Blue Ribbon Pre-hospital Care Report
Patricia L. Mor~an
Cc:
Subject:
Attachments:
FlorinJennifer [JenniferFlorin@colliergov.net]
Friday, December 31,20108:05 AM
ButcherTabatha; Chief Robert Metzger (bobmetzger@ggfirecom); Douglas Lee
(duglee@hotmailcom); Dr Talano Uvtalano@comcast.net); Jerry Pinto Ujprx@aolcom);
Kopka, Walter; Patricia L. Morgan; Rosemary LeBailley (rn_roe@hotmailcom); Tober
(rbtobermd@yahoo.com); Tucker, Samuel; Walter Kopka (wkopka@comcast.net);
Watson Wayne
Page, Jeff
January Meeting Agenda Items
Final reportBOTTOMLlNERecommendations FINAL 1230 10 (2).pdf; REPORT-FINAL-
PreHospitalCare 12 30 10pdf
From:
Sent:
To:
Good Morning and Happy New Year to you all.
Per our Chairman, Dr. Talano, I have attached the final recommendations of the EMS Blue Ribbon Committee for your
review. Please read through them carefully and be prepared to discuss this and make a recommendation to the BCC at
our next meeting.
If you have trouble opening the documents please let me know.
Thank you!
Jennifer
Florin
Administrative Assistant
Collier County EMS
8075 Lely Cultural Parkway
Suite 267
Naples, FL 34113
(239) 252-3759
(239) 252-6490 - Fax
'i'" 'r I ) ( :; I; r, . . ide ii, ~ '
J.'.','
"fl,';
BOTTOM-LINE RECOMMENDA nONS
FOR
PREHOSPITAL EMERGENCY MEDICAL TREATMENT AND TRANSPORT
(PEMTT) SERVICES
PREFACE
Collier County, Florida is one ofthe 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 evidcnce 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 (PEM'n') 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 lof5
RECOMMENDA nONS
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 Publie 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. Outsource 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 fi-om 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 ofthe public and private sectors.
Page 2oj'5
10. Encourage discussion of functional consolidation of tire 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 eollaborate to designate one leader to be the one voice
for all PEMTT treatment and transport matters conducted BY fire services operating in
Collier County.
J 4. Mandate that all PEMTT vehicles be equipped with standardized life saving equipment
COMPATIBLE with AREA hospital emergency department equipment and supplies.
Puge 3 0/5
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 Firefie: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 Chiet: City of Marco Island Fire-Rescue District
Steve Mcinerny, Chiet: City of Naples Fire District
Robert Metzger, Chiet~ 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 Chiet~ Collier County Emergency Medical Services
Page .:/ 0/5
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 Emere:encv Department Phvsicians
Todd D. Bethel, MD., Emergency Medicine, Naples Community Hospital
John P. Lewis, MD., ER Physician Director, Naples Community Hospital
John W. Zelahy, M.D.. Emergency Medicine/Internal Medicine
Physicians Reg;onalllospital -- Pine Ridge Road
Robert Tober, M.D., Medical Director, Collier County Emergency Medical Services
Florida Gulf Coast Universitv
Lisa Zidek, Ph.D., Associate Professor, Florida Gulf Coast University
Collier Countv Sheriffs Office
Jim Bloom, Chief of Operations, Collier County Sheritrs Office
Deborah Chester, Manager of Planning & Research, Collier County Sheriffs Office
Page 5 of5
This n.'(Jort
to rt'main
C:()Nf~IDENTIALJ
until presented to
(~ollier (:ountv, Florida
v
Board of ('ount\' C'onuuissioners
.'
n . J an u a rv 1 L 20 II
, '
at th B C l\tl ting.
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 COl'NTY COMMISSIONERS
JAiYU-4RY II, 2011
TABLE OF CONTENTS
Acknow ledgments...... .......... ................. .............. ......... ...... ......... ......... ....... ........... ................. ...2
Executive Summary....... .................................................................................................... ......1 J
I-listory......................................................................................................................................13
Lessons Learned: A Reality Check for System Adjustments ..................................................16
The Current Local Scene .............................................................................................17
Elements of a Reti-eshed Model...................................................................................18
Lessons Learned from King County. Washington....................................................... 19
Lessons Learned from Broward County, Florida ........................................................21
Lessons Learned ti-om Volusia County, Florida..........................................................23
Lessons Learned from Cities of Marco Island and Naples, Florida ............................24
The Panel's Recommendations........................................ ....................................................... .25
B ibl iography .......................... .................................................................................................3 I
Data Analysis
/J/ue Ribbon Panel Repar/jor Collier County, Florida Board afCounty Commissioners regarding
Prehospital E'mergency iiledica! Treatment & Transport (PHivITT) System
Page lot32
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 Firefie: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 Mc1nerny, Chiet~ City of Naples Fire District
Robert Metzger, Chiet~ 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 Chiet~ Collier County Emergency Medical Services
Blue Ribbon Panel Report/or Collier County. Florida Board ofCounr.v Commissioners regarding
Prehospital Emergent)' ,.wedical Treatment & Transport (P/:'..\.1TT) !:-J)'stem
Page 2ol32
Hospital Leaders
Joseph Bernard, Chief Operating Officer, Physicians Regional Healthcare System - Collier Boulevard
Phillip Dutcher, Chief Operating Officer, NCH Healthcare System, Inc.
