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EMA Agenda 11/09/202215.A.3 COLLIER COUNTY EMERGENCY MEDICAL AUTHORITY (EMA) AGENDA November 9, 2022— Wednesday 9:30am 3299 Tamiami Trail, Bldg F 51h Floor IT Training Room 1. CALL TO ORDER AND PLEDGE OF ALLEGIANCE 2. AGENDA AND MINUTES a. Approval of Today's Agenda b. Approval of the September 14, 2022, Meeting Minutes 3. OLD BUSINESS a. Performance Measures Update 4. NEW BUSINESS a. MeclTrek COCPN Application b. Collier County EMS COPCN Renewal Application c. EMA Member Term Expiration and Application Process d. Proposed 2023 EMA Meeting Schedule 5. FIRE SERVICE DISCUSSION 6. STAFF REPORTS 7. PUBLIC COMMENT 8. BOARD MEMBER DISCUSSION 9. NEXT MEETING DATE a. December 14, 2022 10. ADJOURNMENT Packet Pg. 517 PC5�- E-NIA vo'cam'--t') 'W�Vcx CR-vlces In COLLIER COUNTY EMERGENCY MEDICAL AUTHORITY (EMA) AGENDA November 9, 2022- Wednesday 9:30am 3299 Tamiami Trail, Bldg F 5" Floor IT Training Room 1. CALL TO ORDER AND PLEDGE OF ALLEGIANCE �t� -Th CLIA V � LqA f-D 2. 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"(I r,r, ,ry } wri 'swan a tfd I� - ---- C&dot Tr#e:#,ih _ -`; ( r� � �. I �I �it '..__.. �I I, � � {If i �I _ I I I gYexfyoti In 5O�� I) -- i , ; s Golden days-, � [ - �7tti f t� li t �rd-l4�ea�M1t ►-- - - _ , J ; � i I C) I i R Ii a - � t3olden O� i YtAYd i L lio4na#ix=- F Q Packet Pg. 555 15.A.3 to u z i L. x Ojj )N#0 R41 00 YWI ltd Bblf MAM011,411110 i Immokalee � �tog3onat Alr7sc�rt Lake Trafford:J i I ttY ffl S)A.A ICR �#�! Ave Marla Oil w*11 #a.d Nnn M Packet Pg. 556 15.A.3 Smokehvu. Bey Marco Island 4 i __ :..._. 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H �ti ••t7ftly ftRa.i O Z C rio s4uno'3'j gnjo Ib_49PPI-3Y ,(� E qur a eva ja'into 4U 5 rtrza�q�t4tRa�,t s O uu j ad S ea u;Q1471111WO F =— 3S PH 43ebg It;juog Packet Pg. 558771 15.A.3 s 4� saldeN 4J9 ' qn,-3 POO v into tuelOutOd Mom ro st � G � a s NO cn 18 Packet Pg. 559771 15.A.3 8 � N N CD L O� 1F4Ilk > Z R4 yy� 0 S Y rSrtunwuw� Q satin 61 v posab alai c d L W {=Llv4 joue&N Solder , � M a L ~ / AIs-1 Z I Q Packet Pg. 560 15.A.3 %Avow - May 3, 2021 To whom it may concern: This letter is in support of MedTrek's application for Certificate of Public Convenience (COPCN) to provide additional transportation services in Collier County, Florida. Avow Hospice collaborates with MedTrek currently and would benefit from the expansion of services. With the growth in the county and at Avow, the need for transportation services continues to grow. During the off -shift hours, finding transportation services is often burdensome to Avow. By providing additional transportation services, wait times will decrease for hospice patients in need of immediate transport. Medtrek has provided exceptional service over the years to Avow and I support the approval of the COPCN for MedTrek Transportation Services. Please feel free to reach out to me if you have additional questions. Sincerely, Rebecca Gatian, MBA, BSN Chief Clinical Officer Avow Hospice 239-261-4404 (239) 261-4404 www.avowcares.org 1095 Whippoo (888) 484-AVOW Naples, FL Packet Pg. 561 15.A.3 Downtown Campus 350 Seventh Street N. Naples, FL 34102 (239) 624-5000 January 31, 2020 To Whom It May Concern, NCH dam Healthcare System North Naples Campus 11190 Healthpark Blvd. Naples, FL 34110 This letter is written on be half of the NCH Healthcare System to support MedTrek's application for its Certificate of Public Convenience (COPCN) to provide additional transport services in Collier County. As NCH and Collier County has continued to grow, we have had an increase in the amount of transport needs, placing a strain on our system due to wait times. MedTrek has seen this growth and is anticipating our and the community's ever-growing needs allowing for more robust transportation services among our many locations for critically ill and routine patients. Having choice is always an advantage for consumers. Having multiple transportation options for all patients ranging from routine to emergent will benefit all concerned. If you require any further information in support of MedTrek, please let me know. Thank you for your consideration, Jon Kling, MBA, BSN, RN System Chief Nursing Officer NCH Healthcare System Phone: (239) 624-4009 2005 HeatthGrades Distingwshed V w .NCHmd org Hospital Award • Clinical Excellence Packet Pg. 562 15.A.3 CNH fir Healthcare -'�"` System January 15, 2020 To Whom It May Concern: Please allow this correspondence to serve as my support for MedTrek Ambulance Service's application for its Certificate of Public Convenience (COPCN) to provide Advanced Life Support services in Collier County. As the Director of Care Coordination for the NCH Healthcare System, I am aware of the great service MedTrek has provided to our patients and community in their current state. This company has exceeded our expectations in terms of service, timeliness, and patient satisfaction. MedTrek is prompt, their staff is courteous, and our patients are being handled in a timely and skilled manner. Despite this, there is a great need for additional transportation options in our community for critically ill and other patients with advanced needs. It is therefore in the public's best interest for the county to provide additional options in this regard, as our geographic region continues to expand. We are confident that our current collaborative relationship with MedTrek will prosper if their application is granted. I fully support the approval of the COPCN for MedTrek. Respectfully, Kristine Jordan, MHA, BSN, RN Director of Care Coordination NCH Healthcare System 350 7t' Street N. Naples, FL 34102 Packet Pg. 563 15.A.3 Medtrek Medical Transport, Inc. APPLICATION FOR CERTIFICATE OF PUBLIC CONVENIENCE AND NECESSITY CLASS 2 ALS TRANSFER ATTACHMENTS: 1. FINANCIALS: BALANCE SHEET AND FINANCIAL COMPILATION 2. LIST OF AMBULANCES 3. LETTER OF SUPPORT FROM HOPE HEALTHCARE 4. CERTIFICATE OF INSURANCE 5. PROTOCOL OCT Packet Pg. 564 15.A.3 To Management of Medtrek Medical Transport, Inc Naples, FI Management is responsible for the accompanying balance sheet of Medtrek Medical Transport , Inc. as of August 31, 2022 in accordance with accounting principles generally accepted in the United States of America. We have performed the compilation engagement in accordance with Statements on Standards for Accounting and Review Services promulgated by the Accounting and Review Services Committee of the AICPA. We did not audit or review the combined financial statements nor were we required to perform any procedures to verify the accuracy or completeness of the information provided by management. We do not express an opinion, a conclusion, nor provide any assurance on these combined financial statements. iCFO Consulting Inc iCFO Consulting, Inc 10/3/2022 Packet Pg. 565 15.A.3 MEDTREK MEDICAL TRANSPORT, INC. Balance Sheet For the month ended August 31, 2022 Assets Cash $178,944 Vehicles 345,000 Stretcher Vans 70,000 Wheelchair Vans 45,000 Stretchers 40,000 Other asset 0 Total assets $678,944 Liabilities Credit card liabilities 30,644 Payroll liabilities 6,612 Other liabilities 0 Total liabilities 37,256 EQUITY Shareholders' equity 641,688 Total Liabilities & Equity $678,944 2 Packet Pg. 566 15.A.3 Medtrek Medical Transport, Inc. APPLICATION FOR CERTIFICATE OF PUBLIC CONVENIENCE AND NECESSITY CLASS 2 ALS TRANSFER ATTACHMENT 2: LIST OF AMBULANCES SPECIFICATION/VEHICLE IDENTIFICATION 2016 CHEVY EXPRESS G4500 2009 CHEVY EXPRESS G3500 2014 CHEVY EXPRESS G4500 2015 CHEVY EXPRESS G3500 2015 CHEVY EXPRESS G3500 1GB3G RCL1G1133054 1GBKG316491110442 1G66G5CL2E1193119 1GB3CZCG5FF664600 1GB3G2CG8F1166562 TYPE III AMBULANCE TYPE III AMBULANCE TYPE III AMBULANCE TYPE I AMBULANCE TYPE III AMUBLANCE w a� 0 a aD E a� 0 z r c m E 0 r r a Packet Pg. 567 15.A.3 Medtrek Medical Transport, Inc. APPLICATION FOR CERTIFICATE OF PUBLIC CONVENIENCE AND NECESSITY CLASS 2 ALS TRANSFER Q Packet Pg. 568 15.A.3 4(n Hope HEALTHCARE October 1, 2022 To Whom It May Concern: I I 9470 Healthl"ark Circle Fort Myers, Florida 33908 800.835.1673 HopeHCS.org Please allow this letter to serve as my support for Medtrek's application for its Certificate of Public Convenience and Necessity (COPCN) to provide non -emergency medical transport in Collier County. Medtrek has been providing exceptional care to our patients and service our community for many years. And it is in the best interest of Collier County citizens to approve their COPCN application to provide ALS and BLS interfacility transport services. Collier County has seen a great deal of growth with its population size, new 50 beds Acute Rehab, more than 500 new beds of Assisted Living Facilities and Nursing Home. The increase in transport needs and that current providers not available to provide services in reasonable time frame has cause significant delays to patient care. Our patients cannot wait 8-10 hours to be transferred from hospital to our inpatient unit. There are instances where patients died at the hospital waiting for transport and even worst in transit because of transport delays. During afternoons and on Fridays, transport providers are not available at all, resulting in patients having to stay overnight and occupying a hospital bed. We are confident that our current relationship with Medtrek will continue to prosper when their COPCN is granted to ease the burden with delays. If any further information is needed, please let me know. T ik you for your onsideration, Clete Cole Commty n unid Admission Liaison Hope Healthcare Hope Healthcare provides specialized care for all people with complex needs related to life -changing illness; see HopeHCS.org for a full listinq of our programs. scare, s registered vuth the P,• ya Gepartr•en; of Consumer Se,,- -.es reg.,tranon number SC -OW '. Pea,e oe ad. se ins or ennties You may obt, e ccpy of out offic•al req'st'st on ,-.y n^aroal info,madon by calling ;he D 6z-.e nr C.,5 .... . y .;nclorsement, approvul or recommendation by tf+e State. Re, 10/18 Hospice bcen 95010,Y)6 Hume Packet Pg. 569 15.A.3 AR" CERTIFICATE OF LIABILITY INSURANCE Ili10/04/2022 ATE (MM/DDIYYYY) r THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsements . PRODUCER CONTACT NAME: Adrine Walker PH°NE (239) 430-3500 q/C No): (239) 430-3546 AMERICAN ACCORD INSURANCE E-MAILDRESS: lnfo@americanaccord.com D 12975 Collier Blvd Ste 109 INSURERS AFFORDING COVERAGE NAIC # INSURERA: Underwriters at Lloyd's London 16792 Naples FL 34116 INSURED INSURER B : NATIONAL INDEMNITY COMPANY OF THE SOUT 42137 INSURER C MEDTREK MEDICAL TRANSPORT INSURER D : 3884 Prospect Ave INSURER E: INSURER F : Naples FL 34104 COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS, ILTR TYPE OF INSURANCE ADDLiSUBR: INS POLICY NUMBER POLICY EFF POLICY EXP MMIDDIYYYY MMIDDIYYYY LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 l j CLAIMS -MADE /� OCCUR I, j DAMAGE T° RENTED PREMISES Ea occurrence $ IOO,000 MED EXP (Any one person) $ 100,000 A CPS2802606 05/22/2022 05/22/2023 'PERSONAL & ADv INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE ! $ 3,000,000 X : POLICYPRO-,, JECT X LOC PRODUCTS - COMP/OP AGG ! $ 3,000,000 OTHER. $ AUTOMOBILE LIABILITY I COMBINED SINGLE LIMIT $ (Ea accidenU ^j ANY AUTO BODILY INJURY (Per person) 1 s 1,000.000 OWNED ^/7 SCHEDULED B _ AUTOS ONLY X' AUTOS 74APS101470-01 07/29/2022 07/29/2023 BODILY INJURY (Per accidenq$ 1,000,000 HIRED j NON -OWNED � AUTOS ONLY AUTOS ONLY !PROPERTYtDAMAGE is Per acciden 1,000,000 Personal Injury $ 10,000 ^UMBRELLA LIAR OCCUR ! �'. EACH OCCURRENCE $ EXCESS LIAB CLAIMS -MADE'. AGGREGATE : $ DIED RETENTION $ I $ WORKERS COMPENSATION [PER OTH- AND EMPLOYERS' LIABILITY ANY PROPRIETORIPARTNERIEXECUTIVE Y / N I I STATUTE ER f I ':.OFFICER/MEMBER EXCLUDED? ❑'NIA :' EL EACH ACCIDENT $' (Mandatory in NH) i i If yes. describe under E.L. DISEASE - EA EMPLOYEE $ DESCRIPTION OF OPERATIONS below E. L. DISEASE - POLICY LIMIT - $ Sexual Abuse Aggregate 300,000 A Sexual Abuse CPS2802606 05/22/2022 05/22/2023 Limit 100,000 DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Vehicle Scheduled 2018 FORD PASSENGERVAN - 1 FTYE2CM9JKA44440 Ded: $1,000/$1,000 2018 FORD PASSENGERVAN - 1FTYE2CM2JKA44442Ded:$1,000/$1,000 2015 FORD TRANSIT- 1 FDZX2CM4FKA1 8751 Ded:$1,000/$1,000 2012 NISSAN PASSENGERVANIN6AFOLYXCN115374Ded:$1,000/$1,000 I."