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Agenda 09/24/2013 Item #16E 6n 9/24/2013 16.E.6. EXECUTIVE SUMMARY Recommendation to approve and authorize the Chair to execute an Interlocal Agreement for an Advanced Life Support Partnership between Collier County and the City of Naples. OBJECTIVE: To provide quality and cost effective fire rescue and emergency medical services to the residents of the City of Naples and Collier County. CONSIDERATION: In an effort to enhance emergency medical services through a continued partnership between Collier County and the City of Naples, this Agreement provides for City firefighter /paramedics to work and train on a County ambulance and County paramedic /firefighters to train with City fire- rescue personnel. This Agreement supersedes the May 22, 2007 Interlocal Agreement for Advanced Life Support Engine Partnership between the County and the City of Naples Fire Department. This Agreement allows for City firefighter/ paramedics who have completed the Office of the Medical Director training and testing to practice independently on City of Naples ALS Engines. In addition, a City of Naples firefighter /paramedic will act as a third crew member and accompany the patient to the hospital on the ambulance for all patients requiring Advanced Life Support. n FISCAL IMPACT: There is no Fiscal Impact associated with this action. GROWTH MANAGEMENT IMPACT: None. LEGAL CONSIDERATIONS: This item has been approved as to form and legality and requires majority vote for approval. — CMG RECOMMENDATION: That the Board of County Commissioners: 1. Approves the Interlocal Agreement between Collier County and the City of Naples for an Advanced Life Support Partnership; and, 2. Authorizes the Chair to execute the Agreement. PREPARED BY: Artie Bay, Supervisor, Emergency Medical Services— Admin. Attachment: Interlocal Agreement n Packet Page -2238- 9/24/2013 16.E.6. COLLIER COUNTY Board of County Commissioners Item Number: 16.16.E.16.E.6. Item Summary: Recommendation to approve and authorize the Chair to execute an Interlocal Agreement for an Advanced Life Support Partnership between Collier County and the City of Naples. Meeting Date: 9/24/2013 Prepared By Name: BayArtie Title: Supervisor - Accounting,EMS Operations 9/10/2013 2:41:32 PM Approved By Name: pochopinpat Title: Administrative Assistant,Facilities Management Date: 9/10/2013 3:06:06 PM Name: KopkaWalter Date: 9/10/2013 9:05:57 PM Name: SummersDan Title: Director - Bureau of Emergency Services, Date: 9/11/2013 8:38:55 AM Name: GreeneColleen Title: Assistant County Attomey,County Attorney Date: 9/12/2013 8:24:08 AM Name: PriceLen Title: Administrator, Administrative Services Date: 9/13/2013 10:10:10 AM Name: GreeneColleen Title: Assistant County Attomey,County Attorney Date: 9/13/2013 11:53:10 AM Packet Page -2239- Name: KlatzkowJeff Title: County Attorney Date: 9/13/2013 1:46:10 PM Name: PryorCheryl Title: Management/ Budget Analyst, Senior,Office of Manag Date: 9/15/2013 1:14:37 PM Name: OchsLeo Title: County Manager Date: 9/17/2013 2:23:13 PM Packet Page -2240- 9/24/2013 16.E.6. 9/24/2013 16.E.6. INTERLOCAL AGREEMENT ADVANCED LIFE SUPPORT PARTNERSHIP BETWEEN COLLIER COUNTY AND CITY OF NAPLES This INTERLOCAL AGREEMENT, made and entered into this _ day of 2013, by and between the Board of County Commissioners, Collier County, Florida, a political subdivision of Florida, (hereinafter "COUNTY") and the CITY OF NAPLES, "hereinafter "CITY"). PURPOSE The purpose of this Interlocal Agreement is to provide quality and cost effective fire rescue and emergency medical services to the residents of the City of Naples and Collier County. The recognition and utilization of existing and future personnel skills, qualifications and resources is in the interest and benefit of both agencies and the public we serve. WITNESSETH WHEREAS, the CITY and COUNTY seek to enhance emergency service further through a continued partnership; and WHEREAS, the Advanced Life Support (hereinafter "ALS ") partnership provides for a CITY Firefighter /Paramedic to work and train on a COUNTY Advanced Life Support transport ambulance providing paramedic duties and/or basic life support EMT duties; and WHEREAS, the ALS partnership allows for a COUNTY Paramedic /Firefighters to train with CITY Fire - Rescue personnel; and WHEREAS, the CITY and COUNTY work cooperatively to assure appropriate response of sufficient emergency medical resources and enhanced continuity of care from the scene to the hospital for all ALS patients. NOW, THEREFORE, in consideration of the above premises, and the mutual covenants, terms, and provisions contained herein, the COUNTY and the CITY agree as follows: SECTION I: DEFINITIONS 1.0 ALS means treatment of life- threatening medical emergencies through the use of techniques such as endotracheal intubation, the administration of drugs or intravenous fluids, telemetry, cardiac monitoring, and cardiac defibrillation by a qualified person, pursuant to rules of the COUNTY Office of Medical Director (hereinafter "OMD "). Page 2 of 12 Packet Page -2241- X, 9/24/2013 16.E.6. 