EMS Policy Agenda 1/21/2011
EMS
POLICY
ADVISORY
BOARD
AGENDA
JANUARY 21, 2011
COLLIER COUNTY EMERGENCY MEDICAL SERVICES
POLICY ADVISORY BOARD
AGENDA
MEETING TO BE HELD:
NEIGHBORHOOD HEALTH CLINIC
121 Goodlette Road N.
Naples, FL 34102
Second Floor Education Room
DATE:
January 21,2011
TIME:
3 :30 p.m.
1. CALL TO ORDER AND PLEDGE OF ALLEGIANCE
2. AGENDA AND MINUTES
A. Approval of Today's Agenda
B. Approval of Minutes from the September 17,2010 Policy Advisory Board Meeting
3. OLD BUSINESS
A. Review of Blue Ribbon Committee Report
4. NEW BUSINESS
A. Election of a Chairman and Vice Chairman
B. Establishment of a schedule for 2011 meetings
5. STAFF REPORTS
A. Review of COPCN application from North Naples Fire
B. Review of COPCN renewal from NCH
6. PUBLIC COMMENT
7. BOARD MEMBER DISCUSSION
8. ESTABLISH NEXT MEETING DATE
9. ADJOURNMENT
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
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 of the 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 1,12 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 ofthe 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 Sheriffs 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 ifthe 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 Sheriffs 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 "A TRUS Program" which will
be a fully automated system capable of informing a caller of the location of an AED unit.
The problem is the HIPPA 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 ofHIPPA.
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
BOTTOM-LINE RECOMMENDATIONS
FOR
PREHOSPIT AL EMERGENCY MEDICAL TREATMENT AND TRANSPORT
(PEMTT) SERVICES
PREFACE
Collier County, Florida is one of the best places in America to live, work and visit.
Daily, we have at least 1,294 public safety professionals (662 Sheriffs Deputies in law
enforcement, 632 Fire Rescue and Emergency Medical Service Officers.. .246 of which are
Paramedics) on call to risk their lives to help, protect and serve us.
The Panel producing this report, over and over again during the past year of its study, was
impressed and regularly gratified by the evidence that all these professionals are dedicated,
focused, and conscientious. They work hard to immediately help us during our most vulnerable
moments.
The data shows clear results.
Our prehospital emergency medical treatment and transport (PEMTT) professionals enjoy
national praise. And, we enjoy living in one of the safest and healthiest communities in America.
National studies rank Collier County as the generally healthiest county in Florida. And, we have
the best cardiology services in Florida.
Moreover, Collier County residents have the highest life expectancy in Florida and the fourth
highest life expectancy in the United States.
And, we want to keep it that way.
The report is dedicated to praising our "best and brightest" PEMTT professionals and
recommending ways in which we can improve the system that supports them. Shifting
demographics, medical advances, technological leaps.. .all dictate that we craft our future by
expertly managing our resources. This report recommends ways in which we all, our
professionals and our citizens, together can continue to be an even healthier, safer community.
Page 10f5
RECOMMENDATIONS
I. The Board of County Commissioners should designate and delegate authority and
responsibility for all PEMTT services to a Public Safety Authority.
2. Reappoint the medical director to report to the designated Public Safety Authority. The
Panel strongly suggests that the medical director work closely with the leaders of the three
hospitals' emergency departments serving Collier County (NCH, PRHS, and Lee Memorial
trauma departments.)
3. Establish a PEMTT Council to report to the designated Public Safety Authority, chaired by
a hospital administrator. Under the guidance of the designated Public Safety Authority, the
medical director, in collaboration with the directors of the emergency departments of the
NCH, Lee Memorial Trauma Center and PRHS, will promulgate all PEMTT personnel
training, quality initiatives, credentialing and testing. Membership on the Council to include
representatives from fire districts, the public and outside independent experts.
4. Out source all test design, administration, evaluation and dispute resolution to professionals
at a local college or university to insure independence and objectivity.
5. The designated Public Safety Authority should propose administrative procedures and
policy to the Board of County Commissioners after thorough vetting of such by the Council.
The Board of County Commissioners should set general policy; the designated Public Safety
Authority should implement and manage the system; The Board of County Commissioners
should evaluate the clinical and financial efficacy of all proposed procedures and policies.
6. With guidance and advice from the PEMTT Council and delegated authority and
responsibility from the Board of County Commissioners, the designated Public Safety
Authority should lead development of a five-year strategic plan...with a required three-year
audit provision... to provide collegial oversight for all involved in establishing a refreshed
PEMTT model for county-wide PEMTT services
7. Establish a two-tiered county-wide PEMTT model:
. Tier One = Timely delivery of Basic Life Support (BLS) Services
. Tier Two = Timely delivery of Advanced Life Support (ALS) Services
8. Mandate that all agencies providing ALS services also provide patient transport to
hospitals.
9. Establish a mandatory Automatic Electric Defibrillator (AED) placement and training
program for all staff at appropriate public locations. Effective and efficient AED execution
must be countywide priority involving all facets of the public and private sectors.
Page 20f5
10. Encourage discussion of functional consolidation of fire service districts in Collier
County and expert reallocation of resources in response to current demographics and
professional standards, utilizing the county's Productivity Committee to comprehensively
study and review all costs and potential service enhancements.
11. Encourage consideration of a pilot project aimed at a functional integration of county
EMS personnel into the fire service districts. To do so, the pilot districts would utilize
position control administration to manage the optimal assignment of Paramedic and EMT
positions and also the possible use of smaller, lighter ambulances to be used in certain non-
ALS required response situations.
12. Encourage all PEMTT agencies within fire service agencies to collaborate in order to
develop common response protocols.
13. Encourage all PEMTT agencies to collaborate to designate one leader to be the one voice
for all PEMTT treatment and transport matters conducted BY fire services operating in
Collier County.
14. Mandate that all PEMTT vehicles be equipped with standardized life saving equipment
COMP A TIBLE with AREA hospital emergency department equipment and supplies.
Page 30f5
The Panel
Geoffrey Moebius, Chair-Blue Ribbon Panel
Community Liaison and Past CEO, Physicians Regional Healthcare System
Edward A. Morton, Vice Chair-Blue Ribbon Panel
Partner & Managing Director, Wasmer Schroeder & Company, Inc.
Past CEO, NCH Healthcare System
Patricia Barton, Community Leader
Edward Boyer, Retired Healthcare System Executive
Russell Budd, President, Wall Systems Inc. of Southwest Florida
Joseph Gauta, M.D., Past President, Collier County Medical Society
Michael V. Reagen, Ph.D., President, The Greater Naples Chamber of Commerce
& Leadership Collier Foundation, Inc.
EMS and Fire Chiefs. Assistant Chiefs and Firefiu:hters
Jorge Aguilera, Deputy Chief of Medical Services and Community Relations
North Naples Fire Control & Rescue District
Dan Bowman, Deputy Chief, Collier County Emergency Medical Services
Chris Byrne, Deputy Chief, City of Marco Island Fire-Rescue District
Steve McInerny, Chief, City of Naples Fire District
Robert Metzger, Chief, Golden Gate Fire Distri~t
Jeff Page, Chief, Collier County Emergency Medical Services
Dan Summers, Executive Director, Collier County Department of Emergency Management
Eric Watson, Firefighter, Big Corkscrew Fire District
Wayne Watson, Deputy Chief, Collier County Emergency Medical Services
Page 40f5
Hospital Leaders
Joseph Bernard, Chief Operating Officer, Physicians Regional Healthcare System - Collier Boulevard
Phillip Dutcher, Chief Operating Officer, NCH Healthcare System, Inc.
Chris Lee, M.D., Associate Medical Director, Collier County Emergency Medical Services
Hospital Emeru:encv Department Physicians
Todd D. Bethel, M.D., Emergency Medicine, Naples Community Hospital
John P. Lewis, M.D., ER Physician Director, Naples Community Hospital
John W. Zelahy, M.D., Emergency MedicinelInternal Medicine
Physicians Regional Hospital - Pine Ridge Road
Robert Tober, M.D., Medical Director, Collier County Emergency Medical Services
Florida Gulf Coast University
Lisa Zidek, Ph.D., Associate Professor, Florida Gulf Coast University
Collier County Sheriffs Office
Jim Bloom, Chief of Operations, Collier County Sheriffs Office
Deborah Chester, Manager of Planning & Research, Collier County Sheriffs Office
Page 5 of5
This report
to remain
CONFIDENTIAL
until presented to
Collier County, Florida
Board of County Commissioners
on January 11, 2011
at the CCMeeting.
BLUE RIBBON PANEL REPORT
FOR
COLLIER COUNTY, FLORIDA
BOARD OF COUNTY COMMISSIONERS
REGARDING
PREHOSPITAL EMERGENCY
MEDICAL TREATMENT
& TRANSPORT (PEMTT) SYSTEM
PRESENTED TO
COLLIER COUNTY, FLORIDA
BOARD OF COUNTY COMMISSIONERS
JANUARY 11, 20Jl
TABLE OF CONTENTS
Acknow ledgments..................................................................................................................... .2
Executive Summary.. ........ ..... ....... ....................... ..... ...... ....... ............. ............... ..... ............... ..II
History.. ..... ....... ........ ........ ..... ........ .... ...... ..... ....... ..... ..... ................ ..... ....... ... ....... .... .... .......... ...13
Lessons Learned: A Reality Check for System Adjustments ..................................................16
The Current Local Scene.............................................................................................l 7
Elements of a Refreshed Model...................................................................................l8
Lessons Learned from King County, Washington.......................................................19
Lessons Learned from Broward County, Florida ........................................................21
Lessons Learned from V olusia County, Florida ............... ...... ..... ................ .......... ......23
Lessons Learned from Cities of Marco Island and Naples, Florida ............................24
The Panel's Recommendations............................................................................ ................... .25
Bibliography.. ..... ...... ..... ....... ........ ..... ..... ..... ... ............... ..... ..... ..... ..... ...... ....... ..... ..... ... ... ..... ....31
Data Analysis
Blue Ribbon Panel Reportfor Collier County, Florida Board of County Commissioners regarding
Prehospila/ Emergency Medical Treatment & Transport (PEM7T) System
Page 1 of 32
ACKNOWLEDGMENTS
ACKNOWLEDGMENTS
The Blue Ribbon Panel wishes to acknowledge those individuals who participated in the review
and development of the proposal and recommendations being presented to the Collier County
Board of Commissioners.
The Panel
Geoffrey Moebius, Chair-Blue Ribbon Panel
Community Liaison and Past CEO, Physicians Regional Healthcare System
Edward A. Morton, Vice Chair-Blue Ribbon Panel
Partner & Managing Director, Wasmer Schroeder & Company, Inc.
Past CEO, NCH Healthcare System
Patricia Barton, Community Leader
Edward Boyer, Retired Healthcare System Executive
Russell Budd, President, Wall Systems Inc. of Southwest Florida
Joseph Gauta, M.D., Past President, Collier County Medical Society
Michael V. Reagen, Ph.D., President, The Greater Naples Chamber of Commerce
& Leadership Collier Foundation, Inc.