- q'ii Collier County Board of Commissioners 3299 Tamiami Trail East, Suite 303 NAPLES FL 34112 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE (D tSl f0 Y V M a E d O Z C d E t v R r Q © 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 26 (2016/03) The ACORD name and logo are registered marks of ACORD Packet Pg. 570 " STATE OF FLORIDA DEPARTMENT OF HEALTH DIVISION OF MEDICAL QUALITY ASSURANCE DATE LICENSE NO. CONTROL NO. 04/30/2022 RN 9312210 3399222 THE REGISTERED NURSE NAMED BELOW HAS MET ALL REQUIREMENTS OF THE LAWS AND RULES OF THE STATE OF FLORIDA. Expiration Date: APRIL 30, 2024 JALIX GEORGES 7557 CAMPANIA WAY UNIT 205 NAPLES, FL - 34104 /:;� 665- Ron DeSantis GOVERNOR DISPLAY IF REQUIRED BYLAW EXPIRATION DATE: APRIL 30, 2024 QUALIFICATION(S): Singl"tale Llwnse 6� Joseph A. Ladapo, MD, PhD State Surgeon General 0 Z 0 O U Your license number is RN 9312210. Please use it in all correspondence with your board/council. Each licensee is solely responsible for notifying the Department in writing of the licensee's current mailing address and practice location address. If you have not received your renewal notice 90 days prior to the expiration date shown on this license, please visit www.FLHealthSource.gov and click "Renew A License" to renew online. The Medical Quality Assurance Online Services Portal gives you the ability to manage your license to perform address updates, name changes, request duplicate licenses and much more. It's simple. Log onto your MQA Online Services account today at http://flhealthsource.gov/. Select the "Account Login" button to access your account. For changes to your name, address or to request duplicate licenses, choose your selection from the dropdown list under "Manage My License". Your profession will open for renewal 90 days prior to your expiration date. When the renewal cycle opens for your profession, the "Renew My License" header will automatically display on your license Dashboard. IMPORTANT ANNOUNCEMENTS ARE YOU RENEWAL READY? The Department of Health will now review your continuing education records at the time of license renewal. To learn more, please visit www.FLHealthSource.gov/AYRR GROUNDS FOR DISCIPLINE You should be familiar with the Grounds for Discipline found in Section 456.072(1), Florida Statutes, and in the practice actfor the profession in which you are licensed. Florida Statutes can be accessed at www.leg.state.fl.us/Statutes r Q Packet Pg. 571 15.A.3 October 3, 2022 Mr. Dan Summers Collier County Emergency Management 8075 Lely Cultural Parkway Naples, FL 34113 Mr. Summers, Attached is the application for a Certificate of Public Convenience and Necessity (COPCN) Class 2 ALS Transfer for Medtrek Medical Transport. Initially Medtrek Medical Transport provided non -urgent transport to the citizens of Collier County. These units facilitated the transport of patients to dialysis, physician offices for appointments or to assisted living. There currently is a need in Collier County for both ALS routine and emergent ALS transport services. Our units and equipment are new with the most up to date technology available in the prehospital environment. Our staff of paramedics are trained to the level of'a Critical Care Paramedic to ensure patient safety during transport. The scope of their practice will be in alignment with the current Collier County EMS protocols with additions added for Critical Care Transport. A robust quality assurance program will be performed to ensure all the standards of care are being followed and the patients receive high quality care during transport. Continuing medical education of the paramedics will be a ongoing process focused on the challenging patient cases these paramedics care for. I thank you for considering our application and make a recommendation to the Collier County Commissioners for this needed service. Medtrck Medical Transport looks forward to serving the Collier County community, providing quality and compassionate care to the critically ill patients. Please feel free to contact me at any time if you should have any questions. Sincerely, Richard Juda, MD Packet Pg. 572 15.A.3 MECTREK Interfacility Transport Protocols 1. Interfacility Transport Protocol 2. EMT Interfacility Transport Guidelines 3. Paramedic Interfacility Transport Guidelines 4. Critical Care Paramedic Interfacility Transport Guiedlines 0912022 Packet Pg. 5 3 15.A.3 MECTREK Interfacility Transport Protocol Purpose To ensure the patient will receive the most appropriate care possible for their condition and to be in compliance with Florida Statutes and Administrative Codes for interfacility transfers on a non-emergent/emergent basis. Recognition Patients undergoing interfacility transport should be classified and aligned with transport resources appropriate for their needs. Medical Direction Authority is responsible for ensuring the patient is aligned with appropriate transport personnel and technology resources. If the EMT/Paramedic is in doubt, they should contact the Medical Direction Authority for further direction. The following classification should be utilized: 1. A patient who is clearly and completely stable with a minimal potential to decompensate during transport. Example: a patient with no IV who being transported for diagnostic testing. Patient may have a device in place, but device must be locked and clamped, not require any maintenance and not be actively running. Such inactive devices may include, but are not limited to, IVs, nasogastric tubes, feeding tubes, PICCU lines, bladder irrigation and wound vacs (wound vacs that are self-contained, gravity draining or battery powered can be transported by BLS providers). 2. A stable patient as above with IV fluids infusing without additive medications. Example: a patient with maintenance IV fluids running. 3. A patient who has been stabilized as much as possible, but may become less stable during transport. Patient has no medications or technology beyond the scope of practice of the Paramedic. Example: a cardiac patient with heparin and IV nitroglycerin infusing. 4. A patient with an acute injury or illness who may become unstable during transport and requires medications or technology within the scope of practice of a Paramedic. Example: a patient receiving critical care drips approved by Base Hospital Medical Direction. 5. A patient with an acute injury or illness who may become unstable during transport and requires medications or technology not within the scope of practice of the Paramedic in attendance and/or may develop complications requiring interventions beyond the scope of practice of the Paramedic provider in attendance. Example: a patient receiving 2 or more vasopressors and who is receiving aortic counterpulsation therapy with and intra-aortic balloon pump. The following details appropriate transport resources: Table Class Staffing Level 1. EMT or Paramedic BLS 2. EMT or Paramedic BLS 3. Paramedic ALS 4. Paramedic Critical Care ALS 5. MD, NP, RN ALS 0912022 Packet Pg. 574 15.A.3 MECTREK Interfacility Transport Protocol General Principles of Care and Medical Direction 1. Under no circumstances shall an EMT/Paramedic function beyond, or potentially beyond the scope of their training and level of certification. The scope of practice for all personnels is limited to the levels of certification and training level of the ambulance service. 2. When providing interfacility transports, the EMT/Paramedic will have medical direction from their Medical Direction Authority. The Medical Director's name will be written in Patient Care Reports (PCR)/Electronic Patient Care Reports (ePCR) as such. 3. All Interfacility Guidelines and Protocols will be followed for patient care. 4. All current adult, pediatric and procedural protocols used by crews to treat patients in the field will apply to Interfacility Transports if applicable to patient's condition/ situation. In addition, advanced protocols, specific for critical care patients, may apply and be used by the critical care transport team members who are qualified and familiar with the procedures listed. 5. Medical Direction Authority may be contacted at any step in patient care. Providers should contact medical director, if a patient's condition is unusual and is not covered by a specific guideline, if a patient's presentation is atypical and the guideline treatment may not be the best treatment for the patient or in any situation where the provider is not sure about the best treatment for the patient. 6. If at any time a member feels a protocol/patient is beyond their skill level or comfort level, DO NOT PROCEED WITH THE TRANSPORT, instead, contact medical authority and/or your supervisor to discuss your concern. 7. Consider additional personnel (such as a second paramedic or EMT) because of types of drugs/devices that are require for patient. 0912022 Packet Pg. 575 15.A.3 MECTREK EMT Interfacility Transport Guidelines Patient BLS Transfer Procedure Once a BLS transport has been deemed appropriate per the Intertacility Transport Protocol, the EMT upon arrival at the transferring facility will: 1. All Patients —Prior to accepting care of patient at sending facility: • Utilize appropriate isolation/universal precautions • Perform initial patient assessment (form a general impression of the patient; assess for immediate life -threatening problems or instability; assess responsiveness, airway, breathing, and circulation) • Obtain transfer information from sending facility. This is to include but is not limited to: o Bedside report from current rendering provider o Transfer papers (summary, appropriate clinical and diagnostic data including vital sign trends, laboratory data, diagnostic study/reports o Beware of appropriate clinical information on patient. (e.g. vital sign trends, diagnostic study/reports) 2. EMT shall establish contact with the receiving facility to ensure patient has an accepting physician, room placement and report given prior to leaving with the patient. 3. The report should include, at a minimum, the following information: • Names of transferring and receiving facilities • Patient's diagnosis • Reason(s) for transfer • Brief history of present illness, any intervention(s) or medications which has occurred to date • Pertinent physical findings • Vital signs, including blood glucose reading (recent), temperatures, pain scale • Current IV infusion with rate • Any treatment being performed (e.g. oxygen) 4. Medical Direction for transport will be Medtrek Administrative Medical Director per Intertacility Transport Protocol. No Administrative/Standing Order will be followed unless given direction to follow by a Medical Direction Authority. 5. Medical Direction Authority may be contacted at any step in patient care. Providers should contact Medical Direction Authority if: • A patient's condition is unusual and/or possible meets ALS transfer criteria • Presentation is atypical and guideline treatment may not be the best treatment for the patient • Any situation where the provider is not sure about the best treatment for the patient 5. All Patients- during intertacility transport of patient: • Continued assessment and documentation of all vital signs at least every 30 minutes, if patient has a change of status every 5-15 minutes from initiation of care to transfer of care at the receiving facility. • Performance parameters will include but are not limited to appropriate vital signs, assessment and documentation, and medical direction contact. 0912022 Packet Pg. 576 15.A.3 MEE'REKParamedic Interfacility Transport Guidelines Patient ALS Transfer Procedure Once an ALS transport has been deemed appropriate per the Interfacility Transport Protocol, the Paramedic upon arrival at the transferring facility will: 1. All Patients —Prior to accepting care of patient at sending facility: • Utilize appropriate isolation/universal precautions • Perform initial patient assessment (form a general impression of the patient; assess for immediate life -threatening problems or instability; assess responsiveness, airway and breathing, and circulation) • Obtain transfer information from sending facility. This is to include but is not limited to: o Bedside report from current rendering provider o Review of appropriate clinical and diagnostic data (summary, appropriate clinical and diagnostic data including vital sign trends, laboratory data, diagnostic study/reports) o Review and confirm all interventions intended to be continued during transport (e.g. medications, procedures, interventions). 2. Personnel shall establish contact with the receiving facility to ensure patient has an accepting physician, room placement and report given rior to leaving with the patient. 