Chris Lee, MD.. Associate Medical Director, Collier County Emergency Medical Services
Hospital Emere: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 Medicine/Internal 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 Sherifrs Office
Jim Bloom, Chief of Operations, Collier County Sheriffs Office
Deborah Chester, Manager of Planning & Research, Collier County Sheriffs Office
Blue Ribbon Panel Reportfbr Co/lieI' County, Florida Board afCounty Commissioners regarding
Prehospital Emergencv Medica! Treatment & Tramport (PEivflTj .)~v~'lem
Page 3 (~r32
Geoffrey Moebius
Chair-Blue Ribbon Panel
Community Liai~'on 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 ofCounl.v Commissioners regarding
Prehospita/ Emergency AIedicat Treafmen! & Transport (PH.\IT7) ~\ysfem
Page .J of32
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 Reportjor Collier County. Florida Board ofCountJi Commi.\"sioners regarding
Prehospiral Emergl.:'ncv Medical Trearmenl & Transport (PEA.fIT) S)'srem
I'age 5 0(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 Award in 20 I 0, the 2007 Youth Haven Frances Pew Hayes Child
Advocate of the Year Award as well as the 2007 AAUW Women of Achievement Award.
H/ue Ribbon Panel Report/or Collier County, Florida Board ofCounly Commissioners regarding
Prehospitaf Hmergency Afedical treatment & Transport (P/:"AllTj Svslem
Page 6 of32
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. Ii-om
George Washington University.
Blue Ribbon Panel Report/br Collier County, Florida Board ofCOUn(l/ Commissioners regarding
Prehospltu/ I:'mergem:v ,lfedical freatment & Transport (PI:"/\177j Svstem
Page 70/32
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. lie is serving as a volunteer on the Selective Service
Board and was a Director l'or 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 l'or three of those years. He served for six years as a member of
the Board of Trustees tar 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
1981. 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 Punel Report/or Collier COlln!y, F{orlda Board of County Commis:,'ioners regarding
Prehospital Emergency A1edical Treatment & Transport (PEM77j Svslem
Page 8 qf 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 Ava 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 Report jar Collier County. Florida Hoard ofCoun(v Commissioners regarding
Prehospilal Emergen(v Medical Treatment & Tramport (PElvITl! Sy.\"fem
Page 9 (!f 32
Michael V. Reagen, Ph.D.
President, The Greater Naples Chamber of 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 ofthe 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.
Naples/Fort 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 Gulj~'hore 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 Report jar Collier Coun~y. Florida Board of County Commissioners regarding
Prehospiwl Fmergen(v A"tedical Treatmenf & Transport (PEA1Tl) 5:vstem
I'age IOof32
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, tire 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 PEMTr 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 sheriffs 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 Pane! Reportjor Collier County, Florida Board afCounty Commissioners regardinR
PrehospiIaI Emergency Medical Treatment & Transpor! (PE,MrI) S:vstem
Page II oj32
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 2010 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 Pane! Repor/for Collier Coun(v, Florida Board ofCoun~}' Commissioners regarding
Prehospita! Emergenc.v Medical Treatment & Transport (PE/w77) ,)yslem
Page /2 of32
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 firetighters 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 tire 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 tindings state the ideal on-scene arrival goal as four minutes for
Blue Ribbon Panel ReportfOr Collier Count.v, Florida Board oj County Commissioners regarding
Prehospirul Emergency A1edical treatment & franspor! (PEAf7T) System
Page 13 of32
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 delibrillated his lirst patient, a 14-year-old boy whose heart went into
librillation after an operation. The defibrillator used on this patient was made by James Rand, a
friend of Beck. Nine years later (1956) Paul Zollused a more powerful unit to perform the first
closed-chest defibrillation.
In Belfast, ambulance-transported physicians first achieved pre-hospital defibrillation in 1966.
Delibrillation by EMTs (Emergency Medical Technicians) without the presence of physicians
was first performed in Oregon in 1969.
Slut: Ribbon Panel ReporljiJr Collier County, Florida Board afCounty Commissioners regarding
Prehospilal Emergenc.v Mediad Treatment & Tran.'-,'porl (PE.l177j ~:Vslem
Page J.J 432
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 lor 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 of the 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 Reporljur Collier County. Florida Board afCounr)-' Commissioners regarding
Prehospital Emergency Medical Trearment & Transport (PE.tlTT) S)'stem
Page /5o{32
LESSONS LEARNED:
A REALITY CHECK FOR SYSTEM ADJUSTMENTS
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;
Vol usia 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 tire 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 Hepar/for Collier Counry, Florida Board a/County Commi~'sioners regarding
Prehospita/ /,"mergencv A/ed/cai {r('(llmenl & Transport (PI:).4T7) S)slem
Page 160/32
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 conOicted 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 tire 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 protessional 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.
