Agenda 01/13/2015 Item #16K 2 1/13/2015 16.K.2.
EXECUTIVE SUMMARY
Recommendation to authorize the County Attorney's Office to file a Petitio for Administrative
Hearing in response to the Florida Department of Health's Administrative omplaint captioned
Department of Health v. Collier County EMS, Case No. 2013-13123 regarding an EMS call from
December 2012.
OBJECTIVE: To file a Petition for Administrative Hearing seeking a hearing with an
Administrative Law Judge.
CONSIDERATIONS: Collier County EMS received an Administrative Complaint from the
Florida Department of Health on or about December 4, 2014. The Complaint stems from a
medical transport incident involving an alleged delay in response time in December 2012. This
matter had come to the Board's attention through public petitions by the Minard family and by a
follow-up staff report to the Board on October 8, 2013 (Item 11C), a copy of which is included
as back-up material'. EMS denies and disputes the allegations in the Complaint and requests
authorization to file a Petition for Administrative Hearing requesting a hearing before an
Administrative Law Judge. Pursuant to Sections 401.411(1) and (7), Fla. Stat., the
Administrative Complaint seeks both a reprimand and fines in the amount of$1,000 per day.
Based on the date of the alleged violation, should the State prevail the County's monetary
exposure could exceed$700,000.
The Complaint alleges that EMS is in violation of Section 401.411(1)(g), Fla. Stat., in that on
December 14, 2012, CCEMS negligently failed to respond to an initial set of EMS alert tones
and that the failure to respond to the initial tones caused a six (6)minute delay in EMS departing
the station in response. The Complaint further alleges that EMS is in violation of Section
401.411(1)(1), Fla. Stat., for failing to report the alleged violation. Collier County EMS denies
any liability or violation of Florida law.
FISCAL IMPACT: Uncertain at this time.
GROWTH MANAGEMENT IMPACT: No Growth Management Impact.
LEGAL CONSIDERATIONS: This item has been reviewed by the County Attorney, is
approved as to form and legality,and requires majority vote for approval. —JAK
RECOMMENDATION: Recommendation to authorize the County Attorney's Office to file a
Petition for Administrative Hearing in response to the Florida Department of Health's
Administrative Complaint captioned Department of Health v. Collier County EMS, Case No.
2013-13123 regarding an EMS call from December 2012.
Prepared by: Walter Kopka,Chief,Collier County EMS
Jeffrey A.Klatzkow,County Attorney
Attachments: Administrative Complaint, Board Agenda Back-Up (October 8, 2013 (11C)), Section
401.411,Fla. Stat.
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COLLIER COUNTY
Board of County Commissioners
Item Number: 16.16.K.16.K.2.
Item Summary: Recommendation to authorize the County Attorney's Office to file a
Petition for Administrative Hearing in response to the Florida Department of Health's
Administrative Complaint captioned Department of Health v. Collier County EMS, Case No.
2013-13123 regarding an EMS call from December 2012.
Meeting Date: 1/13/2015
Prepared By
Name: CrotteauKathynell
Title: Legal Secretary, CAO Office Administration
1/6/2015 1:18:51 PM
Approved By
Name: KopkaWalter
Title: Chief-Emergency Medical Services, EMS Operations
Date: 1/6/2015 3:08:46 PM
Name: GreeneColleen
Title: Assistant County Attorney, CAO General Services
Date: 1/6/2015 3:18:00 PM
Name: IsacksonMark
Title: Director-Corp Financial and Mngmt Svs, Office of Management&Budget
Date: 1/6/2015 3:28:55 PM
Name: KlatzkowJeff
Title: County Attorney,
Date: 1/6/2015 3:33:31 PM
Name: OchsLeo
Title: County Manager, County Managers Office
Date: 1/7/2015 8:46:48 AM
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Kt(±1VED
DEC 042014
EMS Dept.
STATE OF FLORIDA
DEPARTMENT OF HEALTH
BUREAU-OF-EMERGENCY-MEDICAL—OVERSIGHT
DEPARTMENT OF HEALTH, r
rn
Petitioner, m
rn �
. i N.)
v Case No. 2013-13123
COLLIER COUNTY EMS, c; °z
! c.'t
.% -
Respondent.
ADMINISTRATIVE COMPLAINT
The Department of Health("Petitioner"or"Department"), by and through its
undersigned attorney, files an Administrative Complaint against Collier County EMS
("Respondent"or"CCEMS")and states:
NATURE OF ACTION r1
1. Pursuant to § 401.411(7),Fla_ Stat. (20I3),this is an action to reprimand
Respondent's Advance Life Support("ALS")license and impose administrative fines up to
$1,000.00 per day per count as provided by law.
JURISDICTION AND VENUE
2. The Petitioner has jurisdiction pursuant to Chapter 120,Fla. Stat. (2013)and Fla.
Admin. Code R. 28.106.
3. Venue lies pursuant to Fla. Admin. Code R. 28-106.207.
PARTIES
4. Petitioner is a state agency established in § 20.43,Fla. Stat. (2013),and is charged
with regulating emergency medical services pursuant to Chapter 401, Fla. Stat. (2013).
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5. At all times material hereto, Respondent has been licensed as an ALS service
provider, license number ALS 1102.
6. Respondent's address of record is 8075 Lely Cultural Parkway, Suite 267,Naples,
Florida 34113.
COUNT I
RESPONDENT VIOLATED §401.411(1)(g),FLA. STAT. (2013),
BY ENGAGING IN UNPROFESSIONAL CONDUCT
7. Petitioner re-alleges and incorporates paragraphs 1 through 6 as if fully set forth
herein.