3. Contact with the receiving facility should include, at a minimum, the following: • Names of transferring and receiving facilities • Patient's diagnosis • Reason(s) for transfer • Brief history of present illness, any intervention(s) or medications which has occurred to date • Pertinent physical findings • Vital signs, including blood glucose reading (recent), temperatures, pain scale • Current IV infusion with rate patients are receiving • Patients receiving IV medications and on a pump will have the concentration written on label, and drip rate will be cleared with receiving facility prior to leaving with the patient. • Any treatment being performed (e.g. oxygen) • Ask for any additional orders anticipated 4. Medical Direction for transport will be Medtrek Medical Director per Interfacility Transport Protocol. No Administrative/Standing Order will be followed unless listed in guideline and/ or given direction to follow by a Medical Direction Authority. • Approved SO/AO without contacting Medical Direction: • Nausea Vomiting AO • Pain Management AO 5. Medical Direction Authority may be contacted at any step in patient care. Providers should contact Medical Direction Authority if: • A patient's condition is unusual and/or possible meets ALS transfer criteria • Presentation is atypical and guideline treatment may not be the best treatment for the patient • Any situation where the care provider is not sure about the best treatment for the patient 6. All Patients- during interfacility transport of patient: • Patients will have continuous cardiac monitoring and oxygen saturation • Continued assessment and documentation of all vital signs at least every 30 minutes until care is transferred to receiving facility. If patient has a change of status, all vital 0912022 Packet Pg. 577 15.A.3 MEE'REKParamedic Interfacility Transport Guidelines signs should be assessed and documented every 5-15 minutes from initiation of care to transfer of care at the receiving facility. • Performance parameters will include but not limited to appropriate vital signs, assessment and documentation, and medical direction contact. 0912022 Packet Pg. 578 15.A.3 MECTREK Critical Care Paramedic Interfacility Transport Guidelines Purpose Medtrek recognizes the need to transport critically ill and injured patients from outlying hospitals to larger tertiary care centers. Some patients will require additional skills and procedures that paramedics do not normally perform for stabilization during or prior to transports. Some patients will require administration or maintenance of medications not normally carried by ALS vehicles. This will outline the additional skills, procedures and medications. Definition Patient transports will be considered "Critical Care Transports" when: 1. The patient's vital signs or neurological signs are unstable and require monitoring more frequently than every 30 minutes. 2. The patient has an endotracheal tube, king airway, combi-tube and /or require mechanical ventilation. 3. The patient has a chest tube. 4. The patient is receiving IV medications which require the use of a pump to control the rate. 5. The patient required the administration of IV sedation en route. 6. The patient has received any thrombolytic therapy within the last 24 hours. 7. The patient's condition could deteriorate en route and possible requiring contact with Medical Direction Authority for interventions (e.g. MFI). 8. The patient is a high risk OB patient (hypertension, pre-eclampsia, premature labor) and receiving IV medication treatment for this. 9. The patient has burns requiring transfer to a burn center. 10. The patient has sustained multiple traumas and requires transfer for definitive care. 11. The patient requires the administration of blood. Patient Critical Care Transfer Procedure Once an ALS transport has been deemed appropriate per the Interfacility Transport Protocol, the Paramedic upon arrival at the transferring facility will: 1. All Patients — Prior to accepting care of patient at sending facility: • Utilize appropriate body substance isolation/universal precautions • Perform initial patient assessment (form a general impression of the patient; assess for immediate life -threatening problems or instability; assess responsiveness, airway and breathing, and circulation) • Obtain transfer information from sending facility. This is to include but is not limited to: o Bedside report from current rendering provider o Review of appropriate clinical and diagnostic data (summary, appropriate clinical and diagnostic data such as vital sign trends, laboratory data, diagnostic study/reports o Review and confirm all interventions intended to be continued during transport (e.g. medications, procedures, interventions). 2. Personnel shall establish contact with the receiving facility to ensure patient has an accepting physician, room placement and report given prior to leaving with the patient. 3. Contact with the receiving facility should include, at a minimum, the following: • Names of transferring and receiving facilities • Patient's diagnosis • Reason(s) for transfer 0912022 Packet Pg. 579771 15.A.3 MECTREK Critical Care Paramedic Interfacility Transport Guidelines • Brief history of present illness, any intervention(s) or medications which has occurred to date • Pertinent physical findings • Vital signs, including blood glucose reading (recent), temperatures, pain scale • Current IV infusion with rate and/or drips patients are receiving. • Patients receiving IV medications and on a pump will have the concentration written on label, and drip rate will be cleared with receiving facility prior to leaving with the patient. • Any treatment being performed (e.g. oxygen) 4. Medical Direction for transport will be Medtrek Administrative Medical Director per Intertacility Transport Protocol. No Administrative/Standing Order will be followed unless listed in guideline and/or given direction to follow by a Medical Direction Authority. 5. Medical Direction Authority may be contacted at any step in patient care. Providers may contact medical direction authority, if a patient's condition is unusual and is not covered by a _specific guideline, if a patient's presentation is atypical and the guideline treatment may not be the best treatment for the patient or in any situation where the provider is not sure about the best treatment for the patient. 3. All Patients- during interfacility transport of patient: • Patients will have continuous cardiac monitoring and oxygen saturation • Continued assessment and documentation of all vital signs at least every 30 minutes, if patient has change of status every 5-15 minutes from initiation of care to transfer of care at the receiving facility. • See specific guidelines for assessment and documentation criteria • Performance parameters will include but not limited to appropriate vital signs, assessment and documentation, and medical direction contact. 0912022 Packet Pg. 580 15.A.3 MECTREK Interfacility Transport Agents Protocols 1. Interfacility Transport Agent Table 2. Protocol Transport Agents Interfacility 3. Heparin Work Sheet for Interfacility Packet Pg. 581 15.A.3 MECTREK INTERFACILITY TRANSPORT DRUG LIST KEY: IP = Agent shall be administered by infusion pump SVN = Agent shall be administered by small volume nebulizer AGENT EMT PARAMEDIC No Titration Rate change w/ medical directiononly Amiodarone IP X X Antibiotics X X Blood X X Corticosteroids IP X X Dextrose Drip IP (Per hypoglycemia skills) X X Diltiazem IP X X Do amine HCI IP X Electrolytes/Crystalloids (Commercial Preparations) IP X X X Epinephrine IP X X Fentanyl IP X X Furosemide (Lasix) IP X H2 Blockers X X Heparin Na IP X X Insulin IP X X Integrelin IP X X LevophedlP X X Lidocaine IP X X Magnesium Sulfate IP X X Midazolam IP X X Morphine IP X X MVI IP X X Nitroglycerin IV Solution IP X X Pantoprazole X X Pitocin IP X X Phenobarbital Na IP X X Phenytoin Na IP X X Potassium Salts IP X X Procainamide HCl IP X X Propofol IP X X Racemic Epinephrine SVN X Total Parenteral Nutrition, with or without lipids IP X X 7- 0912022 Packet Pg. 582 15.A.3 MECTREK Administer and Monitor Transport Agents Protocol During Interfacility Transport Protocol To ensure the patient will receive the most appropriate care possible for their condition with transporting agents per Florida Statutes and Florida Administrative Codes. Requirement 1. Paramedics with specific training and certification to administer and monitor transport agents during interfacility transport per Medtrek Policy. 2. Paramedics will follow all policies, protocols and guidelines for interfacility transports. Guidelines 1. Verify concentration, dosage and vital sign (VS) parameters on all medications. Referring physician must specify the infusion rate within the orders. In addition, verify with receiving Medical Direction (Base Hospital transporting to) or Administrative Medical Direction. 2. Verify medication is in the correct concentration and on infusion pump as listed above. • Right patient, medication, dose, route, time, reason, documentation. 3. Document dose and route of administration at the beginning and end of transport and patient response. 4. Be familiar with the signs, symptoms and treatment of any major adverse drug reactions of medications being used during transport. 5. Infusion rates must remain constant during transport with no regulations of rates being performed by the paramedic, except for discontinuations of the infusion, or as noted in the specific drug profile. 6. All drips will be labeled with concentration in IV bag. 7. Agents (medications) will not be started by a paramedic during transport. 8. Must be familiar with the IV pump for administration. 9. Do not administer any other drug except the drug that is infusing into existing line. If no another line initiated, start 2"d IV line. 10. Patients shall be placed on cardiac monitors for duration of transport. 11. A non-invasive blood pressure monitor device that will record and print out routine blood pressure reading every fifteen (15) minutes will be utilized. Monitor all other vital signs pertinent to patient's condition with documentation. 12. Reassess patient frequently during transport documenting findings. 13. Contact receiving Medical Direction Authority and/or Administrative Medical Direction criteria during transport: • If pump failure occurs and cannot be corrected, the paramedic is to notify the receiving medical direction authority and/or administrative medical direction authority for direction 0912022 Packet Pg. 5 3 15.A.3 MECTREK Administer and Monitor Transport Agents Protocol During Interfacility Transport Documentation All Interfacility transports involving IV drips will have documentation, be it electronic or hand written, that will detail the patient's chief complaint, reason for the transfer, historical data related to the current problem, pertinent past medical history, medication list, allergy list, and a timed, chronologic description of patient care, medications, vital signs, and changes in patient status with corresponding response of the paramedic to the changes. Transport Checklist 1. Check the IV site and document findings. • Location, patency and redness etc. 2. Verify that IV fluids and medications running into the same site are compatible. Best practice start 2"d IV line. 3. Verify that there are adequate medications for length of transport. 4. Follow all other guidelines listed in protocol. 5. Beware why a medication is being given. 6. Physicians orders have to be written with: • Name, dose, route of administration, rate of administration 0912022 Packet Pg. 584 15.A.3 MECTREK Administer and Monitor Transport Agents Protocol During Interfacility Transport Intravenous Infusion of Amiodarone 1. Must be transported with IV Pump. 2. The following parameters shall apply to all patients with pre-existing Amiodarone infusions. • No titration of medication will be made during interfacility transport even with orders • Must be on cardiac monitor. Monitor VS at least every 15 minutes during interfacility transport and more frequently based on patients condition 3. Amiodarone infusion must be initiated at the transferring hospital. 