Blue Ribbon Panel Reporljor Collier County. Florida Board u.lCounty Commissioners regarding
Prehospital Emergency Medical Treatment & Transpur! fP!:1I1rI) S~vslem
Par;e 17 l!l32
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 tirst 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 PEMTr management based on geography,
community expectations, population demographics, available staffing resources and treatment
protocols set by the medical director.
Blue Ribbon Panel Reportjor Collier Coun(v. Florida Board afCounr.v Commissioners regarding
Prehospilul Emergenc:v lvledica/ Treatment & Tramport (P/:'lVnj System
Page /80f32
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 tor 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 ('oun'.v, Florida Board ofCoun(v Commissioners regarding
Prehospiral t-mergency Medical Treatment & Transport (PE;'vl77) ,)~vslem
Page 19 of32
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 trom 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
seminars.
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 Reportjor Collier County, Florida Board a/County Commissioners regarding
Prehospitaf hmergency Aiedical Trealmenf & Transport (P c"/'v/TT) ::c,'ystem
Page 20 of3::
LESSONS LEARNED FROM BROWARD 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 Fire/EMS Service is now
exploring BLS transport, it does not send tire 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 Repar/for Collier Count}', Florida Board a/County Commissioners regarding
Prehospital Emergency Medical Treatment & Transport (PE/14T[j System
Page 21 of32
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 tield 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.
Bille Ribbon Panel Reportfor Collier Count}', Florida Board olCounty Commissioners regarding
Prehospila/ Emergency .'I4edical Treatmen! & Transport (?FAI7Tj !))slem
Page 22 of32
LESSONS LEARNED FROM VOLUSIA COUNTY, FLORIDA
V olusia County, Florida recently conducted a study worthy of note. V olusia 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 Vol usia 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 V olusia County.
Blue Ribbon Panel ReporT jar Cvllier COllnt.v. Florida Hoard afCounty Commissionf!rs regarding
Prehmpilaf Fmergency ..'vIedicat Tremmenf & Tranlpol'f (PElf77j Svslem
Page 23 oj32
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 tire 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.
Hlue Ribbon Panel Report/or Co/fier County, Florida Board a/Countv Commissioners regarding
Preho.lpital !:'mergem_:v iHedicol Treatment & Transporr (PI:'.HT7J S)!Slem
Page 24 ofT!
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:
I. 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.
Blue Ribbon Panel Reporljor Collier County, Florida Board ofCoun~}' Commissioners regarding
Preho.\pilal Emergency Medical Treatment & Transport (PEMl7) .\)'slem
Page 25 of32
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 tire 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 unitied 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 Reporljhr Collier County. FlOrida Board ofCoun(v Commissioners regarding
Prehospita! Emergency A1edicai Treatment & Transport (PFMDj ~)!Slem
Page 26 ol32
I. If the aforementioned steps of regionalizing and consolidating services for pre-hospital care
demonstrate cost savings and incrcased 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 PEMTT Council and tire 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 PEMrr services In 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 offire 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 Report/or Collier Counry, Ffonda Board a/County Commissioners regarding
Prehospital Emergency Afedical Treatment & Transport (PEMrIJ "\)Islem
Page 27 0( 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 tive-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 citil.ens and visitors within Collier County.
A positive step would entail the use of ALS fire engines and the emergency transportation
services within these tire districts. The fire districts would develop a management process tor
position control that would professionally manage the number of paramedics and EMT positions
within the district to ensure quality and expertise through tield training. The fire districts could
also evaluate the possible opportunity tor the use of smaller, lighter ambulances, such as Ford F-
Blue Ribbon Pane! Reporljor Collier Counry, Florida Board afCounty Commissioners regarding
Prehospi/al Emergency .'I4edical Treatment & Transport fPEA177) ~)slem
Page 28 of32
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 satety 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 Reportj(Jr Coilier Coun(v. Florida Board a/County Commissioners regarding
Prehospital Emergency Aledical Treatment & Transporl fPEM1T) System
Page 29 of32
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 satety 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 that 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.
Respectfu Ily subm itted.
Geoffrey Moebius, Chair
Blue Ribbon Panel Reportj(Jr Collier COl/nty. Florida Board afCounty Commissioners regarding
Prehospital Emergenc:v lv/edical Treatment & Transport rPEJf77j S:vs1em
Poge 30 of32
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: htto:/ Iwww.houstontx.gov/fire/.
3. Emergency Services Consulting, Inc. (2007). Collier County Florida, EMS System
Master Plan 20()7.
4. Cohen, H. (2010, July). Possibilities of Fire and Rescue Services Consolidation in
Volusia County. Submitted to Halifax Area Civic League.
