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August 19,2011
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MINUTES OF THE COLLIER COUNTY
EMERGENCY MEDICAL SERVICES POLICY ADVISORY BOARD
MEETING
August 19, 2011 MO ' W1-0
,
Na les Florida '
Naples,
BY: v
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:
Fiala Chair: James Talano, M.D.
Hiller *� Vice Chair: Chief Walter Kopka
Coyle ,4 Rosemary LeBailly, RN
Colette Chief Robert Metzger
Jerry Pinto (Excused)
ALSO PRESENT: Dr. Robert Tober, Collier County Medical Director
Jeff Page, Chief, Bureau of Emergency Services (Excused)
Maria Franco, EMS Administrative Assistant
Wayne Watson, Deputy Chief, Bureau of Emergency Services
Dan Bowman,Deputy Chief, Bureau of Emergency Services
Jorge Aguilera, Deputy Chief, Medical Services/Community
Misc.Cones:
Relations
Date: Orly Stolts, Chief,North Naples Fire Control &Rescue District
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1. Call to Order:
Chairman James Talano called the meeting to order at 3:43 PM.
A quorum was established. Four members were present.
2. Agenda and Minutes:
A. Approval of Today's Agenda
Chief Robert Metzger moved to approve the Agenda as submitted Second by Vice
Chairman Kopka. Carried unanimously, 4—0.
B. Approval of Minutes: June 10,2011
Chief Robert Metzger moved to approve the Minutes of the June 10, 2011 meeting as
submitted. Second by Vice Chairman Kopka. Carried unanimously, 4--0.
3. Old Business:
A. COPCN("Certificate of Public Convenience) Ordinance Review/Recommendations
to the Board of County Commissioners:
(A copy of the 16-page Ordinance in draft format was distributed to the Members.)
Wayne Watson,Deputy Chief—Bureau of Emergency Services,stated he had been
advised the document had been reviewed by both North Naples and EMS,and the
attorneys for each about one week ago.
Chairman Talano asked the Board members to review the additions and deletions.
Chief Robert Metzger noted he had an opportunity to review the document and
compared it against the"approved"document from North Naples and it appeared to be
the same document.
Chief Metzger moved to recommended supporting the most recent Ordinance language
as presented in the document.
Chairman Talano referenced Pages 7, 8 and 9. He asked why Section 3, (a)through (n),
was eliminated.
Deputy Chief Watson stated the deleted paragraphs cited Chapter 401 of Florida
Statutes. The representatives from North Naples claimed it was unnecessary to repeat the
language since North Naples was contracted by the County to adhere to Florida Statutes.
Both attorneys discussed the issue and agreed.
Vice Chairman Kopka noted Chapter 401 of Florida Statutes outlines the duties of the
Medical Director.
Chairman Talano agreed since the eliminated subparagraphs referred to the Medical
Director's responsibilities,the language was redundant. He noted that no other changes
were made.
(Referenced cites: Section 401.265, Florida Statutes,and Chapter 64(J)—2.004(4)(a)
of the Florida Administrative Code)
Chief Metzger reiterated his support of the change.
Dr.Robert Tober,Collier County Medical Director,suggested a Motion were made to
accept the changes could reference the Section of Florida Statutes and the Florida. $1s
Administrative Code as redundant.
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Chief Metzger withdrew his Motion.
He stated since he did not have the referenced cites available,Ile was not 100%certain
the language was redundant. He continued,stating the language compelled the
Certificate Holder to contract with the County and the Contract would likely cover all of
the issues that both parties wanted initially in the Contract. He stated he was comfortable
with the language.
(3:47 PM—Deputy Chief Jorge Aguilera and Chief Orly Stolts arrived)
Vice Chairman Kopka moved to recommend supporting the Ordinance language,
subject to confirmation that Paragraph 3 of Section 12 conforms with requirements for
the Medical Directors as contained in Florida Statutes,Section 401.265, and Chapter
64(J)—2.004(4)(a)of the Florida Administrative Code.