4. Indications: • Management/prophylaxis of life threatening ventricular arrhythmias • Control hemodynamically stable V-tach when cardioversion is unsuccessful, Rate control of A-fib/aflutter 5. Dosage: • Loading doses to be given at the transferring hospital • Maintenance infusion post resuscitation/conversion: o 1 mg/min IV infusion for 6 hours, then up to 0.5 mg/min for up to 18 hours, maximum daily dose is 2.2 gm 7. Precautions/Comments: • Contraindications: o Bradycardia, second or third degree block without a pacemaker present, cardiogenic shock, hypotension, pulmonary congestion • Adverse reactions: o Bradycardia, hypotension, torsades de pointes, N/V, fever, dizziness, abnormal salivation 3 0912022 Packet Pg. 585 15.A.3 MECTREK Administer and Monitor Transport Agents Protocol During Interfacility Transport Intravenous Infusion of Antibiotics 1. The following parameters shall apply to all patients with pre-existing Antibiotic infusions: • Monitor for signs and symptoms of an allergic response. If any symptoms are noted, stop infusion and initiate Dyspnea: Allergic Reaction SO if reaction is anaphylactic. Notify Medical Direction if this is initiated • Allergy/hypersensitivity reactions commonly occur from start to 1 hour after administration of the first dose 2. Indications: • Used to treat infectious diseases 3. Dosage: • If possible, it is advisable to monitor the patient in the facility for a period of 15 minutes prior to start of transport • Infuse IV antibiotics over 30-60 minutes. Aminoglycosides over 60 minutes unless otherwise specified on the referring physician orders, along with receiving Medical Direction Authority • Can be set up as a "piggyback" (concurrent administration) or administered on a separate channel • If IV antibiotics have finished infusing enroute, and is running on a saline lock, flush or keep line open with NS/LR TKO 4. Precautions/Comments: • Complications: o Allergic reactions: rash, swelling, nausea, vomiting, diarrhea, chills, fever, laryngeal edema, anaphylaxis. Leukopenia. Ototoxicity, nephrotoxicity (aminoglycosides) Only antibiotics prepared in final dilution by the referring facility should be monitored 0912022 Packet Pg. 5 6 15.A.3 MECTREK Administer and Monitor Transport Agents Protocol During Interfacility Transport Intravenous Infusion of Blood/Blood Products 1. The following parameters shall apply to all patients with blood/blood product infusions: • Blood will be infusing a minimum of 30 minutes prior to transport • Identify the patient and the blood by checking the patients ID band against the blood/blood product label and the blood/blood product order for the patients name, blood type, unit identifying number and expiration date. • Infusion will be through filtered infusion tubing compatible with the mechanical infusion device used • The assessment of VS including TEMPERATURE every 30 minutes while blood is infusing and again when transfusion is completed. Vitals must be document. 2. Only infuse with normal saline via blood tubing. Not compatible with any other medications or solutions. 3. Dosage: • Adult 1-2 units over 2-4 hours. • Pediatric 5-15 mL/kg • Paramedics cannot start another unit during transport 4. Precautions and Comments: • Instruct patient to report onset of any unusual symptoms that might indicate a transfusion reaction: o Chills, dizziness, restlessness, nausea, headache, anxiety • Watch for signs of a transfusion reaction: o Temperature elevation, rash, cyanosis, facial flushing, sweating, tachycardia, bradycardia, hypotension, distended neck veins 5. If a transfusion reaction is suspected: • Stop transfusion immediately, do not clear tubing, change tubing. Maintain IV with normal saline • Initiate Dyspnea: Allergic Reaction SO. • Save the remaining blood, bag and tubing • Notify receiving Medical Direction Authority about reaction. If inpatient, inquire if the patient should be taken to the emergency department. If unstable, divert to closest facility • Treat hypotension with normal saline infusion • Monitor and treat other symptoms as needed 6. Documentation will include but not limited to: • Type and volume of blood product infused • Patient response • Any interventions initiated for transfusion reaction • Time started and finished, or transferred to receiving unit 0912022 Packet Pg. 5 7 15.A.3 MECTREK Administer and Monitor Transport Agents Protocol During Interfacility Transport Intravenous Infusion of Corticosteroids 1. Must be transported with IV Pump. 2. No titration of medication will be made during interfacility transport even with orders 3. Medications: • Methylprednisolone • Dexamethasone 4. Indications: • Acute exacerbation of emphysema, chronic bronchitis or asthma • Anaphylaxis • Burns • Cerebral edema (non -traumatic) 5. Dosage: • Adult o Methylprednisone: Solumedrol, Depomedrol, Medrol- 125 mg slow IV push o Dexamethasone: Decadron 8-24mg slow IVP 6. Precautions/Comments • Adverse reactions o Hypertension, seizures, hyperglycemia 6 0912022 Packet Pg. 588 15.A.3 MECTREK Administer and Monitor Transport Agents Protocol During Interfacility Transport Intravenous Infusion of Dextrose 1. Must be transported with IV Pump 2. The following parameters shall apply to all patients with pre-existing Dextrose infusions. • Must be on cardiac monitor. Monitor VS at least every 30 minutes during interfacility transport and more frequently based on patients' condition • Check Blood Glucose prior to leaving emergency department and every (1) hour enroute. • If BS falls below 70 follow Hypoglycemia AO. Contact Medical Direction if no improvement. 0912022 Packet Pg. 5 9771 15.A.3 MEETREK Administer and Monitor Transport Agents Protocol During Interfacility Transport Intravenous Infusion of Diltiazem 1. Must be transported with IV Pump. 2. The following parameters shall apply to all patients with pre-existing Diltiazem infusions: • No titration of medication will be made during interfacility transport even with order • Monitor vital signs: B/P, HR every 15 minutes with continuous EKG monitoring. • Notify receiving Medical Direction Authority if: o Heart rate < 110/> 150 o Systolic BP < 90 or any AV Blocks. 3. Indications: • Rapid ventricular rates associated with atrial fibrillation and atrial flutter and for PSVT refractory to adenosine 4. Dosage: • IV bolus will be given by referring facility. • Maintenance infusion 5.0-15 mg/hr. • Standard dilute 100mg (20mg) in NS 80 mL (1mg/mL) 5. Precautions and Comments: • Complications\Adverse Reactions: o CNS dizziness, paresthesias, headache, weakness, visual disturbance o CV: hypotension, facial flushing, junctional or AV dissociation, chest pain, congestive heart failure, ventricular or atrial arrhythmias, edema o Dermatologic: injection site reaction (itching, burning), sweating o GI: constipation, nausea, vomiting, dry mouth o Contraindicated with Acute MI, Cardiogenic shock, Ventricular tachycardia (VT) or wide complex tachycardia of unknown origin, Beta Blocker use 8 0912022 Packet Pg. 5 0771 15.A.3 MECTREK Administer and Monitor Transport Agents Protocol During Interfacility Transport Intravenous Infusion of Dopamine 1. Must be transported with IV Pump. 2. The following parameters shall apply to all patients with pre-existing Dopamine infusions: • May titrate medication will be made during interfacility transport with Physician order • Monitor vital signs: BP, HR every 15 minutes with continuous EKG monitoring. 3. Indications: • Symptomatic bradycardia with hypotension • Hypotension without hypovolemia 4. Verify concentration and infusion rate prior to leaving referring facility, how supplied: • 400 mg in 250 mL D5W yielding a 1600mcg/mL concentration • 800 mg in 250 mL D5W yielding a 3200 mcg/mL • Maximum infusion is not to exceed 20 mcg/kg/min • Dose: o Dopaminergic (renal) 2-5 mcg/kg/min o Beta agonist (cardiac) 5-15 mcg/kg/min o Alpha agonist (vasopressor) _> 15 mcg/kg/min 5. Drug interactions: • Incompatible in alkaline solutions (sodium bicarbonate) • Beta blocker may antagonize effects of dopamine 6. Precautions and Comments: • Uncontrolled tachycardia, hypertension, ventricular irritability, angina, anxiety, decreased peripheral perfusion • Low doses may cause decrease blood pressure from peripheral dilation • Duration of action effects cease almost immediately with stopping drip 9 0912022 Packet Pg. 5 1771 15.A.3 MECTREK Administer and Monitor Transport Agents Protocol During Interfacility Transport Intravenous Infusion of Epinephrine 1. Must be transported with IV Pump. 2. The following parameters shall apply to all patients with pre-existing Epinephrine infusions: • No titration of medication will be made during interfacility transport even with order • Monitor vital signs: BP, HR every 15 minutes with continuous EKG monitoring. 3. Indications: • Cardiac arrest • Severe bronchospasm, Asthma • Bradycardia • Hypotension (only unresponsive to other therapy • Croup 4. Dosage: • Continuous infusion: 1 mg added to 500 mL of NS administered at 1 mcg/min (dose rage 2-10 mcg/min) 5. Precautions and Comments: • Usually drips are to be started at 1 mcg/min, and titrated up, at five minute intervals, if needed, to a maximum of 4mcg/min for effect. Peds dosing 0.5-1 mcg/kg/min • Side effects include precipitation of V- tach and V- fib, coronary ischemia, and significant hypertension • Any patient demonstrating increased ventricular ectopy, bursts of V-tach, or V-Fib is to have the drip immediately stopped. Notify receiving Medical Direction Authority • Epinephrine is sensitive to light and air; protection from light is recommended • Oxidation turns drug pink, then a brown color; solutions should not be used if they are discolored or contain a precipitate 10 0912022 Packet Pg. 592 15.A.3 MECTREK Administer and Monitor Transport Agents Protocol During Interfacility Transport Intravenous Infusion of Fentanyl 1. Must be transported with IV Pump. 2. The following parameters shall apply to all patients with pre-existing Fentanyl drips: • No titration of medication will be made during interfacility transport even with order • Monitor vital signs: BP, HR every 15 minutes with continuous EKG monitoring CNS, respiratory and to a certain extent CV can be reversed by Naloxone. Use ALS Stabilization AO for this use 3. Indications: Analgesic Sedation post intubation 4. Dosage: • Fentanyl solution for continuous infusion is available as pre- mixed 100 mL bags at concentrations of 10 and 50 mcg/ml. • Usually initial dose begins at dose of 25 mcg/hr (1 mcg/kg/hr) • DO NOT exceed 50 mcg in an hour 5. Patients should be regularly monitored for adequate pain relief. Use pain scale before, during and at transfer of patient. 6. Precautions and Comments: Be prepared for airway management Fentanyl should be used with extreme caution in patients with pulmonary disease or in patients with other respiratory insufficiency or hypoxia Adverse Reactions o Brady-dysrhythmias, hypotension, respiratory depression, excess sedation, seizures, dizziness, diaphoresis, N/V o CNS: CNS depression (dizziness/confusion/sedation), seizures o Cardiovascular: bradycardia, vasodilation, edema o Respiratory: respiratory depression/dyspnea/apnea o Gastrointestinal: constipation, nausea, vomiting i1 0912022 Packet Pg. 5 3 15.A.3 MECTREK Administer and Monitor Transport Agents Protocol During Interfacility Transport Intravenous Infusion of Eptifibatide (Integrelin) 1. Must be transported with IV Pump. 2. The following parameters shall apply to all patients with pre-existing Glycoprotein Inhibitor infusions: • No titration of medication will be made during interfacility transport even with order • Monitor vital signs: B/P, HR every 15 minutes with continuous EKG monitoring • Monitor for signs and symptoms of bleeding 3. Indications: • Treatment of acute coronary syndrome, for pts. To be managed medically or those going to the cath lab 4. Dosage: • Infusion 2.0 mcg/kg/min • In patients with creatinine clearance _< 50 mL/min, dose is reduced to 1.0 mcg/kg/min 5. Precautions/Comments: • Document of calculation of the ordered infusion rate based on recent patient weight (in kilograms). This is essential to decrease the incidence of major and minor bleeding episodes. • Minimizing vascular and other trauma is important in managing platelet aggregation inhibitors. Due to risk procedures to be avoid if possible: Venous punctures, IM injections, etc. 6. Document the following lab values (if available). • Blood Urea Nitrogen (BUN) • Creatine • Hemoglobin • Hematocrit • Platelet Count • Coagulation Studies 12 0912022 Packet Pg. 594 15.A.3 MECTREK Administer and Monitor Transport Agents Protocol During Interfacility Transport Intravenous Infusion of H2 Blockers Zantac, (ranitidine), Pepcid, (famotidine), Tagamet (cinetodine) 1. Must be transported with IV Pump. 2. The following parameters shall apply to all patients with pre-existing H2 Blocker drips: • No Titration of medication • Infusion rate must remain constant during transport with no regulation of rates being performed by the paramedic, except for the discontinuation of the infusion 3. Indications: • Treatment of intractable ulceration or hypersecretory