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Minutes 04/13/2012.* April 13, 2012 MINUTES OF THE COLLIER COUNTY EMERGENCY MEDICAL SERVICES POLICY ADVISORY BOARD MEETING April 13, 2012 Naples, Florida BY :�... ............ 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 REGULAR SESSION, at the Neighborhood Health Clinic, 12 Goodlette Road N., Naples, Florida, with the following Members present: Fiala 1? ✓ Hiller Henning_ _ Coyle _✓ Celetta L ALSO PRESENT: Chairman: James Talano, MD Vice Chair: Chief Robert Metzger Battalion Chief Tabitha Butcher Todd Bethel, MD Excused: Rosemary LeBailly, RN Dr. Robert Tober, Medical Director — Collier County Walter Kopka, Interim Chief — Bureau of Emergency Services Wayne Watson, Deputy Chief — Bureau of Emergency Services Jorge Aguilera, Deputy Chief — Medical Services /Community Relations Dan Bowman, Deputy Chief — Bureau of Emergency Services Misc. Cdr mes Cunningham, Assistant Chief — North Naples Fire Control & Date: --1 12-- At V2— Item #: %L& M 2. Vzr%2- C: "dins to: Rescue District k . April 13, 2012 1. CALL TO ORDER: Vice Chairman Robert Metzger called the meeting to order at 5:02 PM. The Pledge of Allegiance was recited. A quorum was established. Three members were present. (Note: The appointment of Dr. Todd Bethel to the EMS Policy Advisory Board was approved by the Collier County Board of County Commissioners.) 2. AGENDA AND MINUTES: A. Approval of Agenda Battalion Chief Tabitha Butcher moved to approve the Agenda as submitted. A second in support of the Motion was made by Todd Bethel, MD. Carried unanimously, 3 — 0. B. Approval of Minutes — January 20, 2012 Battalion Chief Tabitha Butcher moved to waive reading the Minutes aloud. A second in support of the Motion was made by Todd Bethel, MD. Carried unanimously, 3 — 0. For Battalion Chief Tabitha Butcher moved to approve the Minutes as submitted. A second in support of the Motion was made by Todd Bethel, MD. Carried unanimously, 3 — 0. 3. OLD BUSINESS: A. Response Times — Walter Kopka, EMS Interim Chief (A copy of the "Response Times Comparison Chart" was distributed to the Members.) November, 2011 — Chairman Talano requested a comparison reflecting the operational changes that had been made: • Ambulance dispatch — using tablets for mapping • Tracking "kick -out" times and response times • Station assignments • EMD Changes were also made to staffing levels — ambulances were added in November and December due to increased inter - hospital transports Chart compared 3 -month period • Range: Jan/Feb/March, 2011 to Jan/Feb /March, 2012 • Same number of apparatus was available during each period • Compared the number of calls, the number under 8 minutes (goal), and the number under 12 minutes for the City of Naples and the various zones ■ "Key" — figure shaded in yellow indicates improvement (Chairman Talano arrived at 5:05 PM and presided over the meeting.) • Assessment: • Improvements were noted in most zones, especially in March (each year) • Overall — no significant increases or decreases • Higher response times were noted for rural zones 2 April 13, 2012 Chairman Talano requested an explanation of the results for East Naples, Quail Creek, and Bonita Shores. Chief Kopka responded: East Naples (Zone #23) • Volume of calls decreased in January • Improved response times • In February, the call volume increased • Response times decreased slightly • Zone #23 is big — encompasses a large land mass • Considered to be an "urban" area but is mostly rural Quail Creek (Zone #42) • Also a large zone — fairly busy • Also considered to be an "urban" area but is mostly rural ■ includes Immokalee Road from North Collier Hospital to east of Collier Boulevard • Bonita Shores (Zone 943) • Extends to the Lee County line • No other zones surround it • When the primary ambulance is on a call, the next ambulance is taken from a bordering zone to the south • Rural zones: (Response times are generally higher in the rural zones) • Big Corkscrew • Immokalee • Ave Maria • Everglades • Golden Gate Chairman Talano asked what could be done to improve response times, i.e., bring in neighboring units. Chief Kopka replied: • The long -term goal of the AUIR ( "Annual Update and Inventory Report") is a tool used by the Board of County Commissioners and the Planning Commission to estimate when additional assets or resources may be needed • If a