Backup Documents 07/09/2019 Item #16E 4 ORIGINAL DOCUMENTS CHECKLIST & ROUTING SLIP
TO ACCOMPANY ALL ORIGINAL DOCUMENTS SENT TO 16 E
THE BOARD OF COUNTY COMMISSIONERS OFFICE FOR SIGNATURE
Print on pink paper. Attach to original document. The completed routing slip and original documents are to be forwarded to the County Attorney Office
at the time the item is placed on the agenda. All completed routing slips and original documents must be received in the County Attorney Office no later
than Monday preceding the Board meeting.
**NEW** ROUTING SLIP
Complete routing lines#1 through#2 as appropriate for additional signatures,dates,and/or information needed. If the document is already complete with the
exception of the Chairman's signature,draw a line through routing lines#1 through#2,complete the checklist,and forward to the County Attorney Office.
Route to Addressee(s)(List in routing order) Office Initials Date
1.
2.
3. County Attorney Office County Attorney Office JAK 7/16/19
4. BCC Office Board of County W\--k-30
Commissioners \,r\VX/ --lt t loVc1/4
5. Minutes and Records Clerk of Court's Office
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PRIMARY CONTACT INFORMATION
Normally the primary contact is the person who created/prepared the Executive Summary. Primary contact information is needed in the event one of the addressees
above,may need to contact staff for additional or missing information.
Name of Primary Staff Tabatha Butcher,Chief of Emergency 252-3780
Contact/Department Medical Se 'ces
Agenda Date Item was 7/9/19 Agenda Item Number 16-E-4
Approved by the BCC
Type of Document Interlocal Agreement—City of Marco Number of Original One
Attached Island—Advanced Life Support Documents Attached
PO number or account
number if document is N/A
to be recorded
INSTRUCTIONS & CHECKLIST
Initial the Yes column or mark"N/A"in the Not Applicable column,whichever is Yes N/A(Not
appropriate. (Initial) Applicable)
1. Does the document require the chairman's original signature STAMP OK JAK
2. Does the document need to be sent to another agency for additional signatures? If yes, JAK
provide the Contact Information(Name;Agency;Address;Phone)on an attached sheet.
3. Original document has been signed/initialed for legal sufficiency. (All documents to be JAK
signed by the Chairman,with the exception of most letters,must be reviewed and signed
by the Office of the County Attorney.
4. All handwritten strike-through and revisions have been initialed by the County Attorney's JAK
Office and all other parties except the BCC Chairman and the Clerk to the Board
5. The Chairman's signature line date has been entered as the date of BCC approval of the JAK
document or the final negotiated contract date whichever is applicable.
6. "Sign here"tabs are placed on the appropriate pages indicating where the Chairman's JAK
signature and initials are required.
7. In most cases(some contracts are an exception),the original document and this JAK
routing slip should be provided to the County Attorney Office at the time the item is
input into MinuteTraq. Some documents are time sensitive and require forwarding
to Tallahassee within a certain time frame or the BCC's actions are nullified. Be
aware of your deadlines!
8. The document was approved by the BCC on 7/9/19 and all changes made during the JAK N/A is not
meeting have been incorporated in the attached document. The County Attorney's an option for
Office has reviewed the changes,if applicable. this line.
9. Initials of attorney verifying that the attached document is the version approved by the 61k is not
BCC,all changes directed by the BCC have been made,and the document is ready fo th o ion for
Chairman's signature. this 1' e.
Please contact Tabitha Butcher when ready(3780)
[04-COA-01081/1344830/1]I:Forms/County Forms/BCC Forms/Original Documents Routing Slip WWS Original 9.03.04,Revised 1.26.05,Revised 2.24.05;
Revised 11/30/12
16E4
MEMORANDUM
Date: July 31, 2019
To: Tabatha Butcher, Emergency Medical Services Chief
Emergency Services Division
From: Ann Jennejohn, Deputy Clerk
Minutes & Records Department
Re: A renegotiated Interlocal Agreement for Advanced Life
Support Partnership between Collier County and the
City of Marco Island
Attached for further processing is the original document referenced above
(Item #16E4) approved by the Collier County Board of County
Commissioners on Tuesday, July 9, 2019.
