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BCC Minutes 05/21/1998 W (Collier County Emergency Services) WORKSHOP MEETING OF THE BOARD OF COUNTY COMMISSIONERS' WORKSHOP M_AY 21, 1998 LET IT BE REMEMBERED, that the Board of County Commissioners in and for the County of Collier, having conducted business herein, met on this date at 1:08 p.m. in a WORKSHOP SESSION in Building F of the Government Complex, East Naples, Florida, with the following members ALSO PRESENT: present: CHAIRPERSON: Barbara B. Berry Pamela S. Mac'Kie John C. Norris Robert Fernandez, County Administrator Sue Filson, Administrative Assistant Item #2 DISCUSSION REGARDING COLLIER COUNTY EMERGENCY SERVICES CHAIRPERSON BERRY: Good afternoon. I'd like to convene this workshop for emergency services. If you would please rise for the Pledge of Allegiance. (The Pledge of Allegiance was recited in unison). CHAIRPERSON BERRY: Just to kind of let everyone know what the format is going to be this afternoon so you can kind of plan accordingly, I'd like to have everyone who is going to be presenting information, both from our visiting people here and staff people, I would like and would appreciate if we would let them make their presentations first, and then at the end, we will have an opportunity for public input. So, that's -- that will be the way the meeting or the workshop will be held, and Mr. Ochs, I believe we'll start off with you. MR. OCHS: Thank you, Madam Chairman. Good afternoon, members of the board. For the record, my name is Leo Ochs, support services administrator. On behalf of the staff, we'd like to thank the board for taking some time out this afternoon to discuss several issues relating to the operation of your emergency services department. We appreciate that very much. Before we begin with a very brief presentation, I would also like to acknowledge and certainly welcome all of the invited guests that have come out this afternoon. We really appreciate the great turn out. I think it's a testament to the interest of public safety in our community and we are very grateful that they are here and look forward to their comments at the appropriate time in the workshop today. Just to briefly set the stage for today's workshop in terms of what we, from a staff perspective, hope to accomplish, very simply put, the staff is looking today to obtain some policy level direction and some guidance from the commission with respect to the future levels of service and the scope of services provided by your county emergency services department, and more specifically, to hopefully discuss in some level of detail what you consider to be the appropriate level of interaction or interface between our EMS department and the various municipal and special service fire operations out there in the community. As you know from your communication with your own staff as well as members of the other agencies in the community, the field of emergency services, although it has a long background and a steep tradition, is still one that is evolving even today, not only in our community but throughout the state and certainly throughout the country, and you can see several models and examples of that right here in Collier County as we look at various models of public safety and -- both in city and county government, and we think it's important that we continue to evolve together and work cooperatively in those efforts. With that in mind, just to gain a little bit of and provide a little bit of statewide perspective on some of the current practices and the emerging trends in this whole field of emergency services and public safety, we have a special invited guest here this afternoon, and I would like to call on Chief Flagg right now to make that introduction. CHIEF FLAGG: Good afternoon, commissioners. What I'd like to do is introduce Chief Jim Frazier to you. He is the chair of the Florida Fire Chiefs EMS Committee. I had also invited Chief Judge from Indian River, but he was unfortunately unable to attend. Chief Frazier and I have worked with each other probably 15 or more years in the area of emergency services and specifically in the area of EMS. He's very knowledgeable, has an extensive background in emergency services, and with that, I'd like to ask Jim Frazier to come forward. CHIEF FRAZIER: Thanks, Diane, and I thank the county commission and members of the administration for allowing me to participate in your workshop. I think it's exciting that you're looking at new and different ways to provide services to the community, and on the agenda here, I see that I'm supposed to talk about what are some of the roles of the county and also what are some of the quality, issues or values, principles that should govern emergency medical service provision and fire protection provision, for that matter, emergency services provision. Really, I guess that's where I would like to start is that I think there's a wave going across our country, across our state for sure that the counties' public services are not really in the business of providing fire protection and emergency medical services. They really should be in the business of providing customer service, and that's the principle that I think we need to look at on a day-to-day basis is how do we provide the services that the customer needs in the most cost-effective and efficient and effective manner. I'm very pleased to say that we -- our recent, new county administrator, Mr. Jim Lay (phonetic), has taken a real proactive stand in Sarasota County to really promote quality. Our new -- new logo is dedicated to quality servzce, and some of the basic principles that I think should govern any decision have been laid out in, I think, a very concise and applicable means by Mr. Lay. So, some of the basic principles of quality service -- and I'm sure I'm speaking to the choir here -- is focus on the situation, the issue or the principle, not on the people that are involved in providing the issue; maintain the self-confidence and self-esteem of others in the process of working through the situation; maintain constructive relationships with the participating parties; take initiative -- I really applaud you for this -- for making things better. That's really one of the overriding principles, and lead by example. Certainly, as county commissioners, I'm sure that you realize that on a day-to-day basis that it's your example that sets the pace for the community. Customer service is the primary role of government or should be, and they should do that in an accountable way so that we are accountable to the public, to our administration, and I guess one of the final principles that I'd really like to deal -- to dwell on a bit is management by fact, is that we have to look at the issues from a fact basis, not necessarily an emotional basis. That's pretty much all I have to share with you other than to say that throughout the State of Florida -- and I've been in emergency services for 23 years now. I've been participating in the state emergency medical service arena for a good portion of those 23 years. Communities are growing. The needs of the customer are changing, especially with managed health care, and there is certainly a need for working together, more today than there ever has been, to enable the health care system, and EMS is a good component of that health care system, to be effectively utilized as an access point for the citizens in Collier County and any county in the State of Florida. So, certainly I'm here for any questions and comments as the discussion goes on. If there are any particular issues that you'd like me to address, I'd be glad to do that. There are a lot of ways to get effective efficient emergency medical services from separate services. I've been in the fire service for 23 years. I wouldn't be here today if it weren't for a fire department. When I was 18 months old, the fire department resuscitated me when I was in cardiac arrest. My grandfather is a firefighter. I have cousins that are firefighters. My sons will probably be firefighters, and I happen to have the opinion that a dual role cross-trained service is the best way to provide any emergency medical services. I'll share with that -- that slant with you right off the bat because I feel that the fire service has a lot to offer to the community and offers that to the community in a lot of different ways, one of which should be emergency medical services, so close with that. CHAIRPERSON BERRY: Thanks. COMMISSIONER NORRIS: I have a question. CHAIRPERSON BERRY: Do you want to wait until we hear the whole presentation or do you want to ask it? It's up to you. COMMISSIONER NORRIS: You're the chairman. CHAIRMAN BERRY: Diane, who's following -- CHIEF FLAGG: He's going to do a presentation. CHAIRPERSON BERRY: All right. Write your question down. We'll take them all when we get done. MR. OCHS: Thank you, Chief. Madam Chairman, if I might, I'd just like to, at this point, review with you briefly what the current situation is in terms of our operations out in the field with our emergency medical services; talk a little bit about what we are doing and where we are moving. We are very fortunate in the community to have a long and very successful and productive track record, I think, of partnerships with the other emergency services providers throughout Collier County. With respect to our own department of emergency services, you can see on your screens what our vision statement is, briefly stated, as well as our mission statement in our EMS department has been to provide that world class patient care and services out there in the community in both an efficient and an effective manner. One of the ways we are able to do that is by partnering as we have successfully in many occasions with other emergency services providers, both law enforcement and fire throughout the community. You have a couple of slides here that give some examples of that. I just wanted to point out some of the partnerships that have existed for a long time and have been very successful. One is our combined 911 emergency dispatch center along with our communications system where we have all of our emergency providers on the same 800 megahertz communication system. Many of our emergency services agencies share common facilities. The board is very familiar with that. We also have responses to the scenes. I think you know that both EMS and fire respond to all the fire calls in the county, are there assisting each other on the scenes through incident command. There is also a number of joint training programs that both fire and EMS participate in, and then finally, we have what we have kind of deemed our next level of integration and cooperation with the fire services, and those are beginning with our -- what we call our MOU, which is our medical training memorandum of understanding with the fire service first responders, and as you can see from the screen, the MOU basically establishes within the fire service a consistent level of basic first aid and medical care, medical direction. It provides for quality assurance and medical training of those first responderso We've used that MOU as a building block, if you will, for the next level of interaction, and