5. Goodwin, J. (2010, August). Best Practices in Emergency Services: Integration: The
New Frontier> Retrieved from:
http://www.emergencvbestPractices.com/Currentl ssue/tab i d/22 51 ctll Arch i ve View 1m i
d/573/month/8/vear/20 I O/Default.aspx.
6. Gueugniaud, P.Y., David, J.S., Chanzy, H., Dubien, P.Y. et. al. (2008, July 3).
Vasopressin and Epinephrine vs. tpinephrine Alone in Cardiopulmonary
Resuscitation The New England Journal of Medicine 359, 21-30.
7. Henry, G. (2010). ACTS: Close the Drug Box. Emergency Physicians Monthly.
Retrieved January 20. 20 I 0 trom: htto:llwww.epmonthlv.com/index.php?
option=comcontent&task=view&id~'643<em id~91
8. Herhold, S. (20 I 0, September). lferhold: Why Emergency Medical Costs Spiral out of
Control. Mercury News.
9. National Association State EMS Ofticials. (2008, July). State Emergency Medical
Services Systems: A Model.
10. Nielsen T. (2009, November). Exploring Closest Unit Re,lponse to Fire and Medical
Emergencies in Spokane County. Spokane County Fire Protection District Eight.
Spokane, W A.
II. Office of Pre-Hospital Care - University Emergency Medical Services, Wyoming-
Erie New York, Office of Pre-Hospital Care, Buffalo NY. Retrieved from:
htto:/ Iwww.oocems.org/.
12. Olson, L. (2000). San Mateo County Pre-Hospital Advanced Life Support Services.
Blue Ribbon Pane! ReporljiJr Collier Count}', Florida Board a/Counry ('ommhisioner.\' regarding
Prehospilaf f-'mergency lfedical {rearmem & Transport (P E...I477) .~:v~"/em
Page 3 J (!l32
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
trom: http://www.kingcounty.gov/.
15. Public Health Seattle and King County. (2010, September). Public Health- Seallle &
King County Division of Emergency Medical Services 2010 Annual Report.
Retrieved trom: http://www.kingcountv.gov/.
16. Public Health Seattle and King County. (20 I 0, September). Saving Lives; An
Innovative and Efficient King County Emergency Medical Services. Retrieved from:
http://www.kingcountv.~ov/healthservices/health/news/20 I 0/1 009030 I.aspx.
17. Sampson, D. (2008, April). Regionalizing Fire Services and Breaking Home Rule.
18. Schaitberger H. lo'mergenC)' Medical Services, A Guidebookfl" 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; Impact 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 Re.\ponders. It '.I' Just a Maller of Time.
22. Wikipedia. (2008) Seattle Fire Departments
23. Wolcott, M.D., Foelker, 1'. (2009). Evaluating the Impact; Fire services Provision of
Advanced Life Support. A report to Volusia County, Florida.
Blue Ribbon Panel Report/or Coliier County, Florida Board afCounty Commissioners regarding
Prehospital Emergency A4edical Treatment & Transport (PH..\117J System
Fage 32 of]2
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
~c3hL
PRE-HOSPITAL CALLS FOR SERVICE:
RESPONSE TIMES AND LOCA nONS
As Presented to:
Collier County, Florida
Board of County Commissioners
January 11,2011
Prepared By:
The Collier County Sheriffs Office
3301 Tamiami Trail East, Bldg J
Naples, Florida
PRE.HOSPITAL CALLS FOR SERVICE: RESPONSE TIMES AND LOCATIONS
DECEMBER Z010
Data and Methodology
Data were pulled from Computer .tided Dispatch (CAD) for a one-year time period Guly 2009
through June 2010) in order to identify response time to medical-related calls for service. Thc final
sample of data includes calls for service that had a coded response or ttansport to a hospital, and
were identified as highest priority in C '\D (lor 2). This was done to capture the most scrious calls;
as such, this selection assumes incidents falling into these criteria, recruiting travel or response to a
hospital at. some point during the call, represent serious medical-related calls. Only reactive, citizen-
generated eaUs for service were included in order to more accurately identify response to a call
(compared to proactive calls for servicc recorded in CAD). Finally, to eliminate extreme values and
outliers, calls with a response time longer than 30 minutes were removed.' The final numbcr of calls
for service selected is 17,604. EMS/Fire calIs account for 94 percent. Collier County Sherifrs
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 thc structure of the CAD. Each time
an agency is dispatched, a unique call is created. Thcrefore, if EMS/Fire and SO are both
dispatched to a caU, this will result in two unique calls for service in the CAD data. In addition, it is
important [0 note that based on this methodology, the nature of calls for sherifrs office/policc is
very different than EMS/rirc. General descriptions of call types by agency illustrate this point. The
majority (92 petcenr) for rire/EMS are described, in general, as cardiac or medical calls.' For thc
SO, the same medical call categories represent only 13 percent of selected calls. For Fire/EllIS,
vehicle accid(:nts rcpnscnt 6.2 percent, and crime/disorder~related represent 1.6 percent of calls.3
The highest inodent type category for the SO is suicidal or mentally-ill person (30 percent); another
23 percent arc traffic accidents and 32 percent of calls are crime or disorder-related.
