Agenda 04/12/2022 Item #11D (Authorizing 12 Additional FTE's to EMS)04/12/2022
EXECUTIVE SUMMARY
Recommendation to authorize 12 additional Full Time Equivalent (“FTEs”) positions in the Collier
County EMS Division due to increased customer demands, population, and call volumes, authorize
the necessary budget amendments, and accept EMS’ plan to improve staffing and response times to
meet current and future County demands.
_____________________________________________________________________________________
OBJECTIVE: To ensure the County’s Emergency Medical Services (EMS) operations has sufficient
staffing to support ambulance services and reduce overtime for paramedics and Emergency Medical
Technicians (EMTs) and to provide plans for EMS expansion throughout the next two years.
CONSIDERATIONS: Collier EMS is a nationally accredited emergency response system that has
provided county-wide emergency Advanced Life Support response and transport services for Collier
County residents and visitors for nearly 41 years. EMS handles a multitude of medical, traumatic, and
psychological incidents. The goal of EMS is to provide professional medical support to a scene in time to
take effective action to minimize the effects of the emergency saving lives by quickly preparing them for
medical transport to the local hospitals. Time matters a great deal in an emergency and equally critical is
having sufficient personnel to staff emergency vehicles and provide oversight and incident command on
critical calls.
Over the past fourteen years, Collier County has seen a tremendous increase in populatio n, traffic, and an
influx of retirees creating a substantial demand for EMS services and total number of calls for emergency
response. Call volumes have more than doubled creating higher demands and use of medically advanced
electronic systems to better care for patients at the scene and while in transport. These increased demands
require highly skilled and trained EMTs, which are in great demand state-wide as well as nationally.
Prior to 2007, when EMS added growth units, an additional FTE above minimum staffing was allotted
per growth ambulance to backfill vacancies and to reduce the need to utilize overtime for coverage. The
County eliminated that practice during the recession, and through attrition there are currently no
additional on-duty employees each day to cover vacancies on ambulances. During FY 2021, EMS
employees were mandated or volunteered to work 79,455 overtime hours, at a cost of over $2.6 million.
There are various forms of absences contributing to the number of vacancies within the system . EMS has
experienced an increase in sick leave usage, FMLA and workers’ compensation usage over the last two
years due to COVID leave, injuries and needed time off to address fatigue and mental health. In FY 2021,
all forms of leave usage accounted for 78,746 hours.
For years, vacancies have been covered with employees on overtime and EMS has managed and
continued to provide timely response pulling staff from other districts without issue; however, call
demand and fatigue has placed a burden on first responders, which is also a nationwide dilemma. In
addition to the increase in mandatory work hours, overall call volume in FY 2021 was 10.13% higher
than FY 2020 and patient transports in FY 2021 were 8.42% higher than FY 2020. So far, FY 2022 call
volume is currently 3.49% higher than the same period in 2021.
Mental health and fatigue in first responders are growing issues throughout the country. With the addition
of a pandemic, increased working hours and an increase in call demand, EMS responders are be coming
stressed beyond capacity. EMS has transported 4,465 COVID patients to area hospitals since March 1,
2020; oftentimes, entering homes alone to reduce exposure to other first responders, while wearing heavy
personal protective equipment to protect themselves and family from harm. Collier County population is
estimated to increase 7,000-10,000 persons per year. Additionally, 32.9% of residents are 65 years or
older and future growth will place further demands on the EMS system specifically in the Estates, Eastern
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US 41, and Immokalee areas.
Those changes in service demand require changes and adjustments in the deployment of staff and
resources to maintain acceptable levels of performance and to continue to provide exceptional pre -
hospital care. The last major adjustment to EMS services was in April 2014, with a mid-year expansion of
resources to address response times throughout the County. With the increased demand on the EMS
system, an increase in resources is again warranted. Now more than ever, EMS resources are a vital part
of providing public safety to the community.
It is recommended EMS work through this initial request for staffing and through the budget process to
bring staffing to pre-recession levels to provide for an additional employee per unit for adequate staffing
of vacancies reducing overtime, improving response times, and better handling the increased calls for
service throughout Collier County.
Below are immediate recommendations for a phased approach of adding personnel to improve p ublic
safety, reduce response times and increase EMS availability while meeting current and future demands on
the County’s EMS system. To further improve staffing and response times due to increased call volume,
growth and population, proposed additions of personnel and apparatus are outlined within the attachment
to this item. Additional discussions regarding future FTEs and equipment requests will be presented to the
Board, either through the annual budget process or as a mid-year Executive Summary.
Effective April 12, 2022.
Recommendation: Replace three FTEs (Paramedic II positions) to backfill positions reassigned to staff a
Battalion Chief position to alleviate vacancies and overtime. This will have an FY 2023 fiscal impact of
approximately $281,250.00. Budget amendments will be processed as required to realign existing budgets
in FY 2022.
