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Minutes 07/13/1982 Naples , Florida July 13 , 1982 LET IT BE REMEMBERED, that the Emergency Medical Services Advisory Council met on this date at 4 : 00 P.M. in the 5th floor Conference Room in Building "F" of the Courthouse Complex with the following members as indicated below: CHAIRMAN: Egon Hill MEMBERS: Jan Fillinger (Excused) Dr. Hanns Ehrhardt Sgt. Richard Davidson Chief Jim Biliman (Excused) Mr. David Graham (Excused) Dr. Jack Greenfield Mr. Tom Hafner Mr. Marvil Cecil Mr. Biff Comte EX-OFFICIO MEMBERS : Chief Norris Ijams Dr. John Adams for Dr. Wm. Cox C.G. Whidden for Sheriff Rogers STAFF ADVISORS: Dr. John Adams Douglas Greenfield Dr. Robert Tober (Absent) W. N. Dorrill ALSO PRESENT: Jack Wampler, EMS Billing Coordinator, "Skip" Camp, EMS Paramedic Supervisor, and Billie Moyer. AGENDA I. Roll Call II. Reading/and or approval of minutes a) Regular meeting of June 8 , 1982 III. Advisors Reports IV. Old Business V. Adjourn EMERGENCY MEDICAL SERVICES ADVISORY COUNCIL July 13 , 1982 Chairman Egon Hill opened the meeting at 4 : 05 by stating that he had received a letter from Mr. Wm. Reagan, County Clerk, to the effect that the Council may be required to make a Financial Disclosure Statement. Mr. Hill said he had asked Mr. Burt Saunders , County Attorney, for a ruling on this and then read the reply from Mr. Saunders which revealed that since the EMSAC is purely an "advisory body, " it is not required that its members file Financial Disclosure Statements pursuant to Chapter 112 , Florida Statutes . Pointing out that the positions of Chairman, Vice Chairman and Secretary would have to be replaced by new members on September 30 , Mr. Hill appointed a committee of three to submit names of proper persons to fill these vacancies. Mr. Tom Hafner, Dr. Ehrhardt, and Chief Billman were chosen and asked to report at the August meeting. Mr. Hill said he was very pleased at the billings and collec- tions for the month of June, noting that the collections had risen steadily from 49 . 7% in October, to 70 . 3% in June. He asked, however if this was correct or just a "fluke. " Mr. Jack Wampler, Billing Coordinator for EMS , answered this question by reporting on the progress made in that department since he had started on March 15. One of the reasons for the larger percentage of collections, he feels , is that a call is being placed to the home of every patient transported, thus enabling the billing department to properly bill the responsible party. An example, he said, is Workmen' s Comp cases where we would send the bill directly to the company responsible rather than to the employee. Besides the information obtained in placing this call , he said, most people were relieved in hearing that we will help them file - 2 - EMERGENCY MEDICAL SERVICES ADVISORY COUNCIL July 13 , 1982 their insurance claims and were in most cases cooperative. Ex- plaining that we do not help file claims until a bill is paid, (with certain exceptions) Mr. Wampler stated that it has only been since a Resolution was passed last March that we have done so. Mr. Wampler gave credit to the many agencies who have been helpful in providing vital information. Among them were the EMT Supervisors who are extremely helpful in getting proper infor- mation from the EMT' s , Florida Highway Patrol, Collier County Sheriff ' s Office, Immokalee Sheriff ' s Office, Naples Community Hospital, Naples Water Dept. , Collier Co. Water Dept. (correct billing addresses) , Social Security Office (in determining who might be eligible for Medicare) , and Dr. Schmid, who is authorized to check into people' s wallets and many times identify a victim. Mr. Wampler also mentioned the new Haitian and Cuban agency under HRS supervision which has been quite helpful. Mr. Wampler spoke of the new billing system and said that the EMS billing office now has immediate access to the computer which allows them to get input information and to adjust information. In closing, Mr. Wampler remarked that the 70 . 