EMS and Fire Chiefs. Assistant Chiefs and Firefiu:hters
Jorge Aguilera, Deputy Chief of Medical Services and Community Relations
North Naples Fire Control & Rescue District
Dan Bowman, Deputy Chief, Collier County Emergency Medical Services
Chris Byrne, Deputy Chief, City of Marco Island Fire-Rescue District
Steve McInerny, Chief, City of Naples Fire District
Robert Metzger, Chief, Golden Gate Fire District
Jeff Page, Chief, Collier County Emergency Medical Services
Dan Summers, Executive Director, Collier County Department of Emergency Management
Eric Watson, Firefighter, Big Corkscrew Fire District
Wayne Watson, Deputy Chief, Collier County Emergency Medical Services
Blue Ribbon Panel Reportfor Collier County, Florida Board of County Commissioners regarding
Prehospital Emergency Medical Treatment & Transport (PEM1T) System
Page 2 of 32
Hospital Leaders
Joseph Bernard, Chief Operating Officer, Physicians Regional Healthcare System - Collier Boulevard
Phillip Dutcher, Chief Operating Officer, NCH Healthcare System, Inc.
Chris Lee, M.D., Associate Medical Director, Collier County Emergency Medical Services
Hospital Emeru:encv Department Physicians
Todd D. Bethel, M.D., Emergency Medicine, Naples Community Hospital
John P. Lewis, M.D., ER Physician Director, Naples Community Hospital
John W. Zelahy, M.D., Emergency MedicinelInternal Medicine
Physicians Regional Hospital - Pine Ridge Road
Robert Tober, M.D., Medical Director, Collier County Emergency Medical Services
Florida Gulf Coast University
Lisa Zidek, Ph.D., Associate Professor, Florida Gulf Coast University
Collier County Sheriffs Office
Jim Bloom, Chief of Operations, Collier County Sheriffs Office
Deborah Chester, Manager of Planning & Research, Collier County Sheriffs Office
Blue Ribbon Panel Reportfor Collier County, Florida Board of County Commissioners regarding
Prehospital Emergency Medical Treatment & Transport (PEMIT) System
Page 3 of 32
Geoffrey Moebius
Chair-Blue Ribbon Panel
Community Liaison and Past CEO, Physicians Regional Healthcare System
Geoffrey Moebius serves as the Community Liaison for (the Physicians Regional Healthcare
System) Physicians Regional Medical Center. He came to Naples to oversee the completion of
Cleveland Clinic Florida Naples' new hospital and served as the hospital administrator until
Health Management Associates purchased the facility on May I, 2006. In 2006, Mr. Moebius
became CEO of Physicians Regional Medical Center and served as CEO until retiring in
December, 2009.
Mr. Moebius has a Masters Degree in Health Specialties from Cleveland State University and a
Bachelor of Science from Lake Erie College. In addition, he completed the Kaiser Permanente
Executive Master Program at Stanford University during his tenure with Kaiser Foundation
Health Plan, Cleveland, Ohio.
Mr. Moebius' career began at Meridia Huron Hospital in Cleveland where he worked for five
years as the administrative director of operations. He held leadership positions in administration
with Kaiser Foundation Health Plan in Cleveland and was CEO of Deaconess Hospital of
Cleveland and Saint Michael Hospital, both owned by Primary Health Systems. Prior to joining
Cleveland Clinic Florida, he was the chief administrative officer at Deaconess Hospital LLC,
Cleveland.
He is a presently a member of the Collier Heart Walk Executive Leadership Team, Southwest
Florida American Heart Association Board and serves on the board of The Greater Naples
Chamber of Commerce.
Blue Ribbon Panel Reportfor Collier County, Florida Board of County Commissioners regarding
Prehospital Emergency Medical Treatment & Transport (PEMIT) System
Page 4 of 32
Edward A. Morton
Vice Chair-Blue Ribbon Panel
Partner & Managing Director, Wasmer Schroeder & Company, Inc.
Past CEO, NCH Healthcare System
Prior to joining Wasmer Schroeder & Company, Inc., Morton held the positions of Chief
Executive Officer, Chief Operating Officer and Chief Financial Officer for NCH Healthcare
System.
Morton received his under-graduate education at the University of Notre Dame where he
received a B.S. in Public and Managerial Accounting. Morton continued at the University of
Miami where he received his MBA and, most recently, his MS in Health Science from Florida
Gulf Coast University.
Currently, Morton's professional associations and affiliations include: Trustee, Florida Gulf
Coast University; Trustee, Quest Foundation; Member, Neighborhood Clinic Advisory
Committee; Immediate Past Chairman of the Leadership Collier Foundation; Chairman
Emeritus, Florida Gulf Coast University Foundation; Director, NCH Health System Foundation
and Trustee, Moorings Park Institute.
Former Associations include: Chairman, Naples Area Chamber of Commerce; Vice Chairman,
Florida Gulf Coast University Board of Trustees; Member, City of Naples Redevelopment
Advisory Board; Member, Collier County Board of Economic Advisors; Member, City of Naples
41-10 District Advisory Board; Member, Eagle Scout Selection Committee; Director, Economic
Development Council; Director, Barnett Bank of Naples; Active Duty Service, Captain, United
States Army 1969-1972, and Past Chairman, Education Foundation of Collier County and
Partners in Education.
Academic and professional achievements include a LIFE Award winner of Edison Community
College and was selected as the health representative to the General Electric Strategic Planning
Program for 2005.
Blue Ribbon Panel Reportfor Collier County, Florida Board of County Commissioners regarding
Prehospital Emergency Medical Treatment & Transport (PEM7T) System
Page 5 of 32
Patricia Barton
Community Leader
An alumni of Auburn University, Patricia Barton's involvement in the community is far
reaching, currently serving on several boards including the Juvenile Assessment Center (JAC)
Advisory Board, the Volunteer Collier Board, the PACE Center for Girls-Collier at Immokalee
Advisory Board and the Greater Naples Leadership Board. Past Board participation includes the
YMCA of Collier County, the David Lawrence Mental Health Center and Foundation Board, the
Naples Community Hospital Auxiliary, Edison Community College Foundation Board and the
Statewide Health & Human Services Board.
Her work in Drug Abuse Prevention includes founding member of the Naples Informed Parents,
founding member and Project Director of Florida Informed Parents (now Informed Families) and
Founding member of the National Federation of Parents for Drug-Free Youth (NFP, now
National Family Partnership). Ms. Barton has also been appointed to the Florida Substance
Abuse & Mental Health Corp.
Political activism includes committee member and Vice President for Naples Better Government
from 2002-2006 as well as Chair of numerous campaigns for city council, mayor, school board,
constitutional officer and active in various state and federal campaigns.
Ms. Barton is the recipient of numerous awards including the 2007 PACE State Award for Invest
in the Future and the Pioneer A ward in 2010, the 2007 Youth Haven Frances Pew Hayes Child
Advocate of the Year Award as well as the 2007 AAUW Women of Achievement Award.
Blue Ribbon Panel Reportfor Collier County. Florida Board of County Commissioners regarding
Prehospital Emergency Medical Treatment & Transport (PEMTT) System
Page 6 of 32
Edward Boyer
Retired Healthcare System Executive
Boyer is a seasoned healthcare professional with more than 30 years experience. In his last
position as Senior Vice President of Corporate Services for Bon Secours Health System, Boyer
developed and implemented a system-wide supply chain and performance reporting system, an
offshore captive insurance company and created a new direction for information technology
services. Boyer was responsible for supporting the company's wide range of corporate services,
including information systems services, quality improvement, material management and
insurance and risk management.
Prior to joining Bon Secours, he served as a consultant for several years; first as a principal in the
Baltimore office of Arthur Andersen and then as a managing consultant in the Washington
offices of Towers Perrin. Before this, he acted as president of Maryland Health Care System,
located in Baltimore, MD., a six-hospital consortium that provided its members with a range of
shared services, including strategic planning, systems engineering, purchasing and public
relations.
Boyer received a Bachelor of Arts degree from the University of Maryland and an M.B.A. from
George Washington University.
Blue Ribbon Panel Reportfor Collier County, Florida Board of County Commissioners regarding
Prehospital Emergency Medical Treatment & Transport (PEM7T) System
Page 7 of 32
Russell Budd
President, Wall Systems Inc. of Southwest Florida
Russell demonstrates his belief in community service by his active participation local civic
associations. Junior Achievement of Southwest Florida named Russell a 2005 Laureate for his
entrepreneurial leadership skills. Russell is a graduate 2005-2006 Class of Leadership Florida.
Locally, Russell has served for many years with the Greater Naples Chamber of Commerce
including two years as the Chairman of the Board of Directors. He is also a graduate of
Leadership Collier, Class of '94 as well as the inaugural Leadership Institute Class of 2001 and
is a Past Chairman of the Leadership Foundation.
Russell also completed twelve years of service on the Collier County Planning Commission,
including three years as the Chairman. He is serving as a volunteer on the Selective Service
Board and was a Director for the Bank of Florida-Southwest. In 1993, he was elected to the
Board of Commissioners in the Golden Gate Fire Control and Rescue District and served a four-
year term, acting as Chairman for three of those years. He served for six years as a member of
the Board of Trustees for Seacrest Country Day School.
Russell is dedicated to his family that includes his wife, Dr. Katie Paschall, a professor at Edison
Community College, and their three children, Daniel, Rachael and Emily. His focus on family
serves as the force behind his commitment to the preservation of the Southwest Florida
environment and the improvement of our community.
Russell Budd, President of Wall Systems Inc. of Southwest Florida, founded the organization in
1986. Russell received a Bachelor of Building Construction from the University of Florida in
198 I. He has held a Certified General Contractor (#CGC 021714) in the State of Florida since
1982 and is a licensed Real Estate Broker.
Blue Ribbon Panel Reportfor Collier County, Florida Board of County Commissioners regarding
Prehospital Emergency Medical Treatment & Transport (PEMIT) System
Page 8 of 32
Joseph Gauta, M.D.
Past President, Collier County Medical Society
Joseph Gauta, MD is a board certified gynecologist in Naples, FL. He has been practicing in
Naples since 1998 and founded Especially for Women in 2000 and the Florida Bladder Institute
in 2006.
His expertise includes all aspects of obstetrics and gynecology, with special training and
emphasis in urogynecology. Prior to moving to Naples, Dr Gauta finished his undergraduate
studies at Siena College in Albany, NY.
His medical degree was completed at Albany Medical College and finally specialty training at
Tulane University in New Orleans. Dr Gauta has been actively involved in the political welfare
of the patients and doctors of Florida.
He is the President of the Collier County Medical Society. He was on the Board of Governors of
the Florida Medical Association, currently a member of the Board of Governors of the Florida
Medical Association Political Action Committee, and on the Board of Leadership Collier. He is
also past-President of the Southwest Florida Physicians Association, a 600 member organization
of physicians in our local PHO. Lastly, he is a Board member of A va Healthcare, Inc, a recently
launched health insurer in the state of Florida.
