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Senior Advisory Committee Agenda 11/05/2018November 5, 2018 10:30 AM Senior Advisory Committee Meeting 3299 Tamiami Trl E Naples FL, 34112 Second Floor County Manager’s Front Conference Room 1. Call to Order 2. Pledge of Allegiance 3. Roll Call 4. Adoption of the Agenda 5. Public Comment 6. Adoption of Minutes from Previous Meeting 6.1. October 1, 2018 7. Staff Reports 8. New Business 8.1. Naples Daily News 8.2. Harriet Lancaster Report on Falls and EMS Calls by Seniors 9. Unfinished Business 10. Announcements 11. Committee Member Discussion 12. Next Meeting Time, Date and Location 12.1. December 3, 2018 10:30 a.m. County Manager’s Office Front Conference Room 13. Adjournment 36.A.2 Packet Pg. 1021 Attachment: Agenda and Backup - November 5, 2018 (7500 : Senior Advisory Committee - November 5, 2018) “Community Medicine and Possible Future Impact on Collier County EMS” Roundtable Discussion Points** Hodges University, Naples, FL February 15, 2017  Most Americans get primary medical care via primary care physicians and emergency rooms.  US Health Resources & Services Administration says If today's system for delivering primary care remained fundamentally the same in 2020, there will be a projected shortage of 20,400 primary care physicians, a number that might be somewhat lessened if other healthcare professionals were integrated into health care delivery.  The CDC says 80% of all healthcare cases come from chronic diseases.  Mayo Clinic says chronic non-life threatening conditions are reasons for most US healthcare provisions.  Canadian experts report chronic condition-patients use healthcare services more frequently and intensely.  In Collier County, Florida, according to public health experts, most prevalent chronic conditions include COPD (14,000+ people), diabetes (31,000+ people), hypertension (117,000 people), falls (41,000 people), and asthma (10,000).  In Collier County, Florida most non-crime related 911 calls, responded to by the Sheriff’s 660 certified law enforcement deputies, 75 Naples City and Marco Island’s 37 police officers involve health-related issues.  And in Collier County nearly 70% of all 911 calls responded to by Collier County’s certified fire & rescue officers and all responded to by the County Emergency Medical Service officers involve health-related issues.  Experts agree most chronic health conditions can be managed most effectively and efficiently by proven strategies to delay and prevent their advancement.  For a variety of reasons, especially payment and funding policies, most American emergency rooms are episodically overloaded, the number of primary care physicians is shrinking and, relative to behavioral health and addition services, our jails and other holding facilities have large stabilized but not treated mental illness populations.  Hence, it is imperative that a comprehensive and sustained strategy be implemented to activate proven tactics to improve the quality of primary healthcare, prevent complications, reduce the need for more expensive health services and secure better quality of life for all. 36.A.2 Packet Pg. 1022 Attachment: Agenda and Backup - November 5, 2018 (7500 : Senior Advisory Committee - November 5, 2018) *Compiled by Mike Reagen with much appreciation and sincere apologies for the liberal lifting and cribbing of undocumented ideas, data and comments from the excellent resources acknowledged at end of this paper.  Population Based Healthcare [PBH] / Community Medicine [CM] which assess and make healthcare decisions for the healthcare needs of specific populations rather than on an individual by individual basis, are gaining interest and acceptance.  One model for PBH/CM proactively, systematically and consistently focuses on managing the needs of populations of individuals in those populations with similar chronic diseases that most often present to primary care physicians and emergency rooms.  Significant discussions among collaborative national organizations, agencies and associations are centered on promoting innovation in the USA’s EMS and Fire & Rescue systems staffed by emergency medical technicians and paramedics.  These discussions prompt a private study group in Collier County, FL [aka “Greater Naples”] to determine if there are opportunities to advance EMT & Paramedic services through public commentaries, forums and a possible pilot project in the largest geographical jurisdiction in southwest Florida.  On Feb. 15, 2017, a Roundtable luncheon is scheduled at Hodges University’s Naples Campus to discuss these possible opportunities.  Admittedly, there are several nationally-recognized barriers to refreshing, refocusing or recreating model EMS systems.  Our current EMS systems are fragmented. Financial reimbursement, medical direction, jurisdictional issues, codified organizational cultures and education standards focus exclusively on individual emergency care and transport rather than on primary care of specific population-wide chronic conditions.  Moreover, there is little collaboration between EMS and the academic community. EMS rarely effectively uses data or shares information with other agencies/systems. Indeed, experts state “fragmentation, silos and entrenched interests prevail through emergency and trauma care.”  Also, current, most EMS organizations are not designed to provide community services nor to adapt to new opportunities. EMS is a neglected area of US healthcare. The EMS culture resists innovation and integration within the larger public safety and healthcare systems. Its adaption to the 36.A.2 Packet Pg. 1023 Attachment: Agenda and Backup - November 5, 2018 (7500 : Senior Advisory Committee - November 5, 2018) opportunities presented by PBH/CM may present daunting national challenges.  However, the Institute for Medicine’s [IOM] envisions an EMS system that maximizes community value by providing new essential services to become an integral part of a healthcare system focused on PBH/CM. The IOM sees future EMS agencies bringing definitive primary care of chronic conditions into patients’ homes and helping the nation increase quality care, decrease costs and improve communities’ health.  To do so, the IOM argues significant changes are critical: movement to proactive rather than reactive care; delivering necessary care rather than traditional care; and, moving from a fee-for-service/hospital-based service to aligning EMS to PBH/CM services.  To function effectively, all components of a community’s healthcare system must be integrated. Leaders, “key players” in each community/region, must work together to make decisions, deploy resources and monitor/adjust system operations based on performance feedback.  American healthcare is changing dramatically---focusing increasingly on value, quality over quantity and projected different future payment models.  In several communities/regions in the USA, EMS organizations have experience working with patients in their homes and are already major providers of out—of-hospital care because their leaders recognize the value of home-based care, social determinants of health and community- based care and have retuned their agencies accordingly.  Indeed, many EMS/Fire & Rescue agencies provide EMT and Paramedic care already—operating 24 hours a day, 7 days a week rather than just during business hours—navigate patients, provide essential services and improve the quality of coordinated aspects of patient care.  