conditions • Prevention of upper GI Bleeding 4. Usual dosages: • Zantac: 50 mg in 50-100 mL NS to be run 15- 30 minutes • Pepcid: 20 mg in 50-100 mL NS infuse over 15-30 minutes • Tagamet: 300 mg bolus 5. Precautions and Comments: • Complications: Bradycardia with rapid administration • Adverse Reactions: Malaise, vertigo, reversible confusion, tachycardia, bradycardia, constipation, nausea, vomiting, rash, muscle cramping 13 0912022 Packet Pg. 5 57 15.A.3 MECTREK Administer and Monitor Transport Agents Protocol During Interfacility Transport Intravenous Infusion of Heparin 1. Must be transported with IV Pump. 2. The following parameters shall apply to all patients with pre-existing Heparin infusions: • Use Heparin work sheet and attach with PCR/ePCR • Document of calculation of the ordered infusion rate based on recent patient weight (in kilograms) • No titration of medication will be made during interfacility transport even with orders 3. Indications: • Situations where a hypo-coaguable state is required (i.e. post MI, CVA, pulmonary embolism) 4. Dosage: • Medication concentration will not exceed 100units/ml of IV fluid (25,000 units/250ml or 50,000 units/500 ml) • Maximum hourly dose will NOT exceed 1,300 units/hr • If patient is on higher hourly dose, contact with the receiving base hospital medical direction and/or administrative base hospital medical direction prior to leaving the facility with the following: o Current dose patient is receiving o If pt. received higher bolus than the maximum, notify base hospital for direction with drip amount o If pt. is receiving higher drip rate than the maximum, notify receiving Medical Direction Authority and/or Administrative Medical Direction Authority for direction with drip amount. o Use of heparin worksheet attaching to PCR 5. Document the following lab values if available: PT, PTT, I N R 6. Precautions and Comments: • Skin necrosis can develop at site of injection • Monitor for bleeding, bruising, fever, rash, urticaria 14 0912022 Packet Pg. 596 15.A.3 MECTREK Administer and Monitor Transport Agents Protocol During Interfacility Transport Intravenous Infusion of Insulin 1. Must be on IV Pump. 2. The following parameters shall apply to all patients with pre-existing Insulin drips: • Verify concentration and infusion rate prior to leaving transferring facility and with receiving facility • Check FSGB prior to report to Medical Direction Authority and recheck hourly, more frequently if patient becomes symptomatic • If drip has only been less than 1 hour, monitor 30 minutes for the first hour after drip initiation • No titration of medication will be made during interfacility transport even with orders 3. Indications: Insulin dependent diabetes mellitus Diabetic Ketoacidosis 4. Dosage • Adult: 0.1 unit/kg/hr as continuous infusion • Pediatrics: based on patient's size 5. If hypoglycemia occurs STOP the infusion and contact Medical Direction Authority. • If FSBG falls below 200, contact Medical Direction Authority for orders to continue or discontinue drip (NO titrations of infusion even with orders) • Be prepared to treat hypoglycemia with D10 if necessary and per Medical Direction Authority 6. Precautions and Comments: • Usage: Insulin is a naturally -occurring hormone in the body that causes the uptake of glucose by the cells, decreases blood glucose, and promotes glucose storage. Used in the treatment of Type 1 diabetes, Type 2 diabetes that cannot be controlled by diet or oral agents, and several diabetic ketoacidosis • Incompatibilities/drug interactions o Potency may be reduced 20-80% by the plastic or glass container or tubing before reaching the patient o Beta-blockers may block the s/s of hypoglycemia and delay recovery from hypoglycemia 15 0912022 Packet Pg. 5 7 15.A.3 MECTREK Administer and Monitor Transport Agents Protocol During Interfacility Transport Intravenous Infusion of Lasix (Furosemide) 1. Must be on IV Pump. 2. The following parameters shall apply to all patients with pre-existing Lasix drips: • No titration of medication will be made during interfacility transport even with orders • Assess serum potassium levels prior to leaving facility. Normal values are serum 3.5-5.0. 3. Common dosage • 250 mg of Lasix in 250 cc of NS yielding 1 mg/ml. Maintenance dose: 0.1-0.4 mg/kg/hr not to exceed 4 mg/min. 4. Receiving Medical Direction Authority and/or Administrative Medical Direction Authority contact criteria during transport: • Notify if B/P drops below 15% of initial baseline • Notify any new onset or increase of ventricular ectopy or tachycardia or signs and symptoms of adverse reaction as list below • If pump failure occurs and cannot be corrected, the paramedic is to discontinue the heparin infusion and notify the receiving Medical Direction Authority and/or Administrative Medical Direction Authority 5. Precautions and Comments: • Complications: Digitalis toxicity, hypokalemia, ventricular ectopy, ototoxicity, electrolye imbalance, potassium and magnesium • Adverse Reaction: Hypotension, vertigo, tinnitus, hearing loss, rash, weakness, muscle spasm, photosensitivity, ventricular ectopy 16 0912022 Packet Pg. 598 15.A.3 MECTREK Administer and Monitor Transport Agents Protocol During Interfacility Transport Intravenous Infusion of Levophed (norepinephrine bitartrate) 1. Must be on IV Pump. 2. The following parameters shall apply to all patients with pre-existing Levophed drip: • Monitor for tachycardia and hypotension • Check BP every 2 minutes until desired MAP or Systolic BP is reached (MAP 55-65 or Systolic 80-100 mmhg) and then every 5- 15 minutes thereafter • NEVER leave patient unattended during infusion • No titration of medication will be made during interfacility transport even with orders 3. Indications: • Blood pressure support with hypotension • Treatment of shock 4. Dosage: • Adult: 0.5-1 mcg/min initial dose with a usual rage of 2-30 mcg/minute • Pediatric patient should be transported with RN/MD. Dosing 0 mcg/kg/min up to a max of 1 mcg/kg/minute based on BP management 5. Precautions/Comments • Adverse Reactions o Dizziness, weakness, headache, mood changed, bradycardia, tachycardia, chest pain, shortness of breath and diaphoresis o Contraindications for hypotension secondary to hypovolemia prior to fluid replacement. Profound hypoxia or hypercarbia could cause V-Tach 17 a9/2a22 Packet Pg. 599771 15.A.3 MECTREK Administer and Monitor Transport Agents Protocol During Interfacility Transport Intravenous Infusion of Lidocaine 1. Must be on IV Pump for Interfacility transports. 2. The following parameters shall apply to all patients with pre-existing Lidocaine drip: • Monitor for hypotension, may cause SA nodal depression or conduction problems • Paramedic may titrate with physician's orders only. Verify with medical direction authority prior to leaving facility 3. Indications for suppress ectopy, frequent PVCs 4. Dosage for maintenance infusion: • 2-4 mg/kg • Dose should be decreased for patients with hepatic failure, renal disease, poor perfusion or greater than 70 years of age 5. Discontinue lidocaine if: • Confusion or agitation, tinnitus, dizziness, tremors, seizures 6. Precaution/Comments: • Use caution in patients with conduction disturbances (second or third degree blocks) 18 0912022 Packet Pg. 600 15.A.3 MECTREK Administer and Monitor Transport Agents Protocol During InterFacility Transport Intravenous Infusion of Midazolam 1. Must be transported with IV Pump. 2. The following parameters shall apply to all patients with pre-existing Midazolam: • Regulation of the infusion rate will occur within the parameters as defined by the referring physician and receiving Medical Direction Authority, but may be titrated to the individuals response during transport 3. Indications: • Anti -convulsion • Sedation 4. Receiving Medical Direction Authority or Administrative Medical Direction Authority contact criteria during transport: • In cases of severe respiratory depression, partial airway obstruction (especially when combined with narcotics), hypertension, hypotension, and excessive sedation the medication infusion will be discontinued and notify the receiving Medical Direction Authority and/or Administrative Medical Direction Authority 5. Precautions and Comments: • Dosage reductions are recommended for patients in CHF, septic shock, renal and/or hepatic dysfunction, low serum albumin, pulmonary insufficiency, COPD, or elderly patients • Reduce dose by 30% in patients pre -medicated with narcotics and/or CNS depressants 19 0912022 Packet Pg. 6 1771 15.A.3 MECTREK Administer and Monitor Transport Agents Protocol During Interfacility Transport Intravenous Infusion of Magnesium Sulfate 1. Must be transported with IV Pump. 2. The following parameters shall apply to all patients with pre-existing Magnesium Sulfate: • Consider transporting patient on their left side • Assess and record maternal vital signs, patellar reflex and fetal heart rate prior to transport • No titration of medication during interfacility transport with physician orders • Monitor vital signs every 15 minutes while drug is infusing. Monitor for weakness in extremities (by movement). Watch for signs of respiratory depression and second and third degree heart block • Stop infusion if respiratory rate drops below 12bpm • Patients should be on oxygen therapy • Early indicators of toxicity include: profound thirst, feeling of warmth, sedation, confusion, muscle weakness 3. Indications: • Pre -term labor • PIH 4. Dosage: • Diluted in 4 gm in 100 mL NS with maintenance infusion 1-4 gm/hr 5. Contact receiving Medical Direction Authority for criteria during transport: • If patient experiences a decreasing respiratory rate or other evidence of respiratory difficulty, discontinue drip, prepare to manage airway, consider calcium gluconate contact the online medical direction authority • Decrease the drip rate by half and notify medical direction authority for any of the following: o Decrease in systolic pressure of 20mm from baseline o Decrease in diastolic pressure of 10mm from baseline o Decrease in patella reflex. o Change in mental status 20 0912022 Packet Pg. 602 15.A.3 MEPTREK Administer and Monitor Transport Agents Protocol During Interfacility Transport Intravenous Infusion of Morphine Sulfate 1. Must be transported with IV Pump. 2. Monitor vital signs every 5 minutes. 3. The following parameters shall apply to all patients with pre-existing Morphine Sulfate drips: • Regulation of the infusion rate will occur within the parameters as defined by the referring physician and receiving Medical Direction Authority, but may be titrated to the individuals response during transport • Monitor pain scale with documentation before during and after transfer of care 4. Indications: • Analgesia • Pulmonary edema 5. Dosage: • 0.8- 10 mg/hr IV infusion is typical, please verify dosing prior to transportation 6. Receiving Medical Direction contact criteria during transport: • In cases of severe respiratory depression, sedation, confusion, hypotension, bradycardia, nausea and vomiting, the medication infusion will be discontinued and Naloxone, if indicated, may be administered as directed by your Administrative Medical Direction Authority per your unconscious/unresponsive orders. Notify the receiving Medical Direction Authority and/or Administrative Medical Direction Authority 21 0912022 Packet Pg. 6 3 15.A.3 MECTREK Administer and Monitor Transport Agents Protocol During Interfacility Transport Intravenous Infusion of Multi -Vitamin IV Additive (MVI) 1. Must be transported with IV Pump. 2. The following parameters shall apply to all patients with pre-existing MVI drips: • MVI dose must be diluted in a solution of 500-1000 mL of either LR, NR or D5'/2 • Know compatibility before administering any IV medications through the IV infusion • Access IV insertion site for any redness, swelling or tenderness. If this occurs, STOP infusion and discontinue 3. Precautions/Comments • Fainting and dizziness with undiluted drug administration 22 0912022 Packet Pg. 6 47 15.A.3 MECTREK Administer and Monitor Transport Agents Protocol During Interfacility Transport Intravenous Infusion of Nitroglycerin 1. Must be transported with IV Pump. 2. The following parameters shall apply to all patients with pre-existing Nitroglycerine drip. • Regulation of the infusion rate will occur within the parameters as defined by the referring physician and receiving Medical Direction Authority and/or Administrative Medical Direction Authority, but may be titrated to the individuals response during transport • Patients with