Loading...
Agenda 09/24/2013 Item #10C 9/24/2013 10.C. EXECUTIVE SUMMARY Recommendation to accept the Medical Director's self-appraisal and the performance evaluations of members of the Public Safety Authority and to conduct a performance evaluation for the Medical Director in accordance with the terms of his contract. OBJECTIVE: To provide the Medical Director with feedback on his performance for the past year, approve goals, and make recommendations for areas of focus for the next evaluation period. CONSIDERATIONS: On November 13, 2013,the Medical Director's contract was amended by the Board to include a provision for an annual performance evaluation. In accordance with this provision,the Medical Director prepared a self-assessment for submittal to the Public Safety Authority(PSA). The PSA held a special meeting, attended by eleven members, on June 26,2013 to review the self-appraisal and make an independent performance evaluation. These individual evaluations and a consolidated summary of same were forwarded to County Commissioners as reference for preparing and conducting their independent performance reviews. At the July 9, 2013 BCC meeting,the Board directed the County Manager to reformat the evaluation instrument to more closely mirror that of Board contracted employees. This was completed and forwarded to Commissioners on August 1, 2013. Any feedback received from Commissioners is attached to this item. RECOMMENDATION: That the BCC accepts the Medical Director's self-appraisal and the performance evaluations of members of the Public Safety Authority and conducts a performance evaluation for the Medical Director in accordance with the terms of his contract. PREPARED BY: Len Golden Price,ASD Administrator Packet Page-103- 9/24/2013 10.C. COLLIER COUNTY Board of County Commissioners Item Number: 10.10.C. Item Summary: Recommendation to accept the Medical Director's self-appraisal and the performance evaluations of members of the Public Safety Authority and to conduct a performance evaluation for the Medical Director in accordance with the terms of his contract. Meeting Date: 9/24/2013 Prepared By Approved By Name: pochopinpat Title: Administrative Assistant,Facilities Management Date: 9/16/2013 10:46:15 AM Name: PriceLen Title:Administrator, Administrative Services Date: 9/16/2013 5:28:37 PM Name: KlatzkowJeff Title: County Attorney Date: 9/17/2013 8:54:03 AM Name: KlatzkowJeff Title: County Attorney Date: 9/17/2013 10:16:00 AM Name: IsacksonMark Title: Director-Corp Financial and Mgmt Svs,CMO Date: 9/17/2013 10:16:11 AM Name: IsacksonMark Title: Director-Corp Financial and Mgmt Svs,CMO Date: 9/17/2013 10:59:24 AM Packet Page-104- 9/24/2013 10.C. • Collier County EMS Department atIORk Employee Self Appraisal 2012 through May 2013 Robert B. Tober, M.D., FACEP, FAAEM- Medical Director SECTION I — Performance Review Goals & Objectives: List & discuss major objectives and projects covered by this review. Briefly state the status of each. Supervised the Quality Assurance processes to insure highest level of medical care standards are maintained and that issues are addressed in a timely fashion to reduce risk of any repetition of errors. Continued to monitor performance standards of field medics and utilize programs such as the Field Training Officer Paramedic Refresher program to address deficient documentation and possible skill deterioration. Returned to a more active role in the field riding with responding crews throughout the year. Personally served as instructor at lnservice and other training forums to insure good contact, rapport, and interaction with field employees. Implemented trials with new equipment or alternative medications to maintain and improve patient care while dealing with nationwide shortages, maintaining cost parameters, and staying on the forefront of emergency field care. Monitored our adherence to the reporting requirements of the State (EMSTARS); and our cardiac save data where we continue to set the standard for other organizations. Accomplishments/Achievements: List & briefly describe the most important accomplishments during the past appraisal period. Worked with staff and consultants to help guide CCEMS to successful CAAS accreditation. Continued work with staff to guide CCEMS thru the CAMS Certification Process for Medflight Continued pursuit of online training alternatives to improve knowledge base of responders without exceeding cost parameters in training OT. Packet Page-105- 9/24/2013 10.C. Assisted in the successful lobbying at the State level to have administrative code changed to allow release of some 911 information to registered AED holders (House Bill 801). Continue to work with the ATRUS group and CCSO to notify registered AED device holders to increase survivability and close the time to first response to a cardiac arrest by a first responder proximate to the location and armed with an AED. Have served as executive medical representative for EMS at special events and at meetings such as the Public Safety Authority (PSA), the Targeted Response Group, and the previous EMS Policy Board and EMSAC Completed writing of new Airway Course in Prehospital Medicine for University of Miami Miller School of Medicine Completed writing of new Advanced Stroke Life Support Course for University of Miami Miller School of Medicine Collier County has been selected as a "beta" test site by A.C.A. (the State hospital data storage system) to share patient data of admissions connected by social security numbers. This system will allow for QA tracking by providing diagnosis, treatment, and outcomes of patients as well as accurate revision of patient billing information based on hospital records. Unusual Circumstances: List & briefly describe any unusual circumstances, unplanned projects, changed priorities, or special problems or conditions that have occurred since last review. Have had to adjust to changing medical and political climate. (In this latter regard, I have sent a May 29, 2013 letter to the County Manager in initial response to the claims of the Board Chair and Physicians Regional at the May 14, 2013 Board meeting. This letter was sent to the County Manager because he was generally charged with investigating or coordinating an investigation of these claims.) Nationwide drug shortages have created additional need to view alternatives in field care. Coordinating with additional advisory boards and COPCN holders has also required some change as maintaining medical care standards remains the priority for the County as a whole. Performance Appraisal: Briefly describe your assessment of your overall performance for the last evaluation period I have maintained a high standard of patient care in the face of public criticism and conflicts between receiving facilities. (As to public criticism, please see my reference to the letter to the County Manager.) The performance of EMS has Packet Page-106- 9/24/2013 10.C. been consistently good as reflected by all verifiable data we have in our quality , assurance process and that is the bottom line. We maintain quarterly ALS skills monitoring on all of our paramedics. This QA and monitoring process is constant, transparent and targeted at moving medics to busier zones, intensive one-on-one clinical training and maintenance of skills. SECTION II — Employee Development Education & Training Update: List any job related courses, training, or seminars in which you enrolled or completed since last review. Successfully completed training and authorship of two distinct and landmark subjects; Prehospital Airway Support and Prehospital Advanced Stroke Life Support University of Miami Miller School of Medicine. Completed re-certification by the American Board of Emergency Medicine October 2011-My 4th 10-year cycle of completion. Completion of Annual Emergency Medicine Practice CME's by EBMEDICINE.net Personal Development: List or discuss those areas which you believe you can improve upon during the next appraisal period. Also list specific future promotional or other career development goals. Successful completion of constructive relationships with City of Naples and ENFD and working on an ALS Engine Swap Program over the next 12 months. Organizational Support: Describe any specific development activities or improvements your supervisor or the organization can undertake to assist in your department. More investment into advanced medical devices may be necessary to stay in the forefront of care as the County has come to expect. Increase in FTEs for training personnel will yield a ripple effect that benefits citizens exponentially as field personnel are given more resources to learn new techniques and refine skills which they use both daily and rarely. Participation in more non-local training courses and seminars for personnel can also help the organization develop though with public scrutiny of travel budgets this must be done judiciously. SECTION III — Performance Objectives List the major performance objectives you would like to accomplish during the next appraisal period. For each, indicate the objective, how it should be measured, and by when it should be accomplished. Packet Page -107- 9/24/2013 10.C. Continue to work with the PSA, hospitals, fire districts and community physicians to implement and improve EMS protocols and patient care efforts. Investigate better sharing of training resources throughout our first responder network. Measurement may be reflected by progress reports from the PSA and QA performance data annually. Sincerely, Ro ert B. Tober, M.D., FACEP, FAAEM, Medical Director Packet Page-108- 9/24/2013 10.C. pochopinpat From: OchsLeo Sent: Thursday, August 01, 2013 10:59 AM To: DLCOMM Cc: DL BCCSEC; PriceLen Subject: FW:Medical Director Eval Template.docx Attachments: Medical Director Eval Template.docx Follow Up Flag: Follow up Flag Status: Flagged Commissioners, As directed, please find attached a reformatted rating form for the Medical Director that matches the format and rating system generally used by contract employees. If you would like to add new objectives to the form, please advise me by September 1, 2013. I plan to place the Medical Director's Evaluation on the September 24,2013 agenda. If you have any question, please feel free to contact me. Leo E.Ochs,Jr. Collier County Manager leooch.s@_colliergov.net 239.252.8383 Under Honda Law,e-mail addresses are public records.If you do not want your e-mail address released in response to a public records request,do not send e'ectronic mail to the entity. instead,contact this office;by telephone or in writing. 1 Packet Page -109- 9/24/2013 10.C. Robert B. Tober, MD, FACEM, FAAEM Medical Director Performance Evaluation —June 2013 through July 2013 The Medical Director is an independent contractor directly responsible to the Board of County Commissioners for the implementation of such planning and coordination as may be necessary to deliver advanced life support by Paramedics (including EMS and Fire District personnel) trained to the level of advanced and basic medical technicians. The Medical Director's contract with the Board of County Commissioners provides for an annual evaluation. These goals are based on the broad areas generally expected to be performed by the Medical Director as well as specific areas of focus in accordance with his contract. 1. Leadership and Organizational Direction — To supervise and accept direct responsibility for the medical performance of the paramedics working for Collier County EMS; provide clear and consistent medical direction to the EMS workforce; to consistently display professionalism and personal and business ethics consistent with Agency guiding principles; to maintain focus and commitment to long range strategic planning as the key to achieving Agency's vision and mission. Below Meets Exceeds Standard Standard Standard 1 2 3 Rating Commissioner's Comments: 2. Operational Effectiveness—To develop medically correct standing orders or protocols relating to life support system procedures; to issue standing orders and protocols to ensure transport of each patient to facilities that offer the type and level of care appropriate to the patient's medical condition;to ensure and certify that security procedures for medications, fluids and controlled substances are in compliance with Florida statutes and the Florida Administrative Code;to assume direct responsibility for the use by a CC paramedic of an 1 Packet Page-110- 9/24/2013 10.C. automatic or semi automatic defibrillator and the performance of esophageal intubation, and, on routine inter facility transports, the monitoring and maintenance of non-medication IVs; to provide continuous 24 hour per day, 7 days per week medical direction. Below Meets Exceeds Standard Standard Standard 1 2 3 Rating Commissioner's Comments: 3. Quality Assurance and Training—To establish a quality assurance committee to review paramedic operations; to audit the performance of systems that includes, but is not limited to, a prompt review of patient care records, direction observation, and comparison of performance standards for drugs, equipment, system protocols and procedures; to be responsible for participating in quality assurance programs that may be developed by the department; to ensure all paramedics are trained in the use of the trauma scorecard methodologies for adult and pediatric trauma patients; to participate as a crewmember on an EMS vehicle for a minimum of 10 hours per year and complete a minimum of 10 hours per year of continued medical education related to pre-hospital care or teaching or a combination of both; to ensure all paramedics have all proper certification and receive all training necessary to maintain their certification. Below Meets Exceeds Standard Standard Standard 1 2 3 Rating Commissioner's Comments: nom. 2 Packet Page-111- 9/24/2013 10.C. 4. Policy Execution and Compliance—To develop protocols that ensure compliance with Florida Statutes and Administrative Codes; to notify the Florida Department of Health in writing when the use of telemetry is not necessary and, in writing, of each substitution by CC EMS o f equipment or medication. Below Meets Exceeds Standard Standard Standard 1 2 3 Rating Commissioner's Comments: 5. Planning and Coordination—To consult in the planning and/or design of vehicles,equipment, supplies, distribution resources,emergency medical services personnel training and medical policy, protocol, planning and development;to consult in coordination of training of paramedical personnel, including the determination of training criteria for certification;to organize,coordinate,and participate as an instructor in the in-service education programs and quality control of the patient care in day to day delivery of emergency medical services by the county,to provide such assistance as may be required in the preparation and administration of any grant programs for the establishment and improvement of the system. Below Meets Exceeds Standard Standard Standard 1 2 3 Rating Commissioner's Comments: 3 Packet Page-112- 9/24/2013 10.C. 6. Communication and Community Relations-To serve as liaison between the County and the . appropriate community hospitals,medical societies,practicing physicians,and training facilities in the area; to work with all stakeholders toward improved communication, information sharing and cooperation in the delivery of pre-hospital services to the general public;to participate in regional or statewide physician's groups involved in pre-hospital care. Below Meets Exceeds Standard Standard Standard 1 2 3 Rating Commissioner's Comments: 4 Packet Page-113- 9/24/2013 10.C. Commissioners Overall Comments and Goals for next rating period: 5 Packet Page-114- 9/24/2013 10.C. Scoring Guidelines for Annual Performance Review Asik Score Result 1 • Some improvements and/or early good performance levels in a few areas Below • Results not reported for many to most areas of importance to the Standards organization's key business requirements • Improvement trends and/or good performance levels reported for most areas of importance to the organization's key business requirements 2 • No pattern of adverse trends and no poor performance levels in areas of Meets importance to the organization's key business requirements Standards • Some trends and/or current performance levels--evaluated against relevant comparisons and/or benchmarks--show areas of strength and/or good to very good relative performance levels • Business results address most key customer, market, and process requirements • Current performance is excellent in most areas of importance to the 3 organization's key business requirements Exceeds • Excellent improvement trends and/or sustained excellent performance Standards levels in most areas • Evidence of industry and benchmark leadership demonstrated in many areas • Business results fully address key customer,market, process,and action plan requirements Final Standard Rating Scale Needs Improvement Meets Expectations Exceeds Expectations 1.00— 1.66 1.67—2.33 2.34—3.00 6 Packet Page -115- 9/24/2013 10.C. Medical Director Evaluation for Dr, Robert Tober 'ACC - July 9, 2013 Tim Nance - Collier County Commissioner/District#5 The following is my assessment of the performance and a constructive suggestion for needed areas of improvement for Dr. Robert Tober, Collier County Medical Director. Lacking previous evaluations or any history of specific goals or areas of focus for improvement, it is personally problematic to employ the evaluation form supplied by Collier County Government, soliciting an assigned numerical grade on specific performance about which I have little direct knowledge or expertise. For my assessment I have relied on the aggregate subjective opinion of numerous citizens,health care professionals, and administrators,that in my opinion,have provided me with constructively critical observation and honest professional critique. My assessment is that Dr. Tober has given general direction to Collier County EMS that overall meets or exceeds the standard generally expected to be performed by the County Medical Director. I have no question that the requirements of Florida Statute are being met. The great preponderance of opinion, including numerous critics, indicate that in the general areas of the overall Medical Direction of the Collier County EMS, including Quality Assurance, Training, and Operational Procedures, Dr. Tober is an extremely skilled and capable Medical Director. His long term dedication to the mission of Collier EMS and emergency medical care is widely acknowledged. Using the presented standards for scoring the appraisal, in these generalized areas I would assign his erformance a numerical grade of 8. roe,.:, That said,there is a clear need for Dr. Tober to improve his interpersonal communications skills and expand his leadership role, as Medical Director. It is my opinion that shortcomings in these non technical skill sets is unfortunately limiting his effectiveness. To fully realize the efficiencies and opportunities possible through the consolidation of Collier First Response agencies, the Medical Director must be the leader in establishing cooperation and coordination between EMS, Fire Districts, hospitals, and physicians. To achieve superior results as Medical Director going forward, Dr. Tober must dedicate himself more effectively to consensus building and conflict resolution between these professionals. A numerical grade of 6 would be appropriate for his performance in these challenging but critical areas. With recognition of outstanding record of service to Collier County, and his noteworthy achievement in the development and management of Collier EMS to date, I would assign Dr. Tober an overall numerical grade of 7 for the past year. With improvement in the aforementioned non technical management areas, a superior performance of 9 or higher is clearly possible. Likewise, failure to improve communications and team building shortcomings could result in much poorer performance. With this caveat, I am in support of extending Dr. Tober's contract as Collier Medical Director with a significant measure of concern. I am confident that a cooperative effort between Dr. Tober as Medical Director, Collier County Government staff, first responders in EMS and the Fire Districts, and health care professionals and administrators,many of whom share similar goals and challenges, will lead to improved and superior group lerformance for our citizens and inspire individual excellence. am personally dedicated to this effort and have hopes and expectations of improvement across the board. Packet Page-116- 9/24/2013 10.C. PSA Consolidated Ratings: Medical Director Bernard Gibson Panozzo Kopka Duetcher Bethel COMMUNICATION ." C1. Provide BCC with timely and accurate ' responses to requests for information, planned updates 5 5 1 8 C2.Provide information to the public Below through public speaking engagements 3 5 1 9 9 standards C3. Participate in regional or statewide Meets physician's groups for pre-hospital care 7 5 1 9 10 standards C4. Notify FDOH of telemetry,medication or equipment substitutions,etc as Exceeds required 7 5 1 9 9 standards C5.Serve as liaison with community hospitals,medical societies,practicing Below physicians,and training facilities 2 1 9 8 standards LEADERSHIP Li.Supervise and accept responsibility for medical performance of paramedics and Meets EMTS 7 5 1 9 9 standards L2.Develop and maintain medically Meets correct standing orders or protocols 7 5 1 9 8 standards L3.Provide for continuous 24/7 medical Below direction 7 5 1 9 10 standards L4. Issue standing orders to ensure transport of patients to facilities that offer a type and level of care appropriate to the eets patient's medical condition 3 1 1 9 8 standards LS. Participate as crewmember on EMS vehicle for a minimum of 10 hours per year 4 1 10 8 QUALITY ASSURANCE QA1.Establish and maintain qualify assurance committee to provide review of medical skills and performance of medical Meets personnel 6 5 1 10 9 standards QA2.In coordination with training -- programs will determine criteria to Meets achieve practioner certification 6 5 1 10 8 standards QA3. Audit the performance of system personnel through quality assurance Meets program 6 5 1 9 8 standards TRAINING T1. Ensure all paramedics are trained in use of trauma scorecard methodologies 7 5 1 10 8 Packet Page-117- 9/24/2013 10.C. Buxton Montagana Vasey Allen Murphy 6, 4 9 3 7 4 7 3 Exceeds 7 4 standard 8 6 Exceeds 8 4 standard 9 5 Exceeds 2 4 standard 9 2 Exceeds 8 4 standard 10 5 Exceeds 8 4 standard 9 4 Exceeds 8 4 standard 7 5 Exceeds 4 standard 9 4 Exceeds 8 4 standard 8 6 Exceeds 7 4 standard 10 6 Exceeds 7 4 standard 10 6 Exceeds 7 4 standard 10 6 Exceeds 7 4 standard 10 5 Packet Page-118- 9/24/2013 10.C. T2.Ensure paramedics are trained in use of automation or semi-automatic defibrillators,endotracheal intubation, monitoring IVs and other skills Below 5 5 1 10 9 standards 73.Ensure paramedics and EM7s are offered training to maintain their Meets certification 5 1 1 8 9 standards T4.Participate as instructor at in-service education programs and provide support Meets in organizing such programs 6 1 1 9 9 standards OPERATIONAL PROCEDURES k °_.. . 