Agenda 09/24/2013 Item #16E 6n
9/24/2013 16.E.6.
EXECUTIVE SUMMARY
Recommendation to approve and authorize the Chair to execute an Interlocal Agreement for an
Advanced Life Support Partnership between Collier County and the City of Naples.
OBJECTIVE: To provide quality and cost effective fire rescue and emergency medical
services to the residents of the City of Naples and Collier County.
CONSIDERATION: In an effort to enhance emergency medical services through a continued
partnership between Collier County and the City of Naples, this Agreement provides for City
firefighter /paramedics to work and train on a County ambulance and County
paramedic /firefighters to train with City fire- rescue personnel. This Agreement supersedes the
May 22, 2007 Interlocal Agreement for Advanced Life Support Engine Partnership between the
County and the City of Naples Fire Department.
This Agreement allows for City firefighter/ paramedics who have completed the Office of the
Medical Director training and testing to practice independently on City of Naples ALS Engines.
In addition, a City of Naples firefighter /paramedic will act as a third crew member and
accompany the patient to the hospital on the ambulance for all patients requiring Advanced Life
Support.
n FISCAL IMPACT: There is no Fiscal Impact associated with this action.
GROWTH MANAGEMENT IMPACT: None.
LEGAL CONSIDERATIONS: This item has been approved as to form and legality and
requires majority vote for approval. — CMG
RECOMMENDATION: That the Board of County Commissioners:
1. Approves the Interlocal Agreement between Collier County and the City of Naples for
an Advanced Life Support Partnership; and,
2. Authorizes the Chair to execute the Agreement.
PREPARED BY: Artie Bay, Supervisor, Emergency Medical Services— Admin.
Attachment: Interlocal Agreement
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COLLIER COUNTY
Board of County Commissioners
Item Number: 16.16.E.16.E.6.
Item Summary: Recommendation to approve and authorize the Chair to execute an
Interlocal Agreement for an Advanced Life Support Partnership between Collier County and the
City of Naples.
Meeting Date: 9/24/2013
Prepared By
Name: BayArtie
Title: Supervisor - Accounting,EMS Operations
9/10/2013 2:41:32 PM
Approved By
Name: pochopinpat
Title: Administrative Assistant,Facilities Management
Date: 9/10/2013 3:06:06 PM
Name: KopkaWalter
Date: 9/10/2013 9:05:57 PM
Name: SummersDan
Title: Director - Bureau of Emergency Services,
Date: 9/11/2013 8:38:55 AM
Name: GreeneColleen
Title: Assistant County Attomey,County Attorney
Date: 9/12/2013 8:24:08 AM
Name: PriceLen
Title: Administrator, Administrative Services
Date: 9/13/2013 10:10:10 AM
Name: GreeneColleen
Title: Assistant County Attomey,County Attorney
Date: 9/13/2013 11:53:10 AM
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Name: KlatzkowJeff
Title: County Attorney
Date: 9/13/2013 1:46:10 PM
Name: PryorCheryl
Title: Management/ Budget Analyst, Senior,Office of Manag
Date: 9/15/2013 1:14:37 PM
Name: OchsLeo
Title: County Manager
Date: 9/17/2013 2:23:13 PM
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9/24/2013 16.E.6.
9/24/2013 16.E.6.
INTERLOCAL AGREEMENT
ADVANCED LIFE SUPPORT PARTNERSHIP
BETWEEN COLLIER COUNTY AND CITY OF NAPLES
This INTERLOCAL AGREEMENT, made and entered into this _ day of 2013,
by and between the Board of County Commissioners, Collier County, Florida, a political
subdivision of Florida, (hereinafter "COUNTY") and the CITY OF NAPLES, "hereinafter
"CITY").
PURPOSE
The purpose of this Interlocal Agreement is to provide quality and cost effective fire
rescue and emergency medical services to the residents of the City of Naples and
Collier County. The recognition and utilization of existing and future personnel skills,
qualifications and resources is in the interest and benefit of both agencies and the
public we serve.
