Agenda 04/26/2011 Item #10D
4/26/2011 Item 10.0.
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EXECUTIVE SUMMARY
Recommendation to acknowledge and accept the changes in protocols instituted by
the Collier County Medical Director.
OBJECTIVE: That the Board of County Commissioners acknowledge and accept the
changes instituted by the Medical Director on April 7, 2011, changing how pre-hospital
emergency medical apparatus are dispatched for lower patient acuity level calls.
CONSIDERATIONS: In response to recent issues within the City of Naples, the
Medical Director deemed it prudent to change protocols for certain components of the
Tiered Response Program.
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In essence; all medical responses will be via lights and sirens, regardless of the reported
severity of the patient's condition. In this manner, a response will be the same for a minor
illness/injury as it might be for a cardiac arrest. Whichever responding agency arrives on
scene first, be it fire or EMS, that agency will communicate the condition of the patient to
the following unit. Once the patient's condition has been determined, the unit not yet on
scene may be downgraded to a cold response (no lights and sirens).
FISCAL IMPACT: There is no fiscal impact.
LEGAL CONSIDERATIONS: This item has been reviewed and approved by the
County Attorney's Office, is legally sufficient for Board action and only requires a
majority vote for Board approval-SRT.
GROWTH MANAGEMENT IMP ACT: There is no Growth Management Impact
resulting from this action.
RECOMMENDATION: That the Board of County Commissioners acknowledge and
accept the change to the Tiered Response Protocols instituted by the County Medical
Director.
PREPARED BY: Artie R. Bay, Supervisor, Emergency Medical Services
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4/26/2011 Item 10.0.
COLLIER COUNTY
Board of County Commissioners
Item Number: 10.0.
Item Summary: Recommendation to acknowledge and accept the changes in protocols
instituted by the Collier County Medical Director.
Meeting Date: 4/26/2011
Prepared By
Name: Hel1)andezMaria
Title: Administrative Secretary,EMS Operations
4/15/2011 8:16:22 AM
Submitted by
Title: Supervisor - Accounting,EMS Operations
Name: BayArtie
4/15/2011 8:16:24 AM
Approved By
Name: PageJeff
Title: Chief - Emergency Medical Services,EMS Operations
Date: 4/15/2011 10:49:40 AM
Name: TeachScott
Title: Deputy County Attorney,County Attorney
Date: 4/15/2011 4:52:29 PM
Name: SummersDan
Title: Director - Bureau of Emergency Services,
Date: 4/18/201110:37:01 AM
Name: PryorCheryl
Title: Management! Budget Analyst, Senior,Office of Management & Budget
Date: 4/18/2011 11:56:10 AM
Name: KlatzkowJeff
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4/26/2011 Item 10.0.
Title: County Attorney,
Date: 4/18/2011 4:28:48 PM
Name: OchsLeo
Title: County Manager
Date: 4/19/2011 1:03:05 PM
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4/26/2011 Item 10.0.
Board of Collier County Commissioners
Office of the Medical Director
Dr. Robert Boyd Tober. M.D., FACEP . Collier County Medical Director
Dr. Douglas S. Lee, M.D., FAAEM . Associate Medical Director
April 7,2011
Board of Coli ier County Commissioners
3299 E. Tamiami Trail, Suite 303
Naples, FL 34112
Dear Commissioners,
Recent issues within the City of Naples have compelled me to closely examine many components of the
Tiered Response Program that EMS has been working on for years in conjunction with Fire and EMD. r have
reached the conclusion that certain components of our Tiered Response Program are in immediate need for
adjustment or definitive improvement. Because of this, I am temporarily suspending some components of the
Tiered Response--specifically ALPHA criteria and running cold until the following changes can be made that
regains both the public's confidence as well as my OW11.
]. Communications between first response agencies must be standardized. The common
communication protocols and radio channels must be reemphasized and more importantly, strictly
followed by all members of Collier County EMS and the Fire Districts operating under the Office of
the Medical Director while engaged in all levels of EMS response, patient assessment and treatment.
This includes the following:
a. EMS TAC 1 is to be monitored by both Fire and EMS on all medical calls
b. Whomever arrives first on-scene shall announce the condition of patient on EMS T AC ] as
soon as a brief assessment is made so that the other responding agency knows what the other
has found.
c. Failure to do this announcement within 2 minutes of arrival should prompt the other agency
to utilize EMS TAC 01 to ask what has been found.
2. Modes of response (en route or responding) must be standardized. Common modes-of-travel
protocols to-and-from the location .of emergency calls must be, identified and more importantly,
strictly followed by all members of Collier County EMS and the Fire Districts operating under the
Office of the Medical Director. These protocols must be specific to the level of the tiered response
(BLS; ALS non-transport; ALS transport; etc.) and the acuity level of the patient (ALPHA,; BRAVO;
CHARLIE; DELTA; ECHO and: OMEGA). The issue ofpatiellt acuity appears inconsistent and we
have too many calls coded as ALPHA that turned out to be Cbarlies and, shortly thereafter, Deltas!
