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Backup Documents 10/26/2010 Item #10H10H AF'T'�(�FIVEID192010 CO ^r County ' CBItt ('ought l:Oglli11.5ElIJQ ( prp Bureau of Emergency Services MEMORANDUM TO: Chairman Fred Coyle Collier County Commissioners Mr. Jeff Klatzkow, County Attorney Mr. Ian Mitchell, Executive Manager to the Board of County Commissioners FROM: Dan E. Summers, Director- - VIA: Mr. Leo Ochs, County Manager RE: Board Agenda Item — October 26th Meeting North Naples Fire Control and Rescue District — Application for Certificate of Public Convenience and Necessity DATE: October 19, 2010 Attached is a copy of the North Naples Fire Control and Rescue District submission, staff comments, correspondence, and reference information regarding their application for an ALS — COCPN. Due to the volume of the publication, we are providing copies to you separate from the normal Board Agenda back -up information, and making a copy available for public inspection at the front desk of the Board office. You might find the table of contents most helpful to see certain aspects of the filing relevant to the discussion, since a large portion of the submission from North Naples included the previously filed 2007 EMS Master Plan. If you have any questions or concerns, please do not hesitate to call me. Thank you. Hand - delivery distribution of copies: Chairman Fred Coyle Commissioner Frank Halas Commissioner Donna Fiala Commissioner Tom Henning Commissioner Jim Coletta County Attorney Jeff Klatzkow County Manager Leo Ochs Chief Orly Stolz, North Naples Fire and Rescue Control District Dr. Robert Tober, Medical Director— Board of County Commissioners VP'Ublic Inspection Copy c/o Ian Mitchell, Executive- Board of County Commissioners ema:�rcvvr.:�rr,., ., OES 8075 Lely Cultural Parkway • Naples, Florida 34113 •239- 252 -3600 • FAX 239- 252 -3700 - www,collierem.org ion NORTH NAPLES FIRE DISTRICT Nlslilc APPLICATION & STAFF RESPONSE OCTOBER 26,2010 10H EXECUTIVE SUMMARY Recommendation to deny North Naples Fire Control and Rescue District's Application for a Certificate of Public Convenience and Necessity for an Advanced Life Support Non- Transport Service. OBJECTIVE: To proceed in the best interest of public health, safety and welfare as it relates to Advanced Life Support (ALS). CONSIDERATION: On September 17, 2009, North Naples Fire Control and Rescue District ( "Fire District ") submitted an Application for a Certificate of Need to provide ALS Non - Transport Services ( "Application "). Staff timely conducted a thorough review of the Application, submitted correspondence for additional information that was not submitted or incomplete within the application, and met with the District's legal counsel. The Application was also placed in suspense for a period of time at the request of the Fire District and then subsequently re- activated at the request of the District's legal counsel. Staffs basis for denial is set forth in a letter to the County Manager, dated July 1, 2010 (see copy attached). Importantly, staff recommends denial of the Application based on the following: Fire District submitted an application for a non - transport Certificate of Public Convenience and Necessity for the purposes of providing Advanced Life Support Non - Transport Operations separate and apart from the County Medical Director's medical direction, coordination, and control, solely to the North Naples Fire District. Such separate medical direction is contrary to the provisions, duties, and responsibilities of the County's Medical Director, as referenced in Florida Statute 401.265. This ruling was further clarified by a Final Order issued by the Florida Department of Health, in Department of Health case number 2010 -0040. (This order is included in the staff response and documentation which due to its size is too large for mass publication. Copies of staff response and documentation are available for examination in the office of the Board of County Commissioners.) The Application did not provide any empirical data for its particular district or the County, supporting a Certificate of Public Convenience and Necessity other than citing references to the 2007 Emergency Medical Service Master Plan document, which was developed to review and analyze County -wide level of service standards in support of the Annual Update to Inventory Reporting (AUIR). Numerous operational changes have taken place since the 2007 report. The Fire District also failed to indicate that it would staff the necessary emergency medical response resources in a manner that would not conflict or delay a medical call if its personnel and apparatus were responding to or involved in a fire response. 10H t FISCAL IMPACT: There is no fiscal impact associated with this Executive Summary. LEGAL CONSIDERATIONS: Ordinance No. 04 -12, Section 7 states: "The Board of County Commissioners shall not grant a certificate unless it shall find, after public hearing and based on competent evidence that each of the following standards has been satisfied: (1) The extent to which the proposed service is needed to improve the overall Emergency Medical Services (EMS) capabilities of the County. (2) The effect of the proposed service on existing services with respect to quality of service and cost of service. (3) The effect of the proposed service on the overall cost of EMS service in the County. (4) The effect of the proposed service on existing hospitals and other health care facilities. (5) The effect of the proposed service on personnel of existing services and the availability of sufficient qualified personnel in the local area to adequately staff all existing services. B. That the applicant has sufficient knowledge and experience to properly operate the proposed service. C. That, if applicable, there is an adequate revenue base for the proposed service. D. That the proposed service will have sufficient personnel and equipment to adequately cover the proposed service area." Ordinance No. 04 -12, Section 8 provides: "In making the determinations provided for in Section 7 above, the Board may, in its sole discretion, appoint a Hearing Officer to hold a public hearing and to make factual findings and conclusions as a result of the hearing. Should a Hearing Officer be appointed, said Hearing Officer shall render a written report to the Board within 30 days of the hearing, which report shall contain the officer's findings and conclusions of fact, and a recommended order. The findings and conclusions of fact shall be binding upon the Board, but the recommended order shall be advisory only." Staff response and documentation for this item is too large for mass publication. Copies of staff response are available for examination in the office of the Board of County Commissioners. —JAK GROWTH MANAGEMENT IMPACT: There is no growth management impact associated with this Executive Summary. RECOMMENDATION: That the Collier County Board of County Commissioners denies North Naples Fire Control and Rescue District's Application for a Certificate of Public 10H i -- Convenience and Necessity for an Advanced Life Support Non - Transport Service as there is no public necessity for the service. PREPARED BY: Dan E. Summers, Director of the Bureau of Emergency Services. CO IT Count y Bureau of Emergency Services Memorandum TO: Mr, Leo Ochs, County Manager FROM: Dan E. Summers, Direct DATE: July 1, 2010 RE: Staff Review - COPCN Application North Naples Fire Control and Rescue District 10H Enclosed is the Certificate of Public Convenience and Necessity filed by the North Naples Fire Control and Rescue District, along with a compilation of written communication involved in the review. The COPCN filing was originally received in your office September 18, 2009 and submitted by 1. Christopher Lombardo, Chairman of the North Naples Board of Fire Commissioners. The appropriate filing fee was also received. During the review of the application, Mr. Richard Yovanovich became the principal agent for this filing. Along the course of the application review period Mr. Yovanovich requested the application be placed "on- hold ", as numerous discussions and meetings were held at their request regarding the current Advanced Life Support Interlocal Agreement(s) which were considered for amendment in lieu of the COPCN process. These lengthy discussions with Mr. Yovanovich, the Medical Director, and others at various boards and committee meetings as well as the Blue Ribbon Study group, did not resolve the many debates between the Advance Life Support and Basic Life Support delivery modalities preferred by North Naples. On May 17, 2010 Mr. Yovanovich notified the County of his desire to re -open our review of the COPCN application. Days following this notification, written communication was transmitted to Mr. Yovanovich, acknowledging his re- activation of the application along with additional requests for information to help provide a thorough review of the application. Subsequent to the additional information referenced above, it has come to my attention that the financial information provided by the North Naples Fire and Rescue District was out -of -date with the re- opening of the COPCN. I communicated by email with Mr. Yovanovich and received the latest financial O`S 8075 Lely Cultural Parkway • Naples, Florida 34113 • 239 - 252 -3600 • FAX 239 -252 -3700 • w .collierem.crg 10H Staff Review- COPCN Application North Naples Fire Control and Rescue District July 1, 2010 Page 2 information. I have deemed the application submittal complete, effective June 29, 2010 within the intent of Ordinance 2005 -16 as required. Mr. Yovanovich has been notified in writing of the application being deemed complete by my office. It should be noted that the bulk of the application submission included a copy of the 2007 EMS System Master Plan prepared by a consultant, in conjunction with discussions associated with a review of the Annual Update to Inventory Reporting (AUIR). The 2007 EMS Master Plan reviewed data and projections during the periods of 2005, 2006, and 2007 which were periods of extensive growth within the County. Due to changes in the EMS delivery systems, national refinements in best practice, and population projections, the 2007 Master plan discounts the substance of the application as requested by North Naples Fire Control and Rescue District in its justification of the COPCN application. Many factors highlighted by North Naples Fire Control and Rescue District in their application have been overcome by a number of changes in either delivery of services or are mute with respect to the spirit of the COPCN supporting county -wide services . They include, but are not limited to, the following: - Absence of growth projections that were predicted during the time of the report. - Refinements in national standards and academic research verifying the importance of a two - tiered BLS /ALS system delivery. - Implementation of the Advanced Practice Paramedic (MedCom) in one -man vehicles. - Improved dispatch procedures. - Cancellation of the ALS agreements at the North Naples and East Naples Fire District. - Ongoing data point analysis by the Blue Ribbon group to further refine system delivery in a two- tiered fashion. - Collier County's extensive network of publicly and privately accessible Automatic External Defibrillators and their associated registration ordinance. Additionally, the COPCN Ordinance in Section 7 states the following: "The Board of County Commissioners shall not grant a certificate unless it shall find, after public hearing and based on competent evidence, that each of the following standards has been met." Essentially, there are eight provisions within Section 7 of the ordinance that have, in my opinion, not been met, further discounting the award of a certificate. I have given the application a thorough review based on criteria provided in the ordinance referenced above. In summary, it is my recommendation that a Certificate of Public Convenience and Necessity should not be granted to the North Naples Fire Control and Rescue District, as it does not demonstrate better protection for the health, safety and welfare of the residents of Collier County as a whole in ambulance and ALS matters, by establishing uniform countywide standards, etc., as referenced in Section 1 of the Purpose statement of the ordinance. In the absence of countywide improvement alone, 10 H 44 Staff Review- COPCN Application North Naples Fire Control and Rescue District July 1, 2010 Page 3 the COPCN application, in my opinion, is not a valid application for services and threatens to increase risk in the pre - hospital care field environment with separate medical controls. The COPCN effort is designed for services within the "County" — geographically overall, and in my opinion, is not applicable for a district limited type of service as requested by North Naples Fire Control and Rescue District. North Naples Fire Control and Rescue District's application provided no indication that they would provide services outside of their boundaries on a routine basis as opposed to the current way in which mutual aid is provided on a case -by -case incident basis, therefore not serving the County as a whole. Denial of this COPCN application does not prohibit the county or the Medical Director from exploring other refinements to the two - tiered concept of pre - hospital care delivery involving the Fire services. Indeed the Fire Service can and does provide important services to the emergency scene. Those efforts should continue in a fashion that provides prompt BLS support in an environment of reduced risk, ensuring adequate resources for their primary mission and links in the chain of care that are consistent standards of practice, and single point medical control. I look forward to meeting with you at your earliest convenience regarding this discussion. Thank you. Attachments: North Naples, COPCN Application cc: Mr. Scott Teach, Deputy County Attorney m -� MIN TABLE OF CONTENTS I Memorandum Leo Ochs County Ordinance II North Naples Fire District Original Submittal - Section 1 - Section 2 - Section 3 - Section 4 - Section 5 - Section 6 - Section 7 - Section 8 (Added by County Staff) —) III County Appendix A - A -1 Letter Received Weiss, Serota - A -2 Letter Transmitted Jim Mudd - A -3 thru A -17 County Ordinance - A -18 & A -19 Letter Transmitted Lombardo - A -20 thru A -22 Letter Transmitted Yovanovich - A -23 & A -24 Letter Transmitted Yovanovich - A -25 & A -26 Letter Transmitted Yovanovich - A -27 thru A -30 County Attorney RLS Response - A -31 thru A -33 Letter Received Yovanovich - A -34 thru A -39 Letter Received Panozzo - A -40 Letter Transmitted Yovanovich - A -41 & A -42 Letter Transmitted Yovanovich - A -43 Letter Received Yovanovich 10H 14 TABLE OF CONTENTS (continued) IV Legal Matters — Appendix B - B -1 Court Ruling of use of Fire Service funds for Emergency Medical Services (City of Fort Lauderdale versus SMM Properties) - B -2 Declaratory Ruling from the Florida DOH, Bureau of Emergency Medical Services regarding North Naples Fire Paramedics and Medical Control being under the purview of the County Medical Director - B -3 Opinion by the County Attorney's office for the rendering of Emergency Medical Care by North Naples Fire Department without valid permits, Medical Director Authorization, and burden upon Collier County - B -4 Florida Statute 401.2101 "EMS Act" 10H Collier County Bureau of Emergency Memorandum TO: Mr. Leo Ochs, County Manager FROM: Dan E. Summers, Directoy/ DATE: July 1, 2010 RE: Staff Review - COPCN Application North Naples Fire Control and Rescue District Enclosed is the Certificate of Public Convenience and Necessity filed by the North Naples Fire Control and Rescue District, along with a compilation of written communication involved in the review. The COPCN filing was originally received in your office September 18, 2009 and submitted by J. Christopher Lombardo, Chairman of the North Naples Board of Fire Commissioners. The appropriate filing fee was also received. During the review of the application, Mr. Richard Yovanovich became the principal agent for this filing. Along the course of the application review period Mr. Yovanovich requested the application be placed "on- hold ", as numerous discussions and meetings were held at their request regarding the current Advanced Life Support Interlocal Agreement(s) which were considered for amendment in lieu of the COPCN process. These lengthy discussions with Mr. Yovanovich, the Medical Director, and others at various boards and committee meetings as well as the Blue Ribbon Study group, did not resolve the many debates between the Advance Life Support and Basic Life Support delivery modalities preferred by North Naples. On May 17, 2010 Mr. Yovanovich notified the County of his desire to re -open our review of the COPCN application. Days following this notification, written communication was transmitted to Mr. Yovanovich acknowledging his re- activation of the application along with additional requests for information to help provide a thorough review of the application. Subsequent to the additional information referenced above, it has come to my attention that the financial information provided by the North Naples Fire and Rescue District was out -of -date with the re- opening of the COPCN. I communicated by email with Mr. Yovanovich and received the latest financial 0NES 8075 Lely Cultural Parkway • Naples, Florida 34113 • 239- 252 -3600 • FAX 239 - 252 -3700 • www.collierem.org s Staff Review- COPCN Application North Naples Fire Control and Rescue District July 1, 2010 Page 2 10 H "I information. I have deemed the application submittal complete, effective June 29, 2010 within the intent of Ordinance 2005 -16 as required. Mr. Yovanovich has been notified in writing of the application being deemed complete by my office. It should be noted that the bulk of the application submission included a copy of the 2007 EMS System Master Plan prepared by a consultant, in conjunction with discussions associated with a review of the Annual Update to Inventory Reporting (AUIR). The 2007 EMS Master Plan reviewed data and projections during the periods of 2005, 2006, and 2007 which were periods of extensive growth within the County. Due to changes in the EMS delivery systems, national refinements in best practice, and population projections, the 2007 Master plan discounts the substance of the application as requested by North Naples Fire Control and Rescue District in its justification of the COPCN application. Many factors highlighted by North Naples Fire Control and Rescue District in their application have been overcome by a number of changes in either delivery of services or are mute with respect to the spirit of the COPCN supporting county -wide services . They include, but are not limited to, the following: - Absence of growth projections that were predicted during the time of the report. - Refinements in national standards and academic research verifying the importance of a two - tiered BLS /ALS system delivery. - Implementation of the Advanced Practice Paramedic (MedCom) in one -man vehicles. - Improved dispatch procedures. - Cancellation of the ALS agreements at the North Naples and East Naples Fire District. - Ongoing data point analysis by the Blue Ribbon group to further refine system delivery in a two - tiered fashion. - Collier County's extensive network of publicly and privately accessible Automatic External Defibrillators and their associated registration ordinance. Additionally, the COPCN Ordinance in Section 7 states the following: "The Board of County Commissioners shall not grant a certificate unless it shall find, after public hearing and based on competent evidence, that each of the following standards has been met." Essentially, there are eight provisions within Section 7 of the ordinance that have, in my opinion, not been met, further discounting the award of a certificate. I have given the application a thorough review based on criteria provided in the ordinance referenced above. In summary, it is my recommendation that a Certificate of Public Convenience and Necessity should not be granted to the North Naples Fire Control and Rescue District, as it does not demonstrate better protection for the health, safety and welfare of the residents of Collier County as a whole in ambulance and AILS matters, by establishing uniform countywide standards, etc., as referenced in Section 1 of the Purpose statement of the ordinance. In the absence of countywide improvement alone, 10 H liq Staff Review- COPCN Application North Naples Fire Control and Rescue District July 1, 2010 Page 3 the COPCN application, in my opinion, is not a valid application for services and threatens to increase risk in the pre - hospital care field environment with separate medical controls. The COPCN effort is designed for services within the "County" — geographically overall, and in my opinion, is not applicable for a district limited type of service as requested by North Naples Fire Control and Rescue District. North Naples Fire Control and Rescue District's application provided no indication that they would provide services outside of their boundaries on a routine basis as opposed to the current way in which mutual aid is provided on a case -by -case incident basis, therefore not serving the County as a whole. Denial of this COPCN application does not prohibit the county or the Medical Director from exploring other refinements to the two - tiered concept of pre - hospital care delivery involving the Fire services. Indeed the Fire Service can and does provide important services to the emergency scene. Those efforts should continue in a fashion that provides prompt BLS support in an environment of reduced risk, ensuring adequate resources for their primary mission and links in the chain of care that are consistent standards of practice, and single point medical control. I look forward to meeting with you at your earliest convenience regarding this discussion. Thank you. Attachments: North Naples, COPCN Application cc: Mr. Scott Teach, Deputy County Attorney 10HIN )AN APR VORDINANCE NO.2005 - 15 ORDINANCE AMENDING ORDINANCE 04 -12 BY AMENDING R 1 AND EXCLUSIONS FROM CERTIFICATE REQUIREMENT. lZ0`. WHEREAS, Collier County desires to make available to its citizens sane, professional emergency health care u-ansportation services for the transfer of patients between and anwtrg local hospital facilities; and WHEREAS, Collier County desires to facilitate the provision of such services and has the necessary equipment, training, expertise, professional certifications and licenses to do so; and WHEREAS, the amendment to Ordinance Number 04 -12 results in a benefit to Collier County by reducing response times for certain transports and providing for the availability or more transport vehicles. _ NOW THEREFORE: BE IT ORDAINED BY THE BOARD Q!pC_CCMNTY COMMISSIONERS OF COLLIER COUNTY, FLORIDA: -; v — c -+z �n m ?'T1 Section 1: Purpose �n �—t This ordinance is adopted pursuant to Chapters 125 and 401, Florida tee Tfi'e^ O N purpose or this ordinance is to provide better protection for the health, safety and 70are or the residents of Collier County, in ambulance and ALS matters, by establishing uniform county -wide standards for certification of ambulance or advanced life support or services, or operations by promulgating complete and clear rules and regulations for operation of all ambulance or rescue companies or services in Collier County. Section 2: Definitions A. Advanced Life Support (ALS) shall mean procedures conducted as defined in applicable Florida Statutes and Florida Administrative Code, Section 64E. B. Administrator shall mean the County Manager or his designee. C. Ambulance means any privately or publicly owned land, air, or water vehicle that is designed, constructed, reconstructed, maintained, equipped or operated, and is used for or intended to be used for air, land, or water transportation of persons, who are sick, injured, or otherwise helpless. D. Board shall mean the Collier County Board of County Commissioners, E. Certificate means a certificate of convenience and necessity as authorized in Section 401.25 (2)(d), Florida Statutes. F. Emergency Call shall mean the transit of an ambulance under conditions which warrants travel with flashing lights and siren operating. 10N G. operator shall mean any person, organization or governmental entity providing ambulance or ALS services. H. Patient shall mean an individual who is ill, sick, injured, wounded, or otherwise incapacitated or helpless. 1, Routine Call or Routine Transfer shall mean the transportation of a patient under non- emergency call conditions. Rescue Service shall mean first response treatment of patients but does not include Advanced Li Fe Support (A LS) or transport. Section 3: Requirements For Certificate It shall be unlawful for any person, firm, agency, or any other entity, including governmental units, to provide an ambulance service or provide advanced life support without first obtaining a certificate therefore from the Board of County Commissioners of Collier County. Section 4: Exemptions and Exclusions From Certificate Requirement Certificates shall not be required for: A. Rescue Services. B. The use of a non - ambulance for any transport of a patient pursuant to the Good Samaritan Act, Section 768 13, Florida Statues. C. Vehicles rendering ambulance -type services when requested to do so by the Board of County Commissioners or County Manager in the event of a major catastrophe or other such emergency which requires more ambulances that are available in the county. D. Ambulances based outside the county which pick up a patient in the county and transport him out of the county, or which pick up a patient out of the county and transport him into the county. E. Vehicles used to transport persons for routine scheduled medical treatments. Vehicles transporting persons who require services en route are not covered by this exemption. section 5: Procedure For Obtaining Certificate An applicant for a certificate shall obtain forms from the department to be completed and returned to the Division Administrator. Each application shall contain: A. The name, age, and address of the owner of the ambulance or ALS provider, or if the owner is a corporation, then of the directors of the corporation and of all the stockholders Words underlined added and words sauez=�sllgh are deleted. 2 1 O H x" holding more that 25% of the outstanding shares. For governmental units, this information shall be supplied for members of the governing body 13. The boundaries of the territory desired to be served. applicant will C The number and brief description of the ambulances or other vehicles the have available- D. The address of the intended headquarters and any sub- stations. E. The training and experience of the applicant. F. The names and addresses of three (3) Collier County residents who will act as references for the applicant. G A schedule of rates which the service intends to charge - ry, Such other pertinent information as the administrator may require. l An application or renewal fee of two hundred fifty dollars ($250.00). (Exception Collier County EMS.) J. Financial data including assets and liabilities of the operator. A schedule of all debts encumbering any equipment shall be included. Section 6: Review of Application The Administrator shall review each application and shall investigate the applicant's reputation, competence, financial responsibility, and any other relevant factors. The Administrator shall also make an investigation as to the public necessity for an ambulance or ALS operation in the territory requested, and shall then make a report to the Board containing his recommendation whether to grant a certificate to the applicant within sixty (60) days of the time the Administrator determines the application is complete. Section 7: Requirement For Board Approval In Granting Certificate The Board of County Commissioners shall not grant a certificate unless it shall find, after public hearing and based on competent evidence that each of the following standards has been satisfied: A. That there is a public necessity for the service. In making such determination, the Board of county Commission shall consider, as a minimum, the following factors: (1) The extent to which the proposed service is needed to improve the overall Emergency Medical Services (EMS) capabilities of the County. (2) The effect of the proposed service on existing services with respect to quality of service and cost of service. Words underlined added and words shFUelr -affanSh are deleted_ 3 10H IN (3) The effect of the proposed service on the overall cost of EMS service in the County. (4) The effect of the proposed service on existing hospitals and other health care facilities. (5) The effect of the proposed service on personnel of existing services and the availability of sufficient qualified personnel in the local area to adequately staff all existing services. B. That the applicant has sufficient knowledge and experience to property operate the proposed service. C' That, if applicable, there is an adequate revenue base for the proposed service. D. That the proposed service will have sufficient personnel and equipment to adequately cover the proposed service area Section 8: Appointment of Hearing Officer In making the determinations provided for in Section 7 above, the Board may, in its sole discretion, appoint a Hearing Officer to hold a public hearing and to make factual findings and conclusions as a result of the hearing. Should a Hearing Officer be appointed, said Hearing Officer shall render a written report to the Board within 30 days of the hearing, which report shall contain the officer's findings and conclusions of fact, and a recommended order. The findings and conclusions of fact shall be binding upon the Board, but the recommended order shall be advisory only. Section 9: Rights and Duties Granted By Certificate The certificate granted by the Board shall be valid for one calendar year and shall be personal to the applicant and not transferable. In the case of a corporation, if there occurs such a transfer of stock or other incidents of ownership as to change the majority or largest stockholder, a new certificate must be applied for. Changes in the officers of the corporation will not require a new certificate, Acceptance of the certificate by the applicant shall obligate the applicant to: A. Service the entire zone granted to the applicant- B. Provide coverage to adjoining zones, when requested to do so by Emergency Control for emergency calls when the certificate holder for that zone is unable to respond. C. Keep posted at his place of business a copy of the fee schedule, which must be filed with the Administrator (If applicable). Words underlined added and words s.rw,.-- =•.FeQs";' are deleted. 4 10H 01 D_ Operate in accordance with the rules and regulations adopted pursuant to this Ordinance and any applicable County Ordinances, and Chapter 401 Florida Statutes, and any administrative regulations adopted pursuant thereto. E Employ at all times sufficient personnel experienced in operation and management of emergency medical services to ensure proper and efficient operation. Section 10: Renewal of Certificate Each certificate holder shall file within ninety (90) days of expiration, an application for renewal of his certificate. Renewals shall be based upon the same standards, as the granting of other factors as may be relevant. The renewal application the original certificate along with such shall be accompanied by a two hundred and fifty dollar ($250.00) renewal fee. The renewal certificate may be approved routinely by the Board, upon advice of the Administrator, or die Board may hold a hearing on same. Section 11: Emergency Provisions The Board may modify, suspend or revoke a certificate in the interest of the public health, safety and welfare, only at public hearing and after reasonable notice has been given to the certificate holder affected. However, if a situation exists which poses a serious threat that ambulance or rescue service will not be available to any certain area of Collier County, the Administrator shall have such temporary emergency powers as are necessary to provide that service. These temporary powers are intended to provide interim protection until such time as the Board meets to resolve the emergency. Section 12: Classifications of Certificates There shall be two (2) classifications of service in Collier County, as follows: A. Class 1: Collier County EMS: ALS Rescue: An EMS provider with the capability of rendering on the scene prehospital ALS services and who may or may not elect to transport patients. An EMS provider rendering this level of service for a governmental - entity shall be. deemed to be operating under the Class I - ALS rescue certificate of public convenience and necessity held by the governmental entity. An EMS provider holding a Class l — ALS rescue certificate may provide post- hospital interfacility medical transfer services and routine ALS and BLS calls within the County. A Certificate Of Public Convenience and Necessity must be obtained from the County before engaging in this level of medical service. Words underlined added and words s'- are deleted . 5 us* 10H `' op - B. Class 2: Collier County Hospitals: 1. ALS Transfer. An EMS provider who renders ALS interfacility medical transfer services. An EMS provider who is awarded a Class 2 - ALS transfer certificate and does not possess a Class I - ALS rescue certificate shall not respond to an emergency call and provide ALS rescue services unless called upon by the appropriate Class I - ALS rescue provider to provide emergency backup service. In these instances, it shall be deemed to be operating under the Class I - ALS rescue certificate of the governmental entity requesting such emergency backup service. Class 2 - ALS transfer certificate holders may provide post - hospital interfacility medical transfer services and routine ALS and BLS calls within the County but only to hospitals owned by the certificate holder, however, the Class 2 certificate holder may provide out -of- County transports. Unless an EMS provider possesses a Class I - ALS Rescue certificate issued by the County, a Certificate - Of Public Convenience and Necessity must be obtained from the County before engaging in this level of medical service. 7. Class -2 transfer certificate holders shall contract with the Class -- I rescue certificate holder's Medical Director for the performance of services set forth in Florida Statutes. Section 401.265 and as specifically set forth herein as follows: a. He shall supervise and accept direct responsibility for the medical performance of the paramedics and Emergency Medical Technicians (hereinafter EMTs). b. He shall develop medically correct standing orders or protocols relating to life support system procedures when communication cannot be established with a supervising physician or when any delay in patient care would potentially threaten the life or health of the patient. C. He shall issue standing orders and protocols to ensure that the Class -2 transfer certificate holder transports each of its patients to facilities that offer a type and level of care appropriate to the patient's medical condition. d. He or his appointee shall provide continuous 24- hour - per -day, 7- day - per -week medical direction which shall include, in addition to the development of protocols and standing orders, direction to the Class -2 transfer r- ^ gh are deleted. 6 Words underlined added and words s�* 10 H 4 certificate holder's personnel as to the availability of "off- line" service to resolve in an emergency as that ter problems, system conflicts, and provide services m is defined by section 252.34(3), Florida Sta(u/r:S. e. He shall establish a quality assurance committee le provide for quality assurance review of all EMTs and paransedics operating under his supervision. F. He shall audit the performance of system personnel by use of a quality assurance program that includes but is not limited to a prompt review of patient care records, direct observation, and comparison of performance standards for drugs, equipment, system protocols and procedures. He shall be responsible for participating in quality assurance programs developed by the Class -2 transfer certificate holder. g, He shall ensure and certify that security procedures of the Class -2 transfer certificate holder for medications, fluids and controlled substances are in compliance with chapters 401, 499 and 893, Florida Statutes, and chapter IOD -45 Oldie Florida Administrative Code. nsure adherence lo, detailed written h. He shall create, authorize and e operating procedures regarding all aspects of the handling of medications, fluids and controlled substances by the EMS personnel and comply with all requirements of chapters 401, 499 and 893, Florida Statutes. i_ He shall notify the Florida Department of Health, (hereinafter the "Department ") in writing when the use of telemetry is not necessary. j. He shall notify the department in writing of each substitution of equipment or medication. risibility for the use by an EMT of an k. He shall assume direct respo automatic or semi - automatic defibrillator; the performance of esophageal intubation by an EMT; and on routine interfacility transports, the monitoring and maintenance of non- medicated I.V.s by an EMT. He shall ensure that the EMT is trained to perform these procedures; shall establish written protocols for the performance of these procedures; and shall provide written evidence to the Florida Department of Health documenting compliance with the provisions of this paragraph. Words underlined added and words my are deleted. 7 s 10H 1. He shall ensure that all EMTs and paramedics are trained in the use of the trauma scorecard methodologies as provided in sections 64E -2.017 of the F,A.C„ for adult trauma patients and 64E- 2.0175, F.A.C., for pediatric trauma patients. M. He shall participate as a crewmember on an EMS vehicle for a minimum of 10 hours per year and complete a minimum of 10 hours per year of continuing medical education related to pre - hospital care or teaching or a combination of both. n. He shall ensure that all of the Class -2 transfer certificate holder's EMTs and paramedics have all proper certifications and receive all training necessary to maintain their certification. Section 13: Transfer Or Assignment of Certificates No certificate issued under this Ordinance shall be assignable or transferable by the person to whom issued except unless approval is obtained from the Board in the same manner and subject to the same application, investigation, fees and public hearing as original applications for certificates. Any majority transfer of shares or stock or interest of any person or operator so as to cause a change in the directors, officers, majority stockholders or managers of such person or operator shall be deemed a transfer or assignment as contemplated in this Ordinance and subject to the same rules and regulations as an y other transfer or assignment. Section 14: Revocation, Alteration Or Suspension Grounds A. Every certificate issued under this Ordinance shall be subject to revocation, alteration and/or suspension of operation, by the Board, for a period of up to one year, where it shall appear that: 1. The operator has failed or neglected for a period of thirty (30) days during any calendar year to render all services authorized by his certificate. 2. The operator has been convicted of a felony or any criminal offense involving moral turpitude. 3. The certificate was obtained by an application in which any material fact was omitted or falsely stated. q The operator has knowingly permitted any of its motor vehicles to be operated in violation the laws which result in conviction of the driver or operator of a Words underlined added and words sn RE;E thIOUs"n are deleted. 8 10 H X14 misdemeanor in the second degree or greater, or has knowingly permitted a driver with more than two previous convictions to operate emergency vehicles. 5, The operator has failed to comply with any of the provisions of this ordinance. 6. The public interest will best be served by revocation, alteration, or suspension of any certificate upon good cause shown. 7. The operator or his agent has demanded money or compensation other that that established and prescribed under this ordinance. (If applicable). g. The operator has without sufficient justification failed or rellrscd to furnish emergency care and/or transportation promptly for a sick or injured person. g. The operator or his agent has been found guilty of malpractice or willful and wanton misconduct in the operation of its service. B. All complaints shall be investigated and a report thereon made to the Board, together with findings and recommendations, within fifteen (15) days. if revocation, suspension or alteration of any certificate appears warranted, the Board shall give notice to the -- operator holding the certificate that the same will be considered at a specific commission meeting, provided the date of such meeting shall not be less than five (5) days from the date of the notice. The Board shall thereupon consider the complaint and either revoke, suspend or alter the certificate or dismiss the complaint. Section 15: General operating Regulations All certificate holders, operators, and drivers shall comply with all state statutes and administrative regulations as following regulations: A. Twenty -four Hour Service. Every certificate holder shall be required to operate sufficient ambulances, as stated on the certificate of operation and determined by the Board, on immediate call at all times. B. Prompt Service Required. Every call for ambulance service shall be answered promptly. Patients shall be loaded and transported without being subject to unreasonable delays. All calls for emergency assistance requiring over twenty (20) minutes from time of notification to arrival on scene shall be reported to the Administrator with complete documentation of the circumstances, which delayed the response. Those instances where more that three (3) minutes elapse between receipt of an emergency call and dispatch of an ambulance shall also be reported to the Administrator with documentation of circumstances. Words underlined added and words � �--, _ti are deleted. 9 k s 10H "M C. Bed Linens. Clean and sanitary bed linens shall be provided for each patient carried and shall be changed as soon as practicable after the discharge of the patient. D. Daily Log. Every operator shall maintain in a daily log upon which shall be recorded the place or origin, time of call, time of dispatch, time of arrival at scene, time left for arrival at hospital, and charges for each trip made and such other hospital, time t Ordinance. Every operator shall operating and patient information as may be required by retain and preserve all daily logs for at least two (2) years, and such logs shall be available for inspection by the Administrator. E. Communications. Each ambulance shall maintain two -way radio communication with the location of primary dispatch from which it operates, as well as any additional communication capabilities required by Ordinance or state law. F. Vehicles and Equipment. Each vehicle shall be equipped with the proper medical and emergency equipment as required by the laws of the State of Florida and shall be subjected to inspection from time to time to insure compliance with the laws of Florida and Ordinance. rdinance. s e addition to the State of Florida Department of Health, Bureau of O. Certification. Emergency Medical Services requirements for certification, each paramedic must be dical Director. Each paramedic must work with a Collier certified by the County Me County EMS ambulance for a sufficient length of time for the ambulance service medical director to properly judge his capability. At minimum, the paramedic must work in that capacity not less than one full months work shift annually. Salaries of other than Collier County EMS paramedics will be paid by the agency seeking the Medical Director Certification. H Application. Each ambulance or ALS service shall be subject to those rules and regulation as promulgated by Ordinances of the Board for the purpose of carrying out this ordinance. section 16: Central Place of Business Each operator shall maintain a central place of business which shall be entirely within his _ designated operating zone, at which place he shall provide two -way radio communication with his vehicles, the County Emergency Control Communications Center, and his place of business, a properly listed telephone for receiving all calls for service and at which central place of business he shall keep such business records and daily logs available for inspection or audit by Words underlined added and words stniek- " b are deleted. 10 *s°a ion the Administrator. Every operator shall keep on file will, the Administrator and the County Emergency Control Communications Center a business address and telephone number at which the operator may be reached at ail times. This information will be maintained at the Emergency Control Center. Section 17: Records To Be Kept operating and Every operator shall keep accurate records of receipts from operations, p other expenses, capital expenditure and such other operating and patient information as may be required by the Board. Section 18: Rates Every operator shall file with the Board a schedule of the rates. Such rates shall be tiled as a part of each new or renewal application, and a -rate schedule shall also be filed when changes in rates are proposed. All such rates shalt be subject to review and approval by the Board. Section 19: Operator's Insurance insurance with Every ambulance operator shall carry bodily injury and property damage to secure solvent and responsible insurers authorized to transact o business uence State of of or caused by the payment for any loss or damage resulting from any Each vehicle shall be insured for the operation or use of any of the operator's motor vehicles. sum of at least one hundred thousand dollars ($100,000.00) for injuries to or death of any one person arising out of any one accident and the sum of at least three hundred thousand dollars ($300,000.00) for injuries to or death or more than one person in any one accident and for the sum of at least fifty thousand dollars ($50,000.00) for damage to property arising from any one accident. They shalt also have malpractice insurance. Every insurance policy or contract for such insurance shall provide for the payment and satisfaction of any financial judgment entered against the operator and present insured . or any person driving the insured vehicle. Such insurance shall be obtained and certificates or certified copies of such policies shall be filed with the Board. All such insurance policies, certificates thereof or certified copies of such insurance policies shall provide for a thirty (30) day cancellation notice to the Board. Section 20: Conduct of Drivers And Attendants All drivers, EMT's and paramedics shall comply with the laws of the State of Florida, in order to meet the requirements set out in this Ordinance and no driver, EMT or paramedic registered hereunder shall: 1 words underlined added and words srrR6 - are deleted. - k 10 H A Fail or refuse to promptly transport, if applicable, or attend any sick or injured person after responding to a call. g, Demand or receive compensation other that that established and approved in accordance with this ordinance or fail to give a receipt for moneys received. (If applicable). - ion, discount or any reduced rate not provided in the C. Give or allow rebate, commiss established rate. (if applicable.) _ D. At any time induce or seek to induce any person engaging an ambulance or ALS service to patronize or retain the services of any hospital, convalescent home, mortuary, cemetery, attomey, accident investigator, nurse, medical doctor or other service occupation or profession. g. Al any time release his patient from his care until he is assured that some responsible person is available to receive such patient. F. At any time use a siren or flashing red light unless on an emergency call. G. Disobey the lawful orders of the law enforcement officer at the scene of an accident, or other similar such emergency or at a fire scene, the fire officer in charge. H. Smoke while within the confines of an ambulance. 1. Operate or ride in an ambulance without using seatbelts. (Personnel attending patients are exempt). Section 21: Passengers No person shall be aboard ambulances when engaged in emergency or routine medical calls except the following: A. Driver, attendants and fire or law enforcement personnel; B. Patients; C. Not more that one relative or close friend of the patient, or if the situation warrants, the paramedic in charge may authorize more than one passenger. D. Physicians and nurses; S. Personnel in an observing capacity that are being trained for ambulance or ALS service. F. Operator's supervisory personnel. Section 22: Obedience to Traffic Laws, Ordinances or Regulations. A. The driver of an ambulance or ALS vehicle when responding to an emergency call or while transporting a patient may exercise the following privileges when such driver has Words underlined added and words mss`* are deleted. 12 ION III reasonable grounds to believe that an emergency in fact exists requiring the exercise of such privileges: I. of the otherwise applicable provisions of law, ordinance Park or stand, irrespective or regulations. 2. Proceed past a red light or stop signal or stop sign, but only after slowing down as may be necessary for safe operations. 3. Exceed the maximum speed limits permitted by law so long as he does not endanger life or property. 4. Disregard laws, ordinances or regulations governing direction or movement or turning in specified directions so long as he does not endanger life or property. B. The exemptions herein granted shall apply only when such vehicle is making use of audible and/or visible signals meeting the requirements Of this Ordinance. C. The foregoing provisions shall not relieve the driver of a vehicle from the duty to drive with due regard for the safety of all persons, nor shall such provisions protect the driver from the consequences of his reckless disregard for the safety of others. Section 23: Violations In addition to the remedies provided herein, a violation of any provision of this ordinance shall be Punishable as provided by law for the violation of County ordinances. Section 24: Uniformity of Application The Ordinance shall constitute a uniform law applicable in all of Collier County. Section 25: Authority To Enforce It is hereby declared to be the duty of the Board of County Commissioners of Collier County, its officers, agents, employees and other governmental agencies, the sheriffs department of Collier County, its deputies and agents, fire departments, as well as the police departments of the various municipalities falling under the provisions of this Ordinance to strictly enforce the provisions of this Ordinance. Section 26: Repeal and Codification Ordinance 75 -50 is hereby repealed. This Ordinance shall be codified in the Collier County Code as Chapter 4 of said Code, and said Code is hereby amended accordingly. Section 27: Conflict and Severability In the event this Ordinance should ever conflict with any other ordinance of Collier County, or applicable ordinance of any municipality, or other applicable law, rule or regulation, Words underlined added and words ytFaen-thfausk are deleted. 13 10 H .q the more restrictive shall apply. If any section, sub - section, sentence, clause, phrase or portion of this Ordinance is for any reason held invalid or unconstitutional by any court of competent jurisdiction, such portion shall be deemed a separate, distinct and independent provision and such holding shall not affect the validity of the remainder of the Ordinance. Section 28: Effective Date This ordinance shall become effective upon receipt of notice that it has been filed with the Secretary of State. PASSED AND DULY ADOPTED by the Board of County Commissioners of Collier County, Florida, this a 3 day of / J4 2005. ATTEST: DWIGHT E. BROCK, Clerk By: fittest as to Char aiS*atrra oo`ilv�.`.....?Q, c, legsl. AMvedrestQ. ?., . '�. iett - r� Scott Teach '"d', Assistant County, ttA eY BOARD OF COLLIE T R�COOOU�'NTT,Y COUNTY, By' F Chairtnan red W. Coyle, •IhiS or tote's filed wish the sec ¢tcl y of Seat ? :Aff%ce the 04 n�t o` nd a know)edaer^e^ f doy fife received this of [ Onp�+ry'CYh _a,��t. are deleted. ]4 Words underlined added and words �R 10H �P' STATE OF FLORIDA) COUNTY OF COLLIER) I, DWIGHT E. BROCK, Clerk of Courts in and for the Twentieth Judicial Circuit, Collier County, Florida, do hereby certify that the foregoing is a true and correct copy of: ORDINANCE 2005 -16 Which was adopted by the Board of County Commissioners on the 23nd day of March 2005, during Regular Session. WITNESS my hand and the official seal of the Board of County Commissioners of Collier County, Florida, this 2Bth day of March, 2005. DWIGHT E. BROCK,. IS'�y° ; Clerk of Court "C:f ¢ ' � of rw�r Ex- officio to 410, �� couunntyyjC/1ommis i s By: Linda A. Hou,` " &4Yy'' Deputy rte. 40 d . i ;' l 10'H J. Christopher Lombardo, Chairman r Rk. i 1885 Veterans Park Drive Margaret Hanson, Vice Chairman Na les, FL 34109 Paul J. Moriartv Sr., Treasurer P James Burke, Commissioner FL (239) 597 -3222 John O. McGowan, Commissioner Fax (239) 597 -7082 North Naples Fire Control and Rescue District September 17, 2009 5tr I n 2009 Collier County Manager Jim Mudd County Manager's Office 3301 E. Tamiami Trail Naples, FL 34112 Dear County Manager Mudd, The North Naples Fire Control and Rescue District ( "District') believes that its residents deserve to receive the highest level of Advanced Life Support ( "ALS ") services available. Based on this belief the District has entered into two separate interlocal agreements with Collier County allowing for the District's provision of ALS service beginning in 2005. In 2007, Collier County EMS attempted to terminate the original interlocal agreement entered into between the District and Collier County as a result of rising conflicts between Collier County EMS and the District. As a result, a successor agreement, the Intedocal Agreement Advanced Life Support Partnership between Collier County and North Naples Fire Control and Rescue District was entered into on September 11, 2007 ( "Interlocal Agreement "). This Interlocal Agreement temporarily resolved some of the differences between our agencies. For a short period of time, the District and Collier County EMS were able to function in a cooperative partnership resulting in the supplementation of Collier County EMS activities by the District and a higher level of ALS service provision to the District's. residents. Two reports were independently prepared confirming the effectiveness of the District's provision of service and the corresponding benefits to Collier County and the residents of the District - the 2007 EMS Master Plan and the Collier County Productivity Committee /EMSAC Report. However, over the course of the last year, increasing conflicts have been renewed as a result of the Interlocal Argreement or its intent having been breached in several areas by Collier County. These breaches have repeatedly threatened the ability of the District to comply with the terms of the Interlocal Agreement. Further, the Interlocal Agreement's intent to "provide quality and cost effective fire rescue emergency medical services" is no longer being achieved as a direct result of the actions of the Office of the Medical Director and Collier County EMS. Those actions include the following: 10H Count Manager Jim Mudd September 17, 2009 Page Two Continuous revisions to the ALS Engine Protocol. Beginning in September of 2008, the ALS Engine protocol has been changed significantly five times by Dr. Taber, the Office of the Medical Director (912008, 10/2008, 1/2009, 4/2009, and 7/2009). These changes in protocol prevent a State certified paramedic from providing even national or state recognized minimum standards of patient care. Additionally, these continuous revisions to the ALS Engine protocol have resulted in increased confusion over Dr. Taber's authorization, even among the District's most experienced paramedics, and a reduction of care being provided to our residents. Dr. Taber's continuous revisions to ALS Engine Protocol have significantly restricted the District's ability to provide ALS services and reduced the medications originally carried by the District's ALS engines by more than sixty percent. Dr. Taber unilaterally continues to develop new or revised certification requirements even though Section 4.2 of the Interlocal Agreement provides that "necessary qualifications... will be cooperatively developed and defined." The continued non - compliance by Dr. Taber of this requirement further complicates the difficulties with the implementation of the Interlocal Agreement because revisions are made to qualifications without adherence to Section 4.2. There is also no clear agreed upon method to certify new paramedics or those paramedics who have been Tober- decertified. Dr. Taber's 2009 mandatory Ride -Time requirement was implemented even though compliance is difficult for the District due to the large number of District paramedics and there being only one Collier County EMS vehicle that must be ridden to satisfy the requirement. This has resulted in the majority of the District's paramedics losing their Tober- Certified status; thus, the District has been unable to provide ALS services to the fullest extent allowed under the Interlocal Agreement. Had the District been included in the development of the certification requirement as provided in the Interlocal Agreement, the District may have had the opportunity to assist with the development of a requirement that satisfied Dr. Taber's needs but was realistic to implement. By the end of November, the District will have no Taber - Certified paramedics or ALS Engines in operation. This means that the District will no longer be providing ALS services to its residents. It also means that the District is no longer able to augment Collier County EMS within our boundaries. 10H 1 County Manager Jim Mudd September 17, 2009 Page Three Dr. Tober has been requested, in writing on several occasions to provide the process to reinstate the Tober - Certified status for the District's paramedics decertified by Dr. Tober. No response has been received to these requests. Although the intent of the swapped employee component of the Interlocal Agreement is to provide training and increased patient contact, neither has occurred as District paramedics are either driving the Collier County EMS ALS transport unit or placed in the back of the unit without any supervision, thus minimizing training opportunities. The District's paramedics have been unfairly penalized in this regard by the unfair treatment of Dr. Tober. Dr. Tober has stated that when he feels Collier County EMS paramedics are lacking in patient contact, he freely moves them around. Why were the Collier County EMS paramedics not Tober - decertified? The treatment of Collier County EMS paramedics is far short of the resulting decertification the District's paramedics have experienced and is a violation of the Interlocal Agreement that requires that paramedics be treated equally. Recognizing the District's difficulties in meeting Dr. Tober's training requirements, and in an effort to fully comply with Dr. Tober's evolving and unilaterally developed requirements, the District has requested additional Tober designated trainers as well as the opportunity to place a third employee on the Collier County EMS ALS transport units. Both requests were denied by Dr. Tober. The District supported Dr. Tober's movement from EMS into the Office of the Medical Director in hopes that his direct reporting to the Collier County Board of Commissioners would eliminate existing conflicts. However, since the creation of the Office of the Medical Director, existing conflicts have not been resolved. Rather, there is an increasing lack of respect towards the District's paramedics exhibited by Dr. Tober, including unfounded allegations of cheating, and Dr. Tober's reference to the District's paramedics as "clowns ". In addition, Dr. Tober has stated several times that his office is just "too busy" to deal with the fire districts. 10H I County Manager Jim Mudd September 17, 2009 Page Four On several occasions, Dr. Tober has filed complaints related to both the District as an agency and the District's paramedics with the State Bureau of Emergency Medical Services without notifying the District, and without making any attempt to allow the District to first address or remedy the issue. Two committees were created to assist with the issues related to the provision of ALS service in the County: the Quality Assurance Committee and the Emergency Medical Services Policy Advisory Board. Neither of these committees are actively meeting. The Quality Assurance Committee is not meeting due to legal concerns and lack of availability of Dr. Tober. The EMS Policy Advisory Board was in effect suspended by Dr. Tober as he has demanded the removal of the Collier County Fire Chiefs Association's representative before another meeting would be held. For several years, the Board of Fire Commissioners of this District has repeatedly demonstrated their commitment to the provision of ALS services by District paramedics in conjunction with Collier County EMS. This has been consistently supported by the dedication of personnel, resources and finances provided to this partnership. Since 2005 alone, the District has expended close to $2.2 million dollars in support of the provision of ALS service. There is a rapidly increasing deterioration of the relationship between District staff, Collier County EMS staff and the Office of the Medical Director which has resulted in most if not all communications between our agencies occurring through attorneys. Although the District believes that the difficulties it incurs with EMS and the Office of the Medical Director is acceptable if the District's provision of ALS services to its residents results in even one saved life, the reduction in its Tober- Certified paramedics and the continued difficulties identified above have resulted in a reduction of the level of service to its residents that is no longer acceptable. The District cannot function under an Interlocal Agreement where the rules constantly change resulting in the disruption of the provision of ALS services. Due to the above reasons, we believe the best remedy to the situation is the issu- ance to the District of a certificate of public convenience and necessity ( "COPCN ") for ALS Non - Transport services. To that end, we are enclosing our ion County Manager Jim Mudd September 17, 2009 Page Five application for a COPCN ALS Non - Transport Services. It is our contention that the issuance of such a COPCN will provide the means for our agencies to move past our existing conflicts and develop a system that allows for the highest standard of ALS provision through the cooperative efforts of our agencies. The District has engaged the firm of Coleman, Yovanovich & Koester, P.A. to assist with the COPCN process. Please direct all future communication regarding this issue to Richard Yovanovich, Coleman, Yovanovich & Koester, P.A., 4001 Tamiami Trail North, Suite 300, Naples, FL 34103. We request this item be placed on the December 1, 2009 Board of County Commission Meeting Agenda. Respectful) J. CHRISTOPHER LOMBARDO Chairman, Board of Fire Commissioners ion _ North Naples Fire Control and Rescue District 1885 Veterans Park Drive -- Naples, FL 34109 (239) 597 -3222 Fax(239)597 -7082 September 17, 2009 Application for a Certificate to Provided Advanced Life Support (Non- Transport) An applicant for a certificate shall obtain forms from the department to be completed and returned to the division administrator. Each application shall contain: (1) The name, age, and address of the owner of the ambulance or ALS provider, or if the owner is a corporation, then of the directors of the corporation and of all the stockholders holding more that 25 percent of the outstanding shares. For governmental units, this information shall be supplied for members of the governing body. ➢ Name: J. Christopher Lombardo Address: 1885 Veterans Park Drive Naples, Florida 34109 Age: 51 ➢ Name: Margaret Hanson Address: 1885 Veteran Park Drive Naples, Florida 34109 Age: 74 ➢ Name: Paul J. Moriarty Sr. Address: 1885 Veterans Park Drive Naples, Florida 34109 Age: 64 ➢ Name: John McGowan Address: 1885 Veterans Park Drive Naples, Florida 34109 Age: 42 ➢ Name: M James Burke Address: 1885 Veterans Park Drive Naples, Florida 34109 Age: 71 (2) The boundaries of the territory desired to be served. The district shall include the following described lands: Sections 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 32, 33, 34, 35, and 36, Township 48 South, Range 25 East; Sections 1, 2, 3, 4, 5, 8, 9, 10, 11, 12, 13, 14, 15, 9/17/2009 Page 1 of 12 16, 21, 22, 23, and 24, Township 49 South, Range 25 East; Sections 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 18, 19, 20, 21, 22, 23, 24, 29, 30, 31, and 32, Township 48 South, Range 26 East; Sections 5, 6, 7, 8, 18, and 19, Township 49 South, Range 26 East; but not including any lands presently within the corporate boundaries of the City of Naples. The foregoing description notwithstanding, the following area, commonly known as "Seagate ", "Park Shore Unit 2 ", "Park Shore Unit 5" and "Naples Cay" shall be excluded from the district: That part of government lot one, Section 16, Township 49 South, Range 25 East, Collier County, Florida, described as follows: Commencing at the North quarter corner of Section 16, Township 49 South, Range 25 East, a 4 x 4 concrete monument with brass cap set by the county engineer, also being the northeast corner of government lot one and being the point of beginning: Thence run South 00 degrees 45 minutes 40 seconds east for 1327.70 feet to a concrete monument the southeast corner of the northeast quarter of the northwest quarter of Section 16 also being the southeast corner of government lot one, thence south 89 degrees 23 minutes 20 seconds west for 1650.75 feet to a concrete monument, thence north 00 degrees 36 minutes 40 seconds west for 70.00 feet to a concrete monument, thence north 07 degrees 42 minutes 20 seconds east for 153.60 feet to concrete monument set at the water line of a canal, thence north 64 degrees 11 minutes 00 seconds east for 130.27 feet to a concrete monument set at the water line of a canal, thence north 04 degrees 11 minutes 05 seconds east for 38.77 feet to the point of curve, thence along the arc of said curve having a radius of 1545 feet, a tangent of 176.03 feet, a delta angle of 13 degrees right for the arc distance of 350.57 feet to the point of curve of a reverse curve, thence along the arc of curve having a radius of 765.00 feet, a tangent of 286.02 feet, a delta angle of 41 degrees left for the are distance of 560.33 feet to the point of tangent, thence north 15 degrees 37 minutes 05 seconds west for 70.85 feet to a concrete monument set at the water line of a canal, thence north 15 degrees 57 minutes 05 seconds west for 98.80 feet to a concrete monument, thence north 89 degrees 28 minutes 40 seconds east along the North boundary of Section 16, also being the north line of government lot one, for 1776.65 feet to a concrete monument with brass cap, the north quarter comer of Section 16, also the northeast corner of government lot one and the point of beginning. Commencing at the East 1/4 of Section 21, Township 49 South, Range 25 East, Collier County, Florida; thence along the East and West 1/4 line of said Section 21, South 89 degrees 26 minutes 20 seconds west 3665.68 feet to the southwest corner of Park Shore Unit No. 1 according to the plat thereof as recorded in Plat Book 8, pages 43 and 44, Collier County Public Records, Collier County, Florida, and the place of beginning of this description: thence north 0 degrees 31 minutes 40 seconds west 1709.98 feet; thence north 7 degrees 46 minutes 00 seconds east 918.77 feet; thence north 541.25 feet; thence north 84 degrees 00 minutes 00 seconds west 570.17 feet; thence north 2 degrees 25 minutes 00 seconds west 97.35 feet; thence south 87 degrees 35 minutes 00 seconds west 110.00 feet; thence south 87 degrees 00 minutes 00 seconds west 1160 feet more or less to the Mean High Water Line of the Gulf of Mexico; thence along said Mean High Water Line, southerly 3275 feet more or less to the east and west 1/4 line of said Section 21; thence along said east and west 1/4 line of Section 21; north 89 degrees 28 minutes 20 seconds east 1540 feet more or less to the place of beginning: being a subdivision of part of the south 1/3 of Section 16 and of part of the north 1/2 of Section 21, Township 9/16/2009 Page 2 of 12 ion 040 49 South, Range 25 East, Collier County, Florida. Commencing at the northeast comer of government Lot 2 of Section 16, Township 49 South, Range 25 East, Collier County, Florida said comer being also the northeast comer of Lot 8 of Block 35 of Park Shore Unit No. 4 according to the plat thereof as recorded in Plat Book 10, pages 10I, 102, and 103, Collier County Public Records, Collier County, Florida; thence along the north line of said government Lot 2, along the north line of said Park Shore Unit No. 4, and along the south line of Seagate Subdivision Unit No. 1 according to the plat thereof as recorded in Plat Book 3, Page 85, Collier County Public Records, Collier County, Florida, South 89 degrees 25 minutes 50 seconds west 1330.53 feet to the west line of said Park Shore Unit No. 4 and the place of beginning of the parcel herein described; thence along. the west line of said Park Shore Unit No. 4 in the following described courses: South 37 degrees 25 minutes 50 seconds west 250.89 feet, south 0 degrees 34 minutes 10 seconds east 225.44 feet, south 26 degrees 45 minutes 30 seconds east 632.19 feet and south 5 degrees 09 minutes 00 seconds east 580.72 feet to the northwest corner of Park Shore Unit No. 3 according to plat thereof as recorded in Plat Book 8, pages 59 and 60, Collier County Public Records, Collier County, Florida; thence along the west line of said Park Shore Unit No. 3, South 5 degrees 09 minutes 00 seconds east 1879.04 feet to the north line of Park Shore Unit No. 2 according to the plat thereof as recorded in Plat Book 8, pages 54 and 55, Collier County Public Records, Collier County, Florida; thence along the northerly line of said Park Shore Unit No. 2, in the following described courses: north 84 degrees 00 minutes 00 seconds west 433.28 feet, north 2 degrees 25 minutes 00 seconds west 97.35 feet, south 87 degrees 35 minutes 00 seconds west 110.00 feet, and south 87 degrees 00 minutes 00 seconds west 1160 feet more or less to the Mean High Water Line of the Gulf of Mexico; thence along said Mean High Water Line, northerly 3350 feet more or less to a point on the westerly extension of the south line of said Seagate Subdivision which south line bears south 89 degrees 25 minutes 50 seconds west and passes through the place of beginning; thence along said south line and the westerly extension thereof, north 89 degrees 25 minutes 50 seconds east 1450 feet more or less to the place of beginning; being a part of the west 1/2 Section 16, Township 49 South, Range 25 East, Collier County, Florida, containing 118 acres more or less. Commencing at the northwest corner of the northwest 1/4 of the northeast 1/4 of Section 16, Township 49 South, Range 25 East; thence North 89 degrees 24 minutes 40 seconds East, 1650.75 feet along the north line of Parkshore Unit 4 and Unit 5 to the place of beginning; thence North 89 Degrees 24 minutes 40 seconds East along said north line of Parkshore Unit 5, 740.98 feet; thence North 4 degrees 40 minutes 20 seconds West, 125.32 feet; thence North 89 degrees 24 minutes 40 seconds East, 4.73 feet; thence North 4 degrees 40 minutes 20 seconds West, 350.89 feet; thence North 89 degrees 24 minutes 40 seconds East, 197.19 feet to a concrete monument on the coastal construction line; thence west to the mean high water line of the Gulf of Mexico; thence northerly along said mean high water line to the North line of Section 16, Township 49 South, Range 25 East; thence East along the north line of said Section 16 to the northwest comer of Seagate Subdivision; thence southerly along the west line of said Seagate Subdivision to the place of beginning less the following described lands: Parcel 2 in O.R. Book 14, Page 195 and 196; that parcel conveyed to Jane Homer Lee as described in O.R. Book 34, Page 301 and 302; that parcel conveyed to Seagate, 9/16/2009 Page 3 of 12 ION Inc., as described in O.R. Book 182, Page 248 and 249. Subject to existing easements and rights of ingress and egress. (3) The number and brief description of the ambulances or other vehicles the applicant will have available. This is a request to provide ALS (Non- Transport) services within the service area of the North Naples Fire control and Rescue District ( "District "). Accordingly, there will be no ambulances provided by the District. Transport will remain the responsibility of Collier County EMS. The District will provide ALS services through state licensed and District trained paramedics to those in need of ALS services until County EMS paramedics arrive and can take over the care of the patient. The vehicles to be utilized by the District are as follows: ➢ 2007 Ford F250 ➢ 2005 Ford F250 ➢ 2006 Ford Expedition ➢ 2005 Ford F250 ➢ 2006 Ford Expedition ➢ 1998 Pierce Quantum ➢ 2000 Pierce Quantum ➢ 1998 Pierce Quantum ➢ '1998 Pierce Quantum ➢ 2002 Pierce Quantum ➢ 2004 Pierce Quantum ➢ 1998 Pierce Quantum ➢ 2006 Pierce Quantum VIN # 1FTSW21P67EA47402 VIN # 1FTSW21P05EC07402 VIN # IFMPUI6516LA64031 VIN # 1FTSW21P25EC07403 VIN # 1FMPU16506LA97618 VIN # 4PICT02S4WA000600 VIN # 4P1CT02S6YA000780 VIN # 4PICT0289WA000592 VIN # 4PICT02S1WA000604 VIN # 4PICT02S02A002256 VIN # 4P1CT02S93A003679 VIN # 4P1CT02S5WA000816 VIN # 4P1CUO1S36A006032 (4) The address of the intended headquarters and any sub - stations. ➢ North Naples Fire Control & Rescue District (Headquarters) 1885 Veterans Park Drive Naples, Florida 34109 ➢ North Naples Fire Control & Rescue District (Station 40) 1441 Pine Ridge Road Naples, FL 34105 ➢ North Naples Fire Control & Rescue District (Station 42) 7010 Immokalee Road Naples, FL 34119 ➢ North Naples Fire Control & Rescue District (Station 43) 16325 Vanderbilt Beach Drive Naples, FL 34134 ➢ North Naples Fire Control & Rescue District (Station 44) 8970 Hammock Oak Drive Naples, Florida 34108 9/19/2009 Page 4 of 12 ION ➢ North Naples Fire Control & Rescue District (Station 45) 1885 Veterans Park Drive Naples, Florida 34109 ➢ North Naples Fire Control & Rescue District (Station 46) 3410 Pine Ridge Road Naples, Florida 34105 ➢ North Naples Fire Control & Rescue District (Station 47) 2795 N Airport Road Naples, Florida 34105 (S) The training and experience of the applicant. ➢ The North Naples Fire Control & Rescue District has been involved in providing Fire Rescue and Emergency Medical Services since 1961. In addition, the District has been providing Advanced Life Support (ALS) first response non - transport in conjunction with the Collier County Emergency Medical Services Department since 1999. The District's leadership team is composed of the following members: • Orly Stolts, Fire Chief (20 years experience) Florida certified Firefighter/Emergency Medical Technician • James Cunningham, Assistant Chief of Operations (13 years of experience) Florida certified Firefighter /Paramedic • Becky Bronson, Assistant Cbief of Administrative Services ( 8 Years of experience) Florida Certified Firefighter • Jorge Aguilera, Deputy Chief of EMS (23) years of experience, formally the Division Chief of Training for Collier County Emergency Medical Services Department) Florida certified Firefighter/Paramedic • Michael Swanson, Deputy Chief of Training (18 years of experience) Florida certified Firefighter /Emergency Medical Technician (6) The names and addresses of three Collier County residents who will act as references for the applicant. ➢ Jack Pointer 105 Erie Dr Naples, 1-134110 ➢ Gina Downs 386 Emerald Bay Circle #G2 Naples, F134110 ➢ Jim Learn 222 Willoughby Drive _ Naples, P134110 9/16/2009 Page 5 of 12 IONIdl;,y (7) A schedule of rates which the service intends to charge. ➢ The North Naples Fire Control & Rescue District is requesting a Certificate to provide Advanced Life Support response non - transport services. Currently there is no charge for this service, and the District seeks to continue with this practice. (S) Financial data including assets and liabilities of the operator. A schedule of all debts encumbering any equipment shall be included. ➢ See Attachment A Requirement for board approval in granting certificate The board of county comtnissioners shall not grant a certificate unless it shall find, after public hearing and based on competent evidence that each of the following standards has been satisfied: (1) That there is a public necessity for the service. In malting such determination, the board of county commission shall consider, as a minimum, the following factors: a. The extent to which the proposed service is needed to improve the overall emergency medical services (EMS) capabilities of the county. The North Naples Fire Control & Rescue District has been providing ALS first response non - transport services within its district boundaries for over 10 (ten) years. Consequently, the Districts enabling Act 99 -450, laws of Florida article IV "Powers of the District" section 2 allows the district to establish and maintain emergency medical services and rescue response consistent with section 191.008 (1), Florida Statues, and the provision of chapter 401, Florida Statues, and any certificate of public convenience and necessity or its equivalent issued. (See Attachment B) Over the years the District has proven its ability to provide not only a high level of ALS service, but also the ability to positively augment the Collier County Emergency Medical Services Department, by improving the County EMS response time's benchmarks to Emergency Medical Calls within the District. In many of the District's response zones, the response times have improved by over 5% (See Attachment Q. The District employs 56 state certified firefighter /paramedics to provide ALS services. This successful enhancement to the existing Collier County Emergency Medical Services has been thoroughly documented and support by two independent groups. Both of these groups' studies and/or reports have been previously provided to the Board of County Commissioners for their review and have also been included as part of this application as reference material. The first report was prepared in 2007 by Emergency Services Consulting Inc at the request of the Collier County Emergency Medical Services Department. This report titled 2007 EMS Master Plan was financed by the Collier County Emergency Medical Services Department through the utilization of available State of Florida grant funds. 