Ip(/lMS h, SO "'" I\1PD ",
Accidents
Alarm
Crime/Disorder
Fire
Medical
Other
Suicidal /Mentilly III Per~()n
1U21 6.2 236 22.7 2 9.5
1B 0.1 0 0.0 0 0.0
262 1.6 335 32.3 33.3
21 0.1 0 00 0 0.0
1519B 91.9 136 13.1 6 2B.6
6 0.0 19 I.B [ 4.B
19 0,1 312 30.1 5 23.B
j1'm:l1 1(151:; 1\lO lH~;iol WH -., 100
Because Fire/EMS is involved in all medical calls R'luiring 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 duplicatc call issue, the numbcrs for SO, and particularly for
1\lP, are small for a one-Ye<lt period, which makes it difficult to determine patterns and trends.
Finally, as discussed above, the nature of law enforcement calls sclected with these criteria are much
different for police agencies than Fire/E.\lS.
1 This only removed a very small pt:rcentage (0.9) and i... necessary due to the srructurc of CAD Jata; for instance, on
occasion calla do not get dO!'icd properly, or ti"e closed at a later time due to system updates or other reasons. W'hen this
happens the time field cannot be alte.red; thcrcforc, the time entered can m.1l1represent ar..1UaI response.
1. ~edical category includes cardiac call, medical alarm, medical call, and person down.
3 Crime/ disocder category includes assault/battery, criminal mischief. robbery, bwghuy, trespassing, disturbance,
suspicious incidents, etc.
EMS/Fire Pre-Hospitat Calls For Service - Collier Count; Sheriffs Office - December 2010 - Page 1
De.criptive Stati.tics - Fire/EMS CaD.
Call ftequency by weekda.y - 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 call,.
fI 1.\ 1 j. 'j1'~ II' \ f', r< \ ot
Sun
Mon
'I'ue
Wed
Thu
Fri
13.3
15.0
14.6
14.8
14.0
14.8
'1
:~
'.~
,
-'
-
.
"
.,
.
,.
Call frequency by month - JanuaI) shows the highest frequency by month; however, by daily
average the highest frequency is February. Overall, most calls occurred December through March.
~tmllh I-'Hoi.JlIf 11\ \ P'OJ< (fll \\ ~ pa D.l'
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sop
Oct
Nuv
Dec
1653
1529
1612
1329
1336
1175
1189
1168
t264
1398
1374
1518
lV.V
9.2
9.7
8.0
8.1
7.1
7.2
7.1
7.6
8.4
8.3
Q.2
S2.t
54.6
52.0
44.3
43.1
39.2
38.4
37."7
42.1
45.1
45.8
49.0
Tout lu::'1.. tol! H 4:; ,
1700
16&3
Monthly Trcnd by Number and Average CaIlo per Day, Jul2009 - Jun 2010
'000
1600
1400
'300 I
1200 -
1100 [
1000
54,8
H
36.4
;1'i~
[~Fr8quency ~~iD~
45.1
450
160.0
49,0
50.0
151C 40.0
Jon
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- 10.0
A",
t 30.0
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Do,
00'
"""
EMS/Fire Pre-Hospital Call. I'or Service - Collier County Sheriffs Office - December 2010 - Page 2
Call freq)len<;y by week - the nwnber 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 detennine 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 11 19 21 23 25 27 29 31 33 35 37 39 41 43 4S 47 49 61
Call frequenc;y by hour - CaU frequency was higher during daytime hours; 71 percent of the caUs
occurred from 8:00 a.m. to 8:00 p.m.
U 431 2.6 t2 969 5.9
1 343 2.1 13 954 5.8
2 386 2.3 14 946 5.7
3 362 2.2 t5 926 5.6
4 307 1.9 16 867 5.2
5 319 1.9 1~ 848 5.1
6 410 2.5 18 811 4.9
, 566 3.4 19 843 5.1
8 785 4.7 20 709 4.3
9 994 6.0 21 600 3.6
10 100, 6.1 22 5~5 35
11 1084 6.6 2, 'ill" ,1
EMS/Fire Pre-Hospital Calls For Service - Collier eoual;" Sheriffs Office - December 2010- Page 3
Hour
1;;
"
8
11 12 13 14 Hi 16 17 18 19 20 21 22 23
hour
Call frequen" by time of.~ ~nd day of week - the below chan shows patterns by day of week and
rim" of day. The darker shades on the grid lines represent higher values. On average, the high"st
fr"quency of calls occurred earlier in the week during the midday hours.
