated that we have been working with the
City for the last few weeks to get that engine back up because per the agreement they are
required to have two ALS engines up 24 hours a day. He stated that we have offered to
do an additional swap and put our personnel on the truck; and we have asked Chief
Murphy of the City of Marco if he would be willing to allow one of his guys to work in
the City of Naples to help them; and neither one has happened yet. The City of Naples is
very busy at the moment with contract negotiations, so this is being made secondary.
The other component to this is per the agreements the fire department medics that work
the ALS engines have agreed to do a certain amount of training to keep up their ability to
work under Dr. Tober's license. One of the things they agreed to is to attend 75% of the
in-service training provided by Dr. Tober. County medics have to attend 100%. Chief
Page stated that they are not complying with that. In some instances there are medics that
have attended zero meetings. The other component is an online course. It usually takes
about an hour and there is some material to read and a test at the end. They are also not
up to date with those. The issue and the reason this is all being brought up is that the
draft report suggests that we rely heavily on the ALS engines, and he wants the group to
know that we can't always do that. And specifically that two ALS engines do not equal a
transport unit.
The packets that are being handed out have a cover page that explains all the material
behind it in the backup. It reviews not only the training, but the types of procedures they
are doing also. Chief Page added that quite often they are just giving oxygen. Rarely do
they start an IV, and almost never are drugs administered. They don't get the opportunity
because there are not that many occurrences where they would need them, and even those
few instances, we are not that far behind.
Nancy asked who has the governance on the non-compliance. Chief Page stated that
ultimately it is Dr. Tober's decision. Dr. Tober did deal with the issue at the City of
Naples by telling them that they are not allowed to man that one ALS engine until they
are up to speed with the training. Chief Page stated that this agreement was agreed upon
by the Cities councils, the independent fire district councils and the BCC. He stated that
he wants to give them every opportunity to comply. Nancy asked about the time frame
of them being out of compliance. Chief Page stated it has been two years since these
agreements have been complete. Everyone was in agreement that the liability they are
facing is huge, and they are appalled at these results. Chief Page stated that Dr. Tober did
have to work today, but he is available by phone if anyone wants to speak with him.
Gina asked if Chief Page knew why they were reluctant to do the training. Chief Page
stated that he really didn't know. Steve thought that maybe it wasn't paid time. Janet
stated that what really bothered her was the one hour test that they aren't doing. She felt
that it shouldn't be that hard to find one hour while on duty to take a test. Steve asked
Chief Page if we make employment contingent upon taking the training. Chief Page
stated that we will pull people off the road if they don't attend in-services and/or if they
don't keep up with the online tests (Healthstream). Vicky asked if this information and
requirements was built into their contract. Chief Page stated yes, it was. Deputy Chief
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Dan Bowman asked if he could give a little background into the contract. Dan gave a
description of the timeline of meetings and who was involved with creating the training
matrix. He also stated that some departments are showing an effort and trying to attend
meetings and do their online classes, but others are not. He also stated that there is only
one paramedic that works for the fire districts in the county that is 100% compliant, and
he works on Marco Island.
Dan stated that he wanted to review at least the cover page with the group. He started by
saying that this is a preliminary report for training and operations; while its main focus is
training. The cover page has each district listed and their training status of compliance or
non-compliance. He stated that the reason this is labeled preliminary is because he has
given this information to all four of the districts on August 11th to allow them the
opportunity to respond. He stated that he has heard from some of them stating that they
feel the data is incorrect; however they haven't submitted anything additional to add.
Dan added that he didn't see how they were going to make up the in-services that have
been missed. The online classes you can go back and complete if you missed them, but
some of these people haven't attended an in-service training in two years.
Steve asked about the districts mileage rate, and whether they get some portion for being
ALS. He stated that if they aren't in compliance they shouldn't get that. Janet stated that
she thinks they individuals receive a pay incentive for having the initial education to
become a paramedic. Nancy stated that according to this report, that's not acceptable.
Janet agreed and stated that we can't control the fire commissions however this would
make for a good argument as to why are they receiving this incentive if they aren't
keeping up with the training. Chief Page stated that he asked that same question to Chief
McEvoy of the City of Naples Fire. He asked him why he didn't take away the incentive
if they can't pass the tests. His response was that it is in the contract that if they have a
state paramedic license, they get the incentive.