9/16/2009 Page 6 of 12 1 0 1H To further answer the question as to what extend the proposed service is needed to improve the overall emergency medical services (EMS) capabilities of the county, please refer to page 3 of the EMS Master Plan. The author states, "ESCI's findings support this concept, as data indicates the ALS Engine Program provides quantifiable benefit to the overall delivery of the emergency medical services, particularly when system demand is high ". Furthermore, on page 141 the author states "The ALS engines should be utilized to increase the capability of the EMS system in generaP' (See Attachment D). The second report was prepared and presented by the Collier County Productively Committee in August 2008, and presented to the Collier County Board of Commissioner as part of the FY 2008 -09 final budget preparations. On the second page of the summary report the author states "In particular, the seven ALS units provided by North Naples Fire District have made a big improvement in response times in north collier ". The author additionally states "Their contribution, plus the one new EMS unit co- located in north collier, have achieved goal response times, with one exception" (See Attachment E). In support of their recommendation, the Collier County Productivity Committee provided a series of charts displaying the positive contribution in response times stated above. Please refer to Attachment E. Although the data used during this report is dated 3/31107 to 3/31/08 not much has changed within the District since the compilation of this response time report to significantly change the results. The statistical value of these reports in demonstrating the enhancement of Advanced Life Support first response non- transport to the current Collier County Emergency Medical Service System is still valid today. The two attached reports substantiate the different training provided by the County Medical Director to County EMS and the District. The reports encouraged the County Medical Director to provide the same level of training to all ALS providers regardless of the agency providing the service. On September 23, 2008, the County Commission indicated its desire to have the Medical Director report directly to the County Commission and to have the Medical Director provide direct contact to and proper training to the firefighter /paramedics. One of the reasons was to eliminate the confusion cause when the fire districts receive correspondence from County EMS. Another reason was to give the fire districts direct access to the County Medical Director. Since the September 23, 2008, the Collier County Medical Director has publicly stated his opposition to the District providing ALS services. He has stated that he does not see the benefit of training firefighter /paramedics to provide ALS-services because he believes they do not provide the services as frequently as necessary to keep up their skills. Please see composite (Attachment F). He has also stated that he and his assistant do not have the time to provide the training to the firefighter /paramedics to assure that they can properly administer medications. It is clear that the Medical Director does not intend to work with the District to provide training within a schedule that will meet the firefighter /paramedic's schedules. In addition, the County Medical Director has refused to have direct contact with the District and continues to use county EMS staff as the mechanism to contact the District. To assure proper training, the District is willing to employ its own Medical Director to provide training to firefighter /paramedics that the 9/16/2009 Page 7 of 12 10H Collier County Medical Director either cannot provide or refuses to provide to the firefighter /paramedics employed by the District. The granting of a certificate to provide Advanced Life Support non - transport first response service within the North Naples Fire Control & Rescue District shall not only maintain the current improvement to service as identified above, but further enhance the level of medical services by allowing the District to work directly with the State of Florida Bureau of Emergency Medical Services, thereby eliminating the need for inter - local agreements between the District and the Collier County EMS Department. Of additional significant importance, the granting of this certificate would provide the opportunity to develop a more cohesive relationship with the Collier County Office of the Medical Director by allowing the District to contract with a Medical Director which can act as the liaison between the District and the County Medical Director. The 2007 EMS Master Plan (Attachment D) also identified a potential for significant cost savings to the County, by either eliminating existing transport units from areas which are already well serviced or relocating transport units to other areas in the county which are currently under serviced. These options can only be considered by the county if the ALS engines provide parity in the level of .medical services. This is not the case today, but could become a reality if the District is granted a certificate to provide ALS non transport services. Also, "There are areas within Collier County that beneft from the current deployment scheme and some areas that do not benefit to the same degree. Although the current deployment places units in the areas with the highest service demand, residents further away from the more densely populated areas face increasing response times, particularly as the number of simultaneous calls (coneurrency) increases ". This reallocation of existing resources can have an immediate positive impact on some of the counties rural but highly Populated areas, which currently have a much higher response time criteria (12 rains) than the urban areas (9 mins), without compromising the existing level of response in the urban areas. The granting of the certificate to the district, will allow the district to offer parity in the level of service by facilitating the reallocation of services to the rural areas, while not disrupting the current level of service to the urban areas. The denial of the certificate will result in the District no longer providing ALS services. Accordingly, the County response time to provide ALS services will decline unless the County increases its expenditures to provide ALS services. As the Productivity Committee report indicates, the District's provision of ALS (non- transport) services has been a savings to the collier county taxpayer. b. The effect of the proposed service on existing services with respect to quality of service and cost of service. The granting of this certificate will have no impact on the cost of the current Collier County EMS services. ALS first response non - transport services are already being provided to the residents of and visitors to the North Naples Fire Control District at no additional cost. This practice is expected to continue unless a change to the county fee ordinance provides opportunities for billing for such services. The District is not requesting a change to the billing system for ALS services. 9/16/2009 Page 8 of 12 Ion In respect to the quality of service, all district paramedics who are currently providing ALS non - transport services work under the Collier County Office of the Medical Director. The adverse relationship between the District and the County Medical Director is well chronicled. The District will not continue to operate in a system that requires it to report to the county Medical Director. The granting of a certificate to provide Advanced Life Support non - transport first response services will allow the North Naples Fire Control District to enhance its current level of medical services to the residents and visitors by addressing and implementing the recommendations provided by the 2007 EMS Master Plan. The author's states "Increase consistency among all ALS providers and ensure that all providers are able to perform egual skills and procedures prior to 'certifying' them to function within the system ". Furthermore, the EMS Master Plan mentions "all Advance Life Support (ALS) providers functioning within Collier County should have the same level of education and training, and be allowed to perform at a consistent level of care, regardless of the organization for which they operate. ESCi's finding support this concept, as the data indicates the ALS engine program provides quantifiable benefit to the overall delivery of emergency medical services, particularly when system demand is high ". (Attachment D) It is the intentions of the District by obtaining a certificate to provide ALS non transport services to contract with a medical director whom shall meet all F.S. 401 and F.A.C. 64J requirements. The District's Medical Director's primary responsibility shall be to assist the District in expanding its training opportunities, and assuring the competency of all District paramedics to not only continue to meet, but exceed all state and local expectations, as well as the above stated recommendations by ESCL The District is fully aware and agrees with the County Commissioners concerns of fragmentation in the delivery of out -of- hospital Basic and Advanced Life Support, as currently created by the Office of the Medical Director. As stated in the 2007 EMS Master Plan, "ALS Engine personnel are not allowed to carry the same medications and equipment as does Collier County EMS, creating a fragmentation of patient care ". The report goes on to mention "To further confuse this issue, many of the personnel currently functioning within the ALS engine program are current and/or former Collier County EMS personnel with equal or greater training, education, and experience as those operating on the county transport units ". Lastly, "This fragmentation of the certificationllicensure system has created tension among various agencies and serves little purpose in the overall medical direction of the system. With a more consistent training and orientation program of all ALS personnel, regardless of agency, the system can begin to function more uniformly in regards to pre - hospital medical care for the citizens of Collier County". (Attachment D) The District plans to immediately address the fragmentation issue, once granted a Certificate to provide ALS non transport services and acquiring state llcensure, by incorporating the recommendation found on page 30 of the 2007 EMS Master Plan: "Increase training, education and practice consistency among all providers and ensure that all providers are able to perform equal skills and procedures prior to 'certifying' them to function within the system ". This recommendation can be easily accomplished — since "The State of Florida sets minimum standards for paramedic and the local Medical 9/16/2009 Page 9 of 12 IN Director determines what additional education and clinical requirements must be met prior to functioning autonomously, therefore, within Collier County, all fire departments with paramedic capable services must adhere to the same EMS requirements for training and skill competencies as an EMS Paramedic in order for this parity in service provision by ALS engine paramedics to recognized ". (Attachment D) The goal is to assure that fragmentation, or lack of parity in the delivery of Emergency Medical Care, does not continue within the North Naples Fire Control & Rescue District. In addition, the District Medical Director shall be required through its contractual agreement with the District to work closely with the Office of the Collier County Medical Director to assure that residents and visitors of the District can benefit from a well organized, comprehensive, non fragmented and highly sophisticated system of delivering medical services. The current Medical Director has taken a negative stance to eliminating fragmentation, and in fact, he continues to widen the level of disparity in service. The Medical Director refuses to meet directly with District personnel. He has adopted different protocols for the District and County EMS. Most recently, the County Medical Director has decertified 30 of the District's paramedics because they have not satisfied the new ride along criteria the County Medical Director implemented in January 2009. The County Medical. Director now wants each District paramedic to ride in the rear of an ambulance at least once every three months so the District's paramedic can increase patient contact. This new requirement creates problems for the District because the District's paramedics have different protocols and can not provide all medical services a County paramedic can provide. Accordingly, if a patient being transported requires a medical service a District paramedic is not authorized to provide, the County paramedic must stop the vehicle and switch places with the District's paramedic. The Medical Director has made it clear that he does not respect the District's firefighter /paramedics. The relationship between the District and the County Medical Director is irretrievably broken. The only resolution to abolishing fragmentation and to assure proper training and utilization of district personnel is through the granting of a certificate to the District to provide ALS non transport services, and provide the ability to establish clear, concise and consistent medical direction through the District hiring and operating under its own medical director. c. The effect of the proposed service on the overall cost of EMS service in the county. The granting of a certificate for the provision of Advance Life Support first response non - transport services shall have no impact on the overall cost of the Collier County Emergency Medical Service. Advanced Life Support first response non - transport services are currently being provided by the North Naples Fire Control & Rescue District at no cost to the Collier County Emergency Medical Services Department. The North Naples Fire Control & Rescue District is completely funded to continue to offer the same level of Basic and Advanced Life Support service enjoyed by the residents and visitors to the county. If the Certificate is granted the District plans to enhance the level of training and overall services. 9/16/2009 Page 10 of 12 ion In essence, as previously discussed in this application, the county could realize significant savings by either eliminating existing transport units from areas which are already well serviced or relocating transport units to other areas in the county which are currently under serviced. Both of the above stated options can occur without a reduction in the current level of the service within the areas in which the units are either removed or reallocated. However, the county can only consider these options if the ALS engine program was able to provide parity in the level of medical services. This unfortunately is not the case today, but could become a reality if the District is granted a certificate to provide ALS non transport services. If a certificate is not issued to the District, the District will no longer provide ALS services. Accordingly, the response times will suffer unless the County increases the number of EMS paramedics and transport units in service. The financial impacts to the residents and visitors of the county will be significant. As the Productivity committee report substantiated, the provision of ALS services by the District resulted in the recommendation that two stations not be constructed which would save $4,500,000 in construction costs and $942,872 annually in staffing costs. The District is able to employ 56 state certified paramedics and provide its paramedic services for approximately $450,000 per year. The taxpayer's save almost $500,000 per year in operation costs by the District providing ALS services. That does not include the $4,500,000 in construction costs. d. The effect of the proposed service on existing hospitals and other health care facilities. Currently the North Naples Fire Control & Rescue District has two hospitals within its district boundaries. The District has been providing both Basic & Advanced Life Support non - transport service for many years with no negative effect in the operations of either hospital. Consequently, it is important to note that by granting a certificate to provide ALS engine non transport services, the District could potentially improve the operations of both hospital emergency rooms through the delivery of a higher level of ALS service. Hence, patients that are transported to the hospitals could arrive with less acuity of illness or injuries, which could require less intensive hospital resources and potentially lessening the length of stay of patients in the hospital. These are two critical benchmarks that can result in positive impact to the operations of both hospitals, including the emergency rooms. e. The effect of the proposed service on personnel of existing services and the availability of sufficient qualified personnel in the local area to adequately staff all existing services. The North Naples Fire District currently operates 10 Basic Life Support and Advanced Life Support first response non - transport apparatus, utilizing 56 paramedics and 79 Emergency Medical Technicians. The District currently employs a sufficient number of Paramedics, and Emergency Medical Technicians to provide the level of service being requested. It shall have no impact on the staffing levels of the existing - services. 9/16/2009 Page 11 of 12 ION 2) That the applicant has sufficient knowledge and experience to properly operate the proposed service. The North Naples Fire District has been providing Fire and Emergency Medical Services within its boundaries since 1961, and Advanced Life Support non - transport services since 1999. Our management staff has a combined 82 years of experience in providing excellence in service to its community. The District responds to approximately 6000 911 medical calls per year, providing each Paramedic with ample experience in the provision of both Basic Life Support and Advanced Life Support. Additionally, of the 56 Paramedics, 19 have Associate Degrees, 3 have Bachelors Degree's and 1 member has a Master Degree. In addition, due to an almost none existent employee turn over rate the District, the District has a collection of some of the most experienced and tenured Paramedics in the county. Many of the District's most experienced paramedics originally came from the Collier County Emergency Medical Services Department transport service. Finally, all District EMT's and Paramedics not only meet all State of Florida Department of Health certification requirements, but in many instances exceeds them. In addition, all District Paramedics are in compliance with all existing requirement as set forth by the Office of Medical Director. (3) That, if applicable, there is an adequate revenue base for the proposed service. The North Naples Fire Control & Rescue District currently provides Advanced Life Support non - transport services within its district boundaries. The District has consistently funded Fire Operations and Prevention services, as well as Basic Life Support and Advance Life Support non - transport services, utilizing its millage cap of 1 Mil. No change to this funding source is either necessary or expected. (4) That the proposed service will have sufficient personnel and equipment to adequately cover the proposed service area. The North Naples Fire District currently operates 10 Advanced Life Support first response non - transport apparatus utilizing 56 paramedics and 79 Emergency Medical Technicians. The District has enough paramedics and EMT's to provide the level of service being requested. In addition, the District has budgeted designated reserves to purchase any necessary equipment that the District may need, even though 95 percent of necessary and required equipment to provide the enhancement in service is already owned by the district as part of its current participation in the Advanced Life Support first response non - transport program. Comirussloner stopher Lombardo, Chairman Vate 9/16/2009 Page 12 of 12 10H Attactunent;J NORTH NAPLES FIRE CONTROL & RESCUE DISTRICT GENERAL FUND TRIAL BALANCE SUMMARY - 2008 -2009 Budget Final Percent Preliminary Percent ASSETS 2008 -2009 Jul .2009 of Bud et Au ust.2009 of Budget Cash $ 20,723,260 $ 19,081,916 Accounts Receivable $ 23,400 $ 19,050 Interest Receivable Due from Other Funds $ 729,028 $ 778,030 Prepaid Expenses /Deposit $ 4,953 $ 4,953 TOTAL ASSETS $ 21,480,641 $ 19,883,949 LIABILITIES Accounts Payable $ 40,100 $ 20,944 Other Liabilities $ 5,056 $ 5,899 Vendor Deposits $ 16,000 $ 16,000 Accrued Expenses $ TOTAL LIABILITIES $ 61,156) $ (42,843) FUND BALANCE (CASH RESERVE ) $ 13,953,594) $ (13,953,594) INCOME Ad Valorem $ 26,229,650 $ 26,400,658 100.65% $ 26,425,965 100.75% Interest $ 492,000 $ 469.340 95.39% $ 497,746 101.170/a Other Income $ 448,095 1 $ 390,421 87.13% $ 422,538 94.30% TOTAL INCOME $ 27,169,745 $ 27,260,419 100.33% $ 27,346,249 100.65% EXPENSES Personnel $ 21,590,657 $ 16,355,705 7535% $ 17,854,617 82.70% Operational $ 3,859 382 $ 2,684,108 69.55% $ 2,838,976 73.56% Debt Service $ 739,003 $ 65,418 8.85% $ 71,959 9.74% Capital Purchases $ 1,604,253 $ 689,298 42.97% $ 693,186 43.21% TOTALEXPENSES $ 27,793,295 $ 19,794,529 71.22% $ 21,458,738 77.21% BJB/bb Ml -09 1 ION BJB bb 9 -01-09 GENERAL FUND- 2001112009 Amended Budget Final Percent Preliminary Percent 2008.2009 July.2009 Budget Aug.2009 Budget Balance Forward -Desi nated 13,953,594 13,953,594 13,953,594 Balance Forward- Undesi nated Total -Cash Reserve Carry Forward 13,953,594 13,953,594 13,953,594 REVENUE 1 Collier County Ad Valorem Milla e- .9869) 26,103,691 26,103,691 100.00% 26,103,691 100.DO%l 1 2 C.C. -Ad Valorem over 95% 125,959 296,967 322,274 2 3Interest- General 157,000 101,158 64.43% 105,366 67.11% 3 4lnterest -CD 325,000 367,796 113.17% 391,517 120.47% 4 5 Interest -Ad Valorem 10,000 386 3.86% 863 8.63% 5 6 Fire Watch Fees 50,000 22,592 45.18% 23,052 46.10% 6 7 Occupational Lic. Fees 39,375 51,350 130.41% 55,940 142.07% 7 8 Flow Test 9,000 3,605 40.06% 3,885 43.17% 8 9 lHydrant Maintenance Fees 25,000 11,570 46.28%1 11,570 46.28% 9 10 Ins ec.- Thrust Blocks 500 1 0.00%4 0.00% 10 11 Key Boxes 13,750 5,015 36.47% 5,400 1 39.27% 11 12 Reinspection Fees 1,000 500 50.00% Soo 50.00% 12 13 Rental - Cell Tower 35,160 25,841 7150% 35,792 101.80% 13 14 Station Rental -EMS 26,310 21,905 83.26% 23,931 90.96% 14 15 Other Rental 48,000 40,000 83.33% 44,000 91.67% 15 16 Donations, Gifts, Grants 5,000 200 4.00% 200 4.00% 16 17 Disposition of Fixed Assets 20,000 22,589 112.95% 22,589 112.95% 17 18 Proceeds from Sale of Land 18 19 Proceeds from Debt 19 20 Misc. Revenue 15,000 - 4,001 26.67% 4,053 27.02% 20 21 Misc. Rev: Refunds /Reimb. 125,000 141,782 113.43% 151,155 120.92% 21 22 Reimbursement - Training 20,000 4,871 24.36% 4,871 24.36% 22 23 False /Malfunctioning Alarm Fees 15 000 34 600 230.67% 35 600 237.33 00 23 TOTAL INCOME 27,169,745 27,260,419 100.33% 27,346,249 100.65% Personnel Services 30 Salaries 11,520,504 1 9,644,328 83.71%1 10,569,553 91.75% 30 31 Salaries- Prevention 87,950 76.87% 539,479 84.99% 31 32 Commissioners 25,000 83.33% 27,500 91.67% 32 33 On Cali Pa 18,717 74.87% 20,658 82.63% 33 34 Prof. Pay 55,627 91.91% 172,479 10186% 34 35 Prof. Pa - Prevention N169,323 3,700 51.39% 4,100 56.94% 35 36 Holiday 8,499 2.79% 8,499 2.79% 36 37 Overtime -O erations 52,379 76.19% 201,538 100.77% 37 38 Overtime- Prevention 16,977 87.96% 18,895 —97,90%-38 39 1 Overtime- Firewatch 50,000 18,300 36.60% 18,300 1 36.60% 39 40 Overtime -S ec.Teams 188,080 120,349 63.99% 130,219 69.24% 40 41 Overtime - Administration 22,500 8,418 37.41% 8,490 37.73% 41 42 Overtime -Beach Patrol 1,000 0.00% 0.000/6 42 43 Overtime - Paramedic Training 35,000 2,828 8.08% 5,455 15.59% 43 44 1 Overtime - Reimburseable 20,000 3,789 18.952% 3,789 18.95% 44 45 lOvertime - Trainin 41,400 0.00% 0.00% 45 46 Training Bonus 43,900 17,000 38.72% 18,000 41.00% 46 47 Vacation Pay 68,000 65,902 96.91% 65,902 96.91% 47 48 Sick Leave Pay 443,622 9,317 2.10% 9,317 j 2.10% 48 49 Sick Leave- Prevention 16,976 0.00% 0.00% 49 So Social Security 1,005,687 739,262 73.51% 816,318 81.17% 50 51 Soc. Security-Prevention 49,559 39,966 80.64% 44,193 89.17% 51 BJB bb 9 -01-09 10fl BJerob sa1-0e Amended Budget Final Percent Preliminary Percentage of Page 2 2008 -2009 July.2009 Budget Au .2009 Budget 52 Disability Insurance 60,232 34,182 56.75% 36,559 60.70% 521 53 Disability Ins.-Prevention 8,800 13,331 151.49% 14,692 166.95% 53. 54 LifelHealth Insurance 2,628,969 2,394,330 91.07% 2,599,673 98.89% 54 55 Life /Health Ins. -Prey. 121,199 192,965 159.21% 211,090 174.17% 55 56 Life /Health Ins. - Commissioners 49,832 55,886 112.15% 61,149 122.71% 56 57 Hlth. insurance Run Out -07 Plan 15,000 11,718 11,718 78.12% 57 58 Post Employment Health Plan 28,000 28,000 1 100.00% 28,000 100.000/ 58 59 Workers Compensation 700,000 305,964 43.71% 296,037 42.29% 59 60 Worker's Com -Prev. 47,261 92,589 195.910% 102,516 216.91% 60 61 Retirement -FRS 1,360,976 614,900 59.88% 893,153 65.63% fit 62 Retirement- FRS -Prev. 54,407 62,818 115.46% 68,933 126.70°% 62 63 Retirement -175 1,318,255 651,373 49.41% 645,959 49.00%1 63 64 Retirement- 175 -Prev. 87,454 82,002 93.77% 90,641 103.64% 64 65 Retirement - Commissioners 5,493 3,799 69.16% 4,178 76.06°% 65 66 Retirement/ Hlth Ins - Fire Chief 58,704 40,310 68.67% 43,963 74.89% 66 67 Unemployment Insurance 37,464 22,749 1 60.72% 22,749 60.72°% 67 68 Employee Physicals 110,000 4,644 4.22% 35,086 31.90% 68 69 Retirement Recognition 2 000 5,837 291.85% 5.837 291.85% 69 Total Pers. Serv. 21,590,657 16,355,705 75.75°% 17,854,617 82.70°% Operating Expenditures 80 Bld ., Liabilit &Auto Insurance 343,549 247,746 72.11% 247,746 72.11% 80 81 Communications 34,000 16,188 47.61% 17,094 SO.ZB% 81 82 Telephone 200,000 132,118 66,06% 149,126 74.56% 82 63 Utilities 190,100 161,689 85.05°/, 171,442 90.19% 83 Maintenance 84 Vehicle Maint 320,800 220,072 68 -60% 242,093 75.47% 84 85 Bldg. Maint. - General 253,870 182,555 71.91%1 196,756 77.50% 85 86 Bldg. Maint.-St. 40 4,500 1,404 31.20% 5,276 117.240/6 86 87 Bldg. Maint.-St. 42 10,300 5,029 48.83°% 5,652 54.87% 87 88 Bldg. Maint.-St. 43 21,200 10,070 47.50% 12,620 59.53°% 88 89 Bldg. Maint.-St. 44 12,700 8,661 68.20% 8,661 68.20% 89 90 Bldg. Maint.-St. 45 17,900 13,333 74.49°% 17,641 98.55% 90 91 Bldg. Maint.-St. 46 18,100 17,657 97.55% 18,698 103.30°% 91 92 Bldg. Maint.-St. 47 2,000 2,202 110.10% 2,202 110.10°% 92 93 1 Bldg. Maint -Sho /Lo istices 2,500 1,438 1 57.52% 1,658 66.32°% 93 Equipment Maintenance 94 Equip-Repair & Maint. -Fire 33,800 37,446 110.79% 37,815 111.88% 94 95 Equip. Maint- - SCBA 3,500 3,192 91.20% 6,563 158.94% 95 96 Equip. Maint.-Nozzle 5,760 5,586 96.98% 5,586 96.98°% 96 97 Computer Maintenance 80,000 53,000 66.25% 3,316 66.65% 97 98 Hydrant Maintenance &Repair 70,600 - 48,598 68.84% 9,337 69.88% 98 Supplies 99 ALS /Emergenc Medical Su , /Se 92,267 75,835 82.19°% 0,681 87.44°% 99 100 Office Supplies 38,000 24,452 64.35% g26,550 69.87% 100 101 Office Su lies - Prevention 5,660 1,731 30.58°% 1,731 30.58% 101 102 Protective Gear 26,500 19,993 75.45°% 4,550 92.64% 102 103 Uniforms 63,450 17,907 28.22% 8,745 29.54 °% 103 104 Hurricane/Emergency Hurricane/Emergency Supplies 10,000 0.00% 0.00% 104 105 Station Supplies 27,900 25,210 90.36% 27,313 97.90% 105 Equipment-Non. Ca ital 106 Office Equipment 40,000 35,968 89.92% 40,750 101.88% 106 107 Office E ui ment- Prevention 4,857 400 8.24% 400 8.24% 107 108 Fire E ui ment 92,000 32,083 34.87% 37,785 41.07% 108 BJerob sa1-0e IQH aJalb6 e-0 1 -e9 3 Amended Budget Final Percent Preliminary Percentage of Page 3 2008 -2009 July.2009 Budget Aug.2009 Budget 109 Shop Equipment/Supplies 4,150 9,477 228.36% 10,275 247.59% 109 110 Warehouse/1-o istics Su Iles/E 2,000 1,906 95.30% 1,906 95.30% 110 Professional & other fees 111 Professional 225,000 168,820 75.03% 181,135 80.50% 111 112 Pro err A raisers Fees 209,048 178,748 85.51% 178,748 85.51% 112 113 1 Coilector's Fees 525,074 527,169 100,40% 527,229 100.41% 113 114 Auditor 85,000 65,010 76.48% 65,010 76.48% 114 Miscellaneous 115 Water /Sewer Fee -St 44 5,000 4,602 92.04% 4,602 92.04% 115 116 Travel & Per Diem 68,170 20,211 29.650/ 20,771 30.47% 116 117 PIO 3,675 3,165 86.12% 832 22.64% 117 118 PEO 27,900 16,093 57,68% 19,076 68.370/ 118 119 Vehicle Fuel /Oil 350,000 126,082 36.02% 152,288 43.51% 119 120 Public College, Florida State Fire College and Paramedic College Counses 60,000 48,788 81.31% 48,142 80.24%11201 121 ITraining Course /Conference 73,000 36,199 49.59% 39,484 54.09% 121 122 Trainin Supplies/Equipment 34,000 17,413 51.21% 18,781 55.24% 122 123 Miscellaneous 30,000 16,660 55.53% 17,167 57.22% 123 124 Subscription /Dues 8,285 10,883 131.36% 14,422 174.07% 124 125 Subscription /Dues- Prevention 588 0.00% 0.00% 125 126 PETC 1,000 - 0.00% 0.00% 126 127 Legal Advertisements 9,900 3,476 35.11% 3,920 39.60% 127 128 Dive Team 5,450 2,256 41.39% 2,256 41.39% 128 IFire 129 Prevention Materials & Supplies 17,444 5,959 34.16% 5,959 3416%1129 130 Haz Mat 7,000 8,358 11140% 8,358 119.40%1130 131 Technical Rescue 7,475 6,261 83.76% 6,656 89.04% 131 1321 Boat Team 6,000 3,437 57.28% 3,600 60.00% 132 133 CERT Team 13,210 1,406 10.64% 1,406 10.64 % 133 134 1 Peer Fitness 1,000 294 - 29.40% 294 29.40% 134 135 K -9 Search & Rescue 1,500 - 0.00% 0.00% 135 13fi Honor Guard 2,700 128 - 4.74% (128)— - 4.74% 136 137 SOS Program - 137 138 Contingencies 50,000 - 0.00% 0.00% 138 139 Payment to County -Imp. Fees - 139 Total Op. Exp. 3,859,382 69.55% 2,838,976 73.56% R:2,6784,108 Debt Service 150 Princi al Pa �ment -Land Loan 713,889 6.25% 49,088 6.88% 150 151 InterePmt. - Land /Station Loans 25,414 82.89% 22,871 91.07 ° / 151 Total Debt Serv Ca ital Outla 160 Station Im rovements & E ui . 413,700 150,696 36.43°/ 153,186 37.03% 160 161 Fire and Rescue Equip. 73,000 8,604 11.79% 8,604 11.79% 161 162 Protective Gear 20,000 0.00 % 0.00% 162 163 Medical E uipment 163 164 Communication E ui 12,000 1,885 15,71% 1,885 15.71°/ 164 165 Office E uip 30,000 15,134 50.45% 15,134 50.45% 165 166 Com uters 65,305 22,150 33.92% 23,548 36.06% 166 167 TRT 5,525 2,629 51.20% 2,829 51.20% 167 168 Boat Team 6,000 12,940 215.67% 12,940 215,67°/ 168 169 Training E ui ment 1 5,500 34.38% 5,500 34.38% 169 170 Vehicle Purchase 170 aJalb6 e-0 1 -e9 3 ice 7 739,003 6 65,418 8 8.85 °� 7 71,959 9 9.74% 1 -e9 3 ion BJE/bb 9 -01 -09 Amended Budget Final Percent Preliminary Percentage of Page 4 2008 -2009 July.2009 Budget Aug.2009 Budget 171 Shop Equipment 3,700 0.00% 171 172 Lo isticsPNarehouse 5,000 4,950 99.00% 4,950 99.00% 172 173 HazMatTeam 8,000 0.00% 0.00% 173 174 Fire Apparatus 480,000 0.00% 0.00% 174 175 Dive Team 6,000 4,850 80.83% 4,850 80.83% 175 176 Fire Prevention 5,500 5,237 1 95.22% 5,237 95.22% 176 177 Rennovation of Shcp /Maint. Facility - 178 Land 454,523 454,523 454,523 176 Total Capital Outla 1,604,253 689,298 42.97% 693,186 43.21% 150 TOTAL EXPENSES 27,793,295 19,794,529 71.22% 21,458,738 77.21% 150 Prior Year Fund Balance 13,953,594 13,953,594 13,953,594 Total Income 27,169,745 27,260,419 27,346,249 Total Expenses (27,793,295) (11794,529) (21,458,738) Total Cash Reserve 13,330,044 21,419,484 19,841,105 48% CUMMULATIVE RESERVES: Undesi nated Reserve 8,089,440 6,511,061 Maintaining Level of Service 3,948,144 3,948,144 3,948,144 Designated - Replacement Radios 300,000 300,000 300,000 Designated - Health Insurance 500,000 500,000 500,000 Desi nated -ALS Program - - Designated -GASB 45 Post Em p. 500,000 500,000 500,000 Designated-Loan Lump Sum Pmt Designated- Emer .Res. 500,000 - 500,000 500,000 Designated-Operating Reserve 2,400,000 2,400,000 2,400,000 Designated-Fire Apparatus 1,800,000 1,800,000 1,800,000 Designated - Building Fund 1,500,000 1,500,000 1,500,000 Designated - Vehicle Replacement 100,000 100,000 100,000 Desi nated -SCBA Replacement 160,000 160,000 160,000 Designated-Capital Equip. 1,501,000 1,50-11000 1,501,000 Designated- Disaster Pre aredne - - Designated-St. #46 Improvement 20,900 20,900 20,900 Designated - Personal Protective Gear 100,000 100,000 100,000 13,330,044 21,419,484 19,841,105 48% BJE/bb 9 -01 -09 North Naples Fire Control & Rescue District Summary Trial Balance For the Eleven Months Ending August 31, 2009 Account Groups Account Number Description OPERATING EXPENSES CURRENT ASSETS 9CO- 0000 -001 -000 Land $10,728,290.96 900 - 0000- 002 -000 Building and Improvements 12,061,899.42 900- 0000 - 003 -000 Auto, Truck and Equipment 7,610,438.51 900 - 0000- 004 -000 Furniture, Fixtures and Equipment 654,430.14 900 - 0000 - 005 -000 Firefighter Equipment 2,642,629.81 900- 0000 - 007 -000 Construction in Progress 480,362.78 TOTAL CURRENT ASSETS 34,178,051.62 CURRENT LIABILITIES 900 -0000. 008 -000 Amount Provided for Debt 2,132,066.24 TOTAL CURRENT LIABILITIES 2,132,066.24 LONG TERM LIABILITIES 900 -2250- 001 -000 Note Payable - Bank of America (718,599.96) 900 -2390- 000 -000 Vacation Accrual (1,413,466.28) TOTAL LONG TERM LIABILITIES (2,132,066.24) FUND BALANCES 900 - 2800 -000 -000 Investment in Fixed Assets (34,178,051.62) TOTAL FUND BALANCE (34,178,051.62) REVENUES OPERATING EXPENSES AttichU B CHAPTER HB 1115, First Engrossed /ntc 99 -450 nouserma N, h5 1 A bill to be entitled 2 An act relating to the North Naples Fire 3 Control and Rescue District, Collier County; 4 providing for codification of special lases 5 regarding special districts; providing that the 6 district is an independent special district; 7 providing legislative intent; codifying and 8 reenacting provisions of chapter 84 -416, Laws 9 of Florida, as amended; providing for 10 applicability of chapters 191 and 189, F.S., 11 12 and other general laws; providing a district 13 charter; providing that this act shall take 14 precedence over any conflicting law to the 15 extent of such conflict; providing 16 severability; repealing all prior special acts 17 related to the North Naples Fire Control and 18 Rescue District; providing an effective date. 19 Be It Enacted by the Legislature of the State of Florida: 20 Section 1. Pursuant to sections 189.429 and 191.015, 21 Florida Statutes, this act constitutes the codification of all 22 23 special acts relating to the North Naples Fire Control and Rescue District. It is the intent of the Legislature to 24 25 provide a single, comprehensive special act charter for the 26 district, including all current legislative authority granted 27 to the district by its several legislative enactments and to 28 conform the charter to chapter 191, Florida Statutes, the 29 Independent Special Fire Control District Act, and other 30 provisions of general law. 31 COOING: Words strieken are deletions; words underlined are additions. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16I 171 181 19 20 21 22 23 24 2S 26 27 28 291 30 31 10H HB 1115, First Engrossed /ntc Section 2. Chapters 84 -416, 88 -519, 89 -448, 89 -4S5 91 -375, 96 -512, and 98 -489, Laws of Florida, relating to the North Naples Fire Control and Rescue District, are codified, reenacted, amended, and repealed as herein provided. Section 3. The charter for the North Naples Fire Control and Rescue District is re- created and reenacted to read: nomrrT.v T ri nauu�lc Section 1. This act establishes a charter for the North Naples Fire Control and Rescue District, which district was created by chapter 61 -2032, Laws of Florida. The district shall be deemed created by said chapter, for all purposes. Section 2. This act supersedes and repeals all previous special acts relating to the North Naples Fire Control and Rescue District and sets forth within this charter those matters, as applicable, which are covered by such previous special acts. Amendments to this district charter may be made only by special act of the Legislature. This act shall be construed so as to preserve to the district all powers previously granted. Section 3. The district is organized and exists for all purposes set forth in this act and chapter 191, Florida Statutes, as they may be amended from time to time. ARTICLE II Name of District Section 1. The name of the district shall be the "North Naples Fire Control and Rescue District." Section 2. The district shall be an independent special district of the State of Florida, and a body corporate and politic. 2 CODING: words strieken are deletions; words underlined are additions. 16M HB 1115, First Engrossed /ntc 1 ARTICLE III 2 Boundaries of the District 3 Section 1. The district shall include the following 4 described lands: 5 Sections 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 6 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 7 28, 29, 32, 33, 34, 35, and 36, Township 48 8 South, Range 25 East; Sections 1, 2, 3, 4, 5, 9 8, 9, 10, 11, 12, 13, 14, 15, 16, 21, 22, 23, 10 and 24, Township 49 South, Range 25 East; 11 Sections 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 12 17, 18, 19, 20, 21, 22, 23, 24, 29, 30, 31, and 13 32, Township 48 South, Range 26 East; Sections 14 5, 6, 7, 8, 18, and 19, Township 49 South, 15 Range 26 East; but not including any lands 16 presently within the corporate boundaries of 17 the City of Naples. 18 19 The foregoing description notwithstanding, the 20 following area, commonly known as 11Sea ate ", 21 "Park Shore Unit 211, "Park Shore Unit 5" and 22 "Naples Cay" shall be excluded from the 23 district: That part of government lot one 24 Section 16, Township 49 South, Range 25 East, 25 Collier County, Florida, described as follows: 26 27 Commencing at the North quarter corner of 28 Section 16, Township 49 South, Range 25 East, a 29 4 x 4 concrete monument with brass cap set by 30 the county engineer, also being the northeast 31 corner of government lot one and being the 3 CODING: Words stricken are deletions: words underlined are additions. 10H HB 1115, First Engrossed /atc 1 point of beginning: Thence run South 00 degrees 2 45 minutes 40 seconds east for 1327.70 feet to 3 a concrete monument the southeast corner of the 4 northeast quarter of the northwest quarter of 5 Section 16 also being the southeast corner of 6 government lot one, thence south 89 degrees 23 7 minutes 20 seconds west for 1650.75 feet to a 8 concrete monument, thence north 00 degrees 36 9 minutes 40 seconds west for 70.00 feet to a 10 concrete monument, thence north 07 degrees 42 11 minutes 20 seconds east for 153.60 feet to 12 concrete monument set at the water line of a 13 canal, thence north 64 degrees 11 minutes 00 14 seconds east for 130.27 feet to a concrete 15 monument set at the water line of a canal, 16 thence north 04 degrees 11 minutes 05 seconds 17 east for 38.77 feet to the point of curve, 16 thence along the arc of said curve having a 19 radius of 1545 feet, a tangent of 176.03 feet 20 a delta angle of 13 degrees right for the arc 21 distance of 350.57 feet to the point of curve 22 of a reverse curve, thence along the arc of 23 curve having a radius of 765.00 feet, a tangent 24 of 286.02 feet, a delta angle of 41 degrees 25 left for the arc distance of 560.33 feet to the 26 point of tangent, thence north 15 degrees 37 27 minutes 05 seconds west for 70.85 feet to a 28 concrete monument set at the water line of a 29 canal, thence north 15 degrees 57 minutes 05 30 seconds west for 98.80 feet to a concrete 31 monument, thence north 89 degrees 28 minutes 40 4 CODING: Words strieken are deletions; words underlined are additions. 10H HB 1115, First Engrossed /ntc I seconds east along the North boundary of 2 Section 16, also being the north line of 3 government lot one, for 1776.65 feet to a 4 concrete monument with brass tap, the north 5 quarter corner of Section 16, also the 6 northeast corner of government lot one and the 7 point of beginning. 8 9 10 11 12 13 14 15 16 17 16 19 20 21 22 23 24 25 26 27 28 29 30 31 Commencing at the East 1/4 of Section 21, Township 49 South, Range 25 East, Collier County, Florida; thence along the East and West 1/4 line of said Section 21, South 89 degrees 26 minutes 20 seconds west 3665.68 feet to the southwest corner of Park Shore Unit No. 1 according to the plat thereof as recorded in Plat Book 8, pages 43 and 44, Collier County Public Records, Collier County, Florida, and the place of beginning of this description: thence north 0 degrees 31 minutes 40 seconds west 1709.98 feet; thence north 7 degrees 46 minutes 00 seconds east 918.77 feet; thence north 541.25 feet; thence north 84 degrees 00 minutes 00 seconds west 570.17 feet; thence north 2 degrees 25 minutes 00 seconds west 97.35 feet; thence south 87 degrees 35 minutes 00 seconds west 110.00 feet; thence south 87 degrees 00 minutes 00 seconds west 7.160 feet more or less to the Mean High Water Line of the Gulf of Mexico; thence along said Mean High Water Line, southerly 3275 feet more or less to 5 CODING: Words stricken are deletions; words underlined are additions. 10 {,f HB 1115, First Engrossed /ntc v 1 2 3 4 5 6 7 e 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 the east and west 1/4 line of said Section 21; thence along said east and west 1/4 line of Section 21; north 89 degrees 28 minutes 20 seconds east 1540 feet more or less to the place of beginning: being a subdivision of part of the south 1/3 of Section 16 and of part of the north 1/2 of Section 21, Township 49 South, Range 25 East, Collier County, Florida. Commencing at the northeast corner of government Lot 2 of Section 16, Township 49 South, Range 25 East, Collier County, Florida said corner being also the northeast corner of Lot 8 of Block 35 of Park Shore Unit No. 4 according to the plat thereof as recorded in Plat Book 10, pages 101, 102, and 103, Collier County Public Records, Collier County, Florida; thence along the north line of said government Lot 2, along the north line of said Park Shore Unit No. 4, and along the south line of Seagate Subdivision Unit No. 1 according to the plat thereof as recorded in Plat Book 3, Page 85, Collier County Public Records, Collier County, Florida, South 89 degrees 25 minutes 50 seconds west 1330.53 feet to the west line of said Park Shore Unit No. 4 and the place of beginning of the parcel herein described; thence along the west line of said Park Shore Unit No. 4 in the following described courses: 6 COOING: words strieken are deletions; words underlined are additions. I 10H HB 1115, First Engrossed /ntc 7 CODING: Words stricken are deletions; words underlined are additions. South 37 degrees 25 minutes 50 seconds west 2 250.89 feet, south 0 degrees 34 minutes 10 3 seconds east 225.44 feet, south 26 degrees 45 4 minutes 30 seconds east 632.19 feet and south 5 5 degrees 09 minutes 00 seconds east 580.72 feet 6 to the northwest corner of Park Shore Unit No. 7 3 according to plat thereof as recorded in Plat 8 Book 8, pages 59 and 60, Collier County Public 9 Records, Collier County, Florida; thence along 10 the west line of said Park Shore Unit No. 3, 11 South 5 degrees 09 minutes 00 seconds east 12 1879.04 feet to the north line of Park Shore 13 Unit No. 2 according to the plat thereof as 14 recorded in Plat Book 8, pages 54 and 55, 15 Collier County Public Records, Collier County, 16 Florida; thence along the northerly line of 17 said Park Shore Unit No. 2, in the following 18 described courses: north 84 degrees 00 minutes 19 00 seconds west 433.28 feet, north 2 degrees 25 20 minutes 00 seconds west 97.35 feet, south 87 21 degrees 35 minutes 00 seconds west 110.00 feet, 22 and south 87 degrees 00 minutes 00 seconds west 23 1160 feet more or less to the Mean High Water 24 Line of the Gulf of Mexico; thence along said 25 Mean High Water Line, northerly 3350 feet more 26 or less to a point on the westerly extension of 27 the south line of said Seagate Subdivision 28 which south line bears south 89 degrees 25 29 minutes 50 seconds west and passes through the 30 place of beginning; thence along said south 31 line and the westerly extension thereof, north 7 CODING: Words stricken are deletions; words underlined are additions. 1'O " "I HB 1115, First Engrossed /ntc 31 89 degrees 25 minutes 50 seconds east 1450 feet 1 more or less to the place of beginning; being a 2 part of the west 1/2 Section 16, Township 49 3 South, Range 25 East, Collier County, Florida, 4 containing 118 acres more or less. 5 Commencing at the northwest corner of the 6 7 northwest 1/4 of the northeast 1/4 of Section 8 16, Township 49 South, Range 25 East; thence 9 North 89 degrees 24 minutes 40 seconds East, 10 1650.75 feet along the north line of Parkshore 11 Unit 4 and Unit 5 to the place of beginning; 12 thence North 89 Degrees 24 minutes 40 seconds 13 East along said north line of Parkshore Unit 5, 14 740.98 feet; thence North 4 degrees 40 minutes 15 20 seconds West, 125.32 feet; thence North 89 16 degrees 24 minutes 40 seconds East, 4.73 feet; 17 thence North 4 degrees 40 minutes 20 seconds is West, 350.69 feet; thence North 89 degrees 24 19 minutes 40 seconds East, 197.19 feet to a 20 concrete monument on the coastal construction 21 line; thence west to the mean high water line of 22 23 the Gulf of Mexico; thence northerly along said 24 mean high water line to the North line of 25 Section 16, Township 49 South, Range 25 East; 26 thence East along the north line of said Section 27 16 to the northwest corner of Seagate 28 Subdivision; thence southerly along the west 29 line of said Seagate Subdivision to the place of 30 beginning less the following described lands: 31 IN, BB 1115, First Engrossed /ntc v 1 2 Parcel 2 in O.R. Hook 14, Page 195 and 196; 3 that parcel conveyed to Jane Homer Lee as 4 described in O.R. Book 34, Page 301 and 302; that parcel conveyed to Seagate, Inc., as 5 described in O.R. Book 182 Page 248 and 249. 6 Subject to existing easements and rights of 7 ingress and egress. 8 Section 2. Additional lands shall be included in the 9 district only upon amendment of section 1. Section 1 may be 10 amended only by special act, and such amendment shall not become 11 effective except upon approval of the inclusion of such 12 additional lands in the district by a majority of the qualified 13 electors residing in the area proposed to be included voting in 14 a special election called for such purpose. In addition the 15 inclusion of such lands must be approved by a majority of the 16 qualified electors residing within the existing district 17 boundaries. 18 19 Section 3. In the event that property in the district 20 is annexed by the City of Naples between January 1 and July 1 21 of any year, the property shall be regarded as removed from the 22 North Naples Fire Control and Rescue District as of January 1 23 of that year for the purpose of the levy of general ad valorem 24 taxes by the district. If annexation occurs after July 1 the 25 property shall be assessed by the district for ad valorem taxes 26 for that year. On and after the effective date of annexation 27 the district shall be relieved of providing fire service to the 28 annexed area. The city and the district may reach an agreement 29 to determine what portion, if any, of the existing indebtedness 30 or property of the district shall be assumed by the 31 municipality of which the annexed territory 10H HE 1115, First.Engrossed /ntc will become a part, the fair value of such indebtedness or 1 property, and the manner of transfer and financing. Nothing 2 herein shall relieve the property annexed from the payment of 3 general obligation debt service incurred by the district 4 before annexation. 5 ARTICLE IV 6 Powers of the District 7 Section 1. The district shall have the authority to 8 establish, equip, operate, and maintain a fire department and 9 rescue squad within the district and may buy, lease, sell, 10 exchange, or otherwise acquire and dispose of firefighting and 11 rescue equipment and other property, real, personal, or mixed 12 that it may from time to time deem necessary to prevent and 13 extinguish fires or provide rescue services. This shall 14 include, but is not limited to, the authority to hire and fire 15 necessary firefighters and other personnel; to provide water, 16 water supply, water stations, and other necessary buildings; 17 to accept gifts or donations of equipment or money for the use 1s of the district; and to do all things necessary to provide 19 adequate water supply, fire prevention, and proper fire 20 protection for the district. In addition, the board shall 21 have the authority to extend its services outside the district 22 when provided in cooperation with another governmental entity. 23 24 Section 2. The district may establish and maintain 25 emergency medical and rescue response services consistent with 26 section 191.008(1), Florida Statutes, and the provisions of 27 chapter 401, Florida Statutes, and any certificate of public 28 convenience and necessity or its equivalent issued thereunder. 29 Section 3. In addition to any other power to borrow 30 money as may be provided by this act or by law, the district 31 may borrow sufficient funds to provide for 3 months' operating -- 10 CODING: Words strieken are deletions; words underlined are additions. 10,.# HB 1115, First Engrossed /ntc expenses, with such loan to be repaid from anticipated 1 revenues. 2 Section 4. The district shall have authority to 3 inspect and investigate all property for fire hazards. The 4 district board, by resolution duly adopted, may assess fees 5 for fire inspection and maintenance and replacement of 6 hydrants in an amount reasonably related to the cost thereof 7 and may adopt provisions creating a lien or providing for 8 civil enforcement of such assessments. 9 Section 5. The district is authorized to promulgate 10 rules and regulations for the prevention of fire and for fire 11 control in the district, which shall have the same force and 12 effect as law 10 days after copies thereof executed by the 13 chair and secretary of the board have been posted in at least 14 three places. 15 16 Section 6. The duties and powers of the board of 17 commissioners shall be as set forth in this act and chapter 191, Florida Statutes, as they may be amended from time to 18 time. 19 20 ARTICLE v 21 Governing Board Section 1. The district shall be governed by a 22 district board consisting of five commissioners who are 23 24 residents of the district, in accordance with section 191.005, Florida Statutes. 25 26 Section2. As required by section 191.005, Florida Statutes, board members shall assume office 10 days following 27 their election. Annually, within 60 days after the newly 28 elected members have taken office, the board shall organize by 29 electing from its members a chair, a vice chair, a secretary, 30 31 11 CODING: Words strieken are deletions; words underlined are additions. 1 4 c E 7 8 9 ZO 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 MH HB 1115, First Engrossed /ntc and a treasurer. The positions of secretary and treasurer may be held by one member. Section 3. In accordance with section 191.005, Florida Statutes, each commissioner may receive, from the funds of the district, compensation for his or her services in an amount not to exceed $500 per month. The secretary- treasurer may be paid an additional sum for his or her services so long as the total compensation does not exceed $500 per month. Section 4. Members shall be reimbursed for travel and per diem expenses as provided in section 112.061, Florida Statutes. Section 5. In addition to any other circumstance which creates a vacancy in office as provided by the State Constitution or general law, the board shall remove a commissioner from office if the commissioner is absent from three consecutive regular meetings of the district board, unless such absence is due to a valid medical reason or any other excused absence as defined by resolution of the board pursuant to section 191.005, Florida Statutes. Section 6. The board shall operate procedurally in accordance with this act, with chapters 189 and 191, Florida Statutes, and with any other applicable general or special law as they may be amended from time to time. ARTICLE VI Finances Section 1. The powers, functions, and duties of the district regarding ad valorem taxation, bond issuance, other revenue - raising capabilities, budget preparation and approval, liens and foreclosure of liens, use of tax deeds and tax certificates as appropriate for non -ad valorem assessments, and contractual agreements, and the methods for financing the 12 conixa: Words strieken are deletions; words underlined are additions. 10H,I i HB 1115, First Engrossed /ntc district and for collecting non -ad valorem assessments, fees, 1 or service charges, shall be as set forth in this act, in 2 chapters 170, 189, 191, and 197, Florida Statutes, and in any 3 applicable general or special law as they may be amended from 4 time to time. 5 Section 2. The district board shall annually, during 6 the month of June, make an itemized estimate of the amount of 7 moneys required to carry out the provisions of this act for 8 the next fiscal year of the board, which fiscal year shall be 9 from October I to and including the next succeeding September 10 30, which estimate shall state the purpose for which the 11 moneys are required and the amount necessary to be raised by 12 taxation within the district, which budget and proposed 13 millage rate shall be noticed, heard, and adopted in 14 accordance with chapters 192 through 200, Florida Statutes. 15 Section 3. The total millage for the district shall 16 not exceed 1 mill in any one fiscal year. However, the total 17 18 millage may be increased pursuant to section 191.009, Florida 19 Statutes, after such increase has been approved by referendum. 20 Section 4. Taxes provided for herein shall be assessed 21 and collected, and subject to the same commission and fees for 22 assessing and collecting, in the same manner and form as 23 provided for the assessment and collection of county taxes, 24 except as otherwise provided herein. 25 Section 5. When the tax collector has collected the 26 taxes provided for by this act, he or she shall, on or before 27 the 10th day of each month, report to the secretary- treasurer 28 of the district board the collection made for the preceding 29 month and remit the same to the secretary- treasurer of the 30 board. 31 13 CODING: Words stricken are deletions; words underlined are additions. IOH k4'4 HE 1115, First Engrossed /ntc Section 6. All warrants for the payment of labor, 1 equipment, materials, and other allowable expenses incurred by 2 the board in carrying out the provisions of this act shall be 3 payable by the secretary- treasurer of the board on accounts 4 and vouchers approved by the board. 5 Section 7. The district shall have the power to issue 6 general obligation bonds, assessment bonds, bond anticipation 7 notes, notes, or certificates or other evidences of 8 indebtedness (hereinafter "bonds ") pledging the full faith, 9 credit, and taxing power of the district for capital projects 10 consistent with the purposes of the district in accordance 11 with the requirements of section 191.012, Florida Statutes, U and other applicable general law. 13 (1) Except for refunding bonds, no bonds shall be 14 issued unless the issuance thereof has been approved at a 15 referendum held in accordance with the requirements for such 16 17 referendum as prescribed by general law. A referendum shall be 18 called by the board of county commissioners upon the request 19 of the board of the district. The expenses of calling and 20 holding the referendum shall be borne by the district, and the 21 district shall reimburse the county for any expenses incurred 22 in calling or holding such referendum. 23 (2) The district may pledge its full faith and credit 24 for the payment of the principal and interest on such general 25 obligation bonds and for any reserve funds provided therefor 26 and may unconditionally and irrevocably pledge itself to levy 27 a special tax on all taxable property in the district, to the 28 extent necessary for the payment thereof, over and above all 29 other taxes authorized or permitted by this act. 30 (3) If the board determines to issue bonds for more 31 than one purpose, the approval of the issuance of the bonds 14 CODING: words stricken are deletions; words underlined are additions. 10 HB 1115, First Engrossed /ntc for each and all such purposes may be submitted to the 1 electors on one and the same ballot. The failure of the 2 electors to approve the issuance of bonds for any one or more 3 purposes shall not defeat the approval of bonds for any 4 purposes which are approved by electors. 5 (4) Notwithstanding any provision of law to the 6 contrary, all bonds issued under the provisions of this act 7 shall constitute legal investments for savings banks, banks, 8 trust companies insurance companies, executors, 9 administrators, trustees, guardians, and other fiduciaries and 10 for any board, body, agency, instrumentality, county, 11 municipality, or other political subdivision of the state and 12 shall constitute security which may be deposited by banks or 13 trust companies as security for deposits of state, county, 14 municipal or other public funds or by insurance companies, as 15 16 required, or voluntary statutory deposits. - 17 (5) Any bonds issued by the district shall be 18 incontestable in the hands of bona fide purchasers or holders 19 for value and shall not be invalid because of any irregularity 20 or defect in the proceedings for the issue and sale thereof. 21 (6) The state pledges to the holders of any bonds 22 issued under this act that it will not limit or alter the 23 rights of the district to levy and collect the taxes provided 24 for herein and to fulfill the terms of any agreement made with 25 the holders of such bonds and that it will not in any way 26 impair the rights or remedies of such holders. 27 (7) A default on the bonds of the district shall not 28 constitute a debt or obligation of a local general - purpose 29 _government or the state. 30 31 15 CODING: Words strieken are deletions; words underlined are additions. 1 2 3 4 5 6 7 e 9 10 11 12 13 14 15 - 16 17 18 19 20 21 22 23 241 25 26 27 28 29 30 31 ion "R' HE 1115, First Engrossed /ntc Section B. IMPACT FEES. - -The district board may allow for the assessment and collection of impact fees for capital improvement on new construction within the district. (1)(a) It is hereby found and determined that Collier County is located in one of the fastest growing areas in the nation, and new construction and the resulting population growth are placing a strain upon the capabilities of the district to continue to provide the high level of professional fire protection and related emergency services for which the residents of the district vav and which thev deserve. (b) It is readily apparent that additional equipment and facilities will be needed to meet the expanded commercial and residential growth within the district, at a cost beyond that which can be provided from current and anticipated ad valorem tax revenues assessed, collected, and received by the district. (c) It is hereby declared that the cost of new facilities and equipment for fire protection and related emergency services shall be borne by new users of the district's services, to the extent that new construction requires new facilities and equipment, but only to that extent. (d) It is therefore the legislative intent to transfer to the new users of the district's fire protection and related emergency services a fair share of the costs of new facilities imposed on the district by new users, (e) It is hereby declared that the amounts of impact fees for capital improvement provided for in this section are lust, reasonable, and equitable. (2) No person shall issue or obtain a building permit for new residential dwelling units or new commercial or 16 CODING: Words stricken are deletions; words underlined are additions. ION HB 1115, First Engrossed /ntc 1 industrial structures within the district, or issue or obtain 2 construction -plan approval for new mobile home developments 3 located within the district, until the developers thereof have 4 paid to the district the applicable impact fee for capital 5 improvement hereinafter set forth. Impact fees for capital 6 improvement to be assessed and collected hereunder shall not 7 exceed the following, unless revised pursuant to the provisions 8 of section 191.009(4), Florida statutes: 9 (a) Each new residential dwelling unit: $.15 10 per square foot of living area. 11 (b) Each new commercial or industrial structure: 12 $.30 per square foot of usable area. 13 (c) Each new mobile home development: $.15 per square 14 foot of permitted living area. 15 "Living area" means that area of any structure that is covered 16 by a roof. "Permitted living area" means 25 percent of the area 17 covered by the individual lots. 18 (3) For the purpose of this section, each unit of any 19 multifamily structure, whether it be a duplex, triplex, 20 cooperative apartment, or condominium or similar type of 21 structure, shall be considered a residential dwelling unit. 22 (4) For the purpose of this section, any motel, 23 hotel, shopping center, church, nursing home, hospital, 24 congregate living facility (when not part of an actual 25 residence), school, fraternal lodge, veterans' lodge, or similar 26 type of structure shall be considered a commercial structure. 27 (5) Impact fees for capital improvement collected by 28 the district pursuant to this section shall be kept and 29 maintained as a separate fund from other revenues of the 30 district and shall be used exclusively for the acquisition, 31 17 CODING: Words strieken are deletions; words underlined are additions. 1 2 3 h 5 6 7 8 9 10 11 12 13I 14j 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 3.0 31 10H HB 1115, First Engrossed /ntc purchase, or construction of new facilities and equipment, or portions thereof, required to provide fire protection and related emergency services to new construction. "New facilities and equipment" means buildings and capital equipment, including, but not limited to, such fire and emergency vehicles and communications equipment as may from time to time be deemed necessary by the district to provide fire protection and related emergency services to the areas of new construction. (6) The impact fees for capital improvement collected hereunder shall not be used for the acquisition, purchase, or construction of facilities or equipment which must be obtained in any event to meet the needs of the district, regardless of growth within the district. (7) The district board shall maintain adequate records to ensure that impact fees for capital improvement collected hereunder are expended only for permissible new facilities or equipment. (8) The district board shall determine the maximum amount of impact fees to be assessed in any one fiscal year. This determination shall be made prior to the immediately succeeding fiscal year. However, should the district board authorize the collection of impact fees in an amount less than the maximum specified in this act, then these fees shall be uniform in each tvue of new construction subiect to the fee. The district board's determination of the amount of the impact fee to be assessed in any one fiscal year shall be based on the requirements set forth in this section. (9) The impact fee for capital improvement called for in this section may be reduced by 50 percent if the owner of the permitted structure will install fire sprinklers in is CODING: Words strieken are deletions; words underlined are additions. 1 2 3 4 5 6 7 8 9i 10 11 12 13 14 15 16 17 18 ', 19 20 21 22 23 24 25 26 27 28 29 30 31 10 HE 1115, First Engrossed /ntc accordance with NFPA Pamphlets 13 and 13D. Only full sprinkler coverage is acceptable for this reduction. ADTT(T.V VTT miections Section 1. When a referendum or special election is required under the provisions of this act, the district shall reimburse the county for the costs of such election. Section 2. The procedures for conducting any district elections or referenda required and the qualifications of an elector of the district shall be as set forth in chapters 189 and 191, Florida Statutes. ARTICLE VIII Eminent Domain The district shall have the to exercise the ower of eminent domain, pursuant to chapters 73, 74, and 191, Florida Statutes, over any property located within the district, except municipal, county, state, and federal property, for the purpose of acquiring property for the location of fire stations. The location and construction of fire stations shall comply with applicable Collier County ordinances. ARTICLE IX Miscellaneous Section 1. All contracts, obligations, rules, resolutions, or policies of any nature existing on the date of enactment of this act shall remain in full force and effect, and this act shall in no wav affect the validitv of such contracts, obligations, rules, resolutions, or policies. Section 2. This act shall not affect the terms of office of the present district board, nor shall it affect the 19 CODING: Words stricken are deletions; words underlined are additions. 1. 2 3 4 5 6 7 8 9 10 11 12 13 14 15 v 16 17 18I 19 20. 21 22 23 24 25 26 27 28 29 30 31 10F RB 1115, First Engrossed /ntc terms and conditions of employment of any employee of the district. Section 3. Requirements for financial disclosure, meeting notices, reporting, public records maintenance, and planning shall be as set forth in chapters 189, 191 and 286 Florida Statutes, as they may be amended from time to time. Section 4. In the event of a conflict of the provisions of this act with the provisions of any other act the provisions of this act shall control to the extent of such conflict. Section S. In the event any section or provision of this act is determined to be invalid or unenforceable, such determination shall not affect the validity and enforceability of each other section and provision of this act. Section 6. Chapter 61 -2032, Laws of Florida; Chapter 75 -359, Laws of Florida; Chapter 76 -349, Laws of Florida; Chapter 77 -532, Laws of Florida; Chapter 77 -533, Laws of Florida; Chapter 78 -493, Laws of Florida; Chapter 80 -488, Laws of Florida; Chapter 80 -491, Laws of Florida; Chapter 82 -283 Laws of Florida; Chapter 83 -390, Laws of Florida; Chapter 84 -416, Laws of Florida; section 1 of Chapter 88 -519, Laws of Florida; Chapters 89 -448 and 89 -455, Laws of Florida; sections 1 and 3 of Chapter 91 -375, Laws of Florida; and Chapter 96- 512, Laws of Florida, and all references to the North Naples Fire Control and Rescue District contained in Chapter 98 -489 Laws of Florida, are repealed 10 days after the effective date of this act. Section 7. This act shall take effect upon becoming a law. Approved by the Governor JUN 4 1999 Ned in Office Secretary of State JUN 41999 20 COOING: Words stricken are deletions; words underlined are additions. not S IAIE OF PL(-)PJDA DEP.A TMENT OF STATE F 1I ..; I, KATHERINE HARRIS, Secretary of State of the State of 3 Florida, do hereby certify that the above and foregoing is a true .. and nnrrPrf rnrn> of T ?\,.. of Flnrirla Art. of 1000 _ as shown by the records of this office. 0 DSDS 99 (1 -99) Given under my hand and the Great Seal of the State of Florida at Tallahassee, the Capitol, this the 13th. day of July, A.D., 1999. Secretary of State 100 X r✓ .I 0 C U N C O N 'C Q E F Q m tj L C N E F E i- pN L 1— w` 0 N 0V 2 N U N L yu fv O .0 M d O a ti .n o a 00 0 19 19 M M 10 N O O O O N O m M O m W m o .- - n M m 0 o N In .- I n (9 �� o N r- m n ° N w m- J- O n d 1 O G' M o". 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I- I- m •N I � V v � o � CJ C O Q as C C WI� o In ❑ M n m W H O I M h o� n 0 p0 r I m ml m�� r) 00 Ir) m rn• (O N N1 C E r m o m n iN N n o o rn m a- m c m r M n o N m m m m m rn m m m m (O m m m O o) m m �O n n o rn T LL O L rn n N O t0 1p m N n ai of n m m (o ui •i r vi vi ro v v <o � ri o °o ui d' ,. ._ U N ot'o M'O'. V {� _ m O o C o ..ti 0 n11 , ' m O M e)) M1 O m u) , w q m aoq I o {U , n CI m O �i�lpp Nm W N m i� W OJ m M M O OtO K In 16 a]'. Ol m N O O r t0 V m O m rlh m 01 O n In M � 00 m O M (A h m Ol n rn m m 6I m m OI m m W m N N W M v o m v A m �n �� o o m M n V v° m o to r �• M m m m n m (p m m n m m n n m m n m m (p O o h o° v 2 B n v o n W n v m v 1 m ° m m n ° m m r v {o °o m m o m o) 1v N o o °o ° m m (v L O e�-1 in O� �-1 CI .� (D l`. W o m •^ N V �l) � 'U ♦- V V 'O N b 'O 9 O V 'O 'O "O V "Cl V V r N CI (•I CI N (•1 M M V eNy c1 V U tf (°U {^U r N. h N C N 0 N{' I Nf: N L' L IC r: f_ C G' L C f: C C C I nI N V N N N N N 1 N N N N N N N f.: 10H 10HI. Attachment D N IiLMA M U-11 Prepared with the assistance of: Phil Kouvve Kent Greene Robert McNally Matt Hickey Emergency Services Consulting inc. 1 25200 SW Parkway Ave. Suite 3 Wilsonville, OR 97070 503-570-7778 800-757-3724 fax: 503-570-0522 www.escLus IOU Cattier County,.Flodda — EPAS System Master Plan Tableof Contents ............................................................................ ............................... Tableof Figures ....................•......................................................... .............................if Tableof Equations .......................................................................... .............................vi ExacutiveSummary....... ............................................................................................... 1 SectionI .................................................................................... ..............................2 SectionIf .................................................................................... ..............................4 SectionIII ................................................................................... ..............................5 Section One — Current Service Delivery Analysis .................... .............................11 Community Baseline — Organizational Overview ....................... .............................11 Average Cost of Compensation for Operational Personnel ....... .............................16 MedicalOversight ..................................................................... .............................28 FiscalAnalysis .......................................................................... .............................30 ImpactFees .............................................................................. .............................34 Helicopter Operations ( MedFlighq ... ....................................................................... 37 CapitalAssets ........................................................................... .............................41 DistributionAnalysis .................................................................. .............................63 Response Time Performance Objectives .................................. .............................66 Dynamics of Medical Emergencies ............................................ .............................67 Response Time Capability ........................................................ .............................72 Current Population Information .................................................. .............................78 DemandAnalysis ...................................................................... .............................93 ReliabilityAnalysis .................................... ...........................:... ............................103 Recorded System Response Performance .... ..... ..... ............................ ................. 113 Section two — Future System Demand Projections ................ ............................123 CommunityGrowth ................................... ............................... ............................123 PopulationGrowth ..................................... ............................... ............................124 Community Growth Planning ..................... ............................... ............................126 Workload and Geographic EMS Unit Minimum Needs ............. ............................131 Demographic Composition Changes ......... ............................... ............................150 Future Workload Projections based upon Population Growth ... ............................152 Adjustment for Concurrent Call Frequency .................................................. .... .. ... 160 Projected Geographic Expansion of Workload ......................... ............................165 10H Collier County, 19orida — EMS System Blaster Plan Section Three — Conclusions and Summary ........................... ............................173 APPENDICES.................................................. ............................... ............................180 APPENDIX A: Summary of Recommendations ........................... ............................181 APPENDIX 3: Three- Person Ambulance Staffing ....................... ............................183 APPENDIX C: Cost Projections. ................................ ............................................... 184. CapitalEquipment Costs ........................... ............................... ............................184 Recurring Expenditures ............................. ............................... ............................185 Total Cost to Staff One Ambulance.... ... .................................................... .... __ 186 10H Collier County, Florida — ENIS System Master Plan Tabl@ of Figures Figure '1: Average Cost of Compensation for Classification of EMT01 ...........................17 Figure 2: Average Cost of Compensation for Classification EMT02 .. .............................17 Figure 3: Average Cost of Compensation for Classification PAR01 .. .............................18 Figure 4: Average Cost of Compensation for Classification PAR02 .. .............................18 Figure 5: Average Cost of Compensation for Classification PFF01 -- ...........................18 Figure 6: Average Cost of Compensation for Classification PFF02 .. .............................19 Figure 7: Average Cost of Compensation for Classification PARCO .............................19 Figure 8: Average Cost of Compensation for Classification PFFCO . .............................20 Figure 9: Composite Average Cost of Compensation for All Field Staff ......................... 20 Figure 10: Incentive Pay Distribut ion ................................................ .............................21 Figure 11: Collier County EMS Organizational Chart ..... -- .............. .............................23 Figure 12. Fire Districts Providing ALS Engines ............................... .............................25 Figure 13: Emergency Medical Services Advisory Committee Membership ..................29 Figure 14: Collier County EMS User Fees ........................................ .............................31 Figure '15: Gross EMS Collections, 2004 - 2006 ............................... .............................31 Figure 16: Collier County EMS Budget Compared to Budgeted Revenue .....................32 Figure 17: Budget to Actual Revenue Comparison ........................... .............................33 Figure 18: Comparison of Personnel Costs to Total Budget ............. .............................34 Figure 19: Collier County EMS Impact Fees ..................................... .............................35 Figure 20: Collier County EMS Impact Fees ( cant) ........................... .............................36 Figure 21: EMS Impact Fees Collection vs. Expenditure, 2003 - 2007 ..........................37 Figure 22: Helicopter Operations Budget and Personnel Costs ........ .............................38 Figure 23: Helicopter Operations Budget to Revenue ....................... .............................39 Figure 24: Medflight Service Demand ... .............................. ......... --- ... ..... .. ... .. ........... 40 Figure 25: Collier EMS Station Deployment ..................................... .............................64 Figure 26: ALS Engine Locations,.. ... ...................... ......................... ................. ........ 66 Figure 27: Cardiac Arrest Event Sequence ..... ....... ........ .............. --- .......... ................ 68 Figure 28: Travel Time Capability from a CGEMS Station in the Naples Area ...............73 Figure 29: Travel Time Capability from the Immokafee Stat ion ......... .............................74 Figure 30: Travel Time Capability from the Everglades City Station . .............................75 Figure 31: Travel Time Capability from the Stations on the Isle of Capri and Marco Island. ..................................... ...................................................... .... _........................76 10H I Collier County, Florida - MMS System ulasler Plan Figure 32: Travel Time Capability from Area Hospitals ..................... .............................77 Figure 33: Population History ........................................................... .............................78 Figure 34: Naples Area Population Density ...................................... .............................79 Figure 35: Everglades City Population Density ................................. .............................80 Figure 36: Immokalee Area Population Density ................................ .............................81 Figure 37: Isle of Capri & Marco Island Population Density .............. .............................82 Figure 38: Collier EMS Population by Age ........................................ .............................83 Figure 39: Pediatric Population Density. ................... ............................. ...... _ .............. 84 Figure 40: Median Age of Population ............................................... .............................87 Figure 41: Patient Age Ranges ........................................................ .............................88 Figure 42: Median Income.. ............................. ............ .......... _ ................................... 89 Figure 43: Collier County Housing by Occupancy ............................. .............................90 Figure 44: Renter Occupancy Density .............................................. .............................91 Figure 45: Vacant Housing Density .................................................. .............................92 Figure 46: Locations of Patients for Collier County EMS .................. .............................93 Figure 47: Monthly Workload ............................................................ .............................94 Figure 48: Workload by Day of Week .............................................. .............................95 Figure 49: Workoad by Hour of Day... .................................................. ....................... 96 Figure 50: Immokalee Service Demand Density ............................... .............................97 Figure 51: Naples Area Service Demand ......................................... .............................98 Figure 52: Isle of Capri & Marco Island Service Demand ................. .............................99 Figure 53: Everglades City Service Demand .... ............................... ............................100 Figure 54: Eastlands Area Service Demand ..... ............................... ............................101 Figure 55: High Potential Use Facilities ............ ............................... ......:.....................102 Figure 56: Call Disposition Results ................... ............................... ............................103 Figure 57: Unit Hour Utilization... ............. .... __ ........... ......................................... 104 Figure 58: Table of Concurrent Calls by Zone .. ............................... ............................106 Figure 59: Concurrency, Chart by Response Zone .......................... ............................107 Figure 60: Two-Call Concurrency ..................... ............................... ............................108 Figure 61: Three-Call Concurrency .................. ............................... ............................109 Figure 62: Four -Call Concurrency ....... .................... ... ................ ................................. 110 Figure 63: Percentage of Cut -of -Zone Responses per Unit ............ .............................11 I Figure 64: Reliability ....................................... ............................... ........................ ...113 Figure 65: Collier EMS Response Time Performance History ...._ ... ............................116 �a 1 0 H ' I Collier County, Florida - EMS System Master Plan Figure 66: Average Response Time by Hour of Day ........................ ............................117 Figure 67: 901h Percentile Response Time by Hour of Day....... ... _ .............................. 119 Figure 68: Response Performance by Zone ..... ............................... ............................120 Figure 69: Average Response Time Performance......... ....... ...................................... 121 Figure 70: Grid Response Performance ........... ............................... ............................122 Figure 71: Collier Growth Areas... ............................................ ...................... __ ......... 124 Figure 72: Population Projections ..................... ............................... ............................126 Figure 73: LOSS Unit UHU by Hour of Day _ .... ............................... ............................130 Figure 74: Minimal Geographic Coverage .............. ............. ........................................ 132 Figure 75: Annual Average Concurrent Call Amounts ................................ ................. 133 Figure 76: Concurrency by Response Zone ..... ............................... ............................134 Figure 77: Apparatus'Out of Zone' Responses ............................... ............................135 Figure 78: Host Unit 'In Zone' 90th Percentile Response Performance,. ... __ ............ 136 Figure 79: Concurrency by Hour of Day ........... ............................... ............................137 Figure 80: Minimum Unit Needs Based upon Workload by Hour of Day ......................138 Figure 81: Current Unit Needs by Hour of Day . ............................... ............................139 Figure 82: Minimum Units Needed by Area by Hour of Day ............. ............................140 Figure 83: Fire Districts and EMS Response Zones ........................ ............................143 Figure 84: First Arrival Concurrency Analysis for Zones 1, 2, and 3 ............................144 Figure 85: First Arrival Concurrency Analysis for Series 20 Zones .. ............................145 Figure 86: First Arrival Concurrency Analysis for Series 40 Zones .. ............................146 Figure 87: First Arrival Concurrency Analysis for Zone 50 (Marco Island) .... ............... 147 Figure 88: First Arrival Concurrency Analysis for Series 70 Zones . ............................148 Figure 89: Response Time Performance for Calls within ALS Engine Districts ..... ... .... 149 Figure 90: ALS Engine Reliability by EMS Response Zone ............. ............................150 Figure 91: EMS Utilization Rate by Age Range ............................... ............................151 Figure 92: Weighted Population Projections by Age Range ............. ............................153 Figure 93: Projected Population Growth by Age Range.. ............................................ 154 Figure 94: Total Population Projections ............ ............................... ............................155 Figure 95: Workload Projections ....................... ............................... ............................156 Figure 96: Projected Workload by Age ............. ............................... ............................157 Figure 97: Total Workload Projections .............. ............................... ............................158 Figure 98: Growth Rate Comparison.. ............ ................ ..................................... ... _ 159 Figure 99: Projected minimal units needed by Wei dead Threshold.. ......... ........ ....... 160 v MR"" Collier County, Florida- EhIS System Master Plan Figure 100: Projected Unit Needs Based on the Hour of Day .......... ............................152 Figure 101: Peak Hourly Units and Population Change ................... ............................163 Figure 102: Projected Growth in EMS Utilization ............................. ............................164 Figure 103: Table of Growth Unit Needs .......... ............................... ............................164 Figure 104: Reserve Unit Capacity Analysis. .......................................... ............ 165 Figure 105: Collier County Planning Communities ....... ..... ... I .... I ..... ..,.... .......... ...... . .... 166 Figure 106: Population Change by Planning Community ................. ............................167 Figure 107: Projected Planning Community Service Demand ......... ............................168 Figure 108: Projected Percentage of Change in Service Demand ... ............................169 Figure 109: Peak Hour Minimum Unit Needs by Area ..................... ............................170 Figure 110: Additional Unit Needs .................... ............................... ............................171 Figure 111: Summary Table of Calculation Results .......................... ...........................'178 Figure 112: Annual Recurring Vehicle ExpenditUrest ...................... ............................186 Figure 113: Total Cost to Staff One Transport Ambulance .............. ............................187 Equation 1: Current Methodology Evaluation Given Utilization ........ ............................127 Equation 2: Unit Hour Utilization Calculation .... ............................... ............................128 Equation 3: Utilization Rate Determination ....... ............................... ............................151 Equation 4: Adjusted Workload Projection by Age Range ............... ............................155 Equation 5: Minimum Units Needed based on Workload ................. ............................160 Equation 6: Minimum Units Needed by Hour of Day ........................ ............................161 r�_1 -. i •n 1; r ,'' -x-1.1 10 �H ►: � ., Colller County, Florida - EMS System Master Plan Execillive sunlinl fry This Emergency Medical Services Master Plan for Collier County, Florida is offered in response to a request by Collier County government. The purpose of this rnaster plan was to review and analyze current deployment of emergency medical resources within Collier County and to assess future needs specific to resource deployment, staffing, operational policies and addition of growth units to the system. ESCf would like to thank the staff and elected officials of Collier County, as well as the staff of the City of Naples Fire Department, East Naples Fire Control District, North Naples Fire Control District, Golden Gate Fire Control District, Isle of Capri Fire Control District, and Marco Island Fire Department for the excellent cooperation in the preparation of this report. All involved were candid in their comments and provided a large amount of information in a short period of time. Each report objective provides the reader with general information about that element, as well as specific observations and analysis of any significant issues or conditions that are pertinent to the topic discussed. Observations are supported by data collected during the information gathering process, through analysis of the collected data, and from the collective emergency services experience of the ESCi consultants. Finally, specific findings and conclusions are included to resolve identified issues and to take advantage of any opportunities that may exist. It should be noted that one of the primary focuses of this study was to determine the validity of the current LOSS method of determining growth unit additions to the system. In order to evaluate the current methodology, a significant amount of mathematical analysis was accomplished. Further, a new mathematical methodology was created to assist the AUIR and productivity committees in determining the need for additional growth units. This methodology, although relatively complicated, accounts for the various aspects of determining service demand and utilizes projected population figures made available to ESCI. Collier County, Florida — UJI S System Master Plan Section I M Section I includes a detailed review of the resource deployment and staffing system in place within Collier County EMS in its provision of emergency medical services (EMS). Ancillary support systems within EMS have also been reviewed as well to understand, in totality, the system in place for emergency medical incidents. The criteria used to evaluate the department have been developed over many years. These criteria include relevant guidelines from national accreditation criteria, the National Fire Protection Association, federal and state mandates for EMS systems, recommendations by various medical communities (AMA, FACEP, AHA), and generally accepted practices within the EMS industry. From the standpoint of general policy, ESCi recommends that Collier County EMS more closely monitor performance objectives to guide the EMS resource deployment and provide a more accurate measure of service quality. There are areas within Collier County that benefit from the current deployment scheme and some areas that do not benefit to the same degree. Although the current deployment places units in the areas with the highest service demand, residents further away from the more densely populated areas face increasing response times, particularly as the number of simultaneous calls (concurrency) increases. Through analysis of current system deployment and system performance, ESCi Is able to Identify several issues where improvement can be achieved. These Issues are summarized in the following paragraphs: Collier County, Florida - FNS System Master Plan o Create a new position within EMS Administration (Assistant Chief for Administration) to reduce the current span of control of the Chief of EMS It is evident that the Chief of EMS and the two Deputy Chiefs and Battalion Chiefs are reaching, or exceeding, their recommended maximum span of control for direct reports. It is the recommendation of ESCi to create a new position within EMS administration (Assistant Chief for Administration) to oversee administrative responsibilities, thereby allowing the current Deputy Chiefs to concentrate on supervising field operations. Explore additional Battalion Chief positions within the operations division to reduce supervisory span of control to the county recommended seven personnel. The current organization of the agency extends the span of control of field supervisors to between 16 and 22, well above ail recommended limits. Reducing the current span of control will allow field supervisors to more accurately evaluate field personnel and make them more available for response to major incidents throughout Collier County. Increase consistency among all ALS providers and ensure that all providers are able to perform equal skills and procedures prior to 'certifying' them to function within the system The benefits of the ALS engine program are discussed in the report but, for the purposes of this summary, suffice it to say that all Advanced Life Support (ALS) providers functioning within Collier County should have the same level of education and training and be allowed to perform at a consistent level of care, regardless of the organization for which they operate. FSCi's findings support this concept, as the data indicates the ALS engine program provides quantifiable benefit to the overall delivery of emergency medical services, particularly when system demand is high. The State of Florida sets minimum training standards for paramedics and the local Medical Director determines what additional education and clinical requirements must be met prior to functioning autonomously, Therefore, within Collier County, all fire departments with paramedic capable services must adhere to the same EMS requirements far training and skill 10 H� Collier Courtly, Florida - EMS System chaster Plan competencies as an EMS paramedic in order for this parity in service provision by ALS engine paramedics to be recognized. Section If Section II develops population and service demand projections necessary for the creation of future deployment strategies. It does so by examining current and future risk factors for the county, which include population projections, as well as socioeconomic and demographic compositions. All of these factors translate into a community risk assessment of countywide variables that affect current and projected impacts on service demand_ These impacts are then utilized to determine how service demand is translated into utilization, thereby determining the minimum number of units needed as well as an appropriate level of reserve capacity within the system. 4 ej Coiliar County, Florida – EPr7S System Master Plan Section Ili I v This section provides an evaluation of the current methodology utilized by Collier County to determine the need for additional EMS units. ESCi recommends the use of a weighted population figure, since it takes into account seasonal population increases and doesn't allow overestimation by using peak population or underestimation by using residential population only. However, the current formula fails to consider other factors involved that will affect the provision of additional growth units in the future. Specifically, these factors include! • Projected demographic changes • Definition of geographic scale • The effect of simultaneous calls Current and potential contribution of AILS engines Because these factors are not taken into account, this methodology may be too simplistic and result in an inaccurate estimation of additional growth units. In order to develop a more valid methodology, ESCi first evaluated the current workload of Collier County EMS to determine the minimum amount of units needed based upon the effects of concurrent call frequency, the availability of ALS engines, and current population composition. ESCi also analyzed various scenarios for additional reserve unit capacity determination. It should be noted that, as mentioned above, the ALS engines can play a significant role in the delivery of ALS care within Collier County if used appropriately. It is redundant to dispatch both a Collier County EMS unit and an ALS engine to a call when both units will be responding from the same or nearby locations. Where co- located with a transport unit, ALS engines should be utilized on concurrent calls within their respective areas allowing transport units to remain in areas outside of those higher service demand districts. For example, a Collier County EMS unit co- located with an ALS engine should not be dispatched together with that engine to the first call within their district. The EMS unit should be dispatched independently unless additional manpower is, or is expected to be, necessary. The ALS engine should remain in quarters and available to respond if a concurrent call occurs within that district while the EMS unit is handling the initial call. f�7.' - —: vi- q j. 10H Collier County, Florida — EMS System Master Plan If the ALS engine is considered as an initial responding EMS unit for purposes of response time performance analysis, the result would be improved response times within the zone. The response time clock measure would stop when a paramedic (either Fire or EMS) reaches a patient, since response time objectives are based upon patient care rather than what type of vehicle responds to the call. There may be times in which the ALS engine could cancel the EMS unit, thereby adding reserve capacity back to the EMS system. Most times, transportation is necessary, but patient transportation Occurs only after an initial patient examination and initial emergency care modalities. Therefore, the out of area responding EMS transport unit is not measured by an initial response time, but rather a secondary measure in those cases where an ALS engine paramedic has arrived first. Once current workload and associated factors have been determined, ESCi utilized this information to project future growth unit needs based upon future workload demand, projected population totals, and by projected population composition. The table below takes these factors into consideration in determining growth unit "trigger" population numbers through the year 2030. Because one of the strongest effects on the utilization of EMS Is age, population projections by age range were one of the factors utilized in determining projected workload. Semi - decennial projections of population by age were available by the University of Florida's Bureau of Economic and Business Research and the individual years between those projections were determined based on linear projections. The table below illustrates the results of ESCi's calculations In determining a new trigger population for adding growth units to the system. The 'Growth Unit Trigger' column shows the newly calculated threshold. This number changes annually based on changes in the weighted population as calculated from the BEBR population projections. The column titled 'Projected Population' shows the total weighted population used to determine the trigger threshold. The final column is a simple division of the total population by the total number of projected units within the system in any given year. In short, the column highlighted in green should be referenced for the purpose of determining the timing of additional growth units, as requested by the AUIR and productivity committees. ion Collier County; Florida - EMS System blaster Plan It is important that the growth unit value in the table is not inadvertently misused. The 'Growth Unit Trigger' can not he used as a divisor of the total population to determine the minimum unit needs. This value should only be used as a measure of population increase since the last addition of a growth unit. The "Resulting Population per Unit' column is included as a reference for those interested in a ratio of population per unit. It should be noted that the weighted population figures used to calculate the new trigger threshold population are projected estimates and may need to be reexamined periodically. Given the detailed calculations utilized by ESO to come to these conclusions, it is recommended that Collier County consider having the calculations updated after any significant revisions to population estimates are produced by BEER. 1OH Collier County, Florida — EMS System Master Plan - 1erl "l� +�` lldt- tG��ll1 ' {I'111ii1nl, t trjjCtYCu if:�tlfp,l { ((.l +l iTL) rat il,,�t I i'.I IrIC -t�C -( :_ 1 `+riliTLlatl linrts 2007 26279 398098 15924 2008 25391 415783 16193 1 2009 24757 433789 16420 1 2010 26279 450655 16651 1 2011 23487 466732 16839 1 2012 22853 483388 16998 1 2013 22218 500643 17137 1 2014 21583 I 518517 17255 1 2015 1708'1 536061 17250 1 2016 20314 553231 17340 1 2017 19680 570954 17403 1 2018 19045 589248 17447 1 2019 18410 606131 17473 1 2020 18'110 626610 17492 1 2021 17141 644641 17484 1.2 2022 16506 663193 17457 1.2 2023 15872 682282 17412 1.2 2024 15237 701924 17350 1.2 2025 15745 721079 17284 1.2 2026 13968 739706 _ 17242 v� 1.2 2027 13333 758817 17126 1.2 2028 12698 778424 16991 1.2 2029 12064 788500 16836 1.2 2030 11410 798540 16747 1.2 'Ihe Information contained in the (able above Is based on the 2005 weighted population average. In ESCi's evaluation of Collier County EMS, we have determined that, overall; the system's performance is not unlike most other EMS systems in the state of Florida. Current station placement is adequate for current service demand and plans are underway to make use of facilities in rapidly developing areas. County personnel 8 ;:I 1Vfl Collier County, Florida — EMS System ililac:ier Plan recognize the need for periodic outside assessment and evaluation and have actively sought that assistance. Finally, the EMS system is stable In its administration and oversight and is considered progressive within the region. To assist with meeting alternating patterns of service demand, Collier County EMS should consider the implementation of a schedule that fluctuates similarly to peal( service demand. In every study, ESCi attempts to provide a detailed analysis of the current system and, from there, develop recommendations based on scientific projections and estimations of future service demand and other indicators that affect the system as a whole. This report was extremely technical in nature and ESCi has attempted to summarize the more complicated information into a succinct format that can be easily applied by EMS administration and the AUIR and productivity committees. r`f Collier County, Florida - EMS Syslem Rilusier Plan This page left blank 10 Jon kill 10H i Collier County, Florida – Ei»tS System Toaster Plan Cojjjei' Ci)l.1nty, '')O'ridja — ElNI a S1ysll; Tl lj1 + i)r Pji:ln Emergency Services Consulting inc. (ESCi) has been retained by Collier County, Florida, to evaluate the current EMS system to improve efficiency, effectiveness, and responsiveness to the citizens of Collier County as well as to develop or validate the current methodology utilized to determine the addition of growth units to the EMS system. As such, ESCi developed a methodology to fully evaluate the Bureau of Emergency Services EMS Division and the following information is a report of our findings and recommendations. Section One - Curroni Service Delivery Analysis The first objective of any study should be to evaluate the current level of service delivered by the organization. Section One accomplishes this by evaluating the current responsibilities, chain of command, organizational structure, budget and funding, and current service delivery infrastructure. This section also evaluates personnel and staffing levels and analyzes existing standards of response coverage and staff distribution. Additionally, ESCi has evaluated current capital assets, including facilities and vehicles, as well as completed an analysis of current deployment strategies and performance. Community Baseline — Organizational Overview Collier County Emergency Medical Services (EMS) was established by the Collier County Board of Commissioners in 1981 as a consolidated countywide EMS agency providing service to the city of Naples, the city of Marco Island, Everglades City, and all unincorporated areas of Collier County to include North Naples, East Naples, Golden Gate, Big Corkscrew, Isle of Capri, and Immokalee, serving a total resident population of more than 302,000.' The EMS system was presented with both the 1999 Florida Paramedic Service of the Year and 2000 National EMS Provider of the Year awards. In addition, the system operates an aeromedical unit, Medflight, from the Naples Municipal Airport, serving as a primary means of transportation of patients from outlying areas of the county where ' 2005 Census Bureau, Economic Development information. -i 1 J�Ofl r1°4 Collier County, Florida -- EMS Systern Master Plan ground transportation could be detrimental to patient care due to extended travel times, such as along 'alligator alley'. Stalling Not including administrative and supervisory personnel, Collier County EMS employs a total of 163 full -time staff comprised of 123 Paramedics and 40 EMTs. There are currently 12 field Battalion Chiefs (field supervisors) and one Battalion Chief that oversees the training of the entire department. The remainder of the department is comprised of logistical, training, administrative, and operations support staff. The department also utilizes 20 budgeted part -time positions as needed to fill vacancies created by vacation or unscheduled sick leave absences. Although primarily a provider of pre - hospital emergency medical care, Collier County Bureau of Emergency Service EMS Division is recognized as a fire department by the state of Florida, allowing personnel to be certified and receive training as both medical -- personnel and firefighters. This also allows personnel from EMS to 'swap' onto ALS engines and function as both paramedics and firefighters for the departments participating in the ALS engine program. The ALS engine program will be discussed in a separate section of this report. The operational staff of Collier County EMS participates in collective bargaining and is represented by the Southwest Florida Professional Firefighters, Local 1826, International Association of Firefighters, Inc. (IAFF). The personnel covered by the collective bargaining unit include: Emergency Medical Technician Paramedic Paramedic/Firefighter Helicopter Pilot Lieutenant (Company Officer) Lieutenant (Company Officer) /Paramedic /Firefighter Personnel not covered by the collective bargaining unit include: Managerial Employees Confidential Employees 10H Collier County, Florida - EMS Syslern Master plan All employees not specifically included above Rates of pay, as well as method of overtime calculation, seniority, work schedule and hour limits are outlined in the collective bargaining agreement dated 11 October 2006. The work schedule for a majority of Collier County EMS units consists of 24 hours on duty followed by 48 hours off duty on a repeating cycle. Some units operate on a 12- hour schedule, but the bargaining agreement prevents system -wide conversion to a 12- hour schedule. All overtime is paid in accordance with the Fair Labor Standards Act (FLSA), which requires that all hours worked in excess of 40 within the same workweek be paid at a rate of time and one half. For the purposes of overtime calculation, scheduled vacation, and holiday time are counted as hours worked. Holidays are paid at 12 hours per holiday (for 12 -hour and 24 -hour personnel) or 8 hours of paid time off (for 40 -hour personnel). Collier County recognizes 11 holidays per calendar year and employees are paid for those holidays as they occur. No 'banking' of holiday time is allowed. There are several levels of field emergency medical provider within the state of Florida, ranging from the first responder level up to the paramedic level. The following is a brief description of each. More detailed information can be obtained from the Florida Department of Health, Bureau of Emergency Medical Services. Specific information relating to the skills and procedures associated with each individual level of certification can be found in Chapter 401 of the Florida Statutes and Chapter 64E -2 of the Florida Administrative Code. The information contained below is only for comparison and illustration of the various levels of pre - hospital provider available within Collier County. Specific skills, medications, and procedures are determined by the local medical director. First Responder The first responder certification is recognized by the state for those individuals who receive basic medical training below the level of Emergency Medical Technician (EMT). fs] ., I 13 1110H H Collier County, Florida — EMS S /stern M83ler Plan These individuals include police officers, firefighters not trained to the EMT level, and first aid units specifically designed to render basic medical care and assist responding ambulance units or other higher trained personnel. Basic aid such as CPR, Hefmlich maneuver, vital sign assessment, splinting, oxygen delivery, and automatic external defibrillation are a part of the skill set possessed by the first responder. In addition, they are able to assist patients with auto - inject epinephrine, oral glucose administration, and childbirth. Emergency Medical Technician (EMT) The statutes of the state of Florida concerning operation of emergency medical vehicles indicate that any person who has received the proper driver education and training may operate an emergency medical vehicle while transporting a patient. It is, however, an accepted norm that one Emergency Medical Technician and one EMT - Paramedic are on board the vehicle while transporting any patient in an Advanced Life Support system. The Emergency Medical Technician (EMT- Basic) can perform skills in addition to the first responder that include: • Military Anti -shack Trousers (MAST) • Assisting patients with Aibuterol inhalers • Blood glucose monitoring • Traction splint application Emergency Medical Technician - Paramedic (EMT•P) As the highest level of pre - hospital provider in the state of Florida, the paramedic is certified to provide several skills in addition to all the skills afforded to the previous levels of providers. They include: o. Endotracheal intubation o Blood draw sampling Needle thorocostomy 0 Tracheebroncial suctioning Synchronized cardioversion and transcutaneous pacing 2 In accordance with Section 401.281, F.S., 401.281 (b) and (c), F.S„ and 316.003(1), F.S. 0 _: oral Collier County, Plorlda — ENiS Syateai Ltaatar Plan • IV initiation • Medication administration as allowable • Cricothyratomy, either surgically or utilizing a needle catheter • Insertion of a naso.- gastric tube for gastric decompression • Intubation assisted by paralytic agents as well as assisted by non- paralytic medications • Nasotracheal intubation • Mechanical ventilation systems Collier County EMS operates a majority of its units with two paramedics. Due to the 'swap' program with the fire districts participating in the ALS engine program, some units lose one paramedic to the ALS engine; and, in return, are supplied with one firefighter /EMT whose primary responsibility is to drive the EMS transport unit. Supervisory and Administrative Personnel The Chief of Emergency Medical Services is responsible for the oversight of operations and administration of the division. This position has seven direct reports including two Deputy Chiefs, one Chief Pilot for Medflight, one Operations Analyst, one Revenue Manager, one Administrative Assistant, and one Database Manager, and delegates a significant amount of operational control to the Deputy Chiefs. Based on standards for span of control, the Chief of EIv1S and the Battalion Chiefs are at an operational limit and could possibly benefit from an additional Division Chief for Administration. There are currently 13 Battalion Chief positions who oversee day -to -day operations of the field staff. These Battalion Chiefs report to two Division Chief positions that have been delegated operational control of the department. Span of control of the Deputy Chiefs, is within acceptable levels. An organizational chart is provided as Figure 1 t to illustrate the connection and span of control of all personnel identified within this report. Collier County, Florida — EMS System Pilaster Plan I Recommendation: ion Create a new position within EMS Administration (Assistant Chief for j Administration) to reduce the current span of control of the Chief of EMS a Explore additional Battalion Chief positions within the operations division to reduce supervisory span of control to county recommended seven personnel Average Cost of Compensation for Operational Personnel In evaluating the salaries of all Collier County EMS personnel, ESCi utilized standard computational techniques to determine the average cost of compensation for departmental personnel. For the purposes of this study, ESCI focused on field personnel based on the fact that these personnel make up the bulk of the personnel costs for the department. Field personnel combine several varying levels of certification to make up the total operational staff. The transport units within Collier County are comprised of personnel classified as the following: EMT -1, EMT -2, Paramedic -1, Paramedic -1, Paramedic Company Officer, Paramedic /Firefighter -1, Paramedic /Firefighter -2 and Paramedic/Firefighter Company Officer. Each of these groups was evaluated to determine an average cost of compensation, including base salary, benefits, and ancillary costs associated with employment. The results of that analysis are indicated in the following paragraphs and figures. EMT -1 This level of classification Is comprised of temporary or part -time personnel at the EMT level. Collier County currently employs 17 personnel within this classification. The total cost of compensation for this classification Is Indicated in the figure below. IOH Collier County, Florida- F_ttt7S Systern Masker Plan Figure 1: Average Cost of Compensation for Classification of EMT01 Average Base Salary $40,072.96 Benefits $0.00 Ancillary Costs $1,525.00 Total Average Cost of Compensation $41,597.96 This level of classification is not included in the total full -time average cost of compensation shown at the end of this section. EMT -3 This level of classification is comprised of permanent or full -time personnel at the EMT level. Collier County currently employs 37 personnel within this classification. The total cost of compensation for this classification is indicated in the figure below. Figure 2- Average Cost of Compensation for Classification EMT02 Average Base Salary $45,072.38 Benefits $20,242.88 Ancillary Costs $1,525.00 Total Average Cost of Compensation $66,840.26 Paramedic -1 This level of classification is comprised of permanent or full -time personnel at the EMT - Paramedic (EMT -P) level but who are not yet ready to function independently. Collier County Currently employs 18 personnel within this classification. The total cost of compensation for this classification is indicated in the figure below. l0H Collier County, Florida — Mb1$ System Pilaster t'lan Figure 3: Average Cost of Compensation for Classification PAR01 Average Base Salary $47,234.22 Benefits $20,747.02 Ancillary Costs $1,525.00 Total Average Cost of Compensation $69,506.24 Paramedic-2 This level of classification is comprised of permanent or full -time personnel at the EMT -P level and is allowed by the EMS Medical Director to function independently of another EMT -P. Collier County currently employs 28 personnel within this classification. The total cost of compensation for this classification is indicated in the figure below. Figure 4: Average Cost of Compensation for Classification PAR02 Average Base Salary $49,327.83 Benefits $21,235.25 Ancillary Costs $1,525.00 Total Average Cost of Compensation $72,088.08 ParamediGPireiighfer -1 This level of classification is comprised of permanent or full -time personnel at the EMT -P level who are also certified firefighters but are not yet allowed to function independently as an EMT -P. Collier County currently employs ten personnel within this classification. The total cost of compensation for this classification Is indicated in the figure below. Figure 5: Average Cost of Compensation for Classification PFF01 Average Base Salary $52,220.00 Benefits $21,909.70 Ancillary Costs $1,525.00 Total Average Cost of Compensation $75,654.70 10H Collier County, Florida — [IMS System Master Plan Paramedic /firefighter -2 This level of classification is comprised of permanent or full -time personnel at the EMT -P level who are certified firefighters and are allowed to function independently as an EMT - P. Collier County currently employs ten personnel within this classification. The total cost of compensation for this classification is indicated in the figure below. Figure 6: Average Cost of Compensation for Classification PFF02 Average Base Salary $55,875.00 Benefits $22,762.05 Ancillary Costs $1,525.00 Total Average Cost of Compensation $80,162.05 Paramedic Company Officer This level of classification is comprised of permanent or full -time personnel at the EMT -P level. In addition to the duties normally associated with the Paramedic -1 and Paramedic -2 classifications, the Paramedic Company Officer has additional responsibilities consisting of coordinating and overseeing assigned team members and crew activities. Collier County currently employs 40 personnel within this classification. The total cost of compensation for this classification is indicated in the figure below. Figure 7: Average Cost of Compensation for Classification PARGO Average Base Salary $57,676.67 Benefits $23,182.20 Ancillary Costs $1,525.00 Total Average Cost of Compensation $82,383.87 Paramedic /Ffrefi9hter Company Officer This level of classification is comprised of permanent or full -time personnel at the EMT -P level who are also certified firefighters and have been identified as lead personnel within the system. In addition to the duties normally associated with the Paramedic/Firefighter- 1 and Paramedic /Firefighter -2 classifications, the Paramedic /Firefighter Company Officer has additional responsibilities consisting of coordinating and overseeing assigned team 19 ap- 10H Collier County, Florida - EIMS Systam Mastor plan members and crew activities. Collier County currently employs 26 personnel within this classification. The total cost of compensation for this classification is indicated in the figure below. Figure 8: Average Cost of Compensa Average Base Salary Benefits Ancillary Costs Total Average Cost of Compensation Total Average Cost of Compensation tion for Classification PFFCO $71,962 -40 $26,513.63 $1,525.00 $100,001.03 The figure below takes into consideration the information provided in the figures above and calculates out an average cost of compensation for all Collier County EMS field personnel. This overall average will be used in any models identified in Section III of this report. Figure 9. Composite Average Cost of Compensation for All Field Stat'r Average Base Salary $52,886.64 Benefits $22,060.50 Ancillary Costs $1,525.00 Total Average Cost of Compensation $76,472.14 As is standard in most EMS systems across the country, Collier County EMS staffs each of its transport units with two personnel. Utilizing the average total cost of compensation indicated above, the total personnel costs associated with staffing one transport ambulance is approximately $152,944.28. This total will be used later in this report to determine the total cost to place one transport unit into operation. Educational Incentives Although there is extensive training and education involved with obtaining EMS and firefighting certifications and licensure, Collier County offers salary Incentives to those employees who either begin employment with post- secondary education or to those who r.;— I Collier County, Florida - E;11S System Nio. ier Plan obtain that education while employed. The department also offers salary incentives to those employees within the department who accept additional responsibilities or participate in specialized teams. The various incentives are indicated in Figure 10. Figure 10: Incentive Pay Distribution 9 (Jilt Htt� r l Firefighter i $2,635.30 11 SORT` $5,262.28 12 Field Training Officers $5,507.70 11 Medflight $5,507.70 9 Associates Degree' $1,162.77 12 Bachelors Degree' $2,306.87 3 Masters Degreea $4,356.90 1 Although Collier County EMS should he commended for rewarding personnel for educational achievement and the acceptance of additional responsibilities, the method used to calculate educational incentives should be revisited. The current calculation indicates that functioning as a Field Training Officer, a member of SORT, or on Medflight has a higher value than that of formal education at the Associates, Bachelors, and Masters Degree levels. Although these additional responsibilities are important to the operation of the system, cultivation of educated personnel will improve morale and serve the system better in the long term. a Represents a 5 percent salary increase- 4 Special Operations Response Train. Represents a 10 percent salary increase. 5 Represents a 10 percent salary increase above the normal starting salary for Paramedic Company Officer. e Represents a 2 percent salary increase. 7 Represents a 4 percent salary increase. a Represents a 6 percent salary increase. 21 Collier County, Florida— EMS System MasW Plan I Recommendation: ION Work with the bargaining unit to re- evaluate the method utilized to calculate educational incentives and format those incentives based on the weight of tho accomplishment or activity. 22 ` .: .1 ilk; ion L 2 kH F in N W U V I`Y�1 f�l L'�T ION Collier County, Florida — EiNiS System Muster Plan In addition to the county EMS units, several of the dependent and independent fire districts throughout Collier County supplement the system with ALS engines. Those agencies and the corresponding number of AILS apparatus are indicated in Figure 12. Figure '12: Fire Districts Providing ALS Engines North Naples Fire Control and Rescue 7 Marco Island Fire and Rescue 2 City of Naples 2 East Naples Fire Control and Rescue 2 Isle of Capri Fire and Rescue 1 North Maples The North Naples Fire Control and Rescue District operates under an inter -local agreement to provide ALS personnel to support Collier County EMS within the North Naples district, which encompasses approximately 100 square miles along the northwestern coast of Collier County. The district currently employs 54 Paramedic personnel that staff a total of seven AILS engines throughout the district, 24 hours per day from seven stations. Additionally, when staffing levels permit, two more ALS engines are placed into service, bringing the total ALS engine count to nine. The administrative staff of North Naples can also staff four additional quick response vehicles equipped and staffed at the ALS level if necessary. As is the case with the other districts currently participating in the ALS engine 'swap' program, the North Naples personnel that are placed on Collier County EMS units are operating primarily within the North Naples district, which is in contrast to the implied intent of the program to allow FD personnel to be exposed to calls in other parts of Collier County. e Denotes minimum number of ALS engines as required by interlocal government agreement. 10HIY Colller County, Florida —EMS System Meakee Plan North Naples receives approximately $24,312.00 annually from Collier County as remuneration for facility and utility usage by Collier County EMS units occupying space within North Naples facilities. Cky of Naples The City of Naples Police and Emergency Services provides two ALS engines to Collier County EMS under an inter -local agreement. The City of Naples consists of approximately 13 square miles with a variable population between 22,000 and 45,000 depending upon season. The department currently employs 16 paramedic personnel and operates from three stations throughout the district, currently housing two Collier County EMS units in their facilities. The department does participate in the 'swap' program but, as is the case with the other districts, the city personnel placed on Collier County EMS units operate only within the city district. In addition, those personnel are rarely given the opportunity to function as a paramedic and are typically relegated to driving duties. In addition to ad valorem taxes, the City of Naples receives $31,800.00 from Collier County. East Naples East Naples Fire Control and Rescue District currently employs 15 paramedic personnel deployed on two ALS engines (one of which participates in the `swap' program), serving a permanent resident population of 24,450, which varies seasonally. The district currently has an additional six personnel in paramedic training to assist with staffing shortages. Due to the large area covered by East Naples, Collier County currently staffs four transport units within the district, all of which are either housed in East Naples facilities or in close proximity, resulting in a duplication of service throughout the district. Other than ad valorem taxes, no funding for services is exchanged between Collier County and East Naples. Although agreed to within the interlocal government contract ion ; Collier County, Florida — EMS S ystem Master Plan for services, there is some concern within the FD over the lack of supply replacement . when the district uses its supplies during patient care activities. City of Marco Island The Marco Island Fire and Rescue Department currently employs 18 paramedic personnel operating two ALS engines (one of which participates in the 'swap' program) and also utilizes two Battalion Chiefs for additional ALS personnel to cover the 24 square miles of the island and some 100 miles of waterways. Collier County currently houses one ALS unit in the Marco Island primary station, and bath the engine and CCEMS unit respond to medical calls on the island. The district also operates a fire /rescue boat that is staffed with ALS personnel whorl utilized to assist neighboring districts as well as the U.S. Coast Guard. Isle of Capri Isle of Capri Fire Control and Rescue District is one of two dependent fire districts within Collier County. At the time of this report, Isle of Capri was the only dependent fire district participating in the ALS engine program but was considering expanding that operation to Ochopee. Isle of Capri employs one paramedic staffing one ALS engine 24 hours per day, covering an estimated 600 acres (just under one square mile), and serving a variable population between 2,258 and 3,003.10 To participate in the 'SWAP' program, Isle of Capri supplies the Collier County EMS unit with EMT personnel in exchange for their paramedic. In addition to providing personnel and equipment to the ALS engine program, the Collier County EMS unit stationed on Isle of Capri is equipped with extrication equipment, resulting in the ability to serve as a rescue unit in addition to transport. As indicated within the other districts participating in the ALS engine program, Isle of Capri personnel staffing Collier County EMS units work primarily within the Isle of Capri district, limiting their exposure to the variable call types throughout the remainder of r0 Collier County 2003 Economic, Demographic R Community Profile. 2003 Population Estimates. KI i,T Collier County, Florida - HAIS System iMasler Plan Collier County, Further, Isle of Capri personnel are typically relegated to driving the EMS unit rather than participating in patient care during transport to a medical facility for definitive care. Non - Participatory Agencies The remaining fire districts (Irnmokalee, Golden Gate, Ochopee, and Big Corkscrew) do not currently participate in the ALS engine program. Big Corkscrew is in the process of working toward participation and Ochopee (currently under administrative oversight of Isle of Capri) is moving forward with the possibility of sharing personnel with Isle of Capri to offer ALS engines in that district. Medical Oversight The entire Collier County EMS system is overseen by a local physician serving as system medical director as well as a County Commission appointed Medical Services Advisory Council. The Medical Director, Dr. Robert B. Taber, is the original Medical Director for the system and has continued to serve in that role for the past 27 years. By county ordinance, Dr. Taber or his designee is required to provide oversight to the EMS system 24 hours per day, seven days per week, including preparing protocols, evaluating personnel, and quality assurance duties. The Emergency Medical Services Advisory Council (EMSAC) was formed by the Board of County Commissioners In 1981 to serve as an advisory body to the County Commissioners on all matters related to the provision of EMS within Collier County. The council is formed by representatives from the organizations listed in Figure 13. 10H I r Collier County, Florida - EMS System Plaster Plan Figure 13: Emergency Medical Services Advisory Committee Membership 1 , - itf�Ehk,Fiir n, General Resident from each Voting District 5 Resident Members -at -Large 2 City Manager of Naples (representative) 1 City of Marco (representative) 1 Collier County Health Department 1 Collier County Sheriff's Office 1 Collier County f=ire Chief's Association 1 Naples Community Hospital I Health Management Associates I EMS Medical Director (non - voting ex- officio) I It is currently the responsibility of the Medical Director to 'certify' all personnel who work within the system. To accomplish this, Dr. Tober has instituted a system of multiple practice levels among the ALS staff based on agency. Within this system, Collier County ALS personnel are allowed to function to the level identified through the state of Florida with some exceptions. With any EMS system of this size, it is understandable that several levels of medical knowledge and ability would exist. Dr. Tober's rationale for establishing the varying practice levels is identification of the lowest common denominator in medical care for each agency represented and then developing protocols for that level of expertise." Dr. Tober has also expressed concern over the potential degradation of patient care skills with a continued lack of prolonged patient contact, such as that received during transport to medical facilities for definitive care. Additionally, ALS engine personnel are not allowed to carry the same medications and equipment as does Collier County EMS, creating a fragmentation of patient care. To further confuse this issue, many of the personnel currently functioning within the ALS engine program are current and/or former Collier County EMS personnel with equal or greater training, education, and experlence as those operating on the county transport units. This inconsistency in patient care also limits those personnel participating in the " Based on telephone interview with Dr. Taber in regards to medical oversight and system 1OH 4 Collier County, Florida — EMS System Master Plan paramedic 'swap' program from performing certain skills and administering certain medications simply due to the vehicle on which they are deployed. This fragmentation of the certification /licensure system has created tension among the various agencies and serves little purpose in the overall medical direction of the system. With a more consistent training and orientation program of all ALS personnel, regardless of agency, the system can begin to function more uniformly in regards to pre - hospital medical care for the citizens of Collier County. I Recommendation; Increase training, education and practice consistency among all ALS providers and ensure that all providers are able to perform equal skills and procedures prior to 'certifying' them to function within the system. Fiscal Analysis Collier County EMS is a third service provider reliant upon user fees, impact fees, and ad valorem tax dollars for operational funding. The Information below consists of an analysis of operating budgets, impact fee assessments, and utilization, as well as billing and cost recovery efforts; all in an attempt to determine the fiscal soundness of the organization. Billing and Cost Recovery Colller County EMS utilizes Advance Data Processing, Inc. (ADPI) located in Miami, Florida to bill and collect for all EMS users fees associated with transport and /or on scene care without transport. The user fees associated with Collier County EMS are provided in Figure 14. Collier County, Florida - EMS System Master Plan Figure '14: Collier Cot GI_S - Non - Emergency BLS - Emergency ALS1 - Non - Emergency ALSi - Emergency ALS2 - Emergency Spec. Care Transport Flight Service Crround Mileage Air Mileage my EMS User Fees" $675.00 $675.00 $675.00 $675.00 $675.00 $675.00 $5,900,00 $12.00 /mile $100.00 /mile 10fl Based on the credit summary reports generated by ADPI, gross collections from EMS user fees have grown slightly over the past three fiscal years as illustrated in the figure below. Figure 15: Gross EMS Collections, 2004 - 2006 $6.000,000.00_ - $7,000,000.00:�[ j $6,000,000.00 $5,000,000.00 , Cj. $4.000,000,00. tj: — ,} ?? ❑Gross Collections $3,000,000.00 $2,000,000 .00 si,000,00000 n $0.00 2004 2005 2006 The Information provided in Figure 15 was obtained from credit summary reports produced by ADPI. The budget documents provided by Collier County EMS, however, indicate a vastly different collection total. This is due in Bart to collections from sources iz Collier County Ordinances Resolution No. 2006 -222 S 10 Collier County, Florida — EMS System Master Plan other than through ADPI, such as capital contributions, special operations fees, market adjustments, etc. In addition, total collections indicated by Collier County EMS are based on total amounts billed rather than on cash receipts. As is the case In most EMS systems across the country, Medicare accounts for a majority of all transport revenue, In regards to Collier County EMS, Medicare has averaged approximately 41 percent of the total user fees collections with commercial insurance accounting for approximately 30 percent on average. There is, however, a significant gap behveen the total operating budget and collections. The following figures illustrate comparisons between operating budget and budgeted revenue as well as comparisons between actual revenue and budget. Figure 16: Collier County EMS Budget Compared to Budgeted Revenue $30,000,000,00 $25,000,000.00 $20,000,000.00 $15,000,000.00 $10,000,000.00 $5,000,000.00 $0.00 s {af 2003 2004 2005 2006 2007 Budget °ca= °Budgeted Revenue —:— General Fund $30,000,000.00 $25,000,000.00 $20,000,000.00 $15,000,000.00 $10,000,000.00 $5, 000, 000.00 $0.00 2003 2004 2005 2006 2007 Collier County, Ftorlda — EPdS Syi!Iefn Allaster Plan Figure 17: Budget to Actual Revenue Comparison =v^— B udget — Actual Re�,enue The significant increase in operating budget for fiscal year 2007 can be attributed to the addition of four growth units to the system approved for the current fiscal year. Revenue, however, is not keeping pace with the increase in operating budget; and, based on the information provided, the total collection for fiscal year 2007 is estimated to be $16,816,032,00 resulting in a net deficit of approximately $8,830,902.00. As with most EMS systems across the country, a vast majority of the operating budget is dedicated to personnel costs. Figure 18 illustrates the, portion of the total budget allocated to personnel expenditures. IM Collier County, Florida — EMS Synt2m Master Plan Figure 18: Comparison of Personnel Costs to Total Budget $30,000,000.00 $25,000,000.00 -- $20,000,000.00 ---- $15,000,000.00 ' f � Personnel Costs - _ r A $5,000,000.00 :� Is $0.00 2003 2004 2005 2006 2007 Based on the information provided to ESCi, the average annual salary for field operations personnel (across all grades and levels of certification for full -time personnel) is $52,889.64 for a total of $9,836,915.78. This salary does not include any incentive pay, benefits or other compensation nor does the total include any administrative or supervisory personnel. The average salary Indicated above, along with average benefits, incentives and other compensation will be utilized later in this report in personnel cost projections. Imtoact Fees In addition to normal operating funds that come from both user fees and general funds, Collier County EMS has Instituted an Impact fee program to offset the increasing capital costs of the department associated with growth throughout Collier County. Figure 19 and Figure 20 indicate the current impact fees as well as the newly adopted 2008 fee schedule. 1QH Collier County, Florida - EMS System Master Plan Figure '19: Collier County EMS Impact Fees '_- - .ter ?U.i�l RE IDENTIAL Less than 1,500 sq ft $100.59 /dwelling unit $112.46 /dwelling unit 1,500 to 2,499 sq it $112.04 /dwelling unit $125.25 / dwelling unit 2,500 sq it or larger $122.67 /dwelling unit $137.15 /dwelling unit MEAN- RFS]DENTIAL Transient, Assisted, Group Hotel /Motel $46.61 /room $52.11 /room Nursing Home $78-51/bed $87.77 /bed Recreational Marina $16.36 /berth $18.29 /berth Golf Course $4,730.97118 holes $5,289.22/18 holes Movie Theater $703.31 /screen $786.30 /screen Institutional Hospital $134.94/1,000 sq it $150.86/1,000 sq It Elementary School $4.91 /student $5.49 /student Middle School $5.72/student $6.39 /student High School $6.54 /student $7.31 /student Junior College $4.91 1student $5.491student University /College $10.63 /student $11.88 /student Church $46.61/1,000 sq fi $52.11/1,000 sq ft Daycare Center $4.91 /student $5.49 /student Office /Financial Office <50,000 sq it $136.57/1,000 sq it $152.69/1,000 sq It Office 50,001- $105.50/1,000 sq it $117.95/1,000 sq It 100,000 Office 100,001- $89.96/1,000 sq it $100.58/1,000 sq It 200,000 Office 200,001- $76.87/1,000 sq it $85.94/1,000 sq it 400,000 Office > 400,001 $65.42/1,000 sq it $73.14/1,000 sq It Medical Office $141.48/1,000 sq it $158.17/1,000 sq It 35 ion Collier County, Florida — ELMS System Mastsr Plan Figure 20: Collier County EMS Impact Fees (cont) _IQ Retail Specialty $122.6711,000 sq it $137.1511,000 sq ft < 50,000 sq it $234.7111,000 sq it $262.41/1,000 sq ft 50,001- 100,000 $215.08/1,000 sq It $240.46/1,000 sq ft 100,001 - 150,000 $191.3711,000 sq it $213.9511,000 sq ft 150,001- 200,000 $233.07/1,000 sq it $260.57/1,000 sq it 200,001- 400,000 $204.45/1,000 sq ft $228.58/1,000 sq it 400,001- 600,000 $208.54/1,000 sq it $233.15/1,000 sq it 600,001- 1,000,000 $208.54/1,000 sq it $233.15/1,000 sq it Over 1,000,000 sq it $170.9211,000 sq ft $191.09/1,000 sq it Pharmacy w /drive up $153.75/1,000 sq It $171.89/1,000 sq it Home Imp. Store $145.57/1,000 sq It $162.75/1,000 sq ft Quality Restaurant $553.65/1,000 sq It $618.98/1,000 sq ft High Turnover Rest. $579.82/1,000 sq it $648.2411,000 sq ft Fast Food Rest. $715.58/1,000 sq it $800.02/1,000 sq ft Gas Station $161.92 /fuel position $181.03 1fuel position Quick Lube $94.86 /service bay $106.05 /service bay Supermarket $166.01/1,000 sq ft $185.6011,000 sq ft Convenience Store $346.75/1,000 sq it $387.67/1,000 sq it Conv. Store w /gas $355.74/fuel position $397.72/fuel position Auto Repair $260.88/1,000 sq It $291.66/1,000 sq it Tire Store $127.58 /service bay $142.63 /service bay Car Sales $141.4811,000 sq it $158.17/1,000 sq It Self Car Wash $154.56/bay $172.80/bay Bank $210.17/1,000 sq ft $234.9711,000 sq ft Bank w drive -up $169.28/1,000 sq It $189.26/1,000 sq it Industrial General $56.43/1,000 sq ft $63.09/1,000 sq It Business Park $81.78/1,000 sq it $91.43/1,000 sq it Mini- Warehouse $5.72/1,000 sq it $6.3911,000 sq R ion Collier County, Florida — ENIS System Master Plan Impact fees play a significant role in the County's ability to fund its capital improvement plan. As Collier County continues to grow, the impact fees will become an even more integral part to system responsiveness and growth. The figure below identifies the impact fees collected over the past five years compared to the funds expended as part of the capital improvement plan within EMS. Figure 2'1: EMS Impact Fees Collection vs. Expenditure, 2003. 2007'' 2003 2004 2005 2006 2007 • Impact Fees Collected Olmpact Fees Expended It should be noted that previous year collections of impact fees are carried over to subsequent fiscal years, accounting for the difference in collections compared to expenditures in fiscal years 2005 and 2007. Helicopter Operations (MedFlight) MedFlight, Collier County's only medical evacuation flight service, operates from the Naples Regional Airport and operates one EC -135 Eurocopter. The service is routinely used for emergency responses to remote areas of the county with historically long Fiscal year 2007 collected impact fees as of June 4, 2007, resulting in an incomplete year of _.. revenue collection. T J 37 ton Collier County, Florida— EMS Syste�rn Pilaster Plan response times for ground units. MedFlight is primarily utilized for emergency responses and is not routinely utilized for non- emergency interfacility transports but these types of calls are becoming more frequent. Figure 2.2 illustrates the MedFlight helicopter operations budget for the past several fiscal periods. Figure 22: Helicopter Operations Budget and Personnel Casts 2003 2004 2005 2006 2007 ❑ Budget 0 Personnel Costs The figure above illustrates a much greater operations -to- personnel cost ratio for helicopter operations than was evident for ground transport units. The operating costs of any aircraft will far outweigh the cost of staffing. To further biur this difference, only pilot and maintenance salaries are considered in the personnel costs. The remainder of the crew (usually two paramedics) is paid from the regular EMS budget. in regards to being fiscally sound, Figure 23 indicates annual helicopter operations budget compared to revenue generated. It should be noted, however, that this revenue is included in the overall EMS budget and not in the helicopter operations budget, so any revenue indicated has already been addressed in this report. Collier County, Florida - EMS $ystern Master Plan Figure 23: Helicopter Operations Budget to Revenue 14 Figure 24 illustrates service demand for Medflight throughout Collier County. As expected, a large portion of Medflight's service demand is generated along 'Alligator Alley' and in the vicinity of Immokalee as air response is the quickest means of transportation to those portions of the county and the quickest means of transportation back to a medical facility for those patients with life- threatening injuries. Additionally, routine interfacility transports originating from hospitals within Collier County account for a large percentage of Medflight's service demand. These increased areas of service demand are indicated on the map, denoted with an 'H' to indicate locations of area hospitals. 14 Fiscal year 2007 revenue total based on extrapolation of revenue collected as of June 4, 2007. 10He' Collior County, Florida - EMS System %faster Plan Figure 24: Medflight Service Demand Recommendation: 0 Combine all costs associated with the operation of Medflight into that budget in order to illustrate a cost of operation as compared to revenue. Collier County, Florida — EMS System Master Plan 1;4�t.t, Caaital Assets In any EMS system, there are three important issues that must be addressed: highly trained personnel; adequate medical capabilities through protocols; and adequate facilities and equipment, which allow the personnel to perform their assigned functions. Facilities Collier County EMS houses its transport units in a variety of structures ranging from free- standing county -owed buildings to collocation with local independent and dependent fire districts. The following pages contain a summary of ESCis observations at each location. 4 t i 10 Collier County, Florida— EMS System Master Plan � -- - Station #70 4741 Golden Gate Parkway h Medic 70 and Medic 80 operate from this facility that is owned by Collier County but leased and controlled by N the Golden Gate Fire Control District. yl f.: Wr Approximately 1,100 square feet of space and one apparatus hay are available. This building is a nice, functional neighborhood fire station ibut has very limited space dedicated to EMS resulting, in overcrowding in the facility and external parking of one EMS vehicle. The size of the facility is insufficient for its current $ dual use as a fire and EMS facility. The original design did not appear to accommodate EMS staffing. The building blends well with the j surrounding neighborhood, with adequate parking a Design: and effective exit into traffic flow. If the EMS training functions performed at this site were F moved to another site, this facility might be capable of acco i odatirg the two EMS crews, but apparatus parking for both units would have to be negotiated with the lessor. o Consfntcfion: Masonry block with stucco finish. Pitched roof with shingles. No specific problems noted. No fire sprinklers present. Smoke detection o Safety: installed, local alarm only. Back -up generator with auto transfer. -- a Environment., No exhaust removal system present. No environmental concerns noted. $ o Cade Compliance: Appears to be ADA compliant, no other issues . noted. Extremely small space for EMS crew housing. a Sleeping areas serve multi -use as day room, lounge, and office. Single -user restroom /shower h o Efficiency: areas are gender - neutral and use is alternated among staff_ Refrigerator is in closet in apparatus bay. No storage areas are available for EMS use. One medic vehicle must be parked outside, E posing security and theft risk ION 414 Collier County, Florida - EMS System plaster Plan Station #46 3410 Pine Ridge Road Medic 46 operates from this facility that is owned by North Naples Fire i� Department, which leases space for Lyj fI _ housing a Collier County EMS unit Approximately { t. and .crew. 300 square feet of space and one apparatus bay are available. This building is a well- designed neighborhood fire station with reasonably good integration ' between fire and EMS crews who ; share most arouo spaces _ Nice, well- designed fire station with good space layout. While the original design may not have Design: included CMS staffing, the result has been accomodating to the needs of EMS crews. A lack of storage space for EMS detracts from an I otherwise good design. 0 Construction: Masonry block with stucco finish. Pitched roof t with shingles. No specific problems noted. Full fire sprinkler system is present. Smoke' o Safety: detection installed with monitored fire alarm. l Back -up generator with auto transfer. Environment: No exhaust removal system present. No h environmental concerns noted. Code Compliance: Appears to be ADA compliant, no other issues I noted. EMS has three dedicated individual sleeping p rooms. Fire and EMS staff share day room /lounge, kitchen, exercise area, o Efficiency: restroorn /shower areas. One EMS sleeping room doubles as an EMS office. Good integration between fire and EMS. Storage is lacking for EMS needs. ion 41 Collier County, Florida - EMS System Master Flan .,_ .._ .. Station 4 Pine Ridge Road Medic 40 operates from this facility .. .- that is owned by North Naples Fire _ r ; Department, which leases space for housing Collier EMS unit crew. Approximately 2 5 ' ,� r, and square 'x mss,; = "''� feet of space and one apparatus bay are available. This building is a small neighborhood fire station with very al limited space for EMS functions, _ resulting in cramped roams and no storaae- This facility was probably not designed with EMS use in mind and, as a result, has extremely 0 Design: limited space. The crews have done a good Job of compromising original design functions to make the facility work. Construction: Masonry block with stucco finish. Pitched roof with shingles. No specific problems noted. Partial sprinkler system is present. Smoke safety: detection installed with monitored fire alarm. } Back -up generator with auto transfer. Environment- Apparatus exhaust removal present, open forced 9 air-flow style. No environmental concerns noted. i 0 Code Compliance: Door hardware does not appear to have been altered to ADA standards. No other issues noted. EMS apparatus bay is extremely cramped, leaving only inches between bumpers and walls or doors. Inadequate space for working or moving j around EMS truck. EMS has two dedicated Efficiency: individual sleeping rooms, one doubling as office space. Fire and EMS staff share day room /lounge, kitchen, restroom /shower areas, exercise area. Fire and EMS crews report good integration, with daily contact and shared meals. Coffler County, Florida - EMS System Master Plan Station #44 8970 Hammock Oak Drive Medic 44, Medic 81, and BC 81 operate from this facility that is owned by Collier County and built specifically X for use as an EMS station. The building is attached tied to a Sheriffs �J' M N substation. Approximately 1500 square feet of space and two apparatus bays are available. This is a very nice, functional and adequate EMS station with a professional appearance and efficient space design. The structure is located adjacent to North Naples Fire Station 44 on the same cieneral site. This facility was designed specifically for EMS 1 and contains adequate space for most needs. It is o Design: relatively small for two crews and a Battalion Chief, but is efficient and adequate. Apparatus exit into traffic flow is safe and effective, and the I building blends well with the surrounding area. Masonry block and wood frame. Picthed roof, 1 0 Construction: standing seam metal finish in good condition. No specific problems noted. Full fire sprinider system is present. Smoke 0 Safety: detection installed with monitored fire alarm. Back-up generator with auto transfer. Environment: Apparatus exhaust removal present- open forced air-flow style. No environmental concerns noted. • Code Compliance: Appears to be ADA compliant, no other Issues noted. Bathrooms are relatively small, gender-neutral • Efficiency-. single user. Building contains one co-ed dormitory, office area, day roam /lounge, and I lkitchen. Collier County, Florida — EMS System Master Plan Station 443 16325 Vanderbilt Drive NO Medic 43 operates from this facility that is owned by North Napier Fire Department, which leases space for housing Collier County EMS a unit and crew. Approximately 300 square feet of space and one apparatus bay are available. This building is a well- designed neighborhood fire station 1 with reasonably good integration between fire and EMS crews that share most cretin soaves Nice, well-designed fire station with good space layout. While the original design may not have included EMS staffing, the result has been • Design: accomodating to the needs of EMS crews. A look of storage space for EMS detracts from an otherwise good design. Apparatus exit into traffic (low is safe and effective, and the building hlends well with the surrounding area. Masonry block and wood frame. Pitched root, kl 0 Construction: standing seam metal finish in good condition. No specific problems noted. Full fire sprinkler system is present. Smoke • Safety: detection installed with monitored fire alarm. Back-up generator with auto transfer. 0 Environment: No exhaust removal system present. No environmental concerns noted. 0 Code Compliance: Appears to be ADA compliant, no other issues noted. EMS has three dedicated individual sleeping rooms. Fire and EMS staff share day room/lounge, kitchen, exercise area, 0 Efficiency: restroorri/shower areas. One EMS sleeping room doubles as an EMS office, Good integration between fire and EMS. Storage is looking for EMS needs. Collier County, Florida - E.W,9 Systern Master Plan Station #45 i, :i tq 4 Naples Community Hospital North Medic 45 operates from this facility that is simply a regional hospital campus owned by the NCH k Healthcare System. Approximately r-F 540 square feet of space and no apparatus bays are available. The EMS crews here are occupying several unused hospital rooms in in A. unoccupied wing of this community hosoitai. The structure was obviously not intended for use ii 0 Design; as an EMS station, so design is simply "best adaptation" of existing spaces. There is no apparatus bay and the medic unit parks outside. a Construction: Not applicable. C Safety: Not applicable. o Environment: Not applicable. a Code Compliance: Not applicable, The EMS crews have done an admirable job of adapting the old hospital wing for EMS use. Crews occupy 2 old hospital rooms as combined 0 Efficiency: sleeping /lounge areas. A break room provides eating area, but no full kitchen is available. Showers are down the hall in old hospital staff areas. EMS unit is parked outside, poorly secured. 1OH 1 11 Collier County, Florida — EMS System pilaster Plan Station 471 95 13th Street SW Medic 71 operates from this facility that is owned by Collier County and built specifically for use as an EMS station- Approximately 1,500 square feet of space and two apparatus bays are available. This is a very nice, functional and adequate EMS station with a professional appearance and efficient space design. This facility was designed specifically for EMS and contains adequate space for most needs. It is efficient and adequate for a single EMS crew. 0 Design: Apparatus exit Into traffic flow Is safe and effective, and the building blends well with the surrounding area. Masonry block and wood frame. Pitched roof, 0 Construction: standing seam metal finish in good condition. No specific problems noted. No fire sprinkler system is present. Local smoke 0 safety: detection is installed. Back-up generator with auto transfer. Apparatus exhaust removal present, open forced C Environment: air-flow style. No environmental concerns noted. a Code Compliance: Appears to be ADA compliant, no other issues noted. Bathrooms are relatively small, gender - neutral 0 Efficiency: single user. Building contains one co-ed dormitory, office area, day room/lounge, and kitchen. Collier County, Florida — E115 System blaster Plan ION Station #10 14756 Immokalce Road Medic 10 operates from this facility that is owned by Collier County and . . . . . . . . . . . built specifically for use as an EMS 41 station. Approximately 1,500 square feet of space and two apparatus bays I are available. This is a very nice, I functional and adequate EMS station with a professional appearance and efficient space design. This facility was designed specifically for EMS and contains adequate space for most needs. It is efficient and adequate for a single EMS crew. * Design: Apparatus exit into traffic flow Is safe and effective, and the building blends well with the surrounding area. Masonry block and wood frame. Pitched roof, * Construction: standing seam metal finish in good condition- No specific problems noted. No fire sprinkler system is present. Local smoke * Safety: detection is installed. Back-up generator with auto transfer. Apparatus exhaust removal present, open forced 0 Environment: air-flow style. No environmental concerns noted. Appears to be ADA compliant, no other issues Code Compliance: noted. Bathrooms are relatively small, gender-neutral single user. Building contains individual dormitory Efficiency: rooms, office area, day room/lounge, and kitchen. :L Plentiful storage is also featured. 49 ion Coll lidr County, Florida- EVS System Master Plan Station #30 118 South 1st Street Medic 30 and Medic 3*1 operate from this facility that is owned by Collier 3. fi County and built specifically for use as an EMS station. The building is " A" attached to a Sheriff's substation, Approximately 1,200 square feet of i space and two apparatus bays are i available. This is an older, but I 2 functional EMS station that is somewhat small for a two -crew stations This facility was designed specifically for EMS and contains adequate space for most needs. It is if 'cx relatively small for two crows, but is efficient f��dt and 1n 0 Design: adequate. Apparatus exit into traffic low is safe and effective, and the building blends the surrounding area. Masonry block and wood frame. Pitched roof, standing seam metal finish in good condition over - Construction: dorm areas. Flat composition roof over apparatus bays with uncovered roof vent. Facility needs a I thorough cleaning. Full fire sprinkler system is present. Smoke detection installed with monitored fire alarm. 0 Safety: Small, unsecured oxygen cylinders present In apparatus bay area. Back-up generator with auto transfer. Apparatus exhaust removal present, open forced • Environment: air-flow style on roof, but no apparent vent cover present. No environmental concerns noted. Door hardware does not appear to have been • Code Compliance: altered to ADA standards. No other issues noted. Bathrooms are relatively small, gender - neutral Efficiency: single user. Building contains individual dormitory ti rooms, office area, day room/lounge, and kitchen. 50 10fl Collier County, Florida — EMS Systorin Ailoster Plan Station #42 7010 Immokalee Road Medic 42 operates from this facility that is owned by North Naples Fire Department, which leases space for %Z! - housing a Collier County EMS unit and crew. Approximately 550 square feet of space and one apparatus bay are available. This building is a I relatively small neighborhood fire 4 station with little integration between fire and EMS crews that primarily maintain seoarate so2ces This facility was probably not designed with EMS use in mind and, as a result, has extremely Design: cramped spaces. the crews have done a good job of compromising original design functions to make the facility work. Masonry block with stucco or panel finish. Pitched I Construction: roof with shingles. No specific problems noted. Full fire sprinkler system Is present. Smoke safety: detection installed with monitored fire alarm. Back-up generator with auto transfer. No exhaust removal system present. No Environment: environmental concerns noted. Appears to be ADA compliant, no other issues Code Compliance: noted. Extremely small space for EMS crew housing. 