that is the single vehicle response program. This is a program that's in place both in the City of Naples, City of Marco as well as with your dependent fire districts here in the county. Just to very briefly go over the procedures in that single vehicle response program, when there is a 911 emergency call received, we have an EMS paramedic unit, our ambulance unit, ALS level, responding to the calls. That vehicle is staffed by two of your paramedics, and in the case of Marco or the City of Naples, a city firefighter all responding on the ambulance. The fire engine then would remain in the station. If we get a second 911 call and the EMS unit is already committed, then we have a city fire engine first responder responding to the medical call, and -- along with the closest EMS unit so that they can, if needed, transport that patient for further care. That is the existing program of our single vehicle response. What we'd like to spend the bulk of today's discussion on is the concept that we've briefly talked to you about individually, and we've also discussed with the various fire services, and that is the next level of cooperation or interaction with the fire services, and it's called our ALS engine program, and what it's basically designed to do from our perspective is to enhance your current EMS system in the community, and it's designed to do that by increasing the probability of ALS level response on every medical call that comes in for service in the community. Right now, we are able to respond to most medical calls with our ALS as the first response, but many times, because of the volume of calls, our units are already committed or in service and the engine companies would respond or get to the scene first, and they are not, as you know, ALS level. So, in looking at that and looking for ways to enhance our EMS service, we began to meet with fire officials and more specifically, with Chief Rambosk and his staff down at the City of Naples, and after several months of staff work, had developed this concept of an ALS engine program, and I'd like to just take you through the mechanics of it very briefly, if I might. The first component of it is basically identical to the single vehicle response program, and that is, again, just to reiterate, as a 911 call comes in, the ambulance would respond with two paramedics and a firefighter to the scene. The engine would remain in the station. However, the difference now comes in that if there's a second call, where in the past, that city fire engine would respond only as a first responder. Now it would be able to respond as an ALS engine company along with the next closest paramedic unit because the engine, even though it would be ALS equipped, it would not do the actual transport of the patient. So, we still need to bring a transport unit along. The staffing of that unit, again, would involve -- of the engine is two city firefighters, and, again, the change here would be that we would exchange, in effect, one of our paramedics and put that paramedic on the engine. The city, in turn, would send one of their firefighter/paramedics onto our ambulance to train with us. So, it's a full partnership with the intent to get people cross-trained so that whenever a medical call comes in, both first and secondary response is at an ALS level. That level of training would continue through rotations of training for approximately 18 to 24 months, and at that point, again, there would be a subtle change in the response. As you can see on your screen, the single vehicle response program would still kick in. Then we would move on to the ALS engine response if we had a second medical call, again, with the firefighters responding on their engine and one EMS paramedic. The difference is, after 18 to 24 months, you will have fully trained and certified firefighter/paramedics from the city now being able to provide that level of service on their engine. So that, in essence, is the concept, and we believe it's a partnership that will work and work well, but it, obviously, has some policy level implications for this board. One of those is that as we get into this exchange between the two agencies, there will be times when the paramedic, your paramedic stationed on a city fire engine will be required to be acting as a firefighter as opposed to a paramedic. That cross-training is the same as, obviously, we would expect on the ambulance, using the city's firefighter who is now cross-training as a paramedic. So, that would be a departure from what the board has done, obviously in the past, with respect to its EMS service. I should reiterate, even though it is a departure, I should also mention that the majority of the time the medics on those engines would still be responding in their medical capacity because the majority of calls for service are still medical or rescue related as opposed to actual fire fighting. So -- but there is that chance, and that certainly is a policy consideration I think the board needs to discuss. That -- that was the extent of the formal presentation. We wanted to just give you that kind of background and then open it up for discussion. I'm sorry, Diane reminded me that Chief Rambosk is also here this afternoon, and since he's been very involved in the initial planning at the staff level, he wanted to make a few remarks to the board about his work in this area. CHIEF RAMBOSK: Good afternoon. CHAIRPERSON BERRY: Good afternoon. CHIEF RAMBOSK: I'd like to thank you for giving us the opportunity to address you this afternoon on such an important issue. I wanted to take a step back just for your information to kind of let you know what we've been doing, and I know that I've not had a formal chance to give you a presentation but have spoken with some of you and let you know what we have been doing in the city, but a few years ago, Dr. Woodruff had posed some questions to us as a staff and a department to rethink public safety services, to look at the quality and level, to see what we could do to improve those, but more importantly, do it within the existing resources that we have, and our whole new concept, which is, was, a little bit different than what was going on in Collier County for the City of Naples worked very, very well for us. We have had many successes, and that is both in-house and with partnerships, such as what we've been talking about this morning with Collier EMS and yourself. So, we took a different approach. We then went to our own employees. We said, look, we know there are changes to the fire service coming. We researched it as a group and a department. We put together a plan where the employees felt like they wanted to see themselves, what types of training, what types of skills; not just what we envisioned, but -- as a staff, but envisioned as a -- as a group, as a component, and that, obviously, bled right over into our partnerships with Collier EMS. The -- the things that you saw already, the MOU was the start of where we were. I believe we were even -- the first MOU, we might have been the first to sign on with that years ago. We then, when reviewing the revised MOU, we looked at that, and the reason why we felt that that was so important to us was that, obviously, the level and the standards set by yourselves and your department and the medical director were at a level that we felt that we needed to attain because certainly we didn't want to go any lower, and more importantly, we wanted to do something better than not. So, that was real important to us. The single vehicle response plan, the age old question of multiple vehicles to one event was solved by the stroke of a pen and an approval by yourselves and the City of Naples council, and we get no more complaints. So -- yet, we provide more service because our staff stays with the ambulance, whereas before, we used to go our separate ways after we helped. So, it was a tremendous benefit. The only thing that I think -- and the reason why we are here today is because we are looking at that third part where we want to improve the training that we had provided to our own people. Fifty percent of our staff told us they wanted to improve their medical response capability, and we said, that's great. How can we do this? We can't afford to send 25 or 30 people to school. They went on their own. They came back and said, okay, we've done that. How do we now participate with Collier County and allow us to function, and that's really kind of why we are here today. So, we through our variety of partnerships over the past two years with Collier County EMS have been very successful. They have very high standards, some of which we have debated really to death virtually but know that for our community, we've got to provide the best that we can possibly do, and the provision of service that Collier County provides now is certainly superior. We only want to be ~art of that, and we want to help make it better, but we want to make mt cost-effective and do it within the resources that we've got or within reason to do that. Thank you. CHAIRPERSON BERRY: Mr. Norris, you had some questions. COMMISSIONER NORRIS: Yes. Chief Frazier, if I could get you back up there for a second. CHIEF FRAZIER: Sure. COMMISSIONER NORRIS: Where did you say you were from? CHIEF FRAZIER: I'm from Sarasota County. COMMISSIONER NORRIS: Sarasota County, and in Sarasota County, who operates the fire services? CHIEF FRAZIER: Sarasota County. COMMISSIONER NORRIS: Sarasota County does. What about EMS services? CHIEF FP~AZIER: Sarasota County. COMMISSIONER NORRIS: Thank you. Mr. Ochs, can I ask you a question or two? Whenever we are going to make some sort of sweeping change and address some problem, I'd like to know what the problem is. Do we have a quality problem with our EMS service? MR. OCHS: No, I don't believe we do have a quality problem, no. COMMISSIONER NORRIS: Is there some sort of a delivery problem that we are trying to address? What exactly is the problem we are trying to cure here? MR. OCHS: I don't believe we are trying to cure a problem. I think that we are looking always to improve our level of service, and in this case, our concern was or our objective was to try to find a cost-effective way to increase the frequency of ALS first response to a medical call. The reason we are not able to do that now is quite simply that we don't have the number of units that we need all the time to get to every call. We have, as you know, units that are in service when a second call comes in, and there are times when the first responders get to the scene 30 seconds, a minute before we do and vice versa, but in those cases, we were looking for a way to improve the ability to deliver ALS level of care when that first unit arrived, and as a result of that, through discussion, we came up with this ALS engine concept. COMMISSIONER NORRIS: Okay. Let's go to the -- to the transfer of personnel for a moment. Our fully trained EMS paramedics earn how much approximately, just approximately? MR. OCHS: Help me out. COMMISSIONER NORRIS: Thirty-five thousand? MR. OCHS: Twenty-six entry, probably 35 when we have an experienced paramedic. COMMISSIONER NORRIS: And an entry level trainee then -- MR. OCHS: Paramedic, twenty-six. COMMISSIONER NORRIS: Okay, twenty-six -- thirty-five for a fully trained -- MR. OCHS: Yes, I'd say about five years' experience with that. COMMISSIONER NORRIS: So, the proposal is to trade a, let's say an "A", a fully trained ALS paramedic to the City of Naples and take a, let's call it "B," a trainee in return. Now, the problem from the County Commission's perspective is that we just traded a higher for a lower, and we are not responsible for what happens within the City of Naples. That's not our job, but what we have done is lowered the level of personnel that are directly responsible to the EMS department for the moment. That's a problem, and financially, it becomes a problem as well because we are paying 35,000 for a $25,000 employee. MR. OCHS: Well, the way we've viewed it, since the EMS ms a countywide system with ad valorem tax dollars, everyone pays or helps to pay for a portion of the EMS service that isn't funded through direct fees. So, in that regard, we're -- as we always have, we have to look at the total county because we run a single countywide system, and our goal again, just to reiterate, was to try to increase the frequency at which we could provide ALS level of service, and I will say that, obviously, during that 18 to 24 month learning curve, if you will, or certification window, that there will be times when we will have a less experienced paramedic on our ambulance. By the same token -- and I know this is not your concern. It may be for the other jurisdiction. They will have a -- at least one firefighter who is not as seasoned as their experienced people, obviously; but, again, we thought that the short term -- that was a short term issue that could be overcome and was outweighed by the overall benefit of the program in the long run. COMMISSIONER NORRIS: So, what you're essentially saying is that you reduce both levels of services in the interim? MR. OCHS: No, I wouldn't say that. COMMISSIONER NORRIS: Well, I think you did. MR. OCHS: I'd say have some less experienced people, but whether that results in a different outcome, I wouldn't say that necessarily. COMMISSIONER NORRIS: But the fact remains though -- I mean, all of this is very nice, but it comes close to being irrelevant because we have to deal within what our system is set up, and we are not responsible for the fire system in the City of Naples. MR. OCHS: Correct. COMMISSIONER MAC'KIE: Madam Chairman. CHAIRPERSON BERRY: Uh-huh. COMMISSIONER MAC'KIE: I'd just like to -- just for general comment and hear from whoever has anything else to say -- nobody will be surprised to know that I think this is a fantastic idea, and I'm just very, very pleased to be the representative from the City of Naples and commend Dr. Woodruff and Chief Rambosk for working with Chief Flagg to come up with such a wonderful idea where your concern was not for what is your particular backyard and what is your particular nickel and where are you spending your nickel, but your concern was for the greater community $ood on the most fundamental area and the most critical public service we provide. I'm -- I'm honored to be associated with you, and I can't say that about everything that happens in government, but I think you've done an excellent job and you're serving the community extremely well with these innovative ideas. CHAIRPERSON BERRY: Do you have any questions, Pam? COMMISSIONER MAC'KIE: No, just want to hear from the public. I'm ready to cast my vote actually. CHAIRPERSON BERRY: I have a question in regard to training, and maybe Dr. Tober can best -- if you would come up to the podium, please. COMMISSIONER MAC'KIE: And I apologize for leaving Dr. Tober out of that commendation list, because he's who makes it the quality service that it is. DR. TOBER: Thank you. Yes. CHAIRPERSON BERRY: How long does it take to train someone to be what you would consider an up-to-speed paramedic? DR. TOBER: Minimum up-to-speed, about 18 months and really fully veteranized, probably four to five years. I did want to address Commissioner Norris and -- because I think he asked the best question I've heard here today, and that is, what is the problem, and is there a problem, and the problem with that question is that it has such far-reaching implications and answers. In the -- in the microcosm of EMS services and taking a paramedic, sending him to a sick patient and bringing him to one of our hospital facilities, there probably, for the most part, is not a problem, but what has become an expanding problem, and I chose a clumsy way to communicate this to all of you thinking that you were much more in touch with the hammering that I've been receiving over the last few years, is the following, and I don't want anybody to misconstrue these comments, because I am sympathetic to both fire districts and emergency medical services in terms of the problems we all face, but the reality today is that the fire departments -- and God bless them for being there if we need them when we are burning up inside a building and we have these brave guys to come in there and help us. Thank goodness we don't need them a lot for major structural fire, but they are sitting there ready 24 hours a day to help us. I have no problem with the fact that they are sitting there ready to help us, but, obviously, within their own ranks, they've become uneasy with the fact that most of their duties today, although they are always prepared to fight a fire and save somebody's life, most of their duties end up being running flank support for the current emergency medical system, and as such, they have come to me repeatedly over the last few years looking for greater and greater specific professional involvement in the medical system, and although -- at first, I said, well, what we'll try to do here is upgrade first response skills so that everybody is working by the same book, and I thought that would be a very simple sale. That actually, in and of itself, was not a simple sale, and only some of the fire departments signed onto that actual proposed memorandum of understanding that the state had pushed down on me, but what really was looming and is looming is that the fire departments are uneasy about their lack of activity in the higher levels of medical fields and have definitely wanted to play a bigger role. I think anybody in the audience here would support the fact that they have come to me and said they want to send paramedics to school, they want to get involved, and the kind of mission commander that I see myself in the position that you have chosen to put me in in the county is to try to cross bridges way in advance of when I'm going to actually get to that particular stream or obstacle in the road, and if, indeed, the fire departments are going to play a larger more complex role in the medical care of patients, then somehow we need to meld them into the system. We need to train them. The internship and residency has to take place like it does in EMS. It's just not simply going to school. I'm sure the firefighters would agree that I can't take a paramedic, send him to firefighter school and send him into a burning building without getting him killed. I mean, there's a graduated level of experience in both these fields of expertise, and what I worry about, in one of those long-range bridges -- and I live way in advance of myself in everything I do. That's just one of my shortfalls -- is that I've got a repository of fire fighting expertise that wants a bigger part of the medical expertise theater. I also have a repository of medical expertise that is looking at themselves and saying well, we are paid such and such and such an amount. Firefighters are paid a different amount, and they start looking longingly at fire. They are actually looking at each other's grass across a fence with a considerable amount of longing and appeal; not conflict, just wishing they were sort of either on the other side or that the gate was open so they could walk back and forth, and if indeed, and I'm saying if indeed this is going to happen in the future and we are going to take a group of firefighters and bring them into the medical theater and we are going to take a group of paramedics and bring them into the fire theater, then I would rather us do it with our eyes open, with our heads held way above the ground so that we have a very good perspective of the panorama that we are looking at and that one day we don't arrive at some crossroads with either too many people to meet the needs of what we are going to do in fire and EMS, and so what is a problem with me and is a continual problem, and now you've invited me to share that problem with you on a continual basis, is that I am being approached by the fire department saying we want to do more with you. I don't know how to do more with them unless we attempt to investigate the experiment that we have proposed with the city and see if that cross training works. I realize that in the -- in the effort of cross training, I am taking a slightly less experienced man and bringing him over to EMS and conversely taking a less experienced firefighter and throwing him over to the fire department, and I'm open to any other recipe that would accomplish this same end, but these different fire departments are all very, very interested in functionally contributing more to the medical theater. I know the word consolidation is a real dirty word in the industry, but there is going to be some functional melding of skills if we are going to do this, and if we are not going to do it, then I guess somebody needs to make a proclamation that this isn't ever going to happen, so firefighters, stay in your houses and wait for the next building to burn, and paramedics, stay in your ambulances and wait for the next person to get sick and leave it at that, but -- but what's changed and what I've been able to unshoulder onto you is now I am sharing these pressures with you as they come to me. The last -- I think the last proposal I sent to you was from East Naples for a graduated response system. I have no problems with these requests, but I want us all to know that this is happening and try to make the decision together as a group of minds as to how we are going to address these issues. So, to that extent, I do see a problem, Commissioner Norris, not directly in the way we are providing medical services, but the problem is, what does everyone want to do in the future together. COMMISSIONER NORRIS: Okay. Well, that -- that, Dr. Tober, has a really simple solution. You just tell them to talk to us. DR. TOBER: Well, that's what I am. That's what I'm doing. COMMISSIONER NORRIS: You don't have to mess with it. DR. TOBER: No, and believe me, that's a luxury that I'm able to send them to do that now, but that's why I was here, not to make a formal presentation, but to be able to answer any questions that you might have. I don't know if there are any other questions or -- CHAIRPERSON BERRY: At what point can you keep a person current in skills in the medical end? DR. TOBER: Well, that's another -- that's another great question. You know, we always struggle with sufficient clinical engagements to keep somebody's skills up-to-date, be it the