EMS Policy Minutes 03/25/20111612A11"
March 25, 2011
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1 IWMS OF THE MEETING OF THE COLLIER COLTTY
EMERGENCY MEDICAL SERVICES ' " " """............•
POLICY ADVISORY BOARD
Naples, Florida, March 25, 2011
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, 12 Goodlette
Road N., Naples, Florida, with the following Members present:
Date: °l 1 k-4 % \
Item M%L& = 2 NA %.
. pies to:
ALSO PRESENT: Dr. Robert Tober, Collier County Medical Director
Jennifer Florin, EMS Administrative Assistant
Jeff Page, Chief, Bureau of Emergency Services — Staff Liaison
Wayne Watson, Deputy Chief, Bureau of Emergency Services
Dan Bowman, Deputy Chief, Bureau of Emergency Services
Jorge Aguilera, Deputy Chief Medical Services/Community
Relations
C : James Talano, M.D.
Vice Chair: Chief Walter Kopka.
Rosemary LeBailly, RN
�
Chief Robert Metzger
Fiala
Jerry Pinto
Hiller
Hennin
Coyle
Colette ,
Misc. Comes:
Date: °l 1 k-4 % \
Item M%L& = 2 NA %.
. pies to:
ALSO PRESENT: Dr. Robert Tober, Collier County Medical Director
Jennifer Florin, EMS Administrative Assistant
Jeff Page, Chief, Bureau of Emergency Services — Staff Liaison
Wayne Watson, Deputy Chief, Bureau of Emergency Services
Dan Bowman, Deputy Chief, Bureau of Emergency Services
Jorge Aguilera, Deputy Chief Medical Services/Community
Relations
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March 25, 2011
1. Call to Order and Pledge of Allegiance:
Chairman Talano called the meeting to order at 3:40 PM and a quorum was established.
The Pledge of Allegiance was recited.
2. Agenda and Minutes:
A. Approval of Today's Agenda
Jerry Pinto moved to approve the Agenda as submitted Second by Rosemary LeBadly.
Carried unanimously, 4—a
B. Approval of Mmutes — January 21, 2011 Meeting:
Jerry Pinto moved to approve the Minutes as submitted Second by Rosemary L_eBadly.
Carried unanimously, 4 — 0.
3. Old Business:
(None)
4. New Business:
A. Review of COPCN ( "Certificate of Public Convenience and Necessity") Ordinance
and Recommendations to Board of County Commissioners ( "BCC ")
Dr. Robert Tober asked what the specific questions were in reference to the COPCN.
Chief Jeff Page stated the County Attorney and the North Naples Attorney have
corresponded and provided a draft copy of the Ordinance.
Chief Page stated there were two issues that were "sticking" points.
• One requirement : COPCN providers are to contract with the County's Medical
Director but North Naples has its own Medical Director/
• King County was cited as an example. Kings County has a Chief Medical
Director, as well as subsequent Medical Directors for individual Districts or
providers, but the Medical Directors report to the Chief Medical Director as his
liaisons.
Language is to be incorporated into the Ordinance to allow it to be utilized by
future providers — it should not be tailored to one specific provider.
o For example, if North Naples chooses to hire its own Medical Director to
oversee training, and another District wants to be a provider but does not
want the extra expense of hiring a Medical Director, adding a specific
provision in the Agreement would permit the Office of the Medical
Director to be compensated for the work involved in developing new
protocols and additional in- services.
o The language should allow a COPCN provider to contract their own
Medical Director, if they choose, while recognizing the primary Medical
Director who will make overall decisions to ensure that one protocol is
followed Countywide.
(Chief Robert Metzger arrived at 3:45 PM)
Chief Page noted the second issue was "ride time."
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March 25, 2011
• The County Manager tasked EMS to "clean up" the COPCN language to allow
North Naples to re- qualify when necessary. There is nothing in the document
concerning riding -in on ALS .calls.
• Goal: draft a document for future COPCN providers including how they could
achieve their ride times.
• North Naples did not want to abide by the 10 -shift requirements currently in the
Ordinance, or possibly could not, considering the number of people they have.
• North Naples told the Board of County Commissions that on ALS calls, they
would continue the care and ride -in on the calls.