I suggest that both Fire and EMS immediately be dispatched with lights and sirens simultaneously
BEFORE EMD questioning is completed. As additional information is acquired by EMD, this can
be relayed to responding agencies. Consistent and thorough EIvlD Quality Assurance measures
must be practiced within all agencies.
3. Call processing time must become more reasonable. The moment a caller initially contacts
any Dispatch Center in Collier County to the point botl} Fire and EMS are dispatched to an
8075 Lely Cultural Parkway, Suite 267. Naples, Florida 34113. 239-252-3740' FAX 239-252-3298
-- - ------ ._-----_.~-~~~-.._---------_..-_...._-~. --- ,.~._.- .-.- --".
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4/26/2011 Item 10.0.
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emergency medical call should be completed within 60 seconds. The current disparity between the
City of Naples - 45 seconds and Collier County - 120 seconds must be addressed. I.E., as soon as
the dispatcher knows the address of the call, BOTH FIRE and EMS are toned and sent with lights
and sirens. If the nature of the call is detemlined to be of a minor nature, response mode can be
dO\\'ngraded to enroute mode.
4. Emergency Medical Dispatch (EMD) protocols and procedures must become standardized
and consistent. Any disparities that exist ben.veen the City of Naples and Collier County Dispatch
Centers must be addressed with a uniform and efficient method adopted at both Centers. Again, it
should be emphasized that the City dispatch system gets Fire Engines roIling in the city towards the
origin of a 911 call in about 45 seconds. EMS needs to be rolling in the same anlount of time. Et-.1D
can then be initiated AFTER BOTH SYSTEMS ARE ROLLING TOWARDS THE CALL ORIGIN.
5. Street and community familiarization must be improved by all responders. The Collier
County Tiered Response Workgroup, that consists of members from the Fire Districts, EMS, and
Dispatch Centers should identifY and recommend methods to decrease response times and improve
street and community familiarization. While EMS paramedics naturally have greater exposure to the
geography of the entire county, local fire agencies have more familiarity with their specific .
neighborhood streets plus the various nooks and crannies within their district. There are certainly
lessons that can be shared among the agencies.
6. Advance Life Support ALS providers must aggressively assess and treat patients to the
full extent of their protocol. The Collier County Tiered Response Workgroup that consists of
members from tile Fire Districts, EMS, and Dispatch Centers should identify and recommend
methods to improve individual practitioner's confidence and aptitude. Much of my emphasis in the
past and present is based on hands-on experience and ride time on anlbulances to enhance clinical
exposure, decision-making and confidence. We continue to struggle with assuring that paramedics in
the fire districts receive clinical opportunities and hands-on experience. Many appear hesitant to
deliver the most essential of ALS skills - relying on CCEMS paramedics to provide such treatment.
7. Controversies Surrounding Lights and Sirens. There are many peer-reviewed articles in the
literature suggesting that all emergency response could be run cold with only a few e:\."tra minutes, at
most, added to most response times. Part of me supports this notion~ especially since one of the
leading causes of death and disability in emergency services is related to vehicle crashes. Both sides
of the coin can be strongly argued. \\'hen and if \ve re-acquire confidence in our coding of calls,
varying apparatus may be able to revert to cold response to a number of calls; especially Alpha and
select Bravo calls. For the moment however, our first response out of the gate should be prompt,
simultaneous and hot until we have further information about the nature of tile call and its
senousness.
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4/26/2011 Item 10.0.
In summary, we have unnecessary delays in the dispatching of ambulances and fire engines depending on the
caIl type or area within the county. This practice must change and evervone needs to be sent simultaneouslv.
We need to temporarily send both agencies simultaneously with lights and sirens until we gather more
information about the call. We appear to have many cans coded minor when they are much more serious and
vice versa. It is easier (and I hope safer) to soot the calls "hot''' and downgrade to no lights and sirens if EMD
determines with confidence that the call is minor. It is emphasized that this may take 2-3 additional minutes
and both agencies could be well on their way towards their destination by the time this infornlation comes in.
It is hoped that such changes could shave 2-3 minutes off ofBLS/ALS arrival response times. It is imperative
that ALL AGENCIES within the county are singing to tile same hymn book and set of rules for consistency,
safety and effectiveness.
Sincerely,
fl; IV- r;p /
Robert B. Tober, M.D., FACEP
Medical Director, Collier County
cc: Leo Ochs, County Manager, Collier COWlty
Dan Summers, Director, Bureau of Emergency Services
Jeff Page, Chief, Collier County Er'vfS
Kevin Rambosk, Sheriff. Collier County
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