8. On December 14,2012, CCEMS negligently failed to respond to an initial set of EMS
alert tones sent by Dispatch in response to a 911 call/heart attack patient.
9. As a result of the failure to respond, a second set of emergency tones was sent to
i-- CCEMS four(4)minutes later.
10. The failure to respond resulted in a six(6)minute delay in CCEMS departing the
station in response to the 911 call/heart attack patient.
11. Pursuant to §401.411(1)(g), Fla. Stat. (2013),the Petitioner may impose an
administrative fine,not to exceed$1,000.00 per violation and each day constitutes a separate
violation and is subject to a separate fine.
COUNT II
RESPONDENT VIOLATED§401.411(1)(1), FLA. STAT. (2013),
BY FAILING TO REPORT ANY PERSON AS BEING IN VIOLATION
OF CHAPTER 401,PART III,FLA.STAT.
12. Petitioner re-alleges and incorporates paragraphs 1 through 11 as if fully set forth
herein.
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13. CCEMS has failed to notify the Department of its violation of§ 401.411(1)(g),Fla.
Stat.(2013).
14. Pursuant to § 401.411(1)(g),Fla. Stat. (2013), the Petitioner may impose an
administrative fine,not to exceed$1,000.00 per violation and each day constitutes a separate
violation and is subject to a separate fine.
CONCLUSIONS OF LAW
15. Respondent violated §401.411(1)(g),Fla. Stat. (2013)by negligently failing to
respond to EMS alert tones on December 14,2012, thereby experiencing a six (6)minute delay
in leaving the station in response to a 911 call/heart attack patient.
16. Respondent violated § 401.411(1)(0, Fla. Stat. (2013)by failing to notify the
Department of its violation of§401.411(1)(g),Fla. Stat. (2013).
17. Pursuant to § 401.411(1)(a),Fla. Stat. (2013), a licensee may be disciplined for
violation of§§401.411(1)(g) and(1),Fla. Stat.(2013).
18. The classifications of EMS licensure held by Respondent are subject to any final
order which issues in this case, as provided by § 401.411(2),Fla. Stat. (2013).
CLAIM FOR RELIEF
WHEREFORE,Petitioner respectfully requests that the following sanctions be imposed
against Respondent:
a. Make factual and legal findings in favor of Petitioner on Counts I and II.
b. Pursuant to § 401.411(1),Fla. Stat. (2013),reprimand Respondent's ALS license.
c. Pursuant to § 401.411(7),Fla. Stat. (2013), administrative fine Respondent for each
day Respondent is in violation of§§401.411(1)(g)and(l), Fla. Stat. (2013).
Dated this A. day of December,2014.
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Respectfully submitted,
/ 0
Caryl Kili i
Chief Legal Counsel
Fla. Bar No. 0480649
Florida Department of Health
Office of General Counsel
4052 Bald Cypress Way,Bin A-02
Tallahassee,FL 32399-1703
Telephone: 850/245-2005
Fax: 850/413-8743
Email: caryl.kilinski@flhealth.gov
CERTIFICATE OF SERVICE
I HEREBY CERTIFY that a true and correct copy of the foregoing has been furnished by
U.S. certified mail to Collier County EMS, 8075 Lely Cultural Parkway, Suite 267,Naples,
Florida 34113, on this day of December, 2014.
`
Caryl /nski
NOTICE OF RIGHTS
Respondent has the right to request or petition for an administrative hearing to be
conducted in accordance with §§ 120.569 and 120.57, Fla. Stat. (2012). Respondent has the
right to be represented by counsel or other qualified representative. Administrative
hearings are governed by Fla. Admin. Code R. 28-106. A request or petition for an
administrative hearing must be in writing and must be received by the agency clerk within
twenty-one (21) days from the day you received this Administrative Complaint. A request
or petition for a hearing must be in conformance with Fla. Admin. Code Chapter 28-
106.2015(5) and must be sent to the Agency Clerk at the following address:
Agency Clerk
Department of Health
4052 Bald Cypress Way,Bin #A-02
4
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Tallahassee FL 32399-1703.
Mediation is not available as an alternative remedy.
•
Your failure to submit a petition for hearing within 21 days from receipt of this
Administrative Complaint will constitute a waiver of your right to a hearing, and this
complaint will thereby become a final order of the department.
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Emergency Medical Services
Information
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Co er County
Office of the County Manager
MEMO
Date: May 14, 2013
To: Board of County Commissioners
From: Leo E. Ochs, Jr., County Manager
Subject: Internal Investigation
As per your direction given at the May 14, 2013 Board of County Commissioners
meeting, attached please find the March 12, 2013 memorandum from Chief
Walter Kopka regarding the Internal Investigation of events that occurred on ^�
December 14, 2012.
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PREPARED IN ANTICIPATION OF LITIGATION, REFLECTS THE MENTAL IMPRESSIONS, LITIGATION STRATEGIES AND
LEGAL THEORIES OF THE UNDERSIGNED ATTORNEY AND IS EXEMPT FROM PUBLIC RECORDS
DISCLOSURE PURSUANT TO § 119.071(1)(d), FLA. STAT. THIS MESSAGE IS INTENDED FOR THE RECIPIENT ONLY. IF
YOU RECEIVED THIS COMMUNICATION IN ERROR, PLEASE NOTIFY THE SENDER IMMEDIATELY. USE OR
DISSEMINATION BY ANY PERSON OTHER THAN THE INTENDED RECIPIENT IS STRICTLY PROHIBITED.