01.Ensure security procedures for medications,fluids,and controlled substances are in compliance with laws 7 5 1 9 9 02. Create,authorize,and ensure adherence to details written operation procedures for all aspects of handling medication,fluids,and controlled substances in compliance with laws 6 5 1 9 9 03.Serve as consultant for all areas of pre- hospital medical care include equipment, Meets supplies,sources,vehicle design,etc 5 5 1 9 8 standards OTHER KEY RESULT AREAS r.; Below Issue resolution/decision making 2 5 1 8 8 standards Meets Self direction/self-initiation 3 5 1 9 8 standards Ongoing licensure 5 5 1 9 8 Meets Succession planning 4 5 1 8 7 standards Meets System effectiveness measurement 5 5 1 8 9 standards Meets 5.2 4.5 1.0 9.0 8.5 standards Packet Page-119- 9/24/2013 10.C. Exceeds 7 4 standard 10 5 Exceeds 7 4 standard 10 5 Exceeds 7 4 standard 10 5 Exceeds 7 4 standard 10 7 Exceeds 7 4 standard 10 6 Exceeds 7 4 standard 10 6 Exceeds 7 4 standard 9 2 Exceeds 7 4 standard 9 4 Exceeds 10 4 standard 10 6 Exceeds 5 4 standard 10 6 Exceeds 7 4 standard 10 4 Exceeds 7.0 4.0 standard 9.3 4.9 Packet Page-120- 9/24/2013 10.C. Below standards 2 Meets Exceeds standards 5.5 standard 9 Exceeds Exceeds standards 5.5 standard 9 Below Exceeds standards 2 standard 9 Meets Exceeds standards 5.5 standard 9 Meets Exceeds standards 5.5 standard 9 Below Exceeds standards 2 standard 9 Meets Exceeds standards 5,5 standard 9 Exceeds standard 9 r " Meets Exceeds standards 5.5 standard 9 Meets Exceeds standards 5.5 standard 9 Meets Exceeds standards 5,5 standard 9 Exceeds standard 9 Below Exceeds standards 2 standard 9 Meets Exceeds standards 5.5 standard 9 Meets Exceeds standards 5,5 standard 9 Exceeds standard 9 Exceeds standard 9 Meets Exceeds standards 5,5 standard 9 Below Exceeds standards 2 standard 9 Meets Exceeds standards 5,5 standard 9 Exceeds standard 9 Meets Exceeds standards 5.5 standard 9 Meets Exceeds standards 5,5 standard 9 4.578947 9 Packet Page -121- 9/24/2013 10.C. FY2013 Evaluation Plan ��4(-b Robert Tober, County Medical Director 1 EXECUTIVE SUMMARY The County Medical Director is tasked with providing medical leadership for the County's Emergency Medical Services(EMS).The following Evaluation Plan is developed in an effort to provide clear expectations for the County Medical Director for the period from October 2012 through September 2013. The Evaluation plan is based on the broad areas generally expected to be performed by the County Medical Director as well as the requirements of Florida Statute.These include such planning and coordination as may be necessary to deliver pre-hospital medical care by emergency responders through basic life saving Interventions and use of sophisticated technical emergency procedures. Below are the standards for scoring the appraisal. These should help to grade each of the areas on the KRA/appraisal form. Score Result 1-3 • Some adverse trends and/or poor performance levels in a few areas Below • Results not reported for many to most areas of Importance to the organization's r Standards key business requirements F f • Improvement trends and/or good performance levels reported for most areas of i importance to the organization's key business requirements • No pattern of adverse trends and no poor performance levels in areas of 4-7 importance to the organization's key business requirements Meets • Some trends and/or current performance levels--evaluated against relevant Standards comparisons and/or benchmarks--show areas of strength and/or good to very good relative performance levels • Business results address most key customer,market,and process requirements • Current performance is excellent in most areas of importance to the 8-10 organization's key business requirements • Excellent improvement trends and/or sustained excellent performance levels in Exceeds most areas Standards • Evidence of industry and benchmark leadership demonstrated in many areas • Business results fully address key customer, market, process, and action plan requirements Final Standard Rating Needs Improvement Meets Expectations Exceeds Expectations Scale 1.00-3.50 4.00-7.50 8.00-10.00 1 Packet Page-122- 9/24/2013 10.C. The following areas are the broad categories recognized for Medical Director Evaluation which comprise 80%of the evaluation score:Communications;Leadership/Medical Direction;Quality Assurance;Training;and Operational Procedures, COMMUNICATIONS Below Meets Exceeds Standard Standard Standard 1-3 4-7 8-10 C.1 (Internal)The County Medical Director will provide the BCC with timely and accurate responses to requests for information,as well as,coordinating drafts for planned updates to the medical delivery model for the County. C.2 (External)The County Medical Director will be expected to provide information to the public through regular speaking t engagements and Public Relations efforts. C.3 (External)The County Medical Director will be expected to maintain participation in regional or statewide physician's groups Involved In pre-hospital care. C.4 (External)The County Medical Director shall notify the Florida Department of Health in writing regarding use of telemetry,substitutions of medications or equipment,and other operational considerations as required by statute. C.5 (External)The County Medical Director shall serve as a liaison between the County and appropriate community hospitals,medical societies,practicing physicians,and training facilities In the area. LEADERSHIP/ Below Meets Exceeds MEDICAL DIRECTION Standard Standard Standard 1-3 4-7 8-10 L.1 The County Medical Director will supervise and accept responsibility for the medical performance of paramedics and EMTs working for Collier County EMS L.2 The County Medical Director will develop and maintain medically correct standing orders or protocols relating to life 2 Packet Page-123- 9/24/2013 10.C. supporting procedures when communication cannot be established with a supervising physician or when any delay in patient care would potentially threaten the life or health of the patient. L.3 The County Medical Director or his appointee shall provide continuous 24/7 medical direction as to the availability of"off- line"service to resolve problems,system conflicts,and provide (/ services as defined by section 252.34(3)Florida Statutes. L.4 The County Medical Director will issue standing orders to ensure transport of patients to facilities that offer a type and level of care appropriate to the patient's medical condition if 3 available within the service region. L.5 The County Medical Director shall participate as a crewmember on an EMS vehicle for a minimum of 10 hours per year of continuing medical education related to pre- `. hospital care,teaching,or a combination of both. QUALITY ASSURANCE Below Meets Exceeds Standard Standard Standard 1-3 4-7 8-10 QA.1 The County Medical Director will establish and maintain a quality assurance committee to provide for review of medical skills and performance of all medical personnel operating under his /p supervision. QA.2 The County Medical Director in coordination with training programs will determine the criteria to achieve practitioner certification for medical responders. QA.3 The County Medical Director will audit the performance of system personnel through use of and participation In the quality assurance program which will include but is not limited to prompt review of patient care records,direct observation,and comparison of performance standards for drugs,equipment,system protocols "(-) and procedures. /" 3 Packet Page-124- 9/24/2013 10.C. TRAINING Below Meets Exceeds Standard Standard Standard 1-3 4-7 8-10 T.1 The County Medical Director will ensure that all paramedics are trained in the use of the trauma scorecard methodologies as provided in the Florida Administrative Code 64J-2.004 for adults and 64J-2.005 for pediatric patients. T.2 The County Medical Director shall ensure paramedics are trained in the use of automatic or semi-automatic defibrillators, endotracheal Intubation,monitoring both medicated and non- medicated I.V.'s,and the skills required to provide medical care under his written protocols. T.3 The County Medical Director will ensure that all Collier County paramedics and Emergency Medical Technicians are t►'.. offered all training to maintain their certification. `� T.4 The County Medical Director will participate as an instructor at inservice education programs and provide support in j organizing and coordinating such programs. /C� OPERATIONAL PROCEDURES Below Meets Exceeds Standard Standard Standard 1-3 4-7 8-10 0.1 The County Medical Director will ensure and certify that security procedures of Collier County EMS for medications,fluids, `- and controlled substances are in compliance with Florida statutes and Chapter 64F-12 of the Florida Administrative Code. 0.2 The County Medical Director shall create,authorize,and ensure adherence to detailed written operating procedures regarding all aspects of the handling of medications,fluids,and i‘ controlled substances by EMS personnel in compliance with Florida Statute. 0.3 The County Medical Director will serve as a consultant to Collier County EMS for in all areas of pre-hospital medical care including but not limited to equipment selection,supplies, distribution sources,vehicle design,preparation and administration of grant programs,and training opportunities. 4 Packet Page-125- 9/24/2013 10.C. • Other Key Results Areas for 2013: As a reminder,these areas will also be evaluated and will represent 20%of the annual evaluation weight. Issue Resolution/Decision Making:Approaches problems/decisions with a positive attitude and commitment.Identifies issues that impact the organization and seeks creative,new&different remedies.Demonstrates desire to resolve issues& improve the organization in professional manner working within established guidelines and as part of the emergency management team. Below Meets Exceeds Standard Standard Standard 1-3 4-7 8-10 Rating Self Direction/Self Initiation:Uses technical&practical knowledge to Identify needs or improvement opportunities and develops programs designed to Improve pre hospital practices to achieve improved patient care.Contributes to the organization by initiating programs with positive outcomes. Below Meets Exceeds Standard Standard Standard 1-3 4-7 8-10 Rating 3 Ongoing iicensure:Medical Director has maintained board certifications and active participation in broad-based clinical medical specialties and ACLS certification or equivalent as determined in Chapter 64J-1.022,F.A.C. Below Meets Exceeds Standard Standard Standard 1-3 4-7 8-10 Rating S Succession Planning: Medical Director has identified and provided some orientation or training to medical personnel qualified to support or assume medical direction of the agency in the event of emergency or retirement. Continue cross-training,employee development,and succession planning endeavors. Below Meets Exceeds Standard Standard Standard 1-3 4-7 . 8-10 Rating r 5 Packet Page-126- 9/24/2013 10.C. System Effectiveness Measurement:Continue to refine and enhance the quality assurance and response data reports to better measure efficiency and effectiveness.Such reporting and analysis intended to better provide long term and short term planning for delivery of emergency medical care In the County. Below Meets Exceeds Standard Standard Standard 1-3 4-7 8-10 I Rating Commissioner's Comments: �'6 i x- (-SA 3 D F i—No fiNE.D t C A L(—+15..--: 1 C._44. )'1�.(7E.4-C C hk- •57=-1-F I=/f<\LA-.A+-tol cAs' +t r-EA6 N R Af'vtSC; 3EYf±1-ephh . V."(kEet ES -÷t5 Av,-,?r-°e(--k4-t"r —{-4414'7?6 o c -�iW s- r1\SD c kL c.6 ttk a.rt r b -444E 0-4-u-/E- E Ril t,t 4 .� NSit u.-tt G S-��'0KF bK 'r° c►' J �t-Nori '-F.t 1=60<- E a;J t_p 1-t;t4 1C.• Commissioners Suggestions for Improvement: 6 Packet Page-127- 9/24/2013 10.C. FY2013 Evaluation Plan (,i i l!jSC,v\ Robert Tober, County Medical Director EXECUTIVE SUMMARY The County Medical Director is tasked with providing medical leadership for the County's Emergency Medical Services(EMS).The following Evaluation Plan is developed in an effort to provide clear expectations for the County Medical Director for the period from October 2012 through September 2013. The Evaluation plan Is based on the broad areas generally expected to be performed by the County Medical Director as well as the requirements of Florida Statute.These include such planning and coordination as may be necessary to deliver pre-hospital medical care by emergency responders through basic life saving interventions and use of sophisticated technical emergency procedures. Below are the standards for scoring the appraisal. These should help to grade each of the areas on the KRA/appraisal form. Score Result 1-3 • Some adverse trends and/or poor performance levels in a few areas Below • Results not reported for many to most areas of importance to the organization's Standards key business requirements • Improvement trends and/or good performance levels reported for most areas of importance to the organization's key business requirements s • No pattern of adverse trends and no poor performance levels in areas of 14k:, 4-7 importance to the organization's key business requirements Meets • Some trends and/or current performance levels--evaluated against relevant Standards comparisons and/or benchmarks--show areas of strength and/or good to very good relative performance levels • Business results address most key customer,market,and process requirements • Current performance Is excellent in most areas of importance to the 8-10 organization's key business requirements • Excellent improvement trends and/or sustained excellent performance levels in Exceeds most areas Standards • Evidence of industry and benchmark leadership demonstrated in many areas • Business results fully address key customer, market, process, and action plan requirements Final Standard Rating Needs Improvement Meets Expectations Exceeds Expectations Scale 1.00-3.50 4.00-7.50 8.00-10.00 1 Packet Page-128- 9/24/2013 10.C. The following areas are the broad categories recognized for Medical Director Evaluation which comprise 80%of the evaluation score:Communications;Leadership/Medical Direction;Quality Assurance;Training;and Operational Procedures. COMMUNICATIONS Below Meets Exceeds Standard Standard Standard 1-3 4-7 8-10 C.1 (Internal)The County Medical Director will provide the BCC with timely and accurate responses to requests for information,as well as,coordinating drafts for planned updates to the medical delivery model for the County. C.2 (External)The County Medical Director will be expected to provide information to the public through regular speaking engagements and Public Relations efforts. s i C.3 (External)The County Medical Director will be expected to maintain participation in regional or statewide physician's 5-- groups involved in pre-hospital care. C.4 (External)The County Medical Director shall notify the Florida Department of Health in writing regarding use of telemetry,substitutions of medications or equipment,and other operational considerations as required by statute. C.5 (External)The County Medical Director shall serve as a liaison between the County and appropriate community hospitals,medical societies,practicing physicians,and training facilities in the area. LEADERSHIP/ Below Meets Exceeds MEDICAL DIRECTION Standard Standard Standard 1-3 4-7 8-10 L.1 The County Medical Director will supervise and accept - responsibility for the medical performance of paramedics and EMTs working for Collier County EMS L.2 The County Medical Director will develop and maintain medically correct standing orders or protocols relating to life 2 Packet Page-129- 9/24/2013 10.C. +�. supporting procedures when communication cannot be established with a supervising physician or when any delay in _ patient care would potentially threaten the life or health of the patient. L.3 The County Medical Director or his appointee shall provide continuous 24/7 medical direction as to the availability of"off- line"service to resolve problems,system conflicts,and provide services as defined by section 252.34(3)Florida Statutes. L.4 The County Medical Director will issue standing orders to ensure transport of patients to facilities that offer a type and level of care appropriate to the patient's medical condition If available within the service region. L.5 The County Medical Director shall participate as a crewmember on an EMS vehicle for a minimum of 10 hours per year of continuing medical education related to pre- 014 k) hospital care,teaching,or a combination of both. QUALITY ASSURANCE Below Meets Exceeds Standard Standard Standard 1-3 4-7 8-10 QA.1 The County Medical Director will establish and maintain a quality assurance committee to provide for review of medical skills and performance of all medical personnel operating under his supervision. QA.2 The County Medical Director in coordination with training programs will determine the criteria to achieve practitioner certification for medical responders. QA.3 The County Medical Director will audit the performance of system personnel through use of and participation in the quality assurance program which will include but is not limited to prompt review of patient care records,direct observation,and comparison of performance standards for drugs,equipment,system protocols and procedures. 3 Packet Page-130- 9/24/2013 10.C. TRAINING Below Meets Exceeds Standard Standard Standard 1-3 4-7 8-10 T.1 The County Medical Director will ensure that all paramedics are trained in the use of the trauma scorecard methodologies as provided in the Florida Administrative Code 64J-2.004 for adults and 64J-2.005 for pediatric patients. T,2 The County Medical Director shall ensure paramedics are trained in the use of automatic or semi-automatic defibrillators, endotracheal intubation,monitoring both medicated and non- medicated I.V.'s,and the skills required to provide medical care under his written protocols. T.3 The County Medical Director will ensure that all Collier County paramedics and Emergency Medical Technicians are offered all training to maintain their certification. T.4 The County Medical Director will participate as an instructor at inservice education programs and provide support In organizing and coordinating such programs. OPERATIONAL PROCEDURES Below Meets Exceeds Standard Standard Standard 1-3 4-7 8-10 0.1 The County Medical Director will ensure and certify that security procedures of Collier County EMS for medications,fluids, and controlled substances are in compliance with Florida 1. Statutes and Chapter 64F-12 of the Florida Administrative Code. ✓ i 0.2 The County Medical Director shall create,authorize,and ensure adherence to detailed written operating procedures regarding all aspects of the handling of medications,fluids,and �^ controlled substances by EMS personnel in compliance with 5 Florida Statute. 0.3 The County Medical Director will serve as a consultant to Collier County EMS for in all areas of pre-hospital medical care including but not limited to equipment selection,supplies, distribution sources,vehicle design,preparation and administration of grant programs,and training opportunities. 