Surely, the past two decades attest to marvelous advancements when EMS/Fire & Rescue agencies intersect to provide timely care for stroke, heart attack and trauma emergency management. Why cannot this success move to providing primary care to patient populations with chronic conditions that lead to these acute conditions in specific communities?  Recently, Community Paramedicine [CP] has emerged as an innovative and evolving model of community-based healthcare designed to provide more effective and efficient services at a lower cost. 36.A.2 Packet Pg. 1024 Attachment: Agenda and Backup - November 5, 2018 (7500 : Senior Advisory Committee - November 5, 2018)  Community Paramedicine allows paramedics to function outside their traditional emergency response and transport roles to help facilitate more appropriate use of emergency care resources while enhancing access to primary care for medically underserved populations.  Community Paramedicine is successfully operating in North Carolina, Colorado, Minnesota, Maine and Texas where it had been demonstrated that paramedics can be trained to safely and effectively performed in an expanded role with cost savings.  Community Paramedics are licensed paramedics who have receives specialized training in addition to general paramedicine training and work within a designated Community Paramedicine program under local medical control as part of a community-based team of health and social service providers.  Community Paramedics are uniquely positions for expanded roles as they are geographically dispersed in nearly all communities, inner-city and rural; always available, work in home and community-based settings; are trusted and accepted by the public and trained to make health status assessments, recognize and manage life-threatening conditions outside of the hospital; and operate under medical control as part of an organized, system approach to Population Based Healthcare/Community Medicine.  In fifteen California jurisdictions, Community Paramedics are currently engaged in pilot projects focusing on niches of Population Based Healthcare/Community Medicine: Post Discharge, Alternative Destination, Frequent 911 Callers, Hospice Care, and Behavioral Health.  While obstacles and barriers surely exist, conditions in Collier County, Florida may be ideal for an informal study group to look at the future possibilities of the community’s EMS system and to make suggestions about advancing it. Here are just a few opportunities that might be leveraged: o New-elected members of the County Board of Commissioners have taken Office. o The Sheriff of Collier County has installed a nationally recognized CAD central dispatch system where every protective service [first responder] asset/vehicle is viable 24/7 to be dispatched to the nearest need/incident. The system will be totally perfected in 2017. 36.A.2 Packet Pg. 1025 Attachment: Agenda and Backup - November 5, 2018 (7500 : Senior Advisory Committee - November 5, 2018) o The Medical Director of Collier County’s EMS Department, a nationally-regarded emergency medicine physician with 41 years of experience, is now entering his fifth decade of leadership. o The County Manager, a nearly 30-year veteran of public administration, is in the midst of refocusing his administration to a public service model from a public trust model of management. o A nationally recognized EMS leader, well versed in PBH/CM and CP will join Collier County Government in January 2017 to assist in system-analysis and make strategic/tactical recommendations for the future of Collier County’s EMS Dept. o Seven independent fire districts [governments under Florida Law] have morphed into five districts and future district, operations and protocol consolidations are underway. o Demographic growth [population, wealth, property values] is surely underway including the development of several large demographic clusters and continuous care facilities. o The NCH Healthcare System continues to mature, including its two- emergency medicine department at its two locations, the employment of more physicians and the expansion of its support for the Blue Zone program countywide among homeowner’s associations [gated communities], business firms, civic organizations and public institutions [schools].  A small private group of Collier County citizens---with proven expertise in various aspects of human services, health care, public safety, communication and public administration---has been individually discussing the various concepts of Population Based Healthcare/Community Medicine and the future opportunities/challenges of public protection services [mainly EMS and Fire & Rescue Services and law enforcement advances] in Collier County.  The Group recognizes there is a revolution taking place in emergency medical services in several communities across the United States. As the issues of health care accessibility, quality and affordability continue to receive national attention, there is a growing awareness that the traditional role of emergency medical services can be expanded to help address some of these challenges. 36.A.2 Packet Pg. 1026 Attachment: Agenda and Backup - November 5, 2018 (7500 : Senior Advisory Committee - November 5, 2018)  On February 15, 2017, The Group…under the “TBA” of “The Roundtable” …will privately meet at Hodges University in Naples, Florida to discuss the focus of this Synopsis.  In addition to becoming further acquainted, The Roundtable will discuss determining if Collier County EMS can be repositioned to expand its role into prevention/primary care and chronic care management services in support of, and in coordination with, other community health care resources (hospitals, private physicians, public health department, etc.).  If there is interest in pursuing possible opportunities/challenges, The Roundtable may wish to: Produce a series of Guest Commentaries [aka “Op Ed Pieces] for sequential submission for consideration of the Naples Daily News to be published over a six-month period to raise public conscious of aspects of this topic. Produce, possibly under the aegis of Hodges University, a Public Forum at which leaders of Community Paramedic Pilots could present results of their efforts. And seek support for a study of the possibilities of launching a pilot Community Paramedic project in Collier County, Florida.  If a study would be undertaken, it is understood that the research would focus on these outcomes: 1. Identification and definition of new/expanded services provided by EMS in coordination with other community resources. 2. Identification of additional resources required to meet this new role. 3. Consensus and commitment of key stakeholders that expanded role of EMS is a crucial component in the delivery of affordable, quality health services to the community at large. 4. Development of a communication plan to educate key stakeholders and the public on the changing role of EMS and its benefits. 