Dr Gauta has been married to Susan for 13 years, and has three children: Spencer, Stephen and
Samantha.
Blue Ribbon Panel Reportfor Collier County, Florida Board of County Commissioners regarding
Prehospital Emergency Medical Treatment & Transport (PEMIT) System
Page 9 of 32
Michael V. Reagen, Ph.D.
President, The Greater Naples Chamber 0/ Commerce & Leadership Collier Foundation, Inc.
In June 2002, Reagen was named President of The Greater Naples Chamber of Commerce, the
largest of 25 Chambers in the five county SWFL region, and, according to the Florida
Association of Chamber Professionals, among the top seven of 300 chambers in Florida. He is
also President of the Leadership Collier Foundation.
Mike's extensive career has included key executive positions in metropolitan development,
higher education and state government where he was a cabinet officer for three state Governors.
Reagen is a 2003 graduate of Leadership Collier, a 2007 graduate of the Collier County Sheriffs
Citizen Academy and was a member of Collier County Habitat for Humanity. He has served on
Collier County's Freedom Monument Selection Committee and its Fiscal Stability Committee.
He has served on the advisory Boards of Edison College, Lorenzo Walker Technical Institute,
NapleslFort Myers Town Hall, the Rookery Bay Estuarine National Research Center and
Seacrest Country Day School. Mike also participated as a Panelist in the FCCMA Coaching
Program Webinar on Sustainability for Economic Development and is a Member of U.S. Senator
George LaMieux's Jobs Advisory Council.
Active in local affairs, Mike is advisor to the Council for International Visitors, the Civic
Information Center and the Naples Press Club. In 2006, he received The World Food Prize's
Iowa Founders Award; in 2008 he was named one of Gulfshore Life magazine's Men of the
Year, and in 2009 The Collier Education Foundation named him a 'Man of Distinction'. Mike
has served as a Member of the Governance Task Force of the Collier County School District;
Chair, Friendship Health Center Coordination Council; and the Facilitator, Collier County Pre-
Hospital Emergency Medical Services Study Group.
Blue Ribbon Panel Reportfor Collier County, Florida Board of County Commissioners regarding
Prehospital Emergency Medical Treatment & Transport (PEMTT) System
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EXECUTIVE SUMMARY
EXECUTIVE SUMMARY
Blue Ribbon Panel Report
for
Collier County, Florida
Board of County Commissioners
regarding
Prehospital Emergency Medical Treatment & Transport (PEMTT) System
Encouraged by the Collier County Board of Commissioners (BCC), a citizen Blue Ribbon Panel
(the Panel) was assembled in September 2009 to study and review the elements of the continuum
of care (EMS, fire department, hospital emergency department physicians, police and
community) of pre-hospital emergency medical treatment and transport (PEMTT) system in
Collier County, Florida.
The Panel's charge was, after evaluating issues, proposals, and current relevant literature, to
recommend improving PEMTT service to assure all in Collier County are provided the highest
level of medically effective and efficient care.
Collier County has experienced significant population growth during the past 30 years. Its
338,000 citizens (both full time and part time) and nearly two million annual visitors have been
well served during that period by the dedicated professionals within EMS, the fire departments,
the sheriff s office and police departments, whose coordinated and integral response to medical
emergencies deliver timely and expert basic life support (BLS) and advanced life support (ALS)
services.
Blue Ribbon Panel Reportfor Collier County, Florida Board of County Commissioners regarding
Prehospital Emergency Medical Treatment & Transport (PEMT7) System
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Collier County citizens and taxpayers have never accepted average when it comes to community
services and healthcare; neither have the county's public safety forces. The Panel's
recommendations are meant to ensure that by working together, Collier County will continue to
be one of the safest communities in the nation.
In February 20 10 the Panel presented preliminary thoughts to the BCC. After conducting its own
review of the academic literature (see bibliography) the Panel in June recommended establishing
a countywide, two-tiered PEMTT delivery model. Tier One would be charged with the delivery
of timely BLS services and Tier Two with the delivery of timely ALS and transport services.
At that same meeting the Panel also suggested the following: the creation of a PEMTT Council
to refresh the currently standing county committee, as well as an objective review of all 911
dispatch data. The BCC responded by asking the Panel to continue its work and provided
$45,000 in funding for the 911 data review. Professional support to conduct the review was
provided by Florida Gulf Coast University.
This report contains the results of the 911 data review, along with system recommendations. In
addition, it provides a contextual comment on PEMTT history, lessons learned from other
jurisdictions, and specific recommendations for consideration.
Blue Ribbon Panel Reportfor Collier County, Florida Board of County Commissioners regarding
Prehospital Emergency Medical Treatment & Transport (PEMTT) System
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HISTORY
HISTORY
Hospitals and physicians have been involved with pre-hospital care at least since 1921 when Dr.
Claude Beck, an M.D. at Western Reserve University, Cleveland called the fire department so he
could apply a "pulmotor" (an artificial breathing apparatus) to help resuscitate victims who
stopped breathing.
In 1939 the Miami-Dade Fire Department provided first aid training for firefighters to treat
victims. Transport was done by the funeral homes.
The 1960s brought the development of the 911 system and Emergency Medical Services (EMS).
A variety of pre-hospital care delivery systems exist across the 3085 counties of the United
States. System makeup is largely based on the size and scope of local government; whether a
rural or urban setting; funding; and medical expertise. Consistently however, first responders for
pre-hospital care have been fire and sheriff departments. This is primarily due to their functional
organization and duty to respond to accidents, fires and rescue situations. Transportation of
victims has typically been provided by hospitals, private ambulance services, or through
government ambulances managed by fire or county-managed EMS corps.
America's most prestigious pre-hospital delivery systems average a seven-minute on scene
arrival time. Many research findings state the ideal on-scene arrival goal as four minutes for
Blue Ribbon Panel Reportfor Collier County. Florida Board of County Commissioners regarding
Prehospital Emergency Medical Treatment & Transport (PEMlT) System
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basic life support (BLS) services, especially for heart attack victims. Eight minutes is ideal for
advanced life support (ALS) services.
Heart attack (cardiac arrest) became a leading cause of death after the turn of the century and is a
key emergency services need in Collier County.
Humans have always suffered from cardiac problems, but they usually died from causes such as
infectious disease, long before reaching an age where heart problems threatened their life. As the
world of medicine has advanced and people are living longer, heart disease has become a serious
health issue.
Beck (1894-1971), a pioneer of heart surgery; focused on operations to improve circulation in
damaged heart muscles and developed ways to revive heart attack victims, including the
defibrillator and CPR.
In 1947 Beck successfully defibrillated his first patient, a 14-year-old boy whose heart went into
fibrillation after an operation. The defibrillator used on this patient was made by James Rand, a
friend of Beck. Nine years later (1956) Paul Zoll used a more powerful unit to perform the first
closed-chest defibrillation.
In Belfast, ambulance-transported physicians first achieved pre-hospital defibrillation in 1966.
Defibrillation by EMTs (Emergency Medical Technicians) without the presence of physicians
was first performed in Oregon in 1969.
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Today, all should reasonably understand that the use of Automated External Defibrillators
(AEDs) is a community responsibility. AEDs and people properly trained in their use should be
situated in easily accessible public places.
There are 1,587 AEDs registered in Collier County. That is a higher number per capita than
King County (Seattle, Washington), which is among the most prominent pre-hospital care
providers in America. The King County Dispatch Center is the repository for information on all
registered Public Access Defibrillators (PADs) or AEDs. When a call is received regarding a
possible cardiac event the caller is told the location ofthe closest PAD/ AED.
In Florida, Broward County has mandated AEDs be available in all restaurants with specified
occupancies, as well as in airports and seaports. Mandatory staff training is provided by the
companies that sell the AEDs.
This Panel recommends Collier County consider establishing a similar program. Collier County
should also, in establishing this plan, coordinate community AED services and create training for
sheriff and county services staff. Additionally, the county along with the sheriffs office should
implement an automated tracking system to identify AED locations, usage time and other
pertinent data. The Collier county Sheriffs Office should continue to pursue the necessary
legislative changes to implement the above recommendations.
Blue Ribbon Panel Reportfor Collier County. Florida Board of County Commissioners regarding
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Page l50f32
LESSONS LEARNED:
A REALITY CHECK FOR SYSTEM AD,lUSTMENTS
LESSONS LEARNED: A REALITY CHECK FOR SYSTEM ADJUSTMENTS
The Panel reviewed multiple white papers, community structures, state and local blue prints for
developing integrated pre-hospital care systems (see bibliography). Several counties have
exceptional programs evidencing best practices which the Panel recommends Collier County
carefully consider as follows: King County (Seattle), Washington; Broward County, Florida;
Volusia County, Florida, and the Cities of Marco Island and Naples, Florida:
King County is known for medical leadership and structure, expertise in pre-hospital cardiac
care, cost-effective use of resources, and regionalized fire and EMS services.
Under the leadership and command of the Broward County Sheriff, Broward County has
developed a functionally impressive organizational structure, medical leadership, and EMS and
fire cooperation.
Volusia County, like Collier County, has multiple fire districts and a county-wide EMS.
Consequently it has service coordination, leadership challenges, potential cost, and structural
issues it is attempting to address.
The City Fire and Rescue Departments of Marco Island and Naples have good interagency
experiences working closely with Collier County EMS that may be replicated.
Blue Ribbon Panel Reportfor Collier County, Florida Board of County Commissioners regarding
Prehospital Emergency Medical Treatment & Transport (PEM7T) System
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THE CURRENT LOCAL SCENE
All involved in Collier County's system are dedicated, loyal to their professions, community-
spirited and hard working. All, however, are effaced by the currently conflicted dysfunctional
rhetoric that springs from national system-change-angst which has become extraordinarily
personal.
Although outside this Panel's focus, it is obvious that the functions of fire services in Collier
County should consider consolidation and that resources, given modern needs, be professionally
reallocated. Fire Services PEMTT should work to share common protocols for responding to pre-
hospital medical treatment and transport calls. Fire Services PEMTT leaders should at the very
least collaborate on establishing one voice, one leader, for all PEMTT matters.
Collier County's EMS is centrally run, uniformly well trained, dedicated, and loyal to its
distinguished medical director, Dr. Robert Tober. All involved in Collier County appreciate the
historical and present professional contributions of Dr. Tober. All praise and recognize his
competence.
The current PEMTT system in Collier County, however, is now racked by the regular exchange
of personal, ideologically-based arguments that need to cease. Private professional discussions,
of course, should be encouraged; public attacks should end immediately. All energy, passion and
professionalism should be re-channeled into resetting current operations into a new delivery
model.
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ELEMENTS OF A REFRESHED MODEL
The start of a refreshed PEMTT model needs to focus on who arrives on scene quickest with the
highest level of training and expertise in order to begin treatment that will quickly prepare the
patient for transport. This is the crux of the issue that led to the Panel's recommendation of a
two-tiered BLS and ALS model.