4 Packet Page-131- 9/24/2013 10.C. Other Key Results Areas for 2013: As a reminder,these areas will also be evaluated and will represent 20%of the annual evaluation weight. Issue Resolution/Decision Making:Approaches problems/decisions with a positive attitude and commitment.Identifies issues that Impact the organization and seeks creative,new&different remedies.Demonstrates desire to resolve issues& improve the organization In professional manner working within established guidelines and as part of the emergency management team. Below Meets Exceeds Standard Standard Standard 1-3 4-7 8-10 Rating Self Direction/Self Initiation:Uses technical&practical knowledge to Identify needs or improvement opportunities and develops programs designed to Improve pre hospital practices to achieve improved patient care.Contributes to the organization by initiating programs with positive outcomes. Below Meets Exceeds Standard Standard Standard 1-3 4-7 8-10 Rating Ongoing licensure:Medical Director has maintained board certifications and active participation in broad-based clinical medical specialties and ACLS certification or equivalent as determined in Chapter 64J-1.022,F.A.C. Below Meets Exceeds Standard Standard Standard 1-3 4-7 8-10 Rating Sr Succession Planning: Medical Director has identified and provided some orientation or training to medical personnel qualified to support or assume medical direction of the agency in the event of emergency or retirement. Continue cross-training,employee development,and succession planning endeavors. Below Meets Exceeds Standard Standard Standard 1-3 4-7 8-10 Rating 5 5 Packet Page -132- 9/24/2013 10.C. System Effectiveness Measurement:Continue to refine and enhance the quality assurance and response data reports to better measure efficiency and effectiveness.Such reporting and analysis intended to better provide long term and short term planning for delivery of emergency medical care In the County. Below Meets Exceeds Standard Standard Standard 1fd 4-7 8-10 Rating kh(Qh Commissioner's Comments: / Astok Commissioners Suggestions for Improvement: 6 Packet Page-133- 9/24/2013 10.C. FY2013 Evaluation Plan Robert Taber, County Medical Director EXECUTIVE SUMMARY The County Medical Director is tasked with providing medical leadership for the County's Emergency Medical Services(EMS).The following Evaluation Plan is developed in an effort to provide clear expectations for the County Medical Director for the period from October 2012 through September 2013. The Evaluation plan is based on the broad areas generally expected to be performed by the County Medical Director as well as the requirements of Florida Statute.These include such planning and coordination as may be necessary to deliver pre-hospital medical care by emergency responders through basic life saving interventions and use of sophisticated technical emergency procedures. Below are the standards for scoring the appraisal. These should help to grade each of the areas on the KRA/appraisal form. Score Result 1-3 • Some adverse trends and/or poor performance levels in a few areas Below • Results not reported for many to most areas of importance to the organization's Standards key business requirements • Improvement trends and/or good performance levels reported for most areas of importance to the organization's key business requirements • No pattern of adverse trends and no poor performance levels in areas of 4-7 importance to the organization's key business requirements Meets • Some trends and/or current performance levels--evaluated against relevant Standards comparisons and/or benchmarks--show areas of strength and/or good to very good relative performance levels • Business results address most key customer,market,and process requirements • • Current performance is excellent in most areas of importance to the 8-10 organization's key business requirements • Excellent Improvement trends and/or sustained excellent performance levels in Exceeds most areas Standards • Evidence of industry and benchmark leadership demonstrated in many areas • Business results fully address key customer, market, process, and action plan requirements Final Standard Rating Needs Improvement Meets Expectations Exceeds Expectations Scale .00-3.50 4.00—7.50 8.00—10.00 \\ , "171.49 V 3 Packet Page-134- 9/24/2013 10.C. otorAtA The following areas are the broad categories recognized for Medical Director Evaluation which comprise 80%of the evaluation score:Communications;Leadership/Medical Direction;Quality Assurance;Training;and Operational Procedures. COMMUNICATIONS Below Meets Exceeds Standard Standard Standard 1-3 4-7 8-10 C.1 (Internal)The County Medical Director will provide the BCC with timely and accurate responses to requests for information,as well as,coordinating drafts for planned • updates to the medical delivery model for the County. C.2 (External)The County Medical Director will be expected to provide information to the public through regular speaking engagements and Public Relations efforts. C.3 (External)The County Medical Director will be expected to maintain participation in regional or statewide physician's groups involved in pre-hospital care. C.4 (External)The County Medical Director shall notify the Florida Department of Health in writing regarding use of telemetry,substitutions of medications or equipment,and other operational considerations as required by statute. C.5 (External)The County Medical Director shall serve as a liaison between the County and appropriate community hospitals,medical societies, practicing physicians,and training facilities in the area. LEADERSHIP/ Below Meets Exceeds MEDICAL DIRECTION Standard Standard Standard 1-3 4-7 8-10 L.1 The County Medical Director will supervise and accept }} responsibility for the medical performance of paramedics and EMTs working for Collier County EMS t/ L.2 The County Medical Director will develop and maintain medically correct standing orders or protocols relating to life 2 U 1T7--\ R Packet Page-135- 9/24/2013 10.C. supporting procedures when communication cannot be established with a supervising physician or when any delay in patient care would potentially threaten the life or health of the patient. L.3 The County Medical Director or his appointee shall provide continuous 24/7 medical direction as to the availability of"off- line"service to resolve problems,system conflicts,and provide services as defined by section 252.34(3)Florida Statutes. L.4 The County Medical Director will issue standing orders to ensure transport of patients to facilities that offer a type and level of care appropriate to the patient's medical condition if available within the service region. L.5 The County Medical Director shall participate as a crewmember on an EMS vehicle for a minimum of 10 hours per year of continuing medical education related to pre- hospital care,teaching,or a combination of both. QUALITY ASSURANCE Below Meets Exceeds Standard Standard Standard 1-3 4-7 8-10 QA.1 The County Medical Director will establish and maintain a quality assurance committee to provide for review of medical skills and performance of all medical personnel operating under his supervision. QA.2 The County Medical Director in coordination with training programs will determine the criteria to achieve practitioner certification for medical responders. QA.3 The County Medical Director will audit the performance of system personnel through use of and participation in the quality • assurance program which will include but is not limited to prompt review of patient care records,direct observation,and comparison of performance standards for drugs,equipment,system protocols and procedures. 3 Packet Page -136- 9/24/2013 10.C. TRAINING Below Meets Exceeds Standard Standard Standard 1-3 4-7 8-10 T.1 The County Medical Director will ensure that all paramedics are trained in the use of the trauma scorecard methodologies as provided in the Florida Administrative Code 64J-2.004 for adults and 64J-2.005 for pediatric patients. T.2 The County Medical Director shall ensure paramedics are trained in the use of automatic or semi-automatic defibrillators, endotracheal intubation,monitoring both medicated and non- medicated I.V.'s,and the skills required to provide medical care under his written protocols. T.3 The County Medical Director will ensure that all Collier County paramedics and Emergency Medical Technicians are I offered all training to maintain their certification. T.4 The County Medical Director will participate as an instructor • at inservice education programs and provide support in organizing and coordinating such programs. OPERATIONAL PROCEDURES Below Meets Exceeds Standard Standard Standard 1-3 4-7 8-10 0.1 The County Medical Director will ensure and certify that security procedures of Collier County EMS for medications,fluids, and controlled substances are in compliance with Florida Statutes and Chapter 64F-12 of the Florida Administrative Code. 0.2 The County Medical Director shall create,authorize,and ensure adherence to detailed written operating procedures regarding all aspects of the handling of medications,fluids,and controlled substances by EMS personnel in compliance with Florida Statute. 0.3 The County Medical Director will serve as a consultant to Collier County EMS for in all areas of pre-hospital medical care including but not limited to equipment selection,supplies, distribution sources,vehicle design,preparation and administration of grant programs,and training opportunities. 4 fk � I Packet Page-137- 9/24/2013 10.C. Other Key Results Areas for 2013: As a reminder,these areas will also be evaluated and will represent 20%of the annual evaluation weight. Issue Resolution/Decision Making:Approaches problems/decisions with a positive attitude and commitment.Identifies issues that impact the organization and seeks creative,new&different remedies.Demonstrates desire to resolve issues& improve the organization In professional manner working within established guidelines and as part of the emergency management team. Below Meets Exceeds Standard Standard Standard 1-3 4-7 8-10 Rating Self Direction/Self Initiation:Uses technical&practical knowledge to identify needs or improvement opportunities and develops programs designed to Improve pre hospital practices to achieve improved patient care.Contributes to the organization by initiating programs with positive outcomes. Below Meets Exceeds Standard Standard Standard 1-3 4-7 8-10 Rating / Ongoing Ilcensure:Medical Director has maintained board certifications and active participation in broad-based clinical medical specialties and ACLS certification or equivalent as determined in Chapter 64J-1.022,F.A.C. Below Meets Exceeds Standard Standard Standard 1-3 4-7 8-10 Rating Succession Planning: Medical Director has identified and provided some orientation or training to medical personnel qualified to support or assume medical direction of the agency in the event of emergency or retirement. Continue cross-training,employee development,and succession planning endeavors. Below Meets Exceeds Standard Standard Standard 1-3 4-7 8-10 Rating \-\VK Packet Page -138- 9/24/2013 10.C. System Effectiveness Measurement:Continue to refine and enhance the quality assurance and response data reports to better measure efficiency and effectiveness.Such reporting and analysis intended to better provide long term and short term planning for delivery of emergency medical care in the County. Below Meets Exceeds Standard Standard Standard 1-3 4-7 8-10 • Rating Commissioner's Comments: • 1 71 Commissioners Suggestions for Improvement: 6 Packet Page-139- 9/24/2013 10.C. FY2013 Evaluation Plan Robert Tober, County Medical Director /0,4 EXECUTIVE SUMMARY The County Medical Director Is tasked with providing medical leadership for the County's Emergency Medical Services(EMS).The following Evaluation Plan Is developed in an effort to provide clear expectations for the County Medical Director for the period from October 2012 through September 2013. The Evaluation plan is based on the broad areas generally expected to be performed by the County Medical Director as well as the requirements of Florida Statute.These include such planning and coordination as may be necessary to deliver pre-hospital medical care by emergency responders through basic life saving Interventions and use of sophisticated technical emergency procedures. Below are the standards for scoring the appraisal. These should help to grade each of the areas on the KRA/appraisal form. Score Result 1-3 • Some adverse trends and/or poor performance levels in a few areas Below • Results not reported for many to most areas of importance to the organization's Standards key business requirements • Improvement trends and/or good performance levels reported for most areas of importance to the organization's key business requirements • No pattern of adverse trends and no poor performance levels in areas of 4-7 importance to the organization's key business requirements Meets • Some trends and/or current performance levels--evaluated against relevant Standards good relative performance levels comparisons and/or benchmarks--show areas of strength and/or good to very • Business results address most key customer,market,and process requirements • Current performance is excellent in most areas of importance to the 8-10 organization's key business requirements • Excellent improvement trends and/or sustained excellent performance levels In Exceeds most areas Standards • Evidence of industry and benchmark leadership demonstrated in many areas • Business results fully address key customer, market, process, and action plan requirements Final Standard Rating Needs Improvement Meets Expectations Exceeds Expectations Scale 1.00-3.50 4.00-7.50 800-10.00 1 Packet Page-140- 9/24/2013 10.C. )01 VIlt The following areas are the broad categories recognized for Medical Director Evaluation which comprise 80%of the evaluation score:Communications;Leadership/Medical Direction;Quality Assurance;Training;and I Operational Procedures. 1 I COMMUNICATIONS Below Meets Exceeds Standard Standard Standard 1-3 4-7 8-10 �S . (Int nal)The County Medical Director will provide the ^ ("D BCC wit_imely and accurate responses to requests for Cr Pb'S ormation,as well as,coordinating drafts for planned U/(i updates to the medical delivery model for the County. C.2 (External)The County Medical Director will be expected r++!(G to provide information to the public through regular speaking 1. V61iOJp engagements and Public Relations efforts. C.3 (External)The County Medical Director will be expected ,( to maintain participation In regional or statewide physician's 4fi ,f 5 groups involved in pre-hospital care. 7 ✓ f" C.4 (External)The County Medical Director shall notify the Florida Department of Health in writing regarding use of // telemetry,substitutions of medications or equipment,and other operational considerations as required by statute. G t C.5 (External)The County Medical Director shall serve as a / liaison between the County and appropriate community ,,^ hospitals,medical societies,practicing physicians,and training Ce/'`S (AV 1 facilities in the area. i LEADERSHIP/ Below Meets Exceeds MEDICAL DIRECTION Standard Standard Standard 1-3 4-7 8-10 L.1 The County Medical Director will supervise and accept responsibility for the medical performance of paramedics and Q EMTs working for Collier County EMSl ` L.2 The County Medical Director will develop and maintain medically correct standing orders or protocols relating to life 2 A,, Packet Page-141- 1 9/24/2013 10.C. supporting procedures when communication cannot be �� ro established with a supervising physician or when any delay in /pJ / patient care would potentially threaten the life or health of the C r patient. L.3 The County Medical Director or his appointee shall provide t0 f continuous 24/7 medical direction as to the availability of"off- line"service to resolve problems,system conflicts,and provide ' n)�/ services as defined by section 252.34(3)Florida Statutes. / 1✓ L.4 The County Medical Director will issue standing orders to lvi" ensure transport of patients to facilities that offer a type and � _(ktI . 0 f level of care appropriate to the patient's medical condition if ,�(( !J available within the service region. A�h/t[ '/ L.5 The County Medical Director shall participate as a e crewmember on an EMS vehicle for a minimum of 10 hours 0 ��/f� per year of continuing medical education related to pre- //� 0f"`' 0�se5 hospital care,teaching,or a combination of both. v 1 QUALITY ASSURANCE Below Meets Exceeds Standard Standard Standard 1-3 4-7 8-10 QQA.1 The County Medical Director will establish and maintain a `►, O ll, S quality assurance committee to provide for review of medical skills ��➢" and performance of all medical personnel operating under his /� (0 II' supervision. �(,� 1)6 cril QA.2 The County Medical Director in coordination with training programs will determine the criteria to achieve practitioner (�' A l certification for medical responders. 4 � � QA.3 The County Medical Director will audit the performance of system personnel through use of and participation in the quality assurance program which will include but is not limited to prompt I.� review of patient care records,direct observation,and comparison �i 1 of performance standards for drugs,equipment,system protocols and procedures. C. 3 Packet Page-142- i i 9/24/2013 10.C. TRAINING Below Meets Exceeds Standard Standard Standard 1-3 4-7 8-10 I T.1 The County Medical Director will ensure that all paramedics ��i are trained in the use of the trauma scorecard methodologies as . 1',w l R provided In the Florida Administrative Code 64J-2.004 for adults ! and 64J-2.005 for pediatric patients. / i T.2 The County Medical Director shall ensure paramedics are trained in the use of automatic or semi-automatic defibrillators, endotracheal intubation,monitoring both medicated and non- /l 0lni'd� medicated I.V.'s,and the skills required to provide medical care /U �` under his written protocols. T.3 The County Medical Director will ensure that all Collier {�Q��C County paramedics and Emergency Medical Technicians are �,� f�SL^"Y a/,� U I (I' A offered all training to maintain their certification. ' � T.4 The County Medical Director will participate as an instructor �G at inservice education programs and provide support In organizing and coordinating such programs. 9 Dim OPERATIONAL PROCEDURES Below Meets Exceeds Standard Standard Standard 1-3 4-7 8-10 0.1 The County Medical Director will ensure and certify that security procedures of Collier County EMS for medications,fluids, 9 and controlled substances are in compliance with Floridajivi Statutes and Chapter 64F-12 of the Florida Administrative Code. . 0.2 The County Medical Director shall create,authorize,and ensure adherence to detailed written operating procedures regarding all aspects of the handling of medications,fluids,and i controlled substances by EMS personnel in compliance with Florida Statute. 0.3 The County Medical Director will serve as a consultant to Collier County EMS for in all areas of pre-hospital medical care kJ/VIM including but not limited to equipment selection,supplies, �I distribution sources,vehicle design,preparation and N t administration of grant programs,and training opportunities. 4 Packet Page -143- 9/24/2013 10.C. Other Key Results Areas for 2013; As a reminder,these areas will also be evaluated and will represent 20%of the annual evaluation weight. Issue Resolution/Decision Making:Approaches problems/decisions with a positive attitude and commitment.Identifies Issues that Impact the organization and seeks creative,new&different remedies.Demonstrates desire to resolve issues& improve the organization in professional manner working within established guidelines and as part of the emergency management team. Below Meets Exceeds Standard Standard Standard 1-3 4-7 8-10 Rating y I Self Direction/Self Initiation:Uses technical&practical knowledge to identify needs or improvement opportunities and develops programs designed to improve pre hospital practices to achieve Improved patient care.Contributes to the organization by initiating programs with positive outcomes. Below Meets Exceeds Standard Standard Standard 1-3 4-7 8-10 Rating i Ongoing licensure:Medical Director has maintained board certifications and active participation in broad-based clinical medical specialties and ACLS certification or equivalent as determined in Chapter 64J-1.022,F.A.C. GAS �/C C N Jf Below Meets Exceeds J / Standard Standard Standard 1-3 4-7 8-100 139 lie-D Rating i Succession Planning: Medical Director has identified and provided some orientation or training to medical personnel qualified to support or assume medical direction of the agency in the event of emergency or retirement. Continue cross-training,employee development,and succession planning endeavors. • Below Meets Exceeds Standard Standard Standard 1-3 4-7 8-10� I Rating 5 C Packet Page-144- I 9/24/2013 10.C. i I System Effectiveness Measurement:Continue to refine and enhance the quality assurance and response data reports to better measure efficiency and effectiveness.Such reporting and analysis intended to better provide long I term and short term planning for delivery of emergency medical care In the County. i 1 i Below Meets Exceeds Standard Standard Standard 1-3 4-7 8-10 Rating IIIIMIIIIII i ,41 /C/9G- /9.fo?���,ee5 - ii' ilo.91, s Commissioner's Comments: ,/e 7 .66e-- e5 V7Z/1/ 7/S* /77//M5e.,, - AfrKfli /M_s- ir L� /J I 6ik!/ ez—i I ` / ♦ Af -1 . 2/ ,, I/ r j.d . v S #1 AO . a i Sri f Ce Fs . Commissioners Suggestions for Improvement: I i Z3 611-v,7/o,!s afr-- ("&,4,t-el-'1 ---,4---41 7) fr 2)f , ft76', 'f'/,vr 9,V y w,f.