5. Institute a pilot program. Next Steps…if any? -mvr: 12/23/16- 36.A.2 Packet Pg. 1027 Attachment: Agenda and Backup - November 5, 2018 (7500 : Senior Advisory Committee - November 5, 2018) A Few Excellent Resources Abrashkin, K. A., Washko, J., Zhang, J., Poku, A., Kim, H. and Smith, K. L. (2016), Providing Acute Care at Home: Community Paramedics Enhance an Advanced Illness Management Program—Preliminary Data. J Am Geriatr Soc. doi:10.1111/jgs.14484 [pdf] Agarwal, G., Angeles, R. N., McDonough, B., McLeod, B., Marzanek, F., Pirrie, M., & Dolovich, L. (2015). Development of a community health and wellness pilot in a subsidised seniors’ apartment building in Hamilton, Ontario: Community Health Awareness Program delivered by Emergency Medical Services (CHAP-EMS). BMC Research Notes, 8, 113. http://doi.org/10.1186/s13104-015-1061-8 Jane Bedford, MIHP: A Partnership for Patients, Nature Coast EMS, received, 11/10/16. Broemeling, AM, Watson, DE, Prebtani, F, Population Patterns of Chronic Health conditions, co-morbidity and healthcare use in Canada: Implications for policy and Practice, Interior Health Authority and Centre for Health Services and Policy Research, University of British Columbia, Vancouver, British Columbia, Healthcare Quarterly [Toronto, Ont: 2008, 11(3): 70-76] Bigham, B. L., Kennedy, S. M., Drennan, I., & Morrison, L. J. (January 01, 2013). Expanding paramedic scope of practice in the community: A systematic review of the literature. Prehospital Emergency Care, 17(3). CDC National Center for Chronic Disease Prevention and Health Promotion, Report of November 14, 2016. Brian Y. Choi, Charles Bloomberg, Kenneth Williams, Mobile Integrated Health Care and Community Paramedicine: An Emerging Emergency Medical Services Concept, Annals of Emergency Medicine, An International Journal, March 2016, Vol. 67, Issue 3, Pages 361-364. 36.A.2 Packet Pg. 1028 Attachment: Agenda and Backup - November 5, 2018 (7500 : Senior Advisory Committee - November 5, 2018) Community Paramedics: 13 Projects, California Emergency Medical Services Authority, The California Project. California Office of Statewide Health Planning and Development, Health Workforce Pilot Project Program, 2014. Conversations with Robert Tober, M.D., Edward Morton, Tabatha Butcher, Len Price, Jorge Aguilera, Ed Boyer, Aysegul Timur, Ph.D., William Griz, Ph.D., James Delony, Allen Bartlett, Jacklyn Faffer, Ph.D., Edwin Fryer, J.D., Leo Ochs, Stephen Weisberg, M.D., David Trecker, Ph.D., Douglas Johnson, Ph.D., Hon. Kevin Rambosk, Stephanie Spell. Crockett, B. M., Jasiak, K. D., Walroth, T. A., Degenkolb, K. E., Stevens, A. C., & Jung, C. M. (March 21, 2016). Pharmacist Involvement in a Community Paramedicine Team. Journal of Pharmacy Practice. Constance Donavan, 2 Factors Contributing to ER Overcrowding, Healthcare, 12/15/16. Jennifer Goodwin [ED], Pamela Lane, MA [ED], Matt Zavandsky, MS-HAS, EMT, Troy Hagen, MBA, Paramedic, Paul Hinchey, MD, MBA, Kevin McGinnis, MPS, Paramedic, Scott Bourn, Ph.D., RN, Paramedic, Brent Myers, MD, MPH, Mobile Integrated Healthcare and Community Paramedicine [MIH-CP], National Association of Emergency Medical Technicians [NAEMT.Org], Supplement to EMS World. James G. Hodge, JD, LLM, Daniel G. Orenstein, JD, Kim Weidenaar, JD, Expanding the Roles of Emergency Medical Services Providers: A Legal Analysis, Association of State and Territorial Health Offices, Arizona State University’s Sandra Day O’Connor College of Law, funded from The Assistant Secretary for Preparedness Response [ASPR]. Laura Lando, Revolution in EMS Care, Wall Street Journal, 9/26/16. Martin, A., O'Meara, P., & Farmer, J. (August 01, 2016). Consumer perspectives of a community paramedicine program in rural Ontario. Australian Journal of Rural Health, 24, 4, 278-283. Mason, S., Knowles, E., Colwell, B., Dixon, S., Wardrope, J., Gorringe, R., … Nicholl, J. (2007). Effectiveness of paramedic practitioners in attending 999 calls from elderly people in the community: cluster randomised controlled trial. BMJ : British Medical Journal, 335(7626), 919. http://doi.org/10.1136/bmj.39343.649097.55 Petterson, Stephen M; Cai, Angela; Moore, Miranda; Bazemore, Andrew: State Level Projections of Primary Care Workforce, 2010-2030, Robert Graham Center, Sept. 2012. Promoting Innovation in Emergency Medical Services {Draft}, Mount Sinai Health System & University of California, San Diego, July 1, 2016, Supported by a Cooperative 36.A.2 Packet Pg. 1029 Attachment: Agenda and Backup - November 5, 2018 (7500 : Senior Advisory Committee - November 5, 2018) Agreement with the U.S. Department of Transportation, National Highway Traffic Safety Administration in collaboration with the U.S. Department of Health & Human Services— Assistant Secretary for Preparedness & Resp9onse, and The U.S. Department of Homeland Security. Ross, D. W., Schullek, J. R., & Homan, M. B. (January 01, 2013). EMS triage and transport of intoxicated individuals to a detoxification facility instead of an emergency department. Annals of Emergency Medicine, 61, 2, 175-84. Jennifer St. Sauver, Ph.D., et al, Why Patients Visit Their Doctors: Assessing the Most Prevalent Conditions in Defining American Population, Mayo Clinic Proceedings, 2013 Jan; 88(1): 56-57. Paula Span, Going to the Emergency Room Without Leaving the Living Room, The New Old Age, Nov. 4, 2016. Tadros, A. S., Castillo, E. M., Chan, T. C., Jensen, A. M., Patel, E., Watts, K., & Dunford, J. V. (September 07, 2012). Effects of an Emergency Medical Services- based Resource Access Program on Frequent Users of Health Services. Prehospital Emergency Care, 16, 4, 541-547. [pdf] Tavares, W., Donelon, B., & Bowles, R. (September 07, 2016). Informing a Canadian paramedic profile: framing concepts, roles and crosscutting themes. BMC Health Services Research, 16, 1, 1-16. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5015210/ Tohira, H., Fatovich, D., Williams, T. A., Bremner, A., Arendts, G., Rogers, I. R., Celenza, A., ... Finn, J. (September 04, 2016). Which patients should be transported to the emergency department? A perpetual prehospital dilemma. Emergency Medicine Australasia. [pdf] -mvr:1/3/17 - 36.A.2 Packet Pg. 1030 Attachment: Agenda and Backup - November 5, 2018 (7500 : Senior Advisory Committee - November 5, 2018) 36.A.2 Packet Pg. 1031 Attachment: Agenda and Backup - November 5, 2018 (7500 : Senior Advisory Committee - November 5, 2018) 36.A.2 Packet Pg. 1032 Attachment: Agenda and Backup - November 5, 2018 (7500 : Senior Advisory Committee - November 5, 2018) Report on Research Related to the Issue of Repeated Falls and EMS Calls by Senior Residents Prepared by Harriet Lancaster, member of the Senior Advisory Committee to the County Commissioners of Collier County, Florida, Oct. 30, 2018 I read all the materials provided by Chief Butcher. As I understand it there have been in the last year 313 calls related to falls, which apparently did not lead to transport to local hospitals. There are often repeat calls from the same household. The real issue is how to reduce these calls by enabling proper follow up and necessary preventative services to enhance seniors’ lives. This will also reduce the burden on our first responders, EMS and Sherriff’s staff. In order to look into this issue, I called and talked with several relevant service providers/leaders in the county. First, I spoke with Louise Pelletier, who manages the County’s Senior Programs and Social Services, which is mostly funded with Federal funds that come on a formula basis to our Area Agency on Aging and then to the County. There are state funds as well. Louise told me