Minutes 01/20/2012January 20, 2012
MINUTES OF THE COLLIER COUNTY
EMERGENCY MEDICAL SERVICES POLICY ADVISORY BOARD
EMERGENCY MEETING
January 20, 2012
Naples, Florida APR 1 6 2012
LET IT BE REMEMBERED that the Collier County Emergency Medical Services
Policy Advisory Board, having conducted business herein, met on this date at 5:00 PM
in EMERGENCY MEETING SESSION, at the Neighborhood Health Clinic,
12 Goodlette Road N., Naples, Florida, with the following Members present:
Fiala
�V,
—�
Hiller
Henning
Coyle
Coletta
'Sri
ALSO PRESENT:
Chairman: James Talano, MD
Vice Chair: Chief Robert Metzger
Battalion Chief Tabitha Butcher
Rosemary LeBailly, RN
Todd Bethel, MD (Ex- Officio)
Misc. Corres:
Dr. Robert Tober, Collier County Medical Director
DO: '� j 2.--111 -2-
item $:lto-Y--S -W`'2^
Copies to:
Walter Kopka, Interim Chief, Bureau of Emergency Services
Wayne Watson, Deputy Chief, Bureau of Emergency Services
Jorge Aguilera, Deputy Chief, Medical Services /Community Relations
Orly Stolts, Chief, North Naples Fire Control & Rescue District
James Cunningham, Deputy Chief, N. Naples Fire Control & Rescue District
January 20, 2012
1. CALL TO ORDER:
Vice Chairman Robert Metzger called the meeting to order at 5:05 PM.
The Pledge of Allegiance was recited.
A quorum was established. Three members were present.
(Note: Todd Bethel, AID., attended in an "ex-of
ficio "capaci)) since he had not yet been
appointed by the Board of County Commissioners.)
2. AGENDA AND MINUTES:
A. Approval of Agenda
Changes:
• The topic, "Tablets," was added to the Agenda as Item (B) under "3. Old Business."
Battalion Chief Tabitha Butcher moved to approve the Agenda as amended. Second by
Rosemary LeBailly, RN. Carried unanimously, 3 — 0.
(Chairman James Talano, MD, arrived at 5 :07 PM.)
B. Approval of Minutes: November 18, 2011
Vice Chairman Metzger moved to approve the Miirattes as scrbmitte(l. Second by
Battalion Chief Tabitha Butcher. Carried unanimously, 4 — 0.
3. OLD BUSINESS:
A. Medication /Protocol Changes — Walter Kopka, EMS Interim Chief
(A copy of a letter front Dr. Robert Tober, CC Medial Director, to J. Christopher
Lombardo, Chairman — North !Naples Fire Control & Rescue District dated 12/15/2011
was included in the information packet provided to the Board members)
Interim Chief Kopka:
• Dr. Tober granted permission to all fire district paramedics to use medications
(except narcotics)
t'
Bgauirements: , J.
• Accountability (Q /A Process)
o Iiiiage Trend is a software utilized by the County, North Naples, the City
of Naples, and the City of Marco Island to ensure the Office of the
Medical Director ( "OMD ") has access to patient care reports
• Monthly Reporting
o Reports of procedures and administered medications will be sent to the
OMD for review
• Transport Vehicle Response Time
o Recognized: A transport unit may arrive on scene at a different time than
an ALS First Responder which may arrive first
2
January 20, 2012
o Providing a full protocol of medication and procedures to the Districts and
Cities allows ALS to be administered prior to the arrival of a transport unit
Chairman Talano asked if response times for First Responders or the transport units
would be reviewed.
Dr. Robert Tober replied "both." The correlation between arrival of a BLS unit and
patient survival rates will be examined.
Chairman Talano asked if comparison data was available.
Interim Chief Kopka stated EMS response times have been tracked for years.
Chairman Talano asked what was the data being compared to, and if a standard had
been established.
Dr. Tober replied there are national standards for BLS to arrive within 4- minutes travel
time — and that ALS arrive within 8 minutes travel time — with one minute turnaround
time.
Interim Chief Kopka noted the standard was 90% of the time.
Dr. Tober stated there was not as much data from the Fire Districts as from EMS.
Chairman Talano stated it was important information to have available.
Interim Chief Kopka continued:
Medication/supplies
o Will be purchased and distributed by the Cities and Fire Districts
Call -in
o City and Fire District paramedics were required to consult the receiving
facility's ER physician(s) before administering medication or performing a
procedure outside of their standard protocol.