There was no second in support and the Motion failed.
Chief Metzger noted without examining Florida Statutes and the Florida Administrative
Code to compare the language, it would be difficult to confirm that each provision was
contained in one of the two referenced cites.
He again stated the language in the revised Ordinance compels the Certificate Holder to
contract with the County,and he anticipated the County would insist that the paragraphs
would be contained in any contract with the Certificate Holder,especially since the cited
( paragraphs were in the best interests of the County.
Chief Metzger moved to recommend supporting the most recent Ordinance language as
presented. Second by Vice Chairman Kopka. Carried unanimously, 4—0.
(Note: The Board's recommendation will be forwarded to the Board of County
Commissioners)
4. New Business:
A. Overview of the Tiered Response Group("TRG")—Dan Bowman,Deputy Chief,
Bureau of Emergency Services
Deputy Chief Bowman provided an overview:
• The TRG reports to Dr. Tober and consists of personnel from EMS, Sheriff's
Office, Fire, and EMS Management.
• Instituted:April,2009
• Purpose: to create a more efficient system for delivery of pre-hospital services
• Initial focus: EMS operations
• Under the direction of Dr. Tober and the BCC, the scope has broadened to include
Fire Service
• Goal: to collaborate with the Collier County Fire Chiefs' Association to adopt a
system-wide policy while recognizing the needs of the various Fire Districts and
agencies
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• He will present a detailed report of the EMD system at the next Board meeting
Vice Chairman Kopka suggested discussing a proposed change mentioned by Dr.Tober
to the method of dispatching units.
Deputy Chief Bowman noted TRG will meet next week with the Operations Subcommittee
of the Fire Chiefs' Association to confirm the start date.
• In September,all units will be dispatched simultaneously and will respond"hot"to
all locations, except to hospitals or locations with confirmed transport.
• Purpose: to send units as quickly as possible to all calls
• Previously,each District responded differently from different locations'to each call
• Goal: to develop a specific,County-wide dispatching operation
• This is the first step
• The Sheriff's Office has adjusted its operation within its Communications Dispatch
Center to dispatch units within 45 seconds of receipt of a"911"call versus the
previous time of up to two minutes
• As information becomes available concerning the severity of the call, it is provided
to the units which can then adjust their response
• The technology exists to run a safer, more efficient system
Chairman Talano questioned the taxation of resources and personnel, and asked how it
would improve efficiency.
( Deputy Chief Bowman replied the first step does not really improve efficiency but should
improve response time.
Dr.Tober noted it was difficult to anticipate the consequences but it is anticipated that in
the two minutes after the units are dispatched,the system will provide enough
information to adjust the response—i.e.,some units may fade off the call or the units will
proceed but without lights and sirens.
He continued the Blue Ribbon Committee faced the issue of prolonged BLS response to
the scene,and there were issues in the City where the City Fire Department was on scene
prior to EMS receiving notification of the call. The goal is to correct the inconsistencies
as the system evolves.
Chairman Talano asked who would determine whether to reduce the number of units
responding.
Dr.Tober stated when enough information is acquired from Emergency Medical Dispatch,
the units would decide what is the appropriate level of response. For example,if the
"emergency"were a sprained ankle,lights and sirens will be turned off. If it is a cardiac
arrest, lights and sirens will be remain on and all units will answer including the Police.
Deputy Chief Bowman stated the current system has relied on policy and programming.
Communications dispatched all units and even if was determined the"emergency"was a
broken finger,all units still responded and an assessment of the situation was not made
until the units were on scene. The Communications CAD system has not been the best.
He continued the Sheriff's Office EMD system has been able to collect information that
is more reliable and consistent—the officers in the units should be able to make a
decision and adjust the response accordingly before arriving on scene.