All citizens want the best emergency services. It is common sense to have a paramedic with
EMT support first on scene for those cases that require a high level of service (ALS).
A number of factors complicate immediate support response: lengthy distances; extended and/or
protracted response times to hospital; density of an aging population and other demographics;
high-rise residential towers challenging access and other extenuating circumstances.
Clearly, the number of medics and equipment on scene should be determined by the acuity of the
incident versus the complications noted above. Low acuity may range from no transportation
required to an ambulance or other transportation. High acuity episodes (heart attack/stroke or
traumas for example) may need to include additional manpower and multiple pieces of
equipment. This should be determined by centralized PEMTT management based on geography,
community expectations, population demographics, available staffing resources and treatment
protocols set by the medical director.
Blue Ribbon Panel Reportfor Collier County, Florida Board of County Commissioners regarding
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LESSONS LEARNED FROM KING COUNTY
The Panel is impressed with the King County program which was started in 1969 by physicians
Drs. Leonard Cobb (cardiologist) and Michael Copass (Emergency Director Harborview Medical
Center) and Seattle Fire Chief Gordon Vickery. The focus was to provide the highest level of
pre-hospital care to the community with highly trained paramedics and EMTs.
Collier County (338,000 residents) presently has 259 trained paramedics within EMS (113) and
fire departments (146). King County (population 1.9 million) has a total of approximately 250
paramedics. Michele Plorde, Director for King County (PEMTT), says initial and ongoing field-
based training of an elite, select group of paramedics is critical to maintenance of a highly
proficient PEMTTcare service. King County standards exceed Washington State's training
requirements by two times, requiring 2,500 hours of training to become a paramedic.
King County coordinates all initial and ongoing training for EMTs and paramedics from Fire and
EMS, medical direction, strategic planning, placement of units and individual fire department
services with ALS and BLS protocols, promulgated by King County's Medical Director.
The King County EMS Advisory Committee model is worthy of Collier County's consideration.
The Advisory Committee membership appears to be inclusive and could be a model for Collier
County. A PEMTT Council for Collier County could consist of the following entities: medical
director; hospital emergency department directors; hospitals administrative staff; the sheriff or
Blue Ribbon Panel Reportfor Collier County. Florida Board of County Commissioners regarding
Prehospital Emergency Medical Treatment & Transport (PEM1T) System
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designee; EMS and fire department; and community leaders who help with communication and
planning.
This PEMTT Council could be ably and professionally facilitated by the designated public safety
authority with directly delegated authority and responsibility from the Board of County
Commissioners. It should meet to address, for example, paramedic related issues; clinical issues
such as cardiac stroke programs; community education; the county-wide AED program; and
education for all first responders.
The King County medical director conducts a quarterly meeting with the system's six medical
directors, EMS director, and other administrative staff (all involved in coordination of the
medical protocols for personnel training, QI and QA, credentialing, and reviewing of medical
pre-hospital care). As a model for Collier County, the translation would include the opportunity
for a Collier County medical director to meet with hospital emergency room directors to discuss
medical related services including expanding hospital involvement in training and educational
semmars.
Similar to King County, cardiac survival rates should be a base starting point for monitoring and
reporting. Additionally, stroke and trauma survival rates should be reviewed.
Blue Ribbon Panel Reportfor Collier County, Florida Board of County Commissioners regarding
Prehospital Emergency Medical Treatment & Transport (PEM7T) System
Page 20 of 32
LESSONS LEARNED FROM BROW ARD COUNTY. FLORIDA
Broward County, Florida has a unique PEMTT management system, aspects of which might well
serve Collier County.
Broward County started reviewing its interagency PEMTT issues in 1992. The review resulted
in transference of all Fire and EMS PEMTT services to the management of the sheriff in 2003.
All municipalities combined Fire and EMS. All Fire and EMS personnel are considered equal
with medics in both EMS and fire. This integration was considered a critically necessary
improvement in the pre-hospital care system. Since all Broward County PEMTT personnel
report through the sheriffs office there is a chain of command that uniformly manages all local
PEMTT issues. All fire and EMS vehicles are equipped with standardized life saving equipment
consistent with Broward hospitals emergency departments' equipment and supplies.
There are 31 municipalities within Broward County. Professional flexibility in accordance with
different city needs is vital. For example, while the Fort Lauderdale FirelEMS Service is now
exploring BLS transport, it does not send fire engines to transport situations. Broward County's
medical director also serves as the medical director for Ft. Lauderdale and works collegially with
the 31 municipalities, 21 of which provide independent safety services. Some also have medical
directors who set, based on Florida's minimum requirements, local protocols. All medical
directors within Broward County meet monthly in collaboration with the sheriffs office.
Blue Ribbon Panel Reportfor Collier County, Florida Board of County Commissioners regarding
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Broward County's Advisory Committee facilitates the resolution of issues between the county's
medical director and the independent municipality fire districts and other agencies, including
training. Training in Broward County occurs through a variety of venues utilizing the hospitals
as well as the scheduling of fire paramedics on ambulances for vacation/staffing shortage days.
Broward County believes collaborative experience-based field training is critical to keeping up
technical proficiencies.
Note that in both Broward and King counties some hospitals, not all, help provide medical
direction. The directors of the emergency departments within the separate jurisdictions work
collaboratively with the county medical director. Their input is critical for all PEMTT personnel
training and community programs. All hospitals flag cases for review and share data on trauma
cases.
Blue Ribbon Panel Reportfor Collier County, Florida Board of County Commissioners regarding
Prehospital Emergency Medical Treatment & Transport (PEMIT) System
Page 22 of 32
LESSONS LEARNED FROM VOLUSIA COUNTY. FLORIDA
Volusia County, Florida recently conducted a study worthy of note. Volusia has experienced
issues similar to those now challenging Collier County, including increasing costs associated
with fire and EMS services. The Halifax Area Civic League submitted to the county in July
2010 a report titled, "Possibilities of Fire and Rescue Service Consolidation in Volusia County."
As a frame of reference there are 16 incorporated cities or towns in the county. Combined with
unincorporated Volusia County, the population is approximately 507,000. There are 13 separate
governmental fire/rescue services.
The study's recommendation is to merge the fire and rescue services, which can easily be
accomplished through inter-local agreements. Through attrition, overall savings would be
roughly $5.7 million per year. Collier County Commissioners may wish to consult with their
peers in Volusia County.
Blue Ribbon Panel Reportfor Collier County, Florida Board of County Commissioners regarding
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Page 23 of 32
LESSONS LEARNED FROM CITIES OF MARCO ISLAND AND NAPLES. FLORIDA
The collaboration between Marco Island and Naples Fire Departments and Collier County EMS
seems to yield positive results. The three agencies have progressively worked well together in
education, community involvement, AED use, American Heart Association basic life support
programs, and a host of safety programs. The collaboration has fire engine paramedics (ALS
trained staff) which take into account the aspects of both cities. Expanding this collaboration to
other areas of Collier County should be considered wherever feasible.
Blue Ribbon Panel Report/or Collier County, Florida Board of County Commissioners regarding
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THE PANEL'S RECOMMENDATIONS
THE PANEL'S RECOMMENDATIONS
The Panel believes the Board of County Commissioners should investigate the potential
economic savings and clinical enhancements associated with coordinating and regionalizing all
PEMTT services under a unified public safety concept. In turn, the medical director should
report to the designated public safety authority. Because of the multiple layers of organizational
structures within the fire departments and EMS in Collier County there is no local county-wide
managed authority to address system management complaints or issues. The benefits of better
integration are obvious:
1. All pre-hospital care services would be under one management structure.
Standardization can be achieved of units, supplies, management and personnel, and
potential cost savings with direct and indirect administrative and non-service related
personnel in pre-hospital care services and other safety related services.
2. Simplification and standardization of dispatch codes and protocols can be realized.
Plus, the elimination of district boundaries and possible improvement of response times
can only assist with public service.
3. The PEMTT Council could support the contiguous coordination and, where reasonable,
possible integration of County and City of Naples 911 Dispatch Centers, including
community AED program. This would help ensure standardization of 911 codes and
protocols across Collier County and ensure that all potential fire and EMS first
responders covered under a mutual aid services agreement are initially notified by the
dispatch center.
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The lack of consistent, centralized, positive management for EMS, fire, hospitals and emergency
department physicians also allows for disagreements in process and functional issues to reach
outside organizations before any resolution can be obtained.
Placing all PEMTT services eventually under a well-managed and highly professional public
safety authority could have many positive, service-enhancement results for all Collier citizens.
The Panel did not focus on the consolidation of fire services in Collier County. However, the
Panel does recommend that Collier County comprehensively study PEMTT organizational
collaboration similar to that done by the Civic League Study in Volusia County in June 2010. To
that end:
The PEMTT should study the cost implications of fire and EMS services throughout the county
and potential savings, direct and indirect, of regionalizing such services under one management
structure. To start, the PEMTT Council should review recommendations of the 2007 EMS
Strategic Report and ensure recommendations have been implemented or justify why they have
not.
Provided the study supports increased collaboration under a unified PEMTT management
(coordinated public safety concept), the Panel suggests the following steps toward developing a
regionalized pre-hospital care system: County EMS personnel could be integrated within the Fire
Departments.
Blue Ribbon Panel Reportfor Collier County, Florida Board of County Commissioners regarding
Prehospital Emergency Medical Treatment & Transport (PEMIT) System
Page 26 of 32
1. If the aforementioned steps of regionalizing and consolidating services for pre-hospital care
demonstrate cost savings and increased cooperation between fire and EMS, the Panel
suggests initiation of a pilot program with a fire district for the functional integration of
emergency ALS medical services including emergency ALS transportation services. This
program will be monitored by the PEMIT Council and fire district representatives to
ensure quality, training, cost management, expertise and service.
2. EMS services would be managed by the fire district, including among other things,
personnel and equipment. The fire district would integrate existing EMS equipment and
staff. The district would report quarterly to the PEMTT Council on specific
measurement criteria developed by the designated public safety authority, the medical
director and fire district.
The Panel recommends that any such reorganization of PEMTT services III Collier County
should be part of a five-year strategic plan that takes into account the men and women who have
provided excellent service to Collier County in the past, as well as consideration of the
referendum ballot in November 2010.
The five-year strategic plan should consider reviewing and reasonably implementing the Marco
Island paramedic staffing of fire engines and ambulances across Collier County. The use of ALS
engines to support the ambulance service with concurrent calls and back up on high priority
medical runs will help on-scene as first responders and may reduce call time for medical
personnel to ensure that the highest level of medical personnel respond to emergencies. County
Blue Ribbon Panel Reportfor Collier County. Florida Board of County Commissioners regarding
Prehospital Emergency Medical Treatment & Transport (PEMT7) System
Page 27 of 32
safety services could initiate an educational program to improve basic information from citizens
calling into 911 such as location and symptoms of victim, as well as an educational program to
inform drivers to move out of the path of ambulances, fire and police vehicles.