1.1 Basic life support means treatment of medical emergencies by a qualified person through the use of techniques such as patient assessment, cardiopulmonary resuscitation (CPR), splinting, obstetrical assistance, bandaging, administration of oxygen, application of medical antishock trousers, administration of a subcutaneous injection using a premeasured autoinjector of epinephrine to a person suffering an anaphylactic reaction, and other techniques described in the Emergency Medical Technician Basic Training Course Curriculum of the United States Department of Transportation. The term "basic life support" also includes other techniques which have been approved and are performed under conditions specified by rules of the department, and other techniques which have been approved and are performed under conditions specified by rules of the COUNTY OMD. 1.2 FTO means a Field Training Officer; a certified paramedic recognized by the OMD as having sufficient skill and experience to train and direct medical providers in working under the approved medical protocols. 1.3 QA/QI means Quality Assurance / Quality Improvement which is the OMD approved program which assesses and monitors the medical performance of Paramedics and Emergency Medical Techr ,cians. 1.4 PCR means the Patient Care Record which chronicles the medical treatment of the patient. 1.5 Permitted means a non - transporting ALS fire apparatus and rapid response vehicle operating under the ALS license issued to COUNTY Emergency Medical Services Department (hereinafter "EMS ") for the purpose of enhancing 911 medical responses. 1.6 Classifications of paramedics are found in the ALS Operational Plan (Attachment A). 1.7 Non - permitted means any response vehicle that is not required by State Statute to be permitted, but is authorized by the Medical Director. SECTION II: COUNTY'S RESPONSIBILITY The following specific services, duties, and responsibilities will be the obligation of the COUNTY: 2.0 The COUNTY will provide through the County's EMS and the OMD; medical direction, medical protocols, training and quality assurance on a countywide basis. 2.1 The COUNTY, as a licensed provider of advanced life support under Chapter 401, Fla. Stat. and Fla. Admin. Code 64J, will permit up to four (4) CITY fire apparatus or response vehicles as non - transporting ALS vehicle(s) under the COUNTY EMS license for the purpose of enhancing 911 medical responses. 2.2 As pursuant to Chapter 401, Fla. Stat. and Fla. Admin. Code 64J, the City may operate any of their permitted ALS vehicles or apparatus as a BLS responder when a paramedic does not staff the vehicle. Page 2 of 12 Packet Page -2242- Me 9/24/2013 16.E.6. SECTION III: CITY'S RESPONSIBILITY The following specific services, duties, and responsibilities will be the obligation of the CITY: 3.0 The CITY will provide through the City of Naples — Fire Rescue Department firefighter training to County firefighter personnel. 3.1 The CITY will provide, maintain, repair and replace all applicable ALS and BLS equipment and medical supplies on all County recognized permitted ALS fire apparatus /rapid response vehicles, staffed 365 days a year, 24 hours per day including those stationed at the following locations: 1. 855 8th Ave South 2. 977 26th Ave North 3.2 As pursuant to Chapter 401, Fla. Stat. and Fla. Admin. Code 64J, the City may operate any of their permitted ALS vehicles or apparatus as a BLS responder when a paramedic does not staff the vehicle. 3.3 The CITY will maintain a minimum of three (3) ALS apparatus, and up to four (4) permitted by the COUNTY and equipped by the CITY. These units will be designated within the County Sheriff's Office and Naples Police Communications Division's Computer Aided Dispatch (CAD) programs to automatically respond to medical incidents with, or in place of an ALS transport unit committed to a previous medical, rescue or fire operation in accordance with the COUNTY's Emergency Medical Dispatch protocol as an emergency medical response and /or ^ fire suppression vehicle. 3.4 The CITY will comply with medical protocol, equipment standards, and will fully participate in medical training and quality assurance programs in accord with the COUNTY. 