Recommendation: Add nine additional FTEs to begin aligning with pre-recession growth unit practices
and meet goals of staffing recommendations to backfill vacancies without utilizing overtime. Nine FTEs
will provide three additional employees per shift. Estimated cost: $900,563.76 in FY 2023. Budget
amendments will be processed as required to realign existing budgets in FY 2022.
FISCAL IMPACT: The annual cost associated with the addition of twelve (12) FTE’s is $1,181,813.76.
Assuming employee onboarding in May the proposed additions would have a fiscal impact of
approximately $495,000 in Fiscal Year 2022 (EMS Fund 490). Budget amendments will be processed as
required to reallocate current year funding. Staff’s intent is to fund vehicles and equipment in the amount
of $1,700,000 through the Coronavirus State and Local Fiscal Recovery Fund within the Housing Grant
Fund (705), Project 33765.
LEGAL CONSIDERATIONS: This item is approved as to form and legality and requires majority vote
for Board approval. -SRT
GROWTH MANAGEMENT IMPACT: None.
RECOMMENDATION: Recommendation to authorize 12 additional Full Time Equivalent (“FTEs”)
positions in the Collier County EMS Division due to increased customer demands, population, and call
volumes, authorize the necessary budget amendments, and accept EMS’ plan to improve staffing and
response times to meet current and future County demands.
Prepared By: Tabatha Butcher, Chief, Emergency Medical Services
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ATTACHMENT(S)
1. EMS Expansion Cost and Timeline 4-12-22 (PDF)
2. Future EMS Recommendations to Increase Staffing and Improve Response Times Due to
Increased Call Volume and Growth (PDF)
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COLLIER COUNTY
Board of County Commissioners
Item Number: 11.D
Doc ID: 21847
Item Summary: Recommendation to authorize 12 additional Full Time Equivalent (“FTEs”)
positions in the Collier County EMS Division due to increased customer demands, population, and call
volumes, authorize the necessary budget amendments, and accept EMS’ plan to improve staffing and
response times to meet current and future County demands. (Tabatha Butcher, Chief, Emergency Medical
Services)
Meeting Date: 04/12/2022
Prepared by:
Title: Division Director - EMS Operations – Emergency Medical Services
Name: Tabatha Butcher
04/04/2022 8:12 AM
Submitted by:
Title: Division Director - EMS Operations – Emergency Medical Services
Name: Tabatha Butcher
04/04/2022 8:12 AM
Approved By:
Review:
Agenda Clerk Preview Geoffrey Willig Agenda Clerk Preview Completed 04/04/2022 11:01 AM
Emergency Medical Services Tabatha Butcher Director Review Completed 04/05/2022 7:51 AM
County Attorney's Office Scott Teach Level 2 Attorney Review Completed 04/05/2022 3:10 PM
Office of Management and Budget Debra Windsor Level 3 OMB Gatekeeper Review Completed 04/05/2022 3:16 PM
Office of Management and Budget Laura Wells Additional Reviewer Completed 04/05/2022 3:49 PM
County Attorney's Office Jeffrey A. Klatzkow Level 3 County Attorney's Office Review Completed 04/06/2022 8:23 AM
County Manager's Office Amy Patterson Level 4 County Manager Review Completed 04/06/2022 4:37 PM
Board of County Commissioners Geoffrey Willig Meeting Pending 04/12/2022 9:00 AM
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Staffing Improvements
Recommendation Timeframe Cost
Backfill three (3) FTEs to fill current vacancies April 12, 2022 $281,250.00
Add additional staffing of 9 FTEs (3/shift) to backfill
vacancies, reduce overtime and reach staffing goal of 27
additional FTEs
April 12, 2022 $900,563.76
Total $1,181,813.76
Response Time and Workload
Improvements
Zone Recommendation Timeframe Cost
Golden Gate Estates (Zone 71 and
Zone 10)
Add crew and ambulance to Station 71 (7 FTEs)October 1, 2022 $700,438.48
Immokalee and Golden Gate
Estates (Zone 30, 31, 32, 10 and
71)
Add nine (9) FTEs (3/shift) to Station 30, 31 and 32 October 1, 2022 $900,563.76
East Naples and Golden Gate City
(Zone 75, 20, 25 and 70
Add crew and ambulance to Station 75 (7 FTEs)October 1, 2022 $700,438.48
Staffing Improvements
Add additional staffing of 9 FTEs (3/shift) to backfill
vacancies, reduce overtime and reach staffing goal of 27
additional FTEs
October 1, 2022 $900,563.76
Total $3,202,004.48
11.D.1
Packet Pg. 365 Attachment: EMS Expansion Cost and Timeline 4-12-22 (21847 : Recommendation to approve additional