After obtaining the necessary signatures, please return the fully
executed agreement to the Minutes & Record's Department.
After return of the original agreement, our office will have the interlocal
agreement recorded, per Section 9.2, Page 7 of the agreement.
If you have any questions, please call me at 252-8406.
Thank you.
Attachment
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INTERLOCAL AGREEMENT
ADVANCED LIFE SUPPORT PARTNERSHIP
BETWEEN COLLIER COUNTY AND CITY OF MARCO ISLAND
THIS INTERLOCAL AGREEMENT, made and entered into this day of
, 2019, by and between the Board of County Commissioners, Collier County, Florida,
a political subdivision of the State of Florida(hereinafter referred to as the "County")and the City
of Marco Island(hereinafter referred to as the"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 Marco Island and Collier County.
The recognition and utilization of existing and future personnel skills,qualifications and resources
are in the interest and benefit of both agencies and the public we serve.
WITNESSETH
WHEREAS, the parties previously entered into an Interlocal Agreement for Advanced
Life Support dated May 22, 2007, which the parties wish to supersede and replace with this
agreement; and
WHEREAS, both parties seek to continue 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 the County wish to 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 1 of 12
16E4
1.1 Basic Life Support("BLS")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 QA/QI means Quality Assurance / Quality Improvement is the OMD approved program
which assesses and monitors the medical performance of Paramedics and Emergency Medical
Technicians.
1.3 PCR means the Patient Care Record which chronicles the medical treatment of the patient.
1.4 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.
1.5 Classifications of paramedics are found in the ALS Operational Plan(Attachment A).
SECTION II: COUNTY'S RESPONSIBILITIES
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 six (6) 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.
SECTION III: CITY'S RESPONSIBILITIES
The following specific services, duties, and responsibilities will be the obligation of the
City:
3.0 The City will provide through the City of Marco Island-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 City ALS fire apparatus/rapid response
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vehicles staffed 365 days a year, 24 hours per day including those stationed at the following
locations:
1. 1280 San Marco Rd
2. 751 E Elkcam Circle
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 six(6)permitted
by the County and equipped by the City.These units will be designated within the County Sheriff's
Office Computer Aided Dispatch(CAD)programs to automatically respond to medical incidents
with an ALS transport unit in accordance with the County's Emergency Medical Dispatch protocol
as an emergency medical response and/or fire suppression vehicle.
3.4 The City shall only use the County Medical Director by this Agreement and shall utilize
the protocols and standards issued by the County Medical Director to govern the provisions of
advanced life support services.There shall be no charge to the City for these services.Any medical
professional providing training relating to ALS services shall work under the supervision of the
County Medical Director.
3.5 The City shall adhere to the paramedic credentialing and recertification ride-time
requirements as established by the County Medical Director and outlined within the attached
Operational Plan(Attachment A). The City may meet its ride-time requirements by accompanying
a patient on the Collier County EMS ALS transport ambulance from scene to hospital when any
ALS service has been performed on the patient prior to the transport. However,the Collier County
EMS Chief, City Fire Chief and the County Medical Director may identify in writing any
exceptions to the ride time requirements. The City agrees that any time a Collier County EMS
paramedic requests a City paramedic to accompany a patient on a Collier County EMS ALS
transport from scene to hospital for a critical call or for assistance, the City paramedic shall
accompany the patient to the hospital. 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.
3.6 The City will maintain all medical run reports in an approved record system and will handle
them in a manner consistent with County operating guidelines,Federal,and State laws.
3.7 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.