hypotension should be administered with caution • Brady-dysrhythmias and hypotension usually respond to Trendelenburg position Document drip rate at the beginning of transport and patient's response 3. Indications: • Angina • MI • Congestive heart failure 4. Dosage • Usual mixture: Nitroglycerine (50mg/250ml in DW5: 200 mcg/ml) • Start at low range 5 mcg/min • Increase in increments of 5 mcg/min every 5 minutes 5. Precautions/comments: • Hypotension, bradycardia, reflex tachycardia, headache 6. Receiving Medical Direction Authority and/or Administrative Medical Direction Authority contact criteria during transport: • If systolic blood pressure drops below 100, decrease the nitroglycerine by 5 mcg/min or 3.3 mcg/min and if systolic blood pressure doesn't increase call receiving Medical Direction Authority for direction 23 0912011 Packet Pg. 6 57 15.A.3 MECTREK Administer and Monitor Transport Agents Protocol During Interfacility Transport Intravenous Infusion of Pantoprazole (Protonix) 1. Must be transported with IV Pump. 2. The following parameters shall apply to all patients with pre-existing Pantoprazole infusions. . No Titration of medication a. Infusion rate must remain constant during transport with no regulation of rates being performed by the paramedic, except for the discontinuation of the infusion 3. Indications: • GI bleeding, esophageal varices, bleeding ulcer, stress ulcer prophylaxis 4. Dosage: • Continuous infusion: 8 mg/hour IV • Usual Infusion 80 mg in 100 ml (concentration: 0.8 mg/ml) of D5W or NS 5. Precautions/Comments: • Adverse reactions: o Headache, dizziness, vertigo, urticaria, allergic reaction, diarrhea, facial edema 24 0912022 Packet Pg. 606 15.A.3 MErTREK Administer and Monitor Transport Agents Protocol During Interfacility Transport Intravenous Infusion of Pitocin (Oxytocin) 1. Must be transported with IV Pump. 2. The following parameters shall apply to all patients with pre-existing Pitocin infusions. • No Titration of medication will be made during interfacility transport even with orders • Must be on cardiac monitor. Monitor VS at least every 15 minutes during interfacility transport and more frequently based on patients condition • If not started, consult with referring physician and/or medical direction authority 3. Indications: • Postpartum hemorrhage 4. Dosage: • Initial infusion: 20-40 units in 1000 ml of normal saline, infuse 1000 ml over 10 minutes • Maintenance infusion: 10-40 units/hour 5. Precautions/Comments: • Adverse reactions: o Nausea, bradycardia, allergic reactions 25 0912022 Packet Pg. 607 15.A.3 MECTREK Administer and Monitor Transport Agents Protocol During Interfacility Transport Intravenous Infusion of Phenobarbital • Must be transported with IV Pump. • The following parameters shall apply to all patients with pre-existing Phenobarbital infusions: • Monitor for respiratory depression • No titration of medication will be made during interfacility transport even with orders • Monitor vital signs every 15-30 minutes during transport or more frequently based on patient condition • Indications for use: o For treatment of seizures • Dosage o Adult: 100-300 mg IV o Pediatric 10-20 mg/kg initially followed by 1-6 mg/kg/day • Status Epilepticus o Adult 10-20 mg/kg o Pediatric 15-20 mg/kg • Precautions/Comments: o Allergic reaction can cause ANGIOEDEMA o Pre-existing CNS depression o Uncontrolled severe pain o Adverse Reactions: ✓ Respiratory depression, Broncho spasm, hypotension, N/V, drowsiness, lethargy 26 0912022 Packet Pg. 6 8771 15.A.3 MECTREK Administer and Monitor Transport Agents Protocol During Interfacility Transport Intravenous Infusion of Phenytoin 1. Must be transported with IV Pump. 2. The following parameters shall apply to all patients with pre-existing Phenytoin infusions: • Institute seizure precautions • No titration of medication will be made during interfacility transport even with orders 3. Indications: • Treatment of seizures 4. Dosage: • Adult 15-20 mg/kg. Rate should not exceed 25-50 mg/kg • Pediatric 15-20 mg/kg; rate 1-3 mg/kg/min 5. Precautions/Comments • Hypotension, ataxia N/V • If given with dopamine may cause additive hypotension 27 0912022 Packet Pg. 609 15.A.3 MECTREK Administer and Monitor Transport Agents Protocol During Interfacility Transport Intravenous Infusion of Potassium Chloride 1. Must be transported with IV Pump. 2. The following parameters shall apply to all patients with pre-existing potassium chloride infusions: • No potassium will be initiated in the field • Medication concentration will not exceed 40 mEq/liter of IV fluid • Concentrations that exceed 20 mEq will be on infusion pump • All IV bags will be labeled with the amount of drug within the IV bag 3. Indications: • Potassium depletion • Treatment of certain arrhythmias due to cardiac glycoside toxicity 4. Complications: • Local irritation, burning along the vein of infusion, nausea, vomiting, abdominal pain, weakness in legs • In high concentrations: flushing, agitation, hypotension, diaphoresis and, peripheral vascular collapse • EKG changes associated with potassium intoxication: o Tall tented T waves o Depressed S-T segments o Prolonged P-R interval, loss of P-wave o Heart block, v-fib, cardiac arrest • If above s/s occur, stop infusion and call Medical Direction Authority to notify • Adverse Reactions: o Too rapid of IV infusion of an IV solution containing potassium 2s 0912022 Packet Pg. 610 15.A.3 MECTREK Administer and Monitor Transport Agents Protocol During Interfacility Transport Intravenous Infusion of Procainamide 1. Must be transported with IV Pump. 2. The following parameters shall apply to all patients with pre-existing Procainamide infusions: • Patient should remain as close to supine as is tolerable due to hypotension • Monitor VS every 15 minutes during interfacility transport and more frequently based on patients condition • Stop infusion if QRS complex widens by >_ 50%, PR becomes prolonged, blood pressure drops below 90mmHg or toxic side effects and contact Medical Direction Authority • No titration during transportation 3. Indications: • Treatment of atrial and ventricular arrhythmias • Maintenance of sinus rhythm after conversion from atrial fibrillation or atrial flutter 4. Dosage: • Adult: loading infusion of 500-600 mg over 25-30 minutes followed by maintenance infusion of 2-6 mg/min • Pediatrics: 20-80 mcg/kg/min 5. Precautions/Comments: • Adverse reactions: o Confusion, seizures, dizziness, hypotension, ventricular arrhythmia, asystole, heart block • Use caution with: o MI, CHF o Reduce dose and frequency with geriatric patients 29 0912022 Packet Pg. 611 15.A.3 MECTREK Administer and Monitor Transport Agents Protocol During Interfacility Transport Intravenous Infusion of Propofol 1. Must be transported with IV Pump. 2. The following parameters shall apply to all patients with pre-existing potassium chloride infusions: • No titration during interfacility transport • Monitor VS every 15 minutes during transport or more frequently based on patient status • Assess level of sedation throughout transport 3. Indications: • Sedation of intubated, and/or mechanically ventilated patients 4. Dosage: • Adult 5 mcg/kg/min increases in 5 mcg/kg/min increments until sedation achieved prior to transport. Usual range is 5-50 mcg/kg/min • Pediatrics only recommended for procedural sedation not transfers 5. Precautions/Comments • Short -acting hypnotic • Adverse reactions: o Bradycardia, hypotension, apnea, dizziness, headache, cough, hypertension, flushing, involuntary muscle movements, fever 30 0912022 Packet Pg. 612 15.A.3 MECTREK Administer and Monitor Transport Agents Protocol During Interfacility Transport SVN Administration of Racemic Epinephrine (Vaponefrin, Micronefrin) 1. The following parameters shall apply to all patients with pre-existing Racemic Epinephrine SVN: • Currently Racemic Epinephrine is approved for Interfacility use only. It is intended that the patient finish the SVN treatment initiated by the sending facility during transport, without a provider initiating subsequent doses 2. Indications: • Bronchial Asthma, Bronchiolitis, Chronic Bronchitis, Chronic Obstructive Lung Disease, Croup, Laryngeal Edema 3. Dosing: • Inhalation only (small -volume nebulizer): Pediatric Dosage: 0.25-0.75 ml of a 2.25% solution in 2.0 ml normal saline. o <20 kg (child under 6 months):Dilute 0.25ml (of 2.25% solution) in 2.5ml saline and administer via SVN 0 20 — 40 kg (child):Dilute 0.5ml (of 2.25% solution) in 2.5 ml saline and administer via SVN o >40 kg (adolescent): Dilute 0.75ml (of 2.25% solution) in 2.5 ml saline and administer via SVN 4. Precautions/ Comments • Allergy to any of the ingredients [may contain sulfite(s)], Epiglottitis, Hypertension, Underlying Cardiovascular Disease/Insufficiency • The use of Racemic Epinephrine will mainly be seen in the pediatric patient population, most commonly for the treatment of Croup • Monitor vital signs closely • Do not use concurrently with other bronchodilators • After dilution, the solution should be used within 30 minutes. Do not use solution if discolored or if it contains a precipitate • After inhalations, the sputum may be pink in color due to a chemical reaction between the mucous secretions and Racemic Epinephrine solution • Excessive use may cause Bronchospasm • Adverse Reactions: o Angina, Anxiety, Dysrhythmias, Fear, Headache, Lightheadedness, Nausea, Palpitations, Restlessness, Sleeplessness, Weakness 5. In common practice 1:1000 Epinephrine is substituted when the Racemic Epi solution is unavailable: • Pediatric dosing: <4 years of age = mix 2.5ml of 1:1000 Epi with 3ml saline and administer via SVN. • >4 years of age = mix 5ml of 1:1000 Epi with 3ml of saline and administer via SVN. • Adult dosing: mix 5ml of 1:1000 Epi with 3ml saline and administer via SVN • If needed, get order prior to leaving for use of this if patient is still having issues 31 0912022 Packet Pg. 613 15.A.3 MECTREK Administer and Monitor Transport Agents Protocol During Interfacility Transport Administration of Total Parenteral Nutrition, with or without lipids (TPN) 1. Must be transported with IV Pump. 2. The following parameters shall apply to all patients with pre-existing TPN: • Verify solution formula and rate • TPN is considered incompatible with all other medications and IV solutions. Nothing is to be added to the bag or IV tubing • Monitor for s/s of hyper/hypoglycemia. Obtain Blood Glucose as needed and document what the last reading was before to transportation • This should be going through a port/central line. If leaking or cracked, clamp off port and notify Medical Direction Authority 3. Indications: • Provides long term nutrition 4. Precautions and Comments: • Hyperglycemia, hyperosmolar syndrome, electrolyte disturbance 32 0912022 Packet Pg. 4 15.A.3 MECTREK Heparin Worksheet Patient's name: Agency Incident Number: 1. Patient's weight: I- NJ Time of Transport -Current IV drip rate at: Heparin drip concentration: Units/ml Heparin drip ordered dose: Units/kg/hr Time drip started: Heparin drip dosage with pump setting units/hr: Patency of IV confirmed: YES NO Drip IV site/location: 3. Lab Values (If available; do not delay transportation for lab results): Last recorded values: Date: TIME: PT: PTT: INR: 4. Reviewed with sending RN with print name and signature: 5. Medical Direction Authority called prior to leaving with approval of dosing: YES NO 6. Paramedic transporting: 1-20 Packet Pg. 615 15.A.3 ATTACHMENT C MEMORANDUM TO: Amy Patterson, County Manager FROM: Dan Summers, Director Emergency Management DATE: October 26, 2022 REF: 2023 Certificate of Convenience and Necessity for Collier County Emergency Medical Services Department After review of the application to renew this certificate for Collier County Emergency Medical Services Department, no further information is required at this time. The application is complete and sufficient. Packet Pg. 616 15.A.3 COLLIER COUNTY FLORIDA Renewal of Class 1 COPCN This Permit Expires December 31, 2023 Name of Service: Collier County Emergency Medical Services Name of Owner or Manager: Collier County Board of County Commissioners_ Principal Address of Service: 8075 Lely Cultural Parkway, Naples, Florida 34113 Business Telephone: 239 252-3740 Emergency Telephone: 9-1-1 Description of Services Area: The 2,032 square miles encompassing Collier County Number of Ambulances on 24- hour duty: 26 wound units (ambulances) Number of Ambulances on 12- hour duty: 2 ground units (as needed during season taken from reserve fleet Number of reserve Ambulances: 16 Number of non -transport ALS vehicles 13 Number of Medivac helicopter: 2 See attachment "A" for description of vehicles. This permit, as provided in Ordinance 04-12, as amended, shall allow the above named Ambulance Service to operate Emergency Medical Services for a fee or charge for the following area(s): Collier County until the expiration date hereon, except that this permit may be revoked by the Board of County Commissioners of Collier County at any time the service named herein shall fail to comply with any local, state or federal laws or regulation applicable to the provision of Emergency Medical Services. Issued and approved this - day of , 2022. ATTEST: BOARD OF COUNTY COMMISSSIONERS Crystal K. Kinzel, CLERK COLLIER COUNTY, FLORIDA , Deputy Clerk William McDaniel, Chairman Approved as to form & legality: Assistant County Attorney Packet Pg. 617 15.A.3 Memorandum To: Amy Patterson, County Manager From: Tabatha Butcher, Chief Emergency Medical Services Division Date: October 26, 2022 Subject: Certificate of Convenience and Necessity for Collier County Emergency Medical Services Department Per Collier County Ordinance Number 04-12, as amended, please accept the following information for renewal of this required certificate: Collier County Emergency Medical Services Department is operated by the County's Board of County Commissioners located at: 3299 East Tamiami Trail Naples, Florida, 34112 The Board of County Commissioners is comprised of the following individuals: Rick Locastro, District 1 Andy Solis, District 2 Burt Saunders, District 3 Penny Taylor, District 4 William L. McDaniel, Jr., District 5 The age of each member may be located at the Board of County Commissioner's Office. 