WITNESSETH
WHEREAS, the CITY and COUNTY seek to enhance emergency service further
through a continued partnership; and
WHEREAS, the Advanced Life Support (hereinafter "ALS ") partnership provides for a
CITY Firefighter /Paramedic to work and train on a COUNTY Advanced Life Support
transport ambulance providing paramedic duties and/or basic life support EMT duties;
and
WHEREAS, the ALS partnership allows for a COUNTY Paramedic /Firefighters to train
with CITY Fire - Rescue personnel; and
WHEREAS, the CITY and COUNTY work cooperatively to assure appropriate response
of sufficient emergency medical resources and enhanced continuity of care from the
scene to the hospital for all ALS patients.
NOW, THEREFORE, in consideration of the above premises, and the mutual
covenants, terms, and provisions contained herein, the COUNTY and the CITY agree
as follows:
SECTION I: DEFINITIONS
1.0 ALS means treatment of life- threatening medical emergencies through the use of
techniques such as endotracheal intubation, the administration of drugs or
intravenous fluids, telemetry, cardiac monitoring, and cardiac defibrillation by a
qualified person, pursuant to rules of the COUNTY Office of Medical Director
(hereinafter "OMD ").
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1.1 Basic life support means treatment of medical emergencies by a qualified person
through the use of techniques such as patient assessment, cardiopulmonary
resuscitation (CPR), splinting, obstetrical assistance, bandaging, administration
of oxygen, application of medical antishock trousers, administration of a
subcutaneous injection using a premeasured autoinjector of epinephrine to a
person suffering an anaphylactic reaction, and other techniques described in the
Emergency Medical Technician Basic Training Course Curriculum of the United
States Department of Transportation. The term "basic life support" also includes
other techniques which have been approved and are performed under conditions
specified by rules of the department, and other techniques which have been
approved and are performed under conditions specified by rules of the COUNTY
OMD.
1.2 FTO means a Field Training Officer; a certified paramedic recognized by the
OMD as having sufficient skill and experience to train and direct medical
providers in working under the approved medical protocols.
1.3 QA/QI means Quality Assurance / Quality Improvement which is the OMD
approved program which assesses and monitors the medical performance of
Paramedics and Emergency Medical Techr ,cians.
1.4 PCR means the Patient Care Record which chronicles the medical treatment of
the patient.
1.5 Permitted means a non - transporting ALS fire apparatus and rapid response
vehicle operating under the ALS license issued to COUNTY Emergency Medical
Services Department (hereinafter "EMS ") for the purpose of enhancing 911
medical responses.
1.6 Classifications of paramedics are found in the ALS Operational Plan (Attachment
A).
1.7 Non - permitted means any response vehicle that is not required by State Statute
to be permitted, but is authorized by the Medical Director.
SECTION II: COUNTY'S RESPONSIBILITY
The following specific services, duties, and responsibilities will be the obligation of the
COUNTY:
2.0 The COUNTY will provide through the County's EMS and the OMD; medical
direction, medical protocols, training and quality assurance on a countywide
basis.
2.1 The COUNTY, as a licensed provider of advanced life support under Chapter
401, Fla. Stat. and Fla. Admin. Code 64J, will permit up to four (4) CITY fire
apparatus or response vehicles as non - transporting ALS vehicle(s) under the
COUNTY EMS license for the purpose of enhancing 911 medical responses.
2.2 As pursuant to Chapter 401, Fla. Stat. and Fla. Admin. Code 64J, the City may
operate any of their permitted ALS vehicles or apparatus as a BLS responder
when a paramedic does not staff the vehicle.
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SECTION III: CITY'S RESPONSIBILITY
The following specific services, duties, and responsibilities will be the obligation of the
CITY:
3.0 The CITY will provide through the City of Naples — Fire Rescue Department
firefighter training to County firefighter personnel.
3.1 The CITY will provide, maintain, repair and replace all applicable ALS and BLS
equipment and medical supplies on all County recognized permitted ALS fire
apparatus /rapid response vehicles, staffed 365 days a year, 24 hours per day
including those stationed at the following locations:
1. 855 8th Ave South
2. 977 26th Ave North
3.2 As pursuant to Chapter 401, Fla. Stat. and Fla. Admin. Code 64J, the City may
operate any of their permitted ALS vehicles or apparatus as a BLS responder
when a paramedic does not staff the vehicle.