• Evaluations
o Six -month timefiame
Discussion:
Dr. Todd Bethel commented:
o There was some validity to the concern that more risk accompanied
having more "toys in the tool box."
o He cited his experience teaching BLS, stating the paramedics kept up with
basic skills and compressions. Adding more things to the arsenal could
become more of a distraction.
o The goal was to place the patient on a rig and bring him/her to the hospital
as quickly as possible, rather than playing around with different meds
while in the field.
o In certain cases, administering meds may be lifesaving.
o The data should be monitored.
Dr. Tober:
• Previously, Collier County EMS paramedics administered the majority of
drugs
• The program was expanded to include District Fire paramedics — to equal
what is available to transport medics, minus controlled substances
January 20, 2012
o Information will be obtained from the Drug Enforcement Administration
( "DEA ") concerning what type of control EMS is to assert over controlled
substances
Dr. Tober noted there are new, severe rules for Medical Directors. He stated a
consultant will conduct a seminar to explain the most agreed -upon methods of controlling
drugs. He continued the new rules require better security regarding drug storage and
access, and sonic "wasted" drugs will be sent to a lab for testing.
B. Tablets (added topic, per Amended Agenda)
Interim Chief Kopka:
• Background: At a previous meeting, Chairman Talano asked if the use of tablets
had improved response times.
• Response times for November and December, 2010 were compared with response
times from the same period in 2011;
o Result; Almost all zones showed improved times (2 did not)
• There were two 12 -hour ambulances in 2011
• Will have an "apples to apples" comparison using January's data at the next
Board meeting
4. NEW BUSINESS:
A. House Bill #739 — Automated External Defibrillators("AED ")
Interim Chief Kopka:
• Topic has been discussed in previous meetings
• Challenge for Sheriff's Office: notifying a caller of the location of a AED —
concern was potential violation of patient's medical privacy (Public Records law)
• Bill 739 was introduced into Florida House of Representatives — would permit a
911Dispatch Center to contact the owner of a defibrillator during a coronary
emergency
• Has been attached to another Bill — moving along in both the House and Senate
Chairman Talano reiterated that, currently, information concerning the location of the
nearest AED cannot be released under any circumstances.
Dr. Tober confirmed the concern was related to patient privacy and confidentiality of
medical information. The Attorney for the Sheriff's Office advised releasing the
information could violate State laws.
Interim Chief Kopka thanked North Naples for appearing in Tallahassee during the
most recent Legislative session to help push the bill.
B. North Naples COPCN Renewal Application — Review/Recommendation to BCC
Vice Chairman Metzger:
• Stated he read every page — the document appeared to be substantively complete
4
January 20, 2012
Vice Chairman Metzger moved to approve the document and recommend renewal of
North Naples COPCNApplication to the Board of County Commissioners. Second by
Battalion Chief Tabitha Butcher.
Discussion:
Battalion Chief Butcher asked if there were any statistics regarding the impact of the
COPCN on the community.
Deputy Chief Jorge Aguilera stated when North Naples initially applied for a COPCN,
there were very specific requirements that the Board of County Commissioners mandated
were to be met, i.e., response times and providing appropriate care within the confines of
the protocol developed by the Office of the Medical Director. The requirements have
been met.
Chief Butcher asked if there have been instances where the COPCN has been a benefit,
i.e., the ability to administer drugs.
Chief Orly Stolts noted North Naples was not able to administer drugs until after the
COPCN had been approved.
Dr. Tober responded the same drugs were available under the ALS Agreement.
Deputy Chief Aguilera reiterated the drugs were carried on only one truck.
Battalion Chief Butcher asked if having drugs on additional trucks has made a
difference.
Deputy Chief James Cunningham provided the following statistics:
• Total Medication Administration
o 2010-177
o 2011-343
o 2012-28
• BLS Procedures
o 2010-1809
0 2011-1987
o A drastic increase was noted in call volume toward the end of the year.
ALS Procedures
o 2010-278
o 2011-776
o 2012-32
Assisted EMS to Hospital
o 2011-279
o Number of Personnel — 310
o A commitment was made to the BCC that if ALS was administered prior
to the arrival of EMS on scene, North Naples personnel would accompany
the patient to the receiving facility to ensure continuity of care — especially
for cardiac or seriously ill patients.
Deputy Chief Cunninglrarn noted the figures were updated on January 16, 2012. He
also stated until last month, North Naples could not provide ALS beyond its boundaries
even though its engines responded to calls in East Naples and Golden Gate.
Vice Chairman Metzger asked if data was available that addressed patient outcome.
Deputy Chief Aguilera stated data was not tracked beyond instances of cardiac arrest.