physician in the emergency room, a surgeon doing a particular case in the OR or a paramedic. We have had to, on a number of occasions, fall back to our own operating rooms in the hospital to give paramedics recurrent endotracheal intubation training, and I've said to a number of fire chiefs that we can't put too many people out in the field before we would dilute the clinical experiences so severely that nobody is going to get enough experience to stay current, and that's why, again, if everyone in the fire system stepped up to the plate, raised their hand and said, I want to take all my men and train them to become Collier County EMS level paramedics, it couldn't be done. I don't have enough clinical engagements to do it, nor do I have enough supervisors to train them. We may be able to do it a little bit at a time if that's what you guys decide you want to do, but if -- if that's what we're going to do and we are going to meld things one day together somehow, then we have to -- we kind of need that large perspective so that as people leave via attrition and for reasons other than that, that we keep an eye on what our total numbers are and our total clinical experiences are so that we continue to have a system that does provide high quality medical care with enough clinical engagements to keep everybody current and capable. If you ask me for a number -- no one has ever really agreed on the exact number. I like thinking that all of my paramedics get a couple of challenging cases, I mean challenging cases per month, not just routine runs, but even for myself, seeing five or 6,000 people a year in the emergency room, sometimes I don't even think that's enough because I'm humbled on a daily basis by what walks in that door. So, the more -- the more experiences, the better. The busier a paramedic is, the more clinically capable he is. CHAIRPERSON BERRY: That's a big concern for me. If I'm the person laying there on the floor waiting for somebody to intubate, I want to make sure they've done that fairly recently. DR. TOBER: Well, I know, and that's why we keep cycling in and out of the operating room where people are being routinely put to sleep -- it could be said that, well, when that paramedic does that intubation, have we lowered the care provided to that patient in the operating room? Well, all of clinical training involves taking somebody by the hand and getting him in the situation, and although we are not formally designated a training teaching hospital, we do a tremendous amount of clinical teaching with students, particularly paramedics, and that will continue, and we will continue to have to use the OR just to get endotracheal intubation experience. Even for some of our doctors, we have to send them back there because we don't get enough of them in the OR -- I mean, the ER. So, it's a constant struggle to do that. CHAIRPERSON BERRY: Commissioners, any other comments or questions? COMMISSIONER MAC'KIE: No, I've heard enough. CHAIRPERSON BERRY: The gentleman in the back row -- if there are no other questions or any other comments, if you would like to make some comment or make some statement, if you would come up here and sit in the front row, please, so we can expedite this, and we'll start -- just line up over here in the first row -- the first seat over there closest to the door, and anyone else that wishes to do that, just line up, children, in the front row there, and we'll -- COMMISSIONER MAC'KIE: There goes that school teacher again. CHAIRPERSON BERRY: Sir, we'll use this microphone over here if you don't mind. We'll leave this -- DR. TOBER: I just wanted to make one last comment to you, Commissioner Berry, that when you asked about this clinical engagement and competency, we did attempt in designing this program for the city, which I admit is an experimental proposal, to keep quality of care at the very top of the list of what we were going to do so that that wasn't compromised. CHAIRPERSON BERRY: At what point in time will you evaluate this situation again and take a look to see if this is what you had hoped to accomplish or is there an evaluation period as far as you are concerned? DR. TOBER: At first I was uncertain whether or not we were going to get this blessed as a thing that we were absolutely were going ahead to do, and then I think we'd probably look at it on an up to three months and see where we are. Of course, if we start it now, we are starting at the low clinical engagement time of the year. Our calls fall off dramatically -- CHAIRPERSON BERRY: Sure. DR. TOBER: -- until about October again. So, thank you. CHAIRPERSON BERRY: Okay. Step to the microphone and please identify yourself. MR. HAMEL: Thank you. My name is Henry Hamel, H-A-M-E-L, 732 Bay Tree Court, Naples, in Pelican Bay. I am a member of Chief Tobin's North Naples Fire Department Advisory Committee. I'm the president of the Foundation of Pelican Bay. I would just like to make a few differences when we talk about services and what I as a citizen or a person probably in need of these services thinks about it. Compared to the City of Naples, we have Route 75, Interstate 75, a much longer stretch of 41, Pine Ridge, Immokalee, parts of Bonita Beach, Vanderbilt, 951 and other major and fast traffic throughways with much heavier duty trucking. We have a lot of older people, as you know, many more nursing homes, and adult care facilities are being built all the time. In Pelican Bay alone plus Vanderbilt Beach, we probably have the greatest concentration of high-rise buildings in the county. I want to talk about a multiple incident which happened right at the edge of Pelican Bay, where Pelican Bay Boulevard meets Route 41 right there by the First Union Bank building, there were two cars which collided. One ended up in a swale southbound, the other in the middle of the road across the median northbound. There were three engines which responded, one at first and then two others, a truck and two engines, a total of ten fire personnel and one EMS which had a total of two. The extrication job, and each one had to be extricated, is the fire department's job, which they performed beautifully, and the EMS, after these were extricated, of course did the transport. It would not have been possible with any amount of EMS personnel to do the extrication because of the tools and what is needed to extricate unless it took a lot of training and a lot more people because each one had approximately five men trying to extricate them. Now, when you are in need of an emergency service, the important thing is how many people come at first, not how much dollars were saved by seeing what the average necessary is. If I have an emergency, I don't want to find out that they weren't planning for me but next time if I get sick, they'll have the right number of people. As it is, I think the EMS does a fantastic job. I cannot praise them enough, and I don't know of any reason why they shouldn't get the highest accolades, and they are certainly trained at a very high level with Dr. Tober, but I think when you talk about the number of people there and who can render first service, not transport service, first service, you have to keep in mind that properly trained fire personnel could solve this, and I do like to make one point. It may be that Collier County has it backwards. This is one of the few counties which is preserving what I would call winding the clock backwards, but EMS is the tail wagging the dog. In almost every major city and almost every county in the United States, this has gone to fire service, and I used to work in New York City. They had 450 ambulances. They were all run by the fire service; the same thing in Chicago; the same thing in Los Angeles. It's hard to name a place that it hasn't gone this way. Now, that doesn't mean that they don't need training or that the personnel has to be all fired or rehired. What it does say is that there is a recognition nationwide that the fire service has a role to play in emergency medical. Thank you. CHAIRPERSON BERRY: Thank you. COMMISSIONER MAC'KIE: At some point while the speakers are coming up, Leo or whoever would know, somebody, I'm going to want to know the total combined budgets of the independent fire districts as compared with the total budget of EMS because that is one of the questions is which group can do it most efficiently. CHAIRPERSON BERRY: Richard -- UNIDENTIFIED SPEAKER: I was going to say, let the lady go next. CHAIRPERSON BERRY: Oh. COMMISSIONER MAC'KIE: Chivalry lives. CHAIRPERSON BERRY: I was going to say, chivalry is not dead. COMMISSIONER MAC'KIE: I love it. CHAIRPERSON BERRY: I did fail -- I did fail to mention, however, I think, Janet, you're aware of it, it's a five minute limit. MS. VASEY: Yes. Thank you. CHAIRPERSON BERRY: I didn't -- I don't want you to think I'm discriminating, but it's the typical scenario. MS. VASEY: Janet Vasey for the record. I happen to have some of the statistics that I wanted to mention that you had just asked for, Commissioner Mac'Kie. COMMISSIONER MAC'KIE: Great. MS. VASEY: In 1997, the countywide budget for the fire districts was 15.3 million dollars, and that excludes the city fire departments, and I took Marco Island out just because that's the way it is now. That's 16 fire stations and about 190 people, and in 1997, there were just slightly over 6,000 fire related calls, and in that same time period, there were 11,800 or nearly 12,000 rescue calls that the fire districts handled. So, two-thirds of the fire district workload is for rescue and one-third is for fire. The EMS budget for that same period is about seven and a half million, and they have 14 stations, many of them are co-located with the fire, and 112 people, and they responded to 24,783 emergency medical calls. So, there's a duplication there, a pretty substantial one with the county EMS medical calls of twenty-four seven and the seven fire districts, that's the five independent and the two dependent, rescue calls of 11,847. How that breaks down is we have a lot of allocation of resources to emergency services and about 80 percent -- 80 percent of all the calls when you put everything together, 80 percent of emergency calls are medical or rescue in nature, and 20 percent are fire related. Now, that could be different up north where structure fires are more -- are more common and the population is not as old in age as maybe we have down here. So, I think you have to look at Collier as, perhaps, being separate from what you might find up north. So, here, I think that the tail is the fire district and the head of this dog is the EMS because they've got 80 percent -- 80 percent of the workload is medical. COMMISSIONER MAC'KIE: Of 911 calls, is that what you said? MS. VASEY: No. Well, it doesn't have anything to do with police. These are responding to incidents from '97. So, it's just fire and EMS. COMMISSIONER MAC'KIE: Okay. MS. VASEY: In looking at the resources, we've got 60 percent of the resources in looking at personnel in the fire districts and 40 percent in EMS. So, I think we have a mismatch of resources to the kind of workload that we have out there, and I think that Dr. Tober made an incredibly pointed comment when he talks