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•
Vice Chairman Kopka cautioned the decision will be made strictly upon the information
provided by the person making the"911"call who may or may not recognize a cardiac
arrest.
Dr.Tober recalled a personal experience:
• He was the first on scene of an accident in the City of Naples where a woman was
struck by a car and sustained a compound fracture to her wrist
• Fire had been notified and arrived first
• He was on the phone with an EMD operator--even though he was recognized—it
was difficult to get through the questioning
• As a result,EMS was delayed in responding to the call
• The goal is to even out the responses and the new system appears to be the easiest
way to do so
Chief Orly Stolts,North Naples Fire Control and Rescue,stated from the perspective of
North Naples Fire,the new system appeared to be an excellent move because Fire is"all
about"response time. The ability to quickly receive the call from Dispatch could reduce
response time by one to one and one-half minutes. He admitted while it may generate
approximately 2500 additional calls per year in the District,North Naples is willing to
support implementing the system in order to improve response times.
Chairman Talano asked if the same information would be provided to EMS and Fire.
Chief Stolts replied that Dispatch will send both units and,as the process takes place,
will receive EMD updates. The units can then decide if both are necessary or if one can
( be cancelled off and placed back into service for the next call. He stated it was a good
solution.
Dr.Tober noted the greater problem,especially during"season," is the overwhelming of
the"911"Call Center that calls are"stacked"(or placed on hold)due to staffing limits.
The individual answering the call has to talk to the caller,obtain the information,and
transmit it to EMS and Fire.
Deputy Chief Bowman agreed the cause of the stacking was because the old system was
to gather the information and decide which units to dispatch. The new system will
dispatch everybody,work the process and disseminate the information.
Dr.Tober stated"stacking"occurs when there are too many calls for the operators to
answer. He acknowledged that"stacking"might be the first link in the problem.
Chairman Talano requested that Deputy Chief Bowman provide a more detailed report
at the next meeting.
B. Report: Protocol Update—Wayne Watson,Deputy Chief,Bureau of Emergency Services
Deputy Chief Watson noted the Protocol was revised in July and detailed the three
significant changes as follows:
• The Pediatric dose of Dilaudid was reduced—the maximum dosage administered
was cut in half;
• Cyano-kits were made available at the level of ALS Engine(Non-Transport
Medic)—all paramedics in the County have access to the potential treatment for
smoke inhalation which was especially important to the Fire Districts
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` He noted it has been cost prohibitive to distribute the kits but the State recently provided
a large amount to Responders. The shelf life of the kits is approximately two years.
• Amiodarone,which has been under observation regarding its over-all effectiveness,
is contraindicated in pregnancy—Lidocane will be used in its place.
5. Staff Reports:
Deputy Chief Watson re: Quality Assurance
• During the last quarter,a medical call(trauma patient)from North Naples provided
a learning opportunity in the form of a Case Review conducted by Lee Memorial
Hospital.
• Lee County EMS,the North Naples crew,and MedFlight attended.
• Input from the Trauma Center and its perspective was beneficial. The case was
discussed and different options for patient care were suggested.
6. Public Comment:
(None)
7. Board Member Comments:
Chief Robert Metzger:
• Walter Kopka has been appointed to the newly created position of Chief- EMS
Operations.
(. • Chief Jeff Page will retire on August 26,2011 after 30 years of service.
• Walter Kopka will serve as Interim Chief of the Bureau of Emergency Services until
a new Chief is appointed.
8. Next Meeting Date: Friday,November 4,2011 at 3:30 PM
There being no further business for the good of the County,the Meeting concluded by
order of the Chair at 4:13 PM.
COLLIER COUNTY EMERGENCY MEDICAL
SERVICES POLICY ADVISORY BOARD •
Ivy) litio'c'
James lano,M.D.,Chairman
The Minutes were approved by the Board/Committee Chair on NIN �� ,
2011,
"as submitted" 41 OR "as amended"
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