Man
Tue
Wed
Thu
Fri
Set
Sun
o 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23
100-50 050.100 00100-150 . 150-200 I
EMS. Fire Pre-Hospital Call, For Setvice - Collier County Sheriffs Office - December 20tO - 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-la-arrival). This can be separared into two time categories: when the call was created to
when ir 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 dala, the overall create-to-arrn-aI 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-tn-dispatch time averaged 2.0 minutes, with a median of 1.9 minutes.
The dispatch-la-arrival averaged 6.5 minutes, ,,~th a median time of 6.1 minutes.
1,50
1,00
t'
c
GI
::;l
C"
e
IL
Create-to-Arrival Ave
5
25
30
o
o
5
10
15
RTminutes
20
EMS/Hre Pre-Hospital Calls For Service - Collier County Sheriffs Office - December 2010 - Page 5
.'\veCllge Response Time by D'I)' of Week
There were no differences in average create-to-amval response time by day of week.
I
Ii'
:
::Ii
.
,
b.'
...
..S
Sun
""n
T_
Wed
Weekday
F,'
Sa<
Thu
.\ verage Response Times by Month
13)' month, there were small diffcrL'Oces 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.
..
~ 9
c
'l!!
li<
Iii
:I
7
ri.7L_~
-~-----'-"",
,
.7
...
..3
..3
.3
~n ~ ~ A~ ~ ~ ~I A~ ~ ~ ~ ~
month
EMS/Fire Pre-Hospital Call, For Service - Collier County Sheriffs Office - December 2010 - Page 6
Avcl1\gc Response Time by Time of D~v
These data show differences in average response rime by hour, "'1th shorter response times
occurring during the daytime hours. The range from crcate-to-anival response time by hour is 8.1
to 10.3, a difference of2.2 minutes.
The dispatch-to-arrival [{"ponse time showed a similar pattern of shorter response times during the
daytime hours; 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.
10.3
10.
W
~
C
~ 9.
Ii:
c
IV
Gl
:::E 8.0
I'.
Aver Create-lo-Arrive Res ODse Time b Hom
..
;.~
8.3 8.2 82-r.;]==Ji:2I~~ 8.2 '.7 '7
~~~ ~ !1
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 Sheriff', Office - December 2010 ~ p,,&,,"
2.
'a
~ 2.0
~
c
:i
Ii'
Ii
..
:l!
Ui
1.00
10.0
~
Q
c
1:
t:
~
:I!
.
:J
Aver
Creale-to-Dls arch Res oooe Time b Hour
o 2 3 4 5 6 7 a 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23
hour
Hour
It.16tl.1.UllB..2711.2i
.... ...
791 1.n
,
o
I I I I I I t I
2 3 4 6 6 7 8 9 10 1~ 12 13 14 1S 16 17 18 19 20 21 22 23
hour
E!\lS/Fite Pre-Ho,pital Call, For Service - Collier County Sheriff, Office - December 201 0 - Page 8
Avero,ge Response Time bJ Hour and Day of Week
The following chart shows the pattern of average create-to-arrival response time by hour and day of week..
The darker shades represent higher response times, in this case from around midnight through 7;00 a.m. 'lbe
average response times of 1 OR 11 m.inutes occurred more often from Monday through \"(Tednesdar during the
early morning hours.
-Sat
Sun
o 2 3 4 5 6 7 6 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23
Mm
Tue
Wed
--' Thu
Frj
Ie 8.00-9,00 i19.00-10,001il10.00-11~OOI
Averag.e Response Time for Vehicle Accidents
Vehicle accidents represent a small portion of thcse 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 accidenls, based on the data selection criteria, were all idL'fltified 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.
Type ofCaJI
Vehicle Accident
Other Medical
N
1,019
15,526
. Mean
6.7
8.6
5
2.6
4.5
10
3.5
5.3
25
4.6
6."
50
5.8
B.3
75
7.6
10.1
90
10.3
12.1
95
14.4
13.9
EMS/Fire Pre-Hospital Call, For Service - Collier County Sheriff, Office - December 2010- Page 9
Ave.ragr Response Time by Area
C.ID data captures areas identified by Fire districts/stations; the following chatt shows the average
response time for identified areas.
25.
20.
15.
5
....r-
10,
o.
North Naples Fire Departmeot (NNFD) accouots for 33 percent of these calls; followed bv East
Naples Pire Department (ENFD) with 29 percenr and Golden Gate Fire Department (GGFD) \wh
13 percent.
NO
10%
BCFD
2'1.
III lll,'tll..t '-.JllllllHf .. ,,' C,\{j.,
l\lg Corkscrew f l\C~'D
East Naples / ENFD
Immokalee / IFD
~orth Naples. I NNFD
Maroo Island / MFD
Ocbopcc / OFD
Golden Gate I GG}<",,[}
Isle of Cllpri / ICFD
r:itvnf't'-hnle-> INti
\~ C. 20/0
I [<I 29%
1242 8"'
..
=",111 33%
794 5%
133 !"t,
2090 13%.