about planning ahead. I mean, we do need to plan ahead. We need to see if there are better ways to do things, if we can provide better services to the community, if we can reduce some of the duplication of services and better allocate our resources to provide a better job at a lower cost. I just wanted to tell you that embedded in all of these statistics or the fact that even though 20 percent of the calls for fire are -- or 20 percent of the emergency calls are fire, not all of those are really fires. I did an analysis on the North Naples Fire District for their 1996 calls, and in looking at just the structure fires, there were 53 structure fires for the whole year; 10 were mutual aid, 5 were false alarms or canceled, 15 had the structure fire out when the engine arrived, and 23 were actual fire calls of which they pulled a hose six times. So, -- COMMISSIONER MAC'KIE: They did what six times? MS. VASEY: Pulled a fire hose. I kind of use that as a measure of how serious the fire is. Maybe it's probably not accurate 100 percent, but it's a measure. COMMISSIONER MAC'KIE: Got you. MS. VASEY: So, when the big fires occur, we've got to have the fire department, and I couldn't agree with you more. They have to be there, but they are underutilized for fires. So, I think we do need to look at using them for medical and rescue, and we need to plan ahead in how to do that effectively. So, I just think that those are all factors that need to be considered while you're making your decision. Thank you. CHAIRPERSON BERRY: Thanks, Janet. COMMISSIONER MAC'KIE: Just -- can I get it straight that -- when you said the fifteen million -- 15.3 million is the total -- is that all seven fire districts? MS. VASEY: Yes, but it's not the city's. It's the five independent and the two dependent. COMMISSIONER MAC'KIE: The five and the two dependent. Okay. So 15.3 million -- CHAIRPERSON BERRY: That took out Naples and the City of Marco, right, Janet? MS. VASEY: Yes, even though it wasn't a city then, I was trying to do it for today. COMMISSIONER MAC'KIE: Fair. Thank you. CHAIRPERSON BERRY: Dr. Woodruff. DR. WOODRUFF: For the record, I'm Richard Woodruff, the city manager. First of all, I don't know which is the tail, and I don't know which is the head. I have a dog at home named Winston, and I can tell you in his case where his head ms and where his tail is, and I don't know that that's the issue here today. That's not the issue that the city is hearing. The other thing that I would tell you is that I'm from the old school, and I still eat vanilla ice cream. Now, that doesn't mean that anybody out here who has finally gotten so progressive that they eat chocolate or heaven forbid something as dynamic as chocolate chip, you know, is wrong, and I think when we come to this issue today for anybody, the city, the commissioners, the fire people who are here, to think that this is an issue where everybody has to eat vanilla ice cream because that's what the city likes to eat, I don't think that's right. What the city is asking is something that we believe fits the city. We are not saying that this should, could or would fit any other district, dependent or independent. All we are asking is to have your cooperation. We cannot do this alone. Our bottom line here is four minutes. We are really -- again, we are not interested in whether they arrive in a fire truck with top training, whether they arrive in an ambulance with top training, whether they come in a police uniform in top training, four minutes is what we are interested in, and what we know is that the more people we can train regardless what uniform they wear or what delivery vehicle gets them there, if you can get that person there in four minutes, what have you done, you have statistically and realistically improved the chance of saving a life. So, what I ask everybody to do today with every district that's here and every person that's here, please do not approach this issue from a political territory standpoint or from a standpoint that you feel that if the city is permitted to do this, you're going to be forced to do this. That's not where we are coming from at all. We are asking for the people who live inside the city to be given a better chance of getting that four minute response. Thank you for your courtesy. COMMISSIONER NORRIS: Can I ask you a question? DR. WOODRUFF: Yes, sir. COMMISSIONER NORRIS: Would you be still supportive of this proposal if it was modified to some degree, and that degree would be to -- instead of transferring -- crossing people, simply sending your city people to the EMS system to be trained and then returned to your fire system? DR. WOODRUFF: Mr. Norris, if that is the only way that we can make it work, then certainly, we will -- as the old saying goes, a half a loaf is better than no loaf, and if that's the only way that we can get your concurrence, then we will do that. If there are financial issues, and we said this to the county administrator and to the folks in the department, if there are financial issues that you're concerned about, differential of pay, fine, I will be very willing to go to the city council and ask the seven, as we fondly refer to them, to -- COMMISSIONER NORRIS: They are listening, you know. DR. WOODRUFF: That's what I just thought of. COMMISSIONER MAC'KIE: Hi, guys. CHAIRPERSON BERRY: It's too late now, Richard. COMMISSIONER NORRIS: It's on television. DR. WOODRUFF: We would be very willing to look at the financial issues and recommend that the city address whatever financial implications that may be negative from the County Commission standpoint. COMMISSIONER NORRIS: My -- my real point in the financial discussion that I had was not so much the amounts of dollars but rather the appropriateness of spending money collected in one political subdivision to benefit another political subdivision. That's a problem. COMMISSIONER MAC'KIE: Except for the fact that EMS is countywide. The city depends on us for EMS. COMMISSIONER NORRIS: But the city fire department is not countywide. COMMISSIONER MAC'KIE: Right, just like each of the other districts are -- COMMISSIONER NORRIS: Exactly, you're making my point. COMMISSIONER MAC'KIE: Well, I don't think so. DR. WOODRUFF: Once again, though, the bottom line, to answer your question is, if there are financial issues, we are willing to look at them and support them to the city council. COMMISSIONER NORRIS: And once again, the number was not my issue, the amount of money is not my issue. DR. WOODRUFF: We appreciate your courtesy. Thank you. CHAIRPERSON BERRY: Thank you. MR. VASEY: I'm Dennis Vasey, commonly referred to as Duke, and today, I'm going to primarily talk to you about my professional career. I was, in fact, a fire chief, and I did have to deal with this issue. Although it was in the Army, and folks that you might run into would say that all the decisions in the Army are made by someone else, that's not entirely true. As a -- as a fire chief, one of my responsibilities was to ensure training and certification, and I was constantly amazed, and as Dr. Tober pointed out, the infrequency of actual situations that would permit continuous qualification, and it required us to send large numbers of our paramedics back to training facilities, emergency rooms, hospitals, community hospitals, anywhere we could get trauma centers so that they could physically keep up their certification, and then one day I was surprised to learn that the cost of recertification was enormous, and while everyone wanted all of the resources that they could muster at the point of the accident, when it came right down to talking dollars and cents, and Commissioner Norris, you've mentioned this, dollars and cents sometimes are oxymorons because sometimes when we have dollars, we don't have any sense at all, but continuous certification and qualification to a specified standard is a very, very significant venture, and it's very expensive. To the taxpayer who has an emergency, money is of no consequence. To the community at large, the reasonableness of dealing with an emergency is why we are here. Janet pointed out, and our study group discovered that over 80 percent of the emergency calls are medical, and they are all important. Dr. Tober mentioned that you had firefighters that were trained and willing to do this job, who if they didn't have a fire, were trained and willing to do the job. We have an EMS service that is trained, qualified, reputed to be one of the best in any situation, and Dr. Tober tells us that sometimes he has to send them back to various facilities to maintain their currency. So, I guess this is like what Dr. Woodruff mentioned. If you eat vanilla ice cream and you add something to it, you've really gone overboard. The statement was made earlier that in other northern cities, what you have is you have a fire service that handles EMS. Those are all established communities. They've been there for hundreds of years. You can look back at many atlases and find those cities were here in 1500, 1600, and what we've done is as the change in the community has occurred, we've adapted those community services to meet the need and today while we are in this workshop, we are in this workshop to determine the level of need and the best way, the most efficient way to address that need, and what I'm pleased about is that we are here, and I do thank each of you and all of you in this room for coming. CHAIRPERSON BERRY: Thank you. Chief Peterson. CHIEF PETERSON: Good afternoon, commissioners. My name is Don Peterson, fire chief, Golden Gate Fire Control and Rescue District. First of all, I need to let you know it wasn't my intent of speaking today. I had understood the workshop to be a workshop with City of Naples and Collier County and talking about how their interchange of firefighters and paramedics were going to be. Therefore, that's why I wasn't going to get involved. I'd like to share with you, though, that as a fire service in Golden Gate, we have a lot more things to do than run EMS calls, also. The fire service is multifaceted, and that's true all over the county and all over the United States. We are not just running EMS calls. As you well know, the development of Collier County is keeping us busy from the inspection standpoint. We've got reinspections of existing construction, a lot of activities going on in the county. I applaud the city for working with the county, getting to the point that you are. I think it's important that you look at addressing this with the city, and if you look to do this countywide, that there's a lot of other issues. Each department has its own -- we're diversified. We have our own specialties, if you would, per se. Golden Gate, we run a lot of brush fires. We don't run, necessarily, as many structure fires, vehicle fires, vehicle accidents. There's a lot of other issues. The primary issue there I would share with you is from our perspective is provide me the paramedic. Let's make an ALS engine. I don't have the manpower today to provide you an exchange. The people I have today, I need to be able to be diverse, and I think from us being a small department requires our personnel to be more diverse than any of the larger departments