INTERNAL MEMORANDUM
TO: Leo Ochs, County Manager
FROM: Walter Kopka, Chief
THRU: Len Price,Administrator
Dan Summers, Director
DATE: March 12, 2013
RE: Internal Investigation
Situation: On December 14th 2012 at 11:04 am Medic 42 and Engine 72 were dispatched to 5120 Coral Wood
Drive. Medic 42 did not receive initial notification and there was a four minute delay in EMS responding to the
call. When contacted a second time by Dispatch,the EMS crew advised that they did not receive the tones.
Further,the crew documented on the incident report that"the station received no tones and the tablet received
no information". Details of the event and corrective actions taken follow.
Excerpt from Recording Provided by CCSO (Time Stamped)
11:04:45
Tones sounded, Medic 42 and Engine 72 dispatched to 5120 Coral Wood Dr
11:05:47
Engine 71 responds in place of Engine 72, Engine 72 in service
11:08:44
Dispatch checks the status of Medic 42; Medic 42 advises they received no tones; Second set of tones sent
11:09:59
Medic 42 responds from the station
11:11:59
Engine 71 arrives on scene
11:15:51
Medic 42 arrives on scene
11:17:53
Medic 42 makes contact with patient
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PREPARED IN ANTICIPATION OF LITIGATION, REFLECTS THE MENTAL IMPRESSIONS, LITIGATION STRATEGIES AND
LEGAL THEORIES OF THE UNDERSIGNED ATTORNEY AND IS EXEMPT FROM PUBLIC RECORDS
DISCLOSURE PURSUANT TO § 119.071(1)(d),FLA. STAT. THIS MESSAGE IS INTENDED FOR THE RECIPIENT ONLY. IF
YOU RECEIVED THIS COMMUNICATION IN ERROR, PLEASE NOTIFY THE SENDER IMMEDIATELY. USE OR
DISSEMINATION BY ANY PERSON OTHER THAN THE INTENDED RECIPIENT IS STRICTLY PROHIBITED.
11:33:10
Medic 42 leaves for Physicians Regional Pine Ridge hospital with two firefighters on board
11:37:55
Medic 42 arrives at Physicians Regional Pine Ridge hospital
Background Information on EMS Notification Systems
EMS has multiple notification devices to receive information from Collier County Sheriffs Office (CCSO)
Communications Center:
• VHF Pager system (tones)—this system is generated by the CCSO Computer Aided Dispatch sending the
activation for the specific requested apparatus via a transmitter to the specific designated pager frequency.
The page is a six(6)second tone.Any interruption of that six(6)second tone will drop the page and the
pager will not activate.
o This consists of a mounted pager,speakers and antennae in each EMS station.
o Each crew carries a portable pager.
o This is a one way device-it only receives information.
• Tablet-this is a handheld device that receives a text message via the CCSO Computer Aided Dispatch.The
text message uses a program to convert the message to a map as well as provides the dispatch information.
o The tablet is a cellular receiving device.As with any cellular device reception is dependent upon all
factors that affect cellular service including(but not limited to) location,tower, carrier and
obstructions.
o This is a one way device-it only receives information.
• Portable Radio—800mHz
o Each crew member has a portable radio which is a two way device which receives audio information
as well as transmits audio information to dispatch and/other apparatus.
o As with a cellular device the reception is dependent upon all factors that affect cellular service
including (but not limited to) location,towers and obstructions.
Possible EMS Notification Issues
The reason for the lack of notification of the receiving devices cannot be definitively determined.
VHF Pager: Prior to this incident there were documented pager/reception issues and hardware upgrades were
made to the system.There are no systems that log or track incoming pages from the transmitter to the receiving
device.
NOTE: A pager in the standby mode is silent.Once the pager is activated,the pager becomes"live"therefore
ANY radio transmissions are heard through the pager.The pager reset button needs to be pressed to put in back
in the standby/silent mode.
If the pager had activated,the crew would have to reset both the personal pager(carried on person)as well as
the station pager. Each pager is independent and the reset button would need to be pressed on each pager to
reset/silence them. The crew verified that they did not reset the pagers and no radio transmissions were
heard.
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PREPARED IN ANTICIPATION OF LITIGATION, REFLECTS THE MENTAL IMPRESSIONS, LITIGATION STRATEGIES AND
LEGAL THEORIES OF THE UNDERSIGNED ATTORNEY AND IS EXEMPT FROM PUBLIC RECORDS
DISCLOSURE PURSUANT TO § 119.071(1)(d),FLA. STAT. THIS MESSAGE IS INTENDED FOR THE RECIPIENT ONLY. IF
YOU RECEIVED THIS COMMUNICATION IN ERROR, PLEASE NOTIFY THE SENDER IMMEDIATELY. USE OR
DISSEMINATION BY ANY PERSON OTHER THAN THE INTENDED RECIPIENT IS STRICTLY PROHIBITED.
Tablet:It is not known why the tablet did not receive the text message.While we can verify that the text
message was sent by Dispatch, Sprint I shows that the text message was not received.
Portable Radio:There are many factors that could have contributed to the EMS crew not hearing the dispatch
over the radio.
o The radio scans four(4)channels-therefore one of the other scanned channels could have
blocked out the dispatch.
o Station noise-the crew was vacuuming around that time.
o Reception problems with the radios depending upon location and interference.
Deviations from Protocol
There are two deviations from protocol.
1. Collier County Fire Chief Association(CCFCA)—Communication Manual
Initial Radio Announcement/Dispatch CM 10-15
Failure to Acknowledge on Call Back
"Any agency that fails to acknowledge responding to an incident within two minutes should be
contacted by Control North or Control South over the radio to see if the agency is in fact responding."