that Michael Reagen, an involved community leader, was a convener of a Roundtable held at Hodges University on February 15, 2017 on the topic of Community Medicine and Possible Future Impact on Collier County EMS. While I subsequently spoke with Michael Reagen and have attached the participants list and the report from the round table, I also found out from Louise that their health compromised clients had not had any real problems with falls or needs for EMS. Of course, her funded service (which almost always has a waiting list) provides case work management and adaptive equipment to their clients. She attributed their absence of falls primarily to the adaptive equipment which include walkers, raised commodes and lift chairs. They also provide adult diapers to those who can’t readily transfer to the commodes. She understands that falls are a big problem for the elderly. Her programs are limited but perhaps a stock of available adaptive supplies for those with repeat falls could be developed by a nonprofit or even the county through the EMS. Reagen believes that local businesses will supply funds for appropriate programming as they did with Step Smart. My next call was to Mike Reagen. I am attaching the list of participants which is impressive and the findings of the Roundtable. Mike indicated that they hoped the county EMS would apply for grants to train and fund community paramedics on a pilot basis There are currently programs not only in Minnesota (the initial program was provided to us by Chief Butcher) but also in North Carolina, Colorado, Maine and Texas. The Minnesota program receives Medicaid funds as a State initiative. I don’t know how the other programs are funded. Mike indicated that he thought that Chief Butcher’s immediate supervisor was not interested in applying for grants for the program at that time. 36.A.2 Packet Pg. 1033 Attachment: Agenda and Backup - November 5, 2018 (7500 : Senior Advisory Committee - November 5, 2018) Mike urged me to speak with Jorge Aguilera, Assistant Chief of medical Services for North Collier Fire and Rescue about possible approaches. I did not know how far to pursue this at this time as we are in an information gathering mode at this point. We are not implementers but advisors. If the committee thinks it is appropriate, I will speak with Aguilera about what he sees as possible. We also spoke about the 200 CERT trained individuals in the county who could help with identification and possibly as a conduit to follow-up. He believes that Aguilera is the key to the CERT folks who Reagen thinks might be interested in an experimental pilot. He mentioned other possible groups that could help from Red Cross to Boy Scouts. I also talked with Bruce Rosenblatt at Care Patrol. This is a group will come in and do an analysis of needs and make referrals. They are paid by the organizations to whom they refer potential clients. Bruce and his “people” do the assessments. While most of the organizations they refer to charge fees there is sometimes funding for those with very limited resources. Bruce told me he emailed Chief Butcher about helping with follow up visits by Care Patrol to help residents appropriately access services. He has never heard back from her but would be interested in meeting with her to see if there could be some sort of relationship with EMS. He indicated Care Patrol has a medication reminder program and can arrange for food delivery at home at $7.00 a meal. He indicated that veterans and their surviving spouses can also access funds for home health services and assisted living and they can help with those available services. I tried to track down Visiting Nurses whose website showed an office on Airport Pulling. Eventually I got through to an administrator in Lee County who told me there is no longer a Visiting Nurses program in southwest Florida. Hope Hospice bought the non-profit Visiting Nurses of Southwest Florida out and it is now a nonprofit home health service under Hope Hospice’s auspices. They do not have enough staff to do much work in Collier and have few patients in our county. I also spoke with Velma Delgado, who runs Almost Home health services. She indicated she would be willing to come in and do a free assessment to see what the person who has fallen might need. For example, they may not know about food services, Area Agency on Agency services through the county, or how to do a Step Smart revision of their home to make it safer. She would be willing to have her cards distributed by EMS and her organization does paid work with the county’s senior services now. However, there would have to be a discussion about handing out information even for a free assessment from a proprietary group as there are many in the county. I think the solutions lie ultimately with the county through a community paramedics approach, or possibly the CERT program with an expanded mission. Initially the county EMS might establish a relationship with the nonprofit Care Patrol and perhaps a related adaptive equipment “closet.” Please see attached Round Table Report and Participants List provided by Michael Reagen. 36.A.2 Packet Pg. 1034 Attachment: Agenda and Backup - November 5, 2018 (7500 : Senior Advisory Committee - November 5, 2018) Roundtable Participants: Hodges University, February 15, 2017 “Community Medicine and Possible Future Impact on Collier County EMS” Robert B. Tober, M.D., Co-Chair: Dr. Tober graduated from Saint Louis University School of Medicine in 1975 and has been in practice for 40 years. He completed a residency at Barnes Jewish Hospital. He is Medical Director of Collier County’s EMS Department, Medical Director of the Wound Healing Clinic of the NCH Healthcare System, Medical Director of Bentley Village Clinic and Medical Director of the Neighborhood Health Clinic. A former Faculty Member of Edison State College [Southwestern Florida College], he served on the Board of Governors of the University of Miami and as Medical Services Advisor of LifeLinkMD, Inc. Named Physician of the Year by the Collier County Medical Society in 2015, he has been honored as the EMS Medical Director of the Year in 1995 by the State of Florida, the Patients ‘Choice Award 2013-2014, Compassionate Doctor Recognition 2013-2014 and the On-Time Doctor Award in 2014.