The five-year strategic plan ought to also incorporate provisions for a system audit every three
years which would focus on analyses of core business models that could be integrated and
regionalized where possible to reduce or avoid costs to taxpayers. This would allow Collier
County to develop a more cost- and resource-efficient response to low acuity patients and in the
future explore use of contract ambulance or transport services for low acuity or out-of-county
transport (similar to Broward and King County models).
The Panel suggests the Board of County Commissioners offer to initiate this process with certain
fire districts which can and will work with the currently constituted Office of the Medical
Director to ensure that there is no degradation in training, expertise and quality within the
provision of pre-hospital care to the citizens and visitors within Collier County.
A positive step would entail the use of ALS fire engines and the emergency transportation
services within these fire districts. The fire districts would develop a management process for
position control that would professionally manage the number of paramedics and EMT positions
within the district to ensure quality and expertise through field training. The fire districts could
also evaluate the possible opportunity for the use of smaller, lighter ambulances, such as Ford F-
Blue Ribbon Panel Reportfor Collier County, Florida Board of County Commissioners regarding
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Page 28 of 32
350 and F-450 vehicles to be used in certain transportation situations that do not require ALS
services.
The fire districts would, of course, agree to follow the recommendations of the newly designated
public safety authority, working with the reassigned yet currently constituted Office of the
Medical Director and the revamped PEMTT Advisory/Council. A hospital administrator should
chair the PEMTT Advisory Council to assure that all proper processes are initiated and
completed and that emergency department directors of the NCH Healthcare System, The Lee
County Memorial Hospital Trauma Center and the Physicians Regional Healthcare System are
all robustly involved.
The Panel is biased that the new PEMTT Advisory Council, ably and professionally facilitated
by the designated public safety authority, should be chaired by a hospital administrator. The
Panel also strongly believes that one medical leader for the county, working with hospital
medical emergency department leaders, can provide a higher standard of care for the county with
overall superior service. The designated public safety authority, with appropriate guidance and
advice from the PEMTT Council and obviously in accordance with law and germane
professional standards, should develop procedures to address grievances between fire and EMS
on a local basis prior to grievances being sent to the state.
Blue Ribbon Panel Report/or Collier County, Florida Board of County Commissioners regarding
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This new model should improve communications, improve fire districts' management of their
dispatched equipment and prompt significantly more involvement from Collier County hospitals
in training and coordination of all county safety services.
The Panel also strongly suggests that all personnel training, quality initiatives and assurance,
credentialing and testing be centrally overseen and coordinated through the PEMTT Council,
facilitated by the designated public safety authority with the cooperation of the medical director
in collaboration with the directors of the emergency departments of Collier County hospitals to
ensure standards are maintained at a consistently high level.
The Panel recommends th&t all testing services be contracted to testing professionals at a local
college or university which can maintain the integrity and professional demeanor that is expected
of safety forces.
Members of the Panel appreciate the opportunity afforded to them by the Board of County
Commissioners to study the PEMTT System. The Panel stands ready to respond to any future
questions.
Respectfully submitted,
Geoffrey Moebius, Chair
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BIBLIOGRAPHY
Bibliography
I. Carney, C.J. (1999). Pre-Hospital Care - A UK Perspective. British Medical Bulletin
(Volume 55, Issue 4, pp. 757-76). Oxford University Press.
2. City of Houston, Texas Fire Department. Assistant Chief William Barry. Retrieved
from: http://www . houstontx.gov /fi reI.
3. Emergency Services Consulting, Inc. (2007). Collier County Florida, EMS System
Master Plan 2007.
4. Cohen, H. (20 10, July). Possibilities of Fire and Rescue Services Consolidation in
Volusia County. Submitted to Halifax Area Civic League.
5. Goodwin, 1. (2010, August). Best Practices in Emergency Services: Integration: The
New Frontier? Retrieved from:
http://www.emergencybestpractices.com/CurrentI ssue/tabid/22 5/ctl/ Archive View /mi
d/5 73/month/8/year/20 1 OlDefault.aspx.
6. Gueugniaud, P.Y., David, J.S., Chanzy, H., Dubien, P.Y. et. al. (2008, July 3).
Vasopressin and Epinephrine vs. Epinephrine Alone in Cardiopulmonary
Resuscitation. The New England Journal of Medicine 359, 21-30.
7. Henry, G. (2010). ACLS: Close the Drug Box. Emergency Physicians Monthly.
Retrieved January 20, 2010 from: http://www.epmonthlv.com/index.php?
option=comcontent&task=view &id=64 3 &1 tem id=91
8. Herhold, S. (2010, September). Herhold: Why Emergency Medical Costs Spiral out of
Control. Mercury News.
9. National Association State EMS Officials. (2008, July). State Emergency Medical
Services Systems: A Model.
10. Nielsen T. (2009, November). Exploring Closest Unit Response to Fire and Medical
Emergencies in Spokane County. Spokane County Fire Protection District Eight.
Spokane, W A.
11. Office of Pre-Hospital Care - University Emergency Medical Services, Wyoming-
Erie New York, Office of Pre-Hospital Care, Buffalo NY. Retrieved from:
http://www.opcems.org/.
12. Olson, L. (2000). San Mateo County Pre-Hospital Advanced Life Support Services.
Blue Ribbon Panel Reportfor Collier County, Florida Board of County Commissioners regarding
Prehospital Emergency Medical Treatment & Transport (PEMTT) System
Page 31 of32
13. Pratt, F./MD, Pepe P./MD, Katz S./MD, FACEP, EMT-P, Persse, D./MD, EMT-P,
FACEP. (2007). Pre-Hospital 9-1-1 Emergency Medical Response: The Role of the
United States Fire Service in Delivery and Coordination.
14. Public Health Seattle and King County. (2009, November). Medic One/Emergency
Medical Services, 2008-2013; Strategic Plan Revised November 2009. Retrieved
from: http://www.kingcounty.gov/.
15. Public Health Seattle and King County. (20 I 0, September). Public Health- Seattle &
King County Division of Emergency Medical Services 2010 Annual Report.
Retrieved from: htt1J://www.kingcounty.gov/.
16. Public Health Seattle and King County. (2010, September). Saving Lives: An
Innovative and Efficient King County Emergency Medical Services. Retrieved from:
http://www .kingcounty. gov Ihealthserv iceslhealth/newsl20 1 0/1 009030 l.aspx.
17. Sampson, D. (2008, April). Regionalizing Fire Services and Breaking Home Rule.
18. Schaitberger H. Emergency Medical Services, A GUidebookfor Fire-based Systems
(4th Edition).
19. Seattle Fire Department-Emergency Response Totals 2005-2009. Retrieved from:
http://www.seattle.gov.
20. Stiell, I.G., Nesbitt, L.P., Pickett, W., Munkley, D., et al. (2008). The OPALS Major
Trauma Study: 1mpact of Advanced Life Support on Survival and Morbidity.
Canadian Medical Association Journal, 178 (9), 1141-1150.
21. West, G. (2007, April). Integrating Emergency Medical Services in the Fire
Department, Fire/EMS First Responders: It's Just a Matter of Time.
22. Wikipedia. (2008) Seattle Fire Departments
23. Wolcott, M.D., Foelker, T. (2009). Evaluating the Impact: Fire services Provision of
Advanced Life Support. A report to Volusia County, Florida.
Blue Ribbon Panel Reportfor Collier County, Florida Board of County Commissioners regarding
Prehospital Emergency Medical Treatment & Transport (PEM7T) System
Page 32 of 32
DATA ANALYSIS
EVALUATION OF DATA
REGARDING
EMERGENCY RESPONSE IN COLLIER COUNTY
As Presented to:
Collier County, Florida
Board of County Commissioners
January 11,2011
Data Compiled and Reviewed By:
The Collier County Sheriff s Office
Data Review and Approval Completed By:
Dr. Lisa Zidek, Associate Professor
Academic Program Director
U.A. Whitaker School of Engineering
Florida Gulf Coast University
~c31vt
PRE-HoSPITAL CALLS FOR SERVICE:
RESPONSE TIMES AND LOCATIONS
As Presented to:
Collier County, Florida
Board of County Commissioners
January 11, 2011
Prepared By:
The Collier County Sheriff s Office
3301 Tamiami Trail East, Bldg J
Naples, Florida
PRE-HOSPITAL CALLS FOR SERVICE: RESPONSE TIMES AND LOCATIONS
DECEMBER 2010
Data and Methodology
Data were pulled from Computer Aided Dispatch (CAD) for a one-year time period (July 2009
tltrough June 2010) in order to identify response time to medical-related calls for service. The final
sample of data includes calls for service that had a coded response or transport to a hospital, and
were identified as highest priority in C'\D (lor 2). This was done to capture the most serious calls;
as such, this selection assumes incidents falling into these criteria, requiring travel or response to a
hospital at some point during the call) represent serious medical-related calls. Only reactive, citizen-
generated calls for service were included in order to more accurately identify response to a call
(compared to proactive calls for sen-ice recorded in CAD). Finally, to eliminate extreme values and
outliers, calls with a response time longer than 30 minutes were removed.1 The final number of calls
for service selected is 17,604. EMS/Fire calls account for 94 percent. Collier County Sheriffs
Office (SO) had 1,038 calls meeting these criteria and .Marco Island Police (MPD) had 21 calls.
The final number (17,604) of calls includes duplicates due to the structure of the CAD. Each time
an agency is dispatched, a unique call is created. Therefore, if EMS/Fire and SO are both
dispatched to a call, this will result in two unique calls for service in the CAD data. In addition. it is
important to note that based on this methodology, the nature of calls for sheriffs office/police is
very different than EMS/Fire. General descriptions of call types by agency illustrate this point. The
majority (92 percent) for Fire/EMS are described, in general, as cardiac or medical calls.1 For the
SO. the same medical call categories represent only 13 percent of selected calls. For Fire/E1\IS,
vehicle accidents represent 6.2 percent, and crime/disorder-related represent 1.6 percent of calls.3
The highest incident type category for the SO is suicidal or mentally-ill person (30 percent); another
23 percent are traffic accidents and 32 percent of calls are crime or disorder-related.
rife/EMS ,~" SO '::, MPD ",
Accidents
Alarm
Crime/Disorder
Fire
Medical
Other
Suicidal /Mentally III Person
1021 6.2 236 22.:- 2 9.5
18 0.1 0 0.0 0 0.0
262 1.6 335 32.3 33.3
21 0.1 0 0.0 0 0.0
15198 91.9 136 13.1 6 28.6
6 0.0 19 1.8 1 4.8
19 0.1 312 30.1 5 23.8
r!'rrdl l<o5,t5 loil lU")/i !(Ill .?! 10/)
Because Fire/EMS is involved in all medical calls requiring transport to a hospital, these data are
included in analysis below. This is done to avoid including duplicate calls, which can produce
misleading results. In addition to the duplicate call issue, the numbers for SO, and puticularly for
MP, are small for a one-year period, which makes it difficult to determine patterns and trends.