This was not done for four(4) minutes.
2. Collier County Collective Bargaining Unit Contract
Article 28.2 Work Duties
"During the hours of 0830 and noon,employees should perform assigned vehicle/station duties zone
familiarization,study medical/operational protocols,or community events. Radios will be monitored
between 0700 and 2130 hours."
The Standard Operating Guideline for Standard Station Duties states:
"Fridays
Deep station GI...
Floors including all living areas, office,storage area,garage bays and bathrooms swept and mopped (or
vacuumed in appropriate areas)."
The crew acknowledges vacuuming and performing required station maintenance around the time of this
dispatch, which may have limited their ability to monitor the radio.
Corrective Actions/Mitigation
• The Collier County Sheriffs Office has stated the deviation from the Collier County Fire Chief Association
(CCFCA)—Communication Manual was a human error in that the dispatcher missed recognizing a visual
display that two (2) minutes had passed and Medic 42 had not responded yet.Since then, EMS has been
told the notification is not only a visual display-but also an audible tone as well.
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PREPARED IN ANTICIPATION OF LITIGATION, REFLECTS THE MENTAL IMPRESSIONS, LITIGATION STRATEGIES AND
LEGAL THEORIES OF TILE UNDERSIGNED ATTORNEY AND IS EXEMPT FROM PUBLIC RECORDS
DISCLOSURE PURSUANT TO § 119.071(1)(d), FLA. STAT. THIS MESSAGE IS INTENDED FOR THE RECIPIENT ONLY. IF
YOU RECEIVED THIS COMMUNICATION IN ERROR, PLEASE NOTIFY THE SENDER IMMEDIATELY. USE OR
DISSEMINATION BY ANY PERSON OTHER THAN THE INTENDED RECIPIENT IS STRICTLY PROHIBITED.
• A reprogramming of the paging system (narrow banding)was completed in January. EMS pagers have
been inventoried and reprogrammed if applicable.
• A protocol has been established that documents when pagers and/or tablets do not activate.This
report is sent to County staff as well as Sheriffs office staff to determine the cause of the incident as
well as any patterns that can be established.
• A draft protocol change to the Collier County Fire Chief Association (CCFCA)—Communication Manual
has been submitted to the Collier County Fire Chief Association (CCFCA)—Communication sub-
committee to change the notification to 30 seconds(from 2 minutes)from when responding apparatus
must acknowledge a dispatch.This will decrease the amount of time dispatch has to "wait"to verify if
responding apparatus has acknowledged a page.This is scheduled to be heard by the subcommittee this
month and if approved it could be heard by the fire chiefs next month.
• EMS is in the process of changing the protocol that will require one (1) personnel to monitor the radio if
one crew member is working in a noisy environment. Hardware changes are also being reviewed to
determine if better listening devices are available for working in noisy environments. EMS staff should
have final protocol revisions completed in 60 days.
• EMS is reviewing the policy of scanning portable radio"channels"to determine if a policy change will
assure that the proper channels are monitored at all times.EMS staff should have final protocol
revisions completed in 60 days.
• The station pagers/antennas will be reviewed to determine antennae design, condition and
performance.
• EMS field staff is testing an alternative cellular carrier to determine if alternate devices/carriers should
be utilized.An alternate cellular carrier has been tested and has proven to work well.Alternate devices
will be explored in the next 90 days.
• EMS staff have developed an automated query that reports calls in which the response to dispatch is
greater than two minutes. EMS staff is planning to meet with the CCSO staff in the next 30 days to
determine a plan to review the reports.
• There are long term changes to the Sheriff's Office Computer Aided Dispatch system and receiving
hardware and devices.This is a longer term element that will change software and hardware at the
Sheriffs Office level as well as the responder level.
In summary,the four(4) minute difference between the initial dispatch and secondary dispatch has been
reviewed and corrective actions to mitigation recurrences have been taken and will continue to take place
to improve the system. While the EMS response was delayed in this instance,the tiered response system
worked as it was designed.The fire department arrived six minutes after the initial dispatch. EMS arrived
seven minutes after the second dispatch. Had EMS responded at the same time as the fire department
apparatus,the fire department apparatus still would have arrived on the scene prior to EMS and initiated
basic life support protocols. The patient arrived at the hospital 33 minutes after the initial dispatch.
The Medical Examiner's report on this case is not complete at this time.
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INTERNAL MEMORANDUM
TO: Leo Ochs, County Manager
FROM: Walter Kopka, Chief
THRU: Len Price,Administrator
Dan Summers, Director
DATE: May 29, 2013
RE: Internal Investigation —Follow Up
Mr.Ochs,
Below is an update to the Internal Investigation completed on March 20, 2013. Included are corrective actions as
well as associated time frames.
Corrective Actions I Mitigation and Status
1. A reprogramming of the paging system (narrow banding)was completed in January. EMS pagers have
been inventoried and reprogrammed if applicable.
a. Complete March 7, 2013
b. Documented in narrow banding spreadsheet
2. A protocol has been established that documents when pagers and/or tablets do not activate.This
report is sent to County staff as well as Sheriff's office staff to determine the cause of the incident as
well as any patterns that can be established.
a. Complete February 19, 2013
b. Documented in General Order, Reporting Missed Tones or Tablet Notification
c. Ongoing
3. A draft protocol(introduced by EMS) was submitted to the Collier County Fire Chief Association (CCFCA)
Communication Subcommittee to add an acknowledge page protocol.The protocol would require
responding apparatus to acknowledge the dispatch within 30 seconds.This will decrease the amount of
time dispatch has to "wait"to verify if responding apparatus have received a page.
a. This was heard by the fire chief's subcommittee on March 21,2013 and did not get a second/or
approved.
i. This same draft protocol item was brought to the Collier County Fire Chief's Association
on May 23, 2013 and did not get supported or approved.The 30 second "acknowledge"
page was addressed and did not gain support because of the amount of time it takes to
dispatch a call and the amount of radio traffic.