[ rbtobermd@yahoo.com]. Edward Morton, Co-Chair: Member, Board of Governors, State University System of Florida, is a Principal and Managing Director of the investment firm Wasmer & Schroeder & Co. since 2007. He retired in 2006 after 34 years of service, as the CEO of the NCH Healthcare System, a diversified healthcare holding company. He is a Florida native and was raised in Islamorada. He holds a bachelor’s degree from the University of Notre Dame, a Master of Business Administration from the University of Miami and a Master’s of Health Science from Florida Gulf Coast University (FGCU). He is a past Vice Chairman of the Board of Trustees of FGCU and past Chairman of the FGCU Foundation. He has served and currently sits on the board of several civic-minded boards serving the citizens of Southwest Florida. [em@wasmerschroeder.com]. Ed Boyer : M. Boyer spent 40 years in health care [Senior Vice President for the Bon Secours Health System, consultant and principal in the Baltimore Office of Arthur Andersen, managing consultant in the Washington office of Towers Perri, and President of the Maryland Health Care System. Since his retirement, Ed has become active in various civic and charitable activities in Collier County. He currently is a board member and President of Greater Naples Leadership, and serves on the Board of the Florida Southern Gulf Chapter of the American Red Cross and Physicians Regional Health System. He previously was on the Board of the Senior Friendship Health Center and was Treasurer of the Villa Florenza Homeowners Association. Ed also was a member of the Blue-Ribbon Panel that studied Emergency Medical Services in Collier County. A graduate of the University of Maryland, he earned his M.B.A. from George Washington University. [ednanboyer@gmail.com] ]. Aysegul Timur, Ph.D., Co-Host & Dean, Johnson School, Hodges University [HU], joined HU in 1999, and she currently serves as Dean of the School of Business and chairs the Business Administration programs. She received her Ph.D. majoring in Economics, from the University of South Florida, her Master’s and Bachelor’s degrees in Business Administration from the University of Istanbul. Her areas of expertise include business policy, organizational development, quality control, statistics for 36.A.2 Packet Pg. 1035 Attachment: Agenda and Backup - November 5, 2018 (7500 : Senior Advisory Committee - November 5, 2018) strategic planning, health, and international economics. The author of 8 distinguished journal articles, she is a member of Sigma Beta Delta and Beta Gamma Sigma International Honor Societies and has presented at international and national conferences. She is also a member of The Journal of American Academy of Business Editorial Advisory Board, Clute Institute, Southern Economic Association, International Health Economics Association, American Society of Health Economists. Active she with Junior Achievement of SW Florida, Leadership Collier Alumni Association, GCHS, NAP Academy, Engineering Program Advisory Board; and Collier County Public Schools Business Plan competition, community research projects, she is often a guest speaker in SWFL. [atimur@hodges.edu]. William M. Griz, Ph.D., Co-Host & Dean, School of Allied Health, Hodges University [HU], joined Hodges University in 2003 as a full-time faculty member with specializations in management and leadership. In 2009, he became chair of the Interdisciplinary Studies program, and recently, was appointed dean of the School of Allied Health. In 2014, he was named Hodges Professor of the Year. Receiving his doctoral degree from Michigan State University, Griz spent 10 years in clinical practice before accepting a position with Blue Cross Blue Shield of Michigan as an administrator in their HMO network. Throughout the next 20 years, he worked as an administrator and consultant in the managed health care field. [bgriz@hodges.edu]. Jorge A. Aguilera, Assistant Chief of Medical Services, Operational Training and Community Relations, North Collier Fire & Rescue District [NCFRD] is a 34-year veteran of emergency medical services. A graduate of Edison Community College and Hodges University, he has earned seven advanced professional certifications including those from the University of Miami School of Medicine, the National Fire Academy and Florida State Fire Academy, Chief Aguilera is a member of Hodges University’s Identity Fraud Institute Advisory Council, past Chair, Collier County In jury Prevention Coalition, Board of Trustees of Physicians Regional Medical Center, Florida Emergency PIO Deployment, Florida’s Fire Chief Association and the Collier County Public Schools Health Academy Advisory Board among other professional associations. Prior to joining the NCFRD, he was Division Chief of Training, a Lieutenant Paramedic and Flight Medic with Collier County’s Emergency Medical Services Department. [jaguilera@northcollierfire.com]. Jane E. Bedford, BA., RN, CCP, Education Director, Nature Coast Emergency Medical Service, currently Chairs Florida’s Department of Health’s Committees on Access to Care and the Community Paramedic Constituency Group. She earned her Associate Degree [EMS] at Central Florida Community College, her Associate Degree and RN at Hillsborough Community College, her B.S. in Health Care Administration at Ashford University and 23 specialty certifications. A licensed Registered Nurse and Paramedic in Florida, she has served as a Paramedic for 23 years focusing substantially on EMS Quality Assurance, Cardiac Cath Lab Clinical Direction and EMS Education. Director Bedford served as a contributing writer to three textbooks, a speaker/lecturer at four national conferences and a member of 12 important Florida Committees including 36.A.2 Packet Pg. 1036 Attachment: Agenda and Backup - November 5, 2018 (7500 : Senior Advisory Committee - November 5, 2018) Florida’s Governor’s Domestic Security Task Force. She has been honored by Governor Jeb Bush with the Distinguished Service Award for Meritorious Service, the Distinguished Service Award for Paramedic Education and in 2010 was honored by Florida’s Department of Health as the EMS Educator of the Year. [janeb@naturecoastems.org] Tabatha Butcher, Chief, Collier County Emergency Services Department [EMS], has held this position since May 2016. During her nearly 20 years at Collier County Emergency Medical Services, Chief Butcher has held various positions, including: Emergency Medical Technician, Paramedic, Lieutenant, Captain, Flight Paramedic, Battalion Chief and Assistant Chief. She studied Emergency Medical Services Technology at Edison State College and Public Administration at Barry University. In addition, she is a 2014 graduate of the Certified Public Manager Program administered by the Florida Center for Public Management, which is part of the Askew School of Public Administration at Florida State University. Chief Butcher is an experienced instructor of American Heart Association courses, including: Basic Life Support, Advanced Cardiovascular Life Support and Pediatric Advanced Life Support. Tabatha is a graduate of Leadership Collier Class of 2016.Tabatha served as an EMS representative on the EMS Advisory Council and works closely with the Public Safety Authority, Collier County Injury Prevention Coalition and Safe and Healthy Kids Coalition. [TabathaButcher@colliergov.net]. Angel "Al" Brotons, EMT-P, Al Brotons is the Associate Director for Operations and Instructor Development in the Division of Prehospital & Emergency Healthcare, Michael S. Gordon Center for Research in Medical Education, University of Miami, Miller School of Medicine. Mr. Brotons is the AHA training Center director, which has several municipalities as satellites. He continues his work as a firefighter/paramedic and oversees the STEMI and Stroke program for Monroe County Fire Rescue, Marathon, and Islamorada Fire Rescue. [abrotons@med.miami.edu] Jarett Cotter, Jarett Cotter, Lieutenant- is the ALS Coordinating Officer, Greater Naples Fire Rescue District. A 40-year resident of Collier County, he graduated in 1997 from Edison Community College [Florida Southwestern] with an A.S. degree in Fire Science and received his paramedic license in 2000. In 1997, prior to becoming a member of Greater Naples, Lt. Cotter was instrumental in the development of the City of Marco Island and was chosen as the very first assistant to the City Manager. He