3.3 The CITY will maintain a minimum of three (3) ALS apparatus, and up to four (4)
permitted by the COUNTY and equipped by the CITY. These units will be
designated within the County Sheriff's Office and Naples Police Communications
Division's Computer Aided Dispatch (CAD) programs to automatically respond to
medical incidents with, or in place of an ALS transport unit committed to a
previous medical, rescue or fire operation in accordance with the COUNTY's
Emergency Medical Dispatch protocol as an emergency medical response and /or
^ fire suppression vehicle.
3.4 The CITY will comply with medical protocol, equipment standards, and will fully
participate in medical training and quality assurance programs in accord with the
COUNTY.
3.5 The CITY will maintain all medical run reports in an OMD approved records
system and will handle them in a manner consistent with County operating
guidelines, Federal, and State laws.
3.6 The CITY will ensure all CITY personnel providing medical care maintain all state
and federally required licensure. Records shall be maintained by the CITY and
available to the COUNTY upon request.
3.7 The CITY will provide at least one liaison as an Emergency Medical Care
Coordinator (hereinafter "EMCC "), approved by the OMD to function as a
Training Officer / Supervisor for CITY Paramedic and EMT training. The EMCC
shall work with COUNTY EMS Training staff to enhance the BLS and First
Responder Program by assisting in teaching per the annual published in- service
schedule. If the CITY cannot logistically attend ESC training, they may teach
OMD approved curriculum at remote sites provided:
1. The OMD approved EMCC attends all in- service classes taught at the
ESC in order to insure the training liaison is kept up to date on protocol
changes, trends in local treatment, case reviews, etc. and can more
effectively communicate the material in context to their agency's
personnel
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2. The EMCC must use curriculum pre - approved by the OMD for medical
training. In the case of regularly scheduled County in- service, the
approved curriculum will be provided the month after the conclusion of
scheduled in- services at ESC.
3.8 The CITY will designate an OMD approved representative as a Quality
Assurance member to participate in Quality Assurance.
3.9 The CITY may provide additional medical equipment and expand Advanced Life
Support service with prior review and in conjunction with the OMD.
3.10 The CITY shall be responsible for replacing expendable medical supplies and for
the cost of repair and maintenance of all ALS equipment.
SECTION IV: MUTUAL CONVENANTS
4.0 NOTIFICATION OF EXPOSURE TO INFECTIOUS DISEASES: In the event that
Collier County EMS Department is notified of an exposure to infectious disease,
EMS shall notify the CITY's Infectious Control Officer or EMCC so they may take
appropriate action. Upon notification, the treatment procedures shall be the
responsibility of the CITY. In the event that the CITY is noted of an exposure to
infectious disease, the CITY shall notify the EMS Infectious Control Officer or
EMSCOMM so they may take appropriate action.
SECTION V: OPERATING PROCEDURES
5.0 The CITY Firefighter /Paramedics and Firefighter/EMTs will meet the same
requirements and perform at the ALS Non - Transport medical protocol as defined
by the OMD, COUNTY EMS department standard operating procedures, quality
assurance, general orders and chain of command will be followed while working
on the apparatus of the COUNTY EMS Department.
5.1 The CITY Firefighter /Paramedics who are certified to perform as ALS Engine
Paramedics are also subject to ongoing patient contact, training, and assessment
to maintain their certification or expand their scope of practice.
5.2 The ALS Operational Plan, Attachment A, may be revised by mutual written
consent between the Chief of the CITY's Fire Rescue and COUNTY's County
Manager or his designee (e.g. Chief of EMS). Such revisions must not conflict
with the terms and standards set forth in this Agreement.
5.3 Permitted and non - permitted ALS vehicles, programs, personnel or details may
be developed and implemented by joint agreement and in cooperation between
the CITY and COUNTY. Such resources may not conflict with the standards set
forth in this agreement.
5.4 The CITY and COUNTY EMS Department will recognize the respective ranks
and abilities of assigned personnel.
5.5 All discipline and investigations leading to discipline will be handled by the
respective employing agency.
5.6 The CITY and COUNTY will utilize Command Staff and assets for logistical,
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support, and operational needs for national, state and local emergencies.