3.5 The CITY will maintain all medical run reports in an OMD approved records system and will handle them in a manner consistent with County operating guidelines, Federal, and State laws. 3.6 The CITY will ensure all CITY personnel providing medical care maintain all state and federally required licensure. Records shall be maintained by the CITY and available to the COUNTY upon request. 3.7 The CITY will provide at least one liaison as an Emergency Medical Care Coordinator (hereinafter "EMCC "), approved by the OMD to function as a Training Officer / Supervisor for CITY Paramedic and EMT training. The EMCC shall work with COUNTY EMS Training staff to enhance the BLS and First Responder Program by assisting in teaching per the annual published in- service schedule. If the CITY cannot logistically attend ESC training, they may teach OMD approved curriculum at remote sites provided: 1. The OMD approved EMCC attends all in- service classes taught at the ESC in order to insure the training liaison is kept up to date on protocol changes, trends in local treatment, case reviews, etc. and can more effectively communicate the material in context to their agency's personnel Page 3 of 12 Cq Packet Page -2243- 9/24/2013 16.E.6. 2. The EMCC must use curriculum pre - approved by the OMD for medical training. In the case of regularly scheduled County in- service, the approved curriculum will be provided the month after the conclusion of scheduled in- services at ESC. 3.8 The CITY will designate an OMD approved representative as a Quality Assurance member to participate in Quality Assurance. 3.9 The CITY may provide additional medical equipment and expand Advanced Life Support service with prior review and in conjunction with the OMD. 3.10 The CITY shall be responsible for replacing expendable medical supplies and for the cost of repair and maintenance of all ALS equipment. SECTION IV: MUTUAL CONVENANTS 4.0 NOTIFICATION OF EXPOSURE TO INFECTIOUS DISEASES: In the event that Collier County EMS Department is notified of an exposure to infectious disease, EMS shall notify the CITY's Infectious Control Officer or EMCC so they may take appropriate action. Upon notification, the treatment procedures shall be the responsibility of the CITY. In the event that the CITY is noted of an exposure to infectious disease, the CITY shall notify the EMS Infectious Control Officer or EMSCOMM so they may take appropriate action. SECTION V: OPERATING PROCEDURES 5.0 The CITY Firefighter /Paramedics and Firefighter/EMTs will meet the same requirements and perform at the ALS Non - Transport medical protocol as defined by the OMD, COUNTY EMS department standard operating procedures, quality assurance, general orders and chain of command will be followed while working on the apparatus of the COUNTY EMS Department. 5.1 The CITY Firefighter /Paramedics who are certified to perform as ALS Engine Paramedics are also subject to ongoing patient contact, training, and assessment to maintain their certification or expand their scope of practice. 5.2 The ALS Operational Plan, Attachment A, may be revised by mutual written consent between the Chief of the CITY's Fire Rescue and COUNTY's County Manager or his designee (e.g. Chief of EMS). Such revisions must not conflict with the terms and standards set forth in this Agreement. 5.3 Permitted and non - permitted ALS vehicles, programs, personnel or details may be developed and implemented by joint agreement and in cooperation between the CITY and COUNTY. Such resources may not conflict with the standards set forth in this agreement. 5.4 The CITY and COUNTY EMS Department will recognize the respective ranks and abilities of assigned personnel. 5.5 All discipline and investigations leading to discipline will be handled by the respective employing agency. 5.6 The CITY and COUNTY will utilize Command Staff and assets for logistical, Page 4 of 12 Packet Paee -2244- G 9/24/2013 16.E.6. support, and operational needs for national, state and local emergencies. 5.7 The State of Florida recognized Incident Management System (IMS) is the standard for emergency operations. The CITY shall assume command and control of all incidents where the CITY is the Authority having Jurisdiction. In all instances where the CITY has established command, COUNTY EMS shall assume responsibility for, and be in charge of patient care. 5.8 The COUNTY and CITY will share statistical data. SECTION VI: RESOLUTION OF CONFLICTS 6.0 If the two governing entities standard operating procedures, chain of command or any other unforeseen circumstances come into conflict issues will immediately be decided in the following manner; 1. First and foremost by the medical needs of the patient and responder safety. 