82 (f,'g
Of\)
1%
MFD
5%
j, II tr, ~-1 ~ I'H I
1(,(.Q
100/0
~
32%
EMS/Fixe Pre-Hospital Calls For Service - Collier County Sheriffs Office - December 2010 - Page to
Location of Calls
Densil;y Methods Used
Nearest Neighbor llierarchical Clustering (NN) was u,ed to identify groups of incidents that are
spatially close. This is a hierarchical clustering routine that groups points together based on certain
criteria.' The clustering is repeated until all points are groups or the clustering criteria fails (based on
threshold distance, minimum points per cluster, and standard deviations for ellipses, for instance).
The result:;; are ellipses used to identify groups of points spatially close to each other. In addition
kernel density spatial analysis was used, which estimates density over a continuous service; this
method shows ho" density varics and is distributed over space. In this case, areas of high
concentration of calls "ill stand out on the density maps. This is useful for visuwing aggregated
crime patterns in and across defined boundary areas, and for obtaining a general picture of the
meraU spatial distribution of caUs for service. In both cases, these areas that appear as hot spots
represent locations with a greater than average number of calls for service.
Lirnitations
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 imporlant 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. ,\1though the results are based on empirical groupings, this is not a stalistical way for
defining regularity (although such patterns are a human way to define patterns and trends)' Two
different users may interpret the size of a hot spot differently in addition to other parameter
variability. I'or instance, in one geographical jurisdiction, 40 incidents may be considered high
activity, while in another area, this may not be unusual and different parameters would be set to
idenrify a hot spot in this location. As such, output will be different depending on rhe geographical
level, the number of the data involved and the parameters set by the user. Kernel density
calculations face similar limitations; the technique is dependent on an arbitrarily-defined inten-aJ size.
TIle advantages to spatial analysis can be overcome by rWl11ing statistieal lests when possible, and by
using more than one hot spot or density calculation. In this case, in addition to the significance
tcsting, both kernel demit), and NN spatial analysis techniques were used to add confidcnce to
findings.
Oven'iew of Maps included
The following pages show maps of EMS zones, Fire district, and station locations. Pin maps and
density maps countywide and by geographical areas "ithin the county are included. Many of these
maps inelude layers of kernel density and nearest neighbor ellipses to show locations with higher
than a1'erage call,. Call frequency and average response times identified within nearest
neighbor/high acti,ity group' are provided in addition to specific location" mostly medical and
senior living facilitics, ,,'hich represent a high numbers of calls. _ \ map of vehicle accident locations,
identifying locations (intersections) of calls is included. Finall}. maps showing calls relative to
straight line distances from Fire and EMS stations are included.
4 Discussion oC spatial analysis methods used in this report, including advantages and limitations of nearest neighbor and
kernel density techniques, are from various ~ational Institute of Justice mapping publications; for instance, an overview
afhat spots and techniques can be found in the NIJ report Mapping Crime: lloderstanding Hot Spots available at
www.ojp.usdoj.gov/nij
5 Discussion of limitations on NN and kemd densit}' techniques from the National Institute of Justice mapping
publications, pulicularly as outlined in NIj-sponsored CrimeStll.t publications from Ned Levtne & AssociAtes
E~L'i/Fire Pre-Hospital Calls FO[ Service - Collier Count:: Sheriffs Office - December 2010 ~ Page 11
"
.
u
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n
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Collier County
EMS Zones end Statioo.
Dee 2010
l
---_._.__.._----..---_._~--------'-'-
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EMS/Fire Pre-Hospital Calls For Service.. Collier County Sheriff', Office -- December 2010 -- Page 12
Fire Districts and EMS Zones
'=1
Legend
De.osz,....
1'lRD_
OIST1llCT
CJ 8CFD
r--:.~ aT'( FIRE
r="'8'lFD
--: OOFO
;' :.' lem
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J
EMS/Fire Pre-Ho'pital CaDs For Service - Collier County Sheriffs Office .. December 2010 .. Page 13
"L
This pin map identifies the high-priority, pre hospital eall locations countywide. Locations of fire
and EMS stations are included.
Coli... COl.lnty
Hi!#> Ptiortty HospIl8l CFS
Jul 2009. Jun 2010
..
Legend
. Ai'll ..uot'li
.It. B.l3locatiall$
. FlraElI.SCFS
---ltr8l1t.
~~"'+'
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.
EMS/Fire P'e-Ho,pital Calls Fm Service - Collier County Sherirr. Office - Decembc, 2010- Page 14
The following map shows dcnsity countywide, with the darker shades representing more calls. First-
order nearest neighbor clusters, calculated with a minimum of ZOO points per cluster, are represented
by the blue ellipses on the map. The lighter dols on the map represent locations of calls.
Colier County
N_esl Neighbor/Kernel Density
High Priority Pre-hospital Call. f<>r Service
Jul 2009. Jun 2010
)
. IltT'
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EMS/Fite Pre-Hospital CaR, For Service - Collier County Sheriff', Office - December 2010 - Page 15
Ii
.