10' x 20' room serves as watch room, office, lounge. Very small, single-user restroom/shower area is Efficiency: gender-neutral and use is alternated among staff ' Small 10' x 8' kitchen area. No storage areas are available for EMS use. 10H 44, Coiller County, Florida — ENIS System Pilaster Plan 52 Station #75 4590 Santa Barbara Blvd Medic 75, Medic 83, and Unit 32 operate from this facility that is owned It by Collier County. Built specifically for ' OR EMS use. Supports 24 -hour shift x' r employees. Approximately 1,8001 lmz P ? °� square feet of space and 2 apparatus 1 bays are available. Recently built to house multiple EMS units, this facility Is well suited to provide housing for j both apparatus and full -time d personnel. This facility makes good use of available space and blends in Q with its surroundings while providing - easv access to a main road. , Designed with EMS service delivery in mind; this facility offers an open mull-functional area for on 1 duty personnel to use for eating, report writing, j studying, and relaxing. There is enough space ®esign: provided in the bay area to work on and around � apparatus. Facility appears to be malntence keasy friendly. Sleeping quarters provide privacy and access to the rest of the facility. Concrete block bays. The living area is wood frame with stucco exteicr with a pitched roof o Construction: including an attractive clay tile covering which is typical for the area. This is a new facility. The overhead door stops are in place and operating. 100% sprinklerd with smoke detection Safety: observed. The back -up generator is in place and appears in good working order. No exhaust removal system was observed, o Environment: however a large exterior exhaust fan was present ' in the bay area. No environmental concerns noted. • Code Compliance: Appears to be ADA compliant, no other issues noted. Very well suited facility for its intended usage. Adequate lighting is provided thoughout the building. It offers a floor plan that meets and • Efficiency: exceeds the needs of the occupants. There is room for future expansion, and when the local road construction is finished, this facility will be easy to access and require minimum malntence. 52 to Collier County, Florida - ENIS System Nlasier Plan [ Station #24 -` - 2794 Airport Rd. o EARS Unit 24 operates from this � facility that is owned by Collier County. There is a lease agreement I s; that needs to be verified whereas it was undetermined at the time of this report. Approximately 2,500 square feet of space and three apparatus; 'I; bays are available. This facility ; provides a favorable working 3 Y 4 nE enviorment for its intended occupancy. The plot placement of the structure creates safe and easy -- access for apparatus. It appears to have plenty of parking, storage and i extra space for its occupants. Built with full time personnel in mind, this • Design: structure offers private bunking for assigned crews. { I A concrete block structure supports a partially • Construction: arched roof, giving a modern look. The fuel depot is shared with the fire department. (( — I Automatic door stops found in working order.' 4 O Safety: Door locks, detectors, and sprinklers in place and appear to be in goad condition. 1 The fuel depot appears to be in compliance with • Envieonmeni: code and safety issues. The entire site appears ` to be environmentaly friendly. Code Compliance: Appears to be ADA compliant. This facility is well suited for its occupancy. A very functional floorplan provides for good use of o Efficiency: space and easy mobility of personnel. The private, individual quarters are a bonus for the crew. 10 Collier County, Florida -- ENIS Systein Master Plan d Station #3 2375 Tower Dr. EMS 3 and Medflight operate from !m y this facility that is county owned and shared with the local Sheriffs Department. Leased from local � airport. Approximately 500 square f s; ; feet of space and one apparatus bay are available. This facility Is an . r aircraft hanger with an attached bay to quarter a medic unit in addition to the helicopter bay. The living space provided for the personnel is extremely limited. It is a clean and well maintained facility. i Designed to house aircraft, not people. Spacious bay for the helicopter but a very cramped area for ° Design: the medic unit and personnel. Not considered suitable for full -time personnel due to insufficient space dedicated to living quarters. iCons9ruction: ° Metal exterior comercial grade aircraft hanger. No specific problems noted. Smoke detection and sprinklers present. Plenty of 3 ° Safety: fire extinguishers noted. Very cramped space to access apparatus No exhaust removal system present. No other ° Environment: environmental concerns noted. No evidence of ADA compliance observed. h ° Code Compliance: Should review potential issues of combining aircraft hanger and residential occupancies 6 t� Very limited accomodations for personnel ° Efficiency Facility has exceeded its intended ocupancy by housing 24 hour shift personnel. -� d ion Collier County, Florida - UjIS System Piaster Plan Station #1 835 8th. Ave, Medic 1 operates from this facility that It, is owned by the City of Naples. EMS A has a lease for part of the building. Approximately 1100 square feet of space and no apparatus bays are available, This frame and stucco building features a metal roo f typical a, for the area. It was formerly used as the local jail and was altered to facilitate EMS. The medic unit is act parked outside due to the absence of a bay. The location is good however the building is small and lacks adequate security for the ambulance. Bascially a detached building from the firehouse next door, the building has great curb appeal Design: however once inside it is apparent it was never yI intended to house 24 hour, full time staffing. The bedding shares the small dayroom/eat in kitchen. li Wood frame with a metal hip roof featuring stucco Construction: exterior appears to be In good condition. No other concerns. Smoke detetection present. Rack Lip generator Safety: present. No other concerns noted. This structure is located in the hurricane slosh 0 Environment: zone and requires evacuation in such events. 0 Code Compliance: Some attempts to maintain ADA compliance noted. Parking provided across the street. Extremely small living quarters. One open area functions as - Efficiency; a multi-task room and leaves little room for privacy,dining, hygiene or study needs. 10 H 9 Vii. Collier County, Florlda - EDIS System Plaster Plan Station 922 �w 4375 Beepers Dr. EMS 22 operates from this facility that is co -awned with East Naples Fire Control District. Co- staffed. r _?? Approximately 2,100 square feet of space and three apparatus bays are available. This is a three -bay firehouse. EMS has one bay — " dedicated for use. A shared fuel i depot is on site. A very attractive two story facility with plenty of storage offers easv access to the roadway. This building meets and exceeds the needs its a Design: intended occupancy, Plenty of parking and living area with the possibility future expansion. o Construction: Stucco and metal roof typical of the area, this building blends in well with its surroundings. o Satety: No concerns noted. t Environment; None noted. ter III Code Compliance: Appears to be ADA compliant. No other concerns. Efficiency: None. �t j 0 Collier County, Florida- EMS System Master Plan Station 42 977 261h Ave. N Y EMS 2 operates from this facility that is leased from the City of Naples. Co- staffed. Approximately 600 square feet of space and one apparatus bay are available. This structure features a single detached bay and living quarters for the EMS unit. It shares a plot with a larger multi-bay fire station that doubles as the training facility. Although the facility provides well for its intended use, it is somewhat cramped for its occupants. • Design: one large open multi-function area serves personnel. An open bunking area with very limited bathroom facilities is provided. • Construction: None of concern. Back-up generator present and appears • Safety: operational. No other concerns noted • Environment: None noted • Code Compliance: No building code issues noted Small eat-in kitchen. Open bunking area serves Efficiency: as dayroom and study hall. 10H Collier County, Florida- EMS Systern Luster Plan 58 FI L i. 3 � 5'�'f �1. t' . Station tr21 �s 11121 Tamiami Trail I EMS 21 and EMS 82 operate from " this facility that cc-owned with East Fa Naples Fire Control District. `s f Approximately 600 square feet of ors space and two apparatus bays are available. One bay is in a detached structure. This facility is shared by the Sheriff and East Naples FD. This ' �. is an older structure that is at the i limits of its intended use. Future lateral expansion would be questionable to the limited lot size. This wood frame with ° Design: stucco is showing its age. Maintenance and stucco repair issues can be expected. Standard construction for the area, this facility is typical for the area it presently serves. The • Construction: structure appears to be good condition for its age. Several attempts to upgrade over the years were noted. i Not ADA compliant. Extinguishers present. No • Safety: automatic door stops observed. • Environment: Exhaust removal not observed. • Code Compliance: No other concerns noted. g Open bunk area is cramped. Could use expansion to better accommodate the number of ° Efficiency: personnel. The flow of the floor plan is diffflcult to navigate.._�- 58 FI L i. 3 � 5'�'f �1. t' . 1OHN Collier County, Florida - EMS System Nlastel'Plan Station X23 X'n 7227 Isle of Capri Blvd EMS 23 operates from this facility that is leased from East Naples. Approximately 1,200 square feet of i space and three apparatus bays are I available. This facility is an older! station with limited space for occupants. An attached two-story structure provides housing for the personnel. Some previous attempts to upgrade have been made to i accommodate eccuoants- A basic, no frills three-bay fire station with attached living quarters. Choppy floor design * Design: offers cramped living conditions. The laundry and bathroom share one small room. Block walls with hip shingled roof. Nothing * Construction: significant observed. 0 Safety: ved No ADA provisions observed. No exhaust removal system observed. Adequate 0 Environment: fire e'x'tinguishers present. s w occupancy with an type Questionable compliance with Occupancy type Code Compliance: ode Compliance: C C code requirements. o Efficiency: Plenty of bay space to move safelly around provisions for sleeping g apparatus. Inadequate provisions for sleeping and hygiene. 10H r S Collier County, Florida — EMS System Master Plan ' Station X90 175 Capri Blvd. EMS 90 operates from this facility that is owned by the Isle of Capri. }, 17 l r, Approximately 1,500 square feet of PP Y a space and three apparatus bays are This seasoned waterfront =Y available. structure appears to have been well maintained over the years. It offers a helo pad and boat dock. The r structure blends in nicely with the . surrounding community. A large open dayroom area provides plenty of • Design. space for occupants but falls short in hygiene, office, and sleeping quarters provisions. Standard metal hip roof and structure appear in • Construction: servicable condition. No other issues noted. Some ADA compliance observed. No other o Safety: concerns noted • Environment: Exhaust removal not present. No other concerns ADA egress & exit ramp observed. No other • Code Compliance: i concerns noted. o Efficiency: Limited quarters provided for personnel. ION Collier County, Florida — EMS System 'Master plan Station #50 1280 San Marco Rd, C EMS 50 operates from this facility that is owned by the city of Marco. Approximately 3,000 square feet of ; �`� �ilY 1 space and one apparatus bay are j 'il a (r# f�i -.j }fh i�3''•.:I µt ht available. This fire station offers i plenty of roam and extras for its intended use. This is a modern and well planned fully functional facility that should provide service to the - - - - - community for several veers. o Design: No concerns noted. • Construction: No concerns noted. • Safety: None. • Environment: None noted. • Code Compliance: Appears to be ADA compliant. • Efficiency: Plenty of space and facilities provided. 1OH Collier County, Florida - E119 System Master Plan Station 461 201 Buckner Ave. EMS 61 operates from this facility that is owned by Collier County EMS, "r x j Approximately 800 square feet of -J, space and three apparatus bays are v� The barn bay area available. pole y k provides protection from the weather. The living area seems to have an afterthought. This facility does not appear to have been build with lull time Dersonnel in mind. Not designed for full-time occupancy. Very Design: cramped provisions for it's occupants. Not considered adequate for present use. Does not blend in with the Surrounding community. Questionable condition of structure. Although it o Construction; does provides shelter for the apparatus it is not very human occupant friendly. Some staff indicated a rodent problem, which may be considered a health risk for human o Safety: occupancy. Hygiene, dining, and sleeping provisions are very cramped. Numerous trip hazards noted throughout the this facility. No exhaust removal system present. No other 0 Envirommytent: environmental concerns noted. 0 Code Compliance: Not ADA compliant. Extremely small living quarters for personnel. Oluestionable health and safety Issues due to pest j 0 Efficiency: and rodent infiltration. Difficult to navigate through the structure due to crowding and'choppy floorplan. Collier County, Plorlda — EMS System Master plan Recornmendations: O Address environmental and ADA issues with Station #61 possibly even relocation to elsewhere in the general area. Relocate the EMS Training facilities from Station #70 and negotiate indoor parking for both EMS units. Apparatus Collier County EMS currently maintains 34 transport ambulances, 13 staff vehicles, 'I boat with trailer, and 2 utility trailers. The 34 transport units have an average mileage of 134,233 and model years range from 1995 to 2007. Each of the transport ambulances is considered medium to heavy duty in chassis design and is typically built on Freightliner° or Sterline chassis. Administrative and support vehicles are typically light duty SUVs or cars that are equipped with medical equipment but are not suited for transport. Each transport ambulance is scheduled for preventive maintenance every six months or 6000 miles to keep them at optimum serviceability. Although Collier County EMS operates 25 front -line ambulances during any given day, the remaining ambulances are required for reserve capacity and are utilized when front- line units are taken down for service or are otherwise unavailable for regular deployment. Although not individually identified here, the transport equipment currently operated by Collier County EMS has been determined to be reliable and adequate for continued operation. Distribution Analysis Collier County EMS (CCEMS) currently operates out of 22 facilities (including administration) that house response vehicles. An administrative headquarters is not depicted in this section as it does not serve as a point of departure for primary response vehicles (although supervisory staff may respond from this location occasionally). The service coverage area of over 2,025 square miles includes the entire county for emergency medical services. The following map (Figure 25) depicts the locations of the Collier County, Florida — EIVIS System Mosier Plan EMS stations within Collier County and their response zones. The following section illustrates the EMS agency's capability from the currently operated stations and does not take into account any projections or recommendations in changes to deployment. Figure 25: Collier EMS Station Deployment i I a> �nt't i If z�o.nv 3 d i t F4.iE at 1 -iuna .j z f . zi- �c e4° z+riL _.n . .zY I 4. "-1 l I C a L t Coflhr Ca�nfy, FL ' "te �z� It should be noted that some of the identified stations house two ambulances within them such as the Immokalee Station. This serves to reduce the problem of redundancy within heavier call - volume areas. The Helicopter Operations Center (HOC) operates from Station 3 Naples Regional Airport. tl l 10 H M Collier County, ' lorkla - EMS System Blaster Plan Collier County EMS is assisted by five of the ten independent fire districts, including: • North Naples Fire Department • City of Naples Fire Department • East Naples Fire Department • Isle of Capri Fire Department • Marco Island Fire Department These fire departments provide advanced life support services on their apparatus and respond concurrently with CCEMS to emergency medical calls within their respective districts. Certain specific apparatus within these districts participate in a 'swap' program in which Collier County EMS firefighter /paramedics ride on the fire apparatus while district personnel ride on the ambulance. The following map (Figure 26) illustrates their locations within the County and their respective fire districts. 65 IM Collier County, Florida — EMS system Mosier Nlan Figure 26: AILS Engine Locations .,, _ -_ Vila ST Roll 29 V. u , 1 ----= L Collier County, FL cis us Ua�a: 9. _f .e_rfwnl( Local streets have been omitted in the previous figures for clarity of station locations. Because of the extent of the County; subsequent maps will be regions of the County and will include local streets. response Time loerformance Obiec4ives The ultimate goal of any emergency service delivery system is to provide sufficient resources (personnel, apparatus, and equipment) to the scene of an emergency in time to take effective action to minimize the impacts of the emergency. This need applies to '10tN ry Collier County, Florida — FiY15 Systern Pilaster Plan fires, medical emergencies, and any other emergency situation to which the department responds. Before discussing the district's current performance, it is Important to gain an understanding of the dynamics of medical emergencies. Dynamics of Medical Emergencies Emergency medical services handle a multitude of medical, traumatic, and even psychological incidents. The rapid adaptation of technical skills by the paramedic, depending on the event, is crucial to the early intervention of any emergency. Some emergency medical incidents are more critical than others such as heart attack, stroke, and multiple traumas. The need for definitive care in a hospital with highly trained surgical and medical intervention teams supersedes the ability to perform such procedures in the field. However, there are numerous other emergency incidents which can also be deemed critical, which are handled routinely by the paramedic. Asthmatic shortness of breath, overdose, orthopedic injuries, and diabetic hypoglycemic events name but a few emergency medical incidents that require early intervention by the paramedic to alleviate symptoms before they progress to a critical state that may lead to death. Therefore, for serious trauma, cardiac arrest, or conditions that may lead to cardiac arrest, response time is critical. Cardiac arrest is one of the most significant life threatening medical events that can occur. A victim of cardiac arrest has mere minutes in which to receive definitive lifesaving care if there is to he any hope for resuscitation. The American Heart Association (AHA) issued a set of cardiopulmonary resuscitation guidelines designed to streamline emergency procedures for heart attack victims, and to increase the likelihood of survival. The AHA guidelines include goals for the application of cardiac defibrillation to cardiac arrest victims. Heart attack survival chances fall by 7 to 10 percent for every minute between collapse and defibrillation. Consequently, the AHA recommends cardiac defibrillation within five minutes of cardiac arrest. The sequence of events that lead to emergency cardiac care can be represented visually, as in the following figure. 10H Collier County, Florida — EMS Systern Master Plan Figure 27: Cardiac Arrest Event Sequence The percentage of opportunity for recovery from cardiac arrest drops quickly as time progresses. Recent research stresses the importance of rapid cardiac defibrillation and administration of certain medications as a means of improving the opportunity for successful resuscitation and survival. An Oregon fire department recently studied the effect of time on cardiac arrest resuscitation and found that nearly all of their "saves' were within one and ono -half miles of a fire station, underscoring the importance of quick response. Such timelines for care are being applied to heart attack victims, to the arrival at a cardiac angio- catheterization equipped hospital, to stroke victims, and to severe trauma victims to be transported to a surgically readied trauma center hospital. Specialization of hospitals for the care that they provide can save lives but also increase the amount of time a patient is in the ambulance. Although one hospital may be closer, the facility in which the experts are standing by with the tools and training most appropriate for the patient condition becomes the destination in modern EMS systems. While it is true that some requests for emergency medical services are not time - critical, these calls should be prioritized by the dispatch center and handled when the system can allow. Collier County Communications currently utilizes Emergency Medical 9 + °j Tuna CPR sin, VS pR)wufit•7 90% \ Ot (PCVV81}A[:T GIR:IOC apESt $8° 6o r 75% 70°• a s0 r so % w •t0'% Report Ftes T." Pcntl Set of Otsizlch to o c�'tlent cut Scena W 20 °= 25% 10 4a 2% 1 2 3 J 6 6 � 0 9 The percentage of opportunity for recovery from cardiac arrest drops quickly as time progresses. Recent research stresses the importance of rapid cardiac defibrillation and administration of certain medications as a means of improving the opportunity for successful resuscitation and survival. An Oregon fire department recently studied the effect of time on cardiac arrest resuscitation and found that nearly all of their "saves' were within one and ono -half miles of a fire station, underscoring the importance of quick response. Such timelines for care are being applied to heart attack victims, to the arrival at a cardiac angio- catheterization equipped hospital, to stroke victims, and to severe trauma victims to be transported to a surgically readied trauma center hospital. Specialization of hospitals for the care that they provide can save lives but also increase the amount of time a patient is in the ambulance. Although one hospital may be closer, the facility in which the experts are standing by with the tools and training most appropriate for the patient condition becomes the destination in modern EMS systems. While it is true that some requests for emergency medical services are not time - critical, these calls should be prioritized by the dispatch center and handled when the system can allow. Collier County Communications currently utilizes Emergency Medical fire department recently studied the effect of time on cardiac arrest resuscitation and found that nearly all of their "saves' were within one and ono -half miles of a fire station, underscoring the importance of quick response. Such timelines for care are being applied to heart attack victims, to the arrival at a cardiac angio- catheterization equipped hospital, to stroke victims, and to severe trauma victims to be transported to a surgically readied trauma center hospital. Specialization of hospitals for the care that they provide can save lives but also increase the amount of time a patient is in the ambulance. Although one hospital may be closer, the facility in which the experts are standing by with the tools and training most appropriate for the patient condition becomes the destination in modern EMS systems. While it is true that some requests for emergency medical services are not time - critical, these calls should be prioritized by the dispatch center and handled when the system can allow. Collier County Communications currently utilizes Emergency Medical 10H t'IJ Collier County, Florida — ENIS System Master Plan Dispatch to prioritize calls according to their medical criticality, but Collier County EMS continues to run emergency traffic (lights and siren) to nearly every call dispatched through the 9 -1 -1 system. Additionally, these calls do not require the emergency driving techniques that are necessary for the critical incident types discussed earlier. Response time measures should be based upon the calls that are categorized as high priority by dispatch. Response time is a combination of subset times which consists of six steps, beginning with recognition of an emergency and concluding with the transfer of the patient to the hospital staff. The time required for each of the six components varies. The policies and practices of the EMS agency dlrectly influence four of the steps, but two are only indirectly manageable. The five parts of the continuum are: 1. Recognition: The recognition of a medical emergency or a traumatic event may occur immediately if someone happens to be present or if an automatic system, such as a medical alarm necklace, is available. Sometimes, recognition is delayed, sometimes for a considerable period due to patient denial of symptoms or injury. 2. {depart: Today most emergency medical and traumatic events are reported by telephone to the 9 -1 -1 center. Call takers must quickly elicit accurate information about the nature and location of the emergencies from persons who are apt to be excited. A citizen well trained in how to report emergencies can reduce the time required for this phase. 3. Dispatch: The dispatcher must identify the correct EMS units, subsequently dispatch thorn to the emergency, and continue to update information about the emergency while the units respond. This step offers a number of technological opportunities to speed the process including computer aided dispatch and global positioning systems. Turnout: Paramedics assemble on the response vehicle, and begin travel to the incident. Good training and proper station design can minimize the time required for this step. n. Response: This is potentially the longest phase of the continuum. The distance between the station and the location of the emergency influences reflex time the most. The quality and connectivity of sheets, traffic, driver training, geography, and environmental conditions are also a factor. Collier County, Florida - f`_i41S System Master Plan 5. Sett up: Last, once paramedics arrive on the scene of an emergency, equipment is removed from the unit and in many cases, must be brought to the patient inside a house or building which may require long walks, stairs, elevators, and narrow hallways. Once at the patient side, an assessment of their condition can begin. Many EMS agencies are beginning to record a 'patient contact' time to measure the time from arrival at scene to the beginning of patient assessment. This has been coined "vertical response time" in a recent study which found this time to be 2.1 minutes although the time can vary slightly depending on the environment.15 People, Tools, and Time Time matters a great deal in the achievement of an effective outcome to an emergency event. Time, however, isn't the only factor. Equally critical is delivering enough personnel to the scene to perform all of the concurrent tasks required to deliver quality emergency care. For a cardiac arrest this can be up to six personnel; two to perform CPR, two to set up and operate advanced medical equipment, one to record the actions taken by emergency care workers, and one to direct patient care. In multi- casualty situations, usually a motor vehicle collision, the real test of performance is the time it takes to provide all the personnel and equipment needed to deal effectively with the situation at hand, not necessarily the time it takes for the first person to arrive. The first person to arrive at an emergency should conduct an initial scene size -up, request additional resources, and begin triage procedures. Emergency service agencies should have clearly defined response performance objectives established to allow evaluation of capability and service delivery. An Organization's performance objectives should clearly state both the current and desired emergency service capabilities in very measurable terms. For emergency response, performance objectives should define response performance using both time and resource criteria. For example: is Silverman, et al; "The Vertical Response Time: Barriers to Ambulance Response in an Urban Area' Academic Emergency Medicine Journal, 2007 (16). a ION Collier County, Florida — EMS System Master Plan • Provide far, the arrival of adequate resources to initiate basic emergency medical services at the scene of any medical emergency within "X" minutes following dispatch, "X' percent of the time. • Provide for the arrival of adequate resources to initiate advanced emergency medical services operations at the scene of a critical medical emergency within "X" minutes following dispatch, X" percent of the time. With specific performance criteria, an EMS agency can develop deployment methodologies to achieve desired levels of performance, and can quickly identify when conditions in the environment degrade performance. EMS Industry Standards State or federal EMS response time 'standards' do not exist per se, and any establishment of an EMS response standard has been traditionally directed by the medical community. While fire incident response time is based upon repeatable, confirmed laboratory tests of fire behavior, growth, and spread, emernencv medical science is based solely on experiential data and studying the results from a plethora of patient outcomes. The rapid extraction of wounded military personnel from the battlefield to Mobile Army Surgical Hospital (MASH) units in the Korean and Vietnam Wars proved to be valuable in penetrating traumatic injuries. Transferring this knowledge to such incidents at home as well as blunt force trauma from vehicular collisions increased the awareness of response time and scene time for ambulances in the 1970's. Research in cardiac arrest victims followed that led to the further training of firefighters and other ambulance personnel to the 'paramedic' level. This research continues today with heart attacks and strokes. As such, time of response, amount of time spent on scene, and overall time of incident to hospital reception has been explored with little definitive conclusion as to one response time standard for all medical and traumatic events. NFPA 1710 The National Fire Protection Association (NFPA) has issued a response performance standard for all or mostly career staffed fire departments. This standard, among other things, identifies a target response time performance objective for fire departments and a _ �f ION Collier County, Florida — EMS System Master Plan target staffing standard for structure fires. Though not a legal mandate, NFPA 1710 does provide a useful benchmark against which to measure a fire department's performance. There are three time standards within the NFPA 1710 Standard for emergency medical responses. They are: o Turnout tune within one minute, 90 percent of the time a Arrival of a unit with first resporider or higher level of capability (basic life support) within live minutes of dispatch, 90 percent of the time 0 Arrival of an advanced life support unit, where this service is provided by the fire department,. within nine minutes of dispatch, 90 percent of the time. Colfferr County EMS has adopted a nine - minute response time for 90 percent of all calls as its performance standard. This is applied countywide and superseded a former model which varied the response time based upon geographic population levels. Response Time Capability A computer travel model has been developed to illustrate the extent of coverage by apparatus leaving a station in a nine - minute response time. The travel model excludes the one minute allotted for turnout or reflex time. The model takes into account the length of the roadway, the speed capability of the roadway, and reduction thereof for turns and intersections. The following maps illustrate the response time capability, from several areas of the County. Much of the area identified in Figure 28 has coverage by an ambulance from its station, except for the northern border of the County which adjoins Lee County in the North Naples area. There are also areas of residential development east of Station #10 and #71, which are not reachable within nine minutes by a Collier FMS ambulance. 72 oll Collier County, Florida — EMS Systern Master Alan Figure 28: Travel Time Capability from a CCENIS Station in the Naples Area While the coverage of the Immokalee ambulances are well located for the developed area within this agricultural portion of the county, their range of travel does not extend much beyond the immediate area (see Figure 29). Their ability to back -up other units outside of their area Is limited and vice versa, which based upon service demand to be discussed later, is the reason for the second unit at this station. Construction has begun for Ave Maria Town and University, located directly south of this station's travel capability. Facilities are, however, being built for emergency services within the town. ION Collier County, Florida – EMS System Piaster Plan Figure 29: Travel Time Capability from the Immolralea Station The remote area of Everglades City (located in the southern part of the county and surrounded by marshland) is adequately covered by the unit stationed in this area (see Figure 30). The nearest back -up unit, however, comes from the Marco Island area — more than 30 miles away. 1 i U I � I�s i �T I It -- " Collier Cannry, FL 0 1 2 Mifes The remote area of Everglades City (located in the southern part of the county and surrounded by marshland) is adequately covered by the unit stationed in this area (see Figure 30). The nearest back -up unit, however, comes from the Marco Island area — more than 30 miles away. 1O H Collier County, Florida - EONS Systern Master Plan Figure 30: Travel Time Capability from the Everglades City Station The Isle of Capri and Marco Island areas, along the southwest coast of the county, are also considered remote from the main fleet of units in the Naples area. These units provide adequate coverage for their primary areas (see f=igure 31) and serve as an important back -up in cases of call concurrency. Collier County, Florida - EMS System Master Plan Figure 31: Travel Time Capability from the Stations on the Isle of Capri and Marco Island. s, Mx', C� - .••ter �;� �. w; - .� 5�.�„ Collier COmlly, FL maz ion While emergency apparatus often respond from their assigned station locations, there are times In which the apparatus may be out of the station for various reasons but still within its area of service. These randorn locations are too numerous and variable to measure consistently, therefore response models from station locations are often used exclusively. However, in the case of ambulances, an alternate response location that should be considered (not only for response models but return to primary district timeframes) is the travel capability from area hospitals. The following map (Figure 32) illustrates the hospitals as a point of departure for ambulances. j£ ri l¢I .a KYix�Y0`t k \ C� - .••ter �;� �. w; - .� 5�.�„ Collier COmlly, FL maz ion While emergency apparatus often respond from their assigned station locations, there are times In which the apparatus may be out of the station for various reasons but still within its area of service. These randorn locations are too numerous and variable to measure consistently, therefore response models from station locations are often used exclusively. However, in the case of ambulances, an alternate response location that should be considered (not only for response models but return to primary district timeframes) is the travel capability from area hospitals. The following map (Figure 32) illustrates the hospitals as a point of departure for ambulances. Collier County, Florida — E WS System Master Plan Figure 32: Travel Time Capability from Area Hospitals ncxcgit `ill Ni�.,.�„•L R• � 1_ 1 . �xllysidans FaClapal S _ Collier Caunry r1 v r Transport calls continue and units remain unavailable while the crew transfers patient care to hospital staff and the vehicle and equipment are readied for the next call. Once available, a unit is capable of response from the hospital. Figure 32 also shows that more remote stations would have their primary unit out of their primary zone longer if they transport to hospitals other than those closest to their home zone. This Is most obvious for units assigned to Immokalee, Marco Island, Isle of Capri, and Everglades City. Collier County, Florida— EMS System blaster Plan Current Population Information Collier County is the 15'" most populous county in the state of Florida. The estimated 2006 population for the County is 314,649 persons, according to the U.S. Census Bureau. This is a 25 percent increase from the 2000 Census, when it was determined that the population of Collier County was 251,377 persons. The following chart illustrates several years of County population and the annualized rates of growth.' Figure 33: Population History The County has estimated that the population is actually 316,984 for 2006, based upon permits for dwelling units and a person per household multiplier. Although higher than the federal estimate, the County's estimate is lower than the University of Florida's Bureau of Economic & Business Research (BEBR) estimate of 317,800 for 2005. It is also useful to assess the distribution of the population within the county, since there is a direct correlation between population density and service demand. The following map displays the population density of the different areas of the County, based on information from U.S. Census Bureau statistics. ' Data from the 2000 U.S. Census Bureau. IOH 10H Collier County, Florida — ENiS System Master Plan Figure 34; Naples Area Population Density Lr't•- ;� � i z lei r _I y � 1 Cy�y+ t I rooassaW '.� - m: 111 1Gll ., R. \. - y The population of the area is most concentrated within the city limits of Naples. The locations of the CMS stations are within and surrounding this area of higher population density. The remaining maps are based upon the 2000 U.S. Census; but rather than utilizing block groups which are larger geographic extents, the following maps (Figure 35, Figure 36, and Figure 37) utilize census blacks. These smaller geographic units provide definition to areas which would otherwise be lost when they are included into larger areas of the census block groups. Co I Iler County, Florida —EMS System Master Plan Figure 35: Everglades City Population Density d IIN_ V 'e 7 Collier County Fl. FCE USUSSLOCK ii PO P2000 1 S arm LIE q- 10H 10H Collier County, Florida - EMS Systern Master Plan Figure 36: Immokalee Area Population Density -7-U 10H Collier County, Florida - - EMS System Master Plan Figure 37: Isle of Capri 11, Marco Island Population Density As one of the factors that influences emergency service demand, this growth in population and its composition with regards to age and socioeconomic characteristics will need to be examined. Figure 38 examines the population segmented by age groups. 1 01" Collier County, Florida — ENIS Sysloltl Master plan Figure 313: Collier EMS Population by Age Demographics- Population By Age (2005) i I 65 to 74 75 and up Aye <5 6% 7% 13% 5 to 24 23 I 55 to 64 45 to 54 25 44 13% 25% I I The chart above indicates that 19 percent of the population in Collier County is within the age group of 65 years and older; this age group is more prone to medical incidents than any other group. Additionally, 7 percent of the population is under the age of five. This age group can have a higher mortality in emergency incidents than the other groups. These population figures represent resident population; they do not take into account commuting workers, shoppers, tourists, travelers, and other non - residents. Estimating this full figure can be daunting given the number of facilities which require an accounting of population, such as roadway counts, store customer counts, and event attendance figures. Demographic Disk Analysts Although there is always some probability for each citizen to require the use of EMS, age and socioeconomic factors play an important role in the frequency of use of emergency medical services. The median resident age in Collier County is 44.5, compared to the U.S. median of 35.3; this difference is primarily due to the attractiveness of this area to retirees. _ 03 ( ,� :��'7 Selected Oemographlc Information. 2000 to 2005 Total Pop Ago <5 5 to 24 25 to 44 45 to 54 55 to 64 65 to 74 75 and up 2005 302514 19,233 65,474 73743 36,950 36,057 37159 17,66: 2000 251,377 13,441 53,211 fit 720 29,515 31,977 35,068 13,12' change The chart above indicates that 19 percent of the population in Collier County is within the age group of 65 years and older; this age group is more prone to medical incidents than any other group. Additionally, 7 percent of the population is under the age of five. This age group can have a higher mortality in emergency incidents than the other groups. These population figures represent resident population; they do not take into account commuting workers, shoppers, tourists, travelers, and other non - residents. Estimating this full figure can be daunting given the number of facilities which require an accounting of population, such as roadway counts, store customer counts, and event attendance figures. Demographic Disk Analysts Although there is always some probability for each citizen to require the use of EMS, age and socioeconomic factors play an important role in the frequency of use of emergency medical services. The median resident age in Collier County is 44.5, compared to the U.S. median of 35.3; this difference is primarily due to the attractiveness of this area to retirees. _ 03 ( ,� :��'7 10 fl Collier County, Florida - EMS Syshaui Master Plan The very young are vulnerable when faced with serious medical ailments such as asthma. In addition, traumatic events, such as choking, or vehicular accidents are leading causes of mortality in this age cohort. Determining where the predominance of this age cohort lives within the County will help in the deployment of apparatus. The highest concentration of pediatric population within Collier County is located in the Immokalee area as well as near Units 70 and 80 (see Figure 39), Figure 39: Pediatric Population Density 84 — -- — -- 10 R" Collier County, Florida — ENIS System Master Plan In an effort to investigate the Impact of the elderly population on emergency services, reviews of available academic literature yielded many related studies. The majority of this type of research can be found in medical journals. Several studies that focus on other facets of emergency services such as hospitals and police services are reflective of the current Strain on the use of emergency services. The high utilization rate of the emergency department by the elderly has been discussed and it has been found that the inadequacies in the access to primary rare physicians by the elderly at home and in nursing homes is the cause of an inappropriate reliance on emergency reoms and the emergency transportation services (Wofford, Schwartz, and Byrum 1993)." Clark and Fitzgerald (1999)1D found that although the elderly comprise 12 percent of the population, they utilize approximately one -third of emergency ambulance use and two - thirds of non - urgent use in their study area. Another study examined the demand on emergency departments and public emergency units when a patient, whose condition is beyond the resources of current medical science is sent home to live their final days with the family. The study emphasized the need for the use of physician counseling of family members for 'expected' deaths at home so the patient does not needlessly end up in the hospital again (Grant 1993)." Several studies have been conducted relating to the use of emergency services by the population at large. The British Health Department, in response to an over - reliance on emergency services, proposed alternatives be given to those patients or callers who summon emergency help for non - emergent situations (Beecham 1997) ?0 In Milwaukee, as with many U.S. cities, ambulance diversion from overloaded hospitals has generated its own quest for solutions to a growing problem. Usually protective hospital systems are cooperatively providing bed- status data to the emergency service that is accessible and Watford, James L., Earl Schwartz, and JE Byrum. 1993. "The Role of Emergency Services in Health Care for the Elderly: A Review' Journal of Emergency Medicine, 11(3): 317 -26. '8 Clark, MJ and G. Fitzgerald. 1999. 'Older People's Use of Ambulance Services: A Population Based Study" Joumalof Accident & Emergency Medicine, 16(2): 106 -11. 'v Grant, Dorothy. 1997. "MDs Must Help Eliminate 911 Calls After 'Expected' Home Deaths, Medical Examiner Advises" Canadian Medical Association Journal, 156(7): 1035 -10383 " Beecham, Linda. 1997. "Review Proposes More Emergency Care In the Community" British Medical Journal, 314(7076): 251. 14H�� Collier County, Florida - EMS System ,Plaster Plan updated via the internet in an effort to reduce the strain on hospital services (Barthell et.al. 2003)21. Cadigan and Burgarin (1989)22 studied a larger population and found a correlation between the use of emergency services and age and income. The elderly and the poor are more likely to use emergency services. Both Svenson (2000)2s and Rucker of al. (1997)2° find elderly use of emergency services higher than the general population. Rucker et al. (1997) and Dickinson at al. (1996)2' correlated the type of insurance as a factor in emergency services use and time of day services used. The 'Baby- Boom" generation Includes those individuals born between 1946 and 1964. In 2007, the oldest member was 61 years of age and the youngest was 43 years of age. This is the largest segment of the population in the United States. The growth of the elderly (65 years and older) is expected to increase dramatically across the country over the next 30 year's. In Collier County in the year 2000, 19 percent of the population was elderly26 compared to 13 percent nationwide27 and 17.1 percent for the state of Florida." As this cohort ages, medical conditions such as heart disease, cancer, neurological conditions, and cognitive maladies are likely to present within this group. 21 Barthell, Edward, Seth Foidy, Kim Pemble, Christopher Felton, Ronald Greischar, William Pinallo, and William Bazan. 2003. "Assuring Community Emergency Care Capacity with Collaborative Internet Tools: The Milwaukee Experience" Journal of Public Health Management and Practice, 9(1): 35 -42. 22 Cadigan, RT and CE Burgarin. 1969. 'Predicting Demand in Emergency Ambulance Service" Annals of Emergency Medicine, 18(6): 618 -21. z Svenson, James E. 2000. "Patterns of Use of Emergency Medical Transport: A Population - Based Study' American Journal of Emergency Medicine, 18(2):130-4. ' Rucker, Donald, Roger Edwards, Helen Burstin, Anne O'Neil, and Troyen Bresnan. 1997. "Patient - Specific Predictors of Ambulance Use" Annals of Emergency Medicine. 29(4):484-491. 25 Dickinson, Edward, Vincent Verdile, Christopher Kostyun, and Richard Salluzzo. 1996. "Geriatric Use of Emergency Medical Services" Annals of Emergency Medicine, 27(2): 199 -203. 25 U.S. Census Bureau 27 U.S. Census Bureau. 25 University of Florida, BEBR, fit'• INf.,jl I ,j Collier County, Florida — EAiIS System klasier Plan Potentially, this will increase the call volume for emergency services significantly. In visualizing the current distribution of population within Collier County, median age per traffic analysis zone provided by Collier County is displayed in the following figure. Figure 40: Median Age of Population I 1. i I i I i - � I R, r4 Collier County, FL r MDNn ACE Y [a -33 E:. ti - -u a -a= 53.91 The propensity of the elder population groups in Collier County reside west of Interstate 75 and on Marco Island. The following chart details the age ranges of patients treated by Collier County EMS based upon information provided. 10 Tfl Collier County, Florida — EMS System Master Plan Figure 4'1: Patient logo Ranges Patient Contact Age Ranges i i i Aga c5 5 l0 24 S% 12% 75 and up _ u 251044 I i 65 to 74 - 45 to 54 19% 55 to 64 10% 10% I I Senior citizens are the most frequent users of EMS within Collier County, disproportionate to their total population percentage. Planning for deployment of EMS units should be based partially upon the concentrations of senior citizens. Other factors that increase the frequency of EMS use are lower socioeconomic factors such as income. The econornically disadvantaged population often relies upon EMS for minor medical care and entry into the healthcare system via the emergency departments. Their reliance on Medicaid insurance or charitable forgiveness for services rendered often provides the motivation for use of social services, such as EMS. The following map details the median Income for areas within Collier County. I '0 I COltier County, Florida - EMS System Master Plan Figure 42: Median Income �cj I d9 i .. -... __vT.....� .k�.. 'k�'+1i81 - _ 1 aYJ 1 It would be expected that, to the extent of population density, the areas in the shade of brown would have higher service demand than other areas with similar population levels but higher incomes. Housing Risk Analysis Housing value and types are reflections of the level of socioeconomic factors in a community. We begin with a breakdown of housing by occupancy types in the County. 89 v .� Collfer County , FL h. NX INCOME b L "ii i1d 959.ue.515.W10] p�� i ?.IS W00 n00Y.lO r - 50 0]01 175,WO.W 5]'. 0101 t- (,Gd �Y It would be expected that, to the extent of population density, the areas in the shade of brown would have higher service demand than other areas with similar population levels but higher incomes. Housing Risk Analysis Housing value and types are reflections of the level of socioeconomic factors in a community. We begin with a breakdown of housing by occupancy types in the County. 89 10 fl Collier County, Florida - EMS System Master Plan Figure 43: Collier County Housing by Occupancy DGniographics• Housing By Occupancy Vacant 33 b Renter Occupied 17% Owner Occupled L; 50 As a percentage of total housing, owner - occupied housing has remained stable, decreasing slightly from 54 percent in 2000 to 50 percent in 2005. An increase in percentage Of total housing was experienced in owner- occupied properties, and the number of vacant properties has increased significantly. One measure of lower socioeconomic means is the density of rental housing in the area. This is just one measure which must be viewed cautiously in light of areas which are resort areas or areas with higher education institutions, such as Collier County, that frequently have an abundantly supply of rental housing. The following figure illustrates areas of concentrated rental housing by census block group for 2000. Selected Housing Information - 2000 to 2005 Housing Units Owner Occupied Renter Occupied Vacant 2005 1812611 895201 31651 _ 6009C 2000 144536 77825 25148( 41563 change 25%1 15% 26 %1 45 As a percentage of total housing, owner - occupied housing has remained stable, decreasing slightly from 54 percent in 2000 to 50 percent in 2005. An increase in percentage Of total housing was experienced in owner- occupied properties, and the number of vacant properties has increased significantly. One measure of lower socioeconomic means is the density of rental housing in the area. This is just one measure which must be viewed cautiously in light of areas which are resort areas or areas with higher education institutions, such as Collier County, that frequently have an abundantly supply of rental housing. The following figure illustrates areas of concentrated rental housing by census block group for 2000. lQ H Collier County, Florida — EMS System Master Man Figure 44: Renter Occupancy Density The most concentrated area of rental housing is located within the city of Naples near several EMS stations. These areas are expected to have higher service demand along with areas in which there is a higher level of vacant housing, which is shown in the following figure. 10 Collier County, Florida — EMS System Master Flan Figure 45: Vacant Housing Density 1 s i ^�y X71 l4191� 1 3, , 7tido LOC t rtt �?" µ 7 ~� corfturcounty, FL '+� \ VACAFITI5g611 151 14 13 e! The highest concentration of vacant housing is located directly along the coastline. This is due to the multiple hotels, timeshare, and other vacation resorts located in these areas. Additionally, winter season residents who reside elsewhere may own property in these areas as well. It is estimated that 49.3 percent of the vacant housing in Florida is for rent for recreational, seasonal, or occasional use.29 Applying this percentage to the 21 U of F, BEBR tiI r� ' J 10 Collier County, Florida - 1 --PdS System Master Plan vacant housing in Collier County and multiplying it by the average persons per household provided by the County (2.'14) for both single unit and multiple unit dwellings, a seasonal population of 63,396 additional persons reside part -time in Collier County. This Is especially Important when it Is realized that most EMS calls occur within a patient's residence, as detailed in the chart below. Figure 46: Locations of Patients for Collier County EMS Incident Location Types i Oaazh ,' CvnsWdlan 0.]5% '+. EdU li nal facaly 0.35% Ue..IN Nvrd, Faifty ;1e`Freereay PuWc Area 5.56 °s SImeVHi6he+ay , 51 ;' 03W% 122% i 15.82': +l' HOSAliii };Il IAl q Shia g ' 0.10%aclul 0.10'4 Jet QS 2% 12.04 +b Ohre ��S �i" ... aao °; �4 I�s3p,$ ,� P1. Fes4�erce� y. _ 541 Resort 93696 fi OOG: -r �iy 3 y1 \`, 3urlacv SUM � 66nidPhyvaan Mice i;, (167% SMnn, Pvvl OVrer Oesaerca_i ' 3.45 °e OVice:BUS4vss,CVmmercial 0.0696 ; 5.9T6 ylalemmy SYtltlemess Mev I 0.0591 I Future deployment of EMS units should also be based upon the increase In housing units, including those intended for occasional use. Demand Analysis Collier County EMS has provided incident data from 12/21/05 to 7/1£3/07 as received from the Collier County Sheriff's Office Computer -aided Dispatch system (CAD). The County reportedly responded to 40,023 calls in FY 2005 and 42,165 calls in FY 2006 according to information provided for reporting to the Florida Qenchmarking Consortium. The CAD data provided was filtered for unit designations that matched the ground Collier County, Florida — ENIS System Master plan emergency medical transport units using data from the last full year30 While over 42,000 rows of data were attributed to the units, multiple entries for a single incident were found. This would occur when multiple units are assigned or reassigned or to record a particular time stamp. The incidents were predominately handled by a single unit, except in cases of multiple patient situations. While test calls were removed from this data, all other calls were considered workload for this section's analysis. To create a single record for each incident, the dataset was filtered for a unique incident number. The resulting data set yielded 32,292 incidents. A review of incidents by time of occurrence reveals when the greatest response demand is occurring. The following charts show how activity and demand change for Collier County EMS based on various measures of time. ESCI began by breaking down the workload into monthly increments. Figure 47: Monthly Workload '0 Medflight and ALS Engine Response are to be considered separately. 10% — a, I , 6% f — I I, i 10 - JAN FELL MAR APR MAY JUN JUL AUG SEP OCT NOV DEC '0 Medflight and ALS Engine Response are to be considered separately. 104H COW County, Florida — EMS System Plaster Plan Monthly workload appears greatest during the temperate months of the year for south Florida. These months are also times when vacationers and second homesteaders from northern climates spend time in the area. In further analysis, workload is examined by day of the week. It appears that medical service demand increases towards the end of the week except for a spike in activity occurring on Mondays. Figure 48: Workload by Day of Week The final analysis of historical workload concludes with examination of call types by hour of day. The hours of peak activity can strain an under- equipped or under - staffed EMS agency. Understanding when peak activity occurs begins the process of developing deployment strategies and needs assessment. 10B, Coliler County, Florida— ENIS Syslem Ailaster Plan Figure 49: Workload by Hour of Day Activity for medical calls begins to increase dramatically at 5:00 a.m., reaching peak volume during the 11:00 a.m. hour before gradually declining into the afternoon. A brief spike in activity is noted at 3:00 p.m. and again at 5:00 p.m. before consistent decline in service demand progresses into the evening. Peak activity times can be reflected in response time performance in certain cases. The impact of response time on the outcome of emergency incidents has been exhaustively studied, both in the laboratory and in historical data, with predictable correlation between the two. Though seemingly intuitive, it is still useful to review how longer response times can have a negative effect on the ability to successfully intervene in a life- threatening medical emergency. Response time performance is examined in a separate section. In addition to the temporal analysis of the current service demand, it is valuable to examine geographic distribution of service demand. Later in this study, ESCi will evaluate the locations of stations in comparison to the actual service demand within the 96 w� 10H Collier County, Florida — EYIS System 17asier flan area. The following maps indicate the distribution of emergency incidents responded to by the agency in the last year's worth of data." The station in the Imrnokalee area is well located near the highest service demand for Immokatee. The higher service demand extends northwest following Route 29. Other areas have relatively lighter service demand. Figure 50: Immokatee Service Demand Density I' �' 98% successfully geecoded. i f I I� 10H Collier County, Florida - BIS System Pilaster Plan The highest service demand in the Naples area occurs along US Highway 41 and in small neighborhoods near Station 70, Station 45, and Station 75. Outlying stations to the east have relatively lower service demand volumes. Figure 51: Naples Area Service Demand r� I. f � 'A t jYj .xftiy °mac ' I ' s4 i 4(grnY. 1 1 i 1 1 Collier Co only, F4'' - 11 III �T' Ica oemarldsRnl `� t ^'k _�� I - � I �.. lia J..3 - I, C ITl QQ Y tI 'f -5f 1 Fv4'S"Iwi Ih Collier County, Florida - EUIS System Moster Plan The north side of Marco island along the commercial corridor of Collier Boulevard is the. highest service demand area for the stations illustrated in Figure 52. Figure 52: Isle of Capri & Marco Island Service Demand Collier Connfg R St, -:Itv OJ.�,Jnd,5�F4 f] -fJU YI i 1 0 € I 10fl Colter County, Florida - EMS System Master Plan Everglades City is a remote area that has relatively lower service clemand and longer travel time by the unit serving this area due to the geographic extent of need. Figure 59: Everglades City Service Demand Collier County, Florid €r — ENIS System Ntayle, Plan The, sparsely populated Eastlands area has service demand that is based upon incidents such as motor vehicle collisions that occur on the highways. Figure 54: Eastlands Area Service Demand Most of the arras of highest sevice demand are located in areas of high residential population density as in the Naples area, Inunokalee, and to a lesser extent, Marco Island. The correlation between the population density, at risk age cohorts, and socio economic factors provides a basis of factors to consider in future cleployrnent strategies. Coil try County, Florida — EI]S Sys lei n NI aster Plan Certain facilities require special attention, which is not easily discerned from the previous maps. They include facilities of especially high potential for frequent EMS use such as nursing homes and publicly assisted housing developments. The following map details the locations of high potential use facilities as listed in the 2007 Directory of Services from the Collier County Council on Aging. ric7Ure 55: High Potential Use Facilities I i , I CoOCI COU ly, FL i N9 i .v. +1Urt 91n 1 , 1 3 lilE�3 rn — Additionally, it should be noted that an examination of a separate clataset of patient care records (PCR) indicates that most calls result in transportation to a local hospital. This is 102 ION Collier County, Florida —ETYIS System Pdnater Plan detailed in the following chart and must be considered as traits from more remote areas travel to and from these facilities. Figuro 56: Call Disposition Results Call DIsposlllons ALS Eegine Response 0.24 Cam Tanslened Pin:c Tramped lnmr -basFl 0.03•.0 hlmna Lansryil 1 0.00 °6 Hosp'.lel Lanaped Iran -E01 0.40'.; Infer r..q, lem ER 032% _No Pausal leurd 0,75% Rolfability Analysis Worl load and Failure Rates The workload on emergency response units can be a factor in response time performance. The busier a given unit, the less available it is for the next ernergency. If a response unit is unavailable, then a unit from a more distant station must respond, increasing overall response time. A cushion of surplus response capacity above average values must be maintained due to less frequent but very critical times, when atypical demand patterns appear in the system. tl medical calls and multi- casualty events are exarnples. A UI-IU was calculated utilizing the actual time on any assignment for each unit. Unit how' utilization is an important workload indicator because it describes the amount of time a unit is not available for response since It's already committed to an incident. The OIM1Cr o 151' O.t5 "6 1W-1; - - -' Rehab Peat antl RN I.M.. Cdll Can<elletl 13.55•: Special EVenlA ReleS Tmalrenl _ 0A01 -4 i I97­6 OeadalSttna Tenspaned b]vnplhe Unl Ne vea requimtl� fi1. Ak,rp I, Tlealcdand oansporl by 1.17 5 1.95% POV 0206 Rolfability Analysis Worl load and Failure Rates The workload on emergency response units can be a factor in response time performance. The busier a given unit, the less available it is for the next ernergency. If a response unit is unavailable, then a unit from a more distant station must respond, increasing overall response time. A cushion of surplus response capacity above average values must be maintained due to less frequent but very critical times, when atypical demand patterns appear in the system. tl medical calls and multi- casualty events are exarnples. A UI-IU was calculated utilizing the actual time on any assignment for each unit. Unit how' utilization is an important workload indicator because it describes the amount of time a unit is not available for response since It's already committed to an incident. The .Collier County, Florida — EMS System Master Plan IN larger the number, the greater the unit's utilization and the less available it is for assignment to an incident. Studies of fire -based medical units indicate that significant employee burnout can occur with 0.30 unit hour utilization. However, third- service EMS providers suggest higher UFIU ratios are acceptable; in the range of 0.35 - 0.4Q. In private, far - profit ambulance transport companies, a UHU above 0.50 would be acceptable. These variations in UHU ratio thresholds are due in part to the length of a typical shift for the paramedics, Typically, fire -based EMS units work a 24 hour shift, while third party EMS providers typically work a 12 hour shift. Private providers, which are profit- driven typically work 0 hour shifts. Private providers also perform a large amount of non - emergency transportation services which are not dependant upon response time standards or geographic proximity. Since Collier County EMS operates on a 24 hour shift schedule, the fire -based UHU threshold of .30 is most comparable. Typically, the wod(load would be divided appropriately among the different response units; however in this case, geographic extents and service demand variances create an unequal distribution of workload. Figure 57: Unit Flour Utilization ION Collier County, Florida — EMS Syst.ern Master Plan It should be noted [[let UI-IU does not measure crew activity not related to actual delivery of emergency services. For example, the amount of time for a crew to return to its station from a hospital transportation or scene of a call is not measured because they are recorded as 'available' for service. Other necessary activities for crews include crew change, station duties, restocking supplies, daily examination of unit for mechanical and supply inventory, the need for meals and rest room breaks. While high UHU measures indicate the need for additional units to handle workload, law UI -IU measures do not necessarily indicate the need for a reduction in current resource capacity, as is indicated below. Call Concurroncy and Resource Dravidown Another way to look at resource worldoad is to examine the amount of time multiple calls happen within the same time frame on the same clay. ESCi examined the calls during the last full year to find the frequency that GCEMS is handling multiple calls within any time frame. Multiple calls occurring at one time can stretch available resources and extend response times from distant responding available apparatus. As in most communities, the majority of calls in Collier County happen singularly. However, as communities grow the propensity for concurrent calls increases. When call concurrency reaches a level to which it sketches resources to near capacity, response times begin to extend. Although medical calls will cause drawdown as concurrency increases, they usually occupy only one unit at a time. Multi - casually incidents (such as motor vehicle accidents) may need additional ambulances and create periods of extensive resource drawdown in an area. These areas are the basis for first unit dispatch and should be based upon the ability of the units travel time capability. Data that indicated a zone when the CAD incident database was correlated with the patient care record database was uiilized. Obviously, if a match of the record or if a zone was not entered in the PCH record, it could not be utilized- The following table and chart (Figure 58 and Figure 59) cletail the level of concurrency by dispatch response zone. Qq hit„ Collier County, Florida - EMS Syslew Master Plan Enure 58: Table of Concurrent Calls by Zone ION Zone Colts single 2 3 4 5 _Total - - 10 Corkscrew 775 714 54 7 0 �1t3,,/o 6.97% 1 Naples 1468 1288 88% 152 10% 24 2% 4 0% -2 Naples 1896 1637 225 - -_ 32 1.69% 2 0.11 %I 86.34%51.87% 21 E. Naples 2088 1668 79.89 % 373 11.86% 40 4 3 1.92% 0.19% 22 E. Naples 1753 1544 195 12 88.00% 11.12% 0.68 % O.OG% 0.00% 0.06 - 23 E. Naples _ 1102 147 21 1 _ 86.70% 11.57% 1.66% 0.08 24 E. Naples 601 569 28 4.66% 4 0.67% 3 Naples 865 791- 191410,: 66 7.63% 6 0.92% 30131 -I Irnmolcalce J 3695 2553 846 197 76 20 3 69.09% 22.90% _ 5.33% 2.06% 0.64% 0.08 40 N. Naples -I -_- 1802 1537 241 21 3 85.29% 13.37% 1.17% 0.17% _ 42 Urban @slates_ 2033 1680 B2.64%. 305 15.0 43 N. Naples 1444 2145 125 169 19 2 0.14% 7 86.84% 1604 11.75% 397 1.32% 57 74 - -- N. Naples 78751 % 18.51% 2.66% 5 1.01% 0.33% 1 0.20% 45 N. Naples 494 435 53 10.73% 88.06% 46 N. Naples 1230 1101 89,51% 116 10 3 0.24% 9.43% 0.81% 50 Marco 1849 1597 86.37% 499 Ia ?J' /_? - 221 11.95% 24 ] 458/ 30 1.62% i 0.19% 1 0.050% _ 13 2 611 Everglades City 524 70 Golden Gale _ 2303 1992 438 58 79.58% -1715 0% 2.32% 0.52% 71 Rural Estates 857 794 ' l.2tG6W 1032 85.08% 185 ,99�?111 62 0 1 0.00% 012% 20 1 1.65% 0.08% + .23% 160 13.19% 1 75 Golden Gate 1213 I_ 186 - I_ - -_- 90 Capri �1 ti 1's - t f' CcIN01' County, Florida -- EN1S'Systcro Master Flan Figure 59: Conctinancy Chart by Response Zone Concurrent call frequency: i62 E13 ❑A ❑s 900 nesponse Zones Unfortunately, because some of the zones are large geographic areas, an alternate methodology was utilized to show areas of higher concurrency more specifically. A five - mile grid zone was created in which simultaneous geocoded calls were counted and displayed on the following series of maps based upon an increasing amount of simultaneous calls. 000._ —__ i Goo ' - - x units assiynad _ ! -- - - -- Goo- - -- -. --- -- ----- -- -' - I 900 F2 .,Ills o nuA - - 2unils 2units assigned asst ned - 900 - — — 2 unils - asslgnerl zoo — 100 if — — y 1 nesponse Zones Unfortunately, because some of the zones are large geographic areas, an alternate methodology was utilized to show areas of higher concurrency more specifically. A five - mile grid zone was created in which simultaneous geocoded calls were counted and displayed on the following series of maps based upon an increasing amount of simultaneous calls. IOH .Collier County, Florida — EIMS SyMem Nlastp.r Plan Figure Conciarency j oar -- ------ ---- 4w ,J1 rat, Ei COW C.,mly, rL IU 08 �'j 10 Collier Coujily, Florida — EL(S System Master Plan Figure Gi, 7hroo -Call Cancunrency 1 � 1 JAI 1 , 1 1 Q 1 A!1�— Air n ,I ". Uf ell IAJjQp�;+;} COW county, Fl. �.............� _ Freqit,, or]eoncurrent F7-- -I WO T 10H Colller County, Florida – EMS System blaster Plan Figum 62: Four-Call Concurrency d I u t %6 tl3` w4 ;iY�s ' ^,r 4 ;17 2 a H +r � /,I Caplet Counly. FL 1 F 91 -of 1 Concvvent C',iLL -1 -- \. 4 �C •.uary 1') 'i_' ..fit T 1� While call concuriency does extend beyond tour calls, it is important to note that the area with the highest vioildoad typically has the highest rate of concurrent calls. This equines response units from other stations to respond into this area, creating longer response times. In fact, units are responding to out -of -zone calls an average of 19 percent of the time. The fallowing chart illustrates the percent of out -ef -zone responses by apparatus. 110 a;l — Collier Cotgtpf, Flurlda— EMI S System blaster Phil Figure 63: Percentage of Out-of -Zone Responses per Unit Apparatus 'out of zona'responses 70% 1'. I aav li l i aa•s ll� a: 161 �'� 10'� 1 \1 O'�a \1v 141ry a 1p 07, Inn tl Pp 1A O OP 0O, 0,;0 01a 011 OV 04, �O'1 DO'S 4 ry P P1� a. af° �• ae ab e a• A a: aP S A J S a4 d� �. S� b d� :•• S .k ar as ao- c� Tire impact on station area reliability can also be affected by several other factors such as: Out of service for mechanical reasons • Breakdown during assignments. • Replacement schedules, maintenance procedures. e Out of service for training exercises o Using on -duty crews for training, special events, scheduled intorfacility transports. Out of area on move -up deployment as described in EMS policy: o If any Ihr ee of these unils, Medics 451,40,42,43 ate busy then cover 7one 44 in the following order. 43, 40,42,46,24 call 13A 61. v 70, 71, 75, busy= 46 to zone 70 0 70, 75, 46, 24 busy = 71 to zone 70 0 70, 71 busy = 75 to Zone 70 0 44, 43, AE44 busy = 40 to Zone 44 0 44, 40, AC44 busy = 43 fo Zone 44 0 44, f 0, AC44 busy = 43 to7_one 4•l o Zone 30 coverage when no one 30 unit available: 10, 71, 70, 42, 46, 75, 44 0 21, 2.3 busy = 90 to zone 23 unless 50 busy then 22 to zone 21 0 1,3,22busy =801o3 10H G'ofller- County, Fturtda - E,btS System Master Plan 0 7, 3, 21, busy = 23 to zone 21 a 3, 21, 23 busy = 90 to zone 23 0 21, 22, 23 busy = 90 to zone 23 unless 50 busy then 80 to zone 23 o Other scenarios contact DA 80. o Zone 50 coverage when zone 50 AND A T 50 AND AE50 are unavailable: 90,23,21,22,3 o Zone 50 coverage when zone 50 and 90 are unavailable: 3 to 80 o Zone 61 coverage it zone 61 unit unavailable.' 90 to 80,22 o Lack of staffing o Vacations, sickness, military leave without being able to replace staff as necessary. 0 Excessive hospital turnaround time o EMS policy indicates that units are given a fifteen minute timeframe after they arrive at a hospital to transfer care and information to the hospital staff before designating themselves available. o A reasonable time expectation is 20 minutes on non - critical calls based upon industry practice. Calls such as cardiac arrest, severe trauma, and the need for decontamination of a unit are expected to take more time. Additionally, busy hospitals may delay transfer from EMS as they prepare a room for treatment. o An examination of hospital 'turnaround' time for Collier EMS indicated an average of 21 minutes and 42 seconds. Ninety percent of the units are clear from the hospital within 33 minutes and 45 seconds. When these factors impact the reliability of a station to respond within its prescribed territory, response time performance measures for the back -up station /apparatus can be negatively affected. The following chart details the workload and the reliability by zone based upon the first arriving unit on the scene of an incident. The zones, for the most part, translate to the unit number assigned within the zone. For example, Zone 2 represents the area assigned to Medic 2 for primary response. Zones which share units are credited with responses by those primarily assigned apparatus. 112 c n Collier County, F6,ida,- EMS System Pilaster' Plan Ficture Gd; Reliability Reliability of, less than 80 percent for zones may indicate a need for additional units in zones with high workload Areas of lower woddoad may need to review the factors listed above and examine the rate of concurrent calls In neighboring zones as contributory factors to the lower rate of reliability. Recorded_Sstem Resuonse Performance Throughout this document, certain descriptive statistical measures are utilized which may not he familiar to all reactors. In an effort to reduce confusion or the drawing of inaccurate conclusions, this section seeks to provide a brief explanation of these measures. The measures most often used which require clarification are the use of "average" and "percentile" measures. Average The 'average' measure is a commonly used descriptive statistic also called the mean of a data set. It is a measure which is a way to describe the central tendency, or the center of a data set. The average is the sum of all the points of data in a set divided by the total 113 Collier County, Florida —EMS Sys lam blaster Plan (OR number of data points. In this measurement, each data point is counted and the value of each data point has an impact on the overall performance. Averages should be viewed with a certain amount of caution because the average measure can be skewed if an unusual data point, known as an outlier, is present within the data sot. Depending on the sample size of the data set, the skew can be either very large or very small. As an example, assume that a particular station with a response time objective of six minutes or less had five calls on a particular day. If four of the calls had a response time of eight minutes while the other call was across the street and only a few seconds away, the average would indicate the station was achieving its performance goal. However, four of the five calls, or 80 percent, were beyond the stated response time performance objective. The opposite can also be true where one call with an unusually long response time can make otherwise satisfactory performance appear unacceptable- These calls with unusually short or long response time have a direct impact on the total performance measurements and the farther they are from the desired performance, the greater the Impact. The reason we do compute the average is because of its common use and ease of understanding that is associated with it. The most important reason for not using averages for performance standards is that it does not accurately reflect the performance for the entire data set. As illustrated above, one extremely good or bad call skewed the entire average. While it does reflect all values, it does not really speak to the level of accomplishment in a strong manner. Percentile With the average measure, it is recognized that some clata points are below the average and some are above the average. The same is Uue for a median measure which simply arranges the data set in order and finds the value in which 50 percent or the data points are below tho medlar and the other half are above the median value. This is also called the 50 "' percentile. 10 �1 Collier County, Florida - RVIS System Pilaster Plan When you deal with fractiles or percentages, the actual value of the individual data does not have the same impact as it did in the average. The reason lot, this is that the fractile is nothing more than the ranking of the data set. The 90 °i percentile means that 10 pet cent of the data is greater than the value stated and all other data is at or below this level. Higher fractile measurements are normally used for performance objectives and performance measurement because they show that the large majority of the data set has achieved a particular level of performance. This can then be compared to the desired performance objective to determine the degree of success in achieving the goal. Total response time is the amount of time a resident or business waited until an apparatus arrived at the scene of emergency beginning when they first called the designated emergency number, often 9 -1 -1. It is made up of several elements which were discussed earlier (See "Response Time Performance Objectives'). Since Collier EMS has no influence on call processing time, most agencies are measured on response time from the time of dispatch to the arrival on scene. The following chart illustrates the overall response time frequency for Collier County EMS over the last full year of data providecl,'z The data was filtered for dispatch types that could be considered as emergencies." ESCi believes this would give a true representation of response times. Although it is policy for Collier EMS to respond in an emergency mode for all calls originating from 9 -1 -1, certain calls such as headaches, toothaches, and injuries that occurred several days ago are not true emergencies. Emergency response is more dangerous than normal traffic response, endangering the lives of the public and the responders when responding to non- emergent requests for assistance. A reasonable responder would not increase his /her personal risk beyond the simple adherence to agency policy. This practice of emergency mode response to such calls should be reviewed, and It is recommended that certain dispatch criteria be removed from the lights and siren policy. " Mutual aid calls and non - emergent calls were removed from response time analyses as they were found. ]] Detail provided in appendix. SQL, :rte'^ 4000 3500 knULl 2600 U C 2600 G 1500 1000 500 0 O O p .O O.O .O O &,d5 .O O.O O.O O.O O.O O.O O.O O.O O.O O.O O.O O.O O.O 00. 