also has employment experience with former Big Corkscrew, Marco Island, and East Naples Fire/Rescue Districts. With over 25 years of experience in fire- rescue services, Lt Cotter has been recognized for his numerous achievements and is a recipient of the Eagle, Phoenix, and Stork awards. In addition, Lt Cotter received the Emergency Medical Services Commendation Medal presented by the Naples Chapter of the Sons of the American Revolution. Lt Cotter has been in his current position as ALS Coordinating Officer since 2014. He leads the EMS branch, overseeing EMS related health, safety, and training programs. Additionally, Lt Cotter is a point of contact for infection control, handles EMS supply, and is the quality assurance officer. As the ALS 36.A.2 Packet Pg. 1037 Attachment: Agenda and Backup - November 5, 2018 (7500 : Senior Advisory Committee - November 5, 2018) Coordinator, he manages local, regional, and state partnerships and is a key member of the Greater Naples Fire/Rescue Logistics Section team. [jcotter@gnfire.org]. James Delony, Col., USA, Ret., past Vice President for Operations and a Project Manager, DynCorp International, Fort Worth, TX, Col. Delony served as Public Utilities Division Administrator, Collier County, Florida, District Engineer, Wilmington District, US Army Corps of Engineers, Commander, 325 Engineering Battalion and Director of Public Works, Fort Campbell, KY. Col. Delony, a civil engineering graduate of Texas A&M University where he also earned an MS in Constructions Management, he received an MA in Military Arts & Sciences, US Army Command and General Staff College and an MA in Strategic Military Strategy, Quaid-E-Asam University, Islamabad, Pakistan. He is a member of the Collier Citizens Council, the Collier ID Fraud Task Force and is a graduate of the Collier Sheriff’s Advanced Citizens Academy. [delonyjim@gmail.com]. Jacklyn Faffer, Ph.D., MSW: President & CEO, Jewish Family and Community Services of Southwest Florida,, Collier County Leadership Coalition on Aging; Executive Director and CEO, Ruth Rales Jewish Family Services of South Palm Beach County, Inc.; Adjunct Associate Professor, Barry University, Wurzweiler School, Yeshiva University, Hunter College. Director of Social Work Brunswick Hall; Director of Human Services UJA/Federation of Jewish Philanthropies, New York. She helped organize and chair the alliance of senior care organizations in Collier County, Florida that documented the needs of elderly in specific demographic clusters. An outstanding fundraiser, she is credited with establishing the first senior center in Greater Naples. The Center has formed service-linkages with local hospitals and agencies. A Co-Chair of the Collier Injury Prevention Task Force, she serves on the ID Fraud Task Force. [jfaffer@jfcsswfl.org]. James Fogarty, Director Seattle King County Medic One, Department of Public Health King County, Washington, the world-renowned system known for its "Medical Model", tiered response system that produces consistently high survival rates. King County’s response area covers some 2100 square miles, is home to some 1.8 million residents. And encompasses a vast array of densely populated urban Seattle areas, major ports and rail systems, heavy industrial and manufacturing plants (Boeing) as well as some of the most remote areas of the Cascade Mountain range in the Pacific Northwest. This regional system consists of 30 fire departments, 6 advanced life support provider agencies and several public safety dispatch centers. Prior to King County Medic One, he managed a fire based emergency services in Pinellas County Florida. During his 38 years of experience in Emergency Services he has served in many disaster activations such as the 2004 and 2005 "Hurricane Seasons" in Florida and "Hurricane Andrew" in 1992, has managed medical care deployment for presidential visits and has commanded teams into South Florida following Hurricane Andrews’; into Charlotte County following Hurricane Charlie, and into Flagler and Volusia Counties following wildfires within those areas. Director Fogarty earned an MBA, is a graduate of the Executive Fire Officer (EFO) program at the National Emergency Training Center and holds degrees in Emergency Medical Services and Fire 36.A.2 Packet Pg. 1038 Attachment: Agenda and Backup - November 5, 2018 (7500 : Senior Advisory Committee - November 5, 2018) Administration. The author of several published research papers, he has been a contributing author to several forums on Emergency Medical Care and Emergency Management. He is considered a subject matter expert on both Fire and Emergency Medical Services and has assisted FEMA since 1993 conducting over 100 courses on Natural and man-made Disasters. He is former adjunct faculty for Saint Petersburg College and Barry University in Florida and past Chairman for the American Heart Association’s panels. [jfogarty@tampabay.rr.com]. Edwin (Ned) Fryer, Esq. has 35+ years as an attorney focusing on corporate governance and compliance law, especially records management and data privacy. Experienced in technology, he has assisted many business organizations in successfully crafting and implementing records management programs and resolving governance and corporate compliance problems Mr. Fryer has been publicly recognized as one of the pre-eminent lawyers of the Missouri Bar Committee proposing laws to the Missouri General Assembly. Vice chairman of the National Board of Governors of the American Red Cross in Washington, D.C. and as a member of its Executive and Biomedical Services Committees, he is chancellor Emeritus of the Episcopal Diocese of Missouri, a Missouri-licensed paramedic, Civic Relations Officer with the St. Louis Fire Department, trustee of the St. Louis Fire Department Lifesaving Foundation and former chairman of the Downtown St. Louis Emergency Preparedness Organization and held a gubernatorial appointment to the Missouri State EMS Advisory Council. [EdwinFryer@colliergov.net]. Douglas Johnson, Ph.D. Chairman of the Board and Chair of the Clinical Committee, David Lawrence Mental Health Center [DLC], is a retired senior executive in health administration, He has been a board member since 2009 and has previously served as President, Vice President and Secretary. He is also the Chairman of the Clinical Programs Committee. Johnson was the President of Sentara Healthcare in Virginia, which operates more than 100 care giving sites including seven acute care hospitals, and includes nearly 400 primary care and non-primary care specialty physicians. Johnson, a retired Rear Admiral, also served as Navy Assistant Surgeon General supervising the reserve medical component of the Navy and Marine Corps. He is a graduate of Greater Naples Leadership and has served on a variety of healthcare related boards in Virginia. [douglasjohnson2@comcast.net]. Douglas S. Lee, M.D., Associate Medical Director, Collier County Emergency Medical Services Department, is Attending Physician, Lee Health System and Clinical Assistant Professor, Department of Family Medicine, Florida State University. Prior to joining Collier County EMS, Dr. Lee was Medical Director, Cape Coral Fire Rescue, Cape Coral, FL, Attending Physician, Emergency Medicine, NCH System, Naples, FL and Attending Physician, Emergency Medicine, Simi Valley Hospital, CA and Attending