because they have the additional manpower that can take over scene command whereas our engineers today do everything from the fire fighting to scene command until additional resources can get to them. It is important to, and the goal, I think, countywide on everybody's mind is to provide that ALS service to the patients, ~articularly during the busy season of the year. It's -- especially in Golden Gate, we know that it's common for a medic unit to be out of the area with only one there. We are in the middle of everybody. Logically, it only makes sense to move units around to wherever the call load is going. That's why I would share with you, in the avenues of providing an ALS engine versus providing an additional ambulance would save the county money, would save taxpayers money if you provide me one person a day and work somehow with the districts to outfit the equipment as needed. Basically, that's all I wanted to share with you. I was a little concerned about getting sidetracked for the city because of some of the issues that we've dealt with over the years. I would share with you, too, we are one of the fire districts that has not signed the MOU with the county. It's not because we don't want the service. We want the service. We want the training. We want our people to be in line with everybody to be able to provide the best possible care out there, but it's also important to provide that at a cost-effective way for the taxpayer, and in our particular case, that's what it was coming down to, paying over $60 an hour versus $20 or less for basic first response or training, and there's no question whatsoever with instructors that are involved, with the system that's involved, it's a great system, but we need to look at it as a total package, and I know the commission will do that when it comes to the regular agenda that -- but I'd ask that, allow the city to do whatever you go forward with, and let's take a look at the remainder of the issues out there for other districts. Thank you. COMMISSIONER MAC'KIE: Just a question, if you don't mind. CHIEF PETERSON: Sure. COMMISSIONER MAC'KIE: I know you didn't come prepared, so if this is not appropriate -- just your department's budget and total number of personnel, is that something you would have off the top of your head? CHIEF PETERSON: We just -- I've got 16 on shift as of Monday. We are around 1.2 or 1.3. However, I would share with you, where you're going with that, I don't agree with the methodology of taking calls and dividing that into your annual budget. COMMISSIONER MAC'KIE: No, I wasn't going to do that. I've just been ~ryin$ to get a handle on what exactly the fire district budgets are since it's not anything that we look at. So, when I had a shot, I wanted to ask it, and while I'm at it, for saying my little speech about EMS being wonderful, most of us outgrew the motivation to be a fireman, and we are very grateful that you didn't, and that you do all the good work that you do. CHIEF PETERSON: Thank you. CHIEF TOBIN: Good afternoon, commissioners. How are you today? COMMISSIONER NORRIS: Good. CHIEF TOBIN: It's kind of interesting when you see -- oh, James Tobin. I'm the fire chief, North Naples Fire Control and Rescue District. I'm also the president of the Collier County Fire Chiefs. It's kind of interesting that we seemed to get off into money issues when -- when I had taken a look at that I pay $2,000 a year to the county, I have to have confidence in your ability that you're spending that money in the proper manner, and I'm one of those people who don't really complain where the money is being spent or, you know, if there's a raise in taxes, and I spend $140 a year to the fire district, and I spend 18,000 a year to the federal government, and I'm not really sure where that goes. I've had the -- maybe the unfortunate ability lately that we've had a number of major fires. We've seen a number in North Naples, Golden Gate, East Naples, and I want to say congratulations to each and every person who responded to that incident because it was definitely an integrated system. There were no boundaries. There was one group of emergency personnel responding to the emergency, and that's one of the things I wanted to bring up here today was the fact that though we have independent districts, we really don't have any boundaries, and we really are -- we are your fire department. You're the county. We provide the fire service to Collier County. So, in essence, we are your fire department, and we are one of the districts that signed the MOU and are pleased with it, and we -- fire chiefs, you know, are taking no position on what's going to happen between the EMS and the city, but I believe what I wanted to ask you today to do is to form a committee of maybe your chairman or one of your members and maybe the chairman of the steering committee of the fire districts, fire chiefs, the EMS, and let's sit down and really take a look at the delivery system. Let's -- let's take a look at the delivery system because today's firefighters are responsible not only for fire; water rescues, high angle rescues, collapsed rescue, hazardous material incidents, in support of that. I've worked a number of times, for example, with Tom White on hazardous material incidences. We are very pleased with Helen when she comes in and works with us in the fire department. I've had Commander Maguire on a number of different fires. So, if money is a concern and the delivery system is a concern and they have ideas and we have ideas, then why don't we finally sit down and get together. You have participation in this and take a look at the total delivery system and maybe the separation needs to stay. Maybe it needs to have more. Well, let's -- I think we need to maybe put it to rest and work towards a common goal and just find out our roles and responsibilities here in the county. Thank you. COMMISSIONER MAC'KIE: Question, same question about -- just because I've always -- CHIEF TOBIN: Seven point two million. COMMISSIONER MAC'KIE: Seven point two million? CHIEF TOBIN: Eighty-nine personnel. COMMISSIONER MAC'KIE: And your department has a request in with the county to compete with the county's ambulance service? CHIEF TOBIN: No, we have a request, okay -- is the doctor still here? I have a lot of respect for Dr. Tober and what he said. We have requested a limited protocol. We -- we fully understand that we have to work under this man's, over here, direction. We've only asked that in those cases that we have, after he has his comfort level, we understand that, that we be able to do a limited protocol. Now, all right, maybe that's not intubation. We put that in there. Maybe that's just a twelve lead defibrillator. Maybe that's setting up an IV until the medics get there and start the drugs. That's all we've asked for. COMMISSIONER MAC'KIE: You're not looking to have another ambulance system to compete with the county's? CHIEF TOBIN: Absolutely not. COMMISSIONER MAC'KIE: Great. CHIEF TOBIN: We've asked for a nontransport limited protocol in North Naples, and we understand that we have to work under the system. We understand that we have to work within the system, and we understand that we have to meet the criteria of the medical director. Again, when you hear that budget, you need to understand that we protect seven billion dollars' worth of property. How well trained we are, how well we are equipped and how well we respond has a direct effect on how much you pay in your insurance rates. So, the fire department -- not only that, but 75 percent of the building codes come under the fire department. You don't put in the carpet, you don't put up a wall, you don't put in a fixture unless we say it's okay. So, there's a lot more responsibility and services being provided by the fire service today. COMMISSIONER MAC'KIE: I'm clear about that. That's -- I mean, that's absolutely true with all the construction and inspections going on. CHIEF TOBIN: Right. COMMISSIONER MAC'KIE: I don't think fires versus medical calls is the end-all as an analysis point. CHIEF TOBIN: And there's -- you know, there's a lot of issues out there. So, if we can do this with a representative from the Collier County Commission, a representative from the fire district, fire chief, EMS, the county administrator, maybe we can have a task force meet once a week, take a look at the issues and come to a conclusion. Maybe that's the way we need to go. CHAIRPERSON BERRY: Commissioner Norris. COMMISSIONER NORRIS: Chief Tobin, have you ever done an analysis of what your budget would be if you made no calls at all? CHIEF TOBIN: It would be the same because we protect property and area. COMMISSIONER NORRIS: Right. So, whether you make a lot of calls or no calls, you're really only talking about fuel, aren't you, and a few other minor things? CHIEF TOBIN: Oh, correct, the fuel to respond to the calls, that's correct. COMMISSIONER NORRIS: Thank you. MR. DIMARIG: Good afternoon. My name is Pete Dimarig. I'm the president of the Professional Firefighters of Naples. The only message I'd like to convey today is that our goal as an organization is our commitment to our community, and this program will enhance that commitment tremendously, and I just want to extend that we support this program in every way. Thank you. COMMISSIONER MAC'KIE: Thank you. MS. CURLEY: Good afternoon. My name is Doris Curley (phonetic). I have to admit I was a little bit -- I thought this was going to be a workshop. Sorry. CHAIRPERSON BERRY: It is. COMMISSIONER MAC'KIE: It is. MS. CURLEY: A workshop for people to -- for all of us to sit down and discuss exactly what could be done. I didn't think that we were going to actually come up and speak. So, I'm a little disappointed when you said earlier that you have already made your decision, and you want to vote now, and there are two commissioners that are not here, so I was a little disappointed in that. COMMISSIONER MAC'KIE: Just for your comfort, I mean, I've done so much research on this. MS. CURLEY: Oh, no, I'm sure you have, but I've also had the opportunity to ride along in the fire department program, and also, Tom White has taken me on a ride along for the paramedics for the EMS. There is I think -- right now, I don't believe there is a problem, but with the growth in Collier County the way it is, there is going to be a problem. No matter who gets there first, it's -- the advanced life support needs to be with whoever gets there first, and I if the fire fighters are trained as paramedics and they can pass the Tober test, go through the Tober test, that they should be able to perform advanced life support, and the bottom line is the citizens. We are the ones that it is going to affect, our parents, our children, our husbands, our spouses, everybody. It is going to be us. So, I think that no matter how -- or how we can work it out, I think there is -- somehow we can work it out, that they can work together. Fire departments can use the advanced life support, and we are fortune that fire calls are down with education, with building codes. That's wonderful that fire calls are down. That's great. We want that to happen. So let them use their training also as a paramedic