3.8 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
Page 3 of 12
16E4
schedule. If the City cannot logistically attend ESC training, they may teach OMD approved
curriculum at remote sites provided:
1. The OMD approved EMCC or representative attends all required 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.
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 notified of an exposure to infectious disease, the City shall notify the EMS Infectious
Control Officer or EMS Battalion Chief, 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 Expanded 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 under the Expanded Non-
Transport ALS Protocol 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 Chief of EMS. Such revisions must not
conflict with the terms and standards set forth in this Agreement.
Page 4 of 12
16E4
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, 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 and replaces the agreement titled "Interlocal
Agreement Advanced Life Support Engine Partnership, between the City and the County, dated
May 22,2007, which Agreement is hereby terminated and is of no further force or effect.
7.1 This Interlocal Agreement shall remain in full force and effect from the date above and
shall continue unless terminated as set forth below.
7.2 This Interlocal Agreement shall be reviewed and renegotiated as necessary every three(3)
years. 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 the City.
Page 5 of 12
16E4
7.3 Either the County or the City may terminate this Interlocal Agreement after providing
written notice to the other of its intent to terminate at least ninety(90)days in advance of the date
of termination. During this 90-day termination window, the terminating party must provide the
non-terminating party's representatives with an opportunity to consult with the terminating party's
representatives regarding the reason(s) for 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 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.
SECTION VIII: INSURANCE
8.0 Each party shall maintain insurance in the minimum amounts and types required by Florida
State Statutes. Each 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.
8.1 To the extent permitted by law and as limited by and pursuant to the provisions of Florida
Statutes, Section 768.28,the parties 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 either party when it would not
otherwise be responsible.
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 party 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
either party commencing with the work,services,duties and responsibilities described heretofore.
Page 6 of 12
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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
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IN WITNESS WHEROF,the parties hereto have caused this Interlocal Agreement to be
executed by their appropriate officials,as of the date first above written.
AS TO COUNTY:
ATTEST: BOARD OF COUNTY COMMISSIONERS
CRYSIptit644L, Clerk COLLIER C e4,041; LORIDA
Ch
( e);44116100
By: . • • By: _
r --- ` P.;14 lerk W j iam L. McDaniel, Jr., C .rman
1ttest asa at
Appr tilittiand legality:
t ry
i t
t
Jeffrey A...Klatzkow,County Attorney
AS TO CITY:
ATTEST: CITY OF MARCO ISLAND. FLORIDA
By: By:
Laura M. Litzan, City Clerk Erik Brechnitz, Chairman
Approved as to form and
legal sufficiency:
Alan L. Gabriel, City Attorney
Page 8 of 12
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ATTACHMENT A
COLLIER COUNTY EMERGENCY MEDICAL SERVICES AND MARCO ISLAND
FIRE AND RESCUE DEPARTMENT ALS OPERATIONAL PLAN
REFERENCE: ALS Program Interlocal Agreement ,2019
PURPOSE: To provide quality and cost-effective emergency medical services to the residents of
the City of Marco Island(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 six(6)permitted by the
COUNTY and equipped by the CITY.
• Engine 50
• Tower 50
• Squad 50
• Engine 51
• Squad 51
• Engine 52
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 and/or
Expanded Non-Transport Protocol,as determined by the OMD.
The CITY Firefighter/Paramedics who are certified to perform as ALS Engine/Expanded Non-
Transport 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 Marco Island Firefighter / Paramedic will accompany EMS ambulance staff
(third crew member) to the hospital on all patients that have received ALS treatment
beyond an ECG, EKG and IV by the Marco Island Paramedic or that will require ALS
treatment beyond these procedures per protocol. Exceptions to the ride time
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requirement are: special event units, in the event that all apparatus are dedicated to a
structure fire or large incident.
b. The team of EMS staff and City of Marco Island 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 Marco Island Battalion Chief will consult
openly in order to assure continuity and efficiency. It is recognized by COUNTY and
City of Marco Island that harmonious and productive relationships between all
personnel are necessary. Teamwork and cooperation are 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 Marco Island 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 ALS permitted
apparatus.