0�. 04'. 0�. 00. 00. 06. 01 .00.00.40.11.�0'A�.�D•.Nh.NO.�n .�v.'�A7101E ^!L0'JLO hu. 1LO.o!La.ry�"SO. O' Z. Z. w O' O' Z. O O' O' O O' O O' I-lour:Minuto:5oconds Collier County, Florida— EhIS system Masker Plan 10H t.j� rigure 65: Collier EMS Response Time Performance History Collier CMS: Counlywide Response Tine Perfornance Io l_requencv- Cumulative 120% 1 '100 60% 1 00% 40% j 20 0% The most frequently recorded total response time was within the seven - minute range; specifically the average of all calls is 7 minutes and 47 seconds. Ninety percent of all calls are answered within a 12- minute response time countywide. Response times can vary by time of clay in reflection of service demand woddoad, traffic congestion, weather, and distance to the call from the station to name but a few. The average total response time for all emergency incidents ranged from a high average of 10 minutes and 53 seconds for all calls between 6:00 a.m. and 7:00 a.m., to a low average of 6 minutes and 44 seconds for incidents between 9:00 a.m. and 10:00 a.m. (See Figure 66.) Oq Colller Cotmly, Florida — Ch1S System Master Plan Picluke 66: Average Response Time by Hour of Day Average response time is one useful measure to determine how well geographic -based coverage is achieved. As discussed previously, more significant is how well the majority 1 ©H 4 4 Collier Cotuity, Florida - BNIS System Master .Plan of emergency response dernand is being serviced. one useful way to determine how well clemand -based coverage is achieved is by determining maximum response time to a larger percentage of the incidents, in most cases 80 percent. As illustrated previously, the overall 90" percentile response time of the department within the primary jurisdiction of Collier County FMS was 15 minutes and 58 seconds for all call types, The 9d" percentile response time for emergency incidents occurring within Collier County ranged from a high of 23 minutes and 6 seconds during the 6:00 a.m. to 7:00 a.m. howl to a low of 10 minutes and A3 seconds during the 9:00 a.m. to 10:00 a.m. hours. The following figure displays the 90 °i percentile response time performance by hour of day for all calls within the Counly. 118 +l - -'�M1r•- Coder, Couaty, Florkla - ENIS System Pilaster Plan Figure 67: 00" Percentile Response Time by Hour of Day Hourly 90th Percentile Performance 1 , 2 3 4 5 6 7 0 9 10 11 12 13 14 15 16 17 10 19 20 21 22 23 24 00:00 03:00 06:00 09:00 '12:00 15.00 f7 t,•,�.,MG�;y, Collier Cougl'.y. Florida- ENdS System Master Plan Geographic Rosponso Performance In addition to viewing temporal changes in response time, it is also of value to view the impact of location on response limes. In order to accomplish a zone area analysis of current response time, we evaluated the actual response time performance in each station zone. -fire following chart (figure 68) details the average and 90 "' percentile response performance by zone area. Figure 68: Response Performance by lone The average response time performance from dispatch to arrival at the scene of an incident is reflected in the following map. 7 Iii T"," 10 14 Collier County, Florida - E�jlIIS 5yslem iMas,ter Plan Figure G9: Average Response Hrne Performance It Collier C.mif /, R r � A 9 ft p e. ime It can be seen that the majority of calls are within the response time objective for Collier County EMS on the average. However, using a grid zone over the county, actual calls were measured for percentile response performance in each grid sector. The following map illustrates the amount of lime it takes for an apparatus to arrive at an incident (from the llme of initial dispatch). Colller Coulity, Florida— FNIS Sys loin Ma's ter Plait Figure 70: Grid Response Performance I �l I 1, Collier Caunfy, FL Cl LWL SO 1� 00 t pematlJo euspanso Pertarmanco 4r1�i W.L., B h i .�1 J I C 1 C ^•i.�li IN } I� it 4' I a 1 The areas of longest response time are clearly visible through this map; and, as expected, the actual response [line performance is best in areas closest to more stations and hospital locations. F- Z w 2 f" Q a w Cl J Up F- wR ma � 0 w w Z wN 0 = W �C G z0 =)U O U Ir w J J O U Z w w J w } Z LL in N Z W QV5* = Q Q f'aD) wLLw O Q O J a(j0J wFU)w F Q O Z O CL � W Q2Oe. m > — O U) cn UN_H_Q ZDI�w F Z p = 0K Z M Q CL Z_ zQ� O >Q t- F- �U �wN t- Z z IL w L)w¢ w < 0 IL N N W M m c E � O 'O N N N � m L m O 0 m C C O O O U � E O m o cm O U > m O d N N m L E.�' > m ° E 0 m a` ' 2 E m c 0 ry O N CU Y N C U m C m L L . _ _ m U a N O mmamm,o O C N `O [� N a L L m N m X 3 m m L 3 m w T T C m mcc3m.m CL m m Z rn CM (a CU m L O c N N S 9 N— N U o' o SE N L 0 0 w o 0���'3U O U N d N > O O m > O E C C L L E m m N N m > > > m m K c c K A A A A A A Iofl Z O Q z_ Q z z O U w 0 d J w w J m m _ C 'U U m C C E— p O O m C C13 U_ U E � � O O C C C O O am m c c c E E O m m C c O C O m m m Nm c m m c m O L Y O T T D � C m E > m m m m m m c O U U OU = o m m m c O C m m 02 Y m m N c O c EE m �N ` C O m O 5 O L U O U r o 3 3 N O) 0 C �o m m N L � m O O O c m O 0 O Y L w o N c 3 m d) m m m a O'c E N V m m y L N O d O N c - N c °o O.3 E m m C O .0 c OU U m � m o o o a m n T `o J m 0 c m a>i O ° 0 O E m J O N 3 c M O N m m = c m a c O — N O N O m m N co E c E N E ° E O m O F- F- nU aU W N N W M m c E � O 'O N N N � m L m O 0 m C C O O O U � E O m o cm O U > m O d N N m L E.�' > m ° E 0 m a` ' 2 E m c 0 ry O N CU Y N C U m C m L L . _ _ m U a N O mmamm,o O C N `O [� N a L L m N m X 3 m m L 3 m w T T C m mcc3m.m CL m m Z rn CM (a CU m L O c N N S 9 N— N U o' o SE N L 0 0 w o 0���'3U O U N d N > O O m > O E C C L L E m m N N m > > > m m K c c K A A A A A A Iofl Z O Q z_ Q z z O U w 0 d J w w J F- Z w F- Q IL w 0J cn W 0 UO H W X rn a 22 Z�2 wN 0 = W z w z0 DU O U w J J O U Z W W J W Co M2 r O g Z LL U) yZW = U) as ZON WLLN QOJ (L VOJ W 1 N z K O Z LLoU)U) �a�w a 2 a. a)hJ0 waste U — F Q z❑3m F Z ❑ _ 0¢w� Z WF- CL Z_ Z Q O >Q Z OO ❑U � W � HOZ IL w uwQ w a C C E p O O C � U U EE U O C C � C O d N O c_ 0 c c E E O a7 a ° U N G C O G O U E N a) c a) O L U y c N a ° ° c E E E o m m N a) C ) 3c a m c c N w N N C E E cu m c o 0 n O U O L U m a 3 3 m m c m ._ N L � U O O O C M `o_ 5 o L L � v N c 3 > o m a) EN U U U L N ° U (V c (6 N p c C U 00 ao a) -o o a o d a — o J m c o 0 0 N O O E cu J O ca U rn U � N N U C O G O O N ( a) C N m C E N —CE NE (uE ¢ cc a)o mo � nU a U cn N N N O) � N C E a o a w 0 N N (a m O m O U C C � rn N Q N o `o C U a) � 0 3 ° c Y U N J U N o~ C) a L N N C 3 N C) w o U L N N m n ca f0 0 m 'C ° U N 3 m m c Z °o � L U X m (9 l9 L l4 -O C C N U C N N (0 E 0 0 C . U m o o E � c ❑ ❑ m G L O N N 3 O C Y Y N C O U m OX U U > O O U > U C C L L U O O N N ° > > > U A A A A A A Z O Q Z H z O U w ❑ M J W w J ION Collier.Counly; Florida - EMS System MaMerPlau'. Section Two - Future System Demand Projections �qo—m OWL ln —It V growth According to information received from the Collier County Planning Department, numerous commercial and residential developments are currently under construction. These projects are located along the US Highway 41 and 1 -75 corridors in the Naples area. Additional residential development has been occurring in the Rural Estates area and is expected to continue here and in the greater Immokalee area. A preserving lands transfer from east of the Belle Meade area to maintain lower density housing is allowing higher density residential development in the Rural Estates area and areas southeast of Henderson Creek. Tradepod, closer to Imrnokalee, is a planned mixed -use development that proposes 2,750 single and multi - family units and over 460,000 square feet of retail and office complexes. Affordable housing and nearly 3 million square feet of industrial use is also planned. This would increase the service demand for Units 30 and 31. Ave Maria, south of Immokalee, is currently under construction. A private denominational university is planned to accompany a mixed use development which is proposed to include over 11,000 residential units as well as office, retail, and other commercial spare. This community is outside of an EMS station's reach within eight minutes according to the travel model. The developer, however, is planning to build a facility to house emergency services within the community. These new developments will increase the population of residents and visitors to Collier County. The following map illustrates the locations of planned developments, recently granted certificates of occupancy, and the percentage change in population projected from 2007 to 2019 according to the Collier County Planning Department. ^9, -- 123 10H Co l l lei County, Fiorid'a— GNIS Sys loin Master titan Figure 71: Collier Growth Areas Population Growth In developing forecasts for overall population growth, we typically develop several scenarios as such forecasting can change depending upon a variety of factors such as economics, mortality, and fertility. One scenario Is a forecast based on several decades Of census experience. In this scenario, we used historical and estimated census figures from 1970 through 2000. A mathematical forecast is created through the year 2030. While census -based population Projections provide a mathematically based estimate of future population based on historical data, they often fail to account for expected Vends 10H :Collier Gouaiy, Florida — NS System Master Plan in the growth rate of an area. These changes often result from redevelopment, annexation, changes in employment capacity, or other socio- economic factors not reviewed in a census -based projection. In Florida, the University of Florida's Bureau of Economic and Business Research (BEBR) provides extensive research in developing projections for counties and communities statewide. BEBR projections are forecasted in low, medium, and high range estimates based upon different statistical measures and methods. The BEBR believe the medium range projections to be the most realistic for long -term planning purposes. The County Planning Department projects population levels as well based upon several local factors such as certificates of occupancy, building permits, and persons per dwelling unit. While this process is completed for several upcoming years, longer term projections are based upon the very latest BEBR projections. The County Planning Department takes the residential population estimates and projections further by calculating a peak seasonal population Thai, in addition to permanent residents, comes to vacation or inhabit their winter seasonal homes. The County also creates an additional population estimate scenario called the weighted average whereby eight months of estimated permanent population is added to four months of peak population estimates. Using these figures for planning purposes would be more realistic than using the permanent population figures, but is more conservative than the peak season population numbers, vihich would serve as a "worst -case scenario" for resource deployment of EMS units. The following chart details the various population projections compiled for Collier County by census forecast, the University of Florida's BEBR, and the Collier County Planning Department. —— 125 F�f 10H Collier County, Florida FNIS System Master Plan Figure 72: Population Projections Population Projection By Development Forecast It is not the intent of this study to be a definitive authority lot the projection of future population in the service area, but rather to base our recommendations for future emergency medical service needs on a reasonable association with projected service demand. Since we know that the service demand for emergency agencies is based almost entirely on human activity, it is important to have a population -based projection of the future size of the community. While we can see variation in the population projections discussed here, one thing that can be certain is that Collier County will continue to grow in Popttlalion, likely reaching over 000,000 by 2030- Planning should begin now to maintain the resources needed to meet the continuing demand for set vices. uo mtnunity2owt'P Planning In evaluating the deployment of facilities, resources, and staffing, it is imperative that consideration be. given to potential changes in worldoad that could directly affect such deployment. Any changes in service demand can require changes and adjustments in 126 400,G00 300,000 �— 300 000 300] I 2 0 0 30 15 202 0 2125 3030 — J— Caligr CCUn(L' "Permamnl' 3]9,060 070,200 — 4JQIW 497.500 549.2W 500.500 401.465 544100 616,157 754.211 067008 _ 959.369 _ -co" CounlyWe.ghleJ 390,093 450.655 536,061 636,610 721039 769.540 —4-1000 OE6n Lev 1 I 354,600 397.300 433,400 462,000 404,600 - -20Ufi OEOn M! :um ]06.000 451.SW 512,4W ' 567,4W 619, Ica �,- 3- 20060EBfl H'gh 1 116300 505 ,700 593,500 693 CW i 791,000 I� °Cemus FCrtcati 359569_ 412623 4G!5.657 I 5IBG92 571120 - _327760 _ It is not the intent of this study to be a definitive authority lot the projection of future population in the service area, but rather to base our recommendations for future emergency medical service needs on a reasonable association with projected service demand. Since we know that the service demand for emergency agencies is based almost entirely on human activity, it is important to have a population -based projection of the future size of the community. While we can see variation in the population projections discussed here, one thing that can be certain is that Collier County will continue to grow in Popttlalion, likely reaching over 000,000 by 2030- Planning should begin now to maintain the resources needed to meet the continuing demand for set vices. uo mtnunity2owt'P Planning In evaluating the deployment of facilities, resources, and staffing, it is imperative that consideration be. given to potential changes in worldoad that could directly affect such deployment. Any changes in service demand can require changes and adjustments in 126 ION Collier County, Florida — EMS Systein Master Plan the deployment of staff and resources in order to maintain acceptable levels of performance. Currently, the Annual Update and Inventory Report (AUIR) utilizes a formula to determine the amount of additional ENIS units based upon a per capita rate of .000068 units or approximately I unit for every additional 15,000 persons within Collier County. This is based upon the weighted population estimates by the Collier County Planning Department (in previous years, permanent population figures have been used). The historical basis for this formula was communicated to be initiated in 1989 from an examination of the City of Naples EMS service in which that jurisdiclion had 1 unit performing of an acceptable level with a population of 15,000 persons. FSCi finds several flaws in this methodology for estimating the need for additional EMS units in Collier County: First, this method may be economically inefficient by allowing more units than necessary based upon reasonable workload levels. To illustrate this point, ESCi applied the utilization rate of EMS based upon the weighted population to an additional 15,000 Population. which yields less than one unit. Equation 'I: Current Methodology f_'vaivatimi ldiven Utilization UFienis = (8G/ Fop ,,) 'I 000 Where: URrn,s =ENIS Utilization Rato SD= Service Demand POP,.;, = Weighted Population Therefore: 81.12=(32,292/398,098)'1000 Or 61 calls Per 1000 population Applied to an additional 15,000 persons, this yields 1, ?_15 calls (service demand). It has been determined previously that 64 percent of the EMS calls within Collier County result in transportation to the hospital. The average time on call's that resulted in a transport to the hospital fs 'I hour and 43 seronds system wide. The 90 "' percentile time for each call that resulted in a transport is 1 hour and 26 minutes. The remaining calls that did not result In transportation averaged just less than 20 minutes (36 minutes �'I — 127 ION Collier County, Florida — 6141S System Master Flan . at the 90 "' percentile). When the 1,215 calls are measured in terms of time on assignment based upon the historical transport/non- transport ratios, unit hour utilization can be computed. Therefore: Cduatlon 2: Unit Hour Utilization Calculation NAurlu=[( SDaoo °PCTErrsr)'TT] "'[(SDnoo*PCi I FMSNT)31 NT]ITHy Where: NUUHU: New ambulance unit hour utilization SD„po: additional Service Demand PCTEmsT: Percent of EMS calls resulting in a transport PCTEMSNr: Percent of EMS calls that did not result in a transport TI; total time on a call that resulted in a transport TnT: total time on a call that did not result in a transport THV: Total Hours in a year Applied: ((1215'64 %)'126)] [(1215 "36 %)'0:3 61 16 7 60 =.t57 This woddoad equates to the unit responding to only 3.33 calls per day, which is less than half the UHU threshold suggested for fire -based EMS touts. Economically, this may not be beneficial. Applying the utilization rate from above to the UFIU threshold level yields 36,049 additional persons necessary to justify an additional ambulance. Without consideration of variables such as spatial scale, concumency, additional fire department capacity and demographic effects, the current UHU for the agency indicates that 9.74 units could have handled the service demand last year when using the fire- based UHU threshold henchmaik. Nonetheless, this simplistic method fails to consider the previously mentioned variables, which ultimately complicate the .il 'collier Counly, Florida - EiNIS System 111'aster Plan methodology for planning additional unfis. Discussion of each of these variables is discussed in the following paragraphs. Lacks spatial scale A certain population (15,000) can occupy various size areas and as illustrated earlier in this report, higher densities correlate with higher service demand. Additionally, there is a spatial limit to the travel capability of the ambulance. Should this population occupy a larger geographic area (low density), one unit may not be able to provide coverage due to time limitations of distance and speed. rails to consider concurrent call effect It has been demonstrated previously in Ihis report that call concurrency creates a situation in which additional twits are needed in zones. This new population level, which generates its own level of calls, will have instances in which these are likely to be concurrent. Service demand increases during the daytime hours as does the likelihood of calls occurring concurrently. Whorl this occurs during times of higher service demand, additional resources are needed. When these estimated calls are distributed based upon the currant hourly workload, the measure of unit workload (UHU) also rises. IrJ I IOU "i I Collier County, morlda - Ems s:yslern Master Plan Figure 73: LOSS Unit UliU by Flour of Day As indicated in the figure above, this is not enough for an additional unit economically based upon workload thresholds. These additional concurrent calls will further exacerbate the concurrency ra.tlos within the system. This LOSS standard projected further could possibly supply more units than economically feasible. Fails to consider increased capaqdy from fire departments Since the inception of this LOSS method, non - transport advanced life support capability has been initiated within five of the nine fire districts within the county. The increased capacity from these departments serves to buoy the EMS system in general but has not been considered in recent LOSS methodologies. Fails to consider other demographic effects While increased population is a catalyst for increased service demand, the current LOSS methodology does not take into account other demographic variables which can lead to an Increased service demand such as age or clepressed socioeconomic indicators. "130 10H Collior County, Florida - EMS System Master Plan Socioeconomics that are occurring currently such as poverty levels and unemployment are not easily forecasted for the future clue to changing economic aspects of industry, housing, and agricultU e. Although median income levels of geographic areas can be compared to the service demand, less than 45 percent of the calls Occur within the patient's residence. This would introduce a large degree of error into such analysis as some patients may be driving through, shopping within, or working in one area of the county or another. Projections of population by age, as discussed previously, have been developed and can be utilized to project workload and subsequently, the amount of units needed into the future. Perhaps file best way to begin is to analyze the current deployment of stations and units to establish the service needs today analytically and plan for the nrhue based upon those missing parameters already discussed in the current methodology. Workload and GeocMphic EMS Unit Minimum Meods Although the current overall system Ull indicates approximately ten units could handle the service demand. This does not consider the geographic coverage of service demand. The current deployment of stations (22) provides a geographic coverage over 9,4 percent of service demand. In an analysis to determine the absolute minimum locations of current stations in order to provide coverage to 90 percent of the service demand spatially, it was determined that 12 station locations would be necessary. The following figure illustrates this minimal geographic unit coverage. I, tii l 10H Collier - County, Florida— ENIS System Nlastor Plan Figure 74: Mlniinal Geographic Coverage While this does not provide coverage to enclaves of population such as the Isle of Capri and Everglades City, it does demonstrate the need for additional units based upon geographic extent of service demand. This is not to suggest that Collier FMC reduce its Poet of units to this point of operation. ]'here are two key elements missing at this level. First is the level of concurrent calls [hat requires additional units on staff and second is the extent to which the ALS fire engines may aid the EMS system. Both of theso issues need to be explored before any final determination of units can be accomplished. 10H Collier Cou+ity, Florida. -- EMS System Master Plan Effect Of Concurrency Call Concurrency is a common problem facing emergency services deployment especially far police and EMS twits as their calls are frequent and correspond greatly with human behavior and activity. Unlike police units, EMS does not have a'patrol and presence' function to contend with. Whereas, there is a benefit to police units patrolling an area as their very presence can deter crime, this is not true with EMS systems. Multiple emergency medical calls can, at times, reduce the available resources to the point at which an out -of -zone response is necessary. The following chart illustrates the number of calls that OCCUr concurrently countywide. figure 75: Annual Average Concurrent Call Amounts Concurrency levels also vary by area. Some response zones have higher service demand than others and, therefore, have higher instances of concurrent calls. In some of these zones, two units are assigned in response to the higher levels of concurrency. The following chart (Figure 76) details concurrency levels by response zones. ColterCtwnD /; rlorida.— EN1S'.- System . Pilaster Plan Figure 76: Concurrency by Response Zone IOH This reduces the reliability rate for the host unit and increases the response time figures for that area depending on the rate of concurrency and the resources present. LVithin Colllei County, most zones have one EMS unit primarily determined by closest unit response from where it is stationed. Within these zones, concunency has been measured. When the second concurrent call occurs in a zone, it generates an out -of- zone response from another area. This may cause an extended response time result from the out -of- district unit. The following chart illustrates the amount of time EMS units are responding outside of their zone. concurrent call frequency, lag 1119 ❑h 05 00 900 I i c I AGO _ G00 F-2 assignvtl - 500 - 400 2 eMS -- -- -- x un9s i assi Red 2 uNls assl ned asst ivtl 900 Zan its 200 0 Response ZOnes This reduces the reliability rate for the host unit and increases the response time figures for that area depending on the rate of concurrency and the resources present. LVithin Colllei County, most zones have one EMS unit primarily determined by closest unit response from where it is stationed. Within these zones, concunency has been measured. When the second concurrent call occurs in a zone, it generates an out -of- zone response from another area. This may cause an extended response time result from the out -of- district unit. The following chart illustrates the amount of time EMS units are responding outside of their zone. ION Coiller Cotmty; Florida:– GNISSystem Master Plan Figure 77: Apparatus 'Out of Zone' Responses A correlation to these figures and the reliability analysis is obvious as out -01-zone responses are the primary culprit to lower zone reliability of host unit response. While this obviously affects response times overall and within the zone, it would stand to reason that host unit response limes within their own zone ought to be within response time objectives. This is calculated in the following ligure. – "— 135 Apparatus 'out of zone responses I 120% i1' soY. .to% it �\ O�M1 Off, o OM1\ dl'1• '4� O'�'n �'f0 O'� Ong o�M1 On, On? Oea p0 O•`O o•\\ O,lry ie �\ ,e Ooh �e Qe S S <4 S \r S d• S S \� S S S <0 \s" d a \t S <4 S <. d• �, \c A correlation to these figures and the reliability analysis is obvious as out -01-zone responses are the primary culprit to lower zone reliability of host unit response. While this obviously affects response times overall and within the zone, it would stand to reason that host unit response limes within their own zone ought to be within response time objectives. This is calculated in the following ligure. – "— 135 10H Colllel_ County, F1'orid'a —[MS SystemMastut Plan rinnrn iR• Hnat I lnit'in Zone' 90th Percentile Resuonse Performance Unfortunately, this is not the case clue to several factors. The first factor is the crew turnout time performance as previously discussed. Second, some areas such as Everglades City cannot possibly provide coverage to the service demand In the geographic extent of its zone. Third, there may be times in which a unit is responding to its own zone from out of district either because it has cleared the hospital or has been relocated clue to move -up deployment procedures. Without GPS, the dispatchers may be unaware of a unit's exact position. Reliance upon dispatcher memory or an alternate unit's awareness that they are closer to the call can create situations of longer response times within zones. One 'rule of thumb' suggests that once call concurrency exceeds 10 percent, an additional unit is needed. This would result in a total of 35 EMS units for Collier County, which would be o-,conomically unfeasible. To analyze minimal unit needs further, variation in concurrency levels by time of clay is examined. In the following figure, call concurrency levels increase as the service demand also increases, typically during daytime 11etn5. 36 10H Collier C.ounty, Fork la — FMS System Master Plait Fiaure 79: Concurrency by Hour of Day As concurrency increases, more resources are employed to handle the service demand. Move -up procedures are employed to maintain a resornce capacity in areas of high service demand (such as the greater Maples area) to handle additional calls. Once the concurrency, increases past the point of geographic minimums, the units become increasingly out of position. At such times, the resources becorne increasingly scarce and, therefore, increasingly unable to respond within the response time objective. A reserve capacity of units which matches at least the geographic minimum of 92 units is necessary to be able to achieve the response time standard. The following chart (Figure 80) illustrates the minimum number of units necessary to service the increased level of hourly workload clue to concurrency, countywide. Unit levels are divided by the UHU threshold discussed earlier and utilize the average time on a call in Collier County of one hour from clispafch to available for service. 1QH I i j 20 10 16 14 12 10 0 G 4 2 0 Collier County, Fto'riozi — EMS System Nfon- r'plan Figure 00: Minimum Unit Needs Na.ied upon Workload by Hour of Day. Minimum Unit Needs based upon Service Demand Workload by Hour of Day -4-Uhlu - �r—unlls 0 1 2 3 4 5 6 7 0 9 10 11 12 13 14 15 16 17 10 19 20 21 22 23 I lour of Day At peals times, a rnininiu m of 18 mills are required to handle the service demand that occurs when concurrent calls are accounted for. A reserve capacity beyond these levels is necessary for the additional concurrent calls (which occasionally do occur) and to maintain geographic minimums. In order to maintain the response time objective, the geographic minimum through a move -up deployment strategy, is required. The following chart represents the hourly Unit needs in addition to the minimum units needed geographically to maintain response limes. These figures are compared to the static unit deployment practiced currently. 138 .I v;> 10H Collier County, Florida- EINIS System— MaSter Plan Figure 01: Current Unit Needs by Hour of Day Current Unit Needs by Hour of Day i -- Currenl thills Deployed — nnils� 1 30 - 27 29 �� 28 29 m _28. 28 28 28 27 1�I 25 26 29 25 22 28 28 20 20 18 ii i g l 1 2 3 4 5 6 7 8 0 10 11 12 13 14 15 16 17 18 '10 20 21 22 23 24 Han' of Day Because service demand and call concurrence varies by area, the following chart (Figure 82) calculates the minimum unit needs in different areas of the County. Some of the zones have been combined to improve readability of the chart. It is interesting to note that unit needs in Immolcalee actually increase into the early evening, contrasting the overall trend lower during these times for other units. 'Collier C60nfy, Florida - EMS System Master Plan MIN Figure 02: Mini0lnm Units Needed by Area by Hour of Day Higher levels of call concurrency occur less often than lower levels of concurrency. This means that units within the reserve capacity have increasingly less likelihood of receiving a call as the more calls are occurring simultaneously. Therefore, the workload of additional concurrent calls above the minimum units neecled does not justify the economic expense of additional units. The call(s) must be handled nonetheless, but supplying resource capacity to.provide a high level of service to all calls (geographic minimum reserve capacity) at very high concurrency levels is expensive. In order to provide increased capacity for higher levels of call concurrency, several techniques can be employed. • Alternative staffing of units allows for the eccess capacity at lower service demand hours to be exchanged for additiuial units during peak -toad activity. • Use of priority, dispatch systems in which less critical calls are not only allowed to have a longer response lime standard, but an assigned unit may be Collier Gounty;: Finricla'— ELLS Sys teuMaster Plan ion reassigned to a higher priority call in the area, thereby placing this non- emergent call in queue for the next available unit. • Use of response zones which have varying response thne standards based upon service demand and population levels. Longer response time goals require less minimal geographic unit deployments. Alternatively, the response time can remain the same; however, the percentile compliance is reduced to allow for geographic extents or reduced unit minimums. • When concurrency reaches a critical level within the system based upon level of resources and dote Imination of adequate capacity, additional concurrent calls are excluded from performance calculations. -[-his is because at such a point of very high concurrency, system capacity is not sufficient to provide service demand coverage expected to reach calls within the stated travel time. At pealk workload hours, a reserve capacity of seven units is currently available. ESCi does not find this to be unacceptable, however, at the fourteenth concurrent call, the geographic minimum is not maintained and, therefore, statistically, the system would not be able to maintain response time stanclarcis. • Use of first responder fire department units to provide initial medical care, thereby allowing more time for the transport unit to arrive for that particular function which generally occurs later in the emergency care process. Effect of ALS Engines Five of the nine fire districts within Collier County have initiated advanced life support capability similar to the level provided by Collier County EMS. The Impact of this additional emergency medical care capacity within the county has not been fully evaluated. While it has been determined that there are sufficient ENIS resources currently to handle service demand, the ALS engines should be utilized to increase the capacity of the EMS system in general. More specifically, it is generally not a call within a zone with an available ambulance that poses a problem for response time, but as concurrency increases and EMS resources draw thin, these units are able to, and often, respond In absentia of an EMS unit and begin care until an EMS unit arrives from a more distant location. i�r� ColfterCaunly, Florida- EMS System -WSW Plan. 10H Often on the first call in a zone, these fire units are redundant resources except in cases where manpower or other fire- related services are needed (e.g., second call in zones with two assigned EMS units). This can occur in such calls as cardiac arrest, obese patients, and hazardous materials incidents or spills at motor vehicle collisions, among others. Often times, the fire apparatus and the EMS unit trail each other to the call and arrive either simultaneously or within a minute of each other. Subsequent fire or medical calls within the zone may quickly reduce the local fire resources in the area. On most EMS calls that do not require manpower or fire services, one strategy would be to dispatch the EMS unit solo on the first call within the zone allowing the subsequent calls to be handled by the fire apparatus until the out -of -zone EMS unit arrives. Approximately 15 percent of these calls have historically not resulted in a transport. In such cases and if time allows, the fire unit could cancel the responding EMS unit, returning it to the available capacity of the EMS system overall. The arrival of these medically trained fire units can effectively stop the response time clock for clinical care, which is the basis for response time recommendations by the medical community. For example, CPR should he initiated within four minutes after a person suffers cardiac arrest Although these standards suggest that advanced life support measures should be initiated within nine minutes, they do not suggest by whom, outside of individuals obviously trained, equipped, and sanctioned to do so. The following series of figures depicts an analysis of first arrival units based upon concurrency in zones and the average wait time far the EMS unit as concurrency increases. The EMS zones and the fire districts do not coincide; therefore, calls located within ALS engine fire districts were utilized (see Figure 83). �l, 6 t;a ion Ccallier Couri, ), 1716rida - ENIS System blaster Plan Figure 03: Fire Districts and EMS Response Zones Unique CAD numbers of EMS units from the last full year's incident data were matched with the first arriving fire apparatus if one responded to the call in [lie fire district that has ALS engine capability. The EMS response zones were grouped together to reflect the fire district in which !hey are located. Calls outside of the ALS engine fire districts were excluded. For instance, parts of zones which primarily serve the Golden Gate Fire District (70, 71, and 75) also provide primary coverage to areas within East Naples Fire District; only the calls located within this district and answered by ENFD apparatus were included in the analysis. Units that did not have an arrival time, and therefore no 10H J,ii 4 Collier County, Florida — E14IS System Master Plan response time, were also excluded. This could occur as units are cancelled or missing CAD data stamps. Figure 84: First Arrival Concurrency Analysis for Zones 'I, 2, and 3 At the time of this report, dispatch data from the City of Naples that included fire apparatus arrival time was not available. Since the City has its own dispatch center, the County Sheriff's Communications Center does not record their response times, only the transfer of the dispatch information to NFD dispatch. ALS Engine Response In Zones 1,2, R 3 O ENISFIrsl on Scene O Fire F-,rsl on scene F—n Slmullanaeus Arrival -jZI- Average Wait for Transport UJ i 120% _ - - 04:19 I 100% ®_ --_ --. 03:30 00% - - - - - - 02:53 00% - - 02:10 40% " 01:20 - 8 - 20% - - tj - 00:43 00:00 Single 2Concurrently 3Concurrently 4Concurrently 5Concurrently 6Concurrently At the time of this report, dispatch data from the City of Naples that included fire apparatus arrival time was not available. Since the City has its own dispatch center, the County Sheriff's Communications Center does not record their response times, only the transfer of the dispatch information to NFD dispatch. 10 H It si ` .% CollielSeunty, Florida - FhIS.System Master Plan Fiauro 05: first Arrival Concurrencv AnaiVsis for Series 20 Zones This zone area has five EMS units; the extent to which they are pulled out of these zones for calls in other zones will affect the analysis. Generally, as cencurrency increases, the more frequently fire apparatus arrives first on the scene. The average amount of time that a fire apparatus waits for an EMS unit in this area ranges from a low of two minutes and six seconds to a high of over 15 minutes at high call concunency levels. Fortunately, instances of high call concurrency are few (only one instance of seven concurrent calls). Low call concurrency, however, occurs frequently (over 1300 instances of two simultaneous calls). However, the amount of time saved by the fire units arriving first totaled over 63 hours. The majority of time fire units arrive first is enough to begin assessment and treatment but, in some cases, not long enough to have a final determination of transport. Obvious transport cases and cancellations are the exception. l-..1 10 I*►I Gofllcr G'nilht j, Merida - EMS System Nlast8r Plan Figure 86: First Arrival Concurrency Analysis for Series 40 Zones Zones 4040 tNorlh Naples Area) �Sls First on Sceno =s1roulleneans Nrival — r]— pv0ylnit Tinto for Transport Unit 1204. 10:00 - nl n 1 1 I 04:00 e s 20 °M1 tit; �. �. �; 0290 2 [. , 3 ., d c ` cAi °'� 'PO J1 Cr' 0 \ eJ1 °Ji JJ4 c °J� o ° � J IP J J .1 J,1 . i J o SAC JC 4 ry� hG n hG OV 1 b° 0 A° 0 These zones currently have seven EMS units and the wait for an EMS unit when the fire apparatus arrives first is generally consistent until higher and infrequent concurrent calls occur. The average wait time ranges from a low of three minutes and three seconds to an excess of five minutes when the concurrent call level exceeds eight simultaneous calls. A l0H Collier County, Florida- Eir1SSy5tOm I f<is,ter Plan r-i..,,.. n7. r_i.or n..M,,,1 c., ......... . a,,nrw.ra f,,. 7�n. ,n ("An,p� kl,.wn Marco Island has one unit assigned within its zone, which extends into the Goodland area. Once this unit is on an assignment, the next EMS unit comes from the Isle of Capri or (it necessary) Station 23 in Henderson Creek. This is the reason for the increase in the frequency of lho fire unit arriving first on scene when call concurrency level increases. The average wait time for an EMS unit ranged from a low of 'I minute and 38 seconds to a high of G minutes and 37 seconds. Once again, as call concurrency increases and EMS resources are reduced, wait time for transport units increases. Fortunately, care for the patient hasn't been impeded and the determination of transporlation can begin. I C011ler Couhty, Florida ENIS System rilaslei Plan IDim, i f ieure 88: First Arrival Concurrency Analysis for Series 70 Zones Although these zones have four units assigned, they also provide service to a much larger area than the ALS engine fire district areas which are partially in their zones. Once again, calls outside of these ALS engine fire districts were excluded The wait time for EMS units extends longer as the EMS system becomes busier. This average wait time ranges from a low of 2 minutes 59 seconds to a high of h minutes 19 seconds (Figure 88). Based on the above analysis, the arrival of the first apparatus with advanced life support capability can benefit not only the patient but also the EMS system as a whole. Response times can be measured from dispatch to when the patient receives advanced medical aid, wholher it is a fire apparatus of an ambulance. To measure this effect, ilia following chart (Figure 89) illustrates the response time performance for fire apparatus and ENIS units for calls within the ALS engine fire districts. A third, blended, response time performance which selects the lowest response time by agency to measure is also shown. �l ) 10 V1 .4 Collier County, Florida— lib}G.System Master Plan Figure 89: Response Time Performance for Calls within ALS Engine Districts Response Time Performance For Calls in ALS Engine Areas I - j i0 Average 93901h Percentile I i Best 71me .. - - 00.07 I R ' EMS 07:17 ` I I I e i ALS Engine w aF, ?oG z9 00:00 03:00 06:00 09:00 12:00 i The resulting measures for the blended response time analysis improves file 90 °i percentile response time (although it does not yet meet CCEMS's slated performance objective). This however, does not improve the capacity of the system unless one of two scenarios is adopted. • The fire apparatus is utilized on concurrent incidents within the zone rather than the initial call, unless necessary. Fire apparatus cannot replace the transporting capabilities of an ambulance and therefore an acceptable 'secondary' arrival time of 13 minutes from dispatch could be adopted. This may not be enough time for determination of transportation in most cases. More time may result in canceling the out -of -zone EMS unit; however, to extend this time further could put some patients at Increased risk if rapid transport capabilities are necessary. • ALS engines are utilized for first response and the EMS units are granted ilia 13- minute response time in these districts. This would allow areas which have multiple assigned 'EMS units to utilize fewer units and could be redeployed elsewhere. The geographic minimum reduces to seven units based upon this scenario. This would match the amount of currently deployed units (25) at peak 10H t�= Collier, Counly,.Florida — HAS'S;ystem ,.foster Plan demand hours (I8 minimal units plus 7 reserve units). However, [his would require high confidence in [he fire department's reliability able to respond to the majority of calls. The following chart measures the reliability of fire units to respond to medical calls historically over the last year. Figure 00: ALS Engine Reliability by EMS Response Zone With reliability rates less than 90 percent, relinquishing initial response to medical calls would not be beneficial. Should a fire occur which occupies many fire apparatus, the ability of these departments to respond to medical calls may be severely limited. Therefore, it can be surmised that ALS engines are complementary to the EMS system for patient care and response time performance measures, but they may not be able to add capacity within the system itself. Measures for improving EMS capacity discussed in the previous section should be debated for adoption. Demogratahic Comf osition Chan[i The composition of the additional population is an important factor to be considered. While age and socioeconomic status have been associated with higher frequency of use b0 10H Collier County, Flerida EOAS System klasler Plait Of EMS, socioeconomic forecasts of future population are fraught with speculation. However, population estimates based upon fertility, mortality, and migration rates are routinely utilized for planning needs of communities. The most important variable tot- EMS planning is age. The utilization rate for different age groups can be accomplished by comparing the recorded age of patients in the EMS PCR record with the age range population within the County with the following formula. Equation 3: Utilization Rate Determination UR,= (T; /WP, )`'100 Where: , =age range, e.g. 0 -4 years T,= Patient contacts for age range, WI),= VVeighted Population tot, age range; The following figure illustrates the utilization rate by age range over the last year of data. 1. ...... 1.1 M-.n 1.,, Aire M-1— Cc flier CCUllty, Florida — EPAS System Master. Plan The elderly population has higher utilization rates than other age groups. The next section discusses how the elderly population groups are projected to grow in population and this effect upon projected service demand. Future Workloadd Protections based upon Population Growth This utilization rate by age would be further applied to projected age ranges for weighted population projections calculated by file Collier County Planning Department ". Unfortunately, these were not distributed by age range. In order to estimate the age range distribution, similar projections by age range are calculated by the BEER for permanent population figures in five -year increments from 2010 to 2030. The weighted population totals were dish ibuted by age proportionally equal to the projected age range changes calculated by the BE=BR. (See Figure 92 and Figure 93.) 34 2005 Weighted Papulalion ligures supplied for this study '0'H b a N E d m !O (6 W I b O Lt. T C J O U 0 U C d Q .0 N C O .Q IL` C O O M N s O) of Ol L lOH ,r 'i fj «j O h W O M to h M V to N W W W It) M V t O r V loco M W r N ONOMMNrtnm O h N W N W N h W V W h t0 d' Mr M O rN h y M O MCOO OhW d'h W MOtnNMd' (0 m4 O N W m V V V MMMm MMd' Vto W W to d' V' Q A M �-h NI -k Om'- 00016 W 00 tOroMh 'p) In N h O NN W T V d' hh•MOON M W (O a� d'to N N r co V_ ttcc1�. w).N O- NMMMM W co W w M mmmMmmC)d'N N V V N W W LO M M W to Nd'MM h O h P W h V V to OM G N (O too N C) Nh M N WhNd'tn r W V M N V N In V W O M W W O W ClcY NNOiOO mMah -(V C]M NNMmN C) V V V V M (� N N —: NNI MMmMN 6 V W h o tIN V W W V M M h W h dW W m N ONO)NtnN N dON - O h «MOO M W W Mn N O 07 C)n N N W M ONN MN i' MN S W W h h W OM Nm MM OO MM NM W N N N N N V N 01 � 43 W h h W N r W h W O dV ' M WO W M M d' tN o N h h M h W d' ' M dN ' W N N N r M d; r fO W 0 tom N 0 0tn o V dV C6 rC4i to MO N MoNh m p I N N N N N N M M M N n I n I.- V 0 0 0 0 0 0 o 0 a 0 o 0 0 0 0 o 0 a a o o a o 0 0 O o V W M O N O h (D V h N O �- h W O N N �- V 0 - N d-tn N to d' d'd'd' li-M NtoCD M . W . NN tn. 0 o 0 0 0 0 0 0 0 0 0 0 0 0 0 o 0 a 0 o 0 0 0 0 a 0 a 0 0 o o 0 a N N W M M M O m W O W W M W N W V M W m MO. e;pp L NtO N6 to to d' Lnh <I-d'd'd' W M M V N to m m W 1-ml�(od N W toM V 0 0 0 0 0 0 0 0 0 0 0 W to to W W OMh Mh M W MNOh Il. Nto �o to V V V N V ui t0hhh hNM M 6' O: Lf) o 0 0 0 0 t o 0 o a a o o 0 0 0 0 0 0 0 0 oyy 0 a 0 o 0 N( 0 o 0 0 I I to Mtnmd- tO V r M W M O� r N(hD tWp C1�f 11 d'.� -Imr UWi a � tritritritri<F d vitotritrim�P-Z r;Nd'riri 0 0 0 0 0 0 0 0 0 7 0 0 0 a 0 o 0 0 0 0 0 0 0 0 0 0 0 0 Nd W O W O (MOW d (WOm N (7 1V0 (OO to t0 to to V to to to to m (O h ti t0 to to m M Ln - N to o' W to W N O O W N V W M O h to �- W N h W r W V M W W M W N W O h M O M to to O V V r M q W W C) h M C N to - O W W- N M W h M M o N r W O d' c+J - • N r N m M (O N N N N (V m M m v` d' to d' m m W _ f' N oo n W M Om bN N N 6 N On C V V m dM NN CW N N N N N N N N N M M LO v' M V O W m l0 O W h M d' W W to p Wn to to W PI d' r: h W �t M N(V Nh NN 6 C NNN toV t N N N N M<OI'mM 1t1��� N N t0 In W m W N O N h. ,- N m W M N O to h to W W to c0 o O W M` M to V d' W N Q) m O h r cq N'tnN N N N NMNNN NN NNNN PINmm NNO C) C1 mmNN Mfg r d. h NO to to n -N O. d' -M MM 1' :. CI W co rIp ONNtoNM W MMMOO C) C?tn ' P. 8 N W n N NNN o 6 - O N O) r o N p to N 6 N h N n N d- PI N O) r t0 -- .- W M N (J tf! all^ f°t'- (LNMC� W (r loPh 00 310 lOH ,r 'i fj «j 10, RI Collier County, Florida — UIS System WlasterPlan Figure 93: Projected Population Growth by Age Range Graphically, the growth in elderly population is evident despite an overall decrease in population growth rate, as depicted in Figure 94. 154 Projected Population Growth by Age i 70.000 I I -0-7-010 i 60,000 x-2015 - j 2020 . —2025 - =1.020 - - - 50,000 40,000 wee-- �`���. ✓��r�� �. - 30,000 - I I ' 20,000 - 1 10,000 I 0 0 4 5.9 10- 15- 20- 29- 30- 35- 40- 45- 50- SS- GO 65- 70- 75- 00- 65+ 14 19 24 29 34 39 44 49 54 59 64 69 74 79 04 I. Graphically, the growth in elderly population is evident despite an overall decrease in population growth rate, as depicted in Figure 94. 154 10H Collier County, Florida EiylStystem blaster Plan When the utilization rate is applied to the weighted age range projection totals, a new workload projection by age range is produced. Equation 4: !adjusted Worldoad Projection by Age Range W i= (Uri *W Pyl)/100 Where: 1 =age range, e.g. 0 -4 y= projection year, e.g. 2010 Wi= Woddoad by age range URi= Utilization rate by age range WPi= Weighted population by age range The totals are adjusted upward by 15 percent, as this is the amount of calls which did not result in a patient contact. Such calls inclUde unit cancellations before arrival, fire standbys, and no patient found at location, among others. The most dramatic increase fi7 155 �Gl, `�'- ✓'ylr; ti<«� ill Collier Cohn'ty, Flbrlda- EMS iSystem - Waster Plan 10Hiy-J in workload corresponds with the increase in the elderly population. The following figure graphically illustrates the workload by age range. Figure 95: Workload Projections Age Flange 2010 2015 2020. -,� ^- .2025 _ �: 2030 0 -4 1,003 1,:1!17__ 1,314 1,444 1,510 5 -9 350 413 - 473 526 554 10.14 416 494 573 _ _ 650 693 15.19 1,262 1,433 1,681 1,926 2,094 _ _ 20 -24 1,578 1,880 2,069 2,402 2,630 25.29 1,560 1,761 2_025 _ 2,1613 2,407 30.34 1,228 1,452 1,616 1,822 1,857 35.39 1,242 1,399 1,624 1,792 1,928 40.44 1,430 1,547 1,978 2,103 45 -49 1,629 1,680 ____1,721 1,792 1,976 2,185 50.54 1,647 1,953 1,982 2,087 2,207 55.59 1,377 1,723 1,968 1,963 1,964 60.64 1,820 _ 2,252 2,762 3,096 2,949 65 -69 2,013 2,753 3,371 4,106 4,398 70 -74 2,020 2,606 3,577 4,387 5,157 75 -79 2,fi37_ 3,040 3,968 _ 5 ^509 _ G,SG2 80.84 3; 134 _ 3,962 _ 4,l62 6,205 8,443 85+ 5,304 7,540 9,773 12,355 15,812 Totab 31,94! 39,054 46,953 5!,390. fi5,452 Ad usted 36,738 44,912 53,996 64,848. 75,270 MHkr p •l CoI[ter County,' Flo rick= -E419Syst'erit pilaster Plan Figure 96: Projected Workload by Age The following chart (Figure 97) represents the total projected woridoad increase over the study period. ZT Projected Worldoad by Age lunge 10,000 16,000 —2070 � 14,000 —2015 - 2020 12,000 —2025 --2030 - ._ - current . - tp ppp 0,000 —� j 6,000 4,000 2.000 p 0.4 5.9 10- 1S- 20- 25- 30- 35- 40- 45- 50- 55- 60- 66- 70- 75- 00- a5+ 14 19 24 29 34 30 44 49 54 59 64 69 74 79 84 The following chart (Figure 97) represents the total projected woridoad increase over the study period. ZT colur County, Florlda..- [ MS Systervi Mister Piro 10H The declining growth rate in projected population also produces a declining growth rate in projected worload (see Figure 98). Hoviever, the decline in workload Is not as great clue to the increased amount of the elderly population and the conesponclingly higher utilization rate. Li "e" 10H Collier Co tnly; FtoMda - EN15- System Nlasier Plan Figure 06: Growth Rate Comparison The adjusted woddoad totals are then applied to a method in which unit hour utilization (UI-IU) is calculated for the agency and summarily divided by the UI-IU benchmark threshold to determine the minimal amount of units needed based upon workload. I 159 Population & Workload Growth Rate Comparisons �Poojected Annualized Population Growth Rate -0- Projected Annualized Workload Growth Rate) 5.00% _ - Ii - i . 4.50% -- - -- -` -- 4.00% 1 1 3.00% i' 2.50% 2.00% ' 1.50% - 050% 0.00% j 2010 2015 2020 2025 2030 The adjusted woddoad totals are then applied to a method in which unit hour utilization (UI-IU) is calculated for the agency and summarily divided by the UI-IU benchmark threshold to determine the minimal amount of units needed based upon workload. I 159 potfter County, FIbrlda— EN1S System Pd aster Plan 10 f Equation 5: Minimum Units Needed based on Workload Um =((AW "ITj/HRy)/Ul-I Ui Where: ,= Average ,=Year ,= Benchmark Threshold, e.g. Fire- based-0.30 = Minimal U =Units Needed AW= Adjusted Worldoad Total IT =Per Incident Time (minutes) 1 -11 -1=1 -lours UHU =Unit I-tour Utilization The resulting minimal units needed based upon workload is detailed in the following chart. Figure 99: Protected rninirnat units needed by Workload Threshold "'U j 2010 _20'15 - I" .202 -2025: ��42090 _ Fire -based 14 _T 17 21 ^r 25 29 Adjustment for Concurrent Call Fredrlen>� As discussed previously, call concuirency can increase the need for units during times of peak activity. Peak activity times are revealed when the total workload projections are distributed by the historical percentage of service demand by hour of day. 1 �H Collier Carnidy, Florida— ENIS System Plaster Plan Equation 6: Minhnum Units Needed by Hour of Day Umh= f [(AW "W HRp, ) "IT,]IFIE3y)lUWU, Where: ,= average „ =hour ,= benchmark threshold, e.g. Fire - based =.30 , Minirnai ,,,= percentage y= year AW= Adjusted Woddoad Total FIR =Flour IT =Per Incident time (minutes) U =units needed UHU= Unit Flour Utilization ratio During these peak demand hours, more EMS units are required than the minimal units calculated by wotidoad totals alone. The following figure reveals the results of tite analysis described above. IN Collies County, FI'yficla — CMS System bhoter Plan Figure 100: Projected Unit Needs Based on the Flour of Day '•.� Projected Unit Needs by Hour of Day 45 i 40 . —2010 —2015 I j 35 - 2020 —2025 - 30 —2030 1 25 � I 1s 1 2 3 4 0 0 "/ 0 0 10 11 '12 13 14 15 16 17 10 10 20 21 22 23 24 A reserve capacity above these numbers will be necessary based upon occasionally excessive call concuirency. As total population grows, the need for additional peals hour units continues to grow. The following figure (Figure '101) demonstrates the total change in population and the additional peak how' unit minimums projected in the above analysis. ca, ,_ 100,000 00,000 80,000 70,000 00,000 30,000 40,000 30,000 20,000 10,000 0 Collier Caurity, Florida - E,RAS System Master Plan Figure 10'1: Peak liourly Units and Population Chango New Peak Unit Amounts based on Population Change Population Increase --o-Additional Peak worldoad Unlls 2010 10fl 4; �I 2I 1: 01 2015 2020 2025 2090 Because of the growth in workload that is primarily caused by total population growth and growth in the elderly population, population per unit decreases into the future. This is because the utilization rate for CMS increases as the population of this age group also increases in relation to the total population. 63 10H Collier County, Florida - EhIS System Master flan Figure 102: Projected Growth In EMS Utilization The following table details the growth unit needs of each semi - decennial period based upon peals hour unit needs of the projected workload for EN1S measured by the three levels of woddoad threshold. Figure 103: Table of Growth Unit Noods Projected •1 ��� ELI jl �t Hat- 2007 900,000 18 1 800,000 2010 F 20 2 26,279 700,000 25 5 600,000 f 4 i "tom _ _ _M_ 30 5 s r '.- 2025:.' 36 k �4.1V4 15,745 2030 <!1 - - _ 6 11 111 30G,000 4 200,0011 100,000 2010 2015 2020 2025 2030 The following table details the growth unit needs of each semi - decennial period based upon peals hour unit needs of the projected workload for EN1S measured by the three levels of woddoad threshold. Figure 103: Table of Growth Unit Noods The table illustrates that, although the current LOSS methodology overestimates current need, it would eventually not keep pace with service demand needs in the future. It should be cautioned that these results are based Upon iutw'e projections 01 population and unit worklload. Those results. should not be apt >liod to a current G�lblJtttlu;' ��� ELI jl �t 2007 18 0 2010 F 20 2 26,279 2015 - 25 5 17,081 2020 - _ _ _M_ 30 5 18,110 '.- 2025:.' 36 G� 15,745 2030 <!1 - - _ 6 11,410 The table illustrates that, although the current LOSS methodology overestimates current need, it would eventually not keep pace with service demand needs in the future. It should be cautioned that these results are based Upon iutw'e projections 01 population and unit worklload. Those results. should not be apt >liod to a current I O,H Mirl Collier County, Florida— EMS Syslern P-laster Plan unit needs analysis which has been completed in this report based on historical records. In addition to these minimal peak hour unit needs, a determination of reserve capacity units above these minimum levels needs to be considered. The following table illustrates the current peak hour unit capacity and its degradation if growth unit resources are not instituted. Additionally, two reserve capacity scenarios are offered. The first scenario maintains the current reserve capacity level at peak worldoad hours, while the other maintains a geographic minimum reserve capacity to ensure response time objectives. Figure 104: I--leserve Unit Capacity Analysis Proiected Geocniphic Expansion of Workload To project the geographic distribution of these new units, a conversion of the population projections by geographic area to worldoad share of projected totals is necessary. Once accomplished, the necessary minimum peak hour units can be determined. The Collier County Planning Department has segmented the county into separate 'planning communities'. The following figure depicts these communities within the county. I � +l!�d .� t• � �3 ���rt� `�''lji '�r.'i �>rusif i f it.� -� -I v ' ��1��:$s °t �lJr ��' �r��'l� /!� i_.i• 'i�C'�� �tJ[51i11��'� � f� �.JJi� ' r= n.�i -.'=' ' 2007 18 25 7_ _ 25 -,�� 12 30 -- 20 25 5 27 12 32 .2010. .::2015 25 25 0 32 12 37 2020, 30 _ 25 5 37 12 — — 42 2025, 36 25 _ -11 '13 12 _ 48 _ - ..2030. -. 41 255__— -16 _� Proiected Geocniphic Expansion of Workload To project the geographic distribution of these new units, a conversion of the population projections by geographic area to worldoad share of projected totals is necessary. Once accomplished, the necessary minimum peak hour units can be determined. The Collier County Planning Department has segmented the county into separate 'planning communities'. The following figure depicts these communities within the county. 10 H Collier Courtly, Florida.- EhIS System Master Plan Figure 106: Collier County Planning Communities Furthermore, permanent population projections until 2020 were calculated by the Collier County Planning Department for these communities. The population change has been added to the development growth map shown earlier to illustrate the population increase and the sprawl of human settlement in Collier County. These projected service demands are illustrated in Figure 106. ION Collier Counby, Ftorfda.- .JRbIS System M sler plan Figure 106; Population Change by Planning Comrnunity The projected workload totals were dish'ibuted proportionally based upon the projections Of population within each study year for each community. These projected service demands are illustrated in Figure '108. 167 Collier Count,, Florida- Eh19 System Master Ptam ion Figure 107: Projected Planning Connnunity Service Demand Pvojected service Demand by Planaing Community j 0000 .. _ 0000 li 7000 - O2U10 ❑20151 6000 _ ❑20201 a � 5000 9000 7 L I 3000 i 2000 i 1000 0 N. �°y e �� tas� aaa G�� a� °o \z �aQ aao \�aQ `�aQ aac� a a o\Jc` = GAQ aJay o�ep oy�aQ Co r �o��cGcc��a fag Gee J�aO Q J�a CCaio Qo\a\� It can be seen that the greatest increase in service demand occurs in the Rural Estates area, Royal Fakapalins, Immokalee, and Corkscrew communities. This is also evident in the next figure, which illustrates the percent service demand change for each community. 10H�' Collier County; Florida — ENIS,Syslern, iqIaster Plan Figure 100: Projected Percentage of Change in Service Demand The significant growth in the Corkscrew community can be attributed largely to the Ave Maria Town and University development that is still underway. The growth in service demand within these areas may require not only more units but also increases in the geographic minimums necessary for response time performance goals. An hourly service demand analysis was employed to determine the minimum units required during peak activity hours. The result of the analysis is detailed in Figure 109. Projected Percent Service eemm"d Cliengo by Planning Cammenlly 120 °; I I � I 0 ❑zciu I ❑zo ❑2020 I f 40% y o d 't, nc e y <i I v4 0, 2� d �'` �P > °oc °'c, ci' cR oaI •v o`a' i ?� OF 4c3 p' 4aC yep P N .'° 4i 4{ Q°\ The significant growth in the Corkscrew community can be attributed largely to the Ave Maria Town and University development that is still underway. The growth in service demand within these areas may require not only more units but also increases in the geographic minimums necessary for response time performance goals. An hourly service demand analysis was employed to determine the minimum units required during peak activity hours. The result of the analysis is detailed in Figure 109. 1oN�� CellieP CennSty, Florida - EMS- S�yslem M'aM& Plan Figure'109: Peal( Worn• Mininitlin Unit Needs by Area By 2020, additional units are neeclecl in nevoral areas; roost notably the. Estate:, North Naples, and Royal Fal(apalms (see Figure 110). Additional workload is noted in other areas in which reserve capacity Units would be employed for coverage. 170 5'1 ,1ielLhltt pup{ i :! North Naples 3.32 3.80 4.34 South Na les -_ 1.61 1.98 _ 2.38 Central Na les ' 1.11 1.20 _ 1.30 EasCNa "les'!i "' 1.49 1.74 W 2.02 Golden Gate `- 2.54 2.89 3.28 Urban "Estates: "<`� 2.38 3.01 3.71 Rural Estates ': 2.53 _ 3352 4.59 Marco Uninc '; "< 0.08 f 0.10 0.11 Rov al,Ealm alms 1.12_ 1.67 _^ 2.26 Corkscrew. " 0.341I 0.64 0.97 Igimolmlee _ 1.43 1.67 2.17_ 131 C ress, 0.01 0.0 1 0.01 Ever Indes City, 0.05 0.05, 0 O6 Clly of Marco' 0.88 6198 �. 1.10 City of Nn les 1 _ .30 1.44�1.59 By 2020, additional units are neeclecl in nevoral areas; roost notably the. Estate:, North Naples, and Royal Fal(apalms (see Figure 110). Additional workload is noted in other areas in which reserve capacity Units would be employed for coverage. 170 5'1 ION Collier County; Florida - ENIS,System Nlaster flan Figure 110: Additional Unit Needs Additional Unit Needs 3 II I l 2 - - - - j0202011 i 020151'' 1;020101 0 m ey aaa \oO xca` , m \' G O y,Oz beaQ�Q�e a;J4&q G ��ey `\ "P,A °`aa cp \0OKD�No a0 C�nqo O q I 4 I The increased need for additional units due to service demand in areas of greatest population growth is likely to increase the need for additional station placement in these areas as well as increases in the geographic mininuml Unit coverage. Close attention to the patterns of development will dictate the need for additional station locations. t C t?nlir �K 6 U IN- rude t I i<?= North Naples 0.2 0.5 0.5 South Naples o.z 0.4 0 4 Central Nel "lee -= 0.0 0.1 `0 _ 0.1 Eaet Na les 0.1 J .22 0.3 Qolde11 Qate 0.2 0.3 0.4 Urban Estates. - 04 06 _ J 0.7 Rural'EStates 0.6 1.0 1.1 Nlarc,o Unlitc - -.. 0.0 0.0 _0.0 _ Ro al FAI(a ahn ' _ 0.3 0.5 M 0.6 _ Corksorew`,� '- 0.2 0.3 0.3 Immoltalee 0.1 ^ 0.2 0.4 Si C ` Yess . _ o.6---- --0 .0 0.0 _ EvergladestClty 0.0 0.0 0.0 Ch Ot-- Imar00 0.1 0.1 0.1 My of Naples . _ _ 0.1__ 0.1 0.2 _ The increased need for additional units due to service demand in areas of greatest population growth is likely to increase the need for additional station placement in these areas as well as increases in the geographic mininuml Unit coverage. Close attention to the patterns of development will dictate the need for additional station locations. 'Collier Ceti Illy, Floddo- EV4S System,Wsler flan 10H ; i Stations which are well placed currenthy as development progresses should be evaluated for the probability housing an additional unit. Other areas of growth outside of the current response capability will need to be explored for additional facilities. Based upon the projected needs in the Corkscrew and Inunokalee areas, it is recommended that Coltier EMS plan to utilize the facilitios offered in the rive Maria Development. In the Rural Estates Community, a station would be recommended near the intersection of Golden Cteto Boulevard and Everglades Boulevard. These stations would be additions to the current geographic minimums based upon growth patterns within the County. recommendations: Utilize the facilities offered in the Ave Maria development O New station recommended at the intersection of Golden Gate Boulevard andll Everglades Boulevard o Consider suspension of the response time performance measurement at the fourteenth concurrent call. As the current system is expanded, with the addition of growth units, or as the geographic minimum is increased, this number will need to be adjusted proportionally. l� f -.1 10W Pit,, Collier County, P.lortda — FNIS.System. blaster Plat, Section Three — Conclusions and Summary The information contained in a majority of this report can, at times, be overwhelming to the general reader. It is the intent of this section to succinctly summarize some of the more elaborate scientific information covered so that it can be applied within the scope Of Collier County. Finding: ovorall Polnrlation is projected to increase and developnieni is continuing and expanding into formally rural areas. Tas is 'I : Is LOSS method used for AUIR valid? I added unit per 15,000 totalweighted population A1nLlal total population growth has been approx. 10,000 per year Necessary Steps: 1. Determine utilization rate of EMS based on total current weighted population 2. Apply rate to additional total population to determine new unit workload total 3. Calculate UI-IU based upon this workload a. Based upon an annual assessment of additional unit needs ReSURS: • Overall Utilization rate: 01 calls / 1000 populatlon • Workload Total: 1,215 calls • UHU equivalent: A5 Conclusion: • May overestimate need • Probably economically inefficient. • Lacks spatial scale • Ignores concurrent call effect • Ignores ALS Engine contribution fit. 10NP CoIIfer County, Gbgrida -- EMS System Master Plan Ignores demographic effects (age, income, fertility, mortality, immigration) Task 2: Determine a methoclology to calculate the number of CMS units necessary currently, as well as in the future, based upon growth in population and (loveloprnent. Necessary Steps: 1) Determine current unii workload based upon: a) Geographic extent: (Spatial Scale) i) Use GIS to determine minimum unit coverage of service demand at response time objectives (90% of workload within 0 minutes of travel time) b) Concurrent call frequency i) Determine the temporal frequency level that multiple calls are occurring -- concurrently by the hour of clay ii) Calculate UHU per hour to cetermine minimum unit needs temporally iii) Adopt policy for reserve capacity unit determination c) ALS Engine presence. i) Calculate the frequency that fire units arrive prior to EMS units and by the amount of time based upon the concurrent call frequency within response zones. ii) Adopt policy changes d) Current population composition i) Calculate utilization by age range from current information Once current needs are established based on methodology, apply to Projectiais of Population and workload. 2) Project future unit needs and projected worldoad based upon: a) Population growth i) Determine weighted population by age range 17? I - -- 10H Gooier County, Florida -. E,?jIS Systeru tilaster'Plan ii) Apply the utilization rate by age to the weighted population by age, to determine workload totals. Adjust for non - transported calls, b) Concurrency frequency i) Calculate hourly workload per projected year based upon current experience ii) Calculate minimum unit needs by hour of clay for projected workload by hour for each year projected. c) Geographic expansion of commercial and residential development. i) Determine population projections for smaller geographic areas (planning community areas, fire districts, etc) ii) Apply 2a and 2b above to these areas to determine specific unit needs. iii) Compare projected unit need analysis to areas that also demonstrate commercial and residential development. (PUDs, Certificates of Occupancy, building permits, etc). iv) Determine if areas of development are outside of the response capability of current areas stations. Add station locations if necessary iO1lOR Cgtller County, :Florido - EMS Systerrm Mistor Plait II Recommendations: • Establish a priority and non- priority use of warning devices based upon dispatch criteria. • Establish a response lime standard based upon criticality of the request. For example: • Alpha calls: 20 minutes, 80 percent of the time • Bravo Calls: 15 minutes, 80 percent of the time • Charlie and above: 9 minutes, 90 percent of the time • Adopt the 'secondary' unit arrival time criteria when fire units arrive first when requesting fire first response on all calls. • Consider the use of response zones which have varying response time standards. • Utilize the facilities offered in the Ave Maria Development. Consider the viability of utilizing ALS engine on concurrent calls exclusively rather than responding on all calls, using the first arriving unit for response time performance. Adopt a policy by which the ALS Engine can cancel the responding EMS unit II based upon acuity of the patient condition and when the determination of transportation is found to be negative. (e.g. DOA's). Adopt a call concurrency limit if reserve capacity does not equal the geographic minimum adjusted based upon projected minimum peak activity unit levels. 1. 4 Utilize GPS and other technology to ensure closest unit response. 0 Revise dispatch zones based upon computer travel models to ensure fastest response. Implement new calculation to determine number of additional growth units t the county based on demographics and population density rather than weighted population. 0 Stations which are well placed currently as development progresses should bell 176 "( - 'i-"r• °� ion Col Ile r. Cat nity, FIorlda— EMS :Syst,Ini Pit a4er Plan F ed for the probability of an additionally housed unit within them. n would be recommended near the intersection of Golden Gate Blvd and des Blvd. 0, additional units are needed in several areas, most notably the Estates, aples, and Royal Falcapalms. The table below illustrates the results of ESCPs Calculations in determining a new trigger Population for adding growth units to the system. The 'Growth Unit Trigger' column shows the newly calculated threshold. This number changes annually based on changes in the weighted population as calculated from the BEBR population projections. The column titled 'Projected Population' shows the total weighted population used to determine the trigger threshold. The final column is a simple division of the total population by the total nwnher of projected units within the system in any given year. In Shelf, the column highlighted in green should be referenced for the purpose of determining the timing of additional growth units, as requested by the AUIR and productivity committees. It is important that the growth unit value in the table is not inadvertently misused. The 'Growth Unit Trigger can not be used as a divisor of the total population to determine the minimum unit needs. This value should only be used as a measure of population increase since the last addition of a growth unit. The "Resulting Population per Unit' column is included as a reference for those interested in a ratio of population per unit. If Should be noted that the weighted population figures used to calculate the new trigger threshold population are projected estimates and may need to be reexamined periodically. Given the detailed calculations utilized by ESCi to rome to these r_OnClusions, it is recommended that Collier County consider having the calculations updated after any significant revisions to population estimates are producecl by BEBR. `I �c i sYJ tl Collier 0oun Florldia E {MS- .Sys4em' Master Plan Figure 'I'I'I: Summary Tablo of Calculation Results ION I 11 1 _ 398098 15924 � 1 �1 2007 26279 2008 25391 415783 16193Y �1 2009 24757 433789 16420 2010 26279 450655 '1665'1 1 2011 23487 466732 16039 1 2012 22853 483388 16998~ 1 2013 22218. 500643 17137 1 2014 21583 518517 17255 1� 2015 -. 17061. 536061 '17250 1 2016 20314 553231 17340 1 2017 19680 570954 17403 1 2016 —19045 589246 17447 1 2019 16410 - 608131 17473 1 2020 18110 626610 17492 '1 2021 17141 644641 17484 1.2 2022 16506 663193 17457 1.2 ` 2023 15872 682282. 17412 1.2 �. 2024 15237 701924 17350 1.2 2025 15745 721079 17204 1.2 2026 13968 739706 17242 1.2 2027 .13333 758817 17126 -L2 2028 - 778424 16991 12 `T 2029 12064 788500 16838 1.2 2030 - 1`1410 798540 I '16747 I 1.2 'I lie inlrnmation comameu in me lame euuvn in .m..0 — mo —11 '••.w -x•11. population average. In summary, this methodology to determine additional units is superior to the current methodology in several ways: 10H '.q11 Cofller County; Flerida — EMIS System Plaster Plan 1. Dynamically based upon age -based population growth projections by the BEUR and the Collier County Planning Department. 2. Considers peal( load hours in determining the minimum units necessary at those tines. 3. Has geographic scale- - minimum units based upon service demand and travel time capability are established. 4. Is an economically efficient method to determine future unit needs. 5. Considers the impact of ALS engine response. 6. Is reproducible to update the planning conditions for unit deployment and geographic minimums as projections are revised. This page [of iblank 180 -1 � 10H' ` C'olller Comity; rlorldii — ENIS System fulasler Plan APPENDICES APPENDIX A: SUrnmary of Recommendations • Create a new position within ENIS Administration (Assistant Chief for Administration) to reduce the current span of control of the Chief of EMS. • Explore additional Battalion Chief positions within the operations division to reduce supervisory span of control to county recommended seven personnel. • Work with the bargaining unit to re- evaluate the method utilized to calculate educational incentives and formal those incentives based on the weight of the accomplishment or activity. • Increase training, education and practice consistency among all AILS providers and ensure that all providers are able to perform equal skills and procedures prior to 'certifying' them to function within the system. • Combine all costs associated with the operation of Medflight into that division's budget in order to illustrate a cost of operation as compared to generated revenue. • Address environmental and ADA issues with Station Ni possibly even relocation to elsewhere in the general area. • Relocate the EMS Training facilities from Station #770 and negotiate indoor parking for both EMS units. • Utilize the facilities offered in the Ave Maria development. • New station recommended at the inteisection of Golden Gate BoUlevard and Everglades Boulevard. • Consider suspension of the response time performance measurement at the fourteenth concurrent call. As the cm'rent system is expanded, with the addition Of growth units, or as the geographic minimum is increased, this number will need to be adjusted proportionally. • Establish a priority and non - priority use of warning devices based upon dispatch critefin. 10H '�1 Collier County, Florida - ENIS Sys leffuNlasler Plan • Establish a response time standard based upon criticality of the request. For example: • Alpha calls: 20 minutes, 80 percent of the time. • Bravo Calls: '15 minutes, 80 percent of the time. • Charlie and above: 9 minutes, 90 percent of the time. • Adopt the 'secondary' unit arrival time criteria when fire Units arrive first when requesting fire first response on all calls. • Consider the use of response zones which have varying response time standards. • Utilize the facilities offered in the Ave Maria Development. • Consider the viability of utilizing ALS engine on concurrent calls exclusively rather than responding on all calls, using the first arriving unit for response time performance. • Adopt a policy by which the ALS Engine can cancel the responding EMS unit based upon acuity of the patient condition and when the determination of transportation is found to be negative. (e.g. DOA's). • Adopt a Call concurrency limit if reserve capacity (foes not equal the geographic minimum adjusted based upon projected minimum peak activity unit levels. • Utilize CPS and other technology to enSLlre closest unit response. • Revise dispatch zones based upon computer travel models to ensure fastest unit response. • Implement new calculation to determine number of additional growth units within the county based on dernographics and population density rather than total weighted population. • Stations which are well placed currently as development progresses should be evaluated for the probability of an additionally housed unit within them. • A station would be recornmendod near the intersection of Golden Gate 81vct and Everglades Blvd. • By 2020, additional units are needed in several areas, most notably the Estates, North Naples, and Royal Fakapalms. 1.