2. The COUNTY will have jurisdiction of medical issues concerning appropriate patient care. 3. The CITY will have jurisdiction of fire /rescue issues concerning operations and safety. 4. Conflicts involving patient care issues will be resolved through a QA/QI process. 5. Should conflicts arise that are unresolvable, the chain of command within each department will come together in an attempt to resolve those issues at the equivalent levels of each department and in unison move up the chain of command as necessary. SECTION VII: AGREEMENT TERM 7.0 This Interlocal Agreement supersedes the agreement titled "Interlocal Agreement Advanced Life Support Engine Partnership, between the CITY and COUNTY, dated May 22, 2007. 7.1 The Interlocal Agreement shall remain in full force and effect from the date above and shall terminate after written notice of termination. 7.2 This Interlocal Agreement shall be reviewed and renegotiated as necessary after three (3) years. Absent termination or amendment to this Interlocal Agreement, the term of this Interlocal Agreement will automatically renew in (3) three year periods. Nothing within this Agreement shall preclude review and amendment of any provision within the three (3) year period or successive renewal periods when such amendment is mutually agreed to in writing by the COUNTY and CITY. 7.3 Either the COUNTY or the CITY may terminate this Interlocal Agreement after providing written notice of its intent to terminate at least ninety (90) days in advance of the date of termination. 7.4 In the event that the COUNTY's OMD determines that the CITY's failure to fulfill any of the obligations under this Agreement adversely affects or may adversely Page S of 12 EMS Packet Page -2245- 9/24/2013 16.E.6. affect the medical needs of the patient and /or responder safety, the COUNTY may provide written notice to CITY of its intent to recommend that the BCC terminate this Agreement. BCC consideration of termination of this Agreement must occur at the next available regular meeting of the BCC. Advance notice of the BCC meeting date and agenda item must be provided to the OMD and CITY. Unless otherwise determined by the BCC at the meeting, the notice of intent to recommend that the BCC terminate this Agreement shall be deemed to be fully sufficient and to have commenced the (90) ninety day notice period. In the alternative, the BCC at the meeting may, after receiving information from the OMD and CITY, terminate this Agreement without further action or notice to the CITY. Nothing in this Agreement shall limit the authority of the OMD as set forth in the Florida Statutes and the Florida Administrative Code. 7.5 The terminating party must also provide the non - terminating party's representatives with an opportunity to consult with the terminating party's representatives regarding the reason(s) for termination during the notice periods provided in Section VII of this Agreement. SECTION VIII: INSURANCE 8.0 The CITY and COUNTY shall maintain insurance in the minimum amounts and types required by Florida State Statutes. 8.1 The CITY and COUNTY agree that either party may be self- insured on the condition that all self - insurance must comply with all State laws and regulations and must meet with the approval of the other party to this Interlocal Agreement. 8.2 To the extent permitted by law and as limited by and pursuant to the provisions of Florida Statutes, Section 768.28 CITY and COUNTY agree to hold harmless the other, their employees and agents against any and all claims and/or damages by or behalf of any person, employee or legal entity arising from their respective negligent acts pursuant to this Interlocal Agreement that allows employees of the other to occupy and ride in each other's vehicles. Nothing is intended to alter either party's immunity in tort or otherwise impose liability on CITY or the COUNTY when it would not otherwise be responsible. Page 6 of 12 C,q Packet Page -2246- 9/24/2013 16.E.6. SECTION IX: MISCELLANEOUS 9.0 This Interlocal Agreement shall be governed by and construed under the laws of the State of Florida. In the event any litigation is instituted by way of construction or enforcement of this Interlocal Agreement, the parry prevailing in said litigation shall be entitled to collect and recover from the non - prevailing party all court costs and other expenses, including reasonable Attorney's fees. 9.1 It is understood that this Interlocal Agreement must be executed by both parties prior to the CITY and COUNTY commencing with the work, services, duties and responsibilities described heretofore. 