✓ ) Cir -�� 5. ' mr� f//-7- ________72/-"A- 1/1 7 - - BCC- //.25`E... 6 Packet Page-145- 9/24/2013 10.C. FY2013 Evaluation Plan Robert Tober, County Medical Director EXECUTIVE SUMMARY The County Medical Director is tasked with providing medical leadership for the County's Emergency Medical Services(EMS).The following Evaluation Plan is developed in an effort to provide clear expectations for the County Medical Director for the period from October 2012 through September 2013. The Evaluation plan is based on the broad areas generally expected to be performed by the County Medical Director as well as the requirements of Florida Statute.These Include such planning and coordination as may be necessary to deliver pre-hospital medical care by emergency responders through basic life saving interventions and use of sophisticated technical emergency procedures. Below are the standards for scoring the appraisal. These should help to grade each of the areas on the KRA/appraisal form. Score Result 1-3 • Some adverse trends and/or poor performance levels in a few areas Below • Results not reported for many to most areas of importance to the organization's Standards key business requirements • Improvement trends and/or good performance levels reported for most areas of importance to the organization's key business requirements • No pattern of adverse trends and no poor performance levels in areas of 4-7 importance to the organization's key business requirements Meets • Some trends and/or current performance levels--evaluated against relevant Standards comparisons and/or benchmarks—show areas of strength and/or good to very good relative performance levels • Business results address most key customer,market,and process requirements • Current performance Is excellent in most areas of importance to the 8-10 organization's key business requirements • Excellent improvement trends and/or sustained excellent performance levels in Exceeds most areas Standards • Evidence of industry and benchmark leadership demonstrated in many areas • Business results fully address key customer, market, process, and action plan requirements Final Standard Rating Needs Improvement Meets Expectations Exceeds Expectations Scale 1.00-3.50 4.00-7.50 8.00-10.00 1 Packet Page-146- 9/24/2013 10.C. The following areas are the broad categories recognized for Medical Director Evaluation which comprise 80%of the evaluation score:Communications;Leadership/Medical Direction;Quality Assurance;Training;and Operational Procedures. COMMUNICATIONS Below Meets Exceeds Standard Standard Standard 1-3 4-7 8-10 C.1 (Internal)The County Medical Director will provide the BCC with timely and accurate responses to requests for information,as well as,coordinating drafts for planned updates to the medical delivery model for the County. C.2 (External)The County Medical Director will be expected to provide information to the public through regular speaking engagements and Public Relations efforts. 9 C.3 (External)The County Medical Director will be expected to maintain participation in regional or statewide physician's groups involved in pre-hospital care. ID I C.4 (External)The County Medical Director shall notify the Florida Department of Health in writing regarding use of telemetry,substitutions of medications or equipment,and other operational considerations as required by statute. C.5 (External)The County Medical Director shall serve as a liaison between the County and appropriate community hospitals,medical societies,practicing physicians,and training facilities in the area. LEADERSHIP/ Below Meets Exceeds MEDICAL DIRECTION Standard Standard Standard 1-3 4-7 8-10 L.1 The County Medical Director will supervise and accept responsibility for the medical performance of paramedics and EMTs working for Collier County EMS L.2 The County Medical Director will develop and maintain medically correct standing orders or protocols relating to life 2 Packet Page-147- 9/24/2013 10.C. supporting procedures when communication cannot be established with a supervising physician or when any delay in patient care would potentially threaten the life or health of the Si patient. L.3 The County Medical Director or his appointee shall provide continuous 24/7 medical direction as to the availability of"off- line"service to resolve problems,system conflicts,and provide 11> services as defined by section 252.34(3)Florida Statutes. L.4 The County Medical Director will issue standing orders to ensure transport of patients to facilities that offer a type and level of care appropriate to the patient's medical condition if available within the service region. L.5 The County Medical Director shall participate as a crewmember on an EMS vehicle for a minimum of 10 hours per year of continuing medical education related to pre- 6 hospital care,teaching,or a combination of both. QUALITY ASSURANCE Below Meets Exceeds Standard Standard Standard ,, - 1-3 4-7 8-10 QA.1 The County Medical Director will establish and maintain a quality assurance committee to provide for review of medical skills and performance of all medical personnel operating under his 9 supervision. QA.2 The County Medical Director in coordination with training programs will determine the criteria to achieve practitioner certification for medical responders. QA.3 The County Medical Director will audit the performance of system personnel through use of and participation in the quality assurance program which will include but is not limited to prompt review of patient care records,direct observation,and comparison of performance standards for drugs,equipment,system protocols and procedures. Alf"' 3 Packet Page-148- 9/24/2013 10.C. i TRAINING Below Meets Exceeds Standard Standard Standard 1-3 4-7 8-10 T.1 The County Medical Director will ensure that all paramedics are trained in the use of the trauma scorecard methodologies as provided in the Florida Administrative Code 641-2.004 for adults and 64J-2.005 for pediatric patients. T.2 The County Medical Director shall ensure paramedics are trained In the use of automatic or semi-automatic defibrillators, endotracheal intubation,monitoring both medicated and non- medicated I.V.'s,and the skills required to provide medical care under his written protocols. T.3 The County Medical Director will ensure that all Collier County paramedics and Emergency Medical Technicians are offered all training to maintain their certification. T.4 The County Medical Director will participate as an instructor at inservice education programs and provide support in organizing and coordinating such programs. OPERATIONAL PROCEDURES Below Meets Exceeds Standard Standard Standard 1-3 4-7 8-10 0.1 The County Medical Director will ensure and certify that security procedures of Collier County EMS for medications,fluids, and controlled substances are in compliance with Florida 9 i Statutes and Chapter 64F-12 of the Florida Administrative Code. 0.2 The County Medical Director shall create,authorize,and ensure adherence to detailed written operating procedures regarding all aspects of the handling of medications,fluids,and controlled substances by EMS personnel in compliance with Florida Statute. 0.3 The County Medical Director will serve as a consultant to Collier County EMS for in all areas of pre-hospital medical care including but not limited to equipment selection,supplies, distribution sources,vehicle design,preparation and administration of grant programs,and training opportunities. 4 Packet Page-149- 9/24/2013 10.C. Other Key Results Areas for 2013: As a reminder,these areas will also be evaluated and will represent 20%of the annual evaluation weight. Issue Resolution/Decision Making:Approaches problems/decisions with a positive attitude and commitment.Identifies issues that impact the organization and seeks creative,new&different remedies.Demonstrates desire to resolve Issues& improve the organization In professional manner working within established guidelines and as part of the emergency management team. Below Meets Exceeds Standard Standard Standard 1-3 4-7 8-10 Rating 8 Self Direction/Self Initiation:Uses technical&practical knowledge to Identify needs or improvement opportunities and develops programs designed to improve pre hospital practices to achieve improved patient care.Contributes to the organization by initiating programs with positive outcomes. Below Meets Exceeds Standard Standard Standard 1-3 4-7 8-10 Rating 8 Ongoing licensure:Medical Director has maintained board certifications and active participation in broad-based clinical medical specialties and ACLS certification or equivalent as determined in Chapter 64J-1.022,F.A.C. Below Meets Exceeds Standard Standard Standard 1-3 4-7 8-10 Rating 8 Succession Planning: Medical Director has Identified and provided some orientation or training to medical personnel qualified to support or assume medical direction of the agency in the event of emergency or retirement. Continue cross-training,employee development,and succession planning endeavors. Below Meets Exceeds Standard Standard Standard 1-3 4-7 8-10 Rating 7 5 Packet Page-150- 9/24/2013 10.C. System Effectiveness Measurement:Continue to refine and enhance the quality assurance and response data reports to better measure efficiency and effectiveness.Such reporting and analysis intended to better provide long term and short term planning for delivery of emergency medical care in the County. Below Meets Exceeds Standard Standard Standard 1-3 47 8-10 Rating Commissioner's Comments: /.49.k-k_ /s P e r»e v /93t / b T H E ail - A D 4P0A.)4l4lL1TiE . RS. 3t }TiFtE71 774-E_ CC 4€ 1 I 112Eb1 cAL 7Di , /4 rHHs geleescJ6. /r ercr .0/7iG,c.) t� �7?f� Cze iAiTy `4—)D /- LED A OvALI7 y 192vG wt !fit$ APPm,1.�i rvi Exy-. I _n Commissioners Suggestions for Improvement: 6 Packet Page -151- 9/24/2013 10.C. f zs Tel,1303. C. Packet Page -152 9/24/2013 10.C. FY2013 Evaluation Plan Robert Tober, County Medical Director EXECUTIVE SUMMARY The County Medical Director is tasked with providing medical leadership for the County's Emergency Medical Services(EMS).The following Evaluation Plan Is developed in an effort to provide clear expectations for the County Medical Director for the period from October 2012 through September 2013, The Evaluation plan is based on the broad areas generally expected to be performed by the County Medical Director as well as the requirements of Florida Statute.These include such planning and coordination as may be necessary to deliver pre-hospital medical care by emergency responders through basic life saving interventions and use of sophisticated technical emergency procedures. Below are the standards for scoring the appraisal. These should help to grade each of the areas on the KRA/appraisal form. Score Result 1-3 • Some adverse trends and/or poor performance levels in a few areas Below • Results not reported for many to most areas of importance to the organization's key business requirements Standards ) • Improvement trends and/or good performance levels reported for most areas of importance to the organization's key business requirements • No pattern of adverse trends and no poor performance levels in areas of 4-7 importance to the organization's key business requirements Meets • Some trends and/or current performance levels--evaluated against relevant Standards comparisons and/or benchmarks--show areas of strength and/or good to very good relative performance levels • Business results address most key customer,market,and process requirements • Current performance is excellent in most areas of importance to the 8-10 organization's key business requirements • Excellent Improvement trends and/or sustained excellent performance levels in Exceeds most areas Standards • Evidence of industry and benchmark leadership demonstrated in many areas • Business results fully address key customer, market, process, and action plan requirements Final Standard Rating Needs Improvement Meets Expectations Exceeds Expectations Scale 1.00-3.50 4.00-7.50 8.00-10.00 1 Packet Page-153- 9/24/2013 10.C. The following areas are the broad categories recognized for Medical Director Evaluation which comprise 80%of the evaluation score:Communications;Leadership/Medical Direction;Quality Assurance;Training;and Operational Procedures. COMMUNICATIONS Below Meets Exceeds Standard Standard Standard 1-3 4-7 8-10 C.1 (Internal)The County Medical Director will provide the BCC with timely and accurate responses to requests for information,as well as,coordinating drafts for planned • updates to the medical delivery model for the County. C.2 (External)The County Medical Director will be expected to provide information to the public through regular speaking engagements and Public Relations efforts. C.3 (External)The County Medical Director will be expected to maintain participation in regional or statewide physician's groups involved in pre-hospital care. • C.4 (External)The County Medical Director shall notify the Florida Department of Health in writing regarding use of Niko telemetry,substitutions of medications or equipment,and other operational considerations as required by statute. C.5 (External)The County Medical Director shall serve as a liaison between the County and appropriate community hospitals,medical societies,practicing physicians,and training facilities in the area. LEADERSHIP/ Below Meets Exceeds MEDICAL DIRECTION Standard Standard Standard 1-3 4-7 8-10 L.1 The County Medical Director will supervise and accept responsibility for the medical performance of paramedics and EMTs working for Collier County EMS L.2 The County Medical Director will develop and maintain medically correct standing orders or protocols relating to life 2 Packet Page-154- 9/24/2013 10.C. supporting procedures when communication cannot be established with a supervising physician or when any delay in patient care would potentially threaten the life or health of the patient. L.3 The County Medical Director or his appointee shall provide continuous 24/7 medical direction as to the availability of"off- line"service to resolve problems,system conflicts,and provide services as defined by section 252.34(3)Florida Statutes. L.4 The County Medical Director will issue standing orders to ensure transport of patients to facilities that offer a type and level of care appropriate to the patient's medical condition if available within the service region. L.5 The County Medical Director shall participate as a crewmember on an EMS vehicle for a minimum of 10 hours per year of continuing medical education related to pre- hospital care,teaching,or a combination of both. QUALITY ASSURANCE Below Meets Exceeds Standard Standard Standard 1-3 4-7 8-10 °^ QA.1 The County Medical Director will establish and maintain a quality assurance committee to provide for review of medical skills • and performance of all medical personnel operating under his supervision. QA.2 The County Medical Director in coordination with training programs will determine the criteria to achieve practitioner certification for medical responders. QA,3 The County Medical Director will audit the performance of system personnel through use of and participation in the quality assurance program which will include but is not limited to prompt review of patient care records,direct observation,and comparison of performance standards for drugs,equipment,system protocols and procedures. 3 Packet Page-155- 9/24/2013 10.C. TRAINING Below Meets Exceeds Standard Standard Standard 1-3 4-7 8-10 T.1 The County Medical Director will ensure that all paramedics are trained in the use of the trauma scorecard methodologies as 7 provided In the Florida Administrative Code 64J-2.004 for adults and 64J-2.005 for pediatric patients. T.2 The County Medical Director shall ensure paramedics are trained in the use of automatic or semi-automatic defibrillators, endotracheal intubation,monitoring both medicated and non- medicated I.V.'s,and the skills required to provide medical care under his written protocols. T.3 The County Medical Director will ensure that all Collier County paramedics and Emergency Medical Technicians are offered all training to maintain their certification. T.4 The County Medical Director will participate as an Instructor at inservice education programs and provide support in organizing and coordinating such programs. OPERATIONAL PROCEDURES Below Meets Exceeds Standard Standard Standard 1-3 4-7 8-10 0.1 The County Medical Director will ensure and certify that security procedures of Collier County EMS for medications,fluids, and controlled substances are in compliance with Florida Statutes and Chapter 64F-12 of the Florida Administrative Code. 0.2 The County Medical Director shall create,authorize,and ensure adherence to detailed written operating procedures regarding all aspects of the handling of medications,fluids,and ? controlled substances by EMS personnel in compliance with Florida Statute. 0.3 The County Medical Director will serve as a consultant to Collier County EMS for in all areas of pre-hospital medical care including but not limited to equipment selection,supplies, distribution sources,vehicle design,preparation and �J administration of grant programs,and training opportunities. � ' 4 low Packet Page-156- 9/24/2013 10.C. Other Key Results Areas for 2013: As a reminder,these areas will also be evaluated and will represent 20%of the annual evaluation weight. Issue Resolution/Decision Making:Approaches problems/decisions with a positive attitude and commitment.Identifies issues that impact the organization and seeks creative,new&different remedies.Demonstrates desire to resolve issues& improve the organization in professional manner working within established guidelines and as part of the emergency management team. Below Meets Exceeds Standard Standard Standard 1-3 / 4-7 8-10 Rating Self Direction/Self Initiation:Uses technical&practical knowledge to Identify needs or improvement opportunities and develops programs designed to Improve pre hospital practices to achieve improved patient care.Contributes to the organization by initiating programs with positive outcomes. Below Meets Exceeds Standard Standard Standard 1-3 4-7 ( 8-10 Rating Ongoing licensure:Medical Director has maintained board certifications and active participation in broad-based clinical medical specialties and ACLS certification or equivalent as determined in Chapter 641-1.022, F.A.C. Below Meets Exceeds Standard Standard Standard 1-3 4-7 8-10 Rating i Succession Planning: Medical Director has identified and provided some orientation or training to medical personnel qualified to support or assume medical direction of the agency in the event of emergency or retirement. Continue cross-training,employee development,and succession planning endeavors. Below Meets Exceeds Standard Standard Standard 1-3 4-7 8-10 Rating 5 Packet Page-157- 9/24/2013 10.C. System Effectiveness Measurement:Continue to refine and enhance the quality assurance and response data reports to better measure efficiency and effectiveness.Such reporting and analysis intended to better provide long term and short term planning for delivery of emergency medical care In the County. Below Meets Exceeds Standard Standard Standard 1-3 4-7 J 8-10 Rating .c.„,..*"""fre.„4.4f 140e...e.14/V Commissioner's Comments: Commissioners Suggestions for improvement: p °'.SNe en.e.cn..r CA._ 1u-carte. c C-.fCi I- ° •/ f sot. 6e_ ( iLi 5 rb_ • AA,,-/-1-N AinsAms Packet Page -158- 9/24/2013 10.C. FY2013 Evaluation Plan Robert Tober, County Medical Director 3 c.) , 0 A.. �( 1 , EX UTIVE SUMMARY } 3 The County Medical Director is tasked with providing medical leadership for the County's Emergency Medical Services(EMS).The following Evaluation Plan is developed in an effort to provide clear expectations for the County Medical Director for the period from October 2012 through September 2013. The Evaluation plan is based on the broad areas generally expected to be performed by the County Medical Director as well as the requirements of Florida Statute.These include such planning and coordination as may be necessary to deliver pre-hospital medical care by emergency responders through basic life saving interventions and use of sophisticated technical emergency procedures. Below are the standards for scoring the appraisal. These should help to grade each of the areas on the KRA/appraisal form. Score Result 1-3 • Some adverse trends and/or poor performance levels in a few areas Below • Results not reported for many to most areas of importance to the organization's Standards key business requirements • Improvement trends and/or good performance levels reported for most areas of importance to the organization's key business requirements • No pattern of adverse trends and no poor performance levels In areas of 4-7 importance to the organization's key business requirements Meets • Some trends and/or current performance levels--evaluated against relevant Standards comparisons and/or benchmarks--show areas of strength and/or good to very good relative performance levels • Business results address most key customer,market,and process requirements • Current performance is excellent in most areas of importance to the 8-10 organization's key business requirements • Excellent improvement trends and/or sustained excellent performance levels in Exceeds most areas Standards • Evidence of industry and benchmark leadership demonstrated in many areas • Business results fully address key customer, market, process, and action plan requirements Final Standard Rating Needs Improvement Meets Expectations Exceeds Expectations Scale 1.00—3.50 4.00—7.50 8.00—10.00 1 Packet Page-159- 9/24/2013 1O.C. The following areas are the broad categories recognized for Medical Director Evaluation which comprise 80%of the evaluation score:Communications;Leadership/Medical Direction;Quality Assurance;Training;and Operational Procedures. COMMUNICATIONS Below Meets Exceeds Standard Standard Standard 1-3 4-7 8-10 C.1 (Internal)The County Medical Director will provide the BCC with timely and accurate responses to requests for information,as well as,coordinating drafts for planned updates to the medical delivery model for the County. C.2 (External)The County Medical Director will be expected to provide information to the public through regular speaking engagements and Public Relations efforts. C.3 (External)The County Medical Director will be expected to maintain participation in regional or statewide physician's groups involved in pre-hospital care. C.4 (External)The County Medical Director shall notify the Florida Department of Health in writing regarding use of telemetry,substitutions of medications or equipment,and / d other operational considerations as required by statute. {(( C.5 (External)The County Medical Director shall serve as a liaison between the County and appropriate community t hospitals,medical societies,practicing physicians,and training /X facilities in the area. LEADERSHIP/ Below Meets Exceeds MEDICAL DIRECTION Standard Standard Standard 1-3 4-7 8-10 • L.1 The County Medical Director will supervise and accept responsibility for the medical performance of paramedics and EMTs working for Collier County EMS L.2 The County Medical Director will develop and maintain t{t medically correct standing orders or protocols relating to life 'i) C2 Packet Page-160- 9/24/2013 10.C. supporting procedures when communication cannot be established with a supervising physician or when any delay in patient care would potentially threaten the life or health of the patient. ;. L.3 The County Medical Director or his appointee shall provide continuous 24/7 medical direction as to the availability of"off- line"service to resolve problems,system conflicts,and provide services as defined by section 252.34(3)Florida Statutes. L.4 The County Medical Director will issue standing orders to ensure transport of patients to facilities that offer a type and level of care appropriate to the patient's medical condition If available within the service region. L.5 The County Medical Director shall participate as a crewmember on an EMS vehicle for a minimum of 10 hours per year of continuing medical education related to pre- hospital care,teaching,or a combination of both. QUALITY ASSURANCE Below Meets Exceeds Standard Standard Standard 1-3 4-7 8-10 CIA.1 The County Medical Director will establish and maintain a Lj Y quality assurance committee to provide for review of medical skills 1!, and performance of all medical personnel operating under his r: supervision. QA.2 The County Medical Director in coordination with training programs will determine the criteria to achieve practitioner certification for medical responders. QA.3 The County Medical Director will audit the performance of system personnel through use of and participation in the quality assurance program which will include but is not limited to prompt review of patient care records,direct observation,and comparison of performance standards for drugs,equipment,system protocols and procedures. 