There was discussion concerning whether the intent was all ALS calls or the ALS
calls where treatment had begun.
Chief Page met with the District Chiefs on March 24th, and explained when drafting the
language with the County Attorney's Office, the goal was to keep it very clean to avoid
(as Commissioner Coyle stated) "bickering in the streets" concerning what is ALS'
jurisdiction and what is not.
• The Protocol is color- coded. BLS is in yellow, so anything in colors other than
yellow is an ALS function.
• He stated the requirement was changed to "al?' ALS — it was very clean and
would not cause confusion. The "sticky" component was the clinical time in the
back of the unit.
Public Sbeaker.
Deputy Chief Jorge Aguilera:
• The document is not the final draft of the Ordinance.
• Parts of the Ordinance conflict with Florida Statutes — clarification is needed.
• He does not want to move forward with a document that is open to legal
challenges. He suggested tabling further discussion of the issue until the County
Attorney's Office and the District's attorney are able to finalize the document
• The conflict affects other areas of the document, such as the determination of ride
time.
• The BCC's minutes clearly describe North Naples' intention concerning ride
time.
• With more time, a revised document could be drafted that will be free of conflict
with the Statutes and all parties can agree to support.
Chairman Talano asked for the specific reference that is in conflict with Florida
Statutes.
Deputy Chief Aguilera cited page 12 of the draft, under Item "3," Morlda Statutes,
§401.265. He stated a licensed provider is required to either contract with or employ its
own Medical Director and an Ordinance cannot force a licensed provider in one direction
or another. He suggested if the document were worded differently, it would meet North
Naples' stated intention, which is to adhere to the recommendations of the Blue Ribbon
Committee.
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March 25, 2011
Vice Chairman Kopka asked if "ride time" referred to after ALS had begun [treating the
patient] or to maintaining certification.
Deputy Chief Aguilera replied the District's position is if a District paramedic arrives on
the scene first and begins ALS care, there will be a movement with the patient to the
hospital.
Chief Page referenced a letter from Chief Stokes and cited, "The District recommendation
is that anytime a District paramedic provides ALS services, or if the nature of the patient's
condition warrants, the District paramedic will participate in the transfer of the patient to
the hospital. "
Dr. Tober added if the EMS paramedic stated an extra pair of hands were needed, the
District paramedic should ride in.
Chief Metzger cited the language of the Ordinance (See page 15, paragraph "G," under
"Certification "): "At minimum, the paramedic must work in that capacity not less than one
full month's work shift annually, or in the case of non- transport ALSproviders, must
accompany an attended patients on a minimton of all ALS transports from scene to
hospital. "
He continued the statement eliminated the ALS capability of both the responding engine
company and the area's medic transport unit. It is reasonable that, if the Fire Department
paramedic initiates ALS care, the FD medic should ride in.
He stated the Ordinance would affect any other Fire Department organization that may
apply for COPCN in the future.
Chief Metzger reiterated that if the Fire Department paramedic initiates ALS care, he
should ride in. If an FD paramedic arrived after- the -fact, and care had been initiated by an
EMS paramedic, to compel the FD paramedic to ride -in would not be a good use of
resources.
Dr. Tober agreed. He suggested amending the sentence to read: " ... must accompany an
attended patient on a minimum of all ALS transports from scene to hospital if initiated by
the ALS engine paramedic. "
It was noted:
• North Naples intention was to augment the service — not replace it.
• The target goal was to ensure that the paramedics have a reasonable level of
competency in providing pre- hospital care — in all facets of care.
• The idea is to improve delivery with an opportunity to respond to concurrent calls.
Dr. Tober added a second sentence, "In times of dire medical need, the transport medic
may request the presence of the ALS medic as an extra pair of hands. "
Chairman Talano suggested adding Dr. Tober's suggestions to the document as
clarifying and appropriate.