~
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, .:'
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The nearest neighbor first-order ellipse, identified 16 groups of spatially close calls countywide that
met the minimum criteria of 200 points per 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.
"\J~oJ ( hI [1 j "'dUO' ~j ,\q I.!~" 1\ I
1 335 9.4
2 313 10.2
3 419 9.0
4 20~ 9.1
5 602 9.6
6 453 8.1
7 322 5.9
8 615 8.0
9 508 8.2
HI 422 8.7
11 278 7.4
12 4114 10.2
13 389 8.1
14 236 9.6
15 201 6.4
16 441 on
IIllIl hUI, ,,;:'
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EMS/Fire Pre-Hospital Call. For Seffice - Collier County SherifPs Office - December 201 0 - 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 ,,~th 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.
.': I
High Prtoflly Hospttal Call. fer S<<vfce
Nearest Neighbor and K.rneI Demly
.lJ1 2009 - Jun 2010
",
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ClNN91lpses
-m"orstreets
"',llIs
SUba'fit;ions
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EMS/Fire Prc-Hospital Calls For Service - C..ollicr County Sheriffs Office - December 2010 - Page 17
This map identifies locations of places identified as ha,ing a high frequency of calls (the number of
calls range from approximately 70 to 200 calls); these tend to be medical-related or ,enior living
facilities.
, f ----I
I::. 11:THAVF . ArllltJXr.1U! "
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r' . I
. we
j
,
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High Priority Hoopita/ CFS
Jul 2009 - Jun 201 0
High Frequency Call Locllllons
I 1I.1Ur'A.l.Et:R....
Legend
'J. Hi~QlIIFfllq
c::r NN .,....
11 Ho:;pttal
-~rnets
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Manm:are tC UlIy f1lImS
,
EMS/FiLe Pre-Hospital Calls For Servicc - Collier County Sheriff's Office - Decemher 20tO - Page 18
This map shows call point locations and density of calls in the North Naples area; the number of
calls in Ih" idtcntified NN dlip"" arc labeled on the m~p. Fire and EMS station locations are
included.
Legend
~'-
:..
North Naples Area \
High PIIgrjty Hospital CF
Jul 2009 . Jun 2010
..,
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EMS/Fire Pre-Hospital c.n, For Service - Collier County Sheriff', Office - December 2010 - Page 19
Thi, map show, call point locations and deosity 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.
Logond
F1n1EMS CFS
ON.......
.L EMBlDcdom
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-.......-
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EMS/Fire Pre-Ho'pital Call, For Service - Collier County SherifP, Office - December 2010 - Page 20
This map shows call point locations and density of call< in the East Naples/Golden Gate City area;
the Ol1l:Ilber 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 Pre-Hospitat Call, For Service - Collier County Sheriff, Office - December 2010 - Page 21
Tills map shows call point locations and density of calls in the Immokalee area; the number of calls
in the identified NN ellipses are labeled on the map. Fire and EMS station locations are included.
ImmokaleeAreG
High PrtOflty Hospital CFS
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EMS/Fixe Pre-Hospital Call. For Service - Collier County Sheriff', Office - December 2010 - Pag<: 22
This map shows call point localions .nd density of calls in Marco Island; Fire and EMS stalion
lac. lions are included.
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EMS/Fire Pre-Hospital Calls I'm Service - Collier County Sheriff, Office - December 20tO - Page 23
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This map shows call1ocalioos, including density and NN clusters Ca minimum of 25 calls in each
gyoup), of vehicle accident locations. Countywide, there were 1,019 vehicle accident calls meeling
the data sclcction criteria and accounts for 6.2 percent of the lotal calls used in this report.
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Calls '\\-ithin one mile ofPire and EMS station locations:
There were 6,349 calls located within one mile of an EllIS station and 8,145 calls located within one
mile of a fire station. Combined, this numbet 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-arri\ al
response time for calls within one mile of Fire and/ or EMS stations was 7.8 minutes, with a median
response time of7.4 minutes. The average create-to-dispatch time was 2.0 minores and the average
dispatch-tn-urin' response time was 5.8 minutes.
Calls more th:m one mile from }Jire ~nd EM..r;; sta.tion 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 00
ayerage 7.4 minutes.
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El-1SjFire Pre-Hospital Calls For Service - Collier County Sheriffs Office - December 2010 - Page 25
TIlls map .hows the .traight line di.tance from EMS .ration. to the CFS actinty; each concentric
circle represents one mile out from the EMS .tation. EMS zone boundaries, call location points and
density layers are included on the map.
EMS/Fire Pre-JIo.pital Calla For Sert>icc - Collier County Sheriff. Olliee ~ December 2010 - Page 26
This map shows the straight line distance from Fire stations to the CFS activity; each concentric
circle represents one milc out from the Pire stations. Fire district boundaries, caJIlocation points
and density la,ers arc included on the map.
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EMS/Fire Pre-Hospital C.ns For Service - Collier County Sheriff', Office - December 2010 - Pa~ 27