5.7 The State of Florida recognized Incident Management System (IMS) is the
standard for emergency operations. The CITY shall assume command and
control of all incidents where the CITY is the Authority having Jurisdiction. In all
instances where the CITY has established command, COUNTY EMS shall
assume responsibility for, and be in charge of patient care.
5.8 The COUNTY and CITY will share statistical data.
SECTION VI: RESOLUTION OF CONFLICTS
6.0 If the two governing entities standard operating procedures, chain of command or
any other unforeseen circumstances come into conflict issues will immediately be
decided in the following manner;
1. First and foremost by the medical needs of the patient and responder
safety.
2. The COUNTY will have jurisdiction of medical issues concerning
appropriate patient care.
3. The CITY will have jurisdiction of fire /rescue issues concerning
operations and safety.
4. Conflicts involving patient care issues will be resolved through a QA/QI
process.
5. Should conflicts arise that are unresolvable, the chain of command
within each department will come together in an attempt to resolve
those issues at the equivalent levels of each department and in unison
move up the chain of command as necessary.
SECTION VII: AGREEMENT TERM
7.0 This Interlocal Agreement supersedes the agreement titled "Interlocal Agreement
Advanced Life Support Engine Partnership, between the CITY and COUNTY,
dated May 22, 2007.
7.1 The Interlocal Agreement shall remain in full force and effect from the date above
and shall terminate after written notice of termination.
7.2 This Interlocal Agreement shall be reviewed and renegotiated as necessary after
three (3) years. Absent termination or amendment to this Interlocal Agreement,
the term of this Interlocal Agreement will automatically renew in (3) three year
periods. Nothing within this Agreement shall preclude review and amendment of
any provision within the three (3) year period or successive renewal periods
when such amendment is mutually agreed to in writing by the COUNTY and
CITY.
7.3 Either the COUNTY or the CITY may terminate this Interlocal Agreement after
providing written notice of its intent to terminate at least ninety (90) days in
advance of the date of termination.
7.4 In the event that the COUNTY's OMD determines that the CITY's failure to fulfill
any of the obligations under this Agreement adversely affects or may adversely
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affect the medical needs of the patient and /or responder safety, the COUNTY
may provide written notice to CITY of its intent to recommend that the BCC
terminate this Agreement. BCC consideration of termination of this Agreement
must occur at the next available regular meeting of the BCC. Advance notice of
the BCC meeting date and agenda item must be provided to the OMD and CITY.
Unless otherwise determined by the BCC at the meeting, the notice of intent to
recommend that the BCC terminate this Agreement shall be deemed to be fully
sufficient and to have commenced the (90) ninety day notice period. In the
alternative, the BCC at the meeting may, after receiving information from the
OMD and CITY, terminate this Agreement without further action or notice to the
CITY. Nothing in this Agreement shall limit the authority of the OMD as set forth
in the Florida Statutes and the Florida Administrative Code.
7.5 The terminating party must also provide the non - terminating party's
representatives with an opportunity to consult with the terminating party's
representatives regarding the reason(s) for termination during the notice periods
provided in Section VII of this Agreement.
SECTION VIII: INSURANCE
8.0 The CITY and COUNTY shall maintain insurance in the minimum amounts and
types required by Florida State Statutes.
8.1 The CITY and COUNTY agree that either party may be self- insured on the
condition that all self - insurance must comply with all State laws and regulations
and must meet with the approval of the other party to this Interlocal Agreement.
8.2 To the extent permitted by law and as limited by and pursuant to the provisions of
Florida Statutes, Section 768.28 CITY and COUNTY agree to hold harmless the
other, their employees and agents against any and all claims and/or damages by
or behalf of any person, employee or legal entity arising from their respective
negligent acts pursuant to this Interlocal Agreement that allows employees of the
other to occupy and ride in each other's vehicles. Nothing is intended to alter
either party's immunity in tort or otherwise impose liability on CITY or the
COUNTY when it would not otherwise be responsible.
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SECTION IX: MISCELLANEOUS
9.0 This Interlocal Agreement shall be governed by and construed under the laws of
the State of Florida. In the event any litigation is instituted by way of construction
or enforcement of this Interlocal Agreement, the parry prevailing in said litigation
shall be entitled to collect and recover from the non - prevailing party all court
costs and other expenses, including reasonable Attorney's fees.