2. Collier County Emergency Medical Services Department will continue to provide service to the 2,032 square miles encompassing Collier County. 3. Collier County Emergency Medical Services Department has a total of fifty-five (55) State permitted vehicles. forty-two (42) of these are licensed ground transport ambulances and two (2) air ambulances (helicopters). There are also thirteen (13) licensed ALS vehicles (non -transport). Of the above, twenty-six (26) licensed ground ambulances, and one (1) air ambulance (helicopter) operate 24 hours a day, seven days a week. At least two (2) additional ground transport permitted ambulances may operate 12 hours a day, seven days a week (as needed) during the seasonal months and are taken out of the reserve ambulances. The remaining, seventeen (16) licensed ALS ground transport ambulances are held in reserve. (Attachment A). Collier County Emergency Medical Services Packet Pg. 618 15.A.3 4. 5 7. 91 0 Collier County Emergency Medical Services Department has one main office and twenty-six (26) substations located throughout Collier County at the following locations: Headquarters Station 1 Station 2 Station 10 Station 20 Station 21 (2 units) Station 22 Station 23 Station 24 Station 25 Station 30 Station 31 Station 32 Station 40 Station 42 Station 43 Station 44 Station 46 Station 48 Station 50 Station 60 Station 70 Station 71 Station 75 Station 76 Station 90 MedFlight 8075 Lely Cultural Pkwy. 835 8th Avenue South 977 26th Avenue 14756 Immokalee Road 4798 Davis Blvd. 11121 E. Tamiami Trail 4375 Bayshore Drive 7227 Isle of Capri Road 2795 Airport Road North 3675 Hacienda Lakes Blvd 112 South 1st 1107 Carson Road 5368 Useppa Drive 1411 Pine Ridge Rd. 7010 Immokalee Road 16325 Vanderbilt Drive 766 Vanderbilt Beach Road 3010 Pine Ridge Road 16280 Livingston Road 1280 San Marco Road. 201 Buckner Avenue 4741 Golden Gate Parkway 95 13th Street SW 4590 Santa Barbara Blvd. 490 Logan Blvd 175 Isle of Capri Road 2375 Tower Drive Naples, Florida Naples, Florida Naples, Florida Naples, Florida Naples, Florida Naples, Florida Naples, Florida Naples, Florida Naples, Florida Naples, Florida Immokalee, Florida Immokalee, Florida Ave Maria, Florida Naples, Florida Naples, Florida Naples, Florida Naples, Florida Naples, Florida Naples, Florida Marco Island, Florida Everglades, Florida Naples, Florida Naples, Florida Naples, Florida Naples, Florida Naples, Florida Naples, Florida Collier County Emergency Medical Services Department has been licensed and certified to provide Advanced Life Support ambulance service in Collier County since April 6, 1981. Three (3) Collier County residents to act as references: Leslie Laschied 4500 Gulfshore Blvd. N. - #903 Naples, Florida 34103 Dr. James Hampton 823 Bentwood Drive Naples, Florida 34108 Scott Lowe 6101 Pine Ridge Rd Naples, Florida 34119 Collier County Emergency Medical Services Department schedules of service fees (Attachment B). October 26, 2022 Memorandum from Dan Summers, Director of Emergency Management to County Manager Amy Patterson stating no further information required (Attachment Q. Collier County Emergency Medical Services Department financial statement is available in Collier County's Finance Department. Collier County Emergency Medical Services Packet Pg. 619 15.A.3 ORIGINAL DOCUMENTS CHECKLIST & ROUTING SLIP TO ACCOMPANY ALL ORIGINAL DOCUMENTS SENT TO THE BOARD OF COUNTY COMMISSIONERS OFFICE FOR SIGNATURE Print on pint: paper. Attach to original document. The completed routing slip and original documents are to he forrr,arded to the Count) 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 throw #2 complete the checklis and forward to the County ttomey Office. Route to Addressee(s) (List in routing order) Office Initials Date 1. 2. 3. County Attorney Office County Attorney Office JAkIh ZS 4. BCC Office Board of County Commissioners l/%IfbZ 2 Z 5. Minutes and Records Clerk of.Court's Office 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 Cherie DuBock Phone Number 239-252-3756 Contact / Department Agenda Date Item was 9/27/2022 Agenda Item Number -2323-9' Approved by the BCC / Type of Document Resolution —Vb Number of Original 1 Attached 03 cl­ Documents Attached PO number or account number if document is to be recorded INSTRUCTIONS & CHECKLIST the Yes column or mark "N/A" in the Not Applicable column, whichever is Yes N/A (Not 1Initial appropriate. (Initial) Applicable) 1. Does the document require the chairman's original signature? 2. Does the document need to be sent to another agency for additional signatures? If yes, N/A 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 CD 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 CD 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 CD 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 CD signature and initials are required. 7. In most cases (some contracts are an exception), the original document and this routing slip CD should be provided to the County Attorney Office at the time the item is input into SIRE. 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 9/27/2022 (enter date) and all changes CDT'" " made during the meeting have been incorporated in the attached document. The nor County Attorne 's Office has reviewed the changes, if applicable. 9. Initials of attorney verifying that the attached document is the version approved by the BCC, all changes directed by the BCC have been made, and the document is ready for the in tin for Chairman's signature. IAe 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 Packet Pg. 620 15.A.3 RESOLUTION NO.2022 - 152 A RESOLUTION OF THE BOARD OF COUNTY COMMISSIONERS OF COLLIER COUNTY, FLORIDA, PROVIDING FOR UPDATED EMS USER FEES FOR COLLIER COUNTY AMBULANCE SERVICES, UPDATED BILLING AND COLLECTION PROCEDURE, HOSPITAL TRANSPORT BILLING AND FEES, ADJUSTMENTS OF EMS USER FEES PURSUANT TO COLLIER COUNTY ORDINANCE NO. 96-36, WAIVER OF EMS USER FEES FOR SPECIAL EVENTS, AND AN UPDATED PROCEDURE FOR APPROVING HARDSHIP CASES AND PAYMENT PLANS; SUPERSEDING AND REPLACING RESOLUTION NO. 21-175; AND PROVIDING FOR AN EFFECTIVE DATE. WHEREAS, Collier County Emergency Medical Services (hereinafter referred to as "EMS") provides ambulance services to the residents and visitors of Collier County; and WHEREAS, the Collier County EMS operating budget is funded exclusively through ad valorem taxes and user fees; and WHEREAS, the Board of County Commissioners has an Agreement with current Board approved billing provider (hereinafter referred to as to "Billing Consultant") to provide collection services for ambulance services and associated fees; and WHEREAS, this Resolution is intended to apply irrespective of whether EMS billing staff and current Board approved billing provider are responsible for the collection of fees for ambulance services; and WHEREAS, Collier County Ordinance No. 96-36 § 5 provides that the user fees for ambulance services may be established by Resolution of the Board of County Commissioners (hereinafter referred to as to "the Board") NOW THEREFORE, BE IT RESOLVED BY THE BOARD OF COUNTY COMMISSIONERS OF COLLIER COUNTY, FLORIDA, that: SECTION ONE: BASE RATES: EMS USER FEES SERVICE LEVELS BASE CHARGES A. EMS — BLS NON -EMERGENCY B. EMS — BLS EMERGENCY C. EMS — ALS 1 NON -EMERGENCY CODES A0428 $ 800.00 A0429 $ 800.00 A0426 $ 800.00 r" CAd a� a� U M a a� E as 0 z r c m E U a r Q Packet Pg. 621 D. EMS — ALS 1 EMERGENCY A0427 $ 800.00 E. EMS — ALS 2 EMERGENCY A0433 $ 850.00 F. EMS — ALS SCT EMERGENCY A0434 $ 900.00 G. EMS — TREATMENT W/O TRANSPORT A0098 $ 175.00* I-1. EMS — HELICOPTER A0431 $ 7,500.00 MILEAGE RATES: SERVICE LEVELS CODES MILEAGE CHARGE A. EMS —GROUND UNIT A0425 $ 15.00 (Minimum Charge of 1 mile and no cap) B. EMS — AIR UNIT A0436 $ 185.00 * There shall be no Treatment W/O Transport (G) charges for third party calls, public assistance calls, or traffic accidents where only assessments are performed, and no treatment is required. SPECIAL EVENTS AND MISCELLANEOUS RATES: SERVICE LEVELS RATES A TWO (2) MEDICS/ONE ALS VEHICLE (PER HOUR) $ 150.00 B. ONE (1) MEDICINO VEHICLE (PER HOUR) $ 50.00 COPIES**: Subject to statutory exemptions, "public records" are required by Chapter 119. F.S. to be open to inspection and copying. Consistent with Chapter 119, Resolution No. 07-327 establishes copying fees as follows: COPIES OF DOCUMENTS RATES A. One-sided copy which is 14 inches by 8 %s inches or less $ .15 B. Two-sided copy which is 14 inches by 8 '/2 inches or less $ .20 COPY SERVICES The actual cost of duplication for all other copies will be charged. The first hour of cost of duplication will not be charged. "Actual cost of duplication" is defined in § 119.07(1), F.S. as "the cost of the material and supplies used to duplicate the record," but does not include the labor cost and overhead cost associated with such duplication. **Copying fees are subject to change only to the extent that either Chapter 119, F.S. or Resolution No. 07-327, or both, are amended, replaced, or superseded. PAST DUE ACCOUNTS IN COLLECTIONS INTEREST ON PAST DUE ACCOUNTS $ 1 % monthly CAC a Packet Pg. 622 15.A.3 SECTION TWO: BILLING COLLECTION PROCEDURE The following shall be the minimum guidelines for billing and collection procedures for ambulance service fees and charges: A. Initial fees and charges for ambulance service(s) shall be assessed either prior to or following the provision of service, as service dynamics reasonably allow. Unpaid fees and charges, subsequent to time of service shall be reflected in an accounts receivable subsidiary ledger system to be maintained by the EMS Division. Billing Consultant shall follow all applicable rules and regulations set forth by Centers for Medicare/Medicaid (CMS) that pertain to ambulance billing. 4) B. EMS Billing Staff will transmit all data necessary to Billing Consultant to process the claim. 0 Z 1. Billing Consultant will send an initial bill to the service recipient's or responsible party's insurance carrier as soon as insurance information has been received. 0 validated, and entered by the Billing Consultant on the account. 2. When a valid patient address is present, the Billing Consultant will follow the patient statement cycle outlined below. i. An initial statement for ambulance services, including the HIPAA notice of a� privacy practices shall be sent seven (7) or more days after the data is entered L E by the Billing Consultant, but no later than (30) thirty days after service has w been provided. M ii. In the event the service recipient or responsible party does not have or does not provide proof of insurance coverage after three billing cycles (30 day cycles) d Y for a total of (90) ninety days, their account will be sent to the County's a Collection Agency vendor. L E m C. The Billing Consultant will provide a file with patients to be sent to collections to the 0 Z County's contracted collection agency when all attempts to collect on the account have been r E exhausted by the Billing Consultant. The County may direct the Billing Consultant to not 0 send a patient to collections at any time. Billing Consultant may send a patient to Q collections prior to exhaustion of all collection efforts when: 1. The patient account has an invalid address. 