� 1:u� Jli::h..LFc :ell ION Collier County, Florida — ENIS.Sysiem Master Plan APPEi\]DI;( B: Threz- person ArnbUlance Staffing Although the idea of placing three personnel on each lransport ALS ambulance is appealing to some, the fact is that there is little evidence to support this change in staffing. The typical Advanced Life Support EMS crew in the United States consists of two personnel in a configuration on Paramedic /Paramedic or Paramedic /EMT. Pew services in the United States have worked with three - person crews and the only published studies related to this type of staffing refer to services in Hong Kong." Even this study only identifies the service as employing three - person EMS crews but not mention the advantages or disadvantages to this type of system. Little evidence exists examining the ideal Unit Hour Utilization (UHU) for EMS units. NFPA 1710 suggests deployment based on response time and other standards for the safety of the fire personnel. The International Association of Fire Fighters, (IAFF) published a report indicating that the ideal UHU for ENIS personnel in a fire -based EMS system should remain in the vicinity of 0.30 whereas the typical fire apparatus UHU is recommended to remain at approximately 0.20. In recent articles, some fire districts have made operational changes away from three - person EMS crews in order to enhance their ability to staff more units, reduce overtime expanses and keep response readiness more constant." From all available research, it is apparent that three- person EMS crews are typically those in all- volunteer departments and staffing the unit with three personnel is not the nornn but rather only routine when excess personnel are available. The only other EMS vehicles that routinely operate with three personnel are flight services, which require a pilot and two attendant personnel. 33 Crow Maunsell Management. Consultants Ltd. "Consultancy Study on Paramedic Ambulance Service in Hong Kong ". 28 December 2001. 3' Kansan.com. "Newton fire /ENIS Slreamlines Operations." 12 July 2003. Collier Counly, Florida - EMS System.: Master flan APPENDIX G: Cost Projections f^,iau_'ttaf Ear ufpretent Costs There are two schools of thought as to vehicles used in EMS. Historically, agencies have used smaller vehicles that are somewhat more maneuverable, lighter and can fit into smaller spaces. These vehicles, such as Ford F -350, F -450, E -450 or Chevrolet 3500 series trucks are considered medium duty vehicles and, therefore, the strain of serving as an emergency vehicle taxes the designed abilities of the vehicle. In recent years, agencies have opted to purchase larger, heavier duty vehicles to use as ambulances. These vehicles, such as Freightliner M2 and Chevrolet 4500 series, are considered medium -heavy to heavy -duty vehicles and, therefore, should last much longer under [lie heavy strain as an emergency vehicle. In addition, the number of warranty miles is usually much higher with the heavier duty vehicles. In addition to the base cost of any vehicle, options above and beyond the base vehicle price are necessary for the vehicle to operate as an emergency vehicle. Power supplies must be adjusted to carry the electrical load of agency specific equipment; appearance options must match existing agency designs; optional equipment for hazardous road conditions is available; patient compartment shelving requirements for agency specific equipment; security options; weatherproofing chassis; additional wiring, etc. Agency specific medical equipment also adds a significant expense to making a vehicle operational. Operational equipment includes, but is not limited to, radio equipment, cardiac monitor/defibrillators, oxygen equipment, splints, bandaging, pediatric equipment, storage boxes and equipment bags, airway equipment, burn supplies, suction units, etc. Below Is a cost comparison of several types of vehicles. Although the number of warranty miles on the heavy -duty vehicles is higher, maintenance costs tend to be in line with that of the smaller vehicles due to the cost of labor associated with heavy -duty vehicles. 10 H ION 'if Coll(er. Coulity, Florida. —EMS System Master Plan Table 1: Estimated Capital Equipment Costs Fort) F -350 Type I Ford F•450 Type I Ford E -450 Type III Chevrolet 04500 Freightliner M2 $90,000.00 $87,000.00 $108,000.00 $126,000.00 $98,000.00 $95,000.00 $120,000.00 $f35,000.00 $140,600.00 $148,600.00 $145,600.00 $170,600.00 $185,600.00 " Operational Equipment includes all equipiiient necessary to function as an Advanced Life Support Transport Ambulance including, but not limited to: 1. Radio Equipment, front and rear of unit. $8,000.00 2. Radio Equipment, portable. $2,000.00 3. Communications Equipment, voice pager. $600.00 4. Cardiac Monitor /Defibrillator $25,000.00 5. Miscellaneous Medical E=quipment $15,000.00 Total $50,600.00 Recurring Exaftntlitures Although purchasing vehicles and staffing them with qualified personnel is essential for the continued operation of any EMS system, those vehicles must be continually maintained. The table below is an example of the types of recurring expenditures associated with the operation of a transport ambulance or other emergency vehicle utilized on a daily basis. l 10H Collier GounIy,. Florida — CN1S Syslem OAasMr Plan Figure 112: annual Retuning Vehicle Expenditurest �. W ' e . OP Fuel' $20,000.00 Maintenance $1,1300.00 Insurance $100.00 Radio Service Contract $3,000 00 Equipment Service Contract $4,000.00 Oxygen Equipment/Rental $300.00 Miscellaneous Supplies $5,000.00 Tot, t Recurring Expenses $34,700.00 }Per stocked transport unit — estimates based on known average costs. 'Based on 6 mpg at 100 miles per clay al $2.50 per gallon. Total Cost to Staff One Arnhulance Several factors must be considered when estimating the total cost of making one ambulance operational within any jurisdiction. The following information assumes that the personnel staffing the unit are paid at the average cost of compensation indicated earlier in this report with the associated benefits; the vehicle purchased is an average of those listed; and the personnel continue to work a 56 -hour workweek and no change is made to an alternative schedule. The projections shown below do not take into accouni shifts vacated for illness, vacation or otherwise which must be filled either with other full- time staff (which would require overtime pay) or part -time staff. The projections also do not include supervision, management oversight or additional responsibilities such as Off - Duty call- backs, payment of compensatory 'Lima of other ancillary expenditures. ION Collier County, Florida - EiNiS System Master Plan Figure I'I3: Total Cost to Staff One Transport Ambulance It should be mentioned that the above estimates include the purchase of additional vehicles and the hiring of additional personnel. Utilization of existing vehicles and /or personnel will alter these estimates considerably. In addition, these expenses are considered 'start up' costs and are not to be considered annually recurring expenditures. If new equipment was purchased to operate new units, that equipment would not be an expenditure for the next fiscal year. Recurring expenses would be personnel, non - capital, and non- personnel costs only. The above estimation also assumes that the type of personnel service delivery remains unchanged. One option to reduce expenditures is to staff operational units with non - cross trained EMT- Paramedics. This shift in personnel deployment would reduce the annual salary of the personnel clue to their decreased responsibility'(no longer required to train and respond as firefighters as well as EMS personnel), however, an alternative schedule may be necessary to avoid the payment of high overtime premiums to non -fire suppression personnel. f"11 fir;; •�_u9 Personnel Costs - Average Cost of - .$458,832.00 Compensation x 6 personnel Capital Equipment Costs - Vehicle with all -$ 158,200.00 Operational Equipment Recurring Operational Expenditures -$34,700.00 Total Cost of placing one fully staffed -- y651,732.00 ambulance into operation It should be mentioned that the above estimates include the purchase of additional vehicles and the hiring of additional personnel. Utilization of existing vehicles and /or personnel will alter these estimates considerably. In addition, these expenses are considered 'start up' costs and are not to be considered annually recurring expenditures. If new equipment was purchased to operate new units, that equipment would not be an expenditure for the next fiscal year. Recurring expenses would be personnel, non - capital, and non- personnel costs only. The above estimation also assumes that the type of personnel service delivery remains unchanged. One option to reduce expenditures is to staff operational units with non - cross trained EMT- Paramedics. This shift in personnel deployment would reduce the annual salary of the personnel clue to their decreased responsibility'(no longer required to train and respond as firefighters as well as EMS personnel), however, an alternative schedule may be necessary to avoid the payment of high overtime premiums to non -fire suppression personnel. f"11 fir;; •�_u9 Attac ra E EMERGENCY MEDICAL SEl@VICES ADVISORY COUNCIL AND F][ OD CTIIMY COPRIIff 1024 E, J'O i 1T SUB- C0i\'VVMTFE Fox: EMSAC Chairman . Productivity Conunittee Chairman Subject: EMS Master Plan Review Final ]Deport This Joint Subcommittee was formed to review the EMS Master Plan and make recommendations to the EMSAC and Productivity Committee for final approval and submission to the BCC. As we started our review, EMS was experiencing FY08 budget shortages. Our review expanded to include recommendatious 'on EMS units for the F'Y09 budget, which were approved and provided in Juue during the F'Y09 budget workshop. That recommendation is included with an addendum. As we met to approve a final report on the EMS faster Plan, concerns were raised treat the training process and certification are issues between the fire districts and the EMS medical director. Additionally, an ALS engine unit was deactivated.when paramedics failed an EMS medical director examination. These situations need to be corrected as soon as possible. We appreciate the assistance and expert advice provided by Chief Jeff Page and his staff, especially Deputy Chief Dan Bowman, Dave Stedman and Jennifer Florin. Date Approved: Wo tJ ! X-Le' I J rat Subcommittek Chairman 10H ]ENM RG ENCY MEDICAL SERVICES ADVISORY COUNCIL, (EM SAC) AND PRODUCTIVITY Ct➢lY1CMII'ATlE]E JOINT SUIB- CClbl[M[II'p`II']EE IEMS M. [avert Phan Review Final Repor t New revenue sources Given the outlook for continuing funding constraints in the future, the joint subcommittee evaluated a variety of new revenue sources and procedures to improve collections. The following recommendations are provided. Civil Infractions Cost ]Recovery Ordinance. EMS services are paid primarily by property taxes and transport fees. Recently the BCC approved a fee for treatment without transport, allowing EMS to charge for materials and supplies used when services are performed, but no transport occurs. . We recommend establishment of a user fee for people who violate the law and, as a result, need EMS service. People who violate the law would be required to pay for all EMS services (including labor and operational costs) used in responding to the incident. For example, a DUI driver (or red light runner) causing an accident would pay for all EMS services responding to that accident. For a condominium fire started by faulty electrical work done without permits, the ordinance would pursue the violating business for reimbursement of emergency services. Unlike current fees, the Civil Infractions Cost Recovery fee would allow payment for ALL costs incurred in responding to emergencies, whether or not a transport occurred. Pre- determined service fees would be charged to "at- fault" drivers (or businesses if a commercial vehicle) to be paid by the insurance carrier of record or the at -fault driver who doesn't Have insurance. If there are multiple at -fault drivers, total costs would be assessed proportionally. Costs include personnel (maximum salary schedule 1110ff 114 hourly rates plus benefits), vehicles and equipment prorated cost (based on latest FEMA schedule of equipment rates) and materials and supplies consumed during the emergency response. The new ordinance could be incorporated 'alto the EMS billing ordinance or it could be expanded to apply to fire district costs, if desired. Hazardous Material (Hazinat) Coss Recovery Ordinance. We recommend establishment of a user fee, similar to the Civil Infractions Cost Recovery fee, for all county emergency services provided during a hazmat incident. This separate ordinance would encompass, at a minimum, EMS and Ochopee and Isles of Capri dependent fire districts. It could be expanded to encompass all county, law enforcement and independent fire district services as well. Under this ordinance, all public service emergency costs (as described in Civil Infractions Cost Recovery above) associated with the hazardous material incident would be charged to the business causing the incident. This type of ordinance has been upheld in court. Boat Registration Fee. We recommend that a $2.00 fee be added to every boat registration, to help support the cost of EMS boat rescue operations. Rescue operations are expensive and this fee would be paid by the people most likely to benefit from the service. Fees would be charged locally and remitted directly to EMS instead of going to the state. EMS Transport Fee Collection from Hospitals, Doctors' Offices, Nursing Homes, Assisted Living Facilities, etc. The EMS billing ordinance was recently amended to allow EMS to bill hospitals directly for transports between their facilities. This was done, in part, to improve fee collection because Medicare omen will not pay for inter - facility transports. Frequently, doctors want patients transferred from their offices (nursing homes /assisted living facilities /etc.) to the hospital, based on their evaluation of medical need. We recommend that EMS be perraitted IOH to bill private physician's offices as payers of last resort. Nursing homes /assisted living facilities, etc. should be responsible for patient transfers and allow these facilities to obtain reimbursement fiom their patients. EMS Ambulance Holding Time Cost Recovery Fee. Periodically, hospitals hold EMS ambulances for extended wait times before admitting the transported patient. Problems generally occur during the season when hospital beds are not available, causing EMS units to be out -of- service when they are most needed. We recommend adding an Ambulance Holding Time Cost Recovery fee to the EMS billing ordinance, similar to other cost recovery charges that bill for total cost. This fee for wait times would be primarily a code enforcement tool, rather than a revenue generator, designed to discourage excessive holding times. Mei'=hodoloav for Adding New EMS Units The Master Plan recommends using weighted population to determine the number of Eb/IS units needed, and recommends the "implementation of a schedule that fluctuates similarly to pear service demand." We agree that weighted (rather than permanent) population should be used as an estimate of annual demand for service; and agree that, in actual practice, more units should be operational during season and fewer units (or reduced hours) during off - season. Demand for EMS service, and satisfactory response to that demand, is evaluated based on the number of calls for service and the time it takes to respond to those calls, measured against response time goals. In the past, EMS used an 8- minute response time (90% of the time) countywide, but recognized that this goal would not be uniformly met in the rural areas. Due to EMS budget constraints, the goal was recently changed to an 8- minute response time in the urban areas and a 12- minute response in rural areas. 3 IOU MIN With these new goals, the number of EMS units and supporting fire district Advanced Life Support (ALS) engine units are considered adequate, although actual .response times are slightly below the goal. Increases in population (increases in the number of people and eventually in the average age of the population) will increase the demand for service, but response times, coupled with patient outcomes, ultimately determine adequacy of service, not a specific increase in the number of units due to a specific population increase. As a result of a Master Plan recommendation, ALS engine response times were subsequently included in the EMS response time (fractile) reports. We agree that combined response times should be used, indicating the time of the unit arriving first at the scene of a medical emergency. While the Master Plan recognizes that ALS engine unit response times have an influence in meeting response time goats, it does not count any of the actual ALS engine units in meeting the demand for EMS service based on weighted population. Instead the EMS Master Plan uses a "Growth Unit Trigger" calculation to determine when an additional EMS unit should be added. This methodology is complicated, non - linear and would require the consultant to recalculate the need for new units "after any significant revisions to population estimates." When fire district ALS engine response times were first included with EMS response times, it was clear that ALS engine units could reduce the need for new EMS units. By counting response times from the seven dedicated North Naples Fire District ALS engine units, the need for four new EMS'units (and stations) in northern Collier was reduced to just one unit. The impact of the ALS engine units is undeniable; yet, using the Master Plan methodology, the three EMS unit savings are not recognized. 4 toff t It is difficult to determine how to calculate the value of ALS engine units in meeting the population- driven'demand for new EMS units. While ALS engine units are not interchangeable with EMS units, they do provide a safety net and, to some extent, can limit the need for new EMS units. Until there is an acceptable methodology for counting ALS engine unit support, EMS will have to rely or-, projected deficiencies in response times to identify the need for (and location of) new EMS units. And, whenever new ALS engine units are activated (as in North Naples), existing plans for additional EMS units ill that area would have to be reviewed and reduced as necessary. In the absence of any better information, EMS should continue to use a 16,400- weighted population to 1 EMS unit trigger, but it should be revalidated periodically. The problem of how to count ALS engine units may be ultimately _ resolved by merging EMS with a consolidated Collier County fire district, which would dramatically change the delivery of emergency medical services to county residents. The next section discusses how all interim measure could be implemented, changing how demand for service (EMS calls) could be met, what units could respond to calls and what response times could be acceptable. f r°i o rnjy Medical Dftspartch With current fiscal constraints, it is important to provide more service with fewer resources. and more efficiently utilize the existing resources of both EMS and the fire district ALS engine units. There appears to be a potential for increased productivity through the use of a prioritized medical dispatch systern. The Master Plan mares this recommendation and the fire district consolidated study refers to increased efficiencies from such a system, which would reduce the number of responding units and improve response times. 9 The Master Plan suggests establishing a response time standard based on the criticality of the request. For example: Alpha calls: 20 minutes, 80 percent of the time Bravo calls: 15 minutes, 80 percent of the time Charlie and above: 9 minutes, 90 percent of the tune. It is recognized that all calls for medical service are NOT emergencies requiring an 8- minute response time. Many medical calls could be identified with a lower priority, Under a prioritized dispatch procedure the county 911 system would need to be revised to include medical personnel to determine call priority and upgrades to the computer aided dispatch (CAD) system. Priority medical dispatch would require complete agreement and cooperation of the fire districts with their dedicated ALS engine units, and it appears that at least some of the fire districts are very supportive of this concept. However, it is difficult to implement improvements in medical dispatch. The EMS medical director has tried, unsuccessicully, to implement changes designating which unit, EMS or ALS engine (but not both), should respond to Alpha calls for 33 identified medical 911 call incidents. There are too many technical, operational_ and even legal issues to make an absolute recommendation, but this procedure should be fully evaluated. It appears that a priority medical dispatch system is considered workable under a consolidated fire service/EMS organization and, if the procedure is viable, benefits and efficiencies may be achieved sooner rather than later. The increased costs associated with CAD improvements and 911 medical dispatch personnel would be minimal compared to the fixed and operational costs of additional EMS units. It is recommended that, if the 911 system is modified to create a priority medical dispatch system, a pilot program be tested before implementation countywide. 6 .11 Ire � 0 1101 H on ENlf1,S lU Until recently, EMS justified the need for new EMS stations based on call volume and response times of existing EMS units. They did not include any data from fire districts Advanced Life Support (ALS) units also responding to the same medical calls. During the FY06 AUIR, both the productivity committee and the planning commission recommended that fire district ALS .support be counted as part of the total level of service provided countywide and in determining when new EMS units are required. County commissioners approved an EMS master plan study that would address, among other things, the fire district ALS contribution. In FY07, the master plan study recommended that ALS engines should be utilized to increase the capacity of the EMS system in general. The study accounted for the total county service (EMS and fire district) by calculating a blended response time performance using the lowest time by either EMS of ALS traits. In FY06, EMS justified the need for four new stations in north Collier Country, based on call volume and response times. of EMS units alone. These traits were fielded before the new stations were built and the units are currently located at alternate locations in the county. Only one of the four new units is at a temporary location in north Collier where it was originally justified, another unit has been diverted to Ave Maria, and the other two units are temporarily co- located with the EMS units at stations '70 and 75 (in Golden Gate and Radio Road areas), where the need for additional units has never been justified. In evaluating the EMS master plan, the Productivity Cornmittee and EMS Advisory Council (EMSAC) joint subcommittee reviewed the blended response time performance, including combined EMS and ALS 7 IM data, and it is clear that including file district A L,S runts has had a sign.ificam impact on response times and the corresponding need for new EMS units. ha particular, the sever AL,S units provided by Nord, Naples Fire District have made a big unproverrient in response tunes in north Collier. Their contributions, plus the one new EMS Unit co- located in north Collier, have achieved goal response times, with one exception. Zone 42 is below the goal, but performance should be coirected when ti Ile R7 station at Vanderbilt Beach Road and Logan Blvd is completed and the ETIAS twit co- located at station 44 is moved to the ne`,v location. With only one clew station required in north Collier, and one at Ave Maria, the other two stations can be eliminated. The cost savings on the construction of two stations is estimated to be $4.5 M. As a result two EMS units are excess to County requirements and should be eliminated. Operationally those two units should be chosen at the discretion of the EMS Chief. The annual cost savi.:ags from siafiilg 2 units is estimated to be $94- 2,$72. Addendnna It should be noted that if the decision on which two units to eliminate is made based on minimizing the adverse impact to response tinge perforniance, the ELMS units at Isles of Capri and Ave Maria would be chosen. They have the lowest call -volume, are surrounded by other nearby units and there would be almost no adverse impact to response time performance. 8 Attachment F Board of Collier County Commissioners Office of the Medical Director Dr. Robert Boyd Taber, M.D_. FACEP � Collier County Medical Director November S, 2003 Editor Naples Daily News — Statement of Position — Dr. Robert Boyd Tuber, M.D. 1 etters0nap lesnews. corn Today's article in the Naples Daily News is an excellent example of half - truths and one -sided accounting of issues sunnunding ENIS and Fire controversies in this community. I will try to summarize the REAL issues at stake in these controversies. I The Department of Health (DOH) in Tallahassee holds Collier County ENIS and the Medical Director of CCEMS responsible for any and all personnel responding to patients in the prehospital environment, regardless of whether or not they arc cn n tptoyed by ENIS or one of nine independent five districts in Collier County. a. When, by accident, it was discovered that NNFD had an SNIT operating without proper hcensure, CCENIS reported this incident to the state. (CCENIS is required to follow this reporting procedure). The DOH made it abundantly clear to CCENIS that WE were responsible for insuring that all personnel were properly licensed. Asa result of this, we requested that all 9 _ A surrounding fire department submit files o.i all of their EMT's and paramedics operating in the prehospital environment so that ENIS could keep track of their licensing etc. b. When we were told of an SNIT /driver working for City of Naples Fire Department not having completed the driver safety training of heavy emergency vehicles known as EVOC, we immediately responded and took him out Prom behind the wheel. Had we not, and an accident occurred, CCENIS would have been judged reatiss for allowing this driver to continue. In the incident reported in the papa, we were really in a. no -win situation where following DOH guidelines put us under scrutiny and doin, nothing would have put us under equal if not more scrutiny. Fortunately, this was not a patient care issue, but it points to the administrative quandary CCEMS finds itself in amidst a sea of NINE INDEPENDENT FIRE DISTRICCS in our conumnAY, 2. The article also implied that perhaps illy motives were politic<d. ANYONE who looks closely into tlne national dilcan na facin? ENIS and Fire will immediately understand that what is happening in Naples is happening across the USA. There is an enormous political agcndra nationwide initiated by the International Firefighters Association Union to take over LMS as the Ptequency offices diminishes. This has rarely been done in the interest of patient care or economics. a. If I was acting along political lines and not in the interest of safe and prudent patient care and medical oversight, wiry would the following organizations unanimously support my positions of patient care over and above political agcudas ?? ?: (1) Florida Association of ENIS Mcclical Directors (2) American College, of Emergency Physicians (_) Academic Association of 6mergcncy Physicians Collier County Medical Society (representing over 500 physicians in our community) 5) Collicr County Dental Society (representing well over 100 dentists in our community) ... _. 2705 Smlh Pcrs sha, Or • K-M, 3, Fiomla',,; i L,,4 •239 2b2 -s4S3• F ?.X 233 1S :1 .:., 1 Page 2 b. 'fhe only politics I am engaged in are the constant battling of fire departments insisting on having clinical privileges equal to EMS medics when the EVIDENCE points to anything but giving them additional drugs and tools. These drugs are at least as dangerous if not more so than they are life- saving and their appropriate use and the appropriate assessment of the patient can only be done safely by people who do it every day; not as infrequently as our statistics of fire department First response indicates. c. R would be far easier to charge me with recldcss management of our emergency medical system if equipped the fire departments with what they actually demand that I give them. Stellar systems like Richmond Ambulance with is a separate Fire AND EMS system in Virginia directed by perhaps the most published and esteemed physician in EMS medical direction in the nation insists on standards of experience and training that even exceed my training demands. Google Dr. Joe Ornato if you waut to tool.- at a system that restricts its fire righters even more than I do and insists upon even more actual patient contact and ambulance ride time than I do. 3. Today's article suggests that I resist being under the thumb of a fire chief. 85% of what the NINE INDEPENDENT FIP.E DISTRICTS do is run basic life support backup to EMS and extricate people from vehicles in crashes- etc. In other words, the majority of their efforts are medical. 100% of EiNIS's efforts are medical. Why would a fire chief be u1 charge of a consolidated organization that is, for all intensive proposes, primarily a medical effort? Similarly, neither I nor any other physician is qualified to direct a fire response. For that matter, why not first ask the NNE INDEPENDENT FIRE DISTRICTS to get their act together and consolidate FIRST. That consolidated organization could then be directed by a fire chief AND work cooperatively with EMS, winch is the primary medical initiative in Collier County evith the largest number of highly trained medics. 4. Today's article suggests that I would rather direct the efforts of medical training to police rather than fire fighters. This is, again, a total distortion of the facts_ Basic life support (airway, breathing, bleeding, acute allergic reactions, blood pressure issues) are the most important elements of initial emergency care that save most of our lives, regardless of whether those efforts are provided by police, fire or ENIS. Advanced life support and the administration of complex drugs that can save one's life or threaten one's life are primarily administered during the transport phase of emergency care and should ONLY be in the hands of medics that have both high levels oftraining and frequent experience using the drugs. The lire departments state over and over again that a "paramedic is a paramedic is a paramedic" because they are all state license d. Therefore, why should they not all have the same privileges ?'? That totally ignores currency of experience and actual hands -on training and on -going clinical practice with actual patients. a. EMS has 50 or so cross - trained fire fighters. But you do not see these cross - trained EXIS medics operating sophisticated fire fighting apparatus? No— because they have no recent experience; insufficient training and insufficient time in fire situations. Do you hear these cross trained EMS paramedics screanim, that they do not have the same fire fighting privileges as veterans from the fire depa fitments? No you do not b. The largest army of potential life- savers that our county is blessed with are the police forces. They already protect our lives from dangerous drivers, situations and people. They far out- number fire fighters and ENIS personnel. There are more of them on the road at any one ntoment than any other public safety person. I have repeatedly stated to both tine out -going sheriff and in- coming sheriff that I am interested in enhancing tre basic life support abilities of this additional army of dedicated and enthusiastic women and men and i believe they will be supportive of these initiatives. Why' ? ?'? Because it could help save additional lives in our community. Remember that prompt and competent basic life support is the single biggest factor in a life saved or lost in the prehospital environment. c. Similarly, I have repeatedly told the fire departments that what they do most often is what they can do best and that is basic life support. I have not declined to enhance their basic life support 2705 F.[Uth Hu=est� Or.•Nd PI.3. Fk(n1a 141 Ci - 239 F,:" ee4 -2K''. 58 19 skills nor I have I taken ANY drug away from them that they might need in the first 15 -30 minutes of a call. But, like it or not, the fire departments rarely use any of the drugs I gave them over the last year. All 4 hire departments and 102 medics actually carrying drugs over the past 12 months only administered 15 doses of drugs compared to 7547 doses by 120 EMS medics. That was in over 1 year's time. d. I reiterate that BLS and not ALS saves lives AND, giving medics a lot of drugs that they NEVER use is at least as life threatening and irresponsible as it could be `life- saving ". In a recent coaumentary to the Collier Citizen I wrote: "Who do you want reaching into their box of two -edged swords to "save" your life; someone who does it daily or someone who maybe did it 5 years ago? e. The fire departments are upset that I do not spend the time and effort training them in ALS skills like I do our CCEMS medics. Why would I expend these efforts when they rarely if ever have a chance to use and practice these skills? Why not spend the time training them to do what they actually will do prior to the arrival of EMS? 5. Sooner or later, the public at large needs to scrutinize where our tax dollars are going. Times are tough and monies are diminishing. The NINE INDEPP.NDENT FIRE DISTRICTS spend S83,000,000 per year and the vast majority of their efforts are basic Iife support and extrication. CCEMS spends 523,000,000 per year. Eventually, we wil I be asked in some sort of voting referendum what we want to see happen in this community. Consolidate FIRE; and leave EMS alone; consolidate fire with EMS or consolidate fire and place both fire and a separate FMS under the sheriffs department. Make no mistake about it a consolidated fire and E'[S system historically across this country has not saved any tax dollars; usually it increases cost so do not get too intoxicated believing that there are great savings with a consolidated fire and EMS system. Lool< closely at what each of us already spend and I think you will answer your own question. 6. One small measure of the current effectiveness of our mutual public, police, fire and EMS efforts are our survival rates from cardiac arrest. This past year 36% of our patients experiencing cardiac at-rest from ventricular fibrillation (the most common form of cardiac arrest) survived to hospital discharge. This is many times higher than almost anywhere on earth and compares favorably with Seattle, Washington (which is famous for its cardiac arrest survival rates). It is mostly due to the BLS response of the public, police, fire and EMS. Many other counties have been sent our protocols to save additional lives everywhere. The University of Miami has adopted these protocols as well. 7. I am spending too much time defending a statewide and nationally recognized emergency medical system of excellence from the political onslaught of a disjointed Fire system in this county that would rather spend its time trying to figure out how to take over CCEMS than how Better to do its oven job and perhaps how to consolidate NINE NDEPENDENT FIRE DISTRICTS in ONE COUNTY! I have no problem with responsible rcportiag that treats BOTH sides of an issue EQUALLY. This most recent article is NO '1- an example of this! Robert Boyd Tober, M.D., FACED Medical Director Collier County EMS (since 19S 1) Medical Director Neighborhood Health Clinic for the Working Uninsured Medical Director NCH Wound Healing Centers Associate Professor of'Iedicine'Miller School of Medicine: University of Miami 271)5 Swath Hcr_aslwe or. Nz s. Fkrxta 24 104 •239- 252 -$45E- F-X 239272 ? 2483 ion October 26, 2008 Dear Commissioners o_f Collier County and County Managci I fund myself compelled to write to you reference the newly created Ofilce of The Medical Director and its role in fornmlating a safe and responsible oversight of pre - hospital clinical activities by Police, hire and Et/IS. I find myself continually challenged by -Fire administration in the clinical activities that I permit their fire medics to engage in at?d /oe iite training and experience msndates thzt I demand in exchange 'ilor those ufivileges. The current road vve are heading down increasingly is becoming a battle ground of what privileges we are going to grant to fire -based paramedics and, based on those privileges, what training they must receive. This is a critical and potentially high -fist: area because these fire -based medics arc just never going to icceive the clinical experience of a CCEMS -based medic. Of even greater haunting relevance is my conviction that if the the depai unents did only basic life support (BLS) with the addition of epinepluine, benadryl, atropine and ai iodaronc as preliminary advanced life support (_ALS) drugs, the community would be served equally well and prDbably with a safer level of oversight I have plans, one clay, to arm the police with epinephrine and benadryl for acute allergic reactions became'ihesa are such [late - sensitive, life - threatening events. You have all witnessed the raging politics associated with any attempts on my part to responsibly adpst nredieations on fire -based apparatus based on evidence and my own medical expcficuce as well as that of Dr. Douglas Lee. These arguments are 100% political aiul have nothing to do with prudent prelhospital medical care. None Of the contested drugs Vvere ever used by the engines and of the 15 drug dosages actually administered last year, one otthese was adi nistered inappropriately. (Vote: in the same time period, CCMFS administered 75 7 dosages of drugs) I recently copied your commission on training and ride -time guidelines for the fire depaitments to achieve Intermediate or A1S Engine Certification Status. I oin already hearing that these guidelines are too expensive and too time - consuming for t'iem to comply with. Instead, they want me to form yet more committee's to "discuss" these demands and negotiate something that is easier for the fire departments to live with. Such negotiations are not only tint- consuming, but are again heading down political roads that put risk ahead of responsible medical judgment. It has also been brought to illy atleotion that It,' all ire departtnenis and E'NIS were consolidated, "things Would be diiiforznt ". That also is quite untrue. Ii ail departments were consohdatcd under medical direction, the BEST medics world be matched to the toughest calls; the next best to the daily grind of challenging medical calls and the least experienced medics (most of whom ride on tine engines) would be our BLS safety net along with the police. This is close to what we have today and I am wodciag towards improving this and, we are far fro_ni eonsolici,tiecl. I lost some of uty best and most experienced medics to the flre departments it f w years ago. These medics would be ION offered re- training and re- assignment to the first or second category of rescue medics (should they volunteer for reassignment), once their clinical skills were refreshed and re- challenged. Regardless of whether or not the fire departments consolidate aniong thennselves as ONE FIRF, DEPARTlbi�NT alongside ONE EMS DEPE1RMENT, or consolidate with EMS under ONE ENIS/1;IRE DEPARTf/IE NT, or each entity closes ranks under the county's watch or the sheriffs department, medical reality and commons sense must still prevail without the intrusion ofwif, power, money and politics. Regardless 0Fthe formula of consolidation or its continued absence, medical skills, competence and evidence -based medicine must guide our decisions as a comnamity. The Office of The ivledical Director will eventually require a bit snore form and structure to function effectively. It will ir. iuire an expert medical training department (which 1 already have a good foundation) and enough administrative personnel to accomplish its tasks of overseeing medical care in the streets prior to hospital delivery of patients by all agencies concemed. I am happy to have input from fire and police, but this is first and last a physician - determined and directed program. This is not up for debate as far as I or the medical community at large is concerned. In the meantime, I must ask for direction i om your commission about continuing down a. �. -oad that has little basis in fact, experience, evidence or medical common sense. These are not just my opinions; they are standard of care issues that must be fulfilled lo protect my license and our county and county commission from excess tiability. I can not comfortably continue to mitae cornpror ises or acquiesce to demands that run counter to my int uition or sound inedical Judgment and that is exactly what I am doing at this time. It is about the right time to ask for the following: 1. Cease and desist with any Eirther attempts to put ALS in the hands of the fire departments. It is the wrong direction and puts my license and the comity at much higher risk The past 12 -15 months have not supported this direction. 2, Reassign primary BLS responsibilities to the fire departments with the addition of 4 additional drugs named above. I need unequivocal support iicm you to do this. 3. Continue to work tov�ards an enhancement of pi chospital medical care t1tu a structured first -aid course for the police departments. 4. Provide the Office ofNieclieal Dircct.ion with a statement of public support that preempts any further debate over what the f l c deparhncnts will and will not carry on their engines. Vic have arnptc evidence that they do essentially nothing beyond BLS and a few rudimenitury ALS procedures over more than an entire Year. 5. I have, like it or not, been given die responsibility of 4 additional fire departments and 102 paramedics that work for them, i am asking for an additional y143,000 per year to pay an assistant medical director in the name of Dr. Douglas Lee, &I.D., FAAEl4j. Au alternative to this would be io employ both myself and Dr. Let, directly under the county. Although this will be of little benefit to me, D1, Lee is a much younger man unnd could benciri "form the retirement etc. afforded. by Leung a county enptoyee. 10H ;. ,; I reiterate to all of you that the above is heart-felt and my conviction. I also have the unanimous support of the Collier County Medical Society and Collier County Dental Society comprised of physicians and oral surgeons who recognize the obvious standard of care issues alluded to here. . None of these medical issues and principles is up for debate or negotiation. They are fundamental rules followed by people who provide medical care to a wide variety of people and must prevail in the most difficult envirorunent of prehospital care. Sincerely, Robert Boyd Tober, M.D., PACEP Medical Director CCEMS Medical Director NCH Healthcare Wound Healing Centers 'tViedical Director Neighborhood Health Clinic Page l of 1 ION Jorge Aguilera - Intermediate Engine Certification assessment From: "WatsonWayne" <WayneWatson @colliergov.net> To: "Jorge Aguilera" <JAguilera @northnaplesfire com> Date: 11/14/2009 4:04 PM Subject: Intermediate Engine Certification assessment CC: "ToberRobert" <RobcrTober @coi]iergov.neV, "pace <JeffPa,e @colliergov.net> November 14, 2008 To: Deputy Chief Jorge Aguilera North Naples Fire District Subject: Intermediate Engine Certification assessment Chief Aguilera I have been directed to respond to your letter of November 7 (received on the 12th), by the Medical Director. He has carefully considered your request to develop and deliver the written and practical exams to your district's persomzel and given the following clear direction. Eased on concerns over the competency of all medics under his aegis, we ad eed that vwe should start with a consistent benchmark for everyonc. Therefore, the assessment is to be handled by the CCEMS Training staff. I encourage you to submit recommended test bank questions and scenarios to me for review and possible inclusion into the testing material. You are also welcome to. sit in on the testing process at CCEMS. Subsequent assessments by you and your staff are encouraged and expected, independent of the periodic assessments that the OMD has indicated will be taking place for alt persomlel, regardless of affiliation or level of care under his license. Your facilities should be well suited to providing ongoing training with your personal involvement. Please forward any material electronically as soon as possible as I would like to get the assessment process underway in December. Respectfully Wayne Watson Deputy Chief CCEMSIFire 2705 S. Horseshoe Drive 239 - 252 -8459 fax 239 - 252 -3298 10H ,l. Christopher Lombardo, Chairman 1385 Veterans Park Drive Margaret Hanson, Vice Chairman �1L,.�'., � �C Naples, FL 341'39 Paul J. Moriarty, Sr. Treasurer (239) 597 -3222 James Quigley, Commissioner : `�` ' Fax (2309) 597 -7082 John O. McCowan, Commissioner D 070h NnpRes k! Rice CGRI 11 D O Ind D e'�qUiC IDIS`I-T rL November 17, 2003 Dr. Robert Tober Medical Director 2705 South Horseshoe Drive Naples, Florida 34101.1 Dear Dr. Tober, I received an email response from Deputy Chief Wayne Watson in reference to the letter that I wrote to you on November 7 h. The email in essences denied the North Naples Fire Department request to allow the Office of the Medical Director (ONID) assigned designee to provide any necessary testing to the members of the North Naples Fire Department (NNFD), in the same fashion as the Collier County Emergency Medical Services Department (CCEMS) designees are allow too test their own personnel. The reason cited by Deputy Chief Wayne Watson is concerns over existng competency; this statement is baseless and irresponsible- Yet, this is another example of why relationship between the District and the ONID can not seem to get off the ground. In the spirit of fulfilling the original intentions of the OMD, I am again requesting you to consider allowing myself as the NNFD assigned designee to function in the same manner as you allow CCEYIS designee in testing personnel under their responsibility. In order to address the issues of maintaining a consistent benchmark, I offer the following solutions. If the ONID has already developed a written test which has been successfully validated, then simply provide me as your designee a copy of the test and I will proctor the delivery of the ex,ma to all department paramedics. The same goes for any scenario based evaluations. If you already have pre - developed scenarios with associated scoring sheets, then simply make those available to me and I will provide the sane quality scenario based evaluation as provided by your CCEINAS designee- Again, I am only asking to be provided with the same opportunities as your designees at CCEMS. JA,, jaa;nrlr 10 J. Christopher Ha sn, Vice Lombardo, Chairman 1 1395 Veterans park Drive 13argaret Hanson, Vice Chairman - =� . �. Paul J. Moriarty, Sr. Treasurer � -'=�- -- ���_'` Naples, FL 34109 James Quigley, Commissioner (239) 597 -3222 John 0. McGowan, Commissioner Fax (239) 597 -7 032 Hol h Na Res) ILA nu e Col1lL mq nn'adl Rescue IDE'StI nkI I would hope that the response to this letter comes directly from you and not from the Collier County EMS Department. This is a simple matter being made very difficult, I know you keep stating that you are not matting decision based on politics but, it is hard to find any rational, factual or valid reasons for not granting this request other than the obvious. Sincerely, U1 Agiirlera Deputy Chief of Emergency Services and Community Relations JAA/jaa,mh HM I 2,;;u It LO I I "b", 1 D_ I rACLI C, ril Ir-1 t} tie �:ical D I I -1,"r November 17, 2003 North Naples Fire Commission East Naples Fire Commission Big Corkscrew Fire Commission Golden Gate File Commission Immokalee Piro Commission Deer Fire Conmoissioners, I have been the medical director of Collier County EMS since its inception in 193 t Prior to that, I started the advanced life support system in Colliar County in 1979. Ovcr the past 30 years, wa have won numerous awards inclusive of the top EMS system in the suite of Florida in 1999 and the top ELVIS system in the USA year 2000. We have, among other achievements, perhaps the highest survival rate to hospital dischar«e foi cardiac arrest secondary fo vcntricrilar fibrillation anywhere in the country if not the world. You have not been provided any factual information from my office as to what is going on in this county. Because of this, I am writing this short note to all of YOU We have approximately 140 paramedics working for Collier County ENtS and another 100 or so paramedics employed by the nine independent fire districts. There has been extreme controversy over the difference err paramedic clinical privileges afforded to the fire departments versus ENIS. Why is this? Because, the fire departments ate primarily fire departments that provide initial basic life support (BLS) to patients it and when EMS is delayed. Although I have permitted the fire departments to catty 8-td drugs oil their engines, it is important to kII that they leave only used Il of these over a period in excess of 12 months. tllt of these drugs are administered thru vc-ry specific protocols un.. I:e my medical license. All fire departments have conies oCthese protocols - I have been informcd that some of you are being told that the more paramedics there are the better off Ills system of care is. That is not necessarily hue. BLS, which addresses issues such as CPR, early de!lbrillation with an AED (Autoo n is Fxternat Defibrillator), airway, breathing and circulation issues, can be initially addressed by the public, air ENIT or paramedic. Tviost of our lives are saved by good BLS. Drugs rarely matte a difference; are very much two -edged swords and are, for the most part-, administered to patients during the transport phase of an emergency call Throe are a number of studies that indicate that filling a system: %6th more paramedics than is actually needs usualty just dilutes the clinical experiences each medic receives and without a lot of clinical espericnces, a medic rapidly loses his skills. Yes, you could add anoflher set oPhelping hands in the back of all ambulance on select calls, but fltat extra set of helping hands could be either a well- trained EIdT or a paramcclic. REMEMBER; a BUSY paramedic is usually tine BEST paramedic and medical research supports this. .} <W ".A i I I 2,;;u It LO I I "b", 1 D_ I rACLI C, ril Ir-1 t} tie �:ical D I I -1,"r November 17, 2003 North Naples Fire Commission East Naples Fire Commission Big Corkscrew Fire Commission Golden Gate File Commission Immokalee Piro Commission Deer Fire Conmoissioners, I have been the medical director of Collier County EMS since its inception in 193 t Prior to that, I started the advanced life support system in Colliar County in 1979. Ovcr the past 30 years, wa have won numerous awards inclusive of the top EMS system in the suite of Florida in 1999 and the top ELVIS system in the USA year 2000. We have, among other achievements, perhaps the highest survival rate to hospital dischar«e foi cardiac arrest secondary fo vcntricrilar fibrillation anywhere in the country if not the world. You have not been provided any factual information from my office as to what is going on in this county. Because of this, I am writing this short note to all of YOU We have approximately 140 paramedics working for Collier County ENtS and another 100 or so paramedics employed by the nine independent fire districts. There has been extreme controversy over the difference err paramedic clinical privileges afforded to the fire departments versus ENIS. Why is this? Because, the fire departments ate primarily fire departments that provide initial basic life support (BLS) to patients it and when EMS is delayed. Although I have permitted the fire departments to catty 8-td drugs oil their engines, it is important to kII that they leave only used Il of these over a period in excess of 12 months. tllt of these drugs are administered thru vc-ry specific protocols un.. I:e my medical license. All fire departments have conies oCthese protocols - I have been informcd that some of you are being told that the more paramedics there are the better off Ills system of care is. That is not necessarily hue. BLS, which addresses issues such as CPR, early de!lbrillation with an AED (Autoo n is Fxternat Defibrillator), airway, breathing and circulation issues, can be initially addressed by the public, air ENIT or paramedic. Tviost of our lives are saved by good BLS. Drugs rarely matte a difference; are very much two -edged swords and are, for the most part-, administered to patients during the transport phase of an emergency call Throe are a number of studies that indicate that filling a system: %6th more paramedics than is actually needs usualty just dilutes the clinical experiences each medic receives and without a lot of clinical espericnces, a medic rapidly loses his skills. Yes, you could add anoflher set oPhelping hands in the back of all ambulance on select calls, but fltat extra set of helping hands could be either a well- trained EIdT or a paramcclic. REMEMBER; a BUSY paramedic is usually tine BEST paramedic and medical research supports this. .} <W 101H Page. Although I have equipped the fire departments medics with twice the assortment of drugs that they have EVER historically used AND, given them sufficient additional drugs to help stabilize any patient during the first 5 -15 minutes of a call, I have been accused of endangering the public by removing "life - saving" drugs I these engines. Likewise, I have been told that "a paramedic is a paramedic is a p�amedic; that they are all state licensed and therefore should all have the same clinical. privileges ". This idea is not only untrue; it is a totat misrepresentation of reality. Doctors are all licensed by the state but have vastly different skills AND, dncy must demonstrate continuous application of their skills, m they rapidly lose their ability to perfortm those in a hospital setting. All that I have clone is carry these same common -sense issues over to the practice ofparamedic medicinc. The medics who practice their skills the most are the transport medics. If you want or like numbers: 1. CCEIViS performed over 43,000 ALS procedures last year and administered 7547 doses of drugs 2. All 4 ALS Engine companies over an entire year performed 186 ALS procedures and administered 15 doses of drugs. Most of what they dill %vas provide important (and life- saving BLS) to patients. Because of tho above numbers, I grant far liters clinical privileges to the CCENIS medics in teens of medicine administration because this is what they do full -time and they have the largest combined group of on- going clinical experience. Likewise, tlrese same medics, 50 or so having been cross - trained as fire fighters, are the 2 "`� line of back up for the fire departments. They do not operate the sophisticated Fire equipment because they have little or no expettise in doing so and little on -going fire fighting experience, but they are there to help where they can in a tare emergency. I have presented illy dilentrna to the Collier County Mcrlical Society, The Collier County Dental Society, The American College of Emergency Physicians, The Florida Amedcar_ Academy of Emergency Medicine and the Florida EMS Medical Director's Association. They ALL unanimously support me in my efforts to provide responsible medical direction to a comple;< assortment of engine companies and E1IIS. The noxt time you hear brat I am being .in obstructionist to the advancement of fire companies medic'! care programs, stop and think about these issues. All paramedics must work under my license; all medics must demonstrate not only initial competency in their training; they must demonstrate on going competency and on- going patient care. We follow evidence -based medical protocols. NONE of tluc evidcnce to date points to any deficiencies of care in our county nor any deficiencies of medications carried and provided by the firc deparhnents. Should we uncover a deficiency, we will immediately address it, but that has yet to occur. As connfouzable and convenient as it wouLd be for tie to say yes to every demand made by every fie, departtnent, I must make all decisions based on patient safety. I would have no firm footing to stand upon if I '!'anted the fire departments the same clinical privileges as EMS. Quite to flea contrary, I would be judged reckless in giving an assortment of drugs to a group of medics who rarely ever use them. The United States Military is also acutely aware of the fact that they call Train tr medic to very high standards, but unless that medic practices his skills constantly, they rapidly evaporate and training has to be started all over again. That is exactly why I insist on, what I do in this county and have oven =Whetming and unanimous suppod: from a diverse slid highly skilled uaedic'1 comulunity. thank You for your time. ;VI -, p19; n.,�r'C'i!iI f 1, :11,� la J"fl, Sincerely, Dr. Robert Boyd Tober, M.D., FACEP Medical Director Collier County EMS Medical Director NCH Wound Healing Centers Medical Director Neighborhood Health Clinic cc: Collier County Board of County Cornmissioncrs City ofDiaples Council City of Marco Island Council Ochopee Advisory Council Isles of Capri Advisory Council - - — -- - -- '.N1 c! ?r. IiBj� F- ir.F:9 =iii 2"'9 )52 $1', U Page 1 of I 10 h! Jorge Aguilera - Testing and QA Issues From: Robert Tober <rbtobermd @yahoo.com> To: Jorge Aguilera <jguilera @northnaplesfire.com> Date: 11/20/2003 10:26 AM Subject: Testing and QA Issues Jorge, Due to my own understanding of the state and its pressing me, for total responsibility of all QA issues and competency of all people functioning under my license, I am centralizing QA resolution issues at HQ. You are welcome to participate in those issues and I expect you and the other other fire departments to assist Wayne in bringing immediate closure to any and all issues. Testing will also be formulated and administered at HQ. That is the ONLY way I am comfortable that everyone is being surveyed according to what the state expects of me. Unfortunately, we are not one agency and I must rely upon the training department of CCEMS to administer and test all medics functioning under my license. RBT Page I of 2 10H Jorge Aguilera - Re: Testing and QA Issues h3^ a' �YG; i. wv: Yi ?v?S?5�.'Hi.�eti':l3Y[4&'.:�N'.T '.vt.�w'. ^G: 'G �.�.:'.��+.W#4aecr • %. :. .� -'".. .� .'s -v-r: �T'.C.e m:!..�:� From: Robert Tober <rbtobermd @yahoo.com> To: Jorge Aguilera <JAguitera @northnaplestire.cam> Date: 11/22/2003 10:37 AM Subject: Re: Testing and QA Issues CC: Wayne Watson <WayneWatson @colliergov.net> Jorge, Regardless of how far this OMD gets, we are not anywhere near much of anything today. For the present time, all QA and testing issues will remain centralized at CCEMS HQ. That is the way it must be today. RBT - -- On Fri, 11/21/03, Jorge Aguilera <JA4wzi (era @northnaplesfire.com> wrote: From: Jorge Aguilera <JAguilera@northnaplesfire.com> Subject: Re: Testing and QA Issues To: rbtobermd @yahoo.com Date: Friday, November 21, 2008, 3:13 Pbi Bob, I completely understand you statutory responsibilities as a Medical Director with the State of Florida. It was net to long ago that I successfully managed those responsibilities for you as the CCEMS Division Chief of Training. I also understand that those days are long gone, but you must keep in mind that the system that you are comfortable with was only designed to train and provide quality assurance to a limited group of personnel under one department. So, this brings us to the creation of the Office of the Medical Director. It was the intention of the Collier County Cor.,missioners which I spoke to, and whom supported the creation of the OMD. That this new office to provide all tha players (fire departments and EMS) with an equal seat at the table, and at the same time the Fire and EMS departments would jointly prov.ida you with additional resources (Fire and EMS personnel) to address your concerns riith training and quality issues. I understand that the OMD is in i.ts infantile state but, on the other hand I've not seen any movement, not even crawling to address the original intentions of this new entity. With this mind, I would like for you again to reconsider your position of denial, and allow me, your North Naples Fire Department (NNFD) appointed designee to have the same abilities to test (which are formulated by the CMD) and provide quality assurance (under the direction of the OMD) to NNFD personnel, as you allow your designees within the Collier County EMS Department provide to their personnel. This recognition would fall right in line with the original concept of the OMD, and maybe the first positive step toward providing the OMD with some well deserved resources. Bob, again you are making this whole the I /f',Anncuments and Settines \NNFDUserALocal SettinLs \TempAXPgrpwiseA4927EOFFN... 5/5/2009 Page 2 of 2 0'N -,� thing harder than it needs to be. Leave the political posturing out of the equation and allow yourself the opportunity to utilize all the resources which exist within Eire and EMS, to develop the OMD. Actually, I believe by developing the OMD you will be in a better position to meet your statutory responsibilities. >>> Robert Tober <rbtobermd @yahoo.com> 11/20/2008 10:25 AM Jorge, Due to my own understanding of the state and its pressing me for total responsibility of all QA issues and competency of all people functioning under my license, I am centralizing QA resolution issues at HQ. You are welcome to participate in those issues and I expect you and the other other fire departments to assist Wayne in bringing immediate closure to anv and all issues. Testing will also be formulated and administered at HQ. That is the ONLY way I am comfortable that everyone is being surveyed according to what the state expects of me. Unfortunately, we are not one agency and I must rely upon the training department of CCEMS to administer and test all medics functioning under my license. RHT file -ur. mocuments and Settings \NNFDUser \Local Settings \Temp \XPgrpwise \4927EOFFN... 5/5/2009 Pale I of I 10 IN Jars , Thanks far the mail. Hope you guys had a good Chriaonas as md1 mad that your little dog is doing ok. I will Iry to address your isunes iu It,, aidcshat you presented them. I. NNFD in back of ambulance is a step in the right direction. Remember, out wri medics like Tony Camps when, we loan to Fire departments swggle m maintain Ihelr skills unless they ne mm back to an ambulenm. The dam should probably be eolleem3d by both NNFD and CCENIS with NNFD sending information to EMS. You need to get together with Wayne about this because I have inadequate understanding ofhow such nnmkng is implemented In item I -b, I am not sure what you are asking. It says "From on -scene to hopsital and from scene to hospiml ". Those sound like the same things. Items Ic -d -e also need to be worked ant with Wayne. 2. 1 think NNFD hss too many ALS capons; to begin with so any reductions back to BLS am welcome. 3. This is fine 4. Not yet sure haw to do this. It might simply be easier to try to schedule 3 inscrvims that we normally do at HQ at b'elemns Park. It is not convenient for anyone but may have to be done. Ian not sure Nat 1 or Dr. Lee have sufficient date in already, miserable lives to do anything more than we are already doing. I do think that the 4 rare depmtmen6 should be contributing funds to the training department of EMS, regardless of haw we structure this, because tracking of everything That the slate thinks EMS'¢ responsible for doing is a tat ofestre work and headaches for oor departmenl. Neither Douglas Lee or I want any di met funds paid to ass; just in our training department because moss of Ilw Vaeleing Likes place there. Final topic mlaes to what 1 recognize Or do not recognize from NNF D. -i m 90 hr o citation I aslant is Aectmue 1 will mlk things oven. itb Wayne count scenario -based evaluations that you have already time We may just wale upon wdtlen annual csting or smncthmg of that sort This is now mason and both Doug and I are slammed with patients and ehram, l shills. Havea Happy New Year Bab — On Mona 12/29/09, Jorge Aga files am/rleumlctioYnhoa. coral I'm- From Jorge Agudem <nnldemsdeahoo.com% Subject Deccmtxr 22, 2003 Meeting recap To: "Robin Tabmr" <tbtabcrndQyahoo cmn> Date Monday, Deccmocr 29, 2008, 10:13 Ab1 See anached. http: / /tis.ma.2. mail_ yahoo. con -L/do /la>Inch2rarld= fni28ggqlus5,js 12/29/2005 10 H k-1 Hey Bob, thanks for the opportunity to meet. I think we covered a lot of around, hopefully enough to begin the process of moving forward. I would like to take this opportunity to recap our discussions, before I start any official correspondence. I would appreciate it if you would keep the content of this email for your eves only until I can assure that you and I are on the same page. Recap: 1) The NNFD shall officially implement a procedure which will automatically place a NNFD Paramedic in the back of an EMS unit (as a third member) on all Charlie and /or Delta ENID calls including allowing CCENTS paramedic discretion on using an NNFD paramedic on other non Deha- Charlie calls. This program shall be handled as a pilot program for a period of 6 to 9 months, allowing enough time for a retrospective review of the data before the final approval of an appropriate and achievable ride time benchmark. Prior to beginning the pilot program, decisions need to made on the items: a. How the data will be collected, in other words either on the NNFD PCR or the CCEMS PCR_ b. How will we track patient contact times? i.c from on -scene to hospital and from scene to hospital c. Call Types d. Procedures e. Completions of Field Evaluations 2) The NNFD shall review options on how to reduce the number of paramedics identified as ALS Engine Paramedics or what ever the final designator shall be, including the number of potential ALS Engines staffed on a daily bases. This recommendation needs to be thoroughly discussed with all parties involved. As it might require a revision to the ALS inter -local agreement. 3) The NNFD department shall continue to con-unit sending the NNFD designee to the OMD to the Bt- monthly medical in- services in or to train all other NNFD personnel. 4) The ONID shall review options on how to on a quarterly bases (A, B, C shifts) provide in- services at the NNFD training room. NNFD shall invite all other agencies to participate as well. The intended audience for this in- service is non - transport Paramedics, though NNFD will not limited this valuable educational opportunity to just paramedics. Chief Brown and you shall work out the financial details on compensation. Topic which we did not discuss but, I lunow 1 ' It need to address very soon: You mentioned that you tine seeking to create a two level protocol (Transport, non- transport) this concept is consistent with our discussions several weeks ago and I agree completely with this endeavor. What was not discussed at the meeting, is are you willing to consider after NNFD implements recommendation (I) above, recognizing NNFD Paramedics which completed the original ALS Engine certification program to whatever the new non - transport certification title is going to be. All of NNFD paramedics with the exception of (4) have successfully completed an SO hour orientation program. They successfully passed two protocol exams, the last one in February 2003, by the way this was the same exam that ENFD completed and you accepted. Lastly, at your direction I ran them through an intensive scenario based evaluation. It is important to recognize the work, effort and dedication that these NNFD paramedics put forth to meet your requirments and be valuable assets to the Emergency Medical Services System. It is my thought that having to repeat another process which would require any additional repetitive, lengthy and costly orientation programs, is of little value and in our current budget situations cost prohibitive. I do understand that some sort of protocol update /educational / recertification process needs to be implemented but, I hope we can utilize internal (NNFD) resources to achieve the desired outcome. Okay, digests this email and let me know if I am on the right track (call me or email me or both). My plan is to email you and Jeff after the holidays a copy of the draft procedure for placing the third person (paramedic) in back of an EMS unit and to request a meeting to move forward with implementation. Also, in a separate letter to the OMD I'll request for clarification on the certification and in- service topics. I hope you had a great Christmas and even better and healthy New Year. JA 1OH _l �L-( yq1 Y S �i3�Gt`K.1 l+ �O�kti; c C'L`�b.mlv cc'i ^i1' ;-Ill � EJ v9lcr;'rJ Office of lie Modicai Director Or.?oben Eoyd Taber, VD, FACEP • Collier County Medical Ci ;ecter November 24, 2003 �>ear Ploysicians & Concerned Public ofCcllicr County, ION I have beer. the medical director of Coilier County since its incepCou in 1931. Prior cc tha4 sta,,ed din advanced life support system in Collier Cocnty ;n 1979. Over the past 30 years, we have c"on numerous awards inc;usive of Che top PMS system in the stale of plordra is 1999 and the top 'EiviS system in dine USA year 2000. We have, among oGicr arhicvemenis, perhaps the highesg sm-viva; -ate io iaospital discharge to-- cardt£.c arrescsecnndary to ventricLne fibrillation any where in the country it net the world. Over the past 2 -3 years, Ere depatiments across the USA have to ;hen over ENS services, usually with a_: increase in cost and a terrible fragrentatlon of cualigj mad cane of services- Froward County was one of these unafied county sec✓ices that is now into SEVENTEEN (17) separate arr_bulnceserviccs in ONS COUiyTirl!! I Curirtly i aT: struggling against enormous political ageedas c ire systems co do ('.-m sash thing to -�. Collier County_ Why? Decaese the frequency of fire res; oese is tremendously low, es building codes have enonr_ousiy reductd the rummer o, staucr re fl =cs diet (ire res,caids to. In Coilier County, most of the cats that fire now pins on e;-e bac!cup to EMS. Vou E.ave p: bob!y heard about lily struggle with the local fin: dcp2c :tents in the nc;vsnaper and on the Eccal news. a wcald like this opportunity to give you my perspective and reasoning, hoping fi :r csntinued suppo :i icon the community. ?lease read ever cite enclosed letters and consider writing one'ietter in support of what i am trying to c'so; vibleh is to protect and t it) the integrity of EMS and its pvP 'saospi[al enedicol quality cae. ih_•s latter needs to go to all Five (S) Collier County Commissaoneis (names acid addresses mrluded) as well as the Naples Daily News. The newspaper letter camvA be longer than 250 vrords if yea so caxe to F' ✓rite a letter to the editor. I have presented my dilemma to ti2e v_uliier County 1Viedic2l Society and Cney unandmously suppcat trio, but t must have your mvolvemeuL' and the centreission must see tha£ you stand Plmly for my insistence on 2nedical euatity and stand ni:-nIy against fragmentation of d]is systems. Thank You for yourtime. Sinrerety, Dr. Rob r( Ecyd Ti her, M.D., FAC,EP Medical D�reciorColier Coun�v PAS Medical Direei:orNChl Wound Healing CeaCers Ntedtcat DicectorNeighborheod kcalrh Clinic rbtobernd v'Z_ieo.com (239) 4,50 -5375 - Cod 2706 ScuIM f7r hlnplxs, Flndtle 34704.23°- 252 -M50. PX 239- 252 -3?96 Board oa Collier County Col -rim s ;3,11 s Office of t'he Medical Meador Or. Robor, Iloy Tober, ivI.p., i ACEP - Colllcr County Meilcai ❑I rOCWO blovernib�- 2_4, 2005 10H ' ea. iviuses, Physical Therapists, Fhy3ic ar. Assisrmis, Physicians, Dentists, Veterinsatans, airoptacdors arci D,ie Gently Concerned Public, L arci beside nyself with disbelief over lha continued eifo,;[s of the fire departments to insist ill�f all their fire eraedic.s ate the seine as CCEidS medics; tuat all vncdics ere state - certified snd, therefore, a ^.1 zicdics should be given ('ie some clinical privileges. This predicate does NI OTi' racist in hospitals or in med;ci'ne in general. All physicians, dentists end vetcr[marims are also licensed by i6-ie slate, but they do no? have the sane litc same on -going clinical experience or Lie same cli7ical privileges in their eespectivc fields. vle mast till "Ice a look aL 6,.e reasons behind multiple Fire Departments relentless [.rive to acquwe the same clinical privileges and "equality" of MMS medics. It makes absolutely no sense fmn a medical or co,-nmon sense persticciive. We have flee medics doing basic life support With she adminisratior of 15 doses of drags ovrs an e -tire i2 month period. We have Collie; county FEW medics ad cuiatering thousands of doses of dru;s and as ma.ay as 5 -10 times the paLieui engagements of the see depe;imerts. This is simply not a con,est based on medical nezd, medical quality ormcdical reasoning. This -s 100% political. It has a'se been alleged that 1 gave the fire departments little oppo+nmi3y for training. As a waiter of absolute truth, they were offered the same training and mandwoty on -going ambulance expericace as a CCEMS medic, however, hey declined. They stat°.d that they did not have the ii :nc to follow in Cue footsteps of a CCEMS medic ue✓ause :hey had too many fire duties Ctc. t would agree that tbcy have requisite fire training becsase ney are FIRST and FOREMOST fire fighters, Ard eXlrication specialists. We ell can not just be everything io everyone; or F vvnuld be taking care Of etnergeucy patients, admitting then, and opcaatsng on. ihen,. IzjusT does not wo =k [hat way. Instead, we have multiple tiers of physicians f1l I each take care of their part of the p2fien3 care seena,io ihat they practice. Likewise, we have the sacc tiers of cave with police, fire and MVIS. Hveryone does viral they know hmv to do (Well) until the nexi. tier cf care arrives_ I believe That the fire depadirents ultimate goal is to convirce due public Oiat all paTainedics are the same so that they can evens ally do Lbeir own tvanspoas once Lhey Obtain their own CO?CDl (Certil -oa :e of Public i accssity) is operate [belt Own ambulances, This is not a;t accusetion but it is ss well�studicd urd 'mart -[eti opinion. -file rzalLe that they are not going to convince the public tNa¢ hheq neea to raise their mi4lage cafes tnx races) unless they increase the service level (F_e. evaluate and transport pntienis)- At (hat time they wit ry w increase their ndhage with tho promise that they Will only charge less than 1,:2If the cost (to evaluate and transport a paiieni) that we do fiem, ?ilvi5. Even if they do not get the vaillage increase, dtey will still have the additional revenue (from evahaaiion ertd txansport) and the explat2atic.0 as ie Wny they car't IO,ver Ucees i§eir impsct fee - sludgy was done two years ago, No,-al Naples Fire snovred that for every 1vn lot service They go on, it costs Lila public S3,542 (CCElv'!S's cost per run is 5642). Tl,,ey need to gel more vehicles responding Cc e -very call �.� �~ :705 sou0 crwthoa OC •Napier, °lorido 3UIN- 23U 252- 3150-FA^ 239252 -1298 l0 "' Page z regardless al the call type to get that number lower i.e. twice the call volume ='/3 the cost or at least lower jbPe S3542/call. Mary ealighter,.ed emergency medical systejns around the county have realized tha? paramedics are in shod suns ly. Woir, over, in the inr.wes: of BOTH econo. cs and the highest priorit ;es given to patient care, these same systems ax-- eveiving two or inree tiers oGparamedic capabii!ity. For c :maple: I. Low acuity calls Prat re„aire bas_c li:u; su';;po ;t (3LS) foci the mast part (like a sprained ankle), the goal of thesro enlightened comnuvity systems is to deliver BLS to a patient within 5 minete.s of 911 aesswers,—yg the phone -, tills is wfiece cite grestesi number of lives could be sa• ✓e:,. Our emmn-amity eocid also enlist G_e police to prcv de addition.; carp eves and above the already cutstacina -esponse to cardiac &.crest that they have denotistiLted. 2. 9ntermedieate cabs ihai require a little ;nere icnove;edge and ability (tike .`e -ter or geltesahzed weakness'. Yh= would require a much more experiences -pal ms!,eJic. 3. Advanced calls that require lire very oast end ntosC experiences of medics (brezt_iing emergencies, (earl emergencies, serious uaaraa are examy -les }. 'Tiicse same systems z-e putting these advanced practice Medics in smeller, rapid response vcieicks to ante( the most severe calls wi'ih the most experienced medic. 4, I am making a Clip w Duke Unive -ity to study arts encdel and hope to bring it back to Naples and apply the bes5 e; .resource utilization fiat the highese science of bsit_ging the rrost seIions patents together with the ,most cxperie cod' medics. Utilizing this model accon-,p!ishes avo muinaS]y sui)por-ive goals; the Pruden; and responsible uliiizatiotl of e, limi`ed and eu ens;ve resource (toe paramedic), 2nd natoiriing t;,.c cormptexity of t`re call with the best- suited _ medic for the pyab!em. This does require an etccet'et;. e :azcrgeacy medical dispatcia system 'EN1L }and out ovt,, % en,celle it systere) Could be stgnifican ly rein'forced by ir?rodac ±rg a ,-online and regular rotation o` paramedics (iron. all agencies) thru emergency medical dispnceh. (do not ?Crow what ere to do medically and am sGtigglrig with pohilcs that shouI6 not be Ai`P2 of my worries or dilemmas. We already have, an award - winning emergency medical system and I can and wil8 make it even more eiiecrive and more life- saving but 1 must have an end to the politcal ager_das of the fire deparlme u. DL is diluting and e ;daausting my focused eLro;ls to anond to the medical needs of pre hospital Cale. 1 an attempting to bring on Ilne new✓ cardiac aaest protocols aPd pre - hospital. hypotherania- 1 cannot and v ill not be able to forge new pathways of rnedical innovation while, at the same time, exP=diag most of my intellectual and emotional resources defending my flanks fiiein baseless and nonsensical isst'es of the fire departments that par, politics aheaal of prudent and responsible meuicai oversighC (which 1 am specifically clanged with out by the state of CClorida and every single paamedic fire and FN1S -bssed works under Elie authority of any medical license). T he Fire departments in Collies County, are already equiplped with more drugs ran most fire departuients in die nation, and have P73.V ;t defsonstrsted ..need for a. drug that they do not already curry- i rim pwtceting (riot harming) public safoiy by luniting their opportunities anal choices of drugs, especially given the rarity with which grey ever use any of rlicm (15 dmg administrations given by I depia snenis ever 12 months compared tc 7547 drug adtninistrcttions by CM /(S). _ As medical pro.essiona ?s, each and eve ,i one o, you aeeds to respond to this crisis o[ poiit[cs attempting to hump what is medically responsible, reasonable rind ueequivocally Pee right thing to do. A letter to each of the Collier County commissinacrs to exprsss you= concern (and outrage) at these proceedings and events needs to 2705 so0h Hvseshae Or • Noel-s, Flurida 34104 •239 -257. &VU- FAY. 234452 -7290 10H rage 3 raise place immediately. A lerter to the cditoK m`the, Naples wily NeAys is also very cesimble. Lctts to il_e nrvispcpUS hava: to be limitcd to 275 words or less or they will not prim tiiC. — aloe (wa) live here and the lives you protect may be very close ec you. Key Buliei Poir9s erc t11e l-oilowing: hire D=Rrtr errs have primasii Fire and Fxuication Duties ar.d secondary BLS (czsic Isfe supper.) and prelim ay ALS (advancc& life support) ietervocdons IF and when CCENIS is delayed to a cat t. Timely arrival of BLS saves many more lives than ALS amid tb-. Fire Depamnezats era best equip,tee] 20 provide rapid B7 S. ALS is provided so infrequently by the 'Lire denat^ni tents ih—z, their ebilittj io use mu`iiptc drugs safely is compranised by fhc inSTequency twiCh which they ever use any o`thora. The limitedd training resources that EMS has to Lain ce�etyaody are bctte appli_d to BLS for the, greater mass o`fr,e department EM-1 's and medirs and *eserve Gte advanced train,ng of ALS milts to those rnerliaa _,Yost likely to apply those skills (?lze HMS medics). Tmdning all extra IOC fire media in the complexities of a full ALS system of drugs and fools is a.ra cxercise is '-air piing overkill faith absolutely no absiiq 11) retain skills taught. 