9.1 It is understood that this Interlocal Agreement must be executed by both parties
prior to the CITY and COUNTY commencing with the work, services, duties and
responsibilities described heretofore.
9.2 Prior to its effectiveness, this Interlocal Agreement and any subsequent
amendments to this Agreement (including amendments to the ALS Operational
Plan, Attachment A), shall be filed with the Clerk of Courts for the Circuit Court
for Collier County pursuant to Section 163.01(2), Fla. Stat. The COUNTY shall
file this Interlocal Agreement as soon as practicable after approval and execution
by both parties.
(Remainder of page intentionally left blank, signature page to follow]
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IN WITNESS WHEREOF, the parties hereto have caused this Interlocal Agreement to
be executed by their appropriate officials, as of the date first above written.
ATTEST: BOARD OF COUNTY COMMISSIONERS
DWIGHT E. BROCK, CLERK COLLIER COUNTY, FLORIDA,
BY:
Deputy Clerk Georgia A. Hiller, Esq.
Chairwoman
Approved as to form and legality:
Ileen M. Greene
Assistant County Attorney
ATTEST: NAPLES CITY COUNCIL
Pat Ranibosk, City Clerk /)6hn F. Sorey 111, MWor
Approval as to form and legal sufficiency:
-D , �1
Robert D. Pritt
City Attorney
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ATTACHMENT A
COLLIER COUNTY EMERGENCY MEDICAL SERVICES AND NAPLES FIRE AND
RESCUE DEPARTMENT ALS OPERATIONAL PLAN
REFERENCE: ALS Program Interlocal Agreement, , 2013
PURPOSE: To provide quality and cost effective emergency medical services to the
residents of the City of Naples (CITY) and Collier County (COUNTY). The
recognition and utilization of existing and future personnel skills,
qualifications and resources is in the interest and benefit of both agencies
and the public we serve.
The CITY will maintain a minimum of three (3) ALS apparatus, and up to
four (4) permitted by the COUNTY and equipped by the CITY.
• Engine 1
• Engine 2
• Rescue 2
• Ladder 1 (staffing permitting)
1. QUALIFICATION REQUIREMENTS
For the purposes of practicing medicine within the County, there are different
recognized classifications of paramedics: State Certified Paramedics and County
Certified Paramedics.
a. State Certified Paramedics have completed all State requirements and
remain in active good standing with the State and are permitted to practice
ALS under the aegis of any County Certified Paramedic or to practice BLS
independently.
b. County Certified Paramedics have completed all State requirements and
remain in active good standing with the State and have also completed
OMD approved training and testing to be permitted to practice
independently under the ALS Engine or Non - Transport Paramedic
Protocol.
The CITY Firefighter /Paramedics who are certified to perform as ALS Engine
Paramedics are also subject to ongoing patient contact, training, and assessment
to maintain their certification or expand their scope of practice.
2. PROCEDURES
a. City of Naples Firefighter / Paramedic will accompany EMS ambulance
staff (third crew member) and the patient to the hospital on all patients
requiring ALS treatment.
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b. The team of EMS staff and City of Naples will work jointly to provide the
care needed to the patient while enroute to the hospital. EMS staff will
always be lead team member of patient care.
c. The COUNTY Battalion Chief and City of Naples Battalion Chief will
consult openly in order to assure continuity and efficiency. It is
recognized by COUNTY and City of Naples that harmonious and
productive relationships between all personnel are necessary. Teamwork
and cooperation is encouraged and expected.
d. Applicable COUNTY and /or CITY policies, practices, procedures, standard
operating guidelines, general orders, protocols and /or applicable
Bargaining Unit Contract language will be observed.