4. A draft protocol (introduced by EMS)to change the Collier County Fire Chief's Association (CCFCA)—
Communication Manual was submitted to the Collier County Fire Chief's Association —Communication
subcommittee to change the turn out time (call dispatched to apparatus responding)to 90 seconds
(from 2 minutes).
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INTERNAL MEMORANDUM
a. The protocol was approved by the Collier County Fire Chief's Association Communication
Subcommittee on March 21, 2013.
b. The protocol was approved by the Collier County Fire Chief's Association on May 23, 2013 and
will be submitted to the Collier County Sheriff's Office.
c. This is complete internally at EMS with a change in the Communications SOG on May 13, 2013.
5. EMS is in the process of changing the protocol that will require one(1) personnel to monitor the radio if
one crew member is working in a noisy environment. Hardware changes are also being reviewed to
determine if better listening devices are available for working in noisy environments. EMS staff should
have final protocol revisions completed in 60 days.
a. Complete May 13,2013
b. Documented in SOG Communications
6. EMS is reviewing the policy of scanning portable radio"channels"to determine if a policy change will
assure that the proper channels are monitored at all times. EMS staff should have final protocol
revisions completed in 60 days.
a. Complete May 13, 2013
b. Documented in SOG Communications
7. The station pagers/antennas will be reviewed to determine antennae design,condition and
performance.
a. In progress-expected to be complete within 90 days
b. Emergency Medical Services, Emergency Management Information Technology staff are
reviewing current equipment. Documented in Paging System Review.
c. The need for station pagers may be minimized or even eliminated with the "Locution" project
mentioned in#10 below.
8. EMS field staff is testing an alternative cellular carrier to determine if alternate devices/carriers should
be utilized. An alternate cellular carrier has been tested and has proven to work well.Alternate devices
will be explored in the next 90 days.
a. In 30 days options will be outlined for devices and carriers available as well as field testing.
b. Staff has reviewed alternate software available for handheld notification devices.
c. Staff is reviewing alternative devices and possible alternative carriers to test handheld
notification devices.
9. EMS staff have developed an automated query that reports calls in which the response to dispatch is
greater than two minutes. EMS staff is planning to meet with the CCSO staff in the next 30 days to
determine a plan to review the reports.
a. Meeting complete March 27, 2013
b. A query mechanism is in place for EMS Command Staff to review and document calls in which
the response to dispatch time is greater than two minutes.
c. Ongoing
10. There are long term changes to the Sheriff's Office Computer Aided Dispatch system and receiving
hardware and devices.This is a longer term element that will change software and hardware at the
Sheriff's Office level as well as the responder level.
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INTERNAL MEMORANDUM
a. CCSO has chosen a vendor to provide an upgraded station notification system called Locution.
Locution Systems provides automated dispatching and station alerting products for the public
safety industry. CCEMS along with CCSO and fire districts throughout the county met with
representatives from Locution on May 13,2013,to determine the needs and system design.
CCEMS is currently reviewing the needs of each EMS station.
The Medical Examiner's report on this case is not complete at this time.
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INTERNAL MEMORANDUM
TO: Leo Ochs, County Manager
FROM: Walter Kopka, Chief
THRU: Len Price, Administrator
Dan Summers, Director
DATE: July 3, 2013
RE: Internal Investigation—Follow Up#2
Mr. Ochs,
Below is an update to the Internal Investigation Follow Up completed on May 29, 2013. Updates are bold and
italicized.
Corrective Actions I Mitigation and Status
1. A draft protocol (introduced by EMS) was submitted to the Collier County Fire Chief Association (CCFCA)
Communication Subcommittee to add an acknowledge page protocol.The protocol would require
responding apparatus to acknowledge the dispatch within 30 seconds.This will decrease the amount of
time dispatch has to "wait"to verify if responding apparatus have received a page.
a. This was heard by the fire chief's subcommittee on March 21, 2013 and did not get a second/or
approved.
i. This same draft protocol item was brought to the Collier County Fire Chief's Association
on May 23, 2013 and did not get supported or approved.The 30 second "acknowledge"
page was addressed and did not gain support because of the amount of time it takes to
dispatch a call and the amount of radio traffic.
At this time, this proposal(submitted by EMS)does not have further momentum. If needed,further
action(s)will need to be taken by Administrator Price or County Manager Ochs.
2. A draft protocol (introduced by EMS)to change the Collier County Fire Chief's Association (CCFCA)—
Communication Manual was submitted to the Collier County Fire Chief's Association —Communication
subcommittee to change the turn out time (call dispatched to apparatus responding)to 90 seconds
(from 2 minutes).
a. The protocol was approved by the Collier County Fire Chief's Association Communication
Subcommittee on March 21, 2013.
b. The protocol was approved by the Collier County Fire Chief's Association on May 23, 2013 and
will be submitted to the Collier County Sheriffs Office.
c. This is complete internally at EMS with a change in the Communications SOG on May 13, 2013.
This item is complete internally by EMS. Turn out times in excess of ninety seconds are monitored by EMS
supervisory staff and require a documented reason by EMS field staff. Updates are pending from the
Collier County Fire Chiefs Association and the Sheriffs Office.