Finally, as discussed above, the nature aflaw enforcement calls selected with these criteria are much
different for police agencies than Fire/EMS.
1 This only removed a very small percentage (0.9) and is necessary due to the structure of CAD data; for instance, on
occasion calls do not get closed properly, or are closed at a later time due to system updates or other reasons. When this
happens the time field cannot be altered: therefore, the time entered can misrepresent actual response.
2 Medical category includes Cll.C<fuc call, medical alarm, medical call, and person down.
3 Crime/disorder category includes assault/battery, criminal mischief, robbery, butglary, trespassing, disturbance,
suspicious incidents, etc.
EMS/Fire Pre-Hospital Calls For Service - Collier Count; Sheriff's Office - December 2010 - Page 1
Descriptive Statistics - Fire/EMS Calls
Call freq~enq- by weekda~ - Saturday and Sunday had fewer calls than weekdays. Monday had the
highest number of calls during the week; the largest difference in calls by day of week was 278 calls.
IJ.\\ fli"l"'"'' p,,,,,,:
Sun 2197 13.3
Mon 2475 15.0
'rue 2419 14.6
Wed 2456 14.8
Thu 2309 14.0
Fri 2443 14.8
S~t 2246 136
T('I.d lhq; hfll H
~ ~ b ~ b M ,~
Call frequen~ b.,y month - January shows the highest frequency by month; however, by daily
average the highest frequency is February. Overall, most calls occurred December through March.
Monthly Trend by Number and Ave.mge Calls per Day,]uJ 2009 - Jun 2010
1663 60.0
54,6
50.0
1600 38.4
40.0
I
1400 t ,.,
1300
11tlll J=
12001
"~j I---Frequency -A\lg/Oay I
.0
1000
Jan Feb Mar Api' Mty Jun J\l1 Au; Sop oot Nav Dee
1\1""111 FtNPH'll\ \ I'n. "n! Aq,: pN D.l.'>
}ao 1653 lV.0 52.i
Peb 1529 9.2 54.6
Mat 1612 9.7 52.0
Apr 1329 8.0 44.3
May 1336 8.1 43.1
Jun 1175 7.1 39.2
Jul 1189 7.2 38.4
Aug 1168 ':'.1 3~ '7
/.
Sep 1264 7.6 42.1
Oct 1398 8.4 45.1
Nov 1374 8.3 45.8
Dee 1518 9.2 49.0
TO!.il 16;.15 flHH! 4:>.3
~ ~ * - ~ ~ ~ - - ~ ~ ~
EMS/Fire Pre-Hospital Calls Fot Service - Collier County Sheriffs Office - December 2010 - Page 2
Call frequenc;y by week - the number of calls ranged from 398 in week 10 (early March) to week 28
(mid July) with 228 calls; this represents a maximum difference of 170 calls by week. However, in
order to determine patterns throughout the year, such as call volume by week and month, it is
preferable to use more than one year's worth of data points.
40
30
1 3 5 7 9 11 13 15 17 19 21 23 25 Xl 29 31 33 35 37 39 41 43 45 47 49 61
Call frequenc;y by hour - Call frequency was higher during daytime hours; 71 percent of the calls
occuned from 8:00 a.m. to 8:00 p.m.
EMS/Fire Pre-Hospital Calls For Service - Colliet County Sheriffs Office - December 2010 - Page 3
Hour
t:
::s
o
U
o 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23
hour
Call frequcnc.r by time of day and day of week - the below chart shows patterns by day of week and
time of day. The darker shades on the grid lines represent higher values. On average, the highest
frequency of calls occurred earlier in the week during the midday hours.
Man
TUB
Wed
Thu
Fri
Sat
Sun
o 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23
[~-0-50 0 50-100 11100-150 . 150-200J
EMS,Fire Pre-Hospital Calls For Service - Collier County Sheriff's Office - December 2010 - Page 4
Response Times
Overall response time is defined by when a call is created to when Fire or EMS first arrived on scene
(create-to-arrival). This can be separated into two time categories: when the call was created to
when it was dispatched to an agency (create-to-dispatch) and when a call was dispatched to when an
agency arrived on scene (dispatch-to-arrival).
For these data, the overall create-to-amal response time was on average 8.5 minutes. The median
response time was 8.2 minutes, indicating that 50 percent of the calls had EMS/Fire on scene in 8.2
minutes or less. The create-to-dispatch time averaged 2.0 minutes, with a median of 1.9 minutes.
The dispatch-to-arrivaJ averaged 6.5 minutes, with a median time of 6.1 minutes.
1,5
1,0
~
C
CD
::I
tT
!
u..
Create-to-Arrival Ave
5
o
o
5
10
15
RTminutes
20
25
30
EMS/Fire Pre-Hospital Calls For Service - Colliet County Sheriffs Office - December 2010 - Page 5
~'\vera,ge Response Time by Day of Wed.
There were no differences in average create-to-auival response time by day of week.
I
Ii:
:
::Ii
to.S
7.
Sun
Mon
T....
Wed
Wee kday
Thu
Frl
Sst
...\verag.e Response Times by Month
By month, there were small differences in response times (ranging from 8.3 to 8.7 minutes).
However, as discussed above, to determine patterns by month, more than one year's data is
preferable.
""
~
c
.~
~
Iii
III
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18.7L_~
- ~ -~"
"
7.
7.
Jan FlIb """ Apr MIIy JUI'1
Jul Aug Sap Oct Nov Dee
month
EMS/Fire Pre-Hospital Calls For Service - Collier Col.l11ty Sheriff's Office - December 2010 - Page 6
1\ yelllge Response Time b.y Time of Day
These data show differences in average response time by hour, \1.,-ith shorter response times
occurring during the daytime hours. The range from create-to-arrival response time by hour is 8.1
to 10.3, a difference of2.2 minutes.
The dispatch-to-arri.a1 response time showed a similar pattern of shorter response times during the
daytime houtS; the range was from 6.0 to 8.3 minutes on average. The create-to-dispatch response
time did not show a similar pattern (average times ranged from 1.9 to 2.1) by time of day.
11.
CI)
~
c
~
Ii:
c
"
~
:E
7.
6.0
o 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23
hour
EMS/Fire Pre-Hospital Calls For Service - Collier County Sheriffs Office - December 2010 - Page ..,
2.
c
fj
III 2.0
~
c
:i
t:
Iii
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::E
1.5
1.00
~
-
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c
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~
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4.
4.
Ave
Hour
o 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22: 23
hour
Hour
o 2 3 4 6 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22: 23
hour
EMS/Fire Pre-Hospital Calls For Service - Collier County Sheriffs Office - December 2010 - Page 8
Ave~ Response Time Qy Hour and Day ofW~k
The following chart shows the pattem of average create-to-arrival response time by hoUt and day of week.
The darker shades represent higher response times, in this case from around midnight through 7;00 a.m. The
average response times of 10-11 minutes occurred more often from Monday through ~.ednesday during the
early morning hoUlS.
-Sat
SUn
o 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23
Mln
.Tue
Wed
Thu
Fri
lEI 8.00.9.00 119.00-10.00 .10.00-11.00 I
:\ v~e Response Time for Vehide Accidents
Vehicle accidents represent a small portion of these calls (6.2 percent); however, due to the different
nature of these types of calls, response time and location information are included in this report.
Vehicle accidents, based on the data selection criteria, were all identified as priority one calls; for
other medical calls, 56 percent were priority one and 44 percent were coded as priority two.
Response times for vehicle accidents were shorter, on average by almost two minutes, than other
medical-related calls. The average response time was 6.7 minutes for vehicle accidents and 8.6
minutes for other medical-related calls.
EMS/Fire Pre-Hospital Calls For Service - Collier County Sheriffs Office - December 2010- Page 9
Av~ Response Time b.,y Area
CAD data captures areas identified by Fire districts/stations; the following chart shows the average
response time for identified areas.
25.
20.
15.
HF
North Naples Fire Department (NNFD) accounts for 33 percent of these calls; followed by East
Naples Fire Department (ENFD) with 29 percent aod Golden Gate Fire Department (GGFD) with
13 percent.
I'E
10%
OFD
1%
MFD
5%
NNFO
32%
, If<' O"lfld NUl1lb.., .f lit C.IlJ,
Big Corkscrew / BCFD
East Naples / ENFD
Immokalee / IFD
North Nllples / NNFD
Marco Island / MFD
Ochopee / OFD
GoJden Gate / GGFD
Isle of Cllpri " ICFD
Citv of Nanles / NF
34D 2%
4"'84 29%
1242 8~/O
54 It 33%
794 5%
133 10<
,(';
2090 13%
82 0%
1669
l00to
I ",," h;4~ jHlI
EMS/Fire Pre-Hospital Calls For Service - Collier County Sherifrs Office - December 2010 - Page 10
Location of Calls
Densil;y Methods Used
Nearest Neighbor Hierarchical Clustering (NN) was used to identify groups of incidents that are
spatially close. This is a hierarchical clustering routine that groups points together based on certain
criteria.4 The clustering is repeated until all points are groups or the clustering criteria fails (based on
threshold distance) minimum points per cluster, and standard deriations for ellipses. for instance).
The results are ellipses used to identify groups of points spatially close to each other. In addition
kernd density spatial analysis was used. which estimates density over a continuous service; this
method shows hO\1\- density varies and is distributed over space. In this case, areas of high
concentration of calls will stand out on the density maps. This is useful for visualizing aggregated
crime patterns in and across defined boundarr areas) and for obtaining a general picture of the
overall spatial distribution of calls for service. In both cases, these areas that appear as hot spots
represent locations with a greater than average number of calls for service.
Limitations
Density and hot spot spatial analysis is very useful. particularly to identify places with higher
concentration of activity in cases with large numbers such as these calls for service. However, it is
also important to outline limitations with these procedures. The NN technique can be somewhat
arbitrary due to the minimum points rule. For instance. the user is required to define a meaningful
cluster size. Although the results are based on empirical groupings. this is not a statistical way for
defining regularity (although such patterns are a human way to define patterns and trends).5 Two
different users may interpret the size of a hot spot differently in addition to other parameter
variability. For instance, in one geographical jurisdiction, 40 incidents mar be considered high
activity, while in another area. this may not be unusual and different parameters would be set to
identify a hot spot in this location. As such, output will be different depending on the geographical
levd. the number of the data involved and the parameters set by the user. Kemd density
calculations face similar limitations; the technique is dependent on an arbitrarily-defined interral size.
The advantages to spatial analysis can be overcome by running statistical tests "hen possible, and by
using more than one hot spot or density calculation. In this case, in addition to the significance
testing, both kernel density and NN spatial analysis techniques were used to add confidence to
findings.