9.2 Prior to its effectiveness, this Interlocal Agreement and any subsequent amendments to this Agreement (including amendments to the ALS Operational Plan, Attachment A), shall be filed with the Clerk of Courts for the Circuit Court for Collier County pursuant to Section 163.01(2), Fla. Stat. The COUNTY shall file this Interlocal Agreement as soon as practicable after approval and execution by both parties. (Remainder of page intentionally left blank, signature page to follow] Page 7 of 12 Packet Page -2247- G 9/24/2013 16.E.6. IN WITNESS WHEREOF, the parties hereto have caused this Interlocal Agreement to be executed by their appropriate officials, as of the date first above written. ATTEST: BOARD OF COUNTY COMMISSIONERS DWIGHT E. BROCK, CLERK COLLIER COUNTY, FLORIDA, BY: Deputy Clerk Georgia A. Hiller, Esq. Chairwoman Approved as to form and legality: Ileen M. Greene Assistant County Attorney ATTEST: NAPLES CITY COUNCIL Pat Ranibosk, City Clerk /)6hn F. Sorey 111, MWor Approval as to form and legal sufficiency: -D , �1 Robert D. Pritt City Attorney Page 8 of 12 Packet Page -2248- G r 9/24/2013 16.E.6. ATTACHMENT A COLLIER COUNTY EMERGENCY MEDICAL SERVICES AND NAPLES FIRE AND RESCUE DEPARTMENT ALS OPERATIONAL PLAN REFERENCE: ALS Program Interlocal Agreement, , 2013 PURPOSE: To provide quality and cost effective emergency medical services to the residents of the City of Naples (CITY) and Collier County (COUNTY). The recognition and utilization of existing and future personnel skills, qualifications and resources is in the interest and benefit of both agencies and the public we serve. The CITY will maintain a minimum of three (3) ALS apparatus, and up to four (4) permitted by the COUNTY and equipped by the CITY. • Engine 1 • Engine 2 • Rescue 2 • Ladder 1 (staffing permitting) 1. QUALIFICATION REQUIREMENTS For the purposes of practicing medicine within the County, there are different recognized classifications of paramedics: State Certified Paramedics and County Certified Paramedics. a. State Certified Paramedics have completed all State requirements and remain in active good standing with the State and are permitted to practice ALS under the aegis of any County Certified Paramedic or to practice BLS independently. b. County Certified Paramedics have completed all State requirements and remain in active good standing with the State and have also completed OMD approved training and testing to be permitted to practice independently under the ALS Engine or Non - Transport Paramedic Protocol. The CITY Firefighter /Paramedics who are certified to perform as ALS Engine Paramedics are also subject to ongoing patient contact, training, and assessment to maintain their certification or expand their scope of practice. 2. PROCEDURES a. City of Naples Firefighter / Paramedic will accompany EMS ambulance staff (third crew member) and the patient to the hospital on all patients requiring ALS treatment. Page 9 of 12 Packet Page - ?Mc)- CA b. The team of EMS staff and City of Naples will work jointly to provide the care needed to the patient while enroute to the hospital. EMS staff will always be lead team member of patient care. c. The COUNTY Battalion Chief and City of Naples Battalion Chief will consult openly in order to assure continuity and efficiency. It is recognized by COUNTY and City of Naples that harmonious and productive relationships between all personnel are necessary. Teamwork and cooperation is encouraged and expected. d. Applicable COUNTY and /or CITY policies, practices, procedures, standard operating guidelines, general orders, protocols and /or applicable Bargaining Unit Contract language will be observed. 3. COMMUNICATION AND DISPATCH a. COUNTY and City of Naples staff will assure all personnel operate on the appropriate radio frequency, unit identifier dispatch and zone coverage protocol in accordance with Computer Aided Dispatch (CAD) and the CCFCA Communications Manual. Designated assignments are outlined as follows: i. Medical Director approved Emergency Medical Dispatch (EMD) Models shall be designed to assure the initial response of appropriate AILS licensed apparatus. ii. COUNTY and City of Naples chief officers will utilize available City of Naples Fire - Rescue Department licensed resources to assure AILS coverage is continuously maintained within the City of Naples. iii. COUNTY and City of Naples chief officers will assure licensed and non - licensed AILS assets will respond to out -of- district emergencies or coverage when identified by CAD as the closest available ALS unit. b. Applicable COUNTY and /or CITY policies, practices, procedures, standard operating guidelines, general orders, protocols and /or applicable Bargaining Unit Contract language will be observed. 