pattern is ascertained for a particular zone, the cost to add more equipment or a fire station can be justified • It may take several years for a pattern to be tracked • In the short term, there are other resources such as single -car paramedic vehicles that can be moved as needed • Zone coverage can be adjusted to compensate for areas that are lacking Dr. Tober asked if there was a similar comparison for BLS response times. Chief Kopka stated he can retrieve the information. The report stems from EMS' asset inventory. April 13, 2012 Dr. Tober noted law enforcement comprises the largest "army" of potential BLS providers (4 to 1 ratio). He stated BLS response time determines survival -to- hospital /discharge — there is almost no ALS component. Chief Kopka will research the type of data that can be retrieved and will report to the Advisory Board at the next meeting. B. Data Reports — Deputy Chief Wayne Watson, EMS • Background: During the November, 2011 Advisory Board meeting, Deputy Chief Aguilera and Deputy Chief Watson discussed reviewing quality assurance data and the types of reports available in the system. • The information packet provided to the Members included Standard Operating Guidelines sample reports: • Quality Assurance Guideline • Protocol Change Submission Procedures The Quality Assurance Guideline include the following topics: • Responsibility: All Pre - hospital Emergency Medical Responders • Purpose • Background • Reporting Process • Medication by Crew Member reports • Procedures by Crew Member reports • General Activity Summary Report • Procedure Competency Report • Deviations from Protocol are classified by "level" (Level 1 — 4) • Document is to be approved by Dr. Tober, Medical Director for Collier County EMS and Dr. Lee, Assistant Medical Director The Protocol Change Submissions Procedure includes the following: • Responsibility: All Department Employees • Purpose • Background • Process • Prepare an Executive Summary • Prepare a Detailed Report including a bibliography of relevant literature used for medical research and a list of salient keywords • Submission • Document is to be approved by Dr. Tober, Medical Director for Collier County EMS and Walter Kopka, Interim Chief, EMS • Goal: Provide access to pertinent information and track trends o Meds Box: • Is a particular medication not being given — consider removing • Is a medication consistently requested that is not carried — consider adding o Crew: Is specific training needed in a particular area, i.e., "refresher" or full training course — determine competency for various procedures 4 April 13, 2012 Summary Report: (Excel spreadsheet) 0 20 employees were pulled from EMS ranks o General Activity — Meds and Procedures ■ Patient exposure — adequate or lacking — why? ■ Assistance with documentation — acquired skill Provides a sample overview over a nine month period — not representative of entire system "Season" is a factor — variations from season to season Dr. Tober noted when paramedics were rotated from busy to quiet stations they were not familiar with local "shortcuts" and the lack of knowledge impeded response times. • Rotations have been temporarily halted to determine the impact of geographic familiarity on response times. He further stated the paramedics working in Immokalee have more opportunities to perform a number of procedures, especially emergency obstetrical. • The data had not been available previously — still in the process of determining how to "mine" the data effectively. Data categories are automatically populated by computer. 4. NEW BUSINESS: A. Medical Directors Ride -a -Long — Dr. Tober • A new devise has replaced the drill system. The "Bone Injection Gun" allows an IV to be started in the bone. Instructional presentations are in process. B. Injured Athlete — Deputy Chief Watson (A copy of a draft, "Common Medical Protocol re: Injured Athletes, " was distributed to the Members.) • North Naples Fire District suggested a protocol should be devised addressing how to move and secure a patient wearing athletic equipment. • A County -wide standard had not been established previously. • North Naples provided data used to train Athletic trainers to standardize procedures for the various types of equipment. • Concepts were presented and are under review to develop a standard for each type of specialized injury • EMS met with Golden