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EMS Policy Minutes 09/17/2010 R September 17, 2010 MINUTES OF THE MEETING OF THE COLLIER COUNTY EMERGENCY MEDICAL SERVICES POLICY ADVISORY BOARD Naples, Florida, September 17,2010 LET IT BE REMEMBERED that the Collier County Emergency Medical Services Policy Advisory Board, having conducted business herein, met on this date at 3:30 PM in REGULAR SESSION at the Neighborhood Health Clinic, 121 Goodlette Road N., Naples, Florida, with the following Members present: CHAIRMAN: Vice Chair: James Talano, M.D. Chief Robert Metzger (Excused) Chief Walter Kopka Rosemary Bally, RN Jerry Pinto ALSO PRESENT: Dr. Robert Tober, Collier County Medical Director Jeff Page, Chief, Bureau of Emergency Services Wayne Watson, Deputy Chief, Bureau of Emergency Services Richard D'Orazio, EMS Battalion Chief 1 COLLIER COUNTY EMERGENCY MEDICAL SERVICES POLICY ADVISORY BOARD AGENDA MEETING TO BE HELD: Neighborhood Health Clinic 121 Goodlette Road North Naples, FL 2nd Floor Education Room DATE: September 17,2010 TIME: 4:00 PM 1. CALL TO ORDER AND PLEDGE OF ALLEGIANCE 2. AGENDA AND MINUTES A. Approval of Today's Agenda B. Approval of Minutes from Policy Advisory Board Meeting May 21, 2010 3. OLD BUSINESS A. Status of Blue Ribbon Committee Initiative 4. NEW BUSINESS A. Targeted Response Strategies to improve call intake to patient bedside B. Challenges in O-Scene Medical Direction C. Discussion of progress in training County Civilian First Responders 5. STAFF REPORTS 6. PUBLIC COMMENT 7. BOARD MEMBER DISCUSSION 8. ESTABLISH NEXT MEETING DATE 9. ADJOURNMENT September 17, 2010 1. Call to Order and Pledge of Allegiance: Chairman James Talano called the meeting to order at 4:08 PM and a quorum was established. The Pledge of Allegiance was recited. Commissioner Fred Coyle attended. 2. Agenda and Minutes: A. Approval of Today's Agenda Chief Walter Kopka moved to approve the Agenda as submitted. Second by Jerry Pinto. Carried unanimously, 3-0. B. Approval of Minutes from May 21, 2010 Meeting: Jerry Pinto moved to approve the Minutes as submitted. Second by Chief Walter Kopka. Carried unanimously, 3-0. 3. Old Business: A. Status of Blue Ribbon Committee Initiative Dr. Tober noted: . Successfully petitioned the Board of County Commissioners for funding o FGCU will conduct a Study - Dr. Lisa Zidek, Statistician o The Statistician will analyze current data: (1) where calls emanate and what resources are geographically closest to the locations . Goal: better use of existing resources and deploying manpower to reduce call response time . Anticipated completion date: December, 2010 Commissioner Coyle stated: . Jurisdictional issues between the Fire Districts and the municipalities should be discussed between the parties. . The subject is beyond the scope of the Statistical Study and details of the existing situation are probably not known to the FGCU consultant. . He has broached issue with the Mayor of City of Naples who is willing to discuss and consider possible trading of areas as appropriate. . Funding is not available. . The population in the eastern portion ofthe County is growing more rapidly than the western portion, but the transportation network complicates rapid response to emergency medical calls. . The Study should provide a "better handle" on the impediments to response time but not a comprehensive or definitive answer. The Commissioner doubted the results of the Study will be accepted as the primary solution to the problem. He noted the Committee will present the Study Results to the Board of County Commissioners at their first meeting in December. 2 September 17, 2010 Chairman Tolan noted Dr. Tober is the Chair of the Medical Society's Liaison Committee and will report the findings of the Blue Ribbon Committee. B. Fire Department District Borders . Deputy Chief Watson concurred if the Mayor is willing, discussions should be held between the City of Naples and the bordering Fire Districts. . Commissioner Coyle offered his assistance to facilitate meetings and asked to be supplied with the names of the principal negotiators for each Fire District and of other attendees so he could devise a schedule for the meetings. Dr. Tober asked Chief Walter Kopka to summarize the situation: . Problem is in areas where City - County borders meet. . Currently, the geographically closest fire department does not respond to an emergency call. . The issue has not been addressed previously with all the Fire Districts o there may be objections to revising their response protocols. . The present system has evolved over time. 4. New Business: A. Targeted Response Strategies to Improve Call Intake to Patient Bedside Richard D'Orazio, EMS Battalion Chief, responded as the Chair of the Tiered Response Committee: . Reviewing the EMS system as a whole to determine what can be done to improve overall services . Focus: Response time issues (What can be done differently?) . Fresh approach to "Alpha" responses - least serious emergency