5 EIVZS parai?tedics are leaned to the :tae Y?ep�-h:ients every sronth to boost thcis skills env clinical experience, Those 5 medics must return to an arnbclancc full -ti_me every other month to retain their skills. The Fira;-nedics NEVER experienco. this „oudne ,ad fu±l -tisrc cycling on a- lbuIance uniES vdaerc lte vast majority of A{ S arcc-edures and drugs arc used and given. Modem EVIS systems ave using fewer key- decision paramedics and sending them to the most soo'_iuticated and dangerous calls while reserving Jte simple arcl more straight- fenvard calls .o ihosa credits ir✓icn Tess expeoenee. This redmcos wedecal ecrcrs pad matches die worst ponce ±s wit,_ the best nredtcs. EIViS Tuns 36,000 calls peg you and admi:ris:ess thousards of doses oc drugs and has approximately 43,('00 ALS inteeveniior_s per year. All Fire Departments in Coll°;er County ran about 11 1,h the calls z?qd, combined, adminis.cred only r5 doses oFdrugs last yeas and had IM ALS interventions (like doing a 3 -leas; cardiac moeitor on someone or starting an IV line). A syst°an such as ours can only "support" so many medics before dilution of clinical engageAners and exoenence becomes such a problcre brat nobody is Icg Avrb advanocd clinical slabs because of flie iaelc of f cc_aent encounters with complex patients. T tiao of the nine indcoendenT fire departments in our Ccma]i each cost more d_sn all of EMS wualch hrov'.des care to all 2100 square ;nilea of cou_rxty. are looking at a tote fire expense in this county of about S82,000,000 par year compaTad [o $23,000,000 for Ei4S AND, 80% 0s-the fire departments work is suapor ring nad•,ual resprnse to 911. The E�rc L`epartmeeis seu ta!<ing over ;ENlS as the ONLY long terns j_asth tabor €cr their hadgets end revenue given die iaci that there are fexcr fires and 7uildiaig codes have rvtade Tires a relafi °!e rare event (tnoincfully). Nla-ty otlaer Elms systcros have: fallen to fire with wrsequenees uz poor qualify {re- hoshital ca__ =e and no savicge whatsoever{ just another political i-Festarni with tansy and mediocre outcomes. This assault oil LUIS is occurria j7 all ever the US A es tiro depa-! tmetzN seek eorztol et` the last vestige of pub!io safety, A.tlhy would ere allow this to hopper to an averd- wiauing cmesgercy rncd ci< system? The system in Collie; i_cuiry Las wodced is ;!irony for the past 30 ycros; preliminary BLS by police and fire (if 4ley arrive first) followed by ALS by EMS and neospott to the hospital. Those fue agendas are not in the interest of patient care excAcnce; Lficy ace lei the interest of pswer, control and additional revenge----- .':'.EFicOU. 2105 South korsoshoo Dc' Naples, Florida 3a 104 73o - ?6P -[1459 ` ?X 7.z9 d5? -)203 Page I o +% Jorge Aguilera - NNFD Testing announcement clarification From: "WatsonWayne" <WayneWatsotiolliergov.net> To: "Jorge Aguilera" <JAguilera�northnaplesfire.com> Date: 2/6/2009 5:05 PM Subject: NtNFD Testing announcement clarification Attachments: "M FD medical personnel.xls Chief Aguilera, As we discussed on the phone today, here is some clarification for the planned testing of practicing medics in your ALS Engine program. The Mobile Training Lab is scheduled to be at Station 45 on March 3rd 41h and 5t" to provide the assessment. Each medic will need to successfully complete a written test (score of 80% or better) and 2 scenarios. A make up location and day foi personnel who cannot be completed on these days will be announced at a later date. The test will essentially be on the ALS Engine protocol as the Intermediate category is being eliminated at the direction of the OIMD As your personnel worked under that protocol for some time it should not be overly difficult for them to pass The Medical Director is removing versed and epi multidose from that protocol soon so they will not be included. The medications eligible for questions are. Albuterol Amiodarone Aspirin Atropine Atrovent D50 Diphenhydramine Epp 1:1000 Flu 1.10000 Mr. Blister Narcan Nitroglycerine Oral Glucose Oxygen NS LR and their components or generic equivalents They will also have questions and be expected to potentially demonstrate procedures in their scope of practice during the scenarpos Although all practicing medics in the program must complete the test, our records show 3 different types of medical training completed_ Medics who sat in front of the Medical Director, medics who were authorized to work at the Intermediate level by the OMD, and medics who have not been recognized in any fashion (who are likely newer employees or persons who completed their paramedic programs later in their employment) Paramedics who have been previously certified by appearing before the Medical Director will not need to produce any past training credentials other than Inservice attendance (noted in green on the attached spreadsheet). Paramedics who have been authorized to work as Intermediates by the Medical Director (noted in yellow on the attached spreadsheet) should bring (or have on site for review) Inservice attendance and a listing of PCRs which they documented the patient encounter. For persons who have not been recognized in either fashion (noted In red on the attached spreadsheet). Based on conversations we've had over time, I believe you have provided training material for personnel similar to those expressed by the other allied agencies In the Emergency Medical Services Taskforce meeting yesterday, a completed Paramedic Training Manual which should include skills competency and pharmacology worksheets, 25 patient encounters evidenced by EMS2000 PCRs, and 10 completed field performance evaluations. If you have expected participants not listed on the attached sheet or have further questions, please ION Page 2 of 2 contact me. I appreciate your assistance in resolving this issue. Wayne Watson Deputy Chief CCEMS /Fire 2705 S. Horseshoe Drive Naples, FL 34104 office 252 -8459 fax 252 -3298 6 J. Christopher Lombardo, Chai Margaret Hanson, Vice Chair Paul J. Moriarty, Sr. Treasu James Bu rlce, Commission .John 0. McGowan, Commissi PY—FSif NAp�FS Vm �� 1008 1Sf35 Veterans Park Drive Naples, FL 34169 (239) 597 -3222 Fax (239) 597 -7052 North Napkq Fire EColntiroa 2nd Rescue Dist ll A February 12, 2009 Board of Fire Commissioners North Naples Fire Control & Rescue District Dear Commissioners, Last week the District received an cmait request trOlu the Collier County Emergency Medical Services ( "CCEMS ") Department and the Office of the Medical Director ( °OiMD "), advising that on [Mauch 3, 4, and 5'1', CCEMS will be testing all our Paramedics on a newly created level of the Medical Protocol (Non - Transport). Though the District is not unwilling to showcase the quality of its paramedics, neither the above mentioned testing requirement, nor the selection of the dates on whiclrthose tests wilt be administered, had any prior input from the District. Consequently, the District also did not have any input in the preparation or development of the components of the testing process. In other words, this mandate from CCEMS and the OMD did not take into consideration any of the District's previous scheduling commitments or provide adequate time to work through labor notification requirements. Additionally, although all paramedic are required to have a very detail working knowledge of the protocol, it is reasonable to provide personnel with adequate time to prepare for a test they will be required to take. I ammalarn, you aware of this challenge because the District is again being placed in a difficult position by CCEtiSS and the OMD. The consistent inability of CCENIS and the OMD to openly work with the District in the pre - planning, scheduling and development of programs has again placed the district and the OMD at odds. I reiterate that the D1StiCL is not unwilling to showcase the quality of its paramedics, but the District must also be comfortable that the testing process is developed and hnplemented in a manner which is openly and professionally validated and objective. Since no one from my staff has been part of she planning or development process, I am very concerned wit subjecting our personnel and the District to this m mown process, and o the possible impact this Testing will have on the ALS in,er -local agreement. The District Paramedics are going to be tested on a new level of the Medical Protocol which has not even been developed yet. How do we as a District subject oru Paramedics io a testing process which we have no proof has been validaicd, nor has the protocol even been developed? We have no,' even been provided with the grading basis for this nesting. 1bly coucems are not without basis. One need only to review t.ha course Oraction the County took recently witli'ifne City of Naples' paramedics following the administration of a CCEMS test. Unless the BoardReels differently, t am icconnneading we cancel ills March scheduled testing dales until additional discussions with tlhr MAD can take place, and the information we request M Board of Fire Commissioners February 12, 2009 Page Two can be provided. Additionally, we need to make sure that the District is in compliance with our contractual obligations providing bargaining units members at least 90 days notice prior to testing. At the point that staff and I feel comfortable that the testing process is designed in a manner to adequately assess and confirm the status of our paramedics, the District will be more than happy to schedule a series of testing dates. In closing, it is with regret that I again feel obligated to correspond with you in reference to the ongoing issues with CEMS and the ON/11), but until they can truly commit to an open partnership with not only the North Naples Fire Control & Rescue District, but all its stake holders, I am afraid that that this well not be the last correspondence on this issue. Sincerely, MICHAEL L BROCU�- Fire Chief 30fl P MAP I aGP �S 1 J. Christopher Lombardo, Chairman ?, 1885 Veterans Park Drive Margaret Hanson, Vice Chairman E E< Naples, FL 34109 Paul J. Moriarty, Sr. Treasurer ��yy Jam (2 597 -32_2 James Burke, Commissioner ,1'IP (2 John O. McGowan, Comnssioner Fax (239) 597 -7082 Forth Naples Fire Control and Rescue District February 19, 2009 Dr. Robert Tober Office of the Collier County Medical Director 2705 Horseshoe Drive South Naples, FL 34101 Dear Dr. Tober, At our Board meeting on February 12, 2009, the Board had a lengthy discussion regarding your request to have the Collier County Emergency Medical Services Department, acting as your agent, administer a medical protocol test to all North Naples Fire Control and Rescue District paramedics. The Board strongly believes in the concept of testing all paramedics in the County equally to assure that all advanced medical providers are it the highest level of proficiency. The Board takes the process of testiug personnel very seriously, this rest is not being delivered as a pop -quiz, but with the intent of deteriruning the certification status of our paramedics. The final results of this testing process are critical to the operations of the District's medical response. Hence, if the District had received notification in a much more timely fashion it would have made arrangements to prepare and comply with your Mauch testing request. Though the Board suppotts your position of the necessity to test paramedics, they had several concerns regarding the suggested methodology and the manner in which the District was notified of the intent to test our paramedics_ These conceins include the lack of evidence of test validation, the total disregard for the, inchnion of District personnel in the development, planning or administration of the test and, most disturbingly, the fact that the medical protocol on which the paramedics are going to be tested has not even been finalized. Additionally, the testing dates were unilaterally selected by EMS without consulting the District. These dates have been prescheduled for months by the NNFD Training Division to provide a mandatory forestry program- The Collective Bargaining Agreement between the District and Local 2297 sets forth certain obligations concerning the testing of our firefighter /paramedics. This Agreement contains specific provisions regarding the notification of the administration of a test and the contents thereof. The requested testing by ENIS, the time frame of the notice provided, and the lack of specifics as to the test content may put the District in violation of this Collective Bargaining Agreement. Dr. Robert Tober February 19, 2009 Page Two Because of the concerns identified above, the Board has directed Chief Brown to delay the scheduling of any testing of our paramedics until the District has the opportunity to work directly with you and address the concerns of the Board and those expressed by Local 2297. Chief Brown has selected Deputy Chief Jorge Aguilera as the District's designee on this matter and he will be in contact with you within the week. In closing, 1 would like to reiterate that the Board of Fire Commissioners of the North Naples Fire Control & Rescue District fully supports the testing of all County paramedics in an equal, fair, and unbiased format. The Board has instructed Chief Brown to expedite the coordination of testing of all of the District's paramedics once Cie issues identified above have been resolved. We appreciate and respect your efforts in assuring that all paramedics in the County meet the highest standards- and-look forward assisting you in accomplishing these goals. Chairman, Board of Fire Commissioners cc: Board of County Commissioners Jeff Page, Chief, Collier County EMS 10 H 1 .4111 I&H Board of Collier County Commissioners Office of the Medical Director Dr. Robert Boyd Taber, M.D., FACEP • Collier County Medical Director Dr. Douglas S. Lee, M.D., FAAEM Associate Medical Director March 2, 2009 North Naples Fire Control & Rescue District 1885 Veterans Park Drive Naples, FL 34109 Re: Paramedic Testing Paramedics of East Naples Fire, Marco Island Fire and North Naples Fire Please mark your calendar for April 13 "', 14"', 15` ", and 16 "' between 8:30am and 4:30pm. I will be administering a test on the drugs and protocol that you have been canying for the past 18+ months on these dates. The test will not take long and will be administered at the new EMS Headquarters off Collier Blvd. You can either take the test on your shift day or another of the 4 days that the test will be administered. You must notify EMS training which day you are coming since I cannot test all of you on the same day. The test is entirely written and will take no more than 1 hour to complete. Thanks for your immediate attention to the above. Sincerely, Robert Boyd Tober, M.D., FACEP Medical Director CCEMS 2705 Soulh Horseshoe Dr. - Naples, Flonda 34104 - 239-252 -8459• FAX 239- 252 -32FB Mn Page I oft Jorge Aguilera - Fwd: NNFD Letter reference testing From: Orly Stolts To: Aguilera, Jorge; Brown, Michael Date: 3/9/2009 8:37 AM Subject: Fwd: NNFD Letter reference testing >>> Robert Tober <rbtobermdCayahco.mm> 3/9/2009 8:20 AM >>> Dear Orly, I am in receipt of your letter and list of concerns. I have been testing my own medics (successfully) For 31 years without any test "validation ". It is a way for me to determine at what level and depth of knowledge medics are functioning with regards to protocol and drugs that they carry under my license and responsibility and what I need to revisit with them. The protocols have gone through some subtle evolutions that have very little impact on what the fire.departments actually do. Most of the upcoming test's questions address utilization of protocols and drugs that have been unchanged for years as has most of ACLS protocols. Your concerns are unwarranted. In addition, your third- person accounts of the testing of the City of Naples firefighters are inaccurate and unfortunately promulgate mistrust and fear within your department's paramedics. Nobody before has ever participated in my written test preparation of my medics except my OWN training staff. Nevertheless, the current testing was written entirely by me and have no plans to include anyone but myself in this testing development. It is my way of determining what the fire fighter medics know and what they are confused about. Most of what all the fire departments do in this community prior to EMS arriving on the scene is basic life support (BLS) and BLS is what saves most if not all of our lives. I have ........ .. . ............................. stated 'before and I am stating again that the vast majority of drugs are utilized during the transport phase of care and only rarely do immediate drugs at the scene determine life or death (except perhaps in anaphylaxis, angina, CRF, asthma) and most if not. all of these drugs could be given by EMT's. Let me go on record one more time that the fire departments are first and foremost critical_ p rovrde rs of BL„S along with extrication and fire suppression. This BLS is fife - , saym g and of_immense importance to the public safety. The ALS system we have struggled to share with fire is, for the most part, a political boondoggle that continues, due to political unrest in the fire departments. There just has been no evidence of any significant ALS activity on the part of the fire departments. Unfortunately, your department and others are hell -bent on continuing this frustrating, time- consuming agenda. I can only imagine that the enormous drive towards ALS is a shared conviction, that without taking over ALS in your file:NC:ADocuments and Settings \NNFDUscv \Local Settings \Temp,XPgrpwiseA449B4D533N... 3/9/2009 Page Z M H r " own territories, your future is dim in terms of future funding and justification of your current budgets given the frequency of fires and property tax roll backs etc. And, my equal and opposite statement is that sharing ALS with a group of medics whom RARELY provide anything beyond BLS is wasteful, dangerous and in no way contributes to the public's safety. Your department does not have to take this series of tests in April. But, your department will revert back to BLS Fire Status and be only given subcutaneous epinephrine for acute allergic anaphylaxis (bee stings etc). This reduction in medications will not compromise public safety. As a matter of fact, the fewer medications in the hands of rarely practiced decisions and skills is a public safety PLUS! Your medics are carrying a large number of drugs TODAY. They should be able to answer my questions and testing at ANYTIME for the sake of public safety and responsible practice of medicine. If I can not test. your medics at will, there is absolutely no way to understand what they do and do not understand themselves! I have heard that I have "insulted" your medics. I think Chief Bro�,vn used that term at one of your recent fire commission meetings. I am not sure what he considers an insult. They are valued by me as fire fighters and first responders. The fact that they rarely if ever use unsupervised ALS skills and decision - making is evidenced based (20 months+ of data) and simply is the truth. That is not an insult. It is a fact of life in Collier County. They are better off (and the public is safer) with their utilizing the skills and tools they use most often. The problem again with all of this is that it does not fit the FIRE AGENDA of taking over and trying to build a parallel universe of paramedics to displace EMS. That Is the only "insult" AND, it is an insult not to your medics, but to CCEMS, the medics that make up their emergency ambulance crews and the public's expectation that I provide them with responsible medical oversight of prehospital care. Robert Boyd Tober, M.D., ,FACEP Medical Director CCEMS fife: / /C :ADocuments and Settings \NNFDUser \Local Settings \Temp \XPgrpwiscA49B4D533N..- 3/9/2009 Page I of 4 I-o Jorge Aguilera - Re: ALS Enigne Paramedic Certification Process From: Robert Tober <rbtobermd @yahoo.cont> To: Jorge Aguilera <JAguilera @northnaplesfire.com> Date: 3/19/2009 11:58 AM Subject: Re: ALS Enigne Paramedic Certification Process You will get the authorization from me once Wayne has (in hand) what he needs. This stuff goes thru his gate PRIOR to MY Authorization. Bob - -- On Thu, 3/19/09, Jorge Aguilera <J.Aguil era @northnaplesfire.corn> wrote: From: Jorge Aguilera <JAguilera mnorthnaplesfire.com> Subject: Re: ALS Enigne Paramedic Certification Process To: "Robert Tober" <rbtobermd @yahoo.com> Date: Thursday, March 19, 2009, 11:54 AM ----- Intine Attachment Follows I understand, but local certification issues is now under the responsibility of the Office of The Medical Director. EMS is an agent of the OMD in the same (EQUAL) fashion as the other Fire Departments. I am looking for authorization from you not Wayne. Nothing against Wayne but his relationship with you is no different than mine under the new OMD (WE ARE EQUAL) So with all due respect, I understand that you are busy, but the proper flow of information an authorization needs to come from you. I know it is a new concept after so many years but, it is what it is. You did not provide an answer on keeping things the same in relation to our schedule at least til Wednesday. MAI >>> Robert Taber <rbtobermd @vahoo.com> 3/19/2009 11:43) AM >>> Jorge, If they have completed everything, provide it to Wayne. I am way too busy to wade thm this. Wayne is now head of training and HE has to be satisfied that these 5 medics have jumped thru the same hoops as everyone else. Bob - -- On Thu, 3/19/09, Jorge Aguilera < JAguilera@ nor lhnaples'llre.com> wrote: file) /C9Documents and Settings \NNFDUserALocal Settings \Te -nloAXPernwlseA49C23368N... 7/15/2009 Page 2 of 4 From: Jorge Aguiiera <JAguilera@nordmaplestire,eom> Subject: Re: ALS Enigne Paramedic Certification Process To: rbtobermd@yahoo.com Date: Thursday, March 19, 2009, 11:37 AM ---- -hiline Attachment Follows— - -- But as I explain. They did complete it? I'll provide YOU the information. You do understand that these individuals have been practicing since 2006 under your direction based on a very public conversation we had? I am concern with pulling these 5 medics off a rotation and causing an immediate impact to the scheduling and on the inter-local agreement. What I need is for you to grant a grace period. So I can gather the after the fact information which almost three years old. If I can keep the schedule intact at least to wednesday I'll have the training division research and gather the neccessary records. Since you or should I say Dan is so concern with inconsistencies. When I am at my desk I will email you with real issues. I hope you react with the same level of concern for an equality. Let me know on the grace period - - - -- Original Message---- - From: Robert Tober <rbtobermd @yahoo.com> To: Jorge Aguilera <JAsuilera�na nortl1ruplestire.com> Creation Date: 3/19 11:11 am Subject: Re: ALS Enigne Paramedic Certification Process Jorge, I did not understand what these 5 guys had and had not done. I HAVE TO HAVE EVERYONE on the same page. No more free- lancing for any department or their is continued chaos and I live to regret the lack of consistency. (..I On Thu, 3!19/09, Jorge Aguilera < J: 1 guilera @.northnaplesfrre.com> wrote From: Jorge Aguilera <.f _Aguitera@nottlinaplesfire.coni> Subject: Re: ALS Enigne Paramedic Certification Process To: rbtobenndvahou _coin Date: Thursday, March 19, 2009, 10:07 AM r rc.t o r� —A lcerAi ncal 0e trines ATemnAXPvrnwiseA49C23363N... 7/15/2009 Page 3 of4 �t Inline Attachment Follows - - - -- So the email that you sent me a couple of days ago giving the ok for the 5 individuals is not valid? - - - -- Original Message---- - From: Robert Tober <4_btgbcnnd cbyahou.com> To: Jorge Aguilera <. iAguilera @nortlmaplesfire.com> CC: Wayne Watson <Wayne�colliergov.nzt> Creation Date: 3/19 923 am Subject: ALS Enigne Paramedic Certification Process Jorge, Attached are two conununications; one to NN FD last October and one to City of Naples this month relative to the testing of all AI,S Engine Medics April 27 -30, 2009. When I wrote to Mike Brown last October, it was very clear that the "red" firefighters on the last page of the enclosure were NOT to work in the field until they complete the listed standards and are then tested. The letter also identified NEW standards compared to what existed in the past. The new standards were easier to follow but did include ride time and I am not aware that these firefighters accomplished this as well. The standards in my most recent letter of March 2009 (also attached) clearly specified the requirements for all ALS Engine medics and the fact that if they had not yet accomplished these objectives by the time of the ALS Engine testing the end of april, that they could complete them shortly thereafter. And, until completion of everything, nobody can work as an INDEPENDENT NON - TRANSPORT MEDIC. As I have stated before, every medic that completes this process is initially certified and can maintain this status by maintaining their ride time and continuint education requirements as well as steering clear of any QA concerns. These are the standards that exist TODAY. They have unquestionably evolved and are better and more explicit than what you and I agreed upon in 2006. These new standards are now the requirement for the 5 paramedics in question. I am reviewing them one last time with you in this email: 1. Completion of a 40 hour orientation - it appears that you have taken care of this 2. Passage of a ECG test - it appears that you have taken care of this 3. Completion of an pproved paramedic manual with worksheets. - this should be turned into Wayne for all of these medics in question and all future medics 4. Successful completion of 25 PCBs - these may already exist but need to be pulled together for each medic 5. Have at least 10 Field evaluations 6. Passage of the April test with an 80% or better score Once these 5 medics have these bases tagged, they are good to go. My intention is that all ALS Engine medics in all departments be up -to -date wtih equal qualifications. I have no ,,,,,i rtt i,,=rtt nraI emnAXPernwiscA49C23368N... 7/15/2009 Page 4 of 4 ,.4 intention of altering these qualifications and thresholds for any of the ALS engine medics are wiv are back to square 1 with each disrict tyring to do its own thing and ignore the agreed upon standards. Thanks for your attention and compliance with the above. Robert B. Tober, M.D., FACEP Medical Director CCEMS _ E1,41LPAnnc,irt,antc_ and Cettinps \NTIFDilserALocal Settings \TempAXPgipwiseA49C23368N... 7/15/2009 ION "M North F\\TapRes Fire unttrrorn nn e5cue Distrript April 8, 2010 Auditor General's Office Local Government Audits /3462 Claude Pepper Building, Room 4101 111 West Madison Street Tallahassee, FL 32399 -14450 We are pleased to note that the audit report for the fiscal year 2008 /2009 reflected no current year or prior comments which require management's response. The Board of Fire Commissioners and management staff of the North Naples Fire Control & Rescue District have worked diligently to resolve past audit comments and address deficiencies in internal controls, and policy and procedures to insure the financial stability of the District. The audit report for the fiscal year ended September 30, 2009 reflects the connnihnent of the Board and staff to successfully resolve prior year issues. Sincerely, NORTH NAPLES FIRE CONTROL & RESCUE DISTRICT ORLr. ST0LT Fire hief ���L° ---LJ CJ's• �2,, GL � REBECAH BRONSDON Assistant Chief of Administrative Services na F J. Christopher Lombardo, Chairman Mar nret Hanson, Vice Chairman "omit F + + E ! a s lIIIIS Veterans Park Drive v` c „, a Naples, FL 35109 Paul J. Moriarty, Sr. Treasurer Burke, Commissioner { (239) 597 -3222 James FL , Fax (239) 597 -70£12 John O. McGowan, Couuuissioner North F\\TapRes Fire unttrrorn nn e5cue Distrript April 8, 2010 Auditor General's Office Local Government Audits /3462 Claude Pepper Building, Room 4101 111 West Madison Street Tallahassee, FL 32399 -14450 We are pleased to note that the audit report for the fiscal year 2008 /2009 reflected no current year or prior comments which require management's response. The Board of Fire Commissioners and management staff of the North Naples Fire Control & Rescue District have worked diligently to resolve past audit comments and address deficiencies in internal controls, and policy and procedures to insure the financial stability of the District. The audit report for the fiscal year ended September 30, 2009 reflects the connnihnent of the Board and staff to successfully resolve prior year issues. Sincerely, NORTH NAPLES FIRE CONTROL & RESCUE DISTRICT ORLr. ST0LT Fire hief ���L° ---LJ CJ's• �2,, GL � REBECAH BRONSDON Assistant Chief of Administrative Services 10H NORTH NAPLES IMF CONTROL AND RESCUE DISTRICT BASIC FINANCIAL STATEMENTS TOGETHER WITH REPORTS OF INDEPENDENT AUDITOR YEAR ENDED SEPTEMBER 30, 2009 TABLE OF CONTENTS l0H Page(s) INDEPENDENT AUDITOR'S REPORT ................................. ............................... 1 -2 MANAGEMENT'S DISCUSSION AND ANALYSIS (MD &A) ................................... t -xis BASIC FINANCIAL STATEMENTS GOVERNMENT -WIDE FINANCIAL STATEMENTS: Statement of Net Assets .................................................... ............................... 3 Statement of ActMties ..................................................... ............................... 4 FUND FINANCIAL STATEMENTS: Governmental Funds: BalanceSheet ............................................................. ............................... 5 Reconciliation of the Balance Sheet of Governmental Funds to the Statement of Net Assets ......................................... ............................... 6 Statement of Revenues, Expenditures and Changes inFund Balance .......................................................... ............................... 7 Reconciliation of the Statement of Revenues, Expenditures and Changes in Fund Balance of Governmental Funds to the Statement of Activities ........................ 8 Fiduciary Fund - Firefighters' Pension Plan: Statement of Fiduciary Net Assets ....................................... ............................... 9 Statement of Changes in Fiduciary Net Assets ........................ ............................... 10 NOTES TO THE FINANCIAL STATEMENTS .......................... ............................... 11 -46 REQUIRED SUPPLEMENTARY INFORMATION OTHER THAN MD &A BUDGET TO ACTUAL COMPARISON - MAJOR FUNDS (General and Special Revenue Funds) Statement of Revenues, Expenditures and Changes in Fund Balance - Budget and Actual - General Fund - Summary Statement .................................... ............................... 47 Statement of Revenues, Expenditures and Changes in Fund Balance - Budget and Actual - General Fund - Detailed Statement ...................................... ............................... 48 -50 Statement of Revenues, Expenditures and Changes in Fund Balance - Budget and Actual - Impact Fee Fund - Summary Statement ................................. ............................... 51 Statement of Revenues, Expenditures and Changes in Fund Balance - Budget and Actual - Impact Fee Fund - Detailed Statement 52 BUDGET TO ACTUAL COMPARISON - OTHER NON -MAJOR GOVERNMENTAL FUNDS Special Revenue Funds: Statement of Revenues, Expenditures and Changes in Fund Balance - Budget and Actual - Inspection Fee Fund - Summary Statement ......................... ............................... 53 Statement of Revenues, Expenditures and Changes in Fund Balance - Budget and Actual - Inspection Fee Fund - Detailed Statement ........................... ............................... 54 -55 10H TABLE OF CONTENTS (CONTINUED) Page(s) ADDITIONAL REPORTS OF INDEPENDENT AUDITOR Independent Auditor's Report on Internal Control over Financial Reporting and on Compliance and Other Matters Based on an Audit of Basic Financial Statements Performed in Accordance with Government Auditing Standards ........................................... ............................... 56 -57 Independent Auditor's Report to Management ............................. ............................... 58 -59 Management's Response to Independent Auditor's Report to Management ........................................... ............................... Exhibit TUSCAN Company, PA Certified Public Accountants & Consultants 10H Affiliations Florida htclitute of Certified Public Accountants .American Institute of Certified Puhfic Accountants INDEPENDENT AUDITOR'S REPORT Board of Commissioners North Naples Fire Control and Rescue District 1885 Veterans Park Drive Naples, Florida 34109 -0492 Private Companies Practice Section Tas Division We have audited the accompanying basic financial statements of North Naples Fire Control and Rescue District (the "District ") as of September 30, 2009 and for the year then ended. These basic financial statements are the responsibility of the District's management. Our responsibility is to express an opinion on these basic financial statements based on our audit. We did not audit the financial statements of North Naples Fire Control and Rescue District Firefighters' Pension Fund ( "Pension Fund "), which represent 100% of the assets, liabilities and net assets as well as 100°/% of the revenue and expenses of the District's Fiduciary Fund. Those financial statements were audited by other auditors whose report has been furnished to us, and our opinion, insofar as it relates to the amounts included for North Naples Fire Control and Rescue District Firefighters' Pension Trust Fund, is based on the report of the other auditors. We conducted our audit in accordance with auditing standards generally accepted in the United States of America and the standards applicable to financial audits contained in Government Auditing Standards, issued by the Comptroller General of the United States. Those Standards require that we plan and perform the audit to obtain reasonable assurance about whether the basic financial statements are free of material misstatement. An audit includes examining, on a test basis, evidence supporting the amounts and disclosures in the basic financial statements. also includes assessing the accounting principles used and significant estimates made by management, as well as evaluating the overall basic financial statement presentation. We that our audit provides a reasonable basis for our opinion. INTEGRITY ......... SERVICP .,. .,, . E'XPERIENCF. An audit believe 12621 World Plaza Lane, Building 55 • Fort Myers, FL 13907, P1 to (239) 333-2090 ^ Fax: (339) 333 -2097 I Board of Commissioners North Naples Fire Control and Rescue District Page 2 In our opinion, based on our audit and the report of other auditors, the basic financial statements referred to above present fairly, in all material respects, the financial position of North Naples Fire Control and Rescue District as of September 30, 2009, and the results of its operations for the year then ended in conformity with accounting principles generally accepted in the United States of America. In accordance with Government Auditing Standards, we have also issued our report dated March 31, 2010, on our consideration of the District's internal control over financial reporting and our tests of its compliance with certain provisions of laws, regulations, contracts, grants, and other matters. The purpose of that report is to describe the scope of our testing of the internal control over financial reporting and compliance and the results of that testing, and not to provide an opinion on the internal control over financial reporting or on compliance. That report is an integral part of an audit performed in accordance with Government Auditing Standards and should be considered in assessing the results of our audit. The Management's Discussion and Analysis on pages i -xi is not a required part of the basic financial statements but is supplementary information required by the Governmental Accounting Standards Board. We have applied certain limited procedures, which consisted principally of inquiries of management regarding the methods of measurement and presentation of the Management's Discussion and Analysis. However, we did not audit the information and express no opinion on it. Our audit was conducted for the purpose of forming an opinion on the District's basic financial statements taken as a whole. The required supplementary information other than MD &A on pages 47 -55 described in the accompanying table of contents is presented for the purposes of additional analysis and is not a required part of the basic financial statements but is supplementary information required by the Governmental Accounting Standards Board. Such information has been subjected to the auditing procedures applied by us in the audit of the basic financial statements and, in our opinion, is fairly stated in all material respects in relation to the basic financial statements taken as a whole. -1 ? & , Q, TUSCAN & COMPANY, P.A. Fort Myers, Florida March 31, 2010 MANAGEMENT'S DISCUSSION AND ANALYSIS (MD &A) ion 10H Management's Discussion and Analysis Of Financial Statements FYE 9 -30 -09 This Discussion and Analysis of the North Naples Fire Control & Rescue District's ("The District ") basic financial statements is provided to assist the reader in understanding the District's financial activities and significant changes in ending financial position for the fiscal year ended September 30, 2009. The District implemented the requirements of GASB Statement #34 for the fiscal year ended September 30, 2004. This Statement dramatically changed the District's annual reporting requirements, as well as the financial statement format and presentation. Contained within are the basic financial statements, consisting of the government -wide financial statements, governmental fund financial statements and notes to the financial statements. This Discussion and Analysis will also provide an analytical overview of these statements, including comparisons of the District's financial position at September 30, 2009 versus September 30, 2008. District Highlights 1. At the conclusion of fiscal year 2009, the District's assets exceeded its liabilities, resulting in net assets of $36,907,116, as compared to net assets at September 30, 2008 of $35,589,890. 2. The District's total net assets increased $1,317,226 during fiscal year 2009, as compared to an increase of $6,712,970 in total net assets during fiscal year 2008. 3. The District had $12,423,588 of unrestricted net assets at September 30, 2009, that can be used to meet the District's ongoing obligations, as compared to $12,211,914 at September 30, 2008. The amount of unrestricted net assets increased by $211,674. 4. Total revenues and other financing sources on the governmental funds basis decreased $2,663,210 or 8 percent, in comparison to the prior year. 5. Total expenditures on the governmental funds basis increased $2,023,338, or 8 percent, in comparison -to the prior year. Government -wide Financial Statements Government -wide financial statements (Statement of Net Assets and Statement of Activities found on pages 3 and 4) are intended to allow a reader to assess a government's operational accountability. Operational accountability is defined as the extent to which the government has met its operating objectives efficiently and effectively, using all resources available for that purpose, and whether it can continue to meet its objectives for the foreseeable future. Government -wide financial statements concentrate on the District as a whole and do not emphasize fund types. The Statement of Net Assets (page 3) presents information on all of the District's assets and liabilities, with the difference between the two reported as net assets. The District': capital assets are included in this statement and reported net of their accumulated depreciation. The Statement of Activities (page 4) presents revenue and expense information showing how the District's net assets changed during the fiscal year. Both statements are measured and reported using the economic resource measurement focus (revenues and BSBPob 3 -22 -10 10H` expenses) and the accrual basis of accounting (revenue recognized when earned and expense recognized when incurred). Governmental Fund Financial Statements The accounts of the District are organized on the basis of governmental funds, each of which is considered a separate accounting entity. The operations of each fund are accounted for with a separate set of self - balancing accounts that comprise its assets, liabilities, fund equity or retained earnings, revenues and expenditures. Government resources are allocated to and accounted for in individual funds based upon the purpose for which they are to be spent and the means by which spending activities are controlled. Governmental fund financial statements (found on pages 5 and 7) are prepared on the modified accrual basis using the current financial resources measurement focus. Under the modified accrual basis of accounting, revenues are recognized when they become measurable and available as net current assets. Notes to the Financial Statements The notes to the financial statements explain in detail some of the data contained in the preceding statements and begin on page 11. These notes are essential to a full understanding of the data provided in the government -wide and fund financial statements. Government -Wide Financial Analysis The government -wide financial statements are designed so that the user can determine if the District's financial condition is better or worse than the prior year. The following is a Condensed Summary Statement of Net Assets for the District (Primary Government) at September 30, 2009 and 2008: Summary Statement of Net Assets September 30 Assets: 2009 2008 Current and Other Assets $15,760,399 $14,494,161 Capital Assets 24 483,528 24,096,576 Total Assets $40.243.927 $38.590.737 Liabilities: Current Liabilities $ 1,735,748 $ 922,370 Non - Current Liabilities 1,601,063 2,078,477 Total Liabilities _3,336,811 3,000,847 Net Assets: Invested in Capital Assets, Net of Related Debt 24,483,528 23,377,976 Unrestricted 12,423,588 12,211,914 Total Net Assets 36,907,116 35,589,890 Total Liabilities and Net Assets $40,243.927 38.590.737 B]B/bb 3 -22 -10 11 Current and other assets represent 39 percent of total assets at September 30, 2009, as 1 0 H RR compared to 37 percent at September 30, 2008. Current assets at September 30, 2009 are comprised of unrestricted cash balances of $7,051,005, restricted cash of $213,864, investments of $8,083,192 and other assets of $412,338. The balances of unrestricted cash represent amounts that are available for spending at the discretion of the Board of Fire Commissioners of the District. Restricted cash balances are comprised of the impact fee funds restricted for the purchase of capital assets and unspent inspections fee revenue restricted to support the inspection of new construction. The investment in capital assets, net of related debt of $24,483,528, represent 66 percent of net assets at September 30, 2009, as compared to 65 percent at September 30, 2008. These assets are comprised of land, buildings, improvements, equipment, furniture, and vehicles, net of accumulated depreciation, and the outstanding related debt used to purchase the assets. The unrestricted net asset balance of $12,423,588 represents resources available for spending at September 30, 2009. Summary of Revenues, Expenses and Changes in Net Assets For the Years Ended September 30 Revenues: 2009 2008 General Revenues Ad Valorem Taxes $26,670,789 $27,889,425 Miscellaneous Impact Fees 342,496 1,437,474 Investment Earnings 605,567 783,978 Gain on Disp. of Capital Assets 785 -0- Other 230,114 565,482 Program Revenues Charges for Services 580,951 990,945 Grants and Other 67,841 43,843 Total Revenues 28,498,543 31,711,147 Expenses: Public Safety— Fire /Rescue Service 27,181,317 24,998,177 Increase in Net Assets 1,317,226 6,712,970 Net Assets - Beginning of Year 35,589,890 30,496,520 Reclassification -0- (1,619,600 Net Assets -End of Year _ 36 907 j 16 $35.589.890 BJB/bb 3 -22 -10 iii The assessed value of the property within the District decreased 4 percent for the 2008- 2009 fiscal year as compared to the prior year's assessed value, resulting in a decrease in Ad Valorem tax revenues. This is the first year that property values in the District have decreased, resulting in a decrease in Ad Valorem revenue. Although the property value declined, the Board opted to assess a millage rate of 0.9869, which is lower than the 1 mill rate the District has consistently levied since its inception. The decision to reduce the millage rate was made by the Board in accordance with legislation passed in June of 2007. Because the Board did not adopt the rolled -back rate for the 2007 -2008 fiscal year, the District reduced the millage rate for the 2008 -2009 fiscal year to comply with statutory requirements. Historically, the increase in Ad Valorem revenue resulting from the increase in property value had been sufficient to provide adequate funds to support operational, capital and reserve financial requirements in the District without increasing the millage rate. However, the 2008 -2009 General Fund Budget reflects a decrease in Ad Valorem revenue corresponding to the decrease in property value. As a result, it was anticipated that reserves in the amount of $247,442 would be required to fund operations. However, actual revenue received exceeded budgetary projections, and expenditures were less than those budgeted, therefore designated reserves, in the General Fund, were increased by $842,235. The following chart identifies the change in appraised property values in the District and the millage rate maintained by the District. Property Values and Millage Rate Assessed J.000U 4.5600 — 46000 `, 15000 .',aY, — - 10000 26000 2.0000 >x- %4 r a „ ]r.a1 - Nt 1.5000 1.0000 05000 �z,.�. 230 a a 00000 2005 -2006 2006 -2007 2007 -2008 2006 -2009 Appraised Property Value $21,93),342,465 26, 409,664,058— $28,799,996.438 $27,676,299,562 �Millage Rate 10000 —E 10000 1.0000 0.9869 B1B /bb 3 -22 -10 iv $35,000 060,000 $30,000,000,000 $25,000.000,000 $20,006,000,000 $15,M0,00OXG $10,000,000,000 $5,000,000,000 IOH 10 vi' Fund Balance — Governmental Fund Financial Statements Staff has worked hard to meet the Board of Fire Commissioners' directive to increase the fund balance and cash reserve of the General Fund to solidify the District's financial position. The total fund balance of the General Fund, comprised entirely of designated reserves, was $14,795,829 at September 30, 2009. This fund balance represents an increase of $842,235 over the total fund balance of the General Fund at September 30, 2008. In September of 2002, a comprehensive Five Year Plan for the District was developed. This plan is reviewed and revised annually, just prior to preparation of the District's annual budget. The Five Year Plan has become an integral tool to assist in the identification of the financial needs for the future of the District, and as such, has assisted the Board of Fire Commissioners in establishing comprehensive designated reserves to financially provide for the identified needs of the District. The fund balance of $14,795,829 for the fiscal year ended September 30, 2009 is comprised of designated reserves in its entirety. In light of the current and forecasted economic trends and accompanying decrease in property value, the Board determined that the need to build reserves specifically designated to maintain the current level of service was paramount. To that end, in 2008 the Board established a new designated reserve to maintain the level of service in an effort to address anticipated revenue reductions in the 2008 -2009, 2009 -2010 and 2010 -2011 fiscal years. In November of 2009, the Board amended the General Fund Budget to provide for the increase in the designated reserve identified as Maintaining the Level of Service. The Board directed that the balance in this designated reserve would reflect the variance in total cash reserve anticipated at September 30, 2009 based on the difference between anticipated revenue and expenditures and actual revenue and expenditures. Other reserves are designated to accommodate the future financial needs of the District as identified in the Five Year Plan as amended in September of 2009. While designated reserves have been established and maintained in accordance with anticipated future needs of the District, it must be noted that the need may arise for the Board to undesignate a portion of these reserves to fund the District's operations should assessed property values continue to fall. The following Designated Reserves were approved for the fiscal year ended September 30, 2009 in coordination with the Five Year Plan and as a result of the anticipated reduction in future General Fund Ad Valorem revenue: Maintaining Level of Service $ 5,413,929 Replacement Radios /Communications 300,000 GASB 45 Post Employment Benefits 500,000 Health Insurance 500,000 Emergency Reserve 500,000 Operating Reserve 2,400,000 Fire Apparatus 1,800,000 Building Fund 1,500,000 Vehicle Replacement 100,000 SCBA Replacement 160,000 Capital Equipment 1,501,000 Station 946 Improvements 20,900 Personal Protective Gear 100:000 Total Designated Reserves BJBPob 3 -22 -10 v These designated reserves have been established by the Board of Fire Commissioners to meet the future needs of the District. As indicated in the District's Five Year Plan, one new station is anticipated to be operational within the next five years, with funds allocated to initial permitting and planning expenditures for three other stations. Due to the recent and dramatic decline in impact fees, and the anticipated revenue reduction resulting from decreasing property values, the Five Year Plan was revised to delay the construction in full on these three other stations. While impact fees can fund the creation of the infrastructure required for these stations, the staffing and maintenance must be funded by the General Fund. These designated reserves are also created to fund the replacement of capital assets originally funded through impact fees. Additionally, significant increases in health insurance, retirement, and other personnel and operating expenses require that funds be set aside, or designated, to prepare for the funding of future expenditures. This is especially necessary in light of the current economic situation and the anticipated impact of the decline in property values statewide, and the resulting revenue reduction resulting from such decline. As evidenced by the following chart, the District's General Fund fund balance has increased $13,837,643 or over 1444 percent since 1999. While the growth in fund balance is significant, it is by no means an unnecessarily high accumulation of funds. Not only has it become evident that the District must be able to provide for operating and personnel expenses in the event of a serious hurricane or other natural disaster, it has become essential for future planning to ensure the financial stability of the District by increasing designated reserves to provide for the future needs of the District in anticipation of dramatic revenue reductions. It is also designed to allow for replacement of capital assets without a planned increase in millage. BID/bb 3 -22 -10 vi $16,000,000 $14,000,000 $12,000.000 $10,000.000 $8.000,000 $6,000,000 $4,000,000 $2,000,000 S- General Fund Fund Balance 1999 -2009 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 200= 09130/99 /29130/00 ❑9130/01 ❑9130/02 /29130/03 ❑9130/04 09130/051 ❑9130/06 09/30/07 ❑9/30/08 09130/09 10 H M11 Impact Fees Impact fee receipts for the year ended September 30, 2009 represent a decrease of $904,567, or 63 percent, as compared to the prior fiscal year. This is the second consecutive year that the District has realized a significant decrease in impact fee receipts. This dramatic decrease in impact fee receipts is a result of the current economic climate and the related decrease in new construction in the District. This decrease has had a significant effect on the current year impact fee expenses, as well as those anticipated over the course of the next few fiscal years, and has resulted in the extension of projected opening dates for four new stations the District had intended to open over the course of the next five years. The Board of Fire Commissioners has recognized that the growth in the District has been significant over the last several years, and has anticipated the District would reach a point where the growth and resulting impact fees would substantially decrease. However, it was believed that the appropriate increase in rates adopted by the Board in 2007 would partially offset the decrease in construction. Because the decrease in impact fee revenue was so significant, the Five Year Plan was amended to reflect newly calculated anticipated decreases. BJB /bb 3 -22 -10 vii 10H Inspection Fees Inspection fee receipts for the year ended September 30, 2009 represent a decrease of $348,182 or 43 percent over receipts in the prior fiscal year, as compared to a decrease of $48,795, or 6 percent over the inspection fee receipts for fiscal year 2008 vs. 2007. These inspection fees are received by the District for inspections performed on new construction, and are therefore a function of the number of new structures built and completed in the District. This is the third consecutive year in which the District has realized a decrease in inspection fee receipts. The decrease in receipts over the last three fiscal years has been $440,884, or more than 48 percent. This decrease in inspection fees received is a direct result of the decline in new construction and inspections thereon within the District. The decrease in fees over three consecutive years has resulted in the inability of the revenues of the fund to support the operating budget. As a result, the General Fund has provided financial assistance to support the Inspection Fee Fund. This fund will need to be monitored closely in the future to determine if the General Fund will be required to continue to provide financial assistance to support the Inspection Fee Fund operating costs. Budgetary Highlights Budget versus actual comparisons are reported in the required supplementary information other than management's discussion and analysis on pages 47 through 55. General Fund expenditures were less than those budgeted, with personnel expenditures reflecting $211,557 or 1 percent less than budgeted, Operating Expenditures reflecting $660,868 or 17 percent less than budgeted, and Capital Outlay reflecting $142,174 or 9 percent less than budgeted. Differences between the final amended budget and actual expenditures in the General Fund were largely due to fewer non - essential purchases being made, and the serious effort exerted to control expenditures as tightly as possible faced with current and anticipated decrease in property (Ad Valorem) tax revenue. The amendments to General Fund revenue were necessary to reflect an increase in Ad Valorem tax revenue received resulting in collection above the 95 percent subject to budget requirements and to accommodate funds received from the origination of a lease to purchase a fire engine. The amendments to the General Fund expenditures were a result of several factors. Budgeted personnel expenses were reduced by $487,591 to reflect decreases in health insurance premiums and worker's compensation rates, as well as a decrease in the amount of vacation liability paid out. Budgeted operating expenses were decreased by $177,734 to reflect reduced computer maintenance and professional fee expenditures. Budgeted capital expenditures were increased by $502,113 to reflect the purchase of property for a future station site. Finally, budgeted debt service payments were increased by $1,198,090 to reflect the early payment of the lump sum loan payment due in November of 2009 on a land loan, as well as payment in full of an engine lease established in May of 2009. B1B/hb 3 -22 -10 viii 1001 f, Capital Assets Non- depreciable capital assets include land and construction in progress. Depreciable assets include buildings, improvements other than buildings, equipment, furniture and vehicles. The following is a schedule of the District's capital assets as of September 30, 2009 and 2008. Capital Assets September 30, 2009 and 2008 Capital Assets 2009 2008 Land $11,182,814 $10,728,291 Construction in Progress 667,460 480,363 Total Capital Assets not Depreciated 11,850,274 11,208,654 Buildings 12,233,366 12,061,899 Vehicles 7,743,272 7,610,439 Office Equipment 710,211 654,430 Equipment & Machinery 2,548,955 2,642,630 Total Capital Assets Being Depreciated 23,235,804 22,969,398 Accumulated Depreciation Buildings ( 3,368,356) ( 2,973,642) Vehicles ( 4,975,807) ( 4,921,524) Office Equipment ( 427,025) ( 369,580) Equipment & Machinery (1,831,362) ( 1,816,730) Total Accumulated Depreciation (10,602,550) (10,081,476) Total Capital Assets being Depreciated, Net _12,633,254 12,887,922 Capital Assets — Net of Depreciation 24,483,528 24,096,576 Related Debt -0- (718,600) Net Assets Invested in Capital Assets Net of Related Debt $ 24.483,528 $ 23.377.976 Significant capital asset purchases made during the fiscal year ended September 30, 2009 include: 1. The purchase of 6.8 acres of land located adjacent to property already owned by the District for a future station site in the amount of $454,523; 2. Purchase of Velocity Pumper replacement fire engine in the amount of $527,590; 3. Renovation to the training room at Station #45 to address air conditioning and mold issues in the amount of $71,509; 4. Replacement of bay doors at Station #44 in the amount of $46,953; BIB/bb 3 -22 -10 ix 10H ►4' 4, 5. Payment of architecture, engineering and permitting fees for future Station #48 located on Livingston Road in the amount of $187,097; these expenditures could have been funded by impact fees, but receipts were not sufficient to fund these expenses so the General Fund provided funding; 6. Purchase and installation of a boat lift located at the boat slip for the District's fire and rescue boat in the amount of $12,940; 7. Purchase of 16 sets of replacement bunker gear in the amount of $22,240; 8. Purchase of a Bauer air compressor fill system in the amount of $41,982; and 9. Purchase of computer hardware totaling $29,795. For additional information on the District's capital assets, see Note E on pages 27 and 28. Debt Administration As of September 30, 2009, the District had outstanding debt $2,519,610, as compared to $2,132,066 at September 30, 2008. That debt consists of: 1. Compensated absences (accrued vacation liability) in the amount of $1,356,623, as compared to $1,413,466 at September 30, 2008. The decrease in this liability is due to the payment in full of accrued time or reclassification as termination benefits for those employees participating in the early retirement incentive program. 2. Termination benefits in the amount of $1,162,987 consisting of wages and benefits due through September 30, 2010, and health, dental, and vision insurance benefits through 2012 for those employees participating in the District's early retirement incentive program. Economic Facts and Next Year's Budget Millage Rates The following factors were taken into consideration when the budget for the fiscal year ending September 30, 2010 was prepared: 1. Appraised taxable property values decreased by $2,485,923,083 or 9 percent for fiscal year 2009 as compared to a decrease of 4 percent in 2008. This is the second consecutive year that the property value in the District has decreased. The cumulative effect of the last two years' decline in property value is an anticipated reduction in Ad Valorem revenue of approximately $3.6 million, or 12.5 percent. The decrease in 2009 -2010 property value was anticipated, and the staff, under the Board's direction, has worked hard to control expenditures and increase reserves. The decrease in property value was less than the anticipated 15 percent. The decline in property value is expected to continue for the 2010 -2011 and 2011- 2012 fiscal years. Because of these anticipated decreases in revenue, and because the District has no means to substantially make up for the anticipated shortfall in revenue, the 2009 -2010 General Fund budget reflects the anticipated expenditure of just under $2 million of designated reserves to fund the operating budget and maintain the level of service. The District must now consider ways to continue to fund operating expenses without reducing the level of service and without depleting reserves. BfBbb 3 -22 -10 x 2. The District did not reduce its millage rate from 1 mill ($1.00 for each $1,000 of 1 0 H appraised property value) for the fiscal year ending September 30, 2010. The rolled -back millage rate, that is; the rate that would need to be levied to generate the same revenue for the 2009 -2010 fiscal year as was generated during the 2008- 2009. fiscal year, was not levied because it exceeded the maximum millage rate the District is authorized to levy pursuant to its enabling act. The District's millage cap, combined with declining property values, makes it impossible to generate the same revenue as in prior years. Therefore, the District must fund operations with less revenue, while continuing to attempt to maintain service levels. 3. The District had planned to open Stations #48, #49, #410 and #411 within the next two to five years. However, due to the estimated dramatic reduction in revenue resulting from the anticipated and realized decline in property value, and the dramatic reduction in impact fees received, all construction of new station sites, except for the engineering and architecture fees required to complete the permitting process for Station #48, has been halted. 4. No new positions are provided for in the General Fund Budget for 2009 -2010. Thirteen employees participated in the early retirement incentive program established by the Board for the 2008 -2009 fiscal year. As a result, 9 shift positions were vacated. The 2009 -2010 General Fund Budget contains provisions to fill only three of these vacated positions. Because of the anticipated continued reductions in revenue, the intent is to retain as much of the General Fund reserves as possible to avoid potential personnel reductions in the 2010 -2011 fiscal year. 5. Capital purchases have been limited to only those essential items, including the replacement of the concrete drive at Stations 440 and 444 in the total amount of $200,000, the purchase of an emergency generator for Station 440 in the amount of $58,000, the installation of a vehicle exhaust system at Station 443 totaling $29,000 and the replacement of two air conditioning units at Station 445 in the amount of $30,000. Request for Information This financial report is designed to provide the reader an overview of the District. Questions regarding any information provided in this report should be directed to: Becky Bronsdon, Assistant Chief of Administrative Services, North Naples Fire Control & Rescue District, 1885 Veteran's Park Drive, Naples, FL 34109, 239 -597 -3222, e -mail: bbronsdon@,northnaplesfire.com. BJBIbb 3 -22 -10 X1 NORTH NAPLES FIRE CONTROL AND RESCUE DISTRICT STATEMENT OF NET ASSETS September 30, 2009 ASSETS Current assets: Cash and cash equivalents Restricted cash and cash equivalents Investments Due ff om other governments Other receivables Other assets Total current assets Noncurrent assets: Capital assets: Land Construction in progress Depreciable buildings, equipment, and vehicles (net of $10,602,550 accumulated depreciation) Total noncurrent assets TOTAL ASSETS LIABILITIES Current liabilities: Accounts payable and accrued expenses Contract deposits Deferred revenue Current portion of long -term obligations Total current liabilities Noncurrent liabilities: Noncurrent portion of long -term obligations TOTAL LLABILITIES NET ASSETS Invested in capital assets, net of related debt Unrestricted TOTAL NET ASSETS TOTAL LIABILITIES AND NET ASSETS The accompanying notes are an integral part of this statement. Governmental Artivitiec $ 7,051,005 213,864 8,083,192 361,292 42,349 8,697 15,760,399 11,182,814 667,460 12,633 254 24 483,528 $ 40,243,927 $ 610,790 16,000 190,411 918,547 1,735,748 1,601,063 3,336,811 24,483,528 12,423,588 36,907,116 $ 40,243,927 101 Page 3 of 59 1. NORTH NAPLES FIRE CONTROL AND RESCUE DISTRICT STATEMENT OF ACTIVITIES Year Ended September 30, 2009 EXPENSES Governmental Activities Public Safety - Fire Protection Personal services Operating expenses Depreciation Interest and fiscal charges TOTAL EXPENSES - GOVERNMENTAL ACTIVITIES PROGRAM REVENUES Charges for services Operating grants and contributions NET PROGRAM EXPENSES GENERAL REVENUES Ad Valorem taxes Impact fees Interest Gain on disposition of capital assets Other TOTAL GENERAL REVENUES INCREASE IN NET ASSETS NET ASSETS - Beginning of the year NET ASSETS - End of the year The accompanying notes arc an integral part of this statement. Govemmental Activities $ 22,781,089 3,238,389 1,100,913 60,926 27,181,317 580,951 67,841 26,532,525 26,670,789 342,496 605,567 785 230,114 27,849,751 1,317,226 35,589,890 $ 36,907,116 On F, Page 4 of 59 ion NORTH NAPLES FIRE CONTROL AND RESCUE DISTRICT Page 5 of 59 BALANCE SHEET - GOVERNMENTAL FUNDS September 30, 2009 Total General Impact Fee Inspection Fee Governmental Fund Fund Fund Funds ASSETS Cash and cash equivalents $ 7,051,005 $ $ $ 7,051,005 Restricted cash and cash equivalents - 135,457 78,407 213,864 Investments 8,083,192 - - 8,083,192 Due from other governments 248,763 65,904 46,625 361,292 Due from other funds 12,903 2,940 22,337 38,180 Other receivables 42,349 - - 42,349 Other assets 8,697 - 8,697 TOTAL ASSETS $ 15,446,909 $ 204,301 $ 147,369 $ 15,798,579 LIABILITIES AND FUND BALANCE LIABILITIES Accounts payable and accrued expenses $ 609,803 $ 987 $ Due to other funds 25,277 12,903 -- Contract deposits 16,000 - Deferred revenue - _ 190,411 _ TOTAL LIABILITIES 651,080 204,301 _ FUND BALANCE Unreserved, reported in: General Fund: Designated 14,795,829 Undesignated - Special Revenue Funds: Designated (deficit) - TOTAL FUND BALANCE 14,795,829 $ 610,790 38,180 16,000 190,411 855,381 - 14,795,829 147,369 147,369 147,369 14,943,198 TOTAL LIABILITIES ANT) FUND BALANCE $ 15,446,909 $ 204,301 $ 147,369 $ 15,798,579 The accompanying notes are an integral part of this statement. 10N "IN NORTH NAPLES FIRE CONTROL AND RESCUE DISTRICT RECONCILIATION OF THE BALANCE SHEET OF GOVERNMENTAL FUNDS TO THE STATEMENT OF NET ASSETS September 30, 2009 Amount Total fund balance of governmental funds $ 14,943,198 Amounts reported for governmental activities in the Statement of Net Assets are different because: Capital assets used in governmental activities are not financial resources and therefore are not reported in the governmental funds. Capital assets not being depreciated: Land 11,182,814 Construction in progress _ 667,460 Governmental capital assets being depreciated: - Building, Equipment and Vehicles 23,235,804 Less accumulated depreciation (10,602,550) Long -term obligations are not due and payable in the current period and therefore are not reported in the funds. Early termination benefits (1,162,987) Compensated absences 1,3 56,623 Elimination of interfund amounts: Due to other funds (38,180) Due from other funds _ 38,180 11,850,274 Page 6 of 59 12,633,254 (2,519,610) Total net assets of governmental activities $ 36,907,116 The accompanying notes are an integral part of this statement. NORTH NAPLES FIRE CONTROL AND RESCUE DISTRICT STATEMENT OF REVENUES, EXPENDITURES AND CHANGES IN FUND BALANCE - GOVERNMENTAL FUNDS Year Ended September 30, 2009 REVENUES Ad Valorem taxes Intergovernmental revenue Charges for services: Inspection fees and other Impact fees Miscellaneous: Interest Other TOTAL REVENUES 10H Page 7 of 59 Total General Impact Fee Inspection Fee Governmental Fund Fund Fund Funds $ 26,670,789 $ $ $ 26,670,789 67,841 67,841 119,720 - 461,231 580,951 - 342,496 - 342,496 600,040 3,506 2,021 605,567 _ 230,114 _ 230,114 27,688,504 _ 346,002 463,252 28,497,758 EXPENDITURES Current Public safety Personal services 21,379,100 295,845 21,674,945 Operating expenditures 3,198,514 39,875 - 3,238,389 Capital outlay 1,509,669 - - 1,509,669 Debt service Principal reduction 1,246,190 - 1,246,190 Interest and fiscal charges _ 62,975 _ 62,975 TOTAL EXPENDITURES 27,396,448 _ 39,875 295,845 27,732,168 EXCESS OF REVENUES OVER EXPENDITURES 292,056 306,127 167,407 765,590 OTHER FINANCING SOURCES Proceeds from disposition of capital assets 22,589 - - 22,589 Proceeds from capital lease _ 527,590 _ 527,590 TOTAL OTHER FINANCING SOURCES - 550,179 550,179 EXCESS OF REVENUES AND OTHER FINANCING SOURCES OVER EXPENDITURES FUND BALANCE - Beginning of the year FUND BALANCE - End of the year 842,235 306,127 167,407 1,315,769 13,953,594 (306,127) (20,038) 13,627,429 $ 14,795,829 $ $ 147,369 $ 14,943,198 The accompanying notes are an integral part of this statement. NORTH NAPLES FIRE CONTROL AND RESCUE DISTRICT RECONCILIATION OF THE STATEMENT OF REVENUES, EXPENDITURES, AND CHANGES IN FUND BALANCE OF GOVERNMENTAL FUNDS TO THE STATEMENT OF ACTIVITIES Year Ended September 30, 2009 Net change (revenues and other financing sources over expenditures and other financing uses) in fund balance - total governmental funds The increase (change) in net assets reported for governmental activities in the Statement of Activities is different because: Governmental funds report capital outlays as expenditures. In the Statement of Activities, however, the cost of those assets is allocated over their estimated useful lives and reported as depreciation expense. The loss on disposal of capital assets reduces the increase in net assets. Expenditures for capital assets 1,509,669 Less: proceeds on disposition of capital assets (22,589) Add: gain on disposition of capital assets 785 Less: current year depreciation (1,100,913) The issuance of debt is reported as a Financing source in governmental funds and thus contributes to the change in fund balance. In the Statement of Net Assets, however, issuing debt increases long -term liabilities and does not affect the Statement of Activities. Similarly, repayment of principal is an expenditure in the governmental funds but reduces the liability in the Statement of Net Assets. Borrowings (proceeds from issuance): Capital lease (527,590) Repayments (principal retirement): Capital lease 527,590 Note payable 718,600 Some expenses reported in the Statement of Activities do not require the use of current financial resources and therefore are not reported as expenditures in the governmental funds. Decrease in accrued interest payable on long term debt 2,049 Decrease in compensated absences 56,843 Increase in termination benefits (1,162,987) Increase in net assets of governmental activities The accompanying notes are an integral part of this statement. 10N Re Page 8 of 59 Amount $ 1,315,769 386,952 (527,590) 1,246;190 (1,104,095) $ 1,317,226 1 NORTH NAPLES FIRE CONTROL AND RESCUE DISTRICT STATEMENT OF FIDUCIARY NET ASSETS - FIDUCIARY FUND September 30, 2009 ASSETS Investments, at fair value: Money market funds Mutual funds Common stocks U.S. Government securities Corporate bonds Due from other governments Due from District Due from plan participants Accrued investment income TOTAL ASSETS LIABILITIES AND NET ASSETS LIABILITIES Accrued expenses Deferred contributions - prepaid district contributions TOTAL LIABILITIES NET ASSETS Held in trust for pension benefits and other purposes TOTAL NET ASSETS TOTAL LIABILITIES AND NET ASSETS The accompanying notes are an integral part of this statement. ION Page 9 of 59 Firefighters' Pension Fund $ 3,307,370 1,647,788 6,563,868 2,272,418 3,463,334 361,408 171,164 5,321 63,738 $ 17,856,409 $ 23,348 23,348 17,833,061 17,833,061 $ 17,856,409 NORTH NAPLES FIRE CONTROL AND RESCUE DISTRICT STATEMENT OF CHANGES IN FIDUCIARY NET ASSETS - FIDUCIARY FUND Year Ended September 30, 2009 ADDITIONS Contributions: Employer Plan members, made by employer on behalf of employee Buybacks State of Florida, insurance premiums Total contributions Investment income: Net appreciation (depreciation) in fair value of investments Net Realized gain (loss) Interest and dividends Less: investment expenses Net investment income (loss) Other income DEDUCTIONS Refunds of contributions Administrative expenses TOTAL ADDITIONS TOTAL DEDUCTIONS NET INCREASE IN NET ASSETS NET ASSETS - BEGINNING NET ASSETS - ENDING The accompanying notes are an integral part of this statement. 10M Page 10 of 59 Firefighters' Pension Fund $ 2,039,807 3 7, 846 33,580 1,039,931 3,151,164 1,147,227 (1,142,836) 386,259 390,650 (73,071) 317,579 104 3,468,847 75,921 75,921 3,392,926 14,440,135 $ 17,833,061 NORTH NAPLES FIRE CONTROL AND RESCUE DISTRICT Page 11 of 59 NOTES TO THE FINANCIAL STATEMENTS September 30, 2009 NOTE A - SUMMARY OF SIGNIFICANT ACCOUNTING POLICIES Organization North Naples Fire Control and Rescue District (the "District ") is an independent special taxing district located in northern Collier County, Florida. The District was originally established by Laws of Florida, Chapter 61 -2032 and Florida Statute 633.15, then reestablished by Laws of Florida Chapter 84 -416, as amended. The District's governing legislation was recreated, reenacted and codified by Laws of Florida, Chapter 99 -450 on July 13, 1999 and amended by Laws of Florida, Chapter 2006 -353 on June 23, 2006. The District is governed by a five (5) member elected Board of Commissioners. Commissioners serve on a staggered four (4) year term basis. The District provides fire control and protection services, fire safety, inspections, code enforcement, fire hydrant maintenance, firefighter training, and crash and fire rescue services as well as basic life support services. In providing these services, the District operates and maintains seven (7) stations and the related equipment and employs approximately 160 full -time professional firefighters and administrative staff. During the year ended September 30, 2009, the District entered into a joint venture agreement with Edison State College (ESC) for the operation of the North Naples Fire Training Center ( NNFTC) to educate and train students as State Certified Firefighters. The District is licensed to operate the NNFTC and ESC is the program coordinator. The District provides the training room and training facilities for the NNFTC. ESC, as program coordinator, is responsible for the operations of the NNFTC including but not limited to the screening and enrolling of students and for screening and engaging instructors. Therefore, the activities of the NNFTC are not included in the District's basic financial statements. Reporting Entity The District adheres to Governmental Accounting Standards Board (GASB) Statement Number 14, "Financial Reporting Entity," (GASB 14) as amended by GASB Statement Number 39, "Determining Whether Certain Organizations Are Component Units" (GASB 39). This Statement requires the basic financial statements of the District (the primary government) to include its component units, if any. A component unit is a legally separate organization for which the elected officials of the primary government are financially accountable. Based on the criteria established in GASB 14, as amended, there are no component units required to be included in the District's basic financial statements. 10:H NORTH NAPLES FIRE CONTROL AND RESCUE DISTRICT Page 12 of 59 NOTES TO THE FINANCIAL STATEMENTS September 30, 2009 NOTE A - SUMMARY OF SIGNIFICANT ACCOUNTING POLICIES, CONTINUED Government -wide Financial Statements The government -wide financial statements (i.e., the Statement of Net Assets and the Statement of Activities) report information on all of the activities of the District and do not emphasize fund types. These governmental activities comprise the primary government. General governmental and intergovernmental revenues support the governmental activities. The purpose of the govemment -wide financial statements is to allow the user to be able to determine if the District is in a better or worse financial position than the prior year. The effect of all interfund activity between governmental funds has been removed from the government -wide financial statements. Government -wide financial statements are reported using the economic resources measurement focus and the accrual basis of accounting, as are the pension fund financial statements. Under the accrual basis of accounting, revenues, expenses, gains, losses, assets, and liabilities resulting from exchange and exchange -like transactions are recognized when the exchange takes place. Revenues, expenses, gains, losses, assets, and liabilities resulting from nonexchange transactions are recognized in accordance with the requirements of GASB Statement Number 33, "Accounting and Financial Reporting for Nonexchange Transactions" (GASB 33). Amounts paid to acquire capital assets are capitalized as assets in the government -wide financial statements rather than reported as expenditures. Proceeds of long -term debt are recorded as liabilities in the government -wide financial statements rather than as other financing sources. Amounts paid to reduce long -term indebtedness of the reporting government are reported as a reduction of the related liability in the government -wide financial statements rather than as expenditures. The Statement of Activities demonstrates the degree to which the direct expenses of a given function are offset by program revenues. Direct expenses are those that are clearly identifiable with a specific function or segment. Program revenues include: 1) charges to customers or applicants who purchase, use, or directly benefit from goods, services, or privileges provided by a given function, and 2) grants and contributions that are restricted to meeting the operational or capital improvements of a particular function. Taxes and other items not properly included among program revenues are reported instead as general revenues. 