January 20, 2012
Interim Chief Kopka stated trauma alerts are tracked and survival rates were up in all
Districts.
Deputy Chief Wayne Watson confirmed there was no information from Immokalee but
they went up in North Naples and in Golden Gate.
Interim Chief Kopka stated he requested the statistics to be fine -tuned — track if AED was
used by the public or the Sheriff's Office — who was first on scene. He stated there have
been several changes in the cardiac arrest protocol — CPR has changed. It is difficult to
know which one of the changes contributed to the increase in survival rates.
Deputy Chief Watson replied:
• City of Naples — 29% survived to discharge (all rhythms)
• East Naples —12%
• North Naples —12%
Interim Chief Kopka stated it was hoped that linking the computer systems to the
receiving facility versus the necessity to make a phone call in every instance — the
paramedic's impressions — admitting diagnosis — hospital discharge — to link the three
electronically for tracking purposes.
Chief Stoltz cited an example of a call made to "911" due to an allergic reaction to a bee
sting — the patient did not have an "Epi pen" — North Naples arrived on scene first and
dispensed Epinephrine. The patient was very grateful the correct medication was
available for him.
Interim Chief Kopka will research if more detailed data is available from Medicare in
addition to any data from hospitals.
Dr. Tober stated there was no automatic way to obtain the information — he has hand-
pulled cardiac arrest outcomes from the charts.
Interim Chief Kopka stated there may be a way set up a link.
Deputy Chief Cunningham stated the working relationship and interaction in the field
was very good. The program is working. He asked EMS for recommendations for the
field personnel concerning ALS practices.
Interim Chief Kopka noted morale from North Naples was good.
Dr. Tober stated he has received both positive and negative comments but did not have
any specifics.
Deputy Chief Aguilera asked about the possibility of instituting a joint Quality
Assurance program.
Dr. Tober stated until recently he had received very little information from North Naples
and did not know North Naples would be receptive to a joint bi- lateral Q/A program.
Deputy Chief Cunningham replied North Naples will share its data with anyone --- also
sharing protocols — the goal is to be transparent. Every month reports are sent to EMS.
Deputy Chief Aguilera confirmed emails have been sent to Dr. Tober and Collier
County EMS since March, 2011.
Deputy Chief Watson asked for specific questions — data to be tracked in addition to
survival rates and other activity reports — to direct training to any perceived shortcomings
Deputy Chief Aguilera stated questions about whether or not the program is effective
should have been answered. We are working together and looking at the entire call — not
just the mechanics of whether an IV was started. Whether the Level of Service provided
January 20, 2012
to patients is meaningful is a comprehensive Q/A question. He further stated, "We all
should be sitting at the table and looking at the data from first engagement to diagnosis to
discharge."
Deputy Chief Watson replied the system success rate for RSI, for example, goes up each
year — or it if remains consistent within a high percentage of the national standard, shows
the standards are being maintained. It gives a general comparison of whether skills have
improved through the training offered — outcomes are variable based on the criteria.
His point: there should be agreement regarding the type of information being reported.
Deputy Chief Aguilera concurred, stating a coordinated, joint effort should be part of
the EMS system.
Vice Chairman Metzger agreed stating it was a journey in the right direction. He asked
if anything had been heard or seen to compel the Advisory Board to deny the application.
Vice Chairman Metzger restated his previous Motion: To reconzntend to the Board of
County Commissioners to approve the North Naples application for renewal of the
COPCN. Second by Battalion Chief Butcher.
Chairman Talano called for a vote on the Motion. The motion was carried.
(6:00 PM- Vice Chairman Metzger left.)
5. STAFF REPORTS:
• Interim Chief Kopka cited a newspaper editorial which mentioned EMS overtime.
He stated the overtime is factored into the paramedic's salary ($52,000) and voluntary
overtime is less than 1/3 of the budget and is federally- mandated overtime.
• The editorial suggested placing all paramedics on a 40 -hour work week.
• Result: Would be required to hire approximately 144 new paramedics
• There is approximately $1M in the budget for discretionary over -time.
6. PUBLIC COMMENT:
(None)
7. BOARD MEMBERS DISCUSSION:
(None)
S. NEXT MEETING DATE:
• Friday, March 23, 2012, at 3:30 PM
There being no further business for the good of the County, the Meeting concluded by
order of the Chair at 6:05 PM.
January 20, 2012
COLLIER COUNTY EMERGENCY MEDICAL
SERVICES POLICY ADVISORY BOARD
/L, '" .
James Tala o, .D., hairman
The Minutes were approved by the Board/Committee Chair on t ij , 201'
"as submitted" [_] OR "as amended" [�_]