Physician, Emergency Medicine, North Shore University Hospital, New York. He earned is B.A. with Honors from the University of Pennsylvania and his M.D. from the New Jersey Medical School. He Interned at St. Luke’s Roosevelt Hospital, NYC and did his Residency in Emergency Medicine at Mount Sinai School of Medicine where he was 36.A.2 Packet Pg. 1039 Attachment: Agenda and Backup - November 5, 2018 (7500 : Senior Advisory Committee - November 5, 2018) Chief “Resident from 2002 to 2003. Dr. Lee is a Fellow of the American College of Emergency Medicine and of the American Academy of Emergency Medicine. He holds Medical Licenses in both Florida and Hawaii, is ATLS Certified, ACEP Emergency Ultrasound Certified as well as ACLS, ATLS, PASL, and NALS Certified., Board Certified in Emergency Medicine, American Board of Emergency Medicine, he is the recipi9ent of five significant honors/awards including the Roche Pharm Unrestricted Educational Grant, Mount Sinai School of Medicine, the Outstanding in Lifesaving Service Award, Mt. Sinai Emergency Medicine Education Fund and the Triage Research Emergency Research Grant, Amsterdam, The Netherlands. The author of seven major research publications, Dr. lee has made three international presentations, two national presentations and two regional presentations to major medical symposia. Dr. Lee, in addition to serving on seven hospital committees during his career, has also been a featured lecturer at eight lectures at eight medical institutions. [duglee@gmail.com]. Michael Marcus, RN, CEN, EMT-P, Trauma Program Manager for Lee County Trauma Services District since 2007. Currently Michael oversees implementation of regional trauma system plan and Level II Trauma Center in 5 County Trauma Service area which provides a safety net to residents and visitors of Lee, Collier, Charlotte, Hendry and Glades counties. He is responsible for assisting with the integration and collaboration of regional and local acute care hospitals, county emergency medical resources, comprehensive injury prevention and outreach programs, and post-acute care rehabilitation programs as an advocate for the injured patient in the five-county Southwest Florida Region. He plays an active role in all hazards disaster preparedness and emergency response including area wide mass casualty surge planning. Mr. Marcus is an active member of ten regional and Florida Pre-Hospital Medical Care and professional organizations including the Mass Casualty Incident Trauma Task Force, the Florida Committee on Trauma of the American College of Surgeons and is a Trauma Nursing Core Instructor for the Emergency Nurses Association. He has previously served with distinction as an Appointee by Florida’s Surgeon General on the Florida Trauma Registry Ad-Hoc Committee to the Florida Department of Health. Michael co-authored a multicenter study “Variability in Inter-Hospital Trauma Data Abstraction: A Challenge to The Accuracy of Trauma Registry” in conjunction with the Tufts Medical Center, Boston, MA. Journal of Trauma and Acute Care Surgery, Sept. 2015, Vol. 79, No.3. The study was presented at the 28th Annual Scientific Assembly of the Eastern Association for the Surgery of Trauma, January, 2015. [Michael.Marcus@leehealth.org] Leo E. Ochs, Jr., Collier County Manager appointed on September 29, 2009 Leo is a 30-year veteran of local government management. He was hired by Collier County government in 1986 after serving for eight years in various positions with the city government of Joliet, Illinois. Leo obtained his Bachelor’s Degree from Illinois Benedictine University and earned a Master’s Degree in Public Administration from Northern Illinois University. His professional affiliations include both the International and Florida City and County Management Associations. Leo has been an active member of the community. He is a former board member and past President of the United Way of Collier County. He served on the Board of Directors of the Collier County Education Foundation and is a 1999 graduate of the Leadership Collier program sponsored by the Greater Naples Area Chamber of Commerce. Leo also serves on the 36.A.2 Packet Pg. 1040 Attachment: Agenda and Backup - November 5, 2018 (7500 : Senior Advisory Committee - November 5, 2018) College of Business and Public Administration Advisory Board at Hodges University and is a past director on the Leadership Collier Foundation Board. [leoochsjr@gmail.com]. Len Golden Price, Discussion Leader: Department Head, Collier County Administrative Services Division, oversees logistics and internal government services such as computer and telecommunication technology, building maintenance and security, construction and real estate management, purchasing and procurement, vehicle and equipment maintenance, risk and human resource management, and records management, as well as the Bureau of Emergency Services, which includes Fire Service, Emergency Management and EMS. During her 25-year career in public administration, she held executive management positions in the Solid Waste, Equipment Maintenance, and Police Departments with the City of El Paso, Texas. Len holds a Master’s Degree in Organizational Management, Bachelor’s in Business Management and an Associate’s Degree in Financial Accounting. She is a graduate of the Leadership Collier Class of 2007 and earned her Certified Public Manager designation from Florida State University in 2014. [LenPrice@colliergov.net]. Hon. Kevin Rambosk, Sheriff, Collier County, Florida, first elected, 2009, reelected 2016 with 90% majority, is a graduate of Bergen (N.J.) Community College [AAS in Police Science], William Patterson University [BS in Public Safety Administration], Nova University [MBA] and the FBI National Academy. A police officer for 21 years, Rambosk has served with distinction as CCSO Undersheriff, Chief of Operations and Captain, Organized Crime, Naples City Manager, Chief of Naples Police & Emergency Services and with the Internal Security Division of the NJ Sports and Exhibition Authority. A NJ native and 10-year volunteer with the Midland Park Civil Defense, Ambulance Corps, Fire Dept. Reserve & Ridgewood Police Reserve, he holds an Amateur Radio Extra Class license. Honored as a Man of Distinction by the Education Foundation of Collier County, he has been awarded the Good Citizen Medal by the National Society of the Sons of the American Revolution. Active in community service, he is a Member of the Board of Directors of The Florida Sheriffs Association, the Collier Senior Resource Center, the Shelter for Abused Women and Children, the Greater Naples Chamber of Commerce, the Leadership Collier Foundation and The David Lawrence Center. He is a past board member of the SWFL Boy Scouts of America, the Community Blood Center, the Juvenile Justice Council and the Substance Abuse Coalition of Collier County. Sheriff Rambosk Co-Chairs the SWFL Regional Domestic Security Task Force, the Executive Law Enforcement Advisory Board, D.A.R.E., American International, the National Sheriff’s Association Immigration and Boarder Security Committee and is a member of the International Association of Chiefs of Police. [Kevin.Rambosk@colliersheriff.org] 36.A.2 Packet Pg. 1041 Attachment: Agenda and Backup - November 5, 2018 (7500 : Senior Advisory Committee - November 5, 2018) Michael V. Reagen, Ph.D. Convener: Adviser, The Reagen Group; formerly served as Commissioner, Human Services, Iowa; Director, Dept. of Social Services, Missouri; County Administrator, Onondaga County, NY; Research Fellow, Syracuse University Research Corporation; Sr. VP. And Clinical Associate Professor, Des Moines University; In Florida, he has served as a former member, Regional Advisory Council, Southwest Florida Regional Trauma Center; Pres. & CEO [Ret.], Greater Naples Chamber & Leadership Collier Foundation, has served on the boards of several Naples non-profits and facilitated the Blue-Ribbon Panel that studied Emergency Medical Services in Collier County. Currently, he is a member David Lawrence Mental Health Center Board, Wolford College Board, is Adviser to Collier’s 100 Club. He has co- authored three books and authored 60 articles, has taught at seven universities and received several awards including the National Public Service Award from the American Academy of Public Administration. He is past President & CEO, The Greater Naples Chamber and Leadership Collier Foundation. [mike@mikereagen.com] Anke Stugk, [ABD,] Ph.D. Cand., Program Chair of the Business Administration Programs, Johnson School, Hodges University, is an expert in financial management and general business. Professor Stugk an alumna of Hodges University. She received her associate, bachelor’s and master’s degrees from Hodges. After an early career in hospitality, condominium and construction management, she served as vice chair and an assistant professor in the Business Administration program, the assistant to the dean of the Nichols School of Professional Studies and was an adjunct faculty member teaching research and management courses. Stugk is a member of Golden Key International Honor Society and Sigma Beta Delta, and in 2011, she received the Research Collaborator of the Year award from The Greater Naples Chamber of Commerce. [astugk@hodges.edu]. David J. Trecker, Ph.D., former Senior Vice President at Pfizer, received a doctorate in organic chemistry at the University of Chicago. The author of some 60 scientific papers and patents, he served on the editorial board of the Journal of Organic Chemistry and executive committee of the Industrial Research Institute. He was a product manager at Union Carbide and later headed R&D for Pfizer’s chemical business, developing products for the food, energy and water-treatment sectors. After retiring to Naples, Trecker served as chairman of the Greater Naples Better Government Committee, Pelican Bay Foundation and Pelican Bay Property Owners Association. He is currently vice president of the Collier Citizens Council and Collier County Presidents Council and serves on the Pelican Bay Services Division and Classic Chamber Concerts boards. In 2014, he was designated Pelican Bay’s Person of the Year. Trecker is a blogger and op-ed contributor to the Naples Daily News. [djtrecker@yahoo.com]. Stephanie Vick, M.S., B.S.N., R.N., Administrator, Florida Department of Health in Collier County. Overseeing three health department locations, 170+ employees and a budget of $11.2 million, Ms. Vick received her Bachelor of Science in Nursing from The Catholic University of America in Washington D.C., and her Master of Science in Health Services Administration from NOVA/Southeastern University. She has served as Clinic Coordinator, Family and Personal Health Director, Executive CHN Nursing Director, 36.A.2 Packet Pg. 1042 Attachment: Agenda and Backup - November 5, 2018 (7500 : Senior Advisory Committee - November 5, 2018) and, most recently, Interim Administrator. She is a multi-year Davis Productivity Award recipient for her work in community outreach in Collier County. She is an adjunct professor at Hodges University and a trained Public Health Accreditation Board Examiner. Prior to her Collier County service, Ms. Vick was Director of Women and Infant Nursing at the Ohio State University Medical center in Columbus, Ohio where she managed a budget of over $11 million, a construction budget of $7+ million for a new Labor, Delivery and Recovery Department and 260 full time employees. Ms. Vick chaired the Local March of Dimes, was a Board Member of the Healthy Start Coalition, and twice as President for the Florida Association of Public Health Nurses. She is heavily involved in support of wellness initiatives in the health department as well as in the community as demonstrated by her willingness to collaborate with local community partners on the Blue Zones Project. [Stephanie.Vick@flhealth.gov] Stephen C. Weisberg, M.D. Graduated from the University of Minnesota Medical School in 1964 having obtained a B.A. and B.S. prior to the M.D. Trained in Internal Medicine in Minneapolis until 1968 at Hennepin County Medical Center. Served as Chief of Allergy at Fitzsimmons General Hospital 1968-70 as a Major in the U.S. Army. Obtained an M.S. in 1972 in Medicine from the University of Michigan for the study of Allergy and Immunology. In private practice in Minneapolis for 25 years devoted to the care of children and adults with Asthma and Allergic Diseases and served as a Clinical Professor of Medicine at the University of Minnesota as well as 25 years on the County and State Boards of the American Lung Association. Founder and Chair of the National Consortium of Children's Asthma Camps. Founder and Chair of the Naples Men's Discussion Group. Previously volunteer Physician at Neighborhood Health Clinic. Mentor to Collier County High School students through the Education Foundation, now Champions For Learning, and selected in 2014 for the "Men of Distinction Awards." [scweismd@gmail.com]. Jeffrey Ziomek, DPA, Professor, Florida Southwestern State College and Program Chair, Hodges University Certificate EMS Program in partnership with Collier County EMS Department. Dr. Ziomek earned his DPA [ Public Administration, Capella University, his MS [Health Science, Health Professions Education], Florida Gulf Coast University, his B.S. [Business], Empire State College] and his A.S. [Computer Science], Niagara Community College. Since 2008 an Adjunct Faculty at Kaplan University where he serves as a Faculty Evaluator and Course Leader, he also has been a Trainer for the Lee County Board of Elections. For five years, he taught at the Western New York Emergency Medical Services (EMS) Training Institute training physicians and nurses in Advanced Trauma Life Support required for New York State Certification necessary to maintain intern and residency status. Dr. Ziomek has also served as EMS Program Coordinator and EMS/Fire Program Coordinator, Florida Southwestern State College, Fort Myers, Florida; Area Operations Manager and Paramedic with Rural/Metro Medical Services, Buffalo, New York; Administrator of an assisted living facility, and Director of Health Services, AIDS Community Services of Western New York. He is a Certified Florida State Fire Service and EMS Instructor, a member of the Florida Council of Emergency Medical Service Chiefs and was Florida Association of EMS Educators Instructor of the Year, 2010. [jpziomek@fsw.edu] 36.A.2 Packet Pg. 1043 Attachment: Agenda and Backup - November 5, 2018 (7500 : Senior Advisory Committee - November 5, 2018) -mvr:1/17/17- 36.A.2 Packet Pg. 1044 Attachment: Agenda and Backup - November 5, 2018 (7500 : Senior Advisory Committee - November 5, 2018)