3% figure for collections was not a "fluke" and that already this month we are again shooting toward the 70% mark. Mr. Hill apologized for having referred to it as a "fluke" and mentioned that he had been asked to appear on local TV in the next week or so to report on how the new system is doing, adding that in his opinion, they were doing "fantastically. " Mr. Greenfield reported that he had just received the first 15-day printout on collections and all accounts receivable areas - 3 - EMERGENCY MEDICAL SERVICES ADVISORY COUNCIL July 13 , 1982 and advised that it was even broken down by zones, which will make it easier to see where to adjust strength in collections. Mr. Hill inquired if collection agencies are of any help and Mr. Wampler replied that they were not doing badly under the circumstances but that since we have been able to collect more ourselves , we probably won' t be using them as much. Mr. Greenfield added that by using live collection techniques as we do now, and making the second personal contact in 45 days and allowing 90 days instead of 145, has been of great help. APPROVAL OF MINUTES, JUNE 8 , 1982 : Minutes were approved as submitted. ADVISORS REPORTS: Dr. Adams reported that 2 new vehicles had been inspected; one a new unit, and the other refurbished and a new chasis in- stalled, bringing us to a total of 9 vehicles, plus 1 helicopter. Permit applications are on the way to Tallahassee. Mr. Hill asked how much we use the helicopter and Mr Greenfield replied that its use was pretty much seasonal, being used only once or twice a week at the most. Marvin Cecil mentioned that paramedics are now taking blood alcohol tests, which is of great assistance to law enforcement. Mr. Greenfield explained the portion of the new DUI law which states that in the case of severe bodily injury or loss of life resulting from the use of alcoholic beverages or a controlled sub- stance, an officer on the scene has the right to request a paramedic to make a blood alcohol test. He said he had met with Judge Hayes , and representatives of the law enforcement agency and Naples Community Hospital and further stated that he had asked that the paramedic be - 4 - EMERGENCY MEDICAL SERVICES ADVISORY COUNCIL July 13 , 1982 given the right to refuse to do this test if he feels that it would endanger the life of the patient. Mr. Greenfield advised he will be meeting soon with Ray Barnett, Chief Deputy, to work out an agreement with him for providing kits to be used on the scene and making EMS essentially the agent to receive the blood to be turned over to the officer immediately for shipment to Sanford. While Mr. Greenfield did not anticipate too much of a problem with this procedure, except where litigations and sub- poenas may be involved, he was concerned that EMS might be called to take blood every time a person DUI was pulled over. Mr. Whidden assured him that in situations which did not involve bodily injury the subject would be taken to the station for a breatholizer test. Mr. Hill asked what would happen if a patient refused to take the blood (7,.lcohol test and was told by Mr. Whidden that reasonable force could be used in holding the person while the paramedic took the blood. Marvin Cecil suggested the law might need to be checked out on this in the event a paramedic could be sued for manhandling a patient, although he had been told by the judges that they were going to go to the greatest extremes to protect the paramedics . Relating that experience in Illinois with this procedure had been unsatisfactory because a lot of time had to be spent in court by the EMTs, Mr. Greenfield said he felt a solution would be to make only a few of the EMTs eligible to give this test, i.e. a Field Supervisor, if in an appropriate zone, and limiting eligi- bility to only 6 people. - 5 - EMERGENCY MEDICAL SERVICES ADVISORY COUNCIL July 13 , 1982 Mr. Cecil agreed that making the test at the scene would make it a lot easier on doctors in the Emergency Room and would relieve situations where they are sometimes all subpoenaed to go into court the same day, but was greatly concerned that EMS should make sure the courts are going to stand by what they promised, since some very positive things could come of it. Mr. Dorrill mentioned the unfortunate incident of the 11th involving Paramedic Jim Smith, who was stabbed by a person unknown, and it was ascertained that Mr. Smith had been released from the hospital and was doing nicely. Mr. Greenfield reported that although he has never wanted to become directly involved with body removal, he has no complaints with the gentleman from Fort Lauderdale who recently has started removing dead bodies in his station wagon all over the county for the Medical Examiner. He feels the gentleman is well qualified, having worked with one of the best organizations in the state, and is very interested in doing the best he can. Since EMS has only used his services a few times, Mr. Greenfield felt the oper- ation was just too new to