Gate Fire personnel to try different techniques and equipment • Will present results to Dr. Dara and draft will be finalized with Medical Directors prior to the start of football season • An "In- Service" presentation will be made in July o A video will be filmed for use by remove districts Deputy Chief Watson noted the St. John Neumann football team served as "patients" for the field test. The boys ranged in height from 5'10" to 6'5" and weighed between 150 to 285 pounds. April 13, 2012 C. North Naples Fire Rescue EMS Council — Walter Kopka • There was some confusion about how the North Naples EMS Council related to the EMS Policy Advisory Board. • Battalion Chief Butcher and Interim Chief Kopka attend the North Naples EMS Council meetings and provide information requested. • Neither Battalion Chief Butcher nor Interim Chief Kopka are members of the North Naples EMS Council. D. ALS Engines: Status Report — Walter Kopka A brief presentation was made to the Board of County Commissioners in early April Commissioner Fiala requested the status of engine programs throughout the County • North Naples Fire Department has its own COPCN and delivers care under that Certificate • EMS has Memorandums of Understanding ( "MOU ") with the City of Naples and the City of Marco Island to deliver ALS under EMS' Certificates • There are Inter -Local Agreements concerning the two dependent fire departments under the County to deliver ALS care and engine apparatus utilization • In discussion with East Naples regarding training of their personnel as ALS, as well as with Big Corkscrew. • Big Corkscrew has requested an estimate of the costs for ALS training and equipment. The target date to begin the ALS training program is in the next Budget year. • The Fire Chief for Big Corkscrew is also the Chief for Immokalee. E. North Naples Fire District Concept — Walter Kopka (A copy of a Power Point presentation was distributed to the Members.) • The presentation will be made to the Board of County Commissioners' during the Workshop on April 261h (four topics will be presented) • Chief Aguilera noted there is no requirement to vote since it is not a proposal — merely a concept • A member of the Board requested the presentation • Medical units: o 23 — full time (24 hours) o 2 — 12 hour • 1 —contract • One helicopter 5. STAFF REPORTS: Interim Chief Walter Kopka • News Story on NBC -2 o NBC -2 News requested a report on Thursday as the "busiest" day of the week April 13, 2012 • There is less than a 5% difference between the volume of Thursdays and other weekdays • An significant difference was noted on weekends for Trauma Alert patients transported to Lee Memorial Hospital ER and their subsequent admission to the facility — 30 to 40% increase • Peak periods: 9:00 to 10:00 AM — remains steady until 4:00 to 5:00 PM • For overall calls, there is no significant difference "Step Wise" • Coalition with North Naples Fire Department and Physicians Regional Hospital • A "Step Wise" Workshop will be held on April for the residents of the Carlisle • Elderly are more likely to be injured from a trip /fall than from passing out ■ Contributing cause: area rugs (not anchored) • 17% of calls from that community are due to falls • Other topics: medications and potential interactions; vision care; footwear • Also available: • Balance station • Blood pressure station • "Operation Medicine Cabinet" — disposal of old /unused prescription drugs • The Carlisle Physical Therapy Department will conduct home safety inspections before releasing a patient from treatment • Vice Chairman Metzger suggested developing a pilot program to take on the road. • Deputy Chief Aguilera noted the Lee County Coalition (which has a comprehensive membership) invited participation from all the Fire Departments to develop the "Southwest Florida Step Wise Program" Vice Chairman Metzger suggested making a presentation to the Fire Chiefs at their next meeting 6. PUBLIC COMMENT: (None) 7. BOARD MEMBERS DISCUSSION: (None) 8. NEXT MEETING DATE: • Friday, June 15, 2012, at 4:30 PM There being no further business for the good of the County, the Meeting concluded by order of the Chair at 6:05 PM. April 13, 2012 COLLIER COUNTY EMERGENCY MEDICAL SERVICES POLICY ADVISORY BOARD James Talano, M.D., Chairman The Minutes were approved by the Board /Committee Chair on , 2012, "as submitted" [I OR "as amended" [_]