Nancy asked what Dr. Tober wanted the group to do. In other words, how can they help?
Dan stated that he has been running these reports for Dr. Tober because this matrix has a
sunset of October 2008. It was agreed that at that time the Matrix was initially approved,
everyone would get back together and look at the matrix and decide what has worked,
what hasn't worked, and rewrite it if necessary. Chief Page stated that basically Dr.
Tober has asked us to bring all this information to you because he feels it is important
based on the conversation he had with Janet. Janet wanted to describe their conversation
a little. She stated that after Dr. Tober saw the draft report and called her. His main
concern was that the ALS engines and the EMS units were not interchangeable. One of
his other concerns was that the fire departments are really there for fire. And when
there's a fire they all go to that fire, and in turn it creates a ripple effect in the response
times. He was also concerned that they don't get the amount of experience required
because there aren't that many incidents. Janet stated that she feels the reason the fire
departments are in the medical field is because there aren't any fires for them to fight.
She also stated that overall she feels they are over equipped. She added that she has
always thought there should be a way to count them toward meeting the demand, but now
she is thinking otherwise. Dave stated that the risk you run when counting them is not
just the compliance issue, but what if say North Naples decides to pull out of the program
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all together. We would then be in such a deficit in that area that it would take a very long
time to get back up to speed.
Chief Page stated that another risk that we run by counting on them so heavily is that if a
fire department does decide to get out of the program, and we have moved all of our
resources away from that area, they could then go back to their citizens and say that EMS
doesn't have the resources needed and that the fire district now needs to provide their
own transport. He stated that he feels they are looking for a fire-based EMS service and
that this happens all the time around the country. He also added that if we could
consolidate all this would go away, because there would be one person responsible.
Gina stated that she would like to take this report to Jorge Aguilera and Chief Brown
from North Naples Fire and ask them to explain it. She stated that she would want to get
their side of it.
Chief Page stated that there have been some other instances of concern with the fire
departments. For example, recently North Naples was providing an EMT in the swap
program that wasn't licensed with the State of Florida. He had his national registry
paperwork, but never got his state of Florida license. He added that we had to self report
to the state, and the fire department was upset because they thought it could be handled
in-house. However, state statute requires that we have to report violations like these.
Steve asked Janet where the final report would go next. Janet stated that once we are
finished with it, it would back to each council to approve and then to the County
Commission. Steve added that maybe we should add some language to the report to
make it conditional of their compliance. He felt that it needed to be recognized that it's
not as simple as counting them into the calculations. Joe stated that wouldn't include
them at all, and boldly state that we cannot include them because we have no confidence
they are equivalent to an EMS unit personnel. He added that they can still be there, but
we cannot count them against response time or for planning purposes. Chief Page stated
that he thinks they are valuable, and we need to count them in the response times, or we
will be behind again. Janet added that she thinks Joe meant to not include them in the
population figure.
Janet stated that she had some changes to the report that she would like to go over. She
added that as a group they can decide if they want to disclose any of the information they
just learned. She stated that what she had prepared was a change in general terms so that
it didn't get into specifics. Janet reviewed her changes with the group. They included
spelling changes, and a few minor wording changes. Gina asked if page 5 would be the
appropriate place to start adding some provisions to their certifications. Chief Page stated
that certification to the fire districts means just having the state license, and not the
additional training that is required by the medical director. There was also some
discussion about taking this packet to the commissioners. Joe stated that this should be
brought to their attention because they should never be blind sighted. Steve suggested
saying that there is difficulty including fully the ALS engines because of the limited
experience they are exposed to as well as the lack of continuing education training.
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Gina stated that she is a little worried that we received this report at the last minute, and
the group is thinking of changing everything without getting the other side of the story.
Chief Page stated that he isn't asking the group to change any decision. Gina added that
she wants to change it, just with some additional facts first. The other worry from the
group is how this all relates to the Master Plan. Janet stated that the change in wording
recognizes the ALS engines as a safety net and allows us to count their response times.