3 Packet Page-161- 9/24/2013 10.C. TRAINING Below Meets Exceeds Standard Standard Standard 1-3 4-7 8-10 T.1 The County Medical Director will ensure that all paramedics are trained in the use of the trauma scorecard methodologies as provided in the Florida Administrative Code 64J-2.004 for adults and 64J-2.005 for pediatric patients. T.2 The County Medical Director shall ensure paramedics are 7 trained in the use of automatic or semi-automatic defibrillators, endotracheal intubation,monitoring both medicated and non- med icated I.V.'s,and the skills required to provide medical care under his written protocols. T.3 The County Medical Director will ensure that all Collier 7 County paramedics and Emergency Medical Technicians are offered all training to maintain their certification. T.4 The County Medical Director will participate as an instructor L at inservice education programs and provide support in organizing and coordinating such programs. OPERATIONAL PROCEDURES Below Meets Exceeds Standard Standard Standard 1-3 4-7 8-10 0.1 The County Medical Director will ensure and certify that security procedures of Collier County EMS for medications,fluids, and controlled substances are in compliance with Florida Statutes and Chapter 64F-12 of the Florida Administrative Code. 0.2 The County Medical Director shall create,authorize,and ensure adherence to detailed written operating procedures regarding all aspects of the handling of medications,fluids,and controlled substances by EMS personnel in compliance with Florida Statute. 0.3 The County Medical Director will serve as a consultant to Collier County EMS for in all areas of pre-hospital medical care including but not limited to equipment selection,supplies, distribution sources,vehicle design,preparation and administration of grant programs,and training opportunities. 4 Packet Page-162- 9/24/2013 10.C. Other Key Results Areas for 2013; As a reminder,these areas will also be evaluated and will represent 20%of the annual evaluation weight. Issue Resolution/Decision Making:Approaches problems/decisions with a positive attitude and commitment.Identifies issues that Impact the organization and seeks creative,new&different remedies.Demonstrates desire to resolve Issues& improve the organization in professional manner working within established guidelines and as part of the emergency management team. Below Meets Exceeds Standard Standard Standard 1-3 4-7 8-10 Rating 7 Self Direction/Self Initiation:Uses technical&practical knowledge to identify needs or improvement opportunities and develops programs designed to improve pre hospital practices to achieve improved patient care.Contributes to the organization by initiating programs with positive outcomes. Below Meets Exceeds Standard Standard Standard 1-3 4-7 8-10 I Rating 7 • • Ongoing licensure:Medical Director has maintained board certifications and active participation in broad-based clinical medical specialties and ACLS certification or equivalent as determined in Chapter 641-1.022,F.A.C. Below Meets Exceeds Standard Standard Standard 1-3 4-7 8-10 Rating / Succession Planning: Medical Director has identified and provided some orientation or training to medical personnel qualified to support or assume medical direction of the agency In the event of emergency or retirement. Continue cross-training,employee development,and succession planning endeavors. Below Meets Exceeds Standard Standard Standard 1-3 4-7 8-10 Rating r' 5 Packet Page-163- 9/24/2013 10.C. System Effectiveness Measurement:Continue to refine and enhance the quality assurance and response data reports to better measure efficiency and effectiveness.Such reporting and analysis intended to better provide long term and short term planning for delivery of emergency medical care in the County. Below Meets Exceeds Standard Standard Standard 1-3 4-7 8-10 Rating 7 5_ Commissioner's Comments: • 7 7•,r f is A \ \l Commissioners Suggestions for improvement ! ,e �/ t� c./' /'' l ? ! /'r r� r' � r -, 2 f l<^ c.J 7)-1—/ !f/ i / I7�1 ?/i 1,'`i > r G i'...r �.. • i^.- iv 6 Packet Page-164- 9/24/2013 10.C. FY2013 Evaluation Plan Robert Tober, County Medical Director EXECUTIVE SUMMARY The County Medical Director is tasked with providing medical leadership for the County's Emergency Medical Services(EMS).The following Evaluation Plan Is developed In an effort to provide clear expectations for the County Medical Director for the period from October 2012 through September 2013. The Evaluation plan is based on the broad areas generally expected to be performed by the County Medical Director as well as the requirements of Florida Statute.These include such planning and coordination as may be necessary to deliver pre-hospital medical care by emergency responders through basic life saving interventions and use of sophisticated technical emergency procedures. Below are the standards for scoring the appraisal. These should help to grade each of the areas on the KRA/appraisal form. Score Result 1-3 • Some adverse trends and/or poor performance levels in a few areas Below • Results not reported for many to most areas of importance to the organization's Standards key business requirements • Improvement trends and/or good performance levels reported for most areas of importance to the organization's key business requirements • No pattern of adverse trends and no poor performance levels in areas of 4-7 importance to the organization's key business requirements Meets • Some trends and/or current performance levels--evaluated against relevant Standards comparisons and/or benchmarks--show areas of strength and/or good to very good relative performance levels • Business results address most key customer,market,and process requirements • Current performance is excellent in most areas of importance to the 8-10 organization's key business requirements • Excellent Improvement trends and/or sustained excellent performance levels in Exceeds most areas I. Standards • Evidence of industry and benchmark leadership demonstrated in many areas • Business results fully address key customer, market, process, and action plan requirements Final Standard Rating Needs Improvement Meets Expectations Exceeds Expectations Scale 1.00-3.50 4.00-7.50 8.00-10.00 1 Packet Page-165- 9/24/2013 10.C. The following areas are the broad categories recognized for Medical Director Evaluation which comprise 80%of the evaluation score:Communications;Leadership/Medical Direction;Quality Assurance;Training;and Operational Procedures. COMMUNICATIONS Below Meets Exceeds Standard Standard Standard 1-3 4-7 8-10 C.1 (Internal)The County Medical Director will provide the BCC with timely and accurate responses to requests for information,as well as,coordinating drafts for planned 9 updates to the medical delivery model for the County. 11 C.2 (External)The County Medical Director will be expected to provide information to the public through regular speaking engagements and Public Relations efforts. C.3 (External)The.County Medical Director will be expected to maintain participation in regional or statewide physician's �1 groups involved in pre-hospital care. C.4 (External)The County Medical Director shall notify the Florida Department of Health in writing regarding use of telemetry,substitutions of medications or equipment,and other operational considerations as required by statute. C.5 (External)The County Medical Director shall serve as a liaison between the County and appropriate community hospitals,medical societies,practicing physicians,and training facilities in the area. LEADERSHIP/ Below Meets Exceeds MEDICAL DIRECTION Standard Standard Standard 1-3 4-7 8-10 L.1 The County Medical Director will supervise and accept responsibility for the medical performance of paramedics and EMTs working for Collier County EMS L.2 The County Medical Director will develop and maintain medically correct standing orders or protocols relating to life 2 Packet Page-166- 9/24/2013 10.C. { supporting procedures when communication cannot be established with a supervising physician or when any delay in patient care would potentially threaten the life or health of the patient. L.3 The County Medical Director or his appointee shall provide continuous 24/7 medical direction as to the availability of"off- line"service to resolve problems,system conflicts,and provide services as defined by section 252.34(3)Florida Statutes. • L.4 The County Medical Director will issue standing orders to ensure transport of patients to facilities that offer a type and level of care appropriate to the patient's medical condition if available within the service region. L.5 The County Medical Director shall participate as a crewmember on an EMS vehicle for a minimum of 10 hours per year of continuing medical education related to pre- hospital care,teaching,or a combination of both. QUALITY ASSURANCE Below Meets Exceeds Standard Standard Standard 1-3 4-7 8-10 QA.1 The County Medical Director will establish and maintain a quality assurance committee to provide for review of medical skills and performance of all medical personnel operating under his supervision. QA.2 The County Medical Director in coordination with training programs will determine the criteria to achieve practitioner L\ certification for medical responders. QA.3 The County Medical Director will audit the performance of system personnel through use of and participation in the quality assurance program which will include but is not limited to prompt review of patient care records,direct observation,and comparison of performance standards for drugs,equipment,system protocols and procedures. 3 Packet Page -167- 9/24/2013 10.C. TRAINING Below Meets Exceeds • Standard Standard Standard 1-3 4-7 8-10 T.1 The County Medical Director will ensure that all paramedics are trained in the use of the trauma scorecard methodologies as provided in the Florida Administrative Code 64J-2.004 for adults and 64J-2.005 for pediatric patients. T.2 The County Medical Director shall ensure paramedics are trained in the use of automatic or semi-automatic defibrillators, endotracheal intubation,monitoring both medicated and non- medicated 1.V.'s,and the skills required to provide medical care under his written protocols. T.3 The County Medical Director will ensure that all Collier County paramedics and Emergency Medical Technicians are offered all training to maintain their certification. ll i T.4 The County Medical Director will participate as an instructor at inservice education programs and provide support in organizing and coordinating such programs. Lit OPERATIONAL PROCEDURES Below Meets Exceeds Standard Standard Standard 1-3 4-7 8-10 0.1 The County Medical Director will ensure and certify that security procedures of Collier County EMS for medications,fluids, and controlled substances are in compliance with Florida Statutes and Chapter 64F-12 of the Florida Administrative Code. 0.2 The County Medical Director shall create,authorize,and ensure adherence to detailed written operating procedures regarding all aspects of the handling of medications,fluids,and controlled substances by EMS personnel in compliance with Florida Statute. 0.3 The County Medical Director will serve as a consultant to Collier County EMS for in all areas of pre-hospital medical care including but not limited to equipment selection,supplies, "1 distribution sources,vehicle design,preparation and \\\ administration of grant programs,and training opportunities. 4 Packet Page-168- 9/24/2013 10.C. Other Key Results Areas for 2013: As a reminder,these areas will also be evaluated and will represent 20%of the annual evaluation weight. Issue Resolution/Decision Making:Approaches problems/decisions with a positive attitude and commitment.Identifies Issues that impact the organization and seeks creative,new&different remedies.Demonstrates desire to resolve issues& improve the organization in professional manner working within established guidelines and as part of the emergency management team. Below Meets Exceeds Standard Standard Standard 1-3 4-7 8-10 Rating i1 Self Direction/Self Initiation:Uses technical&practical knowledge to identify needs or Improvement opportunities and develops programs designed to improve pre hospital practices to achieve improved patient care.Contributes to the organization by initiating programs with positive outcomes. Below Meets Exceeds Standard Standard Standard 1-3 4-7 8-10 9 Ongoing licensure:Medical Director has maintained board certifications and active participation in broad-based clinical medical specialties and ACLS certification or equivalent as determined in Chapter 64J-1.022, F.A.C. Below Meets Exceeds Standard Standard Standard 1-3 4-7 8-10 Rating 9 Succession Planning: Medical Director has identified and provided some orientation or training to medical personnel qualified to support or assume medical direction of the agency in the event of emergency or retirement. Continue cross-training,employee development,and succession planning endeavors. Below Meets Exceeds Standard Standard Standard 1-3 4-7 8-10 Rating _ 5 i Packet Page-169- 9/24/2013 10.C. System Effectiveness Measurement:Continue to refine and enhance the quality assurance and response data reports to better measure efficiency and effectiveness.Such reporting and analysis intended to better provide long term and short term planning for delivery of emergency medical care In the County. Below Meets Exceeds Standard Standard Standard 1-3 4-7 8-10 Rating 1 Cis Comments: 'CIMIxsair.siertefs Suggestions for Improvement: V tq, /11:- c , I t� � 9�C '.� - jd At,3 6 Packet Page-170- 9/24/2013 10.C. FY2013 Evaluation Plan Robert Tober, County Medical Director IA �!( ©F EXECUTIVE SUMMARY / e -�--' ra` The County Medical Director is tasked with providing medical leadership for the County's Emergency Medical Services(EMS).The following Evaluation Plan is developed in an effort to provide clear expectations for the County Medical Director for the period from October 2012 through September 2013. The Evaluation plan is based on the broad areas generally expected to be performed by the County Medical Director as well as the requirements of Florida Statute.These include such planning and coordination as may be necessary to deliver pre-hospital medical care by emergency responders through basic life saving interventions and use of sophisticated technical emergency procedures. Below are the standards for scoring the appraisal. These should help to grade each of the areas on the KRA/appraisal form. Score Result 1-3 • Some adverse trends and/or poor performance levels in a few areas Below • Results not reported for many to most areas of importance to the organization's Standards key business requirements • Improvement trends and/or good performance levels reported for most areas of importance to the organization's key business requirements • No pattern of adverse trends and no poor performance levels in areas of 4-7 importance to the organization's key business requirements Meets • Some trends and/or current performance levels--evaluated against relevant Standards comparisons and/or benchmarks--show areas of strength and/or good to very good relative performance levels • Business results address most key customer,market,and process requirements • Current performance is excellent in most areas of importance to the 8-10 organization's key business requirements • Excellent improvement trends and/or sustained excellent performance levels in Exceeds most areas Standards • Evidence of industry and benchmark leadership demonstrated in many areas • Business results fully address key customer, market, process, and action plan requirements Final Standard Rating Needs Improvement Meets Expectations Exceeds Expectations Scale 1.00-3.50 4.00-7.50 8.00-10.00 1 Packet Page-171- 9/24/2013 10.C. The following areas are the broad categories recognized for Medical Director Evaluation which comprise 80%of the evaluation score:Communications;Leadership/Medical Direction;Quality Assurance;Training;and Operational Procedures. COMMUNICATIONS Below Meets Exceeds Standard Standard Standard 1-3 4-7 8-10 C.1 (Internal)The County Medical Director will provide the �� BCC with timely and accurate responses to requests for information,as well as,coordinating drafts for planned updates to the medical delivery model for the County. C.2 (External)The County Medical Director will be expected to provide information to the public through regular speaking engagements and Public Relations efforts. C.3 (External)The County Medical Director will be expected to maintain participation in regional or statewide physician's groups involved in pre-hospital care. C.4 (External)The County Medical Director shall notify the Florida Department of Health in writing regarding use of telemetry,substitutions of medications or equipment,and other operational considerations as required by statute. C.5 (External)The County Medical Director shall serve as a liaison between the County and appropriate community hospitals,medical societies,practicing physicians,and training facilities in the area. LEADERSHIP/ Below Meets Exceeds MEDICAL DIRECTION Standard Standard Standard 1-3 4-7 8-10 L.1 The County Medical Director will supervise and accept responsibility for the medical performance of paramedics and EMTs working for Collier County EMS L.2 The County Medical Director will develop and maintain medically correct standing orders or protocols relating to life 2 Packet Page -172- 9/24/2013 10.C. supporting procedures when communication cannot be established with a supervising physician or when any delay in / patient care would potentially threaten the life or health of the (/ patient. L.3 The County Medical Director or his appointee shall provide continuous 24/7 medical direction as to the availability of"off- line"service to resolve problems,system conflicts,and provide (/ services as defined by section 252.34(3)Florida Statutes. L.4 The County Medical Director will issue standing orders to ensure transport of patients to facilities that offer a type and level of care appropriate to the patient's medical condition if available within the service region. L.5 The County Medical Director shall participate as a crewmember on an EMS vehicle for a minimum of 10 hours ,./ per year of continuing medical education related to pre- hospital care,teaching,or a combination of both. QUALITY ASSURANCE Below Meets Exceeds Standard Standard Standard 1-3 4-7 8-10 QA.1 The County Medical Director will establish and maintain a quality assurance committee to provide for review of medical skills and performance of all medical personnel operating under his 1 supervision. QA.2 The County Medical Director in coordination with training programs will determine the criteria to achieve practitioner certification for medical responders. QA.3 The County Medical Director will audit the performance of system personnel through use of and participation in the quality assurance program which will include but Is not limited to prompt review of patient care records,direct observation,and comparison of performance standards for drugs,equipment,system protocols and procedures. 