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INTERNAL MEMORANDUM
3. The station pagers/antennas will be reviewed to determine antennae design, condition and
performance.
a. In progress-expected to be complete within 90 days
b. Emergency Medical Services, Emergency Management Information Technology staff are
reviewing current equipment. Documented in Paging System Review.
c. The need for station pagers may be minimized or even eliminated with the "Locution" project
mentioned in#10 below.
The Paging System Review report is complete. This item will be reviewed post"Locution"implementation
to determine the need and extent of station pagers and components.
4. EMS field staff is testing an alternative cellular carrier to determine if alternate devices/carriers should
be utilized. An alternate cellular carrier has been tested and has proven to work well.Alternate devices
will be explored in the next 90 days.
a. In 30 days options will be outlined for devices and carriers available as well as field testing.
b. Staff has reviewed alternate software available for handheld notification devices.
c. Staff is reviewing alternative devices and possible alternative carriers to test handheld
notification devices.
This is a more difficult item to define and address simply because there is no pattern of failures that EMS
can document.As with any cellular device, reception can be intermittent at certain locations and times.
EMS staff currently is using a "tablet"device with is a cellular device which receives 9-1-1 call information
and places the dispatch information on a map to direct responding apparatus. On the date of this incident
—the tablet did not receive the dispatch information or activate. EMS Field staff has done minimal testing
(week long)on a different cellular device and carrier. Initially the devices show possible positive results-
'"` with comments from users that the device worked"perfectly"without documented failures. EMS will be
reviewing options to expand this field test to different locations/EMS stations/apparatus.
5. There are long term changes to the Sheriff's Office Computer Aided Dispatch system and receiving
hardware and devices.This is a longer term element that will change software and hardware at the
Sheriff's Office level as well as the responder level.
a. CCSO has chosen a vendor to provide an upgraded station notification system called Locution.
Locution Systems provides automated dispatching and station alerting products for the public
safety industry. CCEMS along with CCSO and fire districts throughout the county met with
representatives from Locution on May 13, 2013, to determine the needs and system design.
CCEMS is currently reviewing the needs of each EMS station.
Several meetings with EMS,Sheriff's Office,fire districts and Locution have taken place. The vendor has
provided information about the notification system, components, options and requirements. Site visits
have taken place to review station plans and options.A letter has been sent to EMS from the Sheriff's
Office stating the Sheriff will provide the core components for Locution as well as the requirements for
EMS. EMS has budgeted for these requirements and have staff working with Locution,Sheriff's Office and
the fire districts. Sheriff's Office staff has indicated a end of calendar year purchase.
The Medical Examiner's report on this case is not complete at this time.
Page 2 of 2
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MEMORANDUM
TO: Chief Walter Kopka,Collier County EMS
FROM: Dan E.Summers, Director
DATE: May 22, 2013
RE: Internal Investigation Memorandum of March 12, 2013
In your memo referenced above on page 4 you requested my office to assist with a review of station
pagers and antennas to determine antenna design, condition and performance as part of a corrective
action process. My review is noted below.
Summary: In our review of stations with the greatest potential of VHF pager transmission signal
interference (North Naples-vicinity)we found all pagers and associated receivers working during our
review. Signal strength from the County's VHF transmitter that activates the pager was working properly
and exterior reception was good to excellent. While Harris/Communications International, (the
equipment manufacturer and local service dealer)continue to address an extremely rare intermittent
paging transmission interruption originating from the CCSO 911 Center,we found that field receiving of
paging and performance was sufficient in both signal strength and audio quality from the field
perspective during our review. While recommendations will be made to address the age of the
equipment, strategies for additional levels of redundancy, and hardware in the EMS station facilities,the
redundancy of both a "station-fixed pagers" and a second crewmember assigned pager provides an
acceptable level of reliability complimented by timely telephone contact from 911 if warranted.
It should also be noted that while there are efforts by the Collier County Sheriffs 911 to fund and
construct an network based dispatch system that may allow for more building automation and dispatch
text to personal devices, the VHF paging system should not be abandoned in any fashion. While the
exact cost to make the upgrades discussed below have not yet been thoroughly evaluated,the cost for
replacement conventional-type VHF equipment to make these upgrades and minor replacement(s) is
extremely competitive and the work relatively simple.
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*Recommendations, Discussion and Observations:
1. Collier County EMS field personnel who are assigned supplemental duties to oversee the
EMS division's radio equipment are extremely dedicated and to the extent resources are
available,worked to ensure reliable field equipment. EMS staff has been diligent with the
necessary FCC narrow-banding effort.
2. The VHF band,transmitter,and paging configuration from the transmitter site to the end-
user is extremely robust and signal strength and audio quality for a county of this size is
quite good.
3. As age of a station facility increases,there is the tendency to overlook or become
complacent with both data and radio systems being co-located on the same worktable or
computer station. This is co-location of equipment can generate spurious radio frequency
interference. While we did not observe any significant signal or audio loss when this was
observed,the practice of placing computer modems, routers,and wireless devices next to
one-another with adjacent paging receivers should be discouraged and separation devised
between these networks to avoid any future signal degradation.