and perform advanced life support. Thank you. COMMISSIONER MAC'KIE: You just made me realize I probably should be clear about what it was I was ready to vote on. I represent the City of Naples at semi district, and I'm absolutely supportive of that pilot program. I don't have the answer yet for a countywide idea. MS. CURLEY: Oh, I don't either. That's why I'm hoping we can get one. That's why I'm hoping we'll work together and form one. COMMISSIONER MAC'KIE: Me, too, and I'm listening. CHAIRPERSON BERRY: Are you on a -- are you on a committee or do you -- MS. CURLEY: Yes, I am part of the North Naples Fire Department Citizens' Advisory committee. MR. MILLIGAN: My name is Steve Milligan. I'm fire commissioner from North Naples Fire District. Also, I'm the chairman of the countywide Steering Committee for the fire services and just to share that all of the fire departments are very supportive of what Chief Rambosk and -- has presented as far as for the city. As I shared with the chief the other day, having both been in fire and in law enforcement for many years, there are different changes and there are changing things that are happening. Washington or -- Washington, I was thinking of the county sheriff's department I was in. Collier County Sheriff's Department did not go to an emergency service program when the City of Naples went to police and emergency services, and it's the same thing here. I believe that with the city, as they've asked, I believe it would be a pilot program with the city and the county, and I believe that all of it -- I can speak for the commissioners of the independent districts, would be very supportive of that in seeing what happens from that for the future. I know you look at seven square miles with two units is a whole lot different than 80 some square miles with present -- well, soon will be six stations, eight companies in North Naples or 150 miles, is it, Chief Peterson, square miles for Golden Gate and East Naples and other areas, it's going to be a whole lot different ball game on how we are able to operate and function and work these details out, but I just believe that we would support this proposal as far as what the city wants to do with the county and go that way, but what happens there should have no impetus onto the rest of the county and the other fire districts. COMMISSIONER MAC'KIE: Just a question. I definitely, as you already know, support the idea of the city program. I will tell you that I'm hopeful that it will lead us down a road that will show us how to address the problem countywide. Do you think that we're all looking for a solution to the countywide program or -- MR. MILLIGAN: I believe that, yes. I think we have even presented programs -- COMMISSIONER MAC'KIE: I know you have. MR. MILLIGAN: -- where we could save the county hundreds of thousands of dollars by having ALS engines that are already manned. Commissioner Norris had asked the question, how much more does it cost if you're responding. If you've got the people there, they are going to be on the scene. Why put another ambulance in a location when you've already got an ALS engine that's right there on the scene that could respond, be there until the transport unit gets there? COMMISSIONER MAC'KIE: Or vice versa maybe. CHAIRPERSON BERRY: Thank you. At this time, I would like to read a letter from Commissioner Hancock who was unable to be here. Commissioner Constantine early on had indicated he would not be able to be here today. Commissioner Hancock had an emergency that came up, and he was unable to be here. His letter reads, Dear Commissioner Berry, due to a scheduling conflict, I will be unable to attend the emergency services workshop on Thursday, May 21st, 1998. I've had extensive meetings with Ms. Diane Flagg, emergency services director; Dr. Robert Tober, emergency management services personnel, regarding the ALS engine concept. I am supportive of the commission moving ahead to form the ALS engine partnership provided that a proper training program is established by Dr. Tober and provided that there is minimal or no fiscal impact to the taxpayer. Sincerely, Timothy L. Hancock, commissioner in district two. I would like to comment that this is a workshop. There's not going to be any votes taken. There will be no official action taken today. That would be inappropriate. This will come back before the commission, and at that point in time, we will make a decision as to what direction we are going to go. Chief Flagg. CHIEF FLAGG: Just to summarize some of the things that were discussed this afternoon. The proposed partnership that we are talking about with the City of Naples is a provision of enhanced emergency services to the community from its current, and again, the enhancement is that if that primary paramedic unit is already committed to a 911 call, this provides trained, capable and experienced paramedics on an engine to go to the call and just a swapping of individuals where they are taking the firefighter that would normally be on that engine and put them on the medic unit. The advantage of this partnership is that it utilizes known emergency services professionals, individuals who may have been a firefighter for 10 or 15 years or may have been a paramedic for 10 or 15 years, but they know emergency services. They know emergency service operations. They've been working side by side for several years, and so it's very different than a fire department hiring a green firefighter or EMS hiring a green paramedic. These are known emergency service professionals who have worked side by side with each other, and the additional advantage of this partnership is it enhances the capabilities of these known professionals at their fullest capability, not at a limited capability. So, what you're getting is you're getting an enhanced service utilizing known emergency service professionals that have worked side by side on scenes for several years and you're further enhancing the emergency medical care that they've received, and just as another point, the discussion about the traffic accidents and the single vehicle response program, engines do respond by definition through the program to traffic accidents because not only is there potentially an extrication issue, but there may also be a hazardous material issue if there is fuel leakage. So, just a point of clarification, even though an agency is participating in the single vehicle response program, by definition, the engine still goes. CHAIRPERSON BERRY: Okay. Very good. Dr. Tober. DR. TOBER: I wanted to respond to one other conce~t that you had talked about. I think the door of training needs to swing both ways for the following reason. Again, I'm sharing with you the pressures that I've experienced -- I know many firemen very well, and I know -- obviously, I know the paramedic group of people very, very well, but there is -- and I have been showered with a pervasive worry about the future from both sides. The firemen have worried to me privately about what their future is as firemen in a system where the codes and their own inspections seem to be putting them out of the fire business, although, obviously, fire inspections continue to be a part of what they do, and, of course, the paramedics are in the same boat thinking, well, if I take all these firemen and make them as good as me, but I'm not a fireman, what is left for me in the future, because both sides, whether they want to admit it publicly at this forum or under their breath, see a coalescence either functionally or officially of their services. I think they see that. They seem to talk about that a lot in private to me, and it didn't seem reasonable to take one group and push them through this door without letting this group go through the door the other way, and when we addressed this issue with Kevin Rambosk from the city, you know, I was concerned whether the IFFA, the International Fire Fighters Association, which is a strongly unionized group of people, would object to a mixing of manpower, and I was assured by Kevin that there was not a problem from the IFA -- IFFA standpoint in his organization, and again, that's why we've floated this proposal to you and to your group for deliberation because I think that if I'm to ask my clinical experts to start imparting that clinical expertise to another group of people, I think they need to feel that there is a certain reasonable fair exchange of experiences and learning or they are going to feel like they are shortchanged from the very beginning. COMMISSIONER MAC'KIE: Just on that point, one thing that I am troubled by but don't think we're going to go much further with, perhaps, today is that it's my understanding that as firefighters are EMS trained, they do that on the clock and at the expense of their fire districts primarily. While in the program that we are proposing with the City of Naples, the paramedics could get fire training but only when they are not being paid and only at their expense. Do I have that right? CHIEF FLAGG: When the -- through this partnership program is the paramedics will be on the clock and working in their profession and the same with the firefighters. They will actually be assigned to the units and working in their profession. COMMISSIONER MAC'KIE: But are we going to pay for fire training for the paramedics? CHIEF FLAGG: Presently, the fire -- the paramedics that are in fire school are going at their own expense and on their own time, which is separate from this partnership. This partnership is actually taking advantage of the fact that we have a group of 20, 25 individuals who have extended a tremendous level and demonstrated a level of commitment to the community, to be able to enhance service to the community and to fully maximize their capabilities in both EMS and fire. COMMISSIONER MAC'KIE: So, the answer to the question is these -- these firefighters have already -- these paramedics have already at their own expense and on their own time obtained the training? CHIEF FLAGG: Yes, they are presently in fire school and are scheduled to end next month. COMMISSIONER MAC'KIE: Thank you. COMMISSIONER NORRIS: What about for the future? CHIEF FLAGG: I'm sorry? COMMISSIONER NORRIS: What about for the future? Her question was, what about the ones that are coming? CHIEF FLAGG: In the future and future fire classes, the board has made no policy direction on that. Certainly, that's something that could be reviewed by the board and revised if that was the board's desire. The advantage here certainly is that we have this opportunity to develop this partnership program because of their level of commitment to the community, and the minimal cost that will be incurred for this partnership program is that as firefighters -- there's a state statutory requirement about special risks, which we've planned for and outlined for you-all, and also the minimal costs for the medical equipment. Overall what we'll provide is advanced life support to that community member in that four minutes or less time frame, and realistically, that's what it's all about. MR. FERNANDEZ: Madam Chairman. CHAIRPERSON BERRY: Yes. MR. FERNANDEZ: Ms. Flagg, I believe the question from Mr. Norris spoke to the