3 Packet Page-173- 9/24/2013 10.C. TRAINING Below Meets Exceeds Standard Standard Standard 1-3 4-7 8-10 Ti. The County Medical Director will ensure that all paramedics are trained in the use of the trauma scorecard methodologies as provided in the Florida Administrative Code 64J-2.004 for adults and 64J-2.005 for pediatric patients. T.2 The County Medical Director shall ensure paramedics are trained in the use of automatic or semi-automatic defibrillators, endotracheal intubation,monitoring both medicated and non- medicated I.V.'s,and the skills required to provide medical care under his written protocols. T.3 The County Medical Director will ensure that all Collier County paramedics and Emergency Medical Technicians are offered all training to maintain their certification. T.4 The County Medical Director will participate as an instructor / at inservice education programs and provide support in �,l// organizing and coordinating such programs. OPERATIONAL PROCEDURES Below Meets Exceeds Standard Standard Standard 1-3 4-7 8-10 0.1 The County Medical Director will ensure and certify that security procedures of Collier County EMS for medications,fluids, and controlled substances are In compliance with Florida Statutes and Chapter 64F-12 of the Florida Administrative Code. 0.2 The County Medical Director shall create,authorize,and ensure adherence to detailed written operating procedures regarding all aspects of the handling of medications,fluids,and controlled substances by EMS personnel in compliance with Florida Statute. 0.3 The County Medical Director will serve as a consultant to Collier County EMS for in all areas of pre-hospital medical care including but not limited to equipment selection,supplies, distribution sources,vehicle design,preparation and administration of grant programs, and training opportunities. 4 Packet Page-174- 9/24/2013 10.C. 1 Other Key Results Areas for 2013: As a reminder,these areas will also be evaluated and will represent 20%of the annual evaluation weight. Issue Resolution/Decision Making:Approaches problems/decisions with a positive attitude and commitment.Identifies issues that impact the organization and seeks creative,new&different remedies.Demonstrates desire to resolve issues& improve the organization in professional manner working within established guidelines and as part of the emergency management team. Below Meets Exceeds Standard Standard Standard 1-3 4-7 8-10 Rating Self Direction/Self initiation:Uses technical&practical knowledge to identify needs or Improvement opportunities and develops programs designed to Improve pre hospital practices to achieve improved patient care.Contributes to the organization by initiating programs with positive outcomes. Below Meets Exceeds Standard Standard Standard 1-3 4-7 8-10 Rating Ongoing licensure:Medical Director has maintained board certifications and active participation in broad-based clinical medical specialties and ACLS certification or equivalent as determined in Chapter 641-1.022, F.A.C. Below Meets Exceeds Standard Standard Standard 1-3 4-7 8-10 Rating Succession Planning: Medical Director has identified and provided some orientation or training to medical personnel qualified to support or assume medical direction of the agency in the event of emergency or retirement. Continue cross-training,employee development,and succession planning endeavors. Below Meets Exceeds Standard Standard Standard 1-3 4-7 8-10 f Rating v 5 Packet Page-175- 9/24/2013 10.C. System Effectiveness Measurement:Continue to refine and enhance the quality assurance and response data reports to better measure efficiency and effectiveness.Such reporting and analysis intended to better provide long term and short term planning for delivery of emergency medical care in the County, Below Meets Exceeds Standard Standard Standard 1-3 4-7 8-10 j Rating Comnassiener's Comments: Fir` O)1 -Cet_ 44.hx-ec-LCL717 Tii�t u G 7 . ' -r°:t 4? i)Lit n e f tv&. .aAe _ is i �- �� _ - C • / Pnc CoHiffll99iepecs Suggestions for Improvement: /Lc 4-LA: �-CK�r � �� "Al/ " /i !3.,F e�i � ). fit_� .5 4v rtP t ee . f- La.,.1;1 /Lc�c�(c. c t /�iV u c � xc ec l�d�cC ie7 CC7 ,/ /rl 4 6 Packet Page -176- 9/24/2013 10.C. FY2013 Evaluation Vasei Dr. Tober, EMS Medical Director Scoring. 8-10 points for "Exceeds Standards" is given for • excellent current performance or • sustained excellent performance levels or • industry leadership or • fully addressing patient requirements. Dr. Tober has provided excellent service to EMS patients - award- winning service - and he has "sustained" the excellent performance. He is a recognized innovator, demonstrating leadership in the field of pre-hospital emergency care. Communications C-1 . BCC will have to address responses to their requests. Stroke protocol change was a major update to the medical delivery model. This was a difficult change, done in a timely manner. PRMC became a Comprehensive Stroke Center in November 2012 and by January 2013, Dr. Tober had negotiated a 3-month test of the new LAMS procedure between NCH and PRMC. By the end of March, stroke patients delivered to PRMC by EMS had nearly doubled over the prior year's first quarter. C-2. Dr. Tober lobbied state legislators to allow release of information on where AEDs are located, to improve response times of AEDs to patients. C-3. Dr. Tober continues to teach and develop new pre-hospital emergency classes at U of Miami, Miller School of Medicine. The Packet Page-177- 9/24/2013 10.C. Director of the Prehospital & Emergency Healthcare Division, in her letter of reference describes his "sustained excellent performance." Dr. Tober has held state medical offices, and has a Lifetime Achievement Award in Emergency Medicine from the state. C-4. W.a eC? 2-ed, - 1- o f /c�Ctie i' C-5. Dr. Tober is highly respected by his peers, the Collier County Medical Society. They note his "accomplishments and strength of the CC EMS under his direction." "Under Dr. Tober's directorship, CC EMS is one of the top emergency medical services in the country." His work on the stroke protocols showed his ability in negotiating between PRMC and NCH. He also works with CC Sheriff's Office and ATRUS group on AED locations. Leadership/Medical Direction L-1 . Dr. Tober supervises and trains county EMS paramedics and EMTs. Excellent performance is shown by CCMS letter. They note "accomplishments and strength of the CC EMS under his direction." "Under Dr. Tober's directorship, CC EMS is one of the top emergency medical services in the country." Dr. Motola (Director of Prehospital and Emergency Healthcare at the University of Miami Miller School of Medicine) says: "his leadership has made CC EMS worthy of emulation by EMS departments everywhere." 2009 EMS Medical Director of the year for state of Florida - performance is still that good, showing "sustained" excellent performance. L-2. Dr. Tober's self-evaluation says he helped "guide CCEMS to successful CAAS accreditation" - and excellent achievement since only 150 EMS systems nationally have accomplished this. Packet Page 478- 9/24/2013 10.C. Dr. Tober has excellent protocols that are constantly reviewed by the PSA Medical Director's Subcommittee and revised as necessary. L-3. Medical Director and Deputy are available 24/7. Dr. Motola says: "Dr. Tober's level of dedication, involvement, and enthusjasm as the Collier County EMS Medical Director is unrivaled." Walter . . 5 A-L-'Tib-z en, L-4. Dr. Tober successfully negotiated a major change to stroke protocols between PRMC and NCH. As chair of the PSA Medical Director Subcommittee, Dr. Tober is constantly reviewing and updating protocols. L-5. Dr. Tober's self-appraisal says he has taken an active roll in field riding. Walter . . . /O . tza�".� x e�cs . Quality Assurance QA-1 . Self-Evaluation "Supervised QA processes." Dr. Tober "maintains quarterly ALS skill monitoring on all of our paramedics. This Q A and moitoring process is constant . . . and targeted at moving medics to busier zones, intensive one-on-one clinical training and maintenance of skills." Evidence of excellent performance by CAAS accreditation. Cardiac save rates—set the standard" Collier County EMS has been selected as a "beta" test site by ACA to share patient data of admissions. Shows CC EMS excellence is recognized by others. QA-2. Dr. Tober does In-service training, paramedic refresher and is promoting on-line training. Paramedics go 1. on 1 to be Toberized. Q.c..,z.c.,. fert (y-et-car-.r�ccC'S — �ow'4_ 71 -� Packet Page -179- 9/24/2013 10.C. QA-3. Dr. Tober does QA to "insure highest level of medical care standards are maintained and issues are addressed in a timely fashion to reduce risk of any repetition of errors." EMS selected as beta-testing site to allow QA tracking. Dr. Tober says he frequently followed up with hospitals - on his own - to check on patient outcomes. PSA subcommittee is also working to find a way to do this. Gc�cz 2 f t - 6017,trz,�� 6,,.4-t.t_ 4 „Le¢e`l- Training T-1 . Dr. Tober does In-service and Refresher Training. j Stroke protocol change required fastlextra paramedic aining on LAMS. T-2. Dr. Tober still Toberizes each paramedic 1 on1 to be sure his team meets his high standards. All 3 types of training - in service, refresher and on-line. Dr. Tober also works with CCSO and ATRUS group on AEDs and he lobbied on House Bill 801 to locate AEDs. T-3. Dr. Tober goes 1 on 1 to Toberize all paramedics and maintain highest quality. T-4. Self-evaluation discusses In-service and Refresher training. Dr. Tober had to train everyone on LAMS quickly when stroke protocol test started. Operational Procedures CAAS accreditation shows that EMS is doing an excellent job operationally. 0-1 . Dr. Tober does this. Walter? et --t-g-e-u-----QA- Packet Page-180- 9/24/2013 10.C. 0-2. Dr. Tober has had to deal with national shortages of medications and need to find alternative, substitute medications. 0-3. Dr. Tober addresses in self-evaluation, discussing need for advanced medical devices, increase in training personnel, problems with medication shortages, reference to what can be done with budget constraints. Walter? [? (46s-c � Issue Resolution/Decision Making New protocols for strokes - difficult negotiation. Proven Innovator (top 10 innovator in EMS) Journal of EMS. "Sucessfully completed training and authorship of two distinct and landmark subjects: Prehospital Airway. Support and Prehospital Advanced Stroke Life Support." Self-Direction/Self Initiation Dr. Motola says: "he is readily able to translate medical science into practical approaches to prehospital emergency care." High cardiac save rate. Proven innovator - top 10 "Sucessfully completed training and authorship of two distinct and landmark subjects: Prehospital Airway Support and Prehospital Advanced Stroke Life Support." Ongoing Licensure Clinical medical specialties -- 2 new courses. Walter? Z3'0"-- P`� 41_6/ LS 44.-.,5 du-«,Fri . Succsession Planning Deputy Medical Director is fully trained and ready to step in when, necessary. , kt..0 - w - e2e._ otrt) New Director of EMS promoted in last year. Fully trained and doing an excellent job. Packet Page-181- 9/24/2013 10.C. FY2013 Evaluation Plan Robert Taber, County Medical Director EXECUTIVE SUMMARY The County Medical Director Is tasked with providing medical leadership for the County's Emergency Medical Services(EMS).The following Evaluation Plan is developed in an effort to provide clear expectations for the County Medical Director for the period from October 2012 through September 2013. The Evaluation plan is based on the broad areas generally expected to be performed by the County Medical Director as well as the requirements of Florida Statute.These include such planning and coordination as may be necessary to deliver pre-hospital medical care by emergency responders through basic life saving interventions and use of sophisticated technical emergency procedures. Below are the standards for scoring the appraisal. These should help to grade each of the areas on the KRA/appraisal form. Score Result 1-3 • Some adverse trends and/or poor performance levels In a few areas Below • Results not reported for many to most areas of importance to the organization's Standards key business requirements • Improvement trends and/or good performance levels reported for most areas of importance to the organization's key business requirements • No pattern of adverse trends and no poor performance levels in areas of 4-7 importance to the organization's key business requirements Meets • Some trends and/or current performance levels--evaluated against relevant Standards comparisons and/or benchmarks--show areas of strength and/or good to very good relative performance levels • Business results address most key customer,market,and process requirements • Current performance Is excellent in most areas of importance to the 8-10 organization's key business requirements • Excellent improvement trends and/or sustained excellent performance levels in Exceeds most areas Standards • Evidence of industry and benchmark leadership demonstrated in many areas • Business results fully address key customer, market, process, and action plan requirements Final Standard Rating Needs improvement Meets Expectations Exceeds Expectations Scale 1.00—3.50 4.00—7.50 8.00—10.00 oo'` 1 Packet Page-182- 9/24/2013 10.0. The following areas are the broad categories recognized for Medical Director Evaluation which comprise 80%of the evaluation score:Communications;Leadership/Medical Direction;Quality Assurance;Training;and Operational Procedures. COMMUNICATIONS Below Meets Exceeds Standard Standard Standard 1-3 4-7 8-10 C.1 (Internal)The County Medical Director will provide the BCC with timely and accurate responses to requests for information,as well as,coordinating drafts for planned C/ updates to the medical delivery model for the County. I j C.2 (External)The County Medical Director will be expected 111 to provide information to the public through regular speaking engagements and Public Relations efforts. C.3 (External)The County Medical Director will be expected to maintain participation in regional or statewide physician's groups Involved in pre-hospltal care. C.4 (External)The County Medical Director shall notify the Florida Department of Health in writing regarding use of telemetry,substitutions of medications or equipment,and �} other operational considerations as required by statute, C.5 (External)The County Medical Director shall serve as a liaison between the County and appropriate community hospitals,medical societies,practicing physicians,and training facilities in the area. LEADERSHIP/ Below Meets Exceeds MEDICAL DIRECTION Standard Standard Standard 1-3 4-7 8-10 L.1 The County Medical Director will supervise and accept responsibility for the medical performance of paramedics and EMTs working for Collier County EMS )6 L2 The County Medical Director will develop and maintain medically correct standing orders or protocols relating to life 2 Packet Page-183- 9/24/2013 10.C. supporting procedures when communication cannot be established with a supervising physician or when any delay in patient care would potentially threaten the life or health of the patient. L3 The County Medical Director or his appointee shall provide continuous 24/7 medical direction as to the availability of"off- line"service to resolve problems,system conflicts,and provide services as defined by section 252.34(3)Florida Statutes. L.4 The County Medical Director will issue standing orders to ensure transport of patients to facilities that offer a type and level of care appropriate to the patient's medical condition If available within the service region. L.5 The County Medical Director shall participate as a crewmember on an EMS vehicle for a minimum of 10 hours per year of continuing medical education related to pre- hospital care,teaching,or a combination of both. QUALITY ASSURANCE Below Meets Exceeds Standard Standard Standard 1-3 4-7 8-10 QA.1 The County Medical Director will establish and maintain a /O quality assurance committee to provide for review of medical skills and performance of all medical personnel operating under his supervision. QA.2 The County Medical Director in coordination with training programs will determine the criteria to achieve practitioner certification for medical responders. � V QA.3 The County Medical Director will audit the performance of system personnel through use of and participation in the quality assurance program which will include but is not limited to prompt ' '- review of patient care records,direct observation,and comparison of performance standards for drugs,equipment,system protocols and procedures. + "' 3 Packet Page-184- 9/24/2013 10.C. TRAINING Below Meets Exceeds Standard Standard Standard 1-3 4-7 8-10 T.1 The County Medical Director will ensure that all paramedics are trained in the use of the trauma scorecard methodologies as provided in the Florida Administrative Code 64J-2.004 for adults and 64J-2.005 for pediatric patients. 6 T.2 The County Medical Director shall ensure paramedics are trained In the use of automatic or semi-automatic defibrillators, endotracheal intubation,monitoring both medicated and non- medicated I.V.'s,and the skills required to provide medical care / b under his written protocols. T.3 The County Medical Director will ensure that all Collier County paramedics and Emergency Medical Technicians are offered all training to maintain their certification. 1 V f� 1.4 The County Medical Director will participate as an instructor at inservice education programs and provide support in organizing and coordinating such programs. ) OPERATIONAL PROCEDURES Below Meets Exceeds Standard Standard Standard 1-3 4-7 8-10 0.1 The County Medical Director will ensure and certify that security procedures of Collier County EMS for medications,fluids, and controlled substances are in compliance with Florida Statutes and Chapter 64F-12 of the Florida Administrative Code. 0.2 The County Medical Director shall create,authorize,and ensure adherence to detailed written operating procedures regarding all aspects of the handling of medications,fluids,and controlled substances by EMS personnel in compliance with I O Florida Statute. 0.3 The County Medical Director will serve as a consultant to Collier County EMS for in all areas of pre-hospital medical care including but not limited to equipment selection,supplies, distribution sources,vehicle design,preparation and / U administration of grant programs,and training opportunities. 4 Packet Page -185- 9/24/2013 10.C. Other Key Results Areas for 2013; As a reminder,these areas will also be evaluated and will represent 20%of the annual evaluation weight. Issue Resolution/Decision Making:Approaches problems/decisions with a positive attitude and commitment.Identifies issues that impact the organization and seeks creative,new&different remedies.Demonstrates desire to resolve issues& improve the organization in professional manner working within established guidelines and as part of the emergency management team. Below Meets Exceeds Standard Standard Standard 1-3 4-7 8-3,0 Rating � � Self Direction/Self initiation:Uses technical&practical knowledge to identify needs or improvement opportunities and develops programs designed to improve pre hospital practices to achieve Improved patient care.Contributes to the organization by initiating programs with positive outcomes. Below Meets Exceeds Standard Standard Standard 1-3 4-7 8-10 Rating Ongoing licensure:Medical Director has maintained board certifications and active participation in broad-based clinical medical specialties and ACLS certification or equivalent as determined in Chapter 643-1.022,F.A.C. Below Meets Exceeds Standard Standard Standard 1-3 4-7 8-10 Rating /0 Succession Planning: Medical Director has identified and provided some orientation or training to medical personnel qualified to support or assume medical direction of the agency in the event of emergency or retirement. Continue cross-training,employee development,and succession planning endeavors. Below Meets Exceeds Standard Standard Standard 1-3 4-7 8-10 Rating /v 5 Packet Page-186- 9/24/2013 10.C. System Effectiveness Measurement:Continue to refine and enhance the quality assurance and response data reports to better measure efficiency and effectiveness.Such reporting and analysis intended to better provide long term and short term planning for delivery of emergency medical care In the County. Below Meets Exceeds Standard Standard Standard 1-3 4-7 8-10 Rating I O Commissioner's Comments: Commissioners Suggestions for Improvement: 6 Packet Page-187- 9/24/2013 10.C. FY2013 Evaluation Plan Robert Tober, County Medical Director I�L EXECUTIVE SUMMARY The County Medical Director is tasked with providing medical leadership for the County's Emergency Medical Services(EMS).The following Evaluation Plan is developed in an effort to provide clear expectations for the County Medical Director for the period from October 2012 through September 2013. The Evaluation plan is based on the broad areas generally expected to be performed by the County Medical Director as well as the requirements of Florida Statute.These include such planning and coordination as may be necessary to deliver pre-hospital medical care by emergency responders through basic life saving interventions and use of sophisticated technical emergency procedures. Below are the standards for scoring the appraisal. These should help to grade each of the areas on the KRA/appraisal form. Score Result 1-3 • Some adverse trends and/or poor performance levels in a few areas Below • Results not reported for many to most areas of importance to the organization's Standards key business requirements • Improvement trends and/or good performance levels reported for most areas of importance to the organization's key business requirements • No pattern of adverse trends and no poor performance levels In areas of 4-7 importance to the organization's key business requirements Meets • Some trends and/or current performance levels--evaluated against relevant Standards comparisons and/or benchmarks—show areas of strength and/or good to very good relative performance levels • Business results address most key customer,market,and process requirements • Current performance is excellent In most areas of importance to the 8-10 organization's key business requirements • Excellent improvement trends and/or sustained excellent performance levels in Exceeds most areas Standards • Evidence of industry and benchmark leadership demonstrated in many areas • Business results fully address key customer, market, process, and action plan requirements Final Standard Rating Needs Improvement Meets Expectations Exceeds Expectations Scale 1.00—3.50 4.00—7.50 8.00—10.00 1 Packet Page-188- 9/24/2013 10.C. The following areas are the broad categories recognized for Medical Director Evaluation which comprise 80%of the evaluation score:Communications;Leadership/Medical Direction;Quality Assurance;Training;and Operational Procedures. COMMUNICATIONS Below Meets Exceeds Standard Standard Standard 1-3 4-7 8-10 C.1 (Internal)The County Medical Director will provide the ctC7'd BCC with timely and accurate responses to requests for �jf1 P') 5. information,as well as,coordinating drafts for planned updates to the medical delivery model for the County. 