Deputy Chief Aguilera noted:
• The COPCN Ordinance is in the process of being revised/rewritten, and
• The Public Safety Authority Ordinance is also being drafted.
o The PSA Ordinance mentions " ... the responsibilities and functions of
this potential Authority which include review and involvement in the
issuing and review of a COPCN Ordinance. "
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March 25, 2011
He concluded while the County's Attorney and the District's attorney are working
through the language issues, there might also be some movement in the PSA Ordinance
which could further impact the COPCN Ordinance. He stated that at some point the
COPCN Ordinance must reference the PSA — if the Public Safety Authority becomes
reality. The two documents dovetail together.
Chief Page cited North Naples' statement from the BCC Minutes: "We are committed
that if we start ALS services prior to EMS, or if the patient's condition meets the
additional expertise, we will go to the hospital with the patient. "
Deputy Chief Aguilera confirmed the statement encompassed North Naples'
commitment.
Dr. Tober:
• The Protocol states the starting of a prophylactic IV is in the green Protocol.
• The group could decide to move starting an IV to the yellow Protocol because
some EMTs could theoretically start an IV.
• To avoid any type of contest in the field between an arriving medic and the medic
who was first on the scene as to whether this is or is not ALS, it must be black -
and- white.
Deputy Chief Aguilera reiterated the intent was to be smart about delivering care and to
never take shortcuts.
Chief Robert Metzger stated several of points made by Jorge Aguilera had also been
discussed during the Fire Chiefs' Association Meeting held on March 24th.
• The Association represents all of the responders who make pre- hospital
responses to patients in Collier County.
• The goal is to ensure the changes made result in a non - contentious document.
He explained he was late due to a call from the County Manager. The urgency is due to a
deadline imposed on the County Manager by the Board of County Commissioners to
produce this work - product. He continued the County Manager understands that if the
EMS Board, in reviewing the COPCN Ordinance, determines there are a number issues
creating concern within the First Responders or within medical direction, more direction
is necessary before the EMS Board can recommend adoption of the document to the
BCC.
Chief Metzger paved to recommend tabling review and discussion of the COPCN
Ordinance until there has been an opportunity for further legal consultation to remove
those areas that are currently in dispute
(No second was made in support, and the Motion failed)
Chief Metzger noted Chairman Talano has the authority to call for an additional EMS
Board meeting to be scheduled prior the June I& meeting.
Deputy Chief Aguilera stated if the PSA Ordinance were available, both documents
could be reviewed concurrently.
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March 25, 2011
It was noted a draft of the PSA Ordinance is available and is being reviewed by different
groups.
Chief Page offered the following revised language for inclusion in the COPCN Ordinance:
"At a minimum, the paramedic must work in that capacity not less than
one full month's work shift annually, or in the case of non - transport ALS
providers, if ALS services are provided prior to EIB transport arrival, or
if the patient's condition meets that additional level of expertise, the ALS
non- transport provider will accompany the patient on the ALS transport
from scene to hospital. "
Deputy Chief Aguilera requested an opportunity to review the language
Chief Metzger stated transport was not the sole issue. The Fire Chiefs inquired as to who
as paying for the various equipment, as well as the rates being charged by the County for
the use of the Medical Director. Additionally, what rights, if any, were retained by the
organizations contracting for medical services and what are their expectations concerning
the services to be provided
He concluded the issues raised were not answered and the Fire Chiefs' opinion was the
document was not ready to be finalized He suggested executing a Memorandum of
Understanding ( "MOU ") between the parties while the larger issues were under
consideration.
Deputy Chief Aguilera stated neither the County's Attorney nor the District's attorney
have signed off on the Ordinance as the final draft.
Discussion ensued as to whether or not there as an effort to delay modifying the COPCN
Ordinance until after the Public Safety Authority was established.
Dr. Tober stated there was agreement on the ride times for ALS- initiated calls and
suggested voting on the issue alone.
Deputy Chief Aguilera agreed that setting forth a position between the parties should be
the Hirst step and the agreement could be incorporated into the COPCN before it was
finalized. He offered to draft a statement by the end of next week for review by the
Medical Directors.
Discussion ensued as to what was to be included, Protocol and the color -coded chart,
modification of the Protocol, existing exceptions to the Protocol via MOU with ALS
providers with reference to distribution of certain drugs in the field
Chief Metzger asked, "At what point do we all agree that the Fire Department Paramedic
rides in with the patient ?"