give an opinion, adding that the Medical Examiner and Sheriff ' s Office feel it is an improvement and that the paramedics are "ecstatic. " "Skip" Camp gave the results of a public survey on EMS services which was made last month. Stating that starting with the June 15th billing date, each patient treated or transported to the hospital was sent an evaluation card requesting that they comment on items such as vehicle response time, attitude of technicians and drivers, how the vehicle was driven, and condition of vehicle and linen. - 6 - EMERGENCY MEDICAL SERVICES ADVISORY COUNCIL July 13 , 1982 Mr. Camp reported the results as being tremendously supportive. Of the 46 cards received so far, 45 persons felt the vehicle arrived quickly, the drivers and technicians were courteous and considerate, the vehicle and linen were clean. Only 1 person felt the linen was "gray and crumpled, " but rated all other items as satisfactory. Forty patients signed their evaluation and thirty-one made positive write-in comments in the space provided for remarks . In conclusion, Mr. Camp said it was decided to continue this plan indefinitely, as it provides our organization with continuous feedback from the public we serve, telling us that the public sees an EMS system that responds quickly, with courteous and considerate drivers and technicians; responding in vehicles that are clean and carefully driven. Mr. Greenfield advised he had just received a copy of the new state legislation adopted effective June 23rd and going into effect the 1st of October, for the reenactment of Chapter 401 with new revisions. He invited anyone wanting a copy to contact him. Mr. Greenfield said the issue had received tremendous support statewide but expressed dissatisfaction with lack of support from HRS at both local and state levels in their ineffectiveness in reaching the public and letting them know how important this pro- gram really is. He further added that after speaking with people from HRS on several occasions he had finally told them that if they are to be looked up to as "Big Brother, " it was necessary for them to come down and speak with the people on the local level and indicated - 7 - EMERGENCY MEDICAL SERVICES ADVISORY COUNCIL July 13 , 1982 that we needed the support of HRS in order to show growth in the next decade. Dr. Ehrhardt referred to the cost of postage for the sur- vey cards sent out by the billing department stamped "No Postage Necessary, " and Mr. Greenfield explained that since EMS had established a trust fund with the post office and is eligible for the bulk rate, the cost per card was 15G each. Mr. Greenfield reported that with the new legislation, an EMT will be allowed to intubate esophageally after being prop- erly trained by a physician. He mentioned also that although EMTs are not allowed to start an IV, they can now monitor an IV during transport, thus eliminating the need for the hospital to furnish a nurse to do this. By running a very advanced 2-man team, he said, the driver can now play a more extensive role in patient assessment and treatment in helping stabilize worst situ- ations such as severe trauma, respiratory arrest, cardiac arrest, etc. Mr. Greenfield indicated he had wanted a lot more but is satisfied with what he felt was a giant step and a chance to show Tallahassee what we can do, in hopes for a better program the next time around. Attributing a good deal of the "down time" which had been questioned, to the 2 , 000 mile vehicle maintenance program, rather than to breakdowns, Mr. Greenfield felt that a lot of time was saved by this program in the longrun. He added that vehicles are being assigned to crews for the first time, instead of rotating crews every 30 days , resulting in a more personal attitude toward maintaining high standards of vehicle care and sanitation. - 8 - EMERGENCY MEDICAL SERVICES ADVISORY COUNCIL July 13 , 1982 Mr. Hill inquired how many crews were needed per truck and Mr. Greenfield replied that there were three - (6 people). Mr. Greenfield explained that specific types of emergency driving standards were now being used in unincorporated areas with low traffic density and that only the flashing box lights were being turned on with no beacons or siren, in order to reduce the work load on systems, and felt this would pay off greatly. Biff Comte asked what the monthly maintenance cost on the helicopter amounted to. This was answered by Mr. Dorrill, who replied that we don' t have it broken down by the month, but that a cost accounting