1r" CAW'' C.2 (External)The County Medical Director will be expected to provide information to the public through regular speaking engagements and Public Relations efforts. C.3 (External)The County Medical Director will be expected to maintain participation in regional or statewide physician's groups involved in pre-hospital care. tllJ_ C.4 (External)The County Medical Director shall notify the Florida Department of Health in writing regarding use of telemetry,substitutions of medications or equipment,and other operational considerations as required by statute. C.5 (External)The County Medical Director shall serve as a liaison between the County and appropriate community �7 hospitals,medical societies,practicing physicians,and training �1i° �w%'�2 facilities in the area. C°011)1' il LEADERSHIP/ Below Meets Exceeds MEDICAL DIRECTION Standard Standard Standard 1-3 4-7 8-10 L.1 The County Medical Director will supervise and accept responsibility for the medical performance of paramedics and EMTs working for Collier County EMS f.- L.2 The County Medical Director will develop and maintain medically correct standing orders or protocols relating to life 2 Packet Page-189- 9/24/2013 10.C. supporting procedures when communication cannot be established with a supervising physician or when any delay in patient care would potentially threaten the life or health of the patient. L.3 The County Medical Director or his appointee shall provide continuous 24/7 medical direction as to the availability of"off- line"service to resolve problems,system conflicts,and provide services as defined by section 252.34(3)Florida Statutes. L.4 The County Medical Director will issue standing orders to transport of patients to facilities that offer a type and r.rl level of care appropriate to the patient's medical condition if available within the service region. /J L.5 The County Medical Director shall participate as a crewmember on an EMS vehicle for a minimum of 10 hours per year of continuing medical education related to pre- hospital care,teaching,or a combination of both. (,7 QUALITY ASSURANCE Below Meets Exceeds Standard Standard Standard 1-3 4-7 8-10 IL `' QA.1 The County Medical Director will establish and maintain a quality assurance committee to provide for review of medical skills performance of all medical personnel operating under his 1"1":;4° , supervision. CC) QA.2 The County Medical Director in coordination with training c programs will determine the criteria to achieve practitioner certification for medical responders. QA.3 The County Medical Director will audit the performance of NNN system personnel through use of and participation in the quality x assurance program which will include but is not limited to prompt review of patient care records,direct observation,and comparison of performance standards for drugs,equipment,system protocols j f and procedures. }) ti r 3 Packet Page-190- 9/24/2013 10.C. TRAINING Below Meets Exceeds Standard Standard Standard 1-3 4-7 8-10 T.1 The County Medical Director will ensure that all paramedics— are trained in the use of the trauma scorecard methodologies as provided In the Florida Administrative Code 64J-2.004 for adults and 641-2.005 for pediatric patients. T.2 The County Medical Director shall ensure paramedics are trained in the use of automatic or semi-automatic defibrillators, endotracheal intubation,monitoring both medicated and non- medicated I.V.'s,and the skills required to provide medical care under his written protocols. T.3 The County Medical Director will ensure that all Collier County paramedics and Emergency Medical Technicians are -- offered all training to maintain their certification. T.4 The County Medical Director will participate as an instructor at inservice education programs and provide support in organizing and coordinating such programs. OPERATIONAL PROCEDURES Below Meets Exceeds Standard Standard Standard 1-3 4-7 8-10 0.1 The County Medical Director will ensure and certify that security procedures of Collier County EMS for medications,fluids, and controlled substances are in compliance with Florida Statutes and Chapter 64F-12 of the Florida Administrative Code. g, 0.2 The County Medical Director shall create,authorize,and ensure adherence to detailed written operating procedures regarding all aspects of the handling of medications,fluids,and controlled substances by EMS personnel in compliance with (c Florida Statute. 0.3 The County Medical Director will serve as a consultant to Collier County EMS for in all areas of pre-hospital medical care including but not limited to equipment selection,supplies, distribution sources,vehicle design,preparation and administration of grant programs,and training opportunities. 4 Packet Page-191- 9/24/2013 1O.C. Other Key Results Areas for 2018_ As a reminder,these areas will also be evaluated and will represent 20%of the annual evaluation weight. Issue Resolution/Decision Making:Approaches problems/decisions with a positive attitude and commitment.Identifies issues that Impact the organization and seeks creative,new&different remedies.Demonstrates desire to resolve issues& improve the organization in professional manner working within established guidelines and as part of the emergency management team. 77f► . H!�`. b e i✓ t3 (C mot F' +�7 trt� 'k C (e- iS i ��} i`(� Below Meets Exceeds 0 7' Standard Standard Standard Pot-) 31 P.-. Pei.. Co Pji"1"")5`S 1-3 4-7 8-10 J Rating 6 i coo', Self Direction_/self Initiation:Uses technical&practical knowledge to identify needs or improvement opportunities and develops programs designed to Improve pre hospital practices to achieve improved patient care.Contributes to the organization by initiating programs with positive outcomes. pay w y )1,--.)re-1/4-)6" E t Cr, , Below Meets Exceeds � Standard Standard Standard 1-3 4-7 8-10 I Rating Ongoing licensure:Medical Director has maintained board certifications and active participation in broad-based clinical medical specialties and ACLS certification or equivalent as determined in Chapter 64J-1.022,F.A.C. Below Meets Exceeds Standard Standard Standard 1-3 4-7 8-10 Rating Succession Planning: Medical Director has identified and provided some orientation or training to medical personnel qualified to support or assume medical direction of the agency in the event of emergency or retirement. Continue cross-training,employee development,and succession planning endeavors. Below Meets Exceeds Standard Standard Standard 1-3 4-7 8-10 Rating 5 Packet Page -192- 9/24/2013 10.0. System Effectiveness Measurement:Continue to refine and enhance the quality assurance and response data reports to better measure efficiency and effectiveness.Such reporting and analysis intended to better provide long term and short term planning for delivery of emergency medical care in the County. ewe 1-h ?r 9 /3 erri4... Toe Cc4,11) Se Po& Below Meets Exceeds Standard Standard Standard (91)p 12 r c+e- Cot,k.A4c-tt.)l. t.-, 1-3 4-7 8-10 Rating 14. Commissioner's Comments: IT "5 0°L)EC/t--)S' no 9 r 11-7 rlie" Cex)--'°e cr-Divno) trn ci lc:, 6/22-CY_i3 1t-)9 7-1,...10 co tA4 1.1 foL-e 0_5 t Ce /+MIP 17E0/CAL 0'fret'rn I TH T H 17e t- 1-,114-e-tt CC)tv Scle,t,, c=e1 - ;Li • HILL • '0 k-ace • m3r),..,r" ,L*.er)r:p _r h2pOot.,›PPar- VCr YV TC) Tit E Bt)r 7-14 e rietc.01. Di ktc-ertyk_ CXXIA. t:(49- t tr-f÷ 14-0,-P I C tie' ;1100t-C> & Lz0e0 bee.. 0-1-1t fbAr- cftf blaik C A1/42,0 1414_!, CA...)isSreiuZi Wen tCt-,..eL tS roe ppe_fr Commissioners Suggestions for Improvement: rtiF p La. ro pr-ot-tc.:!)to EL)14112.e-i-aas _TA8.5- cis PrfC_ 14(e,P.-09 Pc( &411._ ropl 111 .SC,I - r ; 1.10 L /9.75 - - iF £ NL /9-4`49 nefelth pe.i ket-tX Wi en 2 -(1"4 6,-1.-k0 el A Pct. 1v)i)tL> ,r5.40t:1 Fon /3-4Prieve-Le-or et)14_ u Lc p3.1-1,:n ffc-4) 12t-OCK 0-sa e5 tir fr0 poiLvivic, cc9/7164in,.) t,,ITH 196, t,i.,,)ct ts:j r HC) 12110-1. E C,F (Dt.(I e-t- kr% 7-HE p s A) C HeL-P 6 .0442* /At Packet Page-193- 9/24/2013 10.C. FY2013 Evaluation Plan Robert Tober, County Medical Director EXECUTIVE SUMMARY The County Medical Director is tasked with providing medical leadership for the County's Emergency Medical Services(EMS).The following Evaluation Plan is developed in an effort to provide clear expectations for the County Medical Director for the period from October 2012 through September 2013. The Evaluation plan is based on the broad areas generally expected to be performed by the County Medical Director as well as the requirements of Florida Statute.These include such planning and coordination as may be necessary to deliver pre-hospital medical care by emergency responders through basic life saving interventions and use of sophisticated technical emergency procedures. Below are the standards for scoring the appraisal. These should help to grade each of the areas on the KRA/appraisal form. Score Result 1-3 • Some adverse trends and/or poor performance levels in a few areas Below • Results not reported for many to most areas of importance to the organization's Standards key business requirements • Improvement trends and/or good performance levels reported for most areas of importance to the organization's key business requirements • No pattern of adverse trends and no poor performance levels in areas of 4-7 importance to the organization's key business requirements Meets • Some trends and/or current performance levels--evaluated against relevant Standards comparisons and/or benchmarks—show areas of strength and/or good to very good relative performance levels • Business results address most key customer,market,and process requirements • Current performance is excellent in most areas of importance to the 8-10 organization's key business requirements • Excellent improvement trends and/or sustained excellent performance levels in Exceeds most areas Standards • Evidence of industry and benchmark leadership demonstrated in many areas • Business results fully address key customer, market, process, and action plan requirements Final Standard Rating Needs Improvement Meets Expectations Exceeds Expectations Scale 1.00—3.50 4.00—7.50 8.00-10.00 1 Packet Page -194- 9/24/2013 10.C. The following areas are the broad categories recognized for Medical Director Evaluation which comprise 80%of the evaluation score:Communications;Leadership/Medical Direction;Quality Assurance;Training;and Operational Procedures. COMMUNICATIONS Below Meets Exceeds Standard Standard Standard 1-3 4-7 8-10 C.1 (Internal)The County Medical Director will provide the BCC with timely and accurate responses to requests for 04/1( 4,67A/4-4d, ,p S ,� information,as well as,coordinating drafts for planned 0 updates to the medical delivery model for the County. ! Ow se C.2 (External)The County Medical Director will be expected `. — to provide information to the public through regular speaking � rig r�z v engagements and Public Relations efforts. / e7, G .;,�� C.3 (External)The County Medical Director will be expected ,,l� `'"�` to maintain participation in regional or statewide physician's / ��+ groups involved in pre-hospital care. C.4 (External)The County Medical Director shall notify the Florida Department of Health in writing regarding use of telemetry,substitutions of medications or equipment,and other operational considerations as required by statute. C.5 (External)The County Medical Director shall serve as a liaison between the County and appropriate community hospitals,medical societies,practicing physicians,and training facilities in the area. r i LEADERSHIP/ Below Meets Exceeds nl 2/LC.y�/ MEDICAL DIRECTION Standard Standard Standard t 1-3 4-7 8-10 671 l" L.1 The County Medical Director will supervise and accept Q �yl 4 responsibility for the medical performance of paramedics and 5' j4,0•4._• f� EMTs working for Collier County EMS j�1 r L.2 The County Medical Director will develop and maintain 66 medically correct standing orders or protocols relating to life or .9.1,411r4-, ota 2 Packet Page -195- 9/24/2013 10.C. supporting procedures when communication cannot be established with a supervising physician or when any delay in patient care would potentially threaten the life or health of the patient. L.3 The County Medical Director or his appointee shall provide continuous 24/7 medical direction as to the availability of"off- line"service to resolve problems,system conflicts,and provide services as defined by section 252.34(3)Florida Statutes. L.4 The County Medical Director will issue standing orders to ensure transport of patients to facilities that offer a type and level of care appropriate to the patient's medical condition If available within the service region. L.5 The County Medical Director shall participate as a crewmember on an EMS vehicle for a minimum of 10 hours per year of continuing medical education related to pre- hospital care,teaching,or a combination of both. QUALITY ASSURANCE Below Meets Exceeds Standard Standard Standard 1-3 4-7 8-10 QA.1 The County Medical Director will establish and maintain a quality assurance committee to provide for review of medical skills and performance of all medical personnel operating under his supervision. QA.2 The County Medical Director in coordination with training programs will determine the criteria to achieve practitioner certification for medical responders. ✓�j QA.3 The County Medical Director will audit the performance of system personnel through use of and participation in the quality assurance program which will include but is not limited to prompt review of patient care records,direct observation,and comparison of performance standards for drugs,equipment,system protocols and procedures. • 3 Packet Page-196- 9/24/2013 10.C. TRAINING Below Meets Exceeds Standard Standard Standard 1-3 4-7 8-10 T.1 The County Medical Director will ensure that all paramedics are trained in the use of the trauma scorecard methodologies as provided in the Florida Administrative Code 64J-2.004 for adults and 64J-2.005 for pediatric patients, T.2 The County Medical Director shall ensure paramedics are trained in the use of automatic or semi-automatic defibrillators, endotracheal intubation,monitoring both medicated and non- medicated I.V.'s,and the skills required to provide medical care under his written protocols. T.3 The County Medical Director will ensure that all Collier County paramedics and Emergency Medical Technicians are offered all training to maintain their certification. s' T.4 The County Medical Director will participate as an instructor at inservice education programs and provide support in organizing and coordinating such programs. OPERATIONAL PROCEDURES Below Meets Exceeds Standard Standard Standard :c4 1-3 4-7 8-10 0.1 The County Medical Director will ensure and certify that security procedures of Collier County EMS for medications,fluids, and controlled substances are in compliance with Florida Statutes and Chapter 64F-12 of the Florida Administrative Code. 0.2 The County Medical Director shall create,authorize,and ensure adherence to detailed written operating procedures regarding all aspects of the handling of medications,fluids,and • controlled substances by EMS personnel in compliance with Florida Statute. 0.3 The County Medical Director will serve as a consultant to Collier County EMS for in all areas of pre-hospital medical care including but not limited to equipment selection,supplies, -7 distribution sources,vehicle design,preparation and administration of grant programs,and training opportunities. 4 Packet Page-197- 9/24/2013 10.C. (tykpoltvi, par C k4,444..e... eaTi1~`. � LL Other Key Results Areas for 2013: 16 As a reminder,these areas will also be evaluated and will represent 20%of the annual evaluation weight. Issue Resolution/Decision Making:Approaches problems/decisions with a positive attitude and commitment.identifies issues that impact the organization and seeks creative,new&different remedies.Demonstrates desire to resolve issues& improve the organization in professional manner working within established guidelines and as part of the emergency management team. Below Meets Exceeds Standard Standard Standard 1-3 4-7 8-10 (Rating 5 Self Direction/Self Initiation:Uses technical&practical knowledge to identify needs or Improvement opportunities and develops programs designed to Improve pre hospital practices to achieve improved patient care.Contributes to the organization by initiating programs with positive outcomes. Below Meets Exceeds Standard Standard Standard 1-3 4-7 8-10 (Rating Ongoing licensure:Medical Director has maintained board certifications and active participation in broad-based clinical medical specialties and ACLS certification or equivalent as determined in Chapter 64J-1.022,F.A.C. Below Meets Exceeds Standard Standard Standard 1-3 4-7 8-10 Rating I Succession Planning: Medical Director has identified and provided some orientation or training to medical personnel qualified to support or assume medical direction of the agency in the event of emergency or retirement. Continue cross-training,employee development,and succession planning endeavors. Below Meets Exceeds Standard Standard Standard 1-3 4-7 i 8-10 Rating 5 5 Packet Page-198- 9/24/2013 10.C. System Effectiveness Measurement:Continue to refine and enhance the quality assurance and response data reports to better measure efficiency and effectiveness.Such reporting and analysis Intended to better provide long term and short term planning for delivery of emergency medical care in the County. Below Meets Exceeds Standard Standard Standard 1-3 4-7 8-10 Rating Commissioner's Comments: /41' air;(it erte„.„41 )(2.4)-zat-c-lat eg-o-ryze_47- / s 4-1.0 54162.. - ' r Commissioners Suggestions for Improvement: / 144Q� �r71'►J d-'..CC pp�,�,,-� /� v�.? C�il/L�C G9rvU� � Lcfi-u.Li - .441 /Jno �agyi�d , 6 Packet Page-199- 9/24/2013 10.C. THIRD AMENDMENT TO COLLIER COUNTY EMERGENCY SERVICES MEDICAL CONSULTANT CONTRACT THIS THIRD AMENDMENT to the Collier County Emergency Services Medical Consultant Contract is made this 13th day of November, 2012, by and between Robert Boyd Tober, Inc. ("Consultant"), and Collier County, Florida(`County"). WHEREAS, by agreement dated September 1, 2001, the parties entered into a Collier County Emergency Services Medical Consultant Contract, a copy of which is attached hereto, together with the First Amendment dated October 14, 2008, and the Second Amendment dated May 26, 2009 (collectively referred to as the "Agreement"); and WHEREAS, at a regularly noticed public meeting on October 9, 2012, the Board of County Commissioners directed that the Agreement be amended to provide for annual performance evaluations; and WHEREAS, certain clarifications are recommended as it relates to compensation upon termination: and WHEREAS, the parties believe that such amendments are in the interest of health, safety and welfare of the citizens of the County. NOW, THEREFORE, IN CONSIDERATION of the mutual promises and for other good and valuable consideration, the receipt and sufficiency of which are acknowledged by the parties, it is agreed that: 1. Paragraph 15 of the Agreement is hereby amended as follows: 15. PRO RATIONS UPON TERMINATION COMPENSATION UPON TERMINATION: In the event of the termination of this Contract, the • • - • - - • 1. •• _, - _ • Consultant shall be paid only for services rendered in accordance with this Contract. Compensation due for any partial month's services will be at a daily rate determined by dividing the annual contract rate by three hundred sixty- five (365). 