Response Time and Workload
Improvements
Zone Recommendation Timeframe Cost
North Naples (Zone 42, 43, 44,
48)
Add crew and ambulance to Station 44 (7 FTEs)Within two (2) years $700,438.48
East Naples and Isles of Capri
(Zone 25, 23 and 90)
Add QRP and vehicle to Station 25 (3 FTEs)Within two (2) years $400,250.56
Eastern North Naples (Zone 76
and 42)
Add crew and ambulance to Station 76 (7 FTEs)Within two (2) years $700,438.48
Golden Gate City (Zone 70)Add QRP and vehicle to Station 70 (3 FTEs)Within two (2) years $400,250.56
Staffing Improvements
Add additional staffing of 9 FTEs (3/shift) to backfill
vacancies, reduce overtime and reach staffing goal of 27
additional FTEs
Within two (2) years $900,563.76
Span of Control and Training
Improvements
Add Battalion 85 for span of control, operations and
supervisory support for added staffing and resources
(3 FTEs)
Within two (2) years $526,500.00
Add two (2) Training Captains for ongoing training and
quality assurance oversight for expanded positions
(2 FTEs)
Within two (2) years $325,000.00
Total $3,953,441.84
Total FTE Count=78 Total $8,337,260.08
Total Vehicles=4 ambulances, 4 SUVs
11.D.1
Packet Pg. 366 Attachment: EMS Expansion Cost and Timeline 4-12-22 (21847 : Recommendation to approve additional
Future EMS Recommendations to Increase Staffing and Improve Response Times Due to
Increased Call Volume and Growth (FY 23-24)
Staffing Recommendation to Reach Goal of Twenty-Seven Additional Employees
It is proposed within FY 23 budget to add nine (9) additional FTEs to continue aligning with pre-
recession growth unit practices and staffing recommendations to backfill vacancies without
utilizing overtime. Nine (9) FTEs will provide three (3) additional employees per shift. Estimated
cost: $900,563.76 in FY 2023.
EMS Advanced Life Support Goal – Travel time response of 8 minutes or less 90% of the
time in urban area; 12 minutes or less 90% of the time in rural area. Below are current EMS
Advanced Life Support response times in each zone.
Zone Under 8 Zone
Under
12
1 93 10 89
2 92 30 94
20 88 31 92
21 90 32 75
22 96 60 67
23 87 71 84
24 93
25 83
40 93
42 86
43 86
44 93
46 95
48 85
50 91
70 86
75 84
76 83
90 77
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Packet Pg. 367 Attachment: Future EMS Recommendations to Increase Staffing and Improve Response Times Due to Increased Call Volume and Growth
Golden Gate Estates (Zone 71 and Zone 10)
Recommendation
a. Short Term: It is proposed in FY 23 budget, beginning October 1, 2022, a unit
(ambulance, equipment, and personnel) be placed at existing EMS Station 71 located
at 13th St SW and Golden Gate Blvd (temporary location) as a measure to aid response
times in Golden Gate Estates in advance of planned station at Desoto Blvd and Golden
Gate Blvd. Estimated cost: $700,438.48 for seven (7) personnel. Ambulance and
medical equipment will be funded with American Rescue Plan funds.
b. Long Term: Construct station at Golden Gate Blvd and Desoto Blvd as outlined in the
AUIR. Ambulance will be re-located to new station. Station completion expected
Summer 2023. Station will be funded with Surtax dollars.
Immokalee and Golden Gate Estates (Zone 30, Zone 31, Zone 32, Zone 10 and Zone 71)
Recommendation
It is proposed within FY 23 budget to add nine (9) paramedic/firefighters (3/shift) to
Immokalee Fire apparatus to provide additional advanced life support coverage in
Immokalee and Ave Maria and allow Immokalee Fire Department to staff Immokalee
Station 31 to increase fire support in the Immokalee area. While EMS meets response time
expectations in Immokalee, the call volume in Immokalee has increased 19% in the last
year, travel distance is long and ambulances from Ave Maria and Golden Gate Estates are
often moved from their areas to provide zone coverage in Immokalee, leaving those areas
open and causing a shift of all resources to the East. Additional paramedic resources in
Immokalee would greatly reduce the movement of ambulances and improve response times
in Golden Gate Estates and Ave Maria. The call volume in Ave Maria has increased 23%
in the last year. The EMS paramedic/firefighters will be located at Immokalee Station 30
(New Market Road), Station 31 (Carson Road) and Station 32 (Ave Maria). Estimated cost:
$900,563.76 for nine (9) personnel.