3. COMMUNICATION AND DISPATCH
a. COUNTY and City of Naples staff will assure all personnel operate on the
appropriate radio frequency, unit identifier dispatch and zone coverage
protocol in accordance with Computer Aided Dispatch (CAD) and the
CCFCA Communications Manual. Designated assignments are outlined
as follows:
i. Medical Director approved Emergency Medical Dispatch (EMD)
Models shall be designed to assure the initial response of appropriate
AILS licensed apparatus.
ii. COUNTY and City of Naples chief officers will utilize available City of
Naples Fire - Rescue Department licensed resources to assure AILS
coverage is continuously maintained within the City of Naples.
iii. COUNTY and City of Naples chief officers will assure licensed and
non - licensed AILS assets will respond to out -of- district emergencies
or coverage when identified by CAD as the closest available ALS
unit.
b. Applicable COUNTY and /or CITY policies, practices, procedures, standard
operating guidelines, general orders, protocols and /or applicable
Bargaining Unit Contract language will be observed.
4. DOCUMENTATION
a. The first arriving licensed and non - licensed AILS unit will document each
patient contact in an OMD approved Patient Care Report (PCR). Collier
EMS utilizes electronic reporting as its primary PCR system but in the
event the City does not have on scene electronic reporting capability,
handwritten reports may be utilized until electronic reporting can be
completed. The PCR must record any notations from on -scene patient
treatment, patient identifying data completed and collected prior to transfer
of patient care, AR number, Dispatch times, and crew signatures with
State paramedic or EMT license numbers. Some specific call types may
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require additional documentation (such as Release /Competency forms for
patient sign outs) as specified by protocol and EMS documentation
standards. When ALS units arrive at the same time, the PCR will be
completed by the transporting unit. Shift PCRs are to be collected in a
secured envelope with completed coversheet and submitted to the
appropriate EMS representative daily.
b. Before the end of shift, an accurate and complete OMD approved
electronic report (E -PCR) will be transmitted for each patient contact
100% of the time. All medical procedures performed by the personnel
assigned to the response will be fully documented. "CHART' format with
documented "BSI" is required.
c. Prior to 0900hrs, or as call volume permits, the City of Naples Battalion
Chief or designee must fax or email a complete ALS Staffing Report to
EMSCOMM's office. If staffing changes are made during the shift, an
updated report will be provided to EMSCOMM prior to or at the end of shift
to reflect staffing changes. EMSCOMM will provide a complete EMS
Staffing report to the City of Naples Battalion Chiefs office.
5. QUALITY ASSURANCE
a. City of Naples Fire - Rescue Department will appoint a Medical Director
approved "Quality Assurance (QA) member to participate on the ALS Non-
Transport Quality Assurance Committee, and will be granted privileges to
enable them to review their department's PCRs.
b. City of Naples Fire - Rescue Department will adhere to QA standards of the
OMD and provide quarterly reports reflecting the monitoring guidelines
employed by the County.
c. Patient care concerns may be found outside of report monitoring and may,
be reported by either agency or allied personnel such as hospital staff,
deputies, etc. Concerns should be made in writing to a QA Committee
member via the Quality Assurance Review Form whenever possible and
including pertinent specific details.
d. The Medical Director will review all potential malpractices and make
recommendations for follow up with call participants and future treatment
or training guidelines. Feedback will be provided to both the complainant
and the treating paramedic by the QA committee upon the resolution of
the issue.
e. At the discretion of the Medical Director or designee, routine or
informational QA Review with City of Naples Fire - Rescue Department
personnel may be handled entirely by the City of Naples Fire - Rescue
Department member. The member shall review and complete all
paperwork with the City of Naples Fire - Rescue Department personnel and
return all necessary documentation to the ALS Non - Transport QA
Committee within thirty [30] calendar days.
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f. In the event the Medical Director orders remediation, the QA member shall
be present understanding that confidential medical information will be
discussed. If a significant issue is identified by the QA Committee, the
EMT or Paramedic may be immediately prohibited from providing patient
care until all processes are completed.
6. TRAINING
a. The CITY Training person(s) is qualified to instruct CITY firefighter
paramedics or EMTs Medical Director approved in- services, certifications,
classes, etc. utilizing preapproved curriculum
b. Any curriculum taught by the CITY EMS Training person(s) must be
submitted with a complete student roster to the OMD in order to qualify for
COUNTY accreditation. In addition, the EMS Training Officer will
accurately record continuing education hours of any personnel completing
their training and provide those records to the COUNTY quarterly.
c. The CITY will provide to the State Fire College appropriate approved
training documentation for recognized State approved fire classes.
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