2. Paragraph 20 is hereby added to the Agreement as follows: Words Struck Through are deleted: Words Underlined are added Packet Page-200- 9/24/2013 10.C. 20. ANNUAL PERFORMANCE EVALUATION The Consultant will prepare a performance self-assessment along with proposed goals for the next year on an annual basis and submit this evaluation to the Public Safety Authority (PSA) no later than the first day of June. The PSA will review the Consultant's self- assessment and will make an independent performance evaluation and recommendations, which the PSA will forward to the Board of County Commissioners no later than the first day of July. The Commissioners will review both the Consultant's self-assessment and the Public Safety Authority's performance evaluation and will prepare separate performance evaluations and recommendations. The Consultant will forward the self- assessment. PSA review and recommendations. and the individual Commissioners' evaluations as an agenda item on the last regular meeting in July. The Commissioners will conduct the required evaluation, approve the proposed goals. and recommend any additional areas of focus for the next evaluation period. An updated performance evaluation plan may be developed in good faith between the Consultant and the County and adopted by the County prior to October 1st of each year for implementation in the next year. 3. Except as expressly provided herein, the Agreement, as amended, remains in fall force and effect according to the terms and conditions contained therein. IN WITNESS WHEREOF, the Consultant and the County have executed this Third Amendment to Collier County Emergency Services Medical Consultant Contract as of the date first written above. ATTEST: BOARD OF COUNTY COMMISSIONERS DWIGHT E. BROCK, Clerk COLLIER COUNTY, FLORIDA By: L ' By: i_1 Attest as to Chd traig4 Deputy I tk( FRED W. COYLE, CHAIRM WITNESSES: ROBERT BOYD TOBER, INC. By: / /E :/!J�1 Print Name: Robert Boyd ober,l'resident Print Name: Ap c t • form and legal sufficiency: Jet. e ' .tzkow Co x t Attorney Packet Page -201- 9/24/2013 10.C. • COLLIER COUNTY EMERGENCY SERVICES MEDICAL CONSULTANT CONTRACT THIS MEDICAL CONSULTING CONTRACT made this // day of . 2.if e ly.k, 2001 by and between ROBERT BOYD TOBER,INC., hereinafter referred to as Consultant, and COLLIER COUNTY,FLORIDA, hereinafter referred to as the County. WITNESSETH WHEREAS, the County is responsible for emergency services in COLLIER COUNTY, Florida; and WHEREAS, Emergency Medical Services, (hereinafter"EMS"), are a Iogical extension of existing health care services performed by the County in the above described geographic area; and WHEREAS, Consultant ROBERT TOBER, M.D., a duly licensed physician in the State of Florida who is specially trained in the field of emergency medicine; and WHEREAS, the County and Consultant have previously entered into a Medical Consulting Contract dated June 18, 1996 which provides for automatic renewal pursuant to certain conditions; and WHEREAS, said conditions have been met for renewal of the contract and the parties hereto manifest their mutual desire to renew same with certain changes contained herein; and NOW THEREFORE, in consideration of the promises and the mutual covenants hereinafter set forth, the parties hereto agree as follows: 1. LICENSE: ROBERT TOBER, M.D. is at the present time a duly licensed physician in the State of Florida and he has agreed to maintain his Iicense in full force and effect during the term of this contract. If for any reason during the tenor of this Contract. the County no longer contracts with DR. TOBER, or if DR. TOBER should lose his license to practice medicine, this contract shall immediately become null and void. Packet Page-202- 9/24/2013 10.C. 2. GENERAL DUTIES: Consultant shall be an independent contractor and shall be directly responsible to the Division Administrator of the Emergency Services Division for the performances of services as Medical Director as more specifically defined in this agreement and as set forth in Section 401.265, Florida Statutes. The Consultant shall be responsible for the implementation of such planning and coordination as may be necessary to deliver advanced Iife support by Paramedics (including EMS and Fire District personnel) trained to the level of advanced and basic medical technicians, which may require intravenous administration of emergency resuscitative drugs and the performance of sophisticated technical emergency procedures. 3. TERM OF CONTRACT: The initial term of this contract shall be from October 1, 2000 to September 30, 2001. The parties agree that the term of the Contract shall be automatically renewed on a yearly basis from October 1, through September 30 with the same terms,conditions and obligations as set forth herein, unless terminated by County upon sixty (60) days written notice to Consultant. 4. COMPENSATION: The County shall pay to the Consultant the sum of 550.000 per annum, as full compensation for the services rendered herein and no other compensation. The County will pay the cost of the professional liability insurance. The Medical Director shall not be eligible for any employee benefits other than this compensation. This sum shall be paid to the Consultant in twelve (12) equal monthly payments commencing with the effective date of the Contract, with each monthly payment being payable by the 10th of each month. The Consultant will be entitled to a 5% annual increase beginning October 1, 2001 upon written notification by the Emergency Services Administrator by September 15th of each year, beginning on September 15. 2001, and upon approval by the Board of County Commissioners. 5. PATIENT RECORDS: The County shall make available, within two days of request, any and all medical records, reports, documents and other relevant materials, including a Packet Page-203- 9/24/2013 10.C. audio and visual tapes requested by the Consultant. This includes all run reports, medical test results, recordings on tape and any other reasonably available similar information. 6. CONFIDENTIAL COMMUNICATIONS: Except as may be provided by general law, the County agrees to keep all medical records confidential and allow no communication of records or patient information without a written release from the patient or the Consultant. 7. REPORT: The County agrees to give the Consultant full and detailed reports regarding any case which it reasonably believes has the potential for legal action against the County or its employees pertaining to EMS. 8. DISCIPLINARY ACTIONS: The County agrees to give the Consultant a full written report of any and all Emergency Medical Services personnel who are known to have violated any standing or verbal orders. Consultant shall be given full support for removal of any program participant as provided for in State regulations governing Advanced Life Support Providers. 9. DUTIES AND RESPONSIBILITIES OF THE CONSULTANT: a. He shall be from a broad-based medical specialty such as emergency medicine, internal medicine, anesthesiology, or other surgical specialty, with demonstrated experience in pre-hospital care and hold an ACLS certificate of successful course completion or be board certified in emergency medicine. b. He shall demonstrate and have available for review documentation of active participation in a regional or statewide physician group involved in pre-hospital care. c. He shall supervise and accept direct responsibility for the medical performance of the paramedics working for Collier County EMS. d. He shall develop medically correct standing orders or protocols relating to life support system procedures when communication cannot be established with a • 3 Packet Page-204- 9/24/2013 10.C. supervising physician or when any delay in patient care would potentially threaten the life or health of the patient. e. He shall issue standing orders and protocols to Collier County EMS to ensure that it transports each of its patients to facilities that offer a type and level of care appropriate to the patient's medical condition if available within the service region_ f. He or his appointee shall provide continuous 24-hour-per-day, 7-day-per-week medical direction which shall include, in addition to the development of protocols and standing orders, direction to Collier County EMS personnel as to the availability of "off-line" service to resolve problems, system conflicts, and provide services in an emergency as that term is defined by section 252.34(3),Florida Statutes. g. He shall establish a quality assurance committee to provide for quality assurance review of all paramedics operating under his supervision. h. He shall audit the performance of system personnel by use of a quality assurance program that includes but is not limited to a prompt review of patient care records, direct observation, and comparison of performance standards for drugs, equipment, system protocols and procedures. He shall be responsible for participating in quality assurance programs that may be developed by the department. i. He shall ensure and certify that security procedures of the Collier County EMS for medications, fluids and controlled substances are in compliance with chapters 401, 499 and 893, Florida Statutes, and chapter I0D-45 of the Florida Administrative Code. j. He shall create, authorize and ensure adherence to, detailed written operating procedures regarding all aspects of the handling of medications, fluids and controlled substances by the EMS personnel and comply with all requirements of chapters 401, 499 and 893, Florida Statutes. 4 Packet Page-205- 9/24/2013 10.C. k. He shall notify the Florida Department of Health, (hereinafter the "Department") in writing when the use of telemetry is not necessary. I. He shall notify the department in writing of each substitution by Collier County EMS of equipment or medication. m. He shall assume direct responsibility for the use by a Collier County paramedic of an automatic or semi-automatic defibrillator and the performance of esophageal intubation, and on routine interfacility transports, the monitoring and maintenance of non-medicated I.V.s. He shall ensure that the paramedic is trained to perform these procedures; shall establish written protocols for the performance of these procedures; and shall provide written evidence to the department documenting compliance with the provisions of this paragraph. n. He shall ensure that all paramedics are trained in the use of the trauma scorecard methodologies as provided in sections 64E-2.017 of the F.A.C., for adult trauma patients and 64E-2.0175,F.A.C., for pediatric trauma patients. o. He shall participate as a crewmember on an EMS vehicle for a minimum of 10 hours per year and complete a minimum of 10 hours per year of continuing medical education related to pre-hospital care or teaching or a combination of both. p. He shall ensure that all Collier County paramedics have all proper certifications and receive all training necessary to maintain their certification. 10. ADDITIONAL DUTIES: Consultant shall also be responsible for assisting in the following additional duties: a. Consultation in the planning for Emergency Medical Services Department to be provided by the County, including the design of vehicles, equipment, supplies, distribution resources, emergency medical services personnel ,training and medical policy, protocol,planning and development. Packet Page-206- 9/24/2013 10.C. b. Consultation in the coordination of training of paramedical personnel, including the determination of training criteria for certification. c. Organizing, coordinating and participating as an instructor in the in-service education programs and quality control of the patient care in day-to-day delivery of emergency medical services by the County. d. Serving as a liaison between the County and the appropriate community hospitals, medical societies, practicing physicians and training facilities in the area. e. Providing such assistance as may be required in the preparation and administration of any grant programs for the establishment and improvement of the system. f. All duties outlined in Rule 64-E Florida Administrative Code for Emergency Medical Services Medical Director that are not specifically set forth herein and as may be changed from time to time by the department.. g. He shall keep adequate records and supporting documentation, which concern or reflect his services under this Contract. h. Consultant represents that it presently has no interest and shall acquire no interest, either direct or indirect, which would conflict in any manner with the performance of services required hereunder. 11. LIABILITY AND REMEDIES IN BREACH OF CONTRACTS: It is recognized that the provision of advanced life support services requires that the County have a Medical Director. Accordingly, the Consultant shall not refuse to perform these services during the terms of this Contract so long as it is ab!e to so perform, and the County shall have the right to specific performance of the provisions of this contract. In addition, the Consultant shall be liable to the County for his unreasonable failure or refusal to perform the services required hereunder. a Packet Page-207- 9/24/2013 10.C. • No modification, or change in this Agreement shall be valid or binding upon the parties, unless in writing, and executed by the party or parties intended to be bound by it. Unless otherwise specified, the laws,rules and regulations of the State of Florida shall govern this Agreement. Any suit or action brought by either party to this Agreement against the other party relating to or arising out of this Agreement must be brought in the appropriate Florida State Court in Collier County, Florida. _ 12. CONFLICTING EMPLOYMENT OR CONTRACTUAL RELATIONSHIP: Nothing in this Contract shall be interpreted as preventing the Consultant from operating any other business or being similarly employed with any other emergency medical service that is lawfully licensed by the County(within Collier County,Florida) and the State. However the Consultant shall not accept any employment or enter into any contractual relationship that would create a conflict between such interest and the performance of its duties hereunder. Nothing in this Contract shall be interpreted as preventing the Consultant, a contractual employee of the County, from being employed in any other capacity, including, but not limited to the operation of a medical practice, the employment as a staff member of any hospital, or the serving as a medical director for any other emergency medical service which is lawfully licensed by the County (if located within Collier County) and the State. 13. SUCCESSOR: The Contract shall be binding upon the successors of the County. This Contract shall not be assignable by the Consultant. 14. TERMINATION: This Contract may be terminated by either party, with or without cause, upon sixty (60) days written notice to the other party of such party's intention to terminate the Contract. 15. PRO-RATIONS UPON TERMINATION: In the event of the termination of this Contract, the Consultant's compensation due under Paragraph 4 shall be prorated on the basis Packet Page-208- 9/24/2013 10.C. of the number of days elapsed from the effective date of the Contract, divided by three hundred sixty-five (365). 16. MANUALS: All manuals of procedure and instructional material, which are created or prepared by the Consultant,shall be and remain the property of the Consultant. 17. ADDITIONAL LICENSES: Consultant agrees to obtain and maintain throughout the period of this Agreerrient, all such licenses as are required to do business by the Consultant in the State of Florida and in Collier County,Florida,including, but not limited to, all licenses required by any State Boards or other Governmental agencies responsible for regulating and licensing the professional services to be provided and performed by the Consultant, pursuant to this Agreement. I8. INSURANCE: The County shall, pay for, and maintain, during the Iife of this agreement, professional liability insurance. Collier County shall be named as an additional insured on the certificate of insurance for the policy. 8 Packet Page-209- 9/24/2013 10.C. . M • IN WITNESS WHEREOF, the parties have executed this agreement as of the date first written above. At-1'EST- - ' • DWIGHT E.$ROCK, CLERK BOARD OF COUNTY COMMISSIONERS of Cs ourts OF COLLIER COUNTY,FLORIDA•'B C . By: ..ii .�/ JAMES ARTER,Ph.D., HAIRMAN Attest• ii••to Chairman's 9---/ (— Of signature only. Witnessed b : ROBERT BOYD TOBER,INC. re=p` r / L� ""-- ROBERT BOYD TOBER, PRESIDENT Approved as to form and Legal Sufficiency: )(2a-r'Q,L<C,--L: c.-‘-kr-J..ke4 1 /4113)64-- f.4CQUELINE HUBBARD ROBINSON ssistant County Attorney H/JackiJEMS Cow:ram/Tobcr Medical Con cracc?{701-Revised 9 Packet Page-210- 9/24/2013 10.C. • c I K2 m FIRST AMENDMENT TO COLLIER COUNTY EMERGENCY SERVICES ,,- 0�r► MEDICAL CONSULTANT CONTRACT This First Amendment to the Collier County Emergency Services Medical Consultant Contract ("Amendment") is made this 14th day of October, 2008, by and between Robert Boyd Tober, Inc. ("Consultant"), and Collier County, Florida("County"). WHEREAS, by agreement dated September 1, 2001, the parties entered into a Collier County Emergency Services Medical Consultant Contract ("Agreement"), a copy of which is attached to this Amendment; and WHEREAS, at a regularly noticed public meeting on September 23, 2008, the Board of County Commissioners directed that the Agreement be amended to authorize the Consultant to be directly responsible to the Board of County Commissioners; and WHEREAS, the parties believe that such an amendment is in the interest of health, safety and welfare of the citizens of the County. NOW, THEREFORE, the parties hereby amend Paragraph 2 of the Agreement as follows: "Consultant shall be an independent contractor and shall be directly responsible to the `' -- . . - - _ : _ . _ _ !' ' Board of County Commissioners of Collier County, Florida for the performances of services as Medical Director as more specifically defined in this agreement and as set forth in Section 401, Florida Statutes... " Except as specifically set forth herein, all other terms and conditions of the Agreement remain in full force and effect. IN WITNESS THEREOF, the parties have executed this First Amendment to the Agreement as of the date first written above. Page t of 2 /r/17c/ Packet Page-211- • 4 9/24/2013 10.C. 161( 2 ROBERT BOYD TOBER, INC. By: A;;it ft; ' :7>. qi •% ROBERT BOYD TOBER, PRESIDENT AT:Eitii 1.''"C,� \ BOARD OF COUNTY COMMISSIONERS D'WIGI-HT_E. BRQCIC, CLERK OF COLLIER OUNTY FLORIDA• a f+ rte` By: _ 1 ..�l ... _ Deputy Clerk TOM NNIN , CHAIRMA • , W,1.,,jj r 61 r ' eP tY Approval as to form and legal sufficiency: Jeffrey A. l zkow County Attorney 08-COA-00127/2 Item# LLi Da Agenda Lc / Data Ree. L(Ildici '�, I Page 2 of 2 Packet Page-212- 9/24/2013 10.C. - 16E 9 _4.. SECOND AMENDMENT TO COLLIER COUNTY EMERGENCY SERVICES MEDICAL CONSULTANT CONTRACT This Second Amendment to the Collier County Emergency Services Medical Consultant Contract ("Amendment") is made this , ,,fday of AA&u , 2009, by and between Robert Boyd Tober, Inc. ("Consultant") and Collier CouTty, Florida ("County"). WHEREAS, by Agreement dated September 1, 2001, the parties entered into a Collier County Emergency Services Medical Consultant Contract ("Agreement"), a copy of which is incorporated herein by reference; and NOW, THEREFORE, the parties hereby amend the Agreement to add Item 19, EXPENSES, as follows: 19. EXPENSES. County shall pay expenses for Dr. Tober, and/or his assistant related to County business, to include, but not be limited to, mailings, office supplies, training, education, seminars, lodging (actual cost of lodging at single occupancy rate with a cap of no more than $150.00 per night), air travel (actual ticket cost limited to tourist or coach class fare), and rental car(actual rental cost limited to compact or standard-size vehicles). Except as specifically set forth herein, all other terms and conditions of the Agreement remain in full force and effect. IN WITNESS WHEREOF, the parties have executed this Second Amendment to the Agreement as of the date first written above. CONSULTANT: TW9 MITNESSES : ROBERT BOYD T , f y.,��ki31C-R i — i 2 r� By: TWIT 5 Robert Boyd Taber, President Li'61-)//fel 'f1}r/1 Type/Print Name SE .a y ITNESS Type/Print Name omoto Packet Page-213- — ^_ 9/24/2013 10.C. 16E9 Date: /I4j ?_(v12cr ? OWNER: ATTEST: J BOARD OF COUNTY COMMISSIONERS OF DWIGHT E.,\WPM -: COLLIER COUNTY FLORIDA CLERK Ok,COURTS 1_ f ! It By i..�-- lib 4111-16......" ,. /} Dates! (• 2-' t'+'° BY: '- 714L �`�-�.� (SAL) Donna Fiala, Chairman Attest kat t ,•9∎44rsee s s t gnature oei■ Approved As To Form a d L al Sufficiency: C.5-4)Arss4taat County Attorney °timely Print Name: g4 Tl p. �4,-1, _ _ ^ ^� Packet Page-214- 9/24/2013 10.C. Board of Collier County Commissioners Donna Fiala Georgia A. Hiller,Esq. Tom Henning Fred W.Coyle Tim Nance District 1 District 2 District 3 District 4 District 5 MEMORANDUM Date: September 16, 2013 To: Len Price, Administrative Services Division Administrator From: Commissioner Tom Henning, District 3 Re: EMS Medical Director Annual Evaluation 2013 Dr. Tober has continued to lead Collier County into a strong future where medical and fire agencies are working to respond effectively to medical calls and providing the best training to our Paramedics I respect Dr. Tober's opinion to keep this medical transport responsibility with Collier County Emergency Medical Services until such time the political environment permits for better working relations with certain fire districts. Dr. Tober has grown EMS from a small department to a large scale response,well organized department. He has implemented life saving measures including on-board medicines, improved CPR training and many other life saving training measures to ensure EMS paramedics are at the highest possible performance level. As discussed at Board of County Commissioner meetings during the year, Dr. Tober will be working towards improving relations with the fire districts without compromising EMS standards. My annual ranking this year for Dr. Tober is a level 3,because he has in fact exceeded expectations considering the politics by some personally attack him and EMS. Our priority is patients just as Dr. Tober's priority is patients and I stand fully behind his performance. /// Commissioner Tom Henning, District 3 Packet Page-215 32r2 Tamiami T rai!Fast.Suite 303•Naples,rionca 3411Z-3/4M•239-232-3497•FAX 239-252-3602