4. While we observed all the paging systems working we are making the following
recommendations that may be classified as preventative maintenance and general
�-- housekeeping:
a. Initiate a phased approach to re-wiring and replacing the aged configuration of
speakers and paging alert devices in each station beginning with those sites that are
the farthest distance from the VHF tower and in the urban corridor typically more
susceptible to radio interference. This effort should include:
i. Improving the cabinet or workstation station receiver location and low
voltage speaker wiring to avoid any accidental disconnect of any speakers or
receiver.
ii. Installation of uninterruptable power supply that could help prevent any
loss from power surge, power interruption or lighting strike.
iii. Confirmation of the installation of paging audio speakers in the bathrooms
of stations.
iv. Installation and consistent use system-wide of either a supplemental horn,
strobe light or overhead lighting when tones are activated, especially for the
evening hours or when crews are servicing their ambulance in the bay areas
when high noise situations may occur.
v. Replacement and proper placement of VHF external antennas for the paging
system receiver. We observed many of the exterior antennas for the paging
system did not clear the metal roof-ridge of the station. Exterior antennas
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should favor the line of site concept to the tower and have at least a three
foot clearance from a metal roof building. These exterior antennas for the
receivers would do well to have lower loss antenna cabling utilized and as a
rule,where wall mounted towers are available, higher antenna height is
always better. Lighting surge protection devices should also be installed.
b. The Motorola brand "Minitor" pager receiver product is the "staple"of fire and EMS
paging systems around the world and predominately used within Collier County
EMS and fire services. The product utilized is very robust and ruggedized for public
safety use. The Minitor product utilization should be continued, but the following
recommendations are being made.
i. Acquire additional pagers so that the pagers may be sent to a Motorola
authorized service center annual for a "bench-check". While these are
extremely reliable units,the minor cost and quick turn-around (3—day
typically) with a preventive maintenance program will help mitigate any
future failures and address any potential power supply or battery issues.
ii. The 110VAC power supply and re-chargeable battery components of the
units should be replaced on a schedule, rather than waiting for failure to be
observed. These components are inexpensive and can be easily stocked and
exchanged.
iii. As funds become available, migrate the pager and portable radio batteries
to lithium-ion batteries where appropriate.
c. In some stations,the Minitor receiver was being used as the receiving base station
for the crew quarters dispatch receiver. Again,these units are quite robust, but may
lack the features best suited for in-building notification as noted below.
i. The Minitor amplified pager and charging station may not have enough
audio output to reliably drive all the overhead speakers in the crew
quarters, depending on the speaker type, number and station design.
ii. We observed that in some cases the Minitor audio speaker output was tied
to a residential quality(Radio Shack)amp to drive in-station audio speakers.
Additionally, it was quite easy to accidentally adjust the volume level on the
Minitor receiver that was being adapted to serve as the station receiver. A
design change is recommended below in item d. It should also be noted that
the crew's assigned pager also provides a back-up to the station pager.
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d. EMS staff may wish to consider the following:
i. Acquire a base-station type tone alert activated receiver that is totally
dedicated for the long-term use as a stationary receiver and is designed
with audio outputs, minimum volume levels and relays for alert devices
such as strobe lights or station lighting controls. Again we stress that this
effort should be segregated from the pending network based notification
system be considered by the Collier County Sheriff's office and when and if
that system is acquired, the VHF paging shall remain as a redundant back-up
system. The Federal Signal brand "Informer" product series, may be an
reasonable and reliable consideration.
ii. Once the base-station type tone alert activated receivers are installed with
improved antenna configurations the available Minitor units could be placed
in crew-rotation for annual preventative maintenance efforts and used and
for spare units during repair.
5. During our inspection we feel that we would be remiss if we did not mention the following
for future consideration:
a. American Messaging a nationwide text paging system currently being used by
Emergency Management and the Sheriff's 911 might be a consideration for a
redundant alpha-numeric pager and or alpha-numeric desktop device. These
subscription cost are quite low and we have found the system very reliable in Collier
County. We have not evaluated the equipment cost for a desktop resource.
b. All of the EMS station rely upon the "receive only" of the VHF paging or monitoring
the County's 800mhz radio and responding via the handheld portable radio or
mobile radio. Should grant funds become available or other funding source the
installation of a low power two-way base station might be worthy of consideration
as a continuity of government communication resource during catastrophic disaster
events.
c. A phased approach to replacing aging low voltage wiring, antennas and speakers
would be a worthwhile investment in future reliability and protection from lighting
or power surges. This will require some close coordination with agencies and
facilities in which EMS units are co-located.
d. Paging receiving stations and the associated building speaker hardware controls
should be in a more secure area that would avoid the accidental power cord or
speaker cable "bumps or tugs", that could cause an interruption to the system
when other portable equipment is being utilized or re-located.
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In closing, I would like to thank Mr.John Daly and Paramedic Geoff Swets, who accompanied me
on these site visits as part of our evaluation process. Staff will continue efforts to build a quality
control component to this communication network. Staff will complete this quality control
standard within the next 90 days.
Thank you.
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C'ottier linty
Memorandum
To: Leo Ochs, County Manager
CC: Len Price, Administrative Services Administrator
Mike Berrios, Information Technology Director
From: John Daly, Telecommunications Manager
Date: September 27, 2013
Subject: 800 MHz System Dropped Audio/Paging Tone
This memo will summarize the steps that have been taken to resolve the occurrence of missing or
dropped audio on the 800 MHz system. This problem was most noticeable on Fire/EMS calls
when the paging alert tones were not properly transmitted by the system. This issue has proved
problematic to resolve due to the intermittent nature of occurrence.