issue -- and I would be interested in the answer of whether approval of the pilot concept with the City of Naples would require the county to train paramedics as firefighters in the future? CHIEF FLAGG: No, it would not. We will have plenty of paramedics who are cross trained to do the partnership. COMMISSIONER MAC'KIE: And I guess I was looking into the future if this should grow into a bigger program, I think, you know, it would be appropriate for people not to have to do it on their own time and with their own dollars. CHIEF FLAGG: Certainly, and that certainly could be brought to the commission for approval. MR. FERNANDEZ: The point is, approval of that concept wouldn't automatically bring with it approval of the concept of training paramedics to be firefighters. COMMISSIONER MAC'KIE: Of course. CHAIRPERSON BERRY: Ail right. At this time, this, I believe, ends the public comment and all the other information that's come. Commissioners, do you have any comments that you would like to make in closing? COMMISSIONER MAC'KIE: Just an urge to support the pilot program with the city. CHAIRPERSON BERRY: Commissioner Norris. COMMISSIONER NORRIS: Yes, I have a comment. Several people, including Chief Frazier, told us about other fire departments, consolidated operations that fire departments service EMS at the same time, combined operations up north, and I think a lot of them do, but that's not the reality of Collier County. Collier County has been set up with a system mainly of independent fire districts versus City of Naples as is now the City of Marco, and we had the two dependent districts that we should be doing something different with, but the main point is that the voters themselves are the ones who said we want separate fire service. The voters said that, and I can tell you that I'm one commissioner who is not going to violate the will of the voters. I'm not going to subvert it, and I'm not going to try to circumvent the will of the voters. The voters have set this up for the fire service to be provided separately, not by Collier County, and any proposal that has Collier County providing fire service, I cannot support for that reason. Now, that doesn't mean that there's not another way to skin the cat. I proposed something to Dr. Woodruff earlier that would alleviate most of my concerns. I don't have a big concern with training EMS, giving EMS training to certain firefighters, but it's the other way around that the voters have said they don't want that, and until they tell us different, that's the way we should do it. That's our job as elected officials, to carry out the will of the voters. Now, if we wanted to provide EMS service to all the independent fire districts at some point in the future, that might be fine, and then we could just go ahead and collapse our countywide EMS system and let the fire departments do it. Why should we provide duplicate services? Why would we need to do that if the independent fire districts were doing the EMS? So, that's a thought that we could look at in the future as well, but it's very interesting to me that one of the reasons given to justify this program is actually the program itself. I mean, one of the reasons given from time to time is we don't want to have duplication of services. Well, when you have EMS providing fire service and fire service providing EMS, you're duplicating services. COMMISSIONER MAC'KIE: They're not doing it at the same time. I mean, that's the point. COMMISSIONER NORRIS: Sure they are. COMMISSIONER MAC'KIE: Right now, they are showing up in two separate vehicles duplicating service, and this would allow -- COMMISSIONER NORRIS: And as you have heard on traffic -- COMMISSIONER MAC'KIE: On traffic. COMMISSIONER NORRIS: -- they are going to do the same thing. COMMISSIONER MAC'KIE: Right, and the other point too on the question, how should we provide this streamlined service, because I think everybody -- COMMISSIONER NORRIS: It's not how. It's whether is the question. COMMISSIONER MAC'KIE: Well, I think the question is how should we, and for me, the point that the fire districts have a fifteen million dollar budget combined and that EMS is doing much more work for seven and a half million dollars is very telling to me about which is the more efficient of the two systems. COMMISSIONER NORRIS: Compare it to the parks department for me, please. What's the parks department's budget, Mr. Fernandez? Compare that to the EMS budget. MR. FERNANDEZ: I don't have that number. COMMISSIONER NORRIS: It's about as relevant. I mean, it's a different operation. COMMISSIONER MAC'KIE: We all have our opinions about that. CHAIRPERSON BERRY: I think it's very difficult to draw any conclusions today. I do agree with the idea, I don't think one size fits all. I think if there's some kind of an agreement struck with the City of Naples, I think the best thing that could happen would be to let that work and let it -- see how it works out and plays out and if that's in the best interest. As far as doing this on a countywide basis at this point in time or anything like that, I would want a lot of input from a lot of residents in Collier County to see that's the direction. What I see right now, we have efficient fire departments, and we've got very efficient EMS operations, and we've got very well trained people in EMS. I certainly don't want to sacrifice that part of it, but that's not to say that we don't start looking into the future in seeing, trying to figure out what is the best delivery system down the road; not today. We are not going -- you know, I'm not going to go out and -- I don't want anybody to walk out of here today and think that as far as this commissioner is concerned that I'm pulling the rug out from either entity. I don't think that that's a proper approach to this whole situation. I think it requires a great deal of study -- and please turn that beeper off. I can't even imagine it's even on. I thought that satellite died. At any rate, I think today, it was great to get this information, hear a lot of different thoughts and different ideas on the whole situation. I think everybody needs to walk out of here -- some of you that didn't -- that came here to get information, I hope you got a little more information than you came with today, give you something more to think about, and in the meantime, as a commission, we'll deal with some of these other issues at the appropriate time. COMMISSIONER MAC'KIE: Just a question about -- this is a contract proposal that will be coming back to the board on an agenda? CHIEF FLAGG: Yes, Commissioner. What -- if I could address Commissioner Norris' point about separate districts. The advantage of a partnership is that the partnership allows each agency to maintain its own governing bodies. So, you get all the servmce benefits but you don't compromise or change governing bodies. So, with partnerships such as these, the fire districts would continue to maintain its governing body, but you're getting all of the benefits of the service levels because people are being trained at the same level, enhancing the services, utilizing individuals in a cross trained format; ultimately, providing a higher level of service to the community. It would be our intent to bring the partnership proposal back to you in the form of an interlocal agreement and in that interlocal agreement, we would agree, obviously, to all the parameters and the specifics with the partnership program within -- conjunction with the legal staff of both the city and the county. We have met both Chief Rambosk, and I have met and talked to the various licensing entities myself, specifically with the Stadium S office and worked everything out, made sure that everything is where it needs to be in terms of providing this partnership program and have been able to develop a program that will provide an enhanced level of service to the community. So, it would be our intent to bring an interlocal back to you for formal approval. COMMISSIONER NORRIS: Well, you missed my point, and maybe it's my fault for not making it clear enough, but if you think it has to do with retaining the political subdivisions of the independent fire districts, that was not it. My point was simply that the voters themselves, the citizens of Collier County set up those independent fire districts, and what they did when they -- what they said when they did that was we want these people to provide fire services. So, any proposal that has Collier County providing fire services, I cannot support. That's simply my point. COMMISSIONER MAC'KIE: This is just another point I've been curious about and used this forum, it's for information. Are all of the independent fire districts, were they all created by referendum or were any of them created by legislative act? CHIEF FLAGG: Well, the independent districts have a legislative act. I can't speak to whether each of them was by referendum. The acts have changed over the years. There were separate independent acts, and then most recently, there was a single act which the biggest change was probably changing the commissioners from three to five. COMMISSIONER MAC'KIE: But do we know -- is that absolutely for sure that each of the five independent districts had a separate referendum vote? COMMISSIONER NORRIS: Most of them are represented here. If there are any that were not, have them say so right now. CHIEF TOBIN: In North Naples, the North Naples Civic Association formed the North Naples Fire Control District. COMMISSIONER MAC'KIE: So, North Naples was -- I'm sorry, just to get -- CHIEF TOBIN: Vote of the people. COMMISSIONER NORRIS: Vote of the people. COMMISSIONER MAC'KIE: If you don't mind, you said North Naples Civic Association formed -- CHIEF TOBIN: Yes, which there isn't one now, but at that time, the North Naples Civic Association formed the North Naples Fire Control and Rescue District. COMMISSIONER NORRIS: And they did that through a vote of the people. CHIEF TOBIN: Yes, they did. COMMISSIONER MAC'KIE: Through a referendum on the ballot? CHIEF TOBIN: Yes. COMMISSIONER MAC'KIE: And they -- what was the role of the North Naples Civic Association then? Did they -- CHIEF TOBIN: There wasn't a fire department, so they thought North Naples needed one. COMMISSIONER MAC'KIE: I understand that. CHIEF TOBIN: And they came up with the boundaries -- COMMISSIONER MAC'KIE: They did the ground work, and then it went to an official vote, Mary Morgan, supervisor of elections kind of a vote? CHIEF TOBIN: That's correct. COMMISSIONER MAC'KIE: Okay. Just want to get that straight. Anybody -- is that the case for everybody? It was all that kind of a vote? I'm just wanting to know that for sure. Thanks. CHAIRPERSON BERRY: Okay. If there's nothing further, this workshop is concluded. There being no further business for the good of the County, the meeting was adjourned by order of the Chair at 2:50 p.m. BOARD OF COUNTY COMMISSIONERS BOARD OF ZONING APPEALS/EX OFFICIO GOVERNING BOARD(S) OF SPECIAL DISTRICTS UNDER ITS CONTROL BARBARA B. BERRY, CHAIRPERSON ATTEST: DWIGHT E. BROCK, CLERK These minutes approved by the Board on AS presented or as corrected TRANSCRIPT PREPARED ON BEHALF OF GREGORY COURT REPORTING BY: Dawn Breehne