East Naples and Golden Gate City (Zone 75, Zone 20, Zone 25, and Zone 70)
Recommendation
It is proposed within FY 23 budget to add a unit (ambulance, equipment, and personnel) at
existing EMS Station 75 located at Santa Barbara and Davis to assist with Zone 75 and
adjacent Zones 20, 25 and 70. Zone 75 is the busiest EMS zone in the county and call
volume has increased 17% in the last year. Estimated cost: $700,438.48 for seven (7)
personnel. Ambulance and medical equipment will be funded with American Rescue Plan
funds.
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Packet Pg. 368 Attachment: Future EMS Recommendations to Increase Staffing and Improve Response Times Due to Increased Call Volume and Growth
Based on operational needs, within FY 23 and FY 24 the following recommendations will be
presented to the Board to attain adequate staffing and improve response times due to
increased demand.
Staffing Recommendation to Reach Goal of Twenty-Seven Additional Employees and
Improve Response Times
Recommendation
Add nine (9) additional FTEs to reach the goal of twenty-seven additional employees and fully
align with pre-recession growth unit practices and staffing recommendations to backfill vacancies
without utilizing overtime. Nine (9) FTEs will provide three (3) additional employees per shift.
Estimated cost: $900,563.76. This final addition of FTEs will meet the goal of 27 additional
employees.
Golden Gate City (Zone 70)
Recommendation
Add a Quick Response Paramedic (QRP) (single paramedic in a non-transport SUV with
equipment) at existing Station 70 located at Golden Gate Parkway and Coronado Parkway.
The QRP will remain in Golden Gate City to respond to calls when the ambulance in Zone
70 is busy. This will eliminate the need to send zone coverage to Golden Gate City .
Estimated cost: $400,250.56 for three (3) personnel. Vehicle and medical equipment will
be funded with American Rescue Plan funds.
North Naples (Zone 42, 43, 44, 48)
Recommendation
a. Short Term: Add a unit (ambulance, equipment, and personnel) at existing EMS Station
44 located at Vanderbilt Beach Road-Pavilion to assist with Zone 44 and adjacent
Zones 42, 43, 44 and 48. Zone 44 is the second busiest EMS zone in the county and
has experienced an 11% increase in call volume over the last year. It is expected with
an additional ambulance in Zone 44 adjacent zones will run less calls in Zone 44
resulting in less movement from their own zones. Estimated cost: $700,438.48 for
seven (7) personnel. Ambulance and medical equipment will be funded with American
Rescue Plan funds.
b. Long Term: Construct station on Old 41 as outlined in the AUIR. Ambulance will be
re-located to new station. Station will be funded with Surtax dollars.
11.D.2
Packet Pg. 369 Attachment: Future EMS Recommendations to Increase Staffing and Improve Response Times Due to Increased Call Volume and Growth
East Naples and Isles of Capri (Zone 25 and Zone 23, Zone 90)
Recommendation
Add a Quick Response Paramedic (QRP) (single paramedic in a non-transport SUV with
equipment) at existing Station 25 located at Lord’s Way off Collier Blvd. The QRP will
respond to calls when the ambulances in Zone 25 and Zone 23 are busy. This will eliminate
the need to send zone coverage to Zone 23 and will keep Medic 90 (Isles of Capri) in zone
more often. Estimated cost: $400,250.56 for three (3) personnel. Vehicle and medical
equipment will be funded with American Rescue Plan funds.
Eastern North Naples (Zone 76 and Zone 42)
Recommendation
a. Short Term: Add a unit (ambulance, equipment, and personnel) at existing EMS Station
76 located at Vanderbilt and Logan to assist with Zone 76 and adjacent Zone 42. It is
expected with an additional ambulance in Zone 76 response times will improve in Zone
76 and Zone 42. Estimated cost: $700,438.48 for seven (7) personnel. Ambulance and
medical equipment will be funded with American Rescue Plan funds.
b. Long Term: Construct Station at Heritage Bay as outlined in the AUIR. Ambulance
will be re-located to new station. Station will be funded with Surtax funds.
Recommendations to Address Span of Control and Training
Increase Operational Span of Control and Supervisory Support for Expanded Positions
Recommendation
Add three (3) FTEs (1/shift) to create Battalion 85 to address span of control for expanded
positions and provide field supervisory support. Estimated cost: $526,500.00 for three (3)
personnel. Vehicle and equipment will be funded with American Rescue Plan funds.
Recommendation
Add two (2) FTEs to add two additional Training Captains to the EMS Training
Department to provide ongoing training and quality assurance oversight to expanded
employee positions. Estimated cost: $325,000.00 for two (2) personnel. Vehicle and
equipment will be funded with American Rescue Plan funds.
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Packet Pg. 370 Attachment: Future EMS Recommendations to Increase Staffing and Improve Response Times Due to Increased Call Volume and Growth