ii. COUNTY and City of Marco Island Chief officers will utilize available City
of Marco Island Fire-Rescue Department permitted resources to assure ALS
coverage is continuously maintained within the City of Marco Island.
iii. COUNTY and City of Marco Island Chief officers will assure permitted ALS
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 permitted ALS unit will document each patient contact in an approved
Patient Care Report (PCR) that meets at a minimum State of Florida EMSTAR 3.4
EMS data collection standards.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
Page 10 of 12
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number, dispatch times, and crew signatures with State paramedic or EMT license
numbers. Some specific call types may require additional documentation (such as
Release/Competency forms for patient sign outs) as specified by protocol and
EMSTAR 3.4 documentation standards. When ALS units arrive at the same time, the
PCR will be completed by the transporting unit. Handwritten 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 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 Marco Island Battalion Chief
or designee must fax or email a complete ALS Staffing Report to DL-EMS Battalion
Chiefs email list. If staffing changes are made during the shift,an updated report will
be provided prior to or at the end of shift to reflect staffing changes.The EMS Battalion
Chief will provide a complete EMS Staffing report to the City of Marco Island
Battalion Chiefs office.
5. QUALITY ASSURANCE:
a. City of Marco Island 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. The City (QA) member may attend the ALS Transport
Quality Assurance Committee when cases are discussed involving a City FF/PM
actions.
b. City of Marco Island 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.
d. At the discretion of the Medical Director or designee, routine or informational QA
Review with City of Marco Island Fire-Rescue Department personnel may be handled
entirely by the City of Marco Island Fire-Rescue Department appointed representative.
Page 11 of 12
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The member shall review and complete all paperwork with the City of Marco Island
Fire-Rescue Department personnel and return all necessary documentation to the ALS
Non-Transport QA Committee within thirty [30] calendar days.
e. 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.
g. In the event the City wishes to order an EMT or Paramedic for remediation or to be
immediately prohibited from providing patient care they will submit in writing the
information to the OMD for consideration.
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) will be submitted with a
complete student roster to the OMD in order to qualify for COUNTY accreditation, if
requested. 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
U
I 6 E 4
INTERLOCAL AGREEMENT
ADVANCED LIFE SUPPORT PARTNERSHIP
BETWEEN COLLIER COUNTY AND CITY OF MARCO ISLAND /41
THIS INTERLOCAL AGREEMENT, made and entered into this ;1 day of
,S . 2019,by and between the Board of County Commissioners, Collier County, Florida,
a po ' 'cal subdivision of the State of Florida(hereinafter referred to as the"County")and the City
of Marco Island(hereinafter referred to as the"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 Marco Island and Collier County.
The recognition and utilization of existing and future personnel skills,qualifications and resources
are in the interest and benefit of both agencies and the public we serve.
WITNESSETH
WHEREAS, the parties previously entered into an Interlocal Agreement for Advanced
Life Support dated May 22, 2007, which the parties wish to supersede and replace with this
agreement:and
WHEREAS,both parties seek to continue 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 the County wish to 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 1 of 12
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1.1 Basic Life Support("BLS")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 QAJQI means Quality Assurance / Quality Improvement is the OMD approved program
which assesses and monitors the medical performance of Paramedics and Emergency Medical
Technicians.
1.3 PCR means the Patient Care Record which chronicles the medical treatment of the patient.
1.4 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.
1.5 Classifications of paramedics are found in the ALS Operational Plan (Attachment A).
SECTION II: COUNTY'S RESPONSIBILITIES
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 six (6) 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.