Dr. Tober confirmed the color -coded chart in the Protocol categorized procedures, and
there was no ambiguity currently. He continued an IV is started on a patient because
there are significant reasons to do so, and meets the criteria for ALS.
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March 25, 2011
Dr. Tober stated he would be comfortable agreeing on two issues:
• That if they go into the green protocol, they are taking the patient to the hospital
and
• We will always be open to modification of how we allocate the colors in the
Protocol.
There was further discussion between Dr. Tober and Deputy Chief Aguilera concerning
the use of non - medicated IVs.
Chief Metzger inserted the incidents discussed incurred infrequently, if at all, and recalled
only one dispute that was resolved after -the -fact. He suggested fairly simple language
could be utilized to address the concern, and the suggestions could be sent to the attorneys
who are revising the more contentious issues.
Dr. Tober stated the first, and cleanest option is to keep the color -coded Protocol at
yellow, blue and green — knowing if you move into green, the patient goes to the hospital.
Chief Metzger concurred. He noted as the system evolves and recognized the need to
modify a process, it could be revised as warranted in the future.
Chief Page suggested including the following language:
" ... or in the case of non - transport ALS providers, i.e., Fire Department
medics, if ALS services are provided prior to EMS or if the patient's condition
meets that initial level of expertise, they must accompany the patient from
scene to hospital. "
The Chief noted the following statement was made by Deputy Chief Aguilera during the
BCC meeting:
"We are committed that if we start ALS services prior to EMS, or if the patient's
condition meets that additional level of expertise, we will for continuum of care
go to the hospital with the patient. "
Chief Metzger amended his initial motion and moved to approve tabling discussion and
revision of the COPCN document for the time being. Second by Vice Chairman Kopka.
Carried unanimously, S — 0.
Chief Metzger moved to recommend that the EMS Board approve recommending to the
Board of County Commissioners to approve amending Paragraph "G" entitled
"Certification" on Page 12 in the COPCN Ordinance to adopt the language suggested
by Chief Page as stated above.
Second by Vice Chairman Kopka. Carried unanimously, S — 0.
B. CCSO Release of AED Information
Vice Chairman Kopka provided background information:
• Both private and public AEDs ( "Automated External Defibrillator ") were
registered with the local EMS provider
• The information (name, address, and phone number) was entered into the EMS
Dispatch computer system
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• In 2010, the Collier County Sheriffs Office stated releasing this information
violated Florida Statutes, § 365.171 (12)
• He cited a memo from Commander Bill Rule, dated February 18, 2010
He requested the EMS Board to recognize that AEDs are critical piece of emergency
equipment and endorse legislature to amend Florida Statutes, § 365.171(12)
Dr. Tober explained the current 911 system was to be augmented by the proposed
"ATRUS Program," a fully automated system capable of informing a caller of the
location of an AED unit. The attorneys for the CCSO objected, claiming the law would
be broken.
mice Chairman %pka moved to approve endorsement by the EAf4 Policy Advisory
Board to support the repeal of Florida Statutes, § 365.171(12) which prohibits the
release of an address of a person requesting emergency service or reporting an
emergency by accessing an emergency communications "911 "system for purposes of
accessing an AED. Second by Jerry Pinto. Carried unanimously, S — 0.
5. Staff Reports:
• Chief Page
• He and Chief Metzger will meet to explore starting an ALS Engine Program
at Golden Gate, including moving a unit into Station #73.
• There are vacancies and he will ask the County Manager if some positions
may be filled.
• Fuel costs are projected to be as high as $500,000 next year.
• IT expenses are also rising.
6. Public Comment:
(see above — Deputy Chief Jorge Aguilera)
7. Board Member Comments:
(None)
8. Next Meeting Date: June 10, 2011 at 3:30 PM
( Note. An additional meeting may be scheduled)
There being no further business for the good of the County, the Meeting concluded by
order of the Cbair at 5:00 PAL
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March 25, 2011
COLLIER COUNTY EMERGENCY MEDICAL
SERVICES POLICY ADVISORY BOARD
James T 0, AD., Chairman
u i
i t c%
The Minutes were �ved by the Board/gOmmittee Chair on .9 2011,
as presented [ -- 1, or as amended r \/