Overview of Maps included
The following pages show maps of IThIS zones) Fire districts and station locations. Pin maps and
density maps countywide and by geographical areas within the county are included. Many of these
maps include layers of kernel density and nearest neighbor ellipses to show locations with higher
than average calls. Call frequency and average response times identified within nearest
neighbor/high acti\;.ty groups are provided in addition to specific locations. mostly medical and
senior living facilities. which represent a high numbers of calls. A map of vehicle accident locations.
identifying locations (intersections) of calls is included. Fioally. maps showing calls relative to
straight line distances from Fire and El\lS stations are included.
4 DistuSsion of spatis.! analysis methods used in this report, including advantages and limitations of nearest neighbor and
kemeJ density techniques, are from various N ationalInstitute of Justice mapping publications; for instllnce, an overview
of hot spots and techniques can be found in the NlJ report Mapping Crime: lTnderstanding Hot Spots awilable at
www.ojp.usdoj.gov/ni;
5 Discussion of limitations on NN and kernel density techniques from the National Institute of Justice mapping
publications, pamcu1arly as outlined in NIJ-sponsored CrimeStat publications from Ned Levine & Associates
E?l.rs/Fire Pre-Hospital Calls For Service - Collier Countj Sheriff's Office - December 2010 - Page 11
1__... .
" ~
t,' ·
J
KIll
Collier County
EMS ZOfleS and Stations
Dee 2010
!i;1
Collier County
Fire Districts and Station&
Dee 2010
*,,'\1.
EMS/Fire Pre-Hospital Calls For Service - Collie: County Sheriffs Office - December 2010 - Page 12
Fire Districts and EMS Zones
Legend
o B4SZanllS
IIhDbtrkts
DISTRICT
CJ Er;FO
a'TY FIRE
f=~ ENFD
~-,
:._.: OOFD
ICFD
:~JIFD
MFD
~..~ ~ NNFD
L.~.~: (FO
EMS/Fire Pre-Hospital Calls For Service - Collier County SherifPs Office - December 2010 - Page 13
This pin map identifies the high-priority, pre-hospital call locations countywide. Locations of fire
and EMS stations are included.
Colier CCIl.lnty
Hi'" PriorIty Hospital CFS
JuI2009. Jun 2010
.'
J
Legend
. Fl.. lIIIlona
.& BE lacltio",
. FlraEMB CI'S
-milia
l!l
II)
.:.-w-................~.~.....
J76
"
,-----..Ii
'"
...."
.
EMS/Fire Pre-Hospital Calls For Service - Collier County Sheriffs Office - December 2010 - Page 14
The following map shows density countywide, with the darker shades representing more calls. First-
order nearest neighbor clusters, calculated with a minimum of 200 points per cluster, are represented
by the blue ellipses on the map. The lighter dots on the map represent locations of calls.
z
~
III
~
CR i48 E
Coller County
Nearest Neighbor/Kernel Density
High Priority P~hospital Calls for Service
.A.l12009 - Jun 2010
~
a:
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EMS/Fire Pre-Hospital Calls For Service - Collier County Sheriff's Office - December 2010 - Page 15
The nearest neighbor first-order ellipses identified 16 groups of spatially close calls countywide that
met the minimum criteria of 200 points pet cluster. Combined, these ellipses represent 37 percent
of the calls. Overall, the average 8.S-minute response time for calls in these locations was the same
as the countywide average create-to-arrival response time.
~'r<\l { IH~h t "\;tHldu..;f !\q t..t:';t" H [
1 335 9.4
2 313 10.2
3 419 9.0
4 208 9.1
5 602 9.6
6 453 8.1
7 322 5.9
8 615 8.0
9 508 8.2
10 422 8.7
11 278 7.4
12 404 10.2
13 389 8.1
14 236 9.6
15 201 6.4
16 441 '_0
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EMS/Fire Pre-Hospital Calls For Setcice - Collie.t County Sheriffs Office - December 2010- Page 16
The following map shows the highest concentration of calls along the coast/western part of Collier
County. The nearest neighbor ellipses identify clusters of calls "ith a minimum of 200 calls; the
shaded areas on the density scale represent higher concentration of calls in that particular location.
The maps include the point layer to show locations of calls for service across the county.
Legend
Fir9lEMS CFS
o NN el~sas
- mlllor streets
streets
aAbcfvi&ions
GolfCo\l"SlI&
ULow
-
..
o
High Pt10rlty Hospital Calls fa ServIce
. Nearest Neighbor and Kernel DensIy
.Ad 2009 - Jun 2010
'..
" 'RD
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. $ ".DEN slue IILV[) W
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EMS/Fire Pre-Hospital Calls For Service - Collier County Sheriffs Office - December 2010 - Page 17
This map identifies locations of places identified as having a bigh frequency of calls (the number of
calls range from approximately 70 to 200 calls); these tend to be medical-related or senior living
facilities.
Legend
II) High Call Fl1lq
CJ NN ellipses
I] Ho:lpltal
- maior lII1lets
slmb
CJLC1N
-
-
CJ
o
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----I
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Jul 2009. Jun 201 0
High Frequency Call Looldlons
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EMS/FiLe Pre-Hospital Calls For Service - Collier County Sheriffs Office - December 2010 - Page 18
This map shows call point locations and density of calls in the North Naples area; the number of
calls in the identified NN ellipses are labeled on the map. Fire and EMS station locations are
included.
.
.
" "..~
North Naples Area
High Priority Hospital CF
JuI2009-,Jun 2010
Legend
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EMS/Fire Pre-Hospital Calls For Service - Collier County Sheriff's Office- December 2010 - Page 19
This map shows call point locations and density of calls in the East Naples area; the number of calls
in the identified NN ellipses are labeled on the map, Fire and EMS station locations are included.
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ElMS/Fire Pre-Hospital Calls For Semce - Collier County Sheriffs Office - December 2010- Page 20
This map shows call point locations and density of calls in the East Naples/Golden Gate City area;
the number of calls in the identified NN ellipses are labeled on the map. Fire and EMS station
locations are included.
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EI\fS,'Fire Pre-Hospital Calls For Service - Collier County Sheriffs Office - December 2010 - Page 21
This map shows call point locations and density of calls in the lnunokalee area; the number of calls
in the identified NN ellipses are labeled on the map. Fire and EMS station locations are included.
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EMS/Fire PIe-Hospital Calls For Service - Collier County Sheriffs Office - December 2010 - Page 22
This map shows call point locations and density of calls in Marco Island; Fire and EMS station
locations are included.
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EMS/Fire Pre-Hospital Calls For Service - Collier County Sheriffs Office - December 2010 - Page 23
This map sho\\"S call locations, including density and NN clusters (a minimum of 25 calls in each
group), of vehicle accident locations. Countywide, there were 1,019 vehicle accident calls meeting
the data selection criteria and accounts for 6.2 percent of the total calls used in this report.
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EMS/Fire Pre-Hospital Calls For Service - Collier County Sherifrs Office - December 2010 - Page 24
Calls v,-ithin one mile of Fire and El\.IS station locations:
There were 6,349 calls located within one mile of an EMS station and 8,145 calls located -..rithin one
mile of a fire station. Combined, this number represents 9,269 calls located within one mile of either
a fire or EMS station; this accounts for 56 percent of the total calls. The average create-to-arrival
response time for calls within one mile of Fire and! or EMS stations was 7.8 minutes, with a median
response time of 7.4 minutes. The average create-to-dispatch time was 2.0 minutes and the average
dispatch-to-aninI response time was 5.8 minutes.
Calls more than one mile from Fire and EMS station locations:
There were 7,276 calls located outside of a one-mile radius from an EMS or Fire station. The
average create-to-arrival response time for these calls was 9.4 minutes. The average create-to-
dispatch response time was 2.0 minutes and the a,erage dispatch-to-arrival response time was on
average 7.4 minutes.
Fire and EMS locations
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EMS/Fire Pre-Hospital Calls For Service - Collier County Sheriff's Office - December 2010 - Page 25
This map shows the straight line distance from EMS statioos to the CFS actinty; each concentric
circle represents one mile out from the EMS station. EMS zone boundaries, call location points and
density layers are included on the map.
EMS/Fire Pre-Hospital Calls For Service - Collier County Sheriff's Office - December 2010 - Page 26
This map shows the straight line distance from Fire stations to the CFS activity; each concentric
circle represents one mile out f:com the Fire stations. Fire district boundaries, caJllocation points
and density la:re:cs are included on the map.
EMS/Fire Pre-Hospital Calls For Service - Collier County Sheriffs Office - December 2010 - Page 27
COLLIER COUNTY EMERGENCY MEDICAL SERVICES
POLICY ADVISORY BOARD
Schedule of Meetings for 2011
Pursuant to Article III: Meetings; of the Emergency Medical Services Policy Advisory Board
Bylaws, the "regular meetings of the membership of the Advisory Board shall be held
bimonthly." The following is a purposed schedule, and is subject to change as deemed necessary
by the Chairman.
January 21, 2011
March 25, 2011
May 27, 2011
July 29, 2011
September 23, 2011
November 18,2011
.J. Chrislllpher Lombardo. Chairmltll
l\lnl'~lll'et Hansoll. Vir(' Chuirmllll
I'nul.J. Moriarty Sr.. Trel\suft'r
.Jnllll'S 8urke. COJllmlssioner
John O. McGowlln. Commissioner
1885 Veterans Park Drive
Nal>lcs, FL 34109
(239) 597.3222
Fux (239) 597.7082
North Naples Fire Control and Rescue District
September 17. 2009
( ),
~[:l"' I ij l009
Collier County Manager Jim Mudd
County Manager's Office
3301 E. Tamiami Trail
Naples. FL 34112
Dear County Manager Mudd,
The North Naples Fire Control and Rescue District ("District") believes that its residents
deserve to receive the highest level of Advanced Life Support ("ALS") services
available. Based on this belief the District has entered Into two separate interlocal
agreements with Collier County allowing for the District's provision of ALS service
beginning in 2005.
In 2007, Collier County EMS attempted to terminate the original interlocal agreement
entered into between the District and Collier County as a result of rising conflicts
between Collier County EMS and the District. As a result, a successor agreement. the
Interlocal Agreement Advanced Ufe Support Partnership between Collier County and
North Naples Fire Control and Rescue District was entered into on September 11. 2007
("1nterlocal Agreement").
This Interlocal Agreement temporarily resolved some of the differences between ollr
agencies. For a short period of time, the District and Collier County EMS were able to
function in a cooperative partnership resulting in the supplementation of Collier County
EMS activities by the District and a higher level of ALS service provision to the District's
residents. Two reports were independently prepared confirming the effectiveness of the
District's provision of service and the corresponding benefits to Collier County and the
residents of the District - the 2007 EMS Master Plan and the Collier County Productivity
Committee/EMSAC Report.