call - to reduce liability and accidents when on emergency runs . Motor vehicle calls have been examined - coded as "unknown injury" - have responded without lights and sirens for the past year until confirmation of injury is provided o Safety issue and wear/tear on equipment . Committee consists of representatives from EMS, the Sheriffs Office, a BLS Fire representative, an ALS Fire representative, a representative from Emergency Management, and Dr. Tober (Rosemary Bally, RN, arrived at 4:26 PM) Dr. Tober added: . The Tiered Response Committee is also examining "911" call delays o Dispatcher asks questions - the caller's answers are coded and entered into an algorithm to determine the level of dispatch o It is approximately 90 seconds before a dispatch order is sent o One option: change the "scripting" to allow a unit to roll without lights and sirens - the call will be updated regarding urgency within 60 to 90 seconds 3 September 17, 2010 Dr. Tober noted there has been a resistance to changing the intake algorithm from the 911 Dispatch. It can take from 1 Yz to 2 minutes before of an EMS vehicle moves. He stated the algorithm is a national algorithm and difficult to change. A conference call was placed to the company that developed the algorithm and it was agreeable to inserting a "pre-alert" voice package. Local dispatch has not indicated they would accept it. Wayne Watson stated one of the problems is the Sheriffs Office Dispatch has been nationally accredited and part of the accreditation is tied into following specific algorithms. Any alteration must be approved and is time consuming to obtain permission to do so. The company confirmed to Sheriffs Office that different areas of the country are using certain variations and the Sheriffs Office is trying to determine if one of the pre-approved variations can be used locally without compromising its accreditation. Another concern is the language barriers which have contributed to the 90-second to two- minute delay. The Sheriff s Office is conferring with the company regarding the issues. It was noted at one time there was an EMS Dispatch "Gatekeeper" who routed the vehicles in response to a call, but the position was eliminated due to budget cuts. Dr. Tober stated there was been controversy concerning the necessity of the position and whether the Gatekeeper contributed to the reduction of response times. Chief Kopka stated the Gatekeeper was critical because the only responsibility of the Gatekeeper was to send information from a call to the responding units. When the position was eliminated, two other individuals became responsible for sending out the units, and talking to the responding units as well as answering incoming calls. Two people are doing the work of three. Calls are stacked up because a Dispatcher cannot talk to units and dispatch a call at the same time. Computer-voiced dispatch may be an option, but it has not been explored yet. Chief Page stated other Counties have personnel from the actual office to staff the positions. The Sheriff, Fire, and EMS Dispatchers had overlays on their computer screens allowing them to track where equipment had been dispatched and what was still available. He stated the EMS Office has offered to attempt the same in Collier County but it is a civilian position and the Sheriffs Office Dispatch Center has a high turnover rate. It is difficult for the Sheriffs Office to keep the positions filled. EMS has offered to take one full-time position from the Sheriffs Office, which is funded by the County, and provide a full-time Paramedic or EMT dispatcher to fill that seat on a permanent basis. An EMT or Paramedic Dispatcher, because of his /her experience, would be able to tell a unit about to leave a hospital to remain in place because another call was coming. EMS has always worked well with the Sheriffs Department and will continue to do so. Dr. Tober stated the controversy is because certain Fire District Chiefs have stated the Gatekeeper position is not necessary while the personnel who actually work in Dispatch have a significantly different opinion. He did not understand the resistance to reinstating the position. It was suggested to discuss the situation with the Sheriffs Office. 4 September 17, 2010 Commissioner Coyle stated there had been discussion about the City and the County having separate dispatchers and did not make sense from a budgetary viewpoint. Dr. Tober noted the County relied upon the City as "back-up" and determined it was necessary to continue the dual system. The County did not state it was in favor of a unified dispatch system. Discussion continued concerning telecommunications switching capabilities, cell phone calls, and the handling of excess calls to the system. Commissioner Coyle stated there are ways to handle the problem. Chief Kopka stated that with the volume of calls that come in during the day, having a Gatekeeper even for 8-hours or 12-hours would be a tremendous help. When Commissioner Coyle