SECTION III: CITY'S RESPONSIBILITIES
The following specific services, duties, and responsibilities will be the obligation of the
City:
3.0 The City will provide through the City of Marco Island-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 City ALS fire apparatus/rapid response
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vehicles staffed 365 days a year, 24 hours per day including those stationed at the following
locations:
1. 1280 San Marco Rd
2. 751 E Elkcam Circle
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 six (6)permitted
by the County and equipped by the City.These units will be designated within the County Sheriff's
Office Computer Aided Dispatch (CAD) programs to automatically respond to medical incidents
with an ALS transport unit in accordance with the County's Emergency Medical Dispatch protocol
as an emergency medical response and/or fire suppression vehicle.
3.4 The City shall only use the County Medical Director by this Agreement and shall utilize
the protocols and standards issued by the County Medical Director to govern the provisions of
advanced life support services.There shall be no charge to the City for these services.Any medical
professional providing training relating to ALS services shall work under the supervision of the
County Medical Director.
3.5 The City shall adhere to the paramedic credentialing and recertification ride-time
requirements as established by the County Medical Director and outlined within the attached
Operational Plan(Attachment A). The City may meet its ride-time requirements by accompanying
a patient on the Collier County EMS ALS transport ambulance from scene to hospital when any
ALS service has been performed on the patient prior to the transport. However,the Collier County
EMS Chief, City Fire Chief and the County Medical Director may identify in writing any
exceptions to the ride time requirements. The City agrees that any time a Collier County EMS
paramedic requests a City paramedic to accompany a patient on a Collier County EMS ALS
transport from scene to hospital for a critical call or for assistance. the City paramedic shall
accompany the patient to the hospital. The City will comply with medical protocol, equipment
standards, and will full) participate in medical training and quality assurance programs in accord
with the County.
3.6 The City will maintain all medical run reports in an approved record system and will handle
them in a manner consistent with County operating guidelines, Federal, and State laws.
3.7 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.
3.8 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
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schedule. If the City cannot logistically attend ESC training, they may teach OMD approved
curriculum at remote sites provided:
1. The OMD approved EMCC or representative attends all required 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.
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 notified of an exposure to infectious disease, the City Ghali notify the EMS Infectious
Control Officer or EMS Battalion Chief,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 Expanded 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 under the Expanded Non-
Transport ALS Protocol 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 Chief of EMS. Such revisions must not
conflict with the terms and standards set forth in this Agreement.
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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, 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 and replaces the agreement titled "Interlocal
Agreement Advanced Life Support Engine Partnership, between the City and the County, dated
May 22, 2007, which Agreement is hereby terminated and is of no further force or effect.
7.1 This Interlocal Agreement shall remain in full force and effect from the date above and
shall continue unless terminated as set forth below.
7.2 This Interlocal Agreement shall be reviewed and renegotiated as necessary every three(3)
years. 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 the City.
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7.3 Either the County or the City may terminate this Interlocal Agreement after providing
written notice to the other of its intent to terminate at least ninety(90)days in advance of the date
of termination. During this 90-day termination window, the terminating party must provide the
non-terminating party's representatives with an opportunity to consult with the terminating party's
representatives regarding the reasons)for 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 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.
SECTION VIII: INSURANCE
8.0 Each party shall maintain insurance in the minimum amounts and types required by Florida
State Statutes. Each 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.
8.1 To the extent permitted by law and as limited by and pursuant to the provisions of Florida
Statutes, Section 768.28,the parties 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 either party when it would not
otherwise be responsible.
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 party 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
either party commencing with the work,services,duties and responsibilities described heretofore.
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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.
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IN WITNESS WHEROF, the parties hereto have caused this Interlocal Agreement to be
executed by their appropriate officials,as of the date first above written.