The initial reports of this issue were received last fall and corresponding repair efforts resulted in
four to six week periods of problem free system performance. In February of this year the problem
became more prevalent. The vendor's technical support group has provided specific
recommendations for system testing and resolution efforts to the local technical staff. In addition
system engineers were sent to Collier to monitor these efforts which included:
• Hardware replacement at the dispatch console position, this is the first step in
troubleshooting
• A radio system audit of the technical parameters in various components including; site
transmitters, audio cards, radio system switch configuration, and the software and
hardware revision levels of system components
• Data and audio capture of radio system activity for analysis by the vendor's engineering
staff
• Modification to specific radio system configurations, these changes are made
incrementally and then evaluated for success in resolution
• Replacement of specific components based on system testing and the system audit
The radio system vendor did issue a Technical Service Memo to all customers in July regarding
this audio issue and recommended replacement of the audio cards for each dispatch console with
a newer version. Unfortunately this did not resolve the issue in Collier. The vendor
recommendation for Collier is that we revert to an older generation audio card and this has
resolved the problem. We have had no further reports of missing audio and specific testing efforts
have verified the problem does not occur with the older generation card.
Information Technology Department
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This is a serious issue and any occurrence is a cause for concern. The difficultly in resolution is
related to the intermittent nature of the problem. Between February and August dispatch
processed 22,835 Fire/EMS run numbers. There were only 47 verified incidents of dropped audio
resulting in a paging tone being dropped. The system testing that has been conducted during the
troubleshooting process of this issue has identified the same rate of occurrence, approximately
.2% of transmissions, and this rate has remained consistent.
Outside of radio system efforts, staff has worked with the various agencies and provided guidance
with the paging equipment resident in each department. I know EMS has initiated preventative
maintenance efforts for their station alerting equipment although I don't have a status on these
efforts.
Please let me know if additional information or clarification is needed. A delineated time line of
the technical efforts is available if desired.
Information Technology Department
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Page 1
L N •
1 of 1 DOCUMENT
LexisNexis(R)Florida Annotated Statutes
Copyright(c)2014 by Matthew Bender&Company,Inc.
a member of the LexisNexis Group.
All rights reserved.
*** Statutes and Constitution are updated through Acts 1-21,23-96,98-101,and 103-255 of the 2014 Regular Session
and 2014 Special Session A. ***
Title XXIX. Public Health.(Chs.381-408).
Chapter 401. Medical Telecommunications and Transportation.
Part III. Medical Transportation Services.
GO TO FLORIDA STATUTES ARCHIVE DIRECTORY
Fla. Stat. §401.411 (2014)
§401.411. Disciplinary action;penalties.
(1)The department may deny,suspend,or revoke a license,certificate,or permit or may reprimand or fine any licensee,
certificateholder,or other person operating under this part for any of the following grounds:
(a)The violation of any rule of the department or any provision of this part.
(b)Being found guilty of,or pleading nolo contendere to,regardless of adjudication in any jurisdiction,a crime
that relates to practice as an emergency medical technician or paramedic,or to practice in any other occupation,when
operating under this part.
(c)Addiction to alcohol or any controlled substance.
(d)Engaging in or attempting to engage in the possession,except in legitimate duties under the supervision of a
licensed physician,or the sale or distribution of any controlled substance as set forth in chapter 893.
(e)The conviction in any court in any state or in any federal court of a felony,unless the person's civil rights
have been restored.
(f)Knowingly making false or fraudulent claims;procuring,attempting to procure,or renewing a certificate,
license,or permit by fakery,fraudulent action,or misrepresentation.
(g)Unprofessional conduct,including,but not limited to,any departure from or failure to conform to the
minimal prevailing standards of acceptable practice under this part,including undertaking activities that the emergency
medical technician,paramedic,health care professional,or other professional is not qualified by training or experience
to perform.
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Page 2
Fla.Stat. §401.411
(h)Sexual misconduct with a patient,including inducing or attempting to induce the patient to engage,or
engaging or attempting to engage the patient,in sexual activity.
(i)The failure to give to the department,or its authorized representative,true information upon request
regarding an alleged or confirmed violation of this part or rule of the department.
(j)Fraudulent or misleading advertising or advertising in an unauthorized category.
(k)Practicing as an emergency medical technician,paramedic,health care professional,or other professional
operating under this part without reasonable skill and without regard for the safety of the public by reason of illness,
drunkenness,or the use of drugs,narcotics,or chemicals or any other substance or as a result of any mental or physical
condition.
(1)The failure to report to the department any person known to be in violation of this part.
(2)A suspension or revocation of a license or certificate is for all classifications unless the department,in its sole
discretion,suspends or revokes one or more classifications thereof.
(3)One year after the revocation of a license or certificate,application may be made to the department for
reinstatement;and the department may authorize reinstatement.
(4)Any charge of a violation of this part by a licensee affects only the license of the service location from which
the violation is alleged to have occurred.Another license may not be issued to the same licensee for a new service
location in the same county or any other county for a period of 3 years from the effective date of revocation.
(5)If the department finds that the terms of any such suspension have been violated,it may revoke such suspension
immediately.
(6)If a person whose license,certificate,or permit has been suspended is found by the department to have violated
any of the other provisions of this part,the department may revoke the license,certificate,or permit.
(7)In addition to any other administrative action authorized by law,the department may impose an administrative
fine,not to exceed$ 1,000 per violation of this part or rule of the department. Each day of a violation constitutes a
separate violation and is subject to a separate fine.In determining the amount of a fine,the department shall consider
the following factors:
(a)The gravity of the violation,including the probability of death or disability as a result of the violation.
(b)Any actions taken to correct the violation.
(c)Any previous violations committed by the violator.
(8)All amounts collected under this section must be deposited into the Emergency Medical Services Trust Fund.
HISTORY: SS. 19,25,ch. 82-402;ss. 12, 13,ch. 83-196;s. 17,ch. 84-317;ss.21,36,ch.92-78;s.2,ch.98-87; s.2,
ch.2010-188,eff.July 1,2010.
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