2. Billing Consultant is directed by County to send a patient to collections. Packet Pg. 6 3 15.A.3 D. Interest will be assessed at 1 % per month on all accounts that are sent to the County's contracted collection agency. If a time payment plan is established with collection agency, no bureau reporting will occur unless the account goes into default after (60) sixty days of non-payment. E. A reasonable and customary payment plan will be made available for all service recipients or responsible parties. Should the service recipient or responsible party at the time fail to meet the terms and conditions of the payment plan for a period of (60) sixty days, the unpaid balance shall reenter the collections process set forth in Section C. above at the point in the collections process at which it was taken out for a payment plan to be administered. F. When ambulance service bill(s), at the any stage in this billing and collection procedure, are returned because the Postal Service cannot effectuate delivery, the Billing Consultant shall make reasonable effort to ascertain the correct mailing address. If reasonable efforts to ascertain a correct address fail, the account(s) may be considered for other collection alternatives. G. Nothing contained in this Section shall preclude reasonable telephone or other appropriate contact for billing and collection purposes, in accordance with all applicable laws. H. Throughout the fiscal year, the EMS Billing Section shall review all past due accounts and report to the Board of County Commissioners on an annual basis, of all past due accounts which are believed to be uncollectible. 1. The Board may, after reviewing these past due accounts and after finding that diligent efforts at collection have proven unsuccessful, remove these past due accounts from active accounts receivable in accordance with generally accepted accounting procedures and pursuant to law by Resolution. J. Probate Estate Cases: Should a decedent have an unpaid balance for ambulance services, the following shall occur: 1. The decedent's Personal Representative or Attorney representing their estate will notify EMS Billing Staff that a probate estate has been filed with the Probate Court. 2. EMS Billing Staff shall ensure that a Notice of a Claim is timely filed with the Probate Court. a� as ea a L E aD 0 z d E a Packet Pg. 624 15.A.3 3. The Office of the County Attorney shall take all reasonable actions that are necessary to pursue such claim. including but not limited, to filing a lawsuit in the County Court to pursue such claim. 4. If the estate has assets and $10,000 or less is owed for ambulance services, the EMS Chief and the County Attorney (or his designee) are authorized to take reasonable actions to reach a settlement with the Personal Representative or his N N attorney. Should a settlement be reached, the EMS Chief and the County rn Attorney (or his designee) are authorized to execute a satisfaction and/or release on behalf of the County. I f the estate has assets and in excess of $10,000 is owed for ambulance services, any negotiated settlement/compromise of the ambulance Z billing claim shall be approved by the Board of County Commissioners. If the L estate has nominal assets or no assets, the County Manager may waive the rates, 0 a fees, and charges as set forth in Ordinance No. 96-36, as it may be amended, replaced. or superseded. L. All accounts with a balance of less than $10 will be written off. SECTION THREE: HOSPITAL TRANSPORT BILLING AND FEES U L A. The fees set forth in Section One of this Resolution shall apply to ambulance transports that E occur between hospital facilities. w B. Should a hospital within the boundaries of Collier County have the need for a transport of a v M patient between hospital facilities located tirilhin the boundaries of Collier County, N ambulance transport will be provided. m Y U C. Should a hospital within the boundaries of Collier County have the need for a transport of a a patient to hospital facilities located owshle the boundaries of Collier County, the County, L 4) will subject to equipment and manpower availability, at its sole discretion, utilize its resources to provide patient transport. 0 Z r D. Hospitals requesting ambulance transports shall be invoiced directly for ambulance transport E service on a monthly basis. U SECTION FOUR: ADJUSTMENT OF EMS USER FEES Q The following shall be minimum guidelines for adjustments to ambulance service fees. The Board of County Commissioners, in accordance with criteria established by the enabling Ordinance, may authorize other adjustments. Packet Pg. 625 15.A.3 A. Medicare and Medicaid Adjustments. Contractual adjustments under Medicare and/or Medicaid assignment will be made in accordance with applicable Medicare and/or Medicaid rules and regulations. B. Victim's Compensation Contractual Adjustments. Contractual adjustments will be made in accordance with applicable state, federal and local rules and regulations. C. Worker's Compensation Contractual Adjustments. Contractual adjustments will be made in accordance with applicable state, federal and local rules and regulations. D. Champus/Tricare Adjustments. Contractual adjustments will be made in accordance with applicable Champus/Tricare rules and regulations. E. Railroad Retirement Adjustments. Contractual adjustments will be made in accordance with applicable state, federal and local rules and regulations pertaining to Railroad Retirement Adjustments. F. Bankruptcy: After receipt of a signed Discharge of Debtor notice, any account balances prior to the discharge date will be adjusted off. G. Social Services Adjustments. Contractual adjustments will be made in accordance with rules established by the County Manager and memorialized by a memorandum of understanding executed by the Social Service Director and the EMS Director. SECTION FIVE: WAIVER OF EMS USER FEE FOR SPECIAL EVENTS. co Pursuant to Ordinance No. 96-36, and from the effective date of this Resolution, user fees N for EMS ambulance stand-by services may be waived if the Board finds that a valid public purpose as has been established in recognition of their charitable contributions to the Community. cc SECTION SIX: HARDSHIP CASES AND PAYMENT PLANS. a- L A. The Board recognizes that certain service recipients may need to be identified and E processed as hardship cases. Payment plans for hardship cases will be set up on a c z monthly basis, with a minimum payment of $25.00. Hardship cases placed on a payment c plan will not accrue interest or be placed into collection. Notwithstanding the foregoing, E if a service recipient has a payment plan and does not make the agreed scheduled payments for a period longer than two (2) months, the account will be turned over to the a County's contracted collection agency and interest will begin to accrue. SECTION SEVEN: SUPERCISION OF RESOLUTION 21-175 This Resolution shall supersedes and replaces Resolution No. 21-175. SECTION EIGHT: EFFECTIVE DATE Packet Pg. 626 15.A.3 This Resolution shall become effective on October 1, 2022. PASSED AND DULY ADOPTED by the Board of County Commissioners of Collier County, Florida, this day of September, 2022. ATTEST: BOARD OF COUNTY COMMISSIONERS N CRYSTAI. K. KINZEL, CLERK COLLIER COUNT N N CD ` „'�• ,. r,/ rr ill • L Icy By: C d .10 uty Clerk 41 L. McDaniel. 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LL LL LL LU W uj LL LL LL LL LL LL LL LL LL LL LL LL LL LL. cr LLI z J F- S 0 0 0 0 0 0 0 C7 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 d_' cr- = w = = W = ct LL' Of Of 0= 0' Q:� LL' or = D: w w = = = w 010101010 O 0 m 010 0 0 0 0 0 01010 0101010 0 0 0 0 LL LL LL LL LL LL LL LL LL LL LL LL LL LL LL LL LL LL LL LL LL LL LL LL LL LL r� CD lD lD Ln a1 61 lD n n 41 01 Ol Ql Ol Ol dl H O -1 O c-i COO r-i r-i ­1 O c-1 O r-1 O -4 O ri O H O H O c-I O r-1 O H O c-i O H O -1 O H O ri O -1 O c-1 O -4 O -1 O -1 O H o N N N N N N N N N N N N N N N N N N N N N N N N N N z z z z z z F- F- F- F- F- F- I F- I F- !- F- F- F- F- F- F- F- F- F- F- F- Ql m O 'd' -1 't m d' d' d' m d• 00 d' w m i-1 O m 00 w 00 r, 00 m w 0 n H r, Ln O m O d' O 01 0 H lD N w m LD r, m 00 a) Ol rn O It d' O lzt O �t O lzt O d' O d' O Ln O m ct m N O -4 O H O ri 1-1 H 1--1 H r-1 -i 'I ri d' ri d' r-i r- ci 00 H 00 r-I 00 r•i m t N N N N m N N N N N N N N N N N N N N N N N N N N N N N N N N N 15.A.3 Advisory Board Application Form Collier County Government 3299 Tamiami Trail East, Suite 800 Naples, FL 34112 (239) 252-8400 Application was received on: 10/13/2022 5:43:04 AM. Name: jDaniel M. Johnson Home Phone: 708-280-0619 Home Address: 16056 Huntington Woods Drive City: Naples Zip Code: 34112 Phone Numbers Business: E-Mail Address: Dion222 comcast.ne Board or Committee: Emergency Medical Authorit Category: Not indicated Place of Employment: Florida Department of Health How long have you lived in Collier County: 4-5 How many months out of the year do you reside in Collier County: I am a year-round residen Have you been convicted or found guilty of a criminal offense (any level felony or first degree misdemeanor only)? No Not Indicated IDo you or your employer do business with the County? Nol Not Indicated NOTE: All advisory board members must update their profile and notify the Board of County Commissioners in the event that their relationship changes relating to memberships of organizations that may benefit them in the outcome of advisory board recommendations or they enter into contracts with the County. Would you and/or any organizations with which you are affiliated benefit from decisions or Packet Pg. 631 15.A.3 recommendations made by this advisory board? No Not Indicated Are you a registered voter in Collier County? Ye Do you currently hold an elected office? No Do you now serve, or have you ever served on a Collier County board or committee? Ye currently on Collier county EMA committee re applying for sea Please list your community activities and positions held: Education: Fire Science degree Paramedic FEMA certifications NIMS certified 100-80 nce / Background Retired Fire Chief from metropolitan Chicago area Paramedic/EMT for 32 years Works for FDOHI rrently Fire Science Administration d Packet Pg. 632 15.A.3 ADVISORY COMMITTEE APPLICANT ROUTING MEMORANDUM FROM: Wanda Rodriguez, Office of the County Attorney DATE: October 11, 2022 APPLICANT: Ellen B. Newberry Yarnell 5940 Golden Oaks Lane Naples, FL 34119 APPLYING FOR: Emergency Medical Authority We have three seats expiring in December on the above referenced advisory committee. The pending vacancies were advertised and persons interested in serving on this committee were asked to submit an application for consideration. TO ELECTIONS OFFICE: Attn: Shavontae Dominique Please confirm if the above applicant is a registered voter in Collier County, and in what commissioner district the applicant resides. Registered Voter: Yes TO STAFF LIAISON: Attn: Tabatha Butcher Commission District: 3 cc: Yolanda Garza An application is attached for your review. Please let me know, in writing, the recommendation for appointment to the advisory committee. In accordance with Resolution No. 2006-83, your recommendation must be provided within 41 days of the above date. Your recommendation memo should include: The names of all applicants considered for the vacancy or vacancies. The committee's recommendation for appointment or non -appointment. The category or area of qualification the applicant is to be appointed in. If the applicant is a reappointment, please include attendance records for the past two years. TO ADVISORY BOARD COORDINATOR: Attn: Wanda Rodriguez This applicant is not recommended for appointment. —OR— This applicant is recommended for appointment. A recommendation memo is attached, please prepare an agenda item for the next available BCC agenda. If you have any questions, please call me at 252-8123. Thank you for your attention to this matter. 0212021 1 Packet Pg. 633 15.A.3 EMERGENCY MEDICAL AUTHORITY MONTHLY MEETING PROPOSED DATES FOR 2023 IT Training Room at 9:30 AM January 11, 2023 February 8, 2023 March 8, 2023 April 12, 2023 May 10, 2023 June 14, 2023 July 12, 2023 August 9, 2023 September 13, 2023 October 11, 2023 November 8, 2023 December 13, 2023 Packet Pg. 634