4. DOCUMENTATION a. The first arriving licensed and non - licensed AILS unit will document each patient contact in an OMD approved Patient Care Report (PCR). Collier EMS utilizes electronic reporting as its primary PCR system but in the event the City does not have on scene electronic reporting capability, handwritten reports may be utilized until electronic reporting can be completed. The PCR must record any notations from on -scene patient treatment, patient identifying data completed and collected prior to transfer of patient care, AR number, Dispatch times, and crew signatures with State paramedic or EMT license numbers. Some specific call types may Page 10 of 12 Packet Page -2250- 9/24/2013 16.E.6. require additional documentation (such as Release /Competency forms for patient sign outs) as specified by protocol and EMS documentation standards. When ALS units arrive at the same time, the PCR will be completed by the transporting unit. Shift PCRs are to be collected in a secured envelope with completed coversheet and submitted to the appropriate EMS representative daily. b. Before the end of shift, an accurate and complete OMD approved electronic report (E -PCR) will be transmitted for each patient contact 100% of the time. All medical procedures performed by the personnel assigned to the response will be fully documented. "CHART' format with documented "BSI" is required. c. Prior to 0900hrs, or as call volume permits, the City of Naples Battalion Chief or designee must fax or email a complete ALS Staffing Report to EMSCOMM's office. If staffing changes are made during the shift, an updated report will be provided to EMSCOMM prior to or at the end of shift to reflect staffing changes. EMSCOMM will provide a complete EMS Staffing report to the City of Naples Battalion Chiefs office. 5. QUALITY ASSURANCE a. City of Naples Fire - Rescue Department will appoint a Medical Director approved "Quality Assurance (QA) member to participate on the ALS Non- Transport Quality Assurance Committee, and will be granted privileges to enable them to review their department's PCRs. b. City of Naples Fire - Rescue Department will adhere to QA standards of the OMD and provide quarterly reports reflecting the monitoring guidelines employed by the County. c. Patient care concerns may be found outside of report monitoring and may, be reported by either agency or allied personnel such as hospital staff, deputies, etc. Concerns should be made in writing to a QA Committee member via the Quality Assurance Review Form whenever possible and including pertinent specific details. d. The Medical Director will review all potential malpractices and make recommendations for follow up with call participants and future treatment or training guidelines. Feedback will be provided to both the complainant and the treating paramedic by the QA committee upon the resolution of the issue. e. At the discretion of the Medical Director or designee, routine or informational QA Review with City of Naples Fire - Rescue Department personnel may be handled entirely by the City of Naples Fire - Rescue Department member. The member shall review and complete all paperwork with the City of Naples Fire - Rescue Department personnel and return all necessary documentation to the ALS Non - Transport QA Committee within thirty [30] calendar days. Page 11 of 12 Packet Page -2251- CA 9/24/2013 16.E.6. f. In the event the Medical Director orders remediation, the QA member shall be present understanding that confidential medical information will be discussed. If a significant issue is identified by the QA Committee, the EMT or Paramedic may be immediately prohibited from providing patient care until all processes are completed. 6. TRAINING a. The CITY Training person(s) is qualified to instruct CITY firefighter paramedics or EMTs Medical Director approved in- services, certifications, classes, etc. utilizing preapproved curriculum b. Any curriculum taught by the CITY EMS Training person(s) must be submitted with a complete student roster to the OMD in order to qualify for COUNTY accreditation. In addition, the EMS Training Officer will accurately record continuing education hours of any personnel completing their training and provide those records to the COUNTY quarterly. c. The CITY will provide to the State Fire College appropriate approved training documentation for recognized State approved fire classes. Page 12 of 12 Packet PaEe -2252- 019