system has been set up incorporating all expenses involved i.e. , overhead insurance, pilot 's salary, phone bill at hangar, rent of hangar, etc. He further explained that at budget time each year every department in the County is asked to indicate the anticipated time of use and by dividing the total expenses by the total anticipated hours of use, an hourly rate is set up. This rigorous cost accounting system was set up and outlined in the Helicopter Policy which was adopted by the Board last year in an effort to enable the helicopter to pay for itself. Mr. Dorrill also made clear the fact that the helicopter does not belong to EMS . Mr. Comte said he thought the public should be made aware that the helicopter is not EMS property, since some people felt it was an awfully expensive piece of equipment for the ambulance service to have, especially since they hardly ever saw it running. Mr. Greenfield answered that one of the reasons it has not been used as much as it could be is the lack of a suitable place to land. - 9 - EMERGENCY MEDICAL SERVICES ADVISORY COUNCIL • July 13 , 1982 Dr. Ehrhardt asked if the body removal service would be the one to remove a body in the case of a person who died at home and was not a cororner' s case. Mr. Greenfield replied that Dr. Schmid had established a set fee to be charged for body removal done by both EMS and by funeral homes and that the body removal service agency had agreed to charge this standard fee. Mr. Dorrill added that in cases where the family has a preference for removal by a funeral home, the funeral home will do so in most cases. In cases where the body is that of an indigent, however, removal by the service will be authorized by Dr. Schmid. Dr. Ehrhardt then asked if bodies at the scene of an accident are always removed by this service. Mr. Greenfield said this would usually be true, since it was important that traffic be cleared and adequate response time has been guaranteed by this service. Mr. Greenfield reported he has been meeting with the Fire Chiefs to discuss a response protocol program and was very pleased with the results . He said the format for drawing up an agree- ment which he and his staff had worked out was well received and that he will get together with the firemen at the next regular meeting in August to set down some formula to go by. Noting that it would take time to sit down and look at all the individual problems and monitor them month by month, he said it would take some time until they would arrive at a workable product. Mr. Hill mentioned unofficially from Jan Fillinger that she may be resigning due to accepting a full time job. - 10 - EMERGENCY MEDICAL SERVICES ADVISORY COUNCIL July 13 , 1982 Next month, Mr. Hill announced, he will review the attendance record for reporting to the Commissioners and that anyone who had been absent 3 consecutive times without proper excuse would be dropped and a new person appointed. Tom Hafner reported his progress on the attempt to get an emergency phone system on Alligator Alley. Since the highway right of way belongs to the Indians , he said, nothing can be done by Florida Dept. of Transportation without the tribe ' s permission. As a result, Mr. Hafner said, Curtis Osceola, a tribal commissioner, and Joe Blanchard, of DOT have been working together to figure out what could be done. Initially, he said, we were told that the Indians were going to put up a half-way station there and set up a command post but that Florida legislature in their mass appropri- ation bill voted in money to the Indians to do a study on how much it would cost to put phones in on the Alley. Realizing that a lot of problems would be involved in channeling calls to the proper agency, such as Florida Highway Patrol , Sheriff ' s Office, the command post, etc. , Mr. Hafner said he has been trying to make an appointment with Curtis Osceola to see what they have come up with in their study and also what the aims of DOT are. ADJOURNMENT There being no other business to come before the Council, the meeting was adjourned at 5 : 09 PM. Mr. Egon Hill, Chairman Prepared by: Billie Moyer - 11 - MEMO TO: Members of EMSAC FROM W. Neil Dorrill , Public Safety Administrator DATE July 13 , 1982 SUBJECT: Minutes of Meeting June 8 , 1982 In accompaniment , please find copy of the Minutes from the Regular Meeting of June 8 , 1982 . Please review these in order that they can be adopted at the next meeting on August 10 , 1982 , at 4: 00 PM. WND/bm cc: C. W. Norman, County Manager File - 14D