However, over the course of the last year, increasing conflicts have been renewed as a
result of the Interlocal Argreement or its intent having been breached in several areas
by Collier County. These breaches have repeatedly threatened the ability of the District
to comply with the terms of the Interlocal Agreement. Further, the Interlocal
Agreement's intent to "provide quality and cost effective fire rescue emergency medical
services" is no longer being achieved as a direct result of the actions of the Office of the
Medical Director and Collier County EMS. Those actions include the following:
Count Manager Jim Mudd
September 17, 2009
Page Two
. Continuous revisions to the ALS Engine Protocol. Beginning in September of
2008, the ALS Engine protocol has been changed significantly five times by Dr.
Tober, the Office of the Medical Director (9/2008, 10/2008, 1/2009,4/2009, and
7/2009). These changes in protocol prevent a State certified paramedic from
providing even national or state recognized minimum standards of patient care.
Additionally, these continuous revisions to the ALS Engine protocol have
resulted in increased confusion over Dr. Tober's authorization, even among the
District's most experienced paramedics, and a reduction of care being provided
to our residents. Dr. Tober's continuous revisions to ALS Engine Protocol have
significantly restricted the District's ability to provide ALS services and reduced
the medications originally carried by the District's ALS engines by more than
sixty percent.
. Dr. Tober unilaterally continues to develop new or revised certification
requirements even though Section 4.2 of the Interlocal Agreement provides that
"necessary qualifications... will be cooperatively developed and defined." The
continued non-compliance by Dr. Tober of this requirement further complicates
the difficulties with the implementation of the Interlocal Agreement because
revisions are made to qualifications without adherence to Section 4.2. There is
also no clear agreed upon method to certify new paramedics or those
paramedics who have been Tober-decertified.
. Dr. Tober's 2009 mandatory Ride-Time requirement was implemented even
though compliance is difficult for the District due to the large number of District
paramedics and there being only one Collier County EMS vehicle that must be
ridden to satisfy the requirement. This has resulted in the majority of the
District's paramedics losing their Tober-Certified status; thus, the District has
been unable to provide ALS services to the fullest extent allowed under the
Interlocal Agreement. Had the District been included in the development of the
certification requirement as provided in the Interlocal Agreement. the District
may have had the opportunity to assist with the development of a requirement
that satisfied Dr. Tober's needs but was realistic to implement. By the end of
November, the District will have no Tober-Certified paramediCS or ALS Engines
in operation. This means that the District will no longer be providing ALS
services to its residents. It also means that the District is no longer able to
augment Collier County EMS within our boundaries.
County Manager Jim Mudd
September 17, 2009
Page Three
. Dr. Tober has been requested, in writing on several occasions to provide the
process to reinstate the Tober-Certified status for the District's paramedics
decertified by Dr. Tober. No response has been received to these requests.
. Although the intent of the swapped employee component of the Interlocal
Agreement is to provide training and increased patient contact, neither has
occurred as District paramedics are either driving the Collier County EMS ALS
transport unit or placed in the back of the unit without any supervision, thus
minimizing training opportunities. The District's paramedics have been unfairly
penalized in this regard by the unfair treatment of Dr. Tober. Dr. Tober has
stated that when he feels Collier County EMS paramedics are lacking in patient
contact, he freely moves them around. Why were the Collier County EMS
paramediCS not Tober~decertified? The treatment of Collier County EMS
paramedics is far short of the resulting decertification the District's paramedics
have experienced and is a violation of the Interlocal Agreement that requires
that paramedics be treated equally.
. Recognizing the District's difficulties in meeting Dr. Tober's training
requirements. and in an effort to fully comply with Dr. Tober's evolving and
unilaterally developed requirements, the District has requested additional Tober
designated trainers as well as the opportunity to place a third employee on the
Collier County EMS ALS transport units. Both requests were denied by Dr.
Tober.
. The District supported Dr. Tober's movement from EMS into the Office of the
Medical Director in hopes that his direct reporting to the Collier County Board of
Commissioners would eliminate existing conflicts. However, since the creation
of the Office of the Medical Director, existing conflicts have not been resolved.
Rather, there is an increasing lack of respect towards the District's paramedics
exhibited by Dr. Tober, including unfounded allegations of cheating, and Dr.
Tober's reference to the District's paramedics as "clowns". In addition, Dr.
Tober has stated several times that his office is just "too busy" to deal with the
fire districts.
County Manager Jim Mudd
September 17, 2009
Page Four
· On several occasions, Dr. Tober has filed complaints related to both the District
as an agency and the District's paramedics with the State Bureau of
Emergency Medical Services without notifying the District, and without making
any attempt to allow the District to first address or remedy the issue.
. Two committees were created to assist with the issues related to the provision
of ALS service in the County: the Quality Assurance Committee and the
Emergency Medical Services Policy Advisory Board. Neither of these
committees are actively meeting. The Quality Assurance Committee is not
meeting due to legal concerns and lack of availability of Dr. Tober. The EMS
Policy Advisory Board was in effect suspended by Dr. Tober as he has
demanded the removal of the Collier County Fire Chiefs Association's
representative before another meeting would be held.
For several years, the Board of Fire Commissioners of this District has repeatedly
demonstrated their commitment to the provision of ALS services by District
paramedics in conjunction with Collier County EMS. This has been consistently
supported by the dedication of personnel, resources and finances provided to this
partnership. Since 2005 alone, the District has expended close to $2.2 million
dollars in support of the provision of ALS service.
There is a rapidly increasing deterioration of the relationship between District staff,
Collier County EMS staff and the Office of the Medical Director which has resulted in
most if not all communications between our agencies occurring through attorneys.
Although the District believes that the difficulties it incurs with EMS and the Office of
the Medical Director is acceptable if the District's provision of ALS services to its
residents results in even one saved life, the reduction in its Tober-Certified
paramedics and the continued difficulties identified above have resulted in a
reduction of the level of service to its residents that is no longer acceptable. The
District cannot function under an Interlocal Agreement where the rules constantly
change resulting in the disruption of the provision of ALS services.
Due to the above reasons, we believe the best remedy to the situation is the issu-
ance to the District of a certificate of public convenience and necessity ("COPCN")
for ALS Non-Transport services. To that end, we are enclosing our
County Manager Jim Mudd
September 17, 2009
Page Five
application for a COPCN ALS Non-Transport Services. It is our contention that the
issuance of such a COPCN will provide the means for our agencies to move past
our existing conflicts and develop a system that allows for the highest standard of
ALS provision through the cooperative efforts of our agencies.
The District has engaged the firm of Coleman, Yovanovich & Koester, PA to assist
with the COPCN process. Please direct all future communication regarding this
issue to Richard Yovanovich, Coleman, Yovanovich & Koester, P.A., 4001 Tamiami
Trail North, Suite 300, Naples, FL 34103. We request this item be placed on the
December 1, 2009 Board of County Commission Meeting Agenda.
R:_~p~gtfl.lUY,..
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L'--/J. CHRISTOPHER LOMBARDO
Chairman, Board of Fire Commissioners
NCH Downtown Naples HospItal
350 Seventh Slteet N.
NaplCls, fL 341 02
(239) 436.5000
NCH
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NCH North Naples Hospital
11190 Healthpark Blvd.
Naples, Fl341l0
(239) 552.70011
p'\:::(~E""l\lr;;<u'"
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November 15.2010
, : '. ;_: ~.:: . . .~.
MI'. Dan Summers. DiI'ectol'
BlII'oau of Emergency Selyices
Collie,' County, Plol'ida
I:MERGENCY MANAGEMENl'
Subject:
Renewal of Celtificate of Public CQnvell iellce & Necessity fOl'
NCH Healthcare System, Inc. Ambulallce Services
Dcal' MI'. Summers:
Pel'suant to Collier County Ordinaltoo 2004-12. please accept the following updated infol'matiol1 fOl,the
renewal of the required certificate for 20 II:
A. NCH Ambulance Services is operated by NCH Healthcare Systems. Inc., 350 71b Avenue North.
Naples PL 311 101
B, NCH Ambulance Services provides the NCH Healthcal'c System. Inc. with inter-faoili!)', and out
of county ambulance transports.
C. NCH opel'ates 110 less than Olle (I) and Ulllo three (3) gl'ound units on immediate call at all times.
D. NCH Ambulance Services is located at 2157 Pine Ridge Road) Naples, Florida.
E. Attachments:
I, NCH Cel1iticate of Liability InslIrance
2. Schedule of Rates Charged
3, Description of Vehicles
4. 3 Collier COllnty References
5. Financial Data
6. Check fOl' $250 Renewal Fee
Please contact me if you need any additional infol'J>>ation.
Sincerely,
.C?~ C?~
Philli~C. gl!tchel'
eh ief Opemtions Officer
Inbj
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\V ~o~o~~~! ~ .~.~~~~~~:
Top 5% itl the Nation for Ovorall Clinical Excellence Six Consecutive Yeal's
www.NCHmd.org .
NCH Downtown Naples Hospital
350 Seventh Street N.
Naples, FL 34102
(239) 436.5000
NCH
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Healthcare
System
NCH North Naples Hospital
11190 Healthpark lllvd.
Naples, FL 3411 0
(239) 552.7000
January 7, 2011
Dnn SUlllmers, Director'
Bureau of Emergc!1cy Se,'vices
8075 Lely Cultuml Parkway, Ste. 445
Naples, FL 34 J 13
Subject: NCH Healthcal'e System COPCN Renewal Application
Deal' Mr. Summers:
As disclIssed in OUl' meeting of Decem bel' 16> 2010, I have included with this lettel' additional
informalionl'egarding NCB Healthcare System's aPl,licatiol1 to renew,om' COPCN celtificate.
Specifically, I have included: I) our operational plan for 20 11,2) information on the Officers of
the NCH m'ganizaUon, and 3) information on the ambulance site locations.
NCH Healthcare S)/stem intends to opel'Ate two ambulances as inter-facility and out ofcon"ty,
non-emel'gency t1'anSpolt vehicles. OUl' plan calls fOI' I) an ambulance to be stationed at the North
Naples Hospital campus, located on Immokalee Road) 24 hours pel' da)', 1 days per week and 2)
an ambulance to be stationed at the Marco Island Health Ccnte" located at 40 Henthwood Drive,
Marco Island, FL) to coincide with the Center's hOllrs ofopel'ation.
In order to .implement this plan, NCH \-vill purchase one additional ambulance vehicle and secure
sufficient staff to operate the ambulance sel'\,ice at the level proposed above. NCH is actively
pursuing both of these items and we anticipate initiating this sel'vice no later than Febl'Ual)l 15)
20 II.
The NCH HeaIthcare System Audited Financial Statements submitted with ollr ol'lgina]
application information are the most current. We anticipate 20 I 0 Statements to be available ill
February 20 II and will submit a copy to YOll at that time.
Please contact mc if you need any additional infol'mation.
Sincerel)',
cY~ c. ~
Phillip C. Dutcher
ChiefOpel't~tions OfficeI'
c: Allen Weisst MD
Kelly Daly
Burt Saunders
Attachments
.~~. .
\V ~D~O~M~! ~ .28~~L~~M~:
Top 5% in the Nation for Oval'all Clinical Excellence Six Consecutive Years
www.NCHmd.org