AS TO COUNTY:
ATTEST: "t mat BOARD OF COUNTY COMMISSIONERS
► r
CRYS' L, Clerk COLLIER C( ' ,FLORIDA
By' Ca /By: a
- a� . Clerk Viii, iam L. McnielJr.,C nnany ;e .(
ApprM*Ii_lfil' nt,aiid legality:
' H
Jeffrey A. K lat7ko—w,County Attorney
I
AS TO CITY:
ATTEST: CITY 0 ARCO I AND. FLORID•
By: - 1
By'
M. lerk Erik Br s. 1 v, I : ,
Approved as to form and
legal sufficiency:
(i6b,,‘fYJ
Alan L. Gabriel, City Attorney
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ATTACHMENT A
COLLIER COUNTY EMERGENCY MEDICAL SERVICES AND MARCO ISLAND
FIRE AND RESCUE DEPARTMENT AIA9ASf
ALS OPEERATIONAL PLAN
REFERENCE: ALS Program Interlocal Agreement 101-I41 . 2019
PURPOSE: To provide quality and cost-effective emergency medical services to the residents of
the City of Marco Island(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 six(6)permitted by the
COUNTY and equipped by the CITY.
• Engine 50
• Tower 50
• Squad 50
• Engine 51
• Squad 51
• Engine 52
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 and/or
Expanded Non-Transport Protocol, as determined by the OMD.
The CITY Firefighter/Paramedics who are certified to perform as ALS Engine/Expanded Non-
Transport 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 Marco Island Firefighter / Paramedic will accompany EMS ambulance staff
(third crew member) to the hospital on all patients that have received ALS treatment
beyond an ECG, EKG and IV by the Marco Island Paramedic or that will require AI.S
treatment beyond these procedures per protocol. Exceptions to the ride time
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requirement are: special event units,in the event that all apparatus are dedicated to a
structure fire or large incident.
b. The team of EMS staff and City of Marco Island 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 Marco Island Battalion Chief will consult
openly in order to assure continuity and efficiency. It is recognized by COUNTY and
City of Marco Island that harmonious and productive relationships between all
personnel are necessary. Teamwork and cooperation are 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 Marco Island 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 ALS permitted
apparatus.
ii. COUNTY and City of Marco Island Chief officers will utilize available City
of Marco Island Fire-Rescue Department permitted resources to assure ALS
coverage is continuously maintained within the City of Marco Island.
iii. COUNTY and City of Marco Island Chief officers will assure permitted ALS
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 permitted ALS unit will document each patient contact in an approved
Patient Care Report (PCR) that meets at a minimum State of Florida EMSTAR 3.4
EMS data collection standards.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
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number, dispatch times, and crew signatures with State paramedic or EMT license
numbers. Some specific call types may require additional documentation (such as
Release/Competency forms for patient sign outs) as specified by protocol and
EMSTAR 3.4 documentation standards. When ALS units arrive at the same time,the
PCR will be completed by the transporting unit. Handwritten 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 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 Marco Island Battalion Chief
or designee must fax or email a complete ALS Staffing Report to DL-EMS Battalion
Chiefs email list. If staffing changes are made during the shift,an updated report will
be provided prior to or at the end of shift to reflect staffing changes.The EMS Battalion
Chief will provide a complete EMS Staffing report to the City of Marco Island
Battalion Chiefs office.
5. QUALITY ASSURANCE:
a. City of Marco Island 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. The City (QA) member may attend the ALS Transport
Quality Assurance Committee when cases are discussed involving a City FF/PM
actions.
b. City of Marco Island 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.
d. At the discretion of the Medical Director or designee, routine or informational QA
Review with City of Marco Island Fire-Rescue Department personnel may be handled
entirely by the City of Marco Island Fire-Rescue Department appointed representative.
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The member shall review and complete all paperwork with the City of Marco Island
Fire-Rescue Department personnel and return all necessary documentation to the ALS
Non-Transport QA Committee within thirty[30]calendar days.
e. 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.
g. In the event the City wishes to order an EMT or Paramedic for remediation or to be
immediately prohibited from providing patient care they will submit in writing the
information to the OMD for consideration.
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)will be submitted with a
complete student roster to the OMD in order to qualify for COUNTY accreditation,if
requested. 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.
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