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Minutes 11/08/1989 EMERGENCY MEDICAL SERVICES ADVISORY COUNCIL Minutes For November 8 , 1989 Members Present: Fred Hubbard Egon Hill Karen Davidson Chuck Buell Gary Young Bill Erickson Jack Winters Bill Snapp Staff Present: George Barton Susan Rossi October minutes approved. OLD BUSINESS George Barton discussed the Immokalee advising that he Crone has(set)up a wrote a letter to the County Manager committee to study to problems involving the lack of emergency care in Immokalee. Jay Reardon and George have a meeting with Mr. Crone later this month to discuss further. EMS is still not seeing an increase in patients transported from Immokalee. NEW BUSINESS EMS has made some changes in the zones system. Golden Gate city and Golden Gate estates have been divided into separate zones ; a Lely zone has been created; also Alligator Alley has been set up as its own zone. These changes will give EMS more accurate stats on the call load areas. Fred Hubbard inquired about emergency phones on the Alley. George advised that the project has been budgeted for. Phones probably will be set up at one mile intervals once the four lanes are completed. EMS finance subcommittee of Bill Snapp, Bill Erickson, Egon Hill and George Barton, have not had the opportunity to meet yet. George suggested inviting a paramedic to sit on the subcommittee. All members agreed to this idea. Passed out to the advisory board were a list of questions and their answers most commonly ask of EMS by the public. Members to look them over, any questions can be brought up at the next meeting. The construction and financing of a new Emergency Services complex was discussed. The current EMS headquarters would not withstand a hurricane. Additional room and a more survivable building is needed. The headquarters lease expires in July ' 90 , and the lease on the helicopter hangar will not be renewed. Jay Reardon is currently working on a joint complex to house the Emergency Services Division (EMS , Helicopter Operations, Emergency Management) . We would prefer to have this facility located on airport property for several reasons. It is very difficult to get FAA approval for the helicopter to be housed other than on airport property; fuel charges would be cheaper if located at airport; and eventually there is a possibility that a bridge will be build over the Gordon River at either 7th or 9th Ave N. After observing the destruction left by hurricane Hugo, the plans for a two story complex will be changed to no less than four stories. This will drive the cost of the complex considerable higher, possibly as much as 5 million dollars. The county finance committee suggested that a sales tax could fund the building. There is already $428,000 in the budget which will cover the first year' s lease on the complex. Egon Hill is on a committee which makes recommendations to the BCC regarding additional sales tax. George Barton will submit a letter to Egon requesting an $. Ol additional sales tax to fund the new complex. A proposal to set up an investment trust fund for rebuilding after a disaster was discussed. Also learned from EMS in Charleston is that it will be necessary to assign paramedics to each emergency shelter and not just at the medical shelters. Paramedics can operate without electricity if necessary and can use their portable radios for communications. Fred Hubbard suggested that the board tour the Marco Urgent Care Center. This would also give members an opportunity to see Medic 4 ' s facility. The council agreed and it was decided that for the December EMSAC meeting members would meet at EMS Headquarters at 3 :30 PM and be driven down to Marco. ***************************************************************** NEXT EMSAC MEETING: Wednesday, December 13th, 3 : 30 pm at EMS H.Q. ***************************************************************** EMS ADVISORY COUNCIL A G E N D A 11/8/89 Call to Order Review of October Minutes OLD BUSINESS * Immokalee Clinic NEW BUSINESS * Zone Changes * Alligator Alley Research Project * Information for Advisory Members * EMS Finance Subcommittee * EMS Bylaws * Modification to EMS Disaster Plan D R A F T EMERGENCY MEDICAL SERVICES Questions & Answers 1. Why do I see so many government vehicles and personnel at the scene of an accident even if it is only a fender bender? Fire trucks , ambulances from EMS, Fire Department resuscitation truck, and 2 or 3 police cars? ANSWER: EMS operates in conjunction with first response provided by the nine fire services who cover Collier County. Those fire services respond from 22 separate locations with the eight EMS paramedic units. EMS response is at the upper limit of the national standard (eight minutes) . EMS' s response times will not decrease appreciably within the urban zone due to the distances units are required to travel. Fire services have a required standard of five minutes to save a life in ,a building/home fire. EMS takes advantage of that five minute response time standard and uses EMT' s on pumpers to provide basic life support in less time than the local EMS paramedic unit can provide service. Police cars on the scene are a function of departmental policy. Within the city of Naples , the police are routinely dispatched on all EMS calls. The Sheriff ' s Office responds to all car accidents and potential violent situations to protect EMS and fire crews from the patients or relatives involved at the scene. The presence or absence of the police in non-dangerous situations or routine street calls not involving car accidents are purely a function of those individual department ' s policies. 2 . Who does it cost so much to get taken to the hospital by an ambulance? I know of some places that don't charge anything. ANSWER: The cost of an ambulance is born by our community residents through a combination of taxes and user fees . The county government has made a decision to fund approximately half of the costs from ad volorum taxes through the General Fund and the other half of the costs from patient revenues. The Federal and State governments have made policy decisions on Medicare and Medicaid which severely restrict what the government will pay on Medicare/Medicaid patients. Federal Medicare pays 80% of fees posted two years prior to the current fee. That policy matter means that Medicare patients must carry supplemental insurance or cover the remainder of the cost from their own pockets . Medicaid pays $32 .50 of the ambulance bills in Florida. The remainder of the bill cannot be covered by the patient under Medicaid regulations. The necessary coverage for the remainder of the bill must come from ad valorum taxes. 3 . How well trained are the personnel on the ambulances? ANSWER: Personnel training is based upon State of Florida regulations and the Collier County regulations provided by the Director of the EMS system. 4 . Do the personnel in the ambulances contact a doctor for instructions? ANSWER: Personnel onboard the ambulances utilize orders prescribed for medical emergencies in writing prior to the emergency. Contact with physicians are made only when those written instructions are insufficient. 5. Why do you sometimes send a helicopter instead of an ambulance? ANSWER: The helicopter response is based upon two factors. 1) To reduce the time necessary to place the patient in a hospital. 2) To maintain a ground unit ' s availability in distant locations such as Immokalee, Everglades and Marco Island. 6. Do the ambulances in Collier County get to an accident as quickly as you want them to? Compare the times it takes here with other areas. ANSWER: As stated in number 1 above, Collier County is at the upper limits of response times for the country. Many urban systems with populations of an increased density experience a lower response time. Collier County EMS units are concentrated in the western urban zone of the county. Response times are increased due to the distances our ambulances must travel. 7. Are there any serious problems with our ambulance service that need to be corrected soon in order that all of the county could feel assured of getting the service they need? ANSWER: Research is ongoing in two primary areas: 1) The Director is concentrating on improving the time committed to 911 center information gathering and dispatch of the units. This is a joint effort with the Sheriff and requires both training and technological changes. 2) EMS faces a current crises with its headquarters building. The lease on an inadequate facility expires July 1990 . No funds have yet been committed for the replacement or enhancement of the current building. It is hoped that work by the Administrator for Emergency Services and the County Manager will soon present a plan to resolve that issue within the context of the current sales tax proposal . 8 . What improvements do you want to make in the next two years? ANSWER: Improvements expected within the next two years unique to Emergency Medical Services would be: 1) The provision of better data transfer on billing information in order to improve the accuracy and efficiency of our billing department. 2) The provision of a proper electronic mapping system to decrease time necessary for units to locate calls. 3) The provision of clot dissolving medications by paramedics in the field.