asked who was the best qualified or interested to meet with the Sheriffs Office, Dr. Tober suggested Richard D'Orazio, Jeff Page, Wayne Watson, Walter Kopka, and Tabitha - all of whom are constantly on the radio. Commissioner Coyle offered to set up a meeting with the Sheriffs Department to discuss the option mentioned by Chief Page. Dr. Tober noted politics are an issue and every possible emergency stakeholder has been invited to participate. He stated any paramedic who is on the radio all day knows how to fix the system, but the hierarchy from Emergency Medical Dispatch will not accept that anything can make a difference. He suggested EMS should set up its own EMS Com. Question: There are two issues - one is the roll over of the calls. Could that be handled if EMS had its own dispatcher? Chief Page stated if the backlog of vacant positions were filled (12-14), it would make a difference. Dr. Tober stated it has not been identified why Emergency Medical Dispatch is reluctant to accept a recommendation, let alone some of the paramedics. Commissioner Coyle stated creating a separate, competing agency may not be the best answer and will contact the Sheriff s Office to set up a meeting. B. Challenges in On-scene Medical Direction Dr. Tober provided an example of an incident which occurred during August. If a doctor, at the scene of an accident, attempts to modify the accepted protocols, the doctor must accept responsibility for the patient, ride in with the patient, and sign the run report at the hospital. He described the incident: A physician employed as a medical educator for the North Naples Fire District responded with a paramedic supervisor to a call for chest pain. They arrived on scene shortly before the experienced paramedic. The paramedic could not follow the protocol because the doctor insisted certain things were to be done out of order. After the patient was delivered to the hospital, the paramedic contacted Dr. Tober directly. Dr. Tober stated the paramedics work under his medical license only. If a paramedic is forced to deviate from medical protocol because of instructions from a doctor at the 5 September 17,2010 scene, that doctor must accept full responsibility for the patient and accompany the patient to the hospital. He clarified the paramedics know the protocol to be followed and if a physician at the scene is not willing to accept responsibility for the patient, the paramedics are entitled to follow the protocol in that particular instance. C. Discussion of Progress in training County Civilian First Responders Wayne Watson stated the program has trained over 120 Collier County employees, such as Domestic Animal Services Officers, Code Enforcement Investigators, Park Rangers, Bailiffs at the Courthouse, etc., in the basics of CPR, and first aid began a few months ago. The program has been tailored to specific County protocols, but is not a certification course. The classes teach compression-only CPR, as well as basic first aid and runs for six hours. The goal is to make County buildings a safe place if someone is experiencing a severe medical emergency. The specifically trained County First Responders would have access to an AED ("Automated External Defibrillator") and would know what to tell the Paramedics in order to mesh with the system. He stated the response from County employees has been overwhelming positive. Each graduate receives a small medical kit with gloves and some bandages. Dr. Tober mentioned some developments regarding the "ATRUS Program" which will be a fully automated system capable of informing a caller of the location of an AED unit. The problem is the HIPP A Law does not allow the release of medical information without written consent which means calling to say a person is having a heart attack violates the privacy component ofHIPP A. Example: If a customer at Midas Muffler, located next door to the Clinic, was experiencing a heart attack, Staff could bring the AED unit to the scene more quickly than an ambulance could arrive. Various representatives are working to modify the law. 5. Staff Reports: . Grant funds have been secured to purchase 18 to 20 AED's which will be distributed to trained County employees - such as DAS Officers or Park Rangers . Pagers will be furnished to certain County workers 6. Public Comment: (None) 7. Board Member Discussion: . The new Board members were introduced: Rosemary Bally, RN, and Jerry Pinto, a retired Pharmacist. . Dr. Talano mentioned a new procedure - the administration of cold saline for acute MI patients. It will be followed to determine if it could be applied in Collier County 8. Next Meeting Date: January 21, 2011 at 3:30 PM 6 September 17, 2010 There being no further business for the good of the County, the Meeting concluded by order of the Vice Chair at 5:12 PM. COLLIER COUNTY EMERGENCY MEDICAL SERVICES POLICY ADVISORY BOARD Robert Talano, M.D., Chairman The Minutes were approved by the Board/Committee Chair on as presented , or as amended 7