She feels the decision is whether the group wants to raise the flag on some of the
problems that exist today. She stated that she also agreed with Gina and we should get
the other side of this before we put something in writing. Nancy stated that she feels we
shouldn't procrastinate on this. She asked if everyone could make a meeting next week.
Janet stated that she didn't have a problem meeting next week as long as everyone would
have the time to do research. She also added that this can't go any faster than the end of
next month because it would have to go before both full committees. Chief Page stated
that this group is the first to see this report. He will be giving it to Mr. Summers as soon
as the meeting is over, and he expects that Mr. Summers will be giving it to Jim Mudd.
Dan stated that this is just one report that he is doing for Dr. Tober. There are others
including a quality assurance report,patient care reporting, and also an operational report.
Joe asked if they would get to see those reports. Dan stated that they could see anything
they wanted. The quality assurance report for example will be a report on the process,
and not the actual run reports. Steve stated that in his private industry they have what
they call peer reviews, and he asked if we had anything similar. Chief Page stated that
the QA reviews are like that, however state statute protects such reports from the public.
Joe stated that he feels that until the ALS engines are in compliance and considered equal
to EMS units, they shouldn't be counted in response times. Janet stated that she
disagreed, but Joe wanted to explain. He stated that in a private business they were
having a problem with response and customer satisfaction, so they hired a bunch of
people who could get to the customer quickly; however they weren't equipped or
qualified as the other crews that came next. He stated that his customer satisfaction level
suffered greatly because of it. He feels that if they aren't the same, they shouldn't be
counted as such. Janet stated that the reason she feels they should be counted is because
of the 1710 document that looks for basic support to arrive in 4 minutes. She stated that
they are arriving and providing at least basic support, so they should be counted for that.
What is in question here is the ALS capability. Chief Page clarified by stating that the
document allows for an 8 minute ALS response only if you have a first responder with
and AED there in 4 minutes. If we weren't to count them, then we would have to be
there in 4 minutes. Vicky stated that our exposure and liability is high because what if
someone from the fire department was to treat someone and there then be an
investigation; only to find that that person wasn't qualified. Chief Page stated that as part
of the states investigation on the North Naples issue we may be required to refund all of
those 43 transports where that non-licensed individual was present, and also notify the
patients that they didn't receive the appropriate level of response.
Janet stated that she didn't have any more changes, but she wanted to bring everyone
attention to the last page of the report. She stated that the last section of the report was
the recommendation that has already been to the commissioners, but she added an
addendum to this report to specify which units it will most likely be downed. She stated
that it's important to add that in because in October the turn back money is allocated, and
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if the commissioners have a problem with these two units, they need to know before that
happens.
It was the consensus of the group that we ask Dr. Tober to attend the next meeting. Since
Dr. Tober was available on Wednesday afternoon, and that was ok with everyone else
(with the exception of Steve), it was decided that we would have the meeting at 1:00pm.
Janet told Steve that if had specific questions to ask Dr. Tober that we could do that for
him. He stated that the only question would be how hard or how soft to address this. He
stated that he agrees with Joe in that they should be taken out of the equation all together,
and that would put the most heat on them to correct it. Janet stated that she felt the heat
will come when it gets out how badly they have managed the program, and haven't kept
up their end of the deal.
Gina asked Chief Page he is feeling differently, and didn't want this to get out to the
commissioners. He responded by saying that he will immediately be giving this to Dan
Summers, and he expects that the County Manager will have it within a few hours after
that. He stated that he would really like for Dr. Tober to be able to sit down with the
commissioners either individually or in a workshop setting to explain all of this.
Sometimes it's hard to get your point across when you hand them all this paper, because
they just have so much going on all the time.
Dan stated that he feels that once this gets to them, there will be opportunities created to
remedy this. However the point is that there has been apathy for two years now. Dave
stated that even if they were to fix everything tomorrow, this is still a good illustration of
why we can't include them completely.
Vicky stated that she is in East Naples's district, and she may be able to at least touch
base with them on these issues.
It was agreed that Gina, Joe and Vicky would try to reach their respective districts before
Wednesday.
Meeting adjourned.
Respectfully Submitted,
Jennifer Florin
Date Adopted: � �/o F
Chaff / SubCommittee Membc Signature