10 fl NORTH NAPLES FIRE CONTROL AND RESCUE DISTRICT Page 13 of 59 NOTES TO THE FINANCIAL STATEMENTS September 30, 2009 NOTE A - SUMMARY OF SIGNIFICANT ACCOUNTING POLICIES, CONTINUED Government -wide Financial Statements, continued Program revenues are considered to be revenues generated by services performed and/or by fees charged such as inspection fees, burn permits, and hydrant tests. Fund Financial Statements The accounts of the District are organized on the basis of funds, each of which is considered a separate accounting entity. The operations of each fund are accounted for with a separate set of self - balancing accounts that comprise its assets, liabilities, fund equity or retained earnings, revenues, and expenditures or expenses, as appropriate. Government resources are allocated to and accounted for in individual funds based upon the purpose for which they are to be spent and the means by which spending activities are controlled. Fund financial statements for the District's governmental and fiduciary funds are presented after the government -wide financial statements. These statements display information about major funds individually and nonmajor funds in aggregate for governmental funds. The fiduciary statement includes financial information for the firefighters' pension fund. The fiduciary fund represents assets held by the District in a custodial capacity for the benefit of other individuals. Governmental Funds When both restricted and unrestricted resources are combined in a fund, expenditures are considered to be paid first from restricted resources, as appropriate, and then from unrestricted resources. Governmental fund financial statements are reported using the current financial resources measurement focus and the modified accrual basis of accounting. Revenues are considered to be available when they are collected within the current period or soon thereafter to pay liabilities of the current period. The District's major funds are presented in separate columns on the governmental fund financial statements. The definition of a major fund is one that meets certain criteria set forth in GASB Statement Number 34, "Basic Financial Statements - and Management's Discussion and Analysis - for State and Local Governments" (GASB 34). The funds that do not meet the criteria of a major fund are considered 10 NORTH NAPLES FIRE CONTROL AND RESCUE DISTRICT Page 14 of 59 NOTES TO THE FINANCIAL STATEMENTS September 30, 2009 NOTE A - SUMMARY OF SIGNIFICANT ACCOUNTING POLICIES, CONTINUED Governmental Funds, continued non -major funds and are combined into a single column on the governmental fund financial statements. Separate financial statements are provided for governmental funds. Major individual governmental funds are reported in separate columns on the fund financial statements. Fiduciary Fund The pension trust fund accounts for the activities of the Firefighters' Pension Plan, which accumulates resources for the pension benefit payments to qualified firefighters. The net assets of this fund are not considered to be net assets of the District and not available to the District's creditors. Measurement Focus and Basis of Accounting Basis of accounting refers to when revenues and expenditures or expenses are recognized in the accounts and reported in the basic financial statements. Basis of accounting relates to the timing of the measurements made, regardless of the measurement focus applied. The government -wide financial statements are reported using the economic resources measurement focus and the accrual basis of accounting. Revenues are recorded when earned and expenses are recorded when a liability is incurred, regardless of the timing of related cash flows. Property taxes are recognized as revenues in the year for which they are levied. Grants and similar items are recognized as revenue as soon as all eligibility requirements have been met. Governmental fund financial statements are reported using the current financial resources measurement focus and the modified accrual basis of accounting. Revenues are recognized as soon as they are both measurable and available. Revenues are considered to be available when they are collectible within the current period and soon enough thereafter to pay liabilities of the current period. For this purpose, the District considers tax revenues to be available if they are collected within sixty days of the end of the current fiscal period. 10 N Owl NORTH NAPLES FIRE CONTROL AND RESCUE DISTRICT Page 15 of 59 NOTES TO THE FINANCIAL STATEMENTS September 30, 2009 NOTE A - SUMMARY OF SIGNIFICANT ACCOUNTING POLICIES, CONTINUED Measurement Focus and Basis of Accounting, continued Revenues susceptible to accrual are property taxes, interest on investments, and intergovernmental revenues. Property taxes are recorded as revenues in the fiscal year in which they are levied, provided they are collected in the current period or within sixty days thereafter. Interest on invested funds is recognized when earned. Intergovernmental revenues that are reimbursements for specific purposes or projects are recognized when all eligibility requirements are met. Expenditures are generally recognized under the modified accrual basis of accounting when the related fund liability is incurred. Exceptions to this general rule include: (1) principal and interest on long -term debt, if any, is recognized when due; and (2) expenditures are generally not divided between years by the recording of prepaid expenditures. When both restricted and unrestricted resources are available for use, it is the District's policy to use restricted resources first, then unrestricted resources as they are needed. Separate financial statements are provided for governmental funds and fiduciary funds, even though the latter are excluded from the government -wide financial statements. Non - current Government Assets/Liabilities GASB 34 requires non - current governmental assets, such as land and buildings, and non - current governmental liabilities, such as notes payable and capital leases, to be reported in the governmental activities column in the government -wide Statement of Net Assets, Major Funds The District reports the following major governmental funds: ion NORTH NAPLES FIRE CONTROL AND RESCUE DISTRICT Page 16 of 59 NOTES TO THE FINANCIAL STATEMENTS September 30, 2009 NOTE A - SUMMARY OF SIGNIFICANT ACCOUNTING POLICIES, CONTINUED Major Funds, continued The General Fund is the District's primary operating fund. It accounts for all financial resources of the District, except those required to be accounted for in another fund. The Impact Fee Fund consists of fees imposed and collected by Collier County based on new construction within the District. The fees are restricted and can only be used for certain capital expenditures associated with growth within the District. Non -Major Fund The District reports the following non -major fund: The Inspection Fee Fund is used by the District to account for the receipt and expenditures of its Inspection Fee Program. Fees are charged for the inspection of new building construction. The fees are collected by Collier County and are distributed by the East Naples Fire Control and Rescue District to the other participating Districts. Fiduciary Fund Fiduciary funds are excluded in the government -wide financial statements because the resources of those funds are not available to support the District's programs. The only type of fiduciary funds the District maintains is a Firefighters' Pension Fund, which accounts for retirement assets held by the Plan that are payable to qualified firefighters upon retirement. Budgetary Information The District has elected to report budgetary comparisons of its major funds and its non -major fund as required supplementary information (RSI). ion NORTH NAPLES FIRE CONTROL AND RESCUE DISTRICT Page 17 of 59 NOTES TO THE FINANCIAL STATEMENTS September 30, 2009 NOTE A - SUMMARY OF SIGNIFICANT ACCOUNTING POLICIES, CONTINUED Investments The District adheres to the requirements of GASB Statement Number 31, "Accounting and Financial Reporting for Certain Investments and for External Investment Pools," (GASB 31) in which all investments are reported at fair value. Investments, including restricted investments, consist of certificates of deposit, U.S. Government securities, corporate debt and equity securities, and securities of government agencies unconditionally guaranteed by the U.S. Government. Capital Assets Capital assets, which include land, construction in progress, buildings, equipment and vehicles, are reported in the government -wide Statement of Net Assets. The District follows a capitalization policy which calls for capitalization of all capital assets that have a cost or donated value of $1,000 or more and have a useful life in excess of one year. All capital assets are valued at historical cost, or estimated historical cost if actual historical cost is not available. Donated capital assets are valued at their estimated fair market value on the date donated. Public domain (infrastructure) capital assets consisting of certain improvements other than building, including curbs, gutters and drainage systems, are not capitalized, as the District generally does not acquire such assets. No debt - related interest expense is capitalized as part of capital assets in accordance with GASB 34. Maintenance, repairs and minor renovations are not capitalized. The acquisition of land and construction projects utilizing resources received from Federal and State agencies are capitalized when the related expenditure is incurred. Expenditures that materially increase values, change capacities or extend useful lives are capitalized. Upon sale or retirement, the cost is eliminated from the respective accounts. NORTH NAPLES FIRE CONTROL AND RESCUE DISTRICT NOTES TO THE FINANCIAL STATEMENTS September 30, 2009 10H Page 18 of 59 NOTE A - SUMMARY OF SIGNIFICANT ACCOUNTING POLICIES, CONTINUED Capital Assets, continued Expenditures for capital assets are recorded in the fund statements as current expenditures. However, such expenditures are not reflected as expenditures in the government -wide statements, but rather are capitalized and depreciated. Depreciable capital assets are depreciated using the straight -line method over the following estimated useful lives: Capital Asset Years Buildings 15 -30 Capital Assets acquired under Capital Lease 10 Office Equipment 3 -30 Vehicles 3 -10 Equipment and Machinery 3 -15 Budgets and budgetary accounting The District adopted an annual budget for the General Fund. The District adopted annual budgets for the Special Revenue Funds - Impact Fee Fund and the Inspection Fee Fund. No budget was adopted or required to be adopted for the Pension Trust Fund. ION NORTH NAPLES FIRE CONTROL AND RESCUE DISTRICT Page 19 of 59 NOTES TO THE FINANCIAL STATEMENTS September 30, 2009 NOTE A - SUMMARY OF SIGNIFICANT ACCOUNTING POLICIES, CONTINUED Budgets and budgetary accounting continued The District follows these procedures in establishing budgetary data for the General Fund, the Impact Fee Fund, and the Inspection Fee Fund: 1. During the summer of each year, the District Fire Chief submits to the Board of Commissioners a proposed operating budget for the fiscal year commencing on the upcoming October 1. The operating budget includes proposed expenditures and the means of financing them. 2. Public hearings are conducted to obtain taxpayer comments. 3. The budget is adopted by approval of the Board of Commissioners. 4. Budget amounts, as shown in these basic financial statements, are as originally adopted or as amended by the Board of Commissioners. 5. The budget is adopted on a basis consistent with accounting principles generally accepted in the United States of America. 6. The level of control for appropriations is exercised at the fund level. Appropriations lapse at year -end. Several budget amendments were approved by the Board of Commissioners during the fiscal year ended September 30, 2009 for the General Fund. Budgeted expenditures in the General Fund were increased by $3,854,766. No budget amendments were approved for the Impact Fee Fund or the Inspection Fee Fund. Impact fees /deferred revenue The District levies an impact fee on new construction within the District. The intent of the fee is for growth within the District to pay for capital improvements needed due to the growth. The fee is imposed and collected by Collier County and remitted to the District. The fee is refundable if not expended by the District within six (6) years from the date of collection. The District, therefore, records this fee as restricted cash and deferred revenue until the date of expenditure, at which time it is recognized as revenue and charged to capital outlay in the fund financial statements and capital assets in the government -wide financial statements. 10H NORTH NAPLES FIRE CONTROL AND RESCUE DISTRICT Page 20 of 59 NOTES TO THE FINANCIAL STATEMENTS September 30, 2009 NOTE A - SUMMARY OF SIGNIFICANT ACCOUNTING POLICIES, CONTINUED Due to /from other funds Interfund receivables and payables arise from interfund transactions and are recorded by funds affected in the period in which the transactions are executed. Due from other governments No allowance for losses on uncollectible accounts has been recorded since the District considers all amounts to be fully collectible. Compensated absences The District's employees accumulate annual leave based on the number of years of continuous service. Upon termination of employment, employees can receive payment of accumulated annual leave if certain criteria are met. The costs of accumulated annual leave benefits (compensated absences) are expended in the respective operating funds when payments are made to employees. However, the liability for all accrued vacation and personal leave benefits is recorded in the govemment -wide Statement of Net Assets. Encumbrances Encumbrance accounting, under which purchase orders, contracts and other commitments for the expenditure of monies are recorded in order to reserve that portion of the applicable appropriation, is not employed by the District because, at present, it is not necessary in order to assure effective budgetary control or to facilitate effective cash planning and control. Management estimates The preparation of financial statements in conformity with accounting principles generally accepted in the United States of America requires management to make estimates and assumptions that affect the reported amounts of assets, liabilities and disclosure of contingent assets and liabilities at the date of the financial statements, and the reported amounts of revenues and expenditures during the reporting period. Actual results could differ from those estimates. 10H NORTH NAPLES FIRE CONTROL AND RESCUE DISTRICT Page 21 of 59 NOTES TO THE FINANCIAL STATEMENTS September 30, 2009 NOTE A - SUMMARY OF SIGNIFICANT ACCOUNTING POLICIES, CONTINUED Fund equity In the governmental fund financial statements, reservation of fund balance indicates amounts that are limited for a specific purpose, are not appropriable for expenditure, or are legally segregated for a specific future use. Designations of fund balance represent tentative management plans, Unreserved, undesignated fund balance indicates funds that are available for current expenditure. Interfund transactions The District considers interfund receivables (due from other funds) and interfund payables (due to other funds) to be loan transactions to and from other funds to cover temporary (three months or less) cash needs. Transactions that constitute reimbursements to a fund for expenditures /expenses initially made from it that are properly applicable to another fund are recorded as expenditures /expenses in the reimbursing funds and as reduction of expenditures /expenses in the fund that is reimbursed. Such amounts are eliminated in the Government -wide Financial Statements. Subsequent events Subsequent events have been evaluated through March 31, 2010, which is the date the basic financial statements were available to be issued. NOTE B - CASH AND CASH EQUIVALENTS Cash and cash equivalents of the primary government (exclusive of the Firefighters' Pension Trust Fund) were $7,264,869, of which $213,864 was restricted. Total cash and cash equivalents included cash on hand of $1,150 at September 30, 2009. Deposits The District's deposit policy allows deposits to be held in demand deposit, money market accounts and the Florida State Board of Administration - Local Government Surplus Trust Fund (SBA). All District depositories are institutions designated as qualified depositories by the State Treasurer at September 30, 2009. The District adheres to GASB Statement Number 31, "Accounting and Financial Reporting for Certain Investments and for External Investment Pools." Under this Statement, the District has elected to show all investments at fair value, with the NORTH NAPLES FIRE CONTROL AND RESCUE DISTRICT NOTES TO THE FINANCIAL STATEMENTS September 30, 2009 NOTE B - CASH AND CASH EQUIVALENTS, CONTINUED Deposits continued 1 0 0 t' d Page 22 of 59 exception of the Local Government Surplus Funds Investment Pool Fund (State Board of Administration), an external 2a7 - like investment pool. The Local Government Surplus Funds Investments Pool Trust Fund's shares are stated at amortized cost, which approximates fair value. These investments are subject to the risk that the market value of an investment, collateral protecting a deposit or securities underlying a repurchase agreements, will decline. Deposits consist of the following at September 30, 2009 The District's deposits were entirely covered by federal depository insurance or by collateral pursuant to the Public Depository Security Act (Florida Statute 280) of the State of Florida except for the $634 held in the SBA. Bank balances approximate market value. The District held no other types of deposits during the year ended September 30, 2009. The local Government Surplus Funds Trust Fund is not required to be categorized because the investments are not evidenced by securities that exist in physical or book entry form. Carrying Bank District Amount Balance Unrestricted _ General Fund $ 1,143,085 $ 1,809,452 Depository Accounts Money Market 5,906,136 5,906,136 SBA 634 634 Total General Fund $ 7,049,855 $ 7,716,222 Restricted Special Revenue Funds Impact Fee Depository Accounts $ 135,457 $ 138,032 Inspection Fee 78,407 78,407 Depository Accounts Total Special Revenue Funds $ 213,864 $ 216,439 The District's deposits were entirely covered by federal depository insurance or by collateral pursuant to the Public Depository Security Act (Florida Statute 280) of the State of Florida except for the $634 held in the SBA. Bank balances approximate market value. The District held no other types of deposits during the year ended September 30, 2009. The local Government Surplus Funds Trust Fund is not required to be categorized because the investments are not evidenced by securities that exist in physical or book entry form. 1 NORTH NAPLES FIRE CONTROL AND RESCUE DISTRICT Page 23 of 59 NOTES TO THE FINANCIAL STATEMENTS September 30, 2009 NOTE B - CASH AND CASH EQUIVALENTS, CONTINUED Restricted cash and equivalents The following is a brief description of the restrictions on cash and cash equivalents: The Impact Fee account is used to account for the deposit of impact fees received and is restricted for certain capital asset acquisition associated with growth within the District. Impact fees are collected by Collier County for the District pursuant to County ordinance and District resolution. The Inspection Fee account is used to account for inspection fees collected by the District for performing fire inspections within the District. Such revenue is restricted for inspection service related costs. NOTE C - INVESTMENTS District - Investments Investments of the District (primary government)(exclusive of the Firefighters' Pension Trust Fund) were $8,083,192 (both carrying value and market value) at September 30, 2009 and consisted of certificates of deposit which were designated as public funds with a qualified public depository, and were, therefore, entirely collateralized pursuant to the Public Depository Security Act (Florida Statute 280) of the State of Florida. Firefighters Pension Plan - Investments Investments held in the Firefighters' Pension Trust Fund totaled $17,254,778 (including $3,307,370 in money market funds, $1,647,788 in equity mutual funds, $6,563,868 in equity securities and $5,735,752 in fixed income securities) at September 30, 2009. Such investments are administered by Firefighters' Pension Board policy. This policy provides for investments in money markets, mutual funds, treasury notes, federal agency guaranteed securities, corporate bonds, notes and/or equities, and real estate. The Firefighters' Pension Trust Fund accounts for resources held to fund the respective firefighter employee pension benefits. The Firefighters' Pension Trust Fund investments were held by a financial and investment institution and insured up to certain limits specific to the trustee /custodian institution and retirement trust funds. i , c•y 1 'fl NORTH NAPLES FIRE CONTROL AND RESCUE DISTRICT Page 24 of 59 NOTES TO THE FINANCIAL STATEMENTS September 30, 2009 NOTE C - INVESTMENTS, CONTINUED Firefighters Pension Plan - Investments, continued Investment Authorization: The Plan's investment policy is determined by the Plan's Board of Trustees. The policy has been designed by the Board to conduct the operations of the Plan in a manner so that the assets will provide the pension and other benefits provided under applicable laws, preserving principal while maximizing the rate of return. The Trustees are authorized to acquire and retain every kind of property (real, personal or mixed) and every kind of investment specifically including, but not by way of limitation, money markets, mutual funds, bonds, debentures, stocks (preferred or common) and other corporate obligations. Investments are carried at quoted market prices at September 30, 2009. Interest and dividend revenues are recorded as earned. Purchases and sales of investments are recorded on the trade -date basis. Unrealized gains and losses are presented as net appreciation (depreciation) in fair value of investments on the statement of changes in plan net assets along with gains and losses realized on sales of investments. Given the inherent nature of investments, it is reasonably possible that changes in the value of those investments will occur in the near term and that such changes could materially affect the amounts reported in the statements of plan net assets. Investment in all equity securities shall be limited to those listed on a major U.S. stock exchange and limited to no more than 62.5% (at market) of the Plan's total asset value. The equity position in any one company shall not exceed 5% of the Plan's total assets at market. Investments in stock of foreign companies shall be limited to 10% of the value of the Plan's total assets at market. No more than 15% of the equity securities are to be invested in small or mid -cap stocks. The fixed income portfolio shall be compromised of securities rated in the highest three (3) categories of quality by a major rating service. Except for Treasury and Agency obligations, the debt portion of the Fund shall contain no more than 10% of a given issuer irrespective of the number of differing issues. The current target allocation of these investments at market is as follows: Authorized Target % of Investments Portfolio Domestic Equities 50% Fixed Income 40% International Equities 10% NORTH NAPLES FIRE CONTROL AND RESCUE DISTRICT NOTES TO THE FINANCIAL STATEMENTS September 30, 2009 NOTE C - INVESTMENTS, CONTINUED 10 fl Page 25 of 59 Interest Rate Risk: Interest rate risk is the risk that changes in market interest rates will adversely affect the fair value of an investment. Generally, the longer the maturity of an investment, the greater the sensitivity of its fair value to change in market interest rates. As a means of limiting its exposure to interest rate risk, the Plan diversifies its investments by security type and institution, and limits holdings in any one type of investment with any one issuer with various durations of maturities. Information about the sensitivity of the fair values of the Plan's fixed income investments to market interest rate fluctuations is provided by the following table that shows the distribution of the Plan's investment by maturity at September 30, 2009: Investment Maturities (in years) Investment Type Fair Value Less than I 1 to 5 6 to 10 U.S. Agencies/Treasuries $ 2,272,418 $ 750,197 $ 875,520 $ 646,701 Corporate bonds 3,463,334 _560,071 _ 2,118,664 784,599 $ 5,735,752 $ 1,310,268 $ 2,994,184 $ 1,431,300 Credit Risk: Credit risk is the risk that a security or a portfolio will lose some or all of its value due to a real or perceived change in the ability of the issuer to repay its debt. The Plan's investment policy utilizes portfolio diversification in order to control this risk. The following table discloses credit rating by fixed income investment type at September 30, 2009, if applicable: U.S, government guaranteed* Quality rating of credit risk debt securities Aa2 Aa3 Al A2 A3 Total credit risk debt securities Fair Percentage of Value Portfolio $2,272,418 13.17 % $ 480,497 2.78 % 110,031 0.64 1,437,585 8.33 1,245,967 7.22 189,254 1.10 $3,463,334 20.07 % * Obligations of the U.S. government or obligations explicitly guaranteed by the U.S. government are not considered to have credit risk and do not have purchase limitations. Ion j NORTH NAPLES FIRE CONTROL AND RESCUE DISTRICT Page 26 of 59 NOTES TO THE FINANCIAL STATEMENTS September 30, 2009 NOTE C - INVESTMENTS, CONTINUED Concentration of Credit Risk: The investments policy of the Plan contains limitations on the amount that can be invested in any one issuer as well maximum portfolio allocation percentages. There were no individual investments that represented 5% or more of Plan net assets at September 30, 2009. Custodial Credit Risk: This is the risk that in the event of the failure of the counterparty, the plan will not be able to recover the value of its investments or collateral securities that are in the possession of an outside party. This risk is generally measured by the assignment of a rating by a nationally recognized statistical rating organization. Consistent with the Plan's investment policy, the investments are held by Plan's custodial bank and registered in the Plan's name. NOTE D - DUE TO/FROM OTHER FUNDS Interfund receivables and payables at September 30, 2009 are as follows: Due from Due to Fund other funds other funds General Fund: Impact Fee Fund $ 12,903 $ 2,940 Inspection Fee Fund 22,337 Total General Fund 12,903 25,277 Special Revenue Funds: Impact Fee Fund General Fund 2,940 12,903 Inspection Fee Fund General Fund 22,337 - Total Special Revenue Funds 25,277 12,903 Total $ 38,180 $ 38,180 Interfund receivables and payables were eliminated for presentation purposes in the Statement of Net Assets at September 30, 2009. NORTH NAPLES FIRE CONTROL AND RESCUE DISTRICT NOTES TO THE FINANCIAL STATEMENTS September 30, 2009 NOTE E - CAPITAL ASSETS ACTIVITY lON --0 Page 27 of 59 The following is a summary of changes in capital assets activity for the year ended September 30, 2009: Balance at Balance at October 1 Increases/ Decreases/ Adjustments/ September 30 2008 Additions Retirements Reclassifications 2009 Capital Assets Not Being Depreciated: Land $ 10,728,291 $ 454,523 $ Construction in Progress 480,363 _187,097 _ Total Capital Assets Not Being Depreciated 11,208,654 641,620 _ Capital Assets Being Depreciated: Buildings 12,061,899 171,467 - Office Equipment 654,430 83,370 (27,589) Vehicles 7,610,439 527,590 (394,757) _ Equipment & Machinery 2,642,630 _ 85.622 (179,297) Total Capital Assets (10,081,476) x,100,913 ) ___579,839 Being Depreciated 22,969,398 _ 868,049 _601,643) Less Accumulated Depreciation: Buildings (2,973,642) (394,714) Office Equipment (369,580) (82,541) 25,096 Vehicles (4,921,524) (449,040) 394,757 Equipment & Machinery (1, 16,730) --J!74-6-181 159986 Total Accumulated Depreciation (10,081,476) x,100,913 ) ___579,839 Total Capital Assets being Depreciated, Net 12,887,922 _ 232,864 21,804 $ - $ 11,182,814 - 667,460 1 1,950,274 12,233,366 710,211 7,743,272 2,548,955 - 23,235,804 - (3,368,356) - (427,025) - (4,975,807) (1,831,362) (10,602,5 - 12,633,254 Capital Assets, Net $ 24,096,576 $ 408,756 $$ (21,804) $ - 24,483,528 Related debt - Net assets invested in capital assets, net of related debt $ 24,483,528 NORTH NAPLES FIRE CONTROL AND RESCUE DISTRICT Page 28 of 59 NOTES TO THE FINANCIAL STATEMENTS September 30, 2009 NOTE E - CAPITAL ASSETS ACTIVITY, CONTINUED Depreciation expense was charged to the following functions during the year ended September 30, 2009: Amount General Government Total Depreciation Expense $1,100,913 NOTE F - LONG -TERM OBLIGATIONS The following is a summary of changes in long -term obligations for the year ended September 30, 2009: Amnnnt $912,500 note payable, Series 2004, payable monthly for 59 months to a financial institution in the amount of $6,542 including interest at 3.54 %, with with a final payment of all unpaid principal and accrued interest of $662,444 on November 1, 2009. The note is collateralized by impact fees and non -ad valorem revenues of the District (paid from the General Fund). During the year ended September 30, 2009, the District paid all unpaid principal and accrued interest on the note. $ Balance Retirements Balance Amounts October 1 And September 30 Due Within _ 2008 Additions Adjustments 2009 One Year Note Payable - Series 2004 $ 718,600 $ - $ (718,600) $ - $ Capital Lease - 527,590 (527,590) - Termination Benefits - 1,162,987 - 1,162,987 918,547 Compensated Absences 1,413,466 (56,843) 1,356,623 - $ 2,132,066 $ 1,690,577 $ (1,303,033) $ 2,519,610 $ 918,547 The following is a summary of long -term obligations at September 30, 2009: Amnnnt $912,500 note payable, Series 2004, payable monthly for 59 months to a financial institution in the amount of $6,542 including interest at 3.54 %, with with a final payment of all unpaid principal and accrued interest of $662,444 on November 1, 2009. The note is collateralized by impact fees and non -ad valorem revenues of the District (paid from the General Fund). During the year ended September 30, 2009, the District paid all unpaid principal and accrued interest on the note. $ ion NORTH NAPLES FIRE CONTROL AND RESCUE DISTRICT Page 29 of 59 NOTES TO THE FINANCIAL STATEMENTS September 30, 2009 NOTE F - LONG -TERM OBLIGATIONS, CONTINUED $527,590 capital lease dated May 18, 2009 payable annually, beginning April 7, 2010, to a financial institution in the amount of $66,429 including interest at 4.51 %, collateralized by the respective vehicle. Final payment due April 7, 2019. During the year ended September 30, 2009, the District paid all outstanding principal and accrued interest on the capital lease and received title to the respective vehicle. Early termination benefits. During the year ended September 30, 2009, the District approved an early retirement incentive package to all sworn employees (see Note M). The early retirement benefits are payable over a three (3) year period ending September, 2012. 1,162,987 Non- current portion of compensated absences. Employees of the District are entitled to paid vacation based on length of service and job classification. _ 1,3 56,623 $ 2,519,610 Interest expense for the year ended September 30, 2009 was $62,975. NOTE G - RETIREMENT PLANS The following three retirement plans have been established by the District: Plan 1 - Florida Retirement System (FRS) Plan 2 - Firefighter's Pension Trust Fund (Florida Statute 175) Plan 3 - Governmental Money Purchase Plan (Chief) Employee participation in a specific plan is based on the respective employee's original hire date. ion NORTH NAPLES FIRE CONTROL AND RESCUE DISTRICT Page 30 of 59 NOTES TO THE FINANCIAL STATEMENTS September 30, 2009 NOTE G - RETIREMENT PLANS, CONTINUED Plan 1 - Plan description and provisions - Florida Retirement System All District personnel employed prior to January 1, 1996 and all other District personnel (other than certified firefighters) including the Board of Commissioners, hired on or after January 1, 1996, are participants in the statewide Florida Retirement System (FRS) under the Authority of Article X, Section 14 of the State Constitution and Florida Statutes, Chapters 112 and 121. The FRS Plan (the "Plan") is noncontributory and is totally administered by the State of Florida. The District contributed 100% of the required contributions for the years ended September 30, 2009, 2008, and 2007. The District's covered payroll for the years ended September 30, 2009, 2008, and 2007 was $5,624,683, $5,612,604, and $5,551,822, respectively. The District's contributions to the Plan were $1,075,003, $1,087,498, and $1,064,613, for the years ended September 30, 2009, 2008, and 2007, respectively, which represents 19 %, 19 %, and 17 %, respectively, of covered payroll. Pension costs for the District ranged between 10% to 21% for the year ended September 30, 2009. There were no employee contributions required or made to the Plan. Employees who retire at or after age 62 with 6 years of creditable service, 6 years of senior management service and age 62, 6 years of special risk service and age 55, or 30 years of service (25 for special risk) regardless of age, are entitled to a retirement benefit, payable for life, equal to 1.6% to 3,0% per year of creditable service, depending on the class of employee (regular, special risk, etc.) based on average final compensation of the five (5) highest fiscal years' compensation. Benefits vest after six years (six years for senior management) of creditable service. Vested employees may retire anytime after vesting and incur a 5% benefit reduction for each year prior to normal retirement age. Early retirement, disability, death and survivor benefits are also offered. Benefits are established by State Statute. The Plan provides for a constant 3% cost -of- living adjustment for retirees. The Plan also provides several other Plan and/or investment options that may be elected by the employee. Each offers specific contribution and benefit options. The Plan documents should be referenced for complete detail. NORTH NAPLES FIRE CONTROL AND RESCUE DISTRICT Page 31 of 59 NOTES TO THE FINANCIAL STATEMENTS September 30, 2009 NOTE G - RETIREMENT PLANS, CONTINUED Plan 1 - Plan description and provisions - Florida Retirement System, continued Description of funding policy - This is a cost sharing, multi- employer plan . available to governmental units within the State. Actuarial information with respect to an individual participating entity is not available. Participating employers are required, by Statute, to pay monthly contributions at actuarially determined rates that, expressed as percentages of annual covered payroll, are adequate to accumulate sufficient assets to pay, benefits when due. Trend information - A copy of the FRS's June 30, 2009 annual report can be obtained by writing the Florida Division of Retirement, Cedars Executive Center, 2639 -C North Monroe Street, Tallahassee, Florida 32399 -1560, or by calling (850) 488 -5706. Plan 2 - Plan description and provisions - Firefighters' Pension Trust Fund The following brief description of the North Naples Fire Control and Rescue District Firefighters' Pension Plan (the "Plan") is provided for general information purposes only. Participants should refer to the plan agreement for a more complete description of the Plan. On July 11, 1996, under the authority of Florida Statute 175 and Laws of Florida, Chapter 95 -338, the District's Board of Commissioners passed Resolutions 96 -004 and 96 -005, providing for the establishment and funding of a single employer defined benefit retirement plan and trust for newly hired fire suppression personnel. The resolutions establish that certified firefighters employed on or after January 1, 1996 are to become participants in the District's Firefighters' Pension Trust Fund. The Plan is totally administered, including all investment management, by a third party administrator and the Plan's appointed Pension Board. During the year ended September 30, 2009, the Plan adopted Governmental Accounting Standards Board (GASB) Statement Number 50 "Pension Disclosures" (GASB 50) which amends GASB Statements Number 25 "Financial Reporting for Defined Benefit Pension Plans and Note Disclosures for Defined Contribution Plans" and Number 27 "Accounting for Pensions by State and Local Government Employers ". GASB 50 requires disclosure in the notes to the financial statements of pension plans and certain employer governments of the current funded status of the plan and other actuarial information. The adoptions of GASB 50 had an impact on the presentation of the notes to the financial statements but had no impact on the Plan's net assets available for Plan benefits. NORTH NAPLES FIRE CONTROL AND RESCUE DISTRICT Page 32 of 59 NOTES TO THE FINANCIAL STATEMENTS September 30, 2009 NOTE G - RETIREMENT PLANS, CONTINUED Plan 2 - Plan description and provisions - Firefighters' Pension Trust Fund, continued During the years ended September 30, 2009, 2008, and 2007, there were employee contributions in the amounts of $33,580, $64,224, and $49,645, respectively. These employee contributions were for the buyback of military service time for certain employees. There were no employee contributions to the Plan during the years ended September 30, 2005 or 2004, as the District funds the scheduled employee required contributions. The employer contributed 100% of its required contributions, as well as those required of the participating firefighters (0.5% pick -up). The Plan provides for full -time firefighting personnel to become eligible to participate in the Plan immediately upon hire. Under District resolution 96 -005, the District elected to pay the 0.5% (1% prior to December 9, 2004) employee required contribution on behalf of the employee. Effective December 9, 2004 the employee contribution was reduced to 0.5% (employee pick up). Effective July 1, 2001 (per resolution 01 -01), benefits under the Plan vest after six years of creditable service. Employees who elect normal retirement at or after age 55 with 6 years of creditable service, or 25 years of service regardless of age, are entitled to a retirement benefit. Employees may elect early retirement after 6 years of creditable service and attainment of age 50 with a reduction in benefit not to exceed 3% for each year before normal retirement. The Plan also includes certain disability and death benefits. Contributions - Contributions to the Plan are derived from three sources: employees (" 1 % pick -up" - 1% of compensation paid by the District on behalf of the employee pursuant to Resolution 96 -005) effective December 9, 2004, the required employee contribution was reduced to 0.5% (employee pick up), State funds (fire [hazard] insurance premium tax per Florida Statute Chapter 175) and employer (remaining amount necessary to meet actuarial requirement). For the period from January 1, 1996 through September 30, 1996, no employer contributions were required. Employer contributions were required from October 1, 1996 through September 30, 2009. The State contributions under Chapter 175 began in June 1997. This revenue is based on property fire insurance premiums paid within the District and is applied up to an approved "frozen" limit of $1,747,716. The District (employer) is required to fund the difference each year between the total contributions from all other sources for the year and the total cost for the year pursuant to the most recent actuarial valuation of the Plan. The total cost for any year equals total normal cost plus the additional amounts sufficient to amortize the ION NORTH NAPLES FIRE CONTROL AND RESCUE DISTRICT Page 33 of 59 NOTES TO THE FINANCIAL STATEMENTS September 30, 2009 NOTE G - RETIREMENT PLANS, CONTINUED Plan 2 - Plan description and provisions - Firefighters' Pension Trust Fund, continued unfunded past service liability over a 30 year period commencing the first year of the Plan's inception. Pursuant to the actuarial study dated October 1, 2008, the District's fiscal year 2009 contribution (District only) requirement was $1,756,227, which approximated 24.8% of the actuarially determined covered payroll. Actual District contributions to the Plan for the year ended September 30, 2009, were $2,077,653, including $283,580 applied from 2008 prepaid contributions and including $37,846 contributed by the District on behalf of the participating firefighters (employee pick -up)). The State contributions for the year ended September 30, 2009 were $1,039,931. At October 1, 2009, $1,277,632 of the Plan's total net assets (state contributions) were restricted for future benefits increases. Pension benefits - Effective July 1, 2001, employees with 6 or more years of service are entitled to monthly pension benefits, beginning at the earlier of age 55 with 6 years of credited service or 25 years credited service regardless of ages, equal to 3.53% of their average final compensation (AFC) over the 5 highest years within the last 10 years of service multiplied by number of years of credited service. Maximum benefit is 100% of AFC. The plan permits early retirement at age 50 with 6 years of credited service. Employees may elect to receive their pension benefits in the form of a 10 year certain and life annuity. If employees terminate before rendering 6 years of credited service, they forfeit the right to receive the portion of their accumulated plan benefits. All retirement benefits are annually increased for cost of living at 3 %. 10fl NORTH NAPLES FIRE CONTROL AND RESCUE DISTRICT Page 34 of 59 NOTES TO THE FINANCIAL STATEMENTS September 30, 2009 NOTE G - RETIREMENT PLANS, CONTINUED Plan 2 - Plan description and provisions - Firefighters' Pension Trust Fund, continued Death and Disability benefits - Upon the death of any vested member, whether or not still in active employment, a survivor benefit is payable to the beneficiary starting when the member would have reached retirement age. The benefit is equal to the vested pension benefit and is payable for 10 years. A spousal and/or minor benefit is provided for line of duty death is equal to a minimum of one half of the members salary for life (spouse) or age 18 (child). Employees who become totally disabled with at least 8 years of credited service receive the greater of the accrued pension benefit or 25% of AFC, if non - service incurred, or 42% of AFC, if active service incurred. Effective December 9, 2004, the active service related benefit was increased to 65 %. Supplemental Benefits - Effective December 31, 2004, each service and disability retiree and their joint pensioners or beneficiaries and vested terminated members shall receive a supplemental payment to be used as a health insurance subsidy payment. The amount shall be five dollars ($5) for each full year of credited service for life. The maximum monthly supplement is one hundred fifty dollars ($150) and the minimum thirty dollars ($30). Income recognition - Interest income is recorded on the accrual basis. Investments are reported at market value. Short-term investments are reported at cost, which approximates market value. Actuarial present value of accumulated plan benefits - Accumulated plan benefits are those future periodic payments, including lump -sum distributions, that are attributable under the Plan's provisions to the service employees have rendered. Accumulated plan benefits include benefits expected to be paid to (a) retired or terminated employees or their beneficiaries, (b) beneficiaries of employees who have died, and (c) present employees or their beneficiaries. Benefits under the Plan are based on employees' age at entry to the Plan and are based upon the current starting salary for firefighters at entry level. Benefits payable under all circumstances, retirement, death, disability and termination of employment, are included, to the extent they are deemed attributable to employee service rendered to the valuation date. to y . NORTH NAPLES FIRE CONTROL AND RESCUE DISTRICT Page 35 of 59 NOTES TO THE FINANCIAL STATEMENTS September 30, 2009 NOTE G - RETIREMENT PLANS, CONTINUED Plan 2 - Plan description and provisions - Firefighters' Pension Trust Fund, continued The actuarial present value of accumulated plan benefits is determined by an actuary and is the amount that results from applying actuarial assumptions to adjust the accumulated plan benefits to reflect the time value of money (through discounts for interest) and the probability of payment (by means of decrements such as for death, disability, withdrawal, or retirement) between the valuation date and the expected date of payment. The significant actuarial assumptions used in the valuations as of October 1, 2007 were (a) life expectancy of participants - RP 2000 (combined healthy, sex distinct) Mortality Table was used, (b) retirement age assumptions (the assumed average retirement age was 55), and (c) annual investment return of 8 %. The October 1, 2008 actuarial valuation reflected assumed average rates of return of 8 %. The foregoing actuarial assumptions are based on the presumption that the Plan will continue. If the Plan terminated, different actuarial assumptions and other factors might be applicable in determining the actuarial present value of accumulated plan benefits. Payment of benefits - Benefit payments to participants are recorded upon distribution. The District contributed 100% of the required contributions. A summary of certain Plan details and trend information is included below. A copy of the Plan and Plan audit for September 30, 2009 can be obtained by writing the District at 1885 Veterans Park Drive, Naples, Florida 34109 -0492, or by calling (239) 597 -3222. NORTH NAPLES FIRE CONTROL AND RESCUE DISTRICT NOTES TO TIM FINANCIAL STATEMENTS September 30, 2009 NOTE G - RETIREMENT PLANS, CONTINUED 10if Page 36 of 59 Plan 2 Plan description and provisions - Firefighters' Pension Trust Fund, continued The following is a summary of the Single Employer - Defined Benefits Plan, including funding policies, contribution methods, benefit provisions and trend information: Year established and governing authority Governing body Determination of contribution requirements: Employer (District) Plan members Funding of administrative costs Period required to vest Annual salary increase Post retirement benefit increase Eligibility for distribution (Normal retirement) Provisions for: Disability benefits Death benefits Early retirement Firefighters' Pension Trust Fund - Plan 2 District Resolution 96- 004 (July 11, 1996) Board of Trustees of Plan Actuarially determined Amount required in excess of Member and applicable State contributions needed in order to pay current costs and amortize any unfunded past service cost over 30 years 0.5% of Covered payroll - Note: The District adopted Resolution 96 -005 to fund the contribution for the employees: (Pick -up) Employer 6 years 6% Cost of living increase of of 3% each year Earlier of 55 with 6 years of credited service or 25 years credited service regardless of age Yes Yes Yes 10H 1 NORTH NAPLES FIRE CONTROL AND RESCUE DISTRICT Page 37 of 59 NOTES TO THE FINANCIAL STATEMENTS September 30, 2009 NOTE G - RETIREMENT PLANS, CONTINUED Plan 2 - Plan description and provisions - Firefighters' Pension Trust Fund, continued Memberships of the Plan consisted of the following at October 1, 2008: Firefighters' Pension Trust Fund - Plan 2 Active plan participants Vested 60 Non - vested 42 Retirees and beneficiaries receiving benefits 0 Terminated Plan members entitled to but not yet receiving benefits 2 Total 104 Number of participating employers 1 Number of participating state agencies 1 Annual Pension Cost Net Pension Obligation and Reserves Current year annual pension costs for the Firefighters' Pension Trust Fund are shown in the trend information provided. The Firefighters' Pension Trust Fund had a net unfunded actuarial accrued liability at October 1, 2008 of $170,727. The Plan assets are legally reserved for the payment of the respective plan member benefits within the Plan. There are no assets legally restricted for plan benefits other than these assets within the Plan. The Firefighters' Pension Trust Fund held certain investments at year end. IOU NORTH NAPLES FIRE CONTROL AND RESCUE DISTRICT Page 38 of 59 NOTES TO THE FINANCIAL STATEMENTS September 30, 2009 NOTE G - RETIREMENT PLANS, CONTINUED Plan 2 - Plan description and provisions - Firefighters' Pension Trust Fund, continued Trend Information Firefighters' Pension Trust Fund Total (2) Required Net Annual State (3) (1) Pension Fiscal Pension District State Frozen Actual Percentage Obligation Year Contribution Contribution Contribution Contribution Contribution Contributed (NPO) 2009 $ 2,796,158 $ 2,039,807 $ 1,039,931 $1,039,931 $ 3,079,738 110% - 2008 $ 2,211,933 $ 1,009,715 $ 1,485,798 $1,485,798 $ 2,495,513 113% - 2007 $ 2,132,248 $ 2,019,430 $ 1,390,449 $ 112,818 $ 2,132,248 100% - 2006 $ 1,178,959 $ 1,066,141 $ 733,516 $ 112,818 $ 1,178,959 100% - 2005 $ 1,000,009 $ 887,191 $ 608,709 $ 112,818 $ 1,000,009 100% - 2004 $ 792,577 $ 679,759 $ 527,004 $ 112,818 $ 792,577 100% - (1) Excludes employee 1% and 0.5 %, as applicable, pick -up but includes employer and State frozen contributions. (2) The District considers its annual pension cost to be its actuarially determined required annual pension contribution including the employer and state contribution. (3) The Plan's frozen limit for 2009 and 2008 was $1,747,716. Pension Trust Required Supplementary Information Schedule of Funding_ Progress Firefighters' Pension Plan: Unfunded Actuarial Actuarial Actuarial UAAL as a Value of Accrued Accrued Annual Percentage of Actuarial Assets Liability (AAL) Liability Funded Covered Covered Valuation (AVA) -Entry Age (UAAL) Ratio Payroll Payroll Date (a) _ (b) _ — b-a (alb) (c) (b -a)/c 10/01/09 $17,833,111 $18,108,267 $ 275,156 98.5% $ 7,522,834 3.7% 10/01/08 $16,719,426 $16,890,153 $ 170,727 99.0% $ 7,082,194 14% 10/01/07 $12,904,948 $12,884,785 $ (20,163) 100.2% $ 7,276,954 -0.3% 10/01/06 $ 8,572,161 $ 9,025,001 $ 452,840 95.0% $ 5,960,908 7.6% 10/01/05 $ 6,322,176 $ 6,783,798 $ 461,622 93.2% $ 3,815,952 12.1% 10/01/04 $ 4,063,514 $ 4,991,512 $ 927,998 81.4% $ 3,300,680 28.1% 10/01103 $ 2,420,236 $ 3,338,115 $ 917,879 72.5% $2,633,944 34.8% 1 NORTH NAPLES FIRE CONTROL AND RESCUE DISTRICT NOTES TO THE FINANCIAL STATEMENTS September 30, 2009 NOTE G - RETIREMENT PLANS, CONTINIJED ID 'IN Page 39 of 59 Plan 2 Plan description and provisions - Firefighters' Pension Trust Fund, continued Valuation date Actuarial cost method Amortization method Remaining amortization period Actuarial asset valuation method Actuarial assumptions: Investment rate Projected salary increase* *Includes inflation at Post retirement cost of living adjustment Plan 3 - Governmental Money Purchase Plan Firefighters' Pension Trust Fund 10/01/09 Frozen Entry Age Level dollar, closed 28 years (as of 10/1/09) Market 8% 6% 3% 3% During the year ended September 30, 2007, the District approved a Governmental Money Purchase Plan (401(a)), a defined contribution plan which is available only to the District's now former Fire Chief. The Plan is completely administered by the Plan custodian. The Plan required the District to make monthly contributions of a percentage of the former Chiefs eligible compensation equal to the average of the rate for the special risk category of the FRS and the contribution rate for the District's Chapter 175 Firefighters' Pension Trust. In addition, as part of the former Chiefs employment agreement, an amount equal to the proportionate share of the annual premium designated for his medical benefits are to be placed in the 401(a) plan in lieu of participation in the District's medical plan. Any amounts in excess of the maximum allowable contributions to a 401(a) plan are placed in the former Chief s 457 Deferred Compensation Plan. The contribution limits for calendar years 2009, 2008, and 2007, were $49,000, $46,000, and $45,000, respectively. On October 12, 2006, the Board adopted Resolution 06 -045 which established the plan and required retroactive contributions to the date of employment of the Fire Chief (June 13, 2006). Ifl `H NORTH NAPLES FIRE CONTROL AND RESCUE DISTRICT Page 40 of 59 NOTES TO THE FINANCIAL STATEMENTS September 30, 2009 NOTE G - RETIREMENT PLANS, CONTINUED Plan 3 - Governmental Money Purchase Plan, continued The contribution rate for the year ended September 30, 2007 was 26.91 % and the contributions totaled $56,056, including the medical premium benefit. The contribution rate for the year ended September 30, 2008 was 26.91 % and the contributions totaled $56,996, including the medical premium benefit. The contribution rate for the year ended September 30, 2009 was 26.91% and the contributions totaled $47,616, including the medical premium benefit. During the year ended September 30, 2009, the Chief elected to early retire. As such, the now former Chief, as part of the District's early retirement incentive package, agreed to retire and is entitled to the benefits described in Note M of the financial statements. NOTE H - POST - EMPLOYMENT BENEFITS OTHER THAN PENSION BENEFITS The District provides insurance (health, life and dental) benefits to its retired employees. All retired full -time employees are eligible for benefits if actively employed by the District immediately before retirement. As of September 30, 2009, there were fifteen (15) retirees receiving these benefits. The benefits are provided both with and without contractual or labor agreements. The benefits may require contribution from the retirees, depending on certain specified criteria and, in particular, length of creditable employment. The District, also, pays up to 50% of retiree dependent coverage. The District finances the benefits on a pay -as- you -go basis and recognizes expenditures at the time premiums are due. The net cost to the District for these benefits totaled $97,052 during the year ended September 30, 2009. NOTE I - RISK MANAGEMENT The District began participating in a self - insurance program for health and dental insurance claims beginning January 1, 2005 and continued to do so through December 31, 2008. The self - insurance program had stated annual individual stop loss limits ($60,000 per individual employee for calendar 2005, $70,000 for calendar 2006, $80,000 for calendar years 2007 and 2008) and aggregate loss limits (approximately $1.8 million for calendar 2006, $2.2 million for calendar 2007, and $2,667,000 for calendar 2008, but varied with number of covered employees) and retained third parry excess coverage (reinsurance) for claims in excess of the loss limits. 10H NORTH NAPLES FIRE CONTROL AND RESCUE DISTRICT Page 41 of 59 NOTES TO THE FINANCIAL STATEMENTS September 30, 2009 NOTE I - RISK MANAGEMENT, CONTINUED Beginning January 1, 2009, the District converted to a fully funded third party insured health plan; however, dental remains a self - insurance plan. Maximum benefit per participant is $1,500 per year, which includes employees, spouses, and family. Maximum dental benefits payable for calendar 2009, is approximately $789,000, but varies with the number of covered participants. Vision insurance was added to the benefits offered and is not a self - insurance plan. In addition, the District added a policy for reimbursement of the cost of certain over - the - counter medications in lieu of prescriptions. There is no stated maximum amount that will be reimbursed for prescriptions. The District incurred $2,879,676 in claims, third party administration costs, premiums and reinsurance premiums during the fiscal year ending September 30, 2009, for the self - insurance and fully- funded insurance programs. No accrual has been made as of September 30, 2009, for estimates of amounts to be paid for actual and incurred claims but not reported (IBNR) claims prior to January 1, 2009 as it is not possible to determine claims incurred and not reported. It is the policy of the District to purchase third party commercial insurance for other remaining forms of potential risks to which it is exposed. The District's risk management activities are reported in the General Fund. No accrual has been recorded for claims and incidents not reported to the insurer. The District had no significant reductions in insurance coverage from the prior year. Reported claims have not exceeded the insurance coverage for the years ended September 30, 1998 through September 30, 2009. The District's total liability within any one year is limited to the annual loss limit, except for tail coverage estimated at approximately three (3) months' average claims in the year of plan termination. The District has no plan to terminate coverage. NOTE J - PROPERTY TAXES Property taxes are levied after formal adoption of the District's budget and become due and payable on November I of each year and are delinquent on April 1 of the following year. Discounts on property taxes are allowed for payments made prior to the April 1 delinquent date. Tax certificates are sold to the public for the full amount of any unpaid taxes and must be sold not later than June 1 of each year. The billing, 10H NORTH NAPLES FIRE CONTROL AND RESCUE DISTRICT Page 42 of 59 NOTES TO THE FINANCIAL STATEMENTS September 30, 2009 NOTE J - PROPERTY TAXES, CONTINUED collection, and related record keeping of all property taxes is performed for the District by the Collier County Tax Collector. No accrual for the property tax levy becoming due in November 2009 is included in the accompanying basic financial statements, since such taxes are collected to finance expenditures of the subsequent period. Procedures for collecting delinquent taxes, including applicable tax certificate sales and tax deed sales, are provided for by Florida Statutes. The enforceable lien date is approximately two years after taxes become delinquent and occurs only upon request of a holder of a delinquent tax certificate. As of September 30, 2009, $247,246 was due from the Collier County Tax Collector to the District for ad valorem taxes and excess fees, and interest. Important dates in the property tax cycle are as follows: Assessment roll certified Millage resolution approved Taxes due and payable (Levy date) Property taxes payable - maximum discount (4 percent) Beginning of fiscal year for which taxes have been levied Due date Taxes become delinquent (lien date) Tax certificates sold by the Collier County Tax Collector July 1 No later than 93 days following certification of assessment roll. November /with various discount provisions through March 31. 30 days after levy date October 1 March 31 April 1 Prior to June 1 For the year ended September 30, 2009, the Board of Commissioners of the District levied ad valorem taxes at a millage rate of $0.9869 per $1,000 (0.9869 mill) of the 2008 net taxable value of real property located within the District. `- t NORTH NAPLES FIRE CONTROL AND RESCUE DISTRICT NOTES TO THE FINANCIAL STATEMENTS September 30, 2009 10H Page 43 of 59 NOTE K - DESIGNATED AND/OR RESERVED FUND BALANCE/NET ASSETS Fund Balance/Net Assets were designated and/or reserved for the following purposes at September 30, 2009: Designated fund balance General Fund - Maintaining level of service General Fund - Replacement Radios /Communications General Fund - Health insurance General Fund - GASB 45 Post Employment Benefits General Fund - Emergency reserve General Fund - Operating reserve General Fund - Capital fire apparatus General Fund - Building improvements General Fund - Vehicle replacement General Fund - SCBA replacement General Fund - Capital equipment General Fund - Station 446 improvements General Fund - Personal Protective Gear Total General Fund Reserved Net Assets Firefighters' Pension Fund - firefighters' retirement benefits Total Reserved Net Assets Amount $ 5,413,929 300,000 500,000 500,000 500,000 2,400,000 1,800,000 1,500,000 100,000 160,000 1,501,000 20,900 100,000 $ 14,795,829 Amount $ 17,833,061 $ 17,833,061 to tit,, NORTH NAPLES FIRE CONTROL AND RESCUE DISTRICT Page 44 of 59 NOTES TO THE FINANCIAL STATEMENTS September 30, 2009 NOTE L - IMPACT FEE FUND ACTIVITY During the year ended September 30, 2009, the Impact Fee Fund had the following activity: Amount Deferred revenue, October 1, 2008 Impact fee receipts (1) 532,907 Interest income 3,506 Other income - Refunds (31,891) Operating fees - collection fees (7,984) Capital outlay Prior Year Deficit Fund Balance (306,127) Deferred revenue, September 30, 2009 $ 190,411 (1) Including Impact fee receipts due from other governments of $65,904. During the year ended September 30, 2009, the District had Impact Fee receipts in the amount of $532,907 and recognized (earned) impact fees of $342,496 which cleared the prior year deficit fund balance. NOTE M - TERMINATION BENEFITS During the year ended September 30, 2009, the District offered an Early Retirement Incentive Package to all sworn employees to reduce the long term operating expenses of the District. Eligible employees were allowed to make a one time irrevocable decision to accept the Early Retirement Incentive Package. The effective date, as selected by each employee, must be no later than ninety (90) days after the employee's anniversary date occurring between October 1, 2008 and September 30, 2009 but under no circumstances may the effective date be later than September 30, 2009. The Package offered one (1) year's base salary and professional pay incentives, and payout of the balance of accrued unused sick, vacation, and holiday pay where applicable. The Early Retirement Incentive Package also allowed for the use of any unused personal and/or Column D time, provided the use of such time is completed prior to the commencement of the Early Retirement Incentive option, no later than ninety days after the employee's anniversary date, or no later than September 30, 2009, whichever is earliest. ION NORTH NAPLES FIRE CONTROL AND RESCUE DISTRICT Page 45 of 59 NOTES TO THE FINANCIAL STATEMENTS September 30, 2009 NOTE M - TERMINATION BENEFITS, CONTINUED Additionally, each eligible employee that chose the Early Retirement Incentive option would receive the same health, vision and dental insurance as bargaining unit employees for employee, spouse, and their dependents, paid one hundred percent (100 %) by the District for three (3) years from the beginning of the each employee's Early Retirement Incentive Package effective date. The District would also continue to provide life insurance for the employee for twelve (12) months immediately following the employee's Early Retirement Incentive Package effective date. Each eligible employee selecting the Early Retirement Incentive option could choose to receive the payout of the base salary and professional incentives in one (1) or two (2) lump sum payments, or to receive the amount incrementally over twenty four (24) pay periods. If the incremental payout was selected, the payment of the balance of accrued, unused sick, vacation, and holiday pay would be paid on the twenty fourth (24th) incremental payment. If the lump sum payment option was chosen, the payment of the balance of the accrued, unused sick, vacation, and holiday pay was paid on dates selected by each employee between their Early Retirement Incentive option effective date and September 30, 2009. Employees selecting the incremental payout was also credited one (1) year of service to be included in the calculation of the retiree health insurance benefit pursuant to District Policy Section 14.05. Thirteen (13) District employees elected to accept the Early Retirement Incentive Package. Two (2) of the thirteen (13) employees chose a single lump sum payment, two (2) chose two(2) lump sum payments, and the remaining eleven (11) chose to be paid incrementally over twenty four (24) pay periods (twelve (12) months). The total cost of the termination benefits is estimated to be $2,157,471 consisting of $994,484 paid during the year ended September 30, 2009, $918,547 included in the government -wide statements as the current portion of long term debt, and $244,440 included in non - current portion of long term debt. Final payment of benefits relating to the Early Retirement Incentive Package will occur during September, 2012. The estimated cost for fiscal years 2010, 2011, and 2012 is based on current rates for health insurance coverages and does not include any rate projected increases as any increase can not be readily estimated. NORTH NAPLES FIRE CONTROL AND RESCUE DISTRICT NOTES TO THE FINANCIAL STATEMENTS September 30, 2009 NOTE M - TERMINATION BENEFITS, CONTINUED 10 ' 0 . •. Page 46 of 59 The estimated cost for the thirteen (13) participants that elected to accept the early retirement incentive package over the next three years is as follows: Year Ending Estimated Cost 9/30/2010 $918,547 9/30/2011 167,843 9/30/2012 76,597 NOTE O - COMMITMENTS AND CONTINGENCIES The District is involved from time to time in certain routine litigation, the substance of which either as liabilities or recoveries, would not materially affect the financial position of the District. Although the final outcome of the lawsuits, assertions, and claims or the exact amount of costs and/or potential recovery is not presently determinable, in the opinion of the District's legal counsel, the resolution of these matters will not have a materially adverse affect on the financial condition of the District. As a general policy, the District plans to vigorously contest any such matters. NOTE P - IMPLEMENTATION OF RECENTLY RELEASED GASB STATEMENTS The Governmental Accounting Standards Board has issued Statement No. 45, "Accounting and Financial Reporting by Employers for Post - Employment Benefits Other Than Pensions" (GASB 45). This Statement will change the manner in which a governmental entity discloses, accrues, and funds its post retirement benefits other than pensions. Upon implementation of this statement, the District will be required to actuarially determine the cost of its post retirement benefits other than pensions and fund those costs annually. This Statement may have a significant effect on the District's annual budget. The Statement is effective for the year ended September 30, 2010, The District intends to implement this Statement at that time and has designated fund balance in the General Fund in the amount of $500,000 to begin funding of this liability. The District contracted an actuary to perform this analysis. The actuary has released and initial estimate of the District's required annual contribution which ranged between $195,000 and $304,000. REQUIRED SUPPLEMENTARY INFORMATION OTHER THAN MD &A I 10 "l` ,I 1015 NORTH NAPLES FIRE CONTROL AND RESCUE DISTRICT Page 47 of 59 STATEMENT OF REVENUES, EXPENDITURES AND CHANGES IN FUND BALANCE - BUDGET AND ACTUAL - GENERAL FUND - SUMMARY STATEMENT Year Ended September 30, 2009 Variance Original Final Favorable Budget Budget Actual (Unfavorable) REVENUES Ad Valorem taxes $ 26,103,691 $ 26,663,348 $ 26,670,789 $ 7,441 Intergovernmental revenue - - 67,841 67,841 Charges for services 138,625 138,625 119,720 (18,905) Miscellaneous: 1,149,730 1,651,843 1,509,669 142,174 Interest 492,000 492,000 600,040 108,040 Other 289,470 289,470 230,114 (59,356) Subtotal - revenues 27,023,786 27,583,443 27,688,504 105,061 Cash brought forward 11,206,075 13,953,594 (13,953,594) TOTAL REVENUES 38,229,861 41,537,037 27,688,504 (13 848,533) EXPENDITURES Current Public safety Personal services 22,078,248 21,590,657 21,379,100 211,557 Operating expenditures 4,037,116 3,859,382 3,198,514 660,868 Capital outlay 1,149,730 1,651,843 1,509,669 142,174 Debt service Principal reduction 53,389 1,241,479 1,246,190 (4,711) Interest and fiscal charges 25,114 35,114 62,975 (27,861) Reserves 10,886,264 13,706,152 13,706,152 TOTAL EXPENDITURES 38,229,861 42,084,627 27;396,448 14,688,179 EXCESS OF REVENUES OVER (UNDER) EXPENDITURES OTHER FINANCING SOURCES (547,590 292,056 839,646 Proceeds from disposition of capital assets - 20,000 22,589 2,589 Proceeds from capital lease _527,590 527,590 - TOTAL OTHER FINANCING SOURCES - 547,590 550,179 2,589 EXCESS OF REVENUES AND OTHER FINANCING SOURCES OVER EXPENDITURES $ - $ - 842,235 $ 842,235 FUND BALANCE - Beginning FUND BALANCE - Ending The accompanying notes are an integral part of this statement. 13,953,594 $ 14,795,829 10 H 0"` NORTH NAPLES FIRE CONTROL AND RESCUE DISTRICT Page 48 of 59 STATEMENT OF REVENUES, EXPENDITURES AND CHANGES IN FUND BALANCE - BUDGET AND ACTUAL GENERAL FUND - DETAILED STATEMENT Year Ended September 30, 2009 EXPENDITURES Variance Current Original Final Favorable Public safety Budget Bud e_ Actual (Unfavorable) REVENUES Ad Valorem taxes 3 26,103,691 $ 26,663,348 $ 26,670,789 $ 7,441 Intergovernmental revenue - - 67,841 67,841 Charges for services 138,625 138,625 119,720 (18,905) Miscellaneous: 577,281 577,281 446,507 130,774 Interest 492,000 492,000 600,040 108,040 Other _ 289,470 289470 230,114 (59356) Subtotal - revenues 27,023,786 27,583,443 27,688,504 105,061 Cash brought forward 11,206,075 13,953 =594_ - (13,953,594) TOTAL REVENUES 38,229,861 41,537,037 27,688,504 (13,848,533) EXPENDITURES Current Public safety Personal services: Salaries Firefighters & Admim 12,155,279 12,155,279 12,361,445 (206,166) Commissioners 30,000 30,000 30,000 - Overtime 577,281 577,281 446,507 130,774 Incentives and holiday pay 550,207 550,207 559,027 (8,820) Payroll taxes Social Security 1,055,246 1,055246 1,019,520 35,726 Benefits Retirement 2,885,289 2,885,289 2,916,692 (31,403) Health insurance 2,950,000 2,843,000 2,926,039 (83,039) Disability insurance 169,032 69,032 64,712 4,320 Vacation 129,417 68,000 65,902 2,098 Sick leave 460,598 460,598 447,949 12,649 Unemployment insurance 37,464 37,464 22,749 14,715 Workers compensation 966,435 747,261 477,635 269,626 Employee physicals 110,000 110,000 35,086 74,914 Retirement recognition 2,000 2,000 5,837 (3,837) Subtotal - Personal services 22,078,248 21,590,657 21,379,100 211,557 The accompanying notes are an integral part of this statement. 10"N NORTH NAPLES FIRE CONTROL AND RESCUE DISTRICT Page 49 of 50 STATEMENT OF REVENUES, EXPENDITURES AND CHANGES IN FUND BALANCE - BUDGET AND ACTUAL GENERAL FUND - DETAILED STATEMENT (CONTINUED) Year Ended September 30, 2009 The accompanying notes are an integral part of this statement. Variance Original Final Favorable Operating expenditures: Budget Budget Actual (Unfavorable) Insurance 343,549 343,549 247,746 95,803 Uniforms 63,450 63,450 48,788 14,662 Communications 34,000 34,000 28,629 5,371 Telephone 200,000 200,000 163,394 36,606 Utilities 190,100 190,100 198,217 (8,117) Maintenance Vehicle 320,800 320,800 304,205 16,595 Equipment 43,060 43,060 51,542 (8,482) Computer 166,734 80,000 57,570 22,430 Hydrant 70,600 70,600 52,583 18,017 Building 343,070 343,070 337,721 5,349 Supplies Office 43,660 43,660 29,402 14,258 Protective gear 26,500 26,500 29,524 (3,024) Station 27,900 27,900 32,270 (4,370) Emergency medical 92,267 92,267 88,906 3,361 Hursicane /emergency 10,000 10,000 - 10,000 Equipment Office _ 44,857 44,857 45,792 (935) Fire 92,000 92,000 53,348 38,652 Shop 4,150 4,150 10,274 (6,124) Warehouse/Logistics 2,000 2,000 1,906 94 Professional and other fees Legal and professional 316,000 225,000 227,930 (2,930) Property appraiser fees 209,048 209,048 178,748 30,300 Tax collector fees 525,074 525,074 530,309 (5,235) Accounting 85,000 85,000 69,290 15,710 Miscellaneous Travel 68,170 68,170 21,456 46,714 Water /sewer fee St. 44 5,000 5,000 4,602 398 Public information officer 3,675 3,675 832 2,843 Public education officer 27,900 27,900 19,472 8,428 Fuel and oil 350,000 350,000 166,904 183,096 Legal advertisements 9,900 9,900 5,974 3,926 Dues and subscriptions 8,873 8,873 11,563 (2,690) CERT team 13,210 13,210 3,485 9,725 Dive team 5,450 5,450 8,128 (2,678) Fire prevention 17,444 17,444 10,557 6,887 Training 167,000 167,000 122,633 44,367 Hazardous materials 7,000 7,000 12,345 (5,345) Technical rescue 7,475 7,475 7,835 (360) Boat team 6,000 6,000 5,300 700 K -9 search and rescue 1500 1,500 - 1,500 Honor guard 2,700 2,700 (128) 2,828 PETC 1,000 1,000 - 1,000 Peer fitness 1,000 1,000 - 1,000 Miscellaneous 30,000 30,000 9,462 20,538 Operational Reserves Contingency _ 50,000 50,000 50,000 Subtotal - Operating expenditures 4,037,116 _3,859,382 3198,514 660,868 The accompanying notes are an integral part of this statement. NORTH NAPLES FIRE CONTROL AND RESCUE DISTRICT STATEMENT OF REVENUES, EXPENDITURES AND CHANGES IN FUND BALANCE - BUDGET AND ACTUAL GENERAL FUND - DETAILED STATEMENT (CONTINUED) Year Ended September 30, 2009 Capital outlay: Land Station improvements Fire & rescue equipment Protective gear Communication equipment Office equipment Computers Technical rescue equipment Boat team Training equipment Shop equipment LogisticsAvarehouse Hazardous materials equip. Fire apparatus _ Dive equipment Fire prevention Subtotal ion 44 Page 50 of 59 Debt service: 22,589 2,589 527,590 Variance Original Final 53,389 Favorable Budget Budget Actual (Unfavorable) - 454,523 454,523 - 413,700 413,700 345,624 68,076 73,000 73,000 76,962 (3,962) 20,000 20,000 22,240 (2,240) 12,000 12,000 - 12,000 30,000 30,000 14,709 15,291 65,305 65,305 29,795 35,510 5,525 5,525 2,829 2,696 6,000 6,000 12,940 (6,940) 16,000 16,000 12,270 3,730 3,700 3,700 - 3,700 5,000 5,000 4,950 50 8,000 8,000 - 8,000 480,000 527,590 527,590 - 6,000 6,000 - 6,000 5,500 5,500 5,237 263 Capital outlay 1,149,730 1,651,843 1,509,669 142,174 Debt service: 22,589 2,589 527,590 527,590 - 547,590 Principal reduction 53,389 1 241,479 1,246,190 (4,711) Interest and fiscal charges 25,114 35,114 62,975 (27,861 Subtotal -Debt service 78,503 1,276,593 1,309,165 (32,572) Reserves: Designated reserves 10,886,264 13,706,152 - 13,706,152 TOTAL EXPENDITURES 38,229,861 42,084,627 27,396,448 14,688,179 EXCESS OF REVENUES OVER (UNDER) EXPENDITURES OTHER FINANCING SOURCES Proceeds from disposition of capital assets Proceeds from capital lease TOTAL OTHER FINANCING SOURCES 547,590 292,056 839,646 - 20,000 22,589 2,589 527,590 527,590 - 547,590 - 550,179 2,589 EXCESS OF REVENUES AND OTHER FINANCING SOURCES OVER EXPENDITURES $ - S FUND BALANCE - Beginning FUND BALANCE - Ending The accompanying notes are an integral part of this statement. 842,235 $ 842,235 13,953,594 $ 14,795,829 1; NORTH NAPLES FIRE CONTROL AND RESCUE DISTRICT STATEMENT OF REVENUES, EXPENDITURES AND CHANGES IN FUND BALANCE - BUDGET AND ACTUAL - IMPACT FEE FUND - SUMMARY STATEMENT Year Ended September 30, 2009 10H MR Page 51 of 59 EXPENDITURES Current Public safety Operating expenditures 18,000 Capital outlay 1,200,000 Reserves - 18,000 39,875 (21,875) 1,200,000 - 1,200,000 TOTAL EXPENDITURES 1,218,000 1,218,000 39,875 1,178,125 EXCESS OF REVENUES OVER (UNDER) EXPENDITURES $ - $ - 306,127 $ 306,127 FUND BALANCE - Beginning (306,127) FUND BALANCE - Ending $ The accompanying notes are an integral part of this statement. Impact Fee Fund Variance Original Final Favorable Budget Budget Actual (Unfavorable) REVENUES Fees: Impact fees $ 1,200,000 $ 1,200,000 $ 342,496 $ (857,504) Miscellaneous: Proceeds from Sale of Land - - ' Interest 20,000 20,000 3,506 (16,494) Other - Subtotal - revenues 1,220,000 1,220,000 346,002 (873,998) Cash brought forward (2,000) (2,000) - 2,000 TOTAL REVENUES 1,218,000 1,218,000 346,002 (871,998) EXPENDITURES Current Public safety Operating expenditures 18,000 Capital outlay 1,200,000 Reserves - 18,000 39,875 (21,875) 1,200,000 - 1,200,000 TOTAL EXPENDITURES 1,218,000 1,218,000 39,875 1,178,125 EXCESS OF REVENUES OVER (UNDER) EXPENDITURES $ - $ - 306,127 $ 306,127 FUND BALANCE - Beginning (306,127) FUND BALANCE - Ending $ The accompanying notes are an integral part of this statement. l NORTH NAPLES FIRE CONTROL AND RESCUE DISTRICT STATEMENT OF REVENUES, EXPENDITURES AND CHANGES IN FUND BALANCE - BUDGET AND ACTUAL IMPACT FEE FUND - DETAILED STATEMENT Year Ended September 30, 2009 11M, iJ A Page 52 of 59 -� EXPENDITURES Miscellaneous Refunds - - 31,891 (31,891) Impact fee collection 18,000 18,000 _ 7,984 10,016 Subtotal - Operating expenditures 18 =000 18,000 39,875 (21,875) Capital outlay: Emergency traffic device - St. 42 - - Station 48 engineering 1,200,000 1,200,000 - 1,200,000 Station 49 engineering - Subtotal - Capital outlay 1,200,000 1,200,000 - 1,200,000 Rcscrves — - TOTAL EXPENDITURES 1,218000 1,218,000 39,875 1,178,125 EXCESS OF REVENUES OVER (UNDER) EXPENDITURES $ - $ - 306,127 $ 306,127 FUND BALANCE - Beginning (306,127) FUND BALANCE - Ending $ The accompanying notes are an integral part of this statement. Variance Original Final Favorable Budget Budget Actual (Unfavorable) REVENUES Fees: Impact fees S 1,200,000 $ 1,200,000 $ 342,496 $ (857,504) Miscellaneous: Proceeds from sale of land - - - - Interest 20,000 20,000 3,506 (16,494) Other Subtotal - revenues 1,220,000 1,220,000 346,002 (873,998) Cash brought forward (2,00) (2,000 2,000 TOTAL REVENUES 1,218,000 1,218,000 346,002 (871,998) -� EXPENDITURES Miscellaneous Refunds - - 31,891 (31,891) Impact fee collection 18,000 18,000 _ 7,984 10,016 Subtotal - Operating expenditures 18 =000 18,000 39,875 (21,875) Capital outlay: Emergency traffic device - St. 42 - - Station 48 engineering 1,200,000 1,200,000 - 1,200,000 Station 49 engineering - Subtotal - Capital outlay 1,200,000 1,200,000 - 1,200,000 Rcscrves — - TOTAL EXPENDITURES 1,218000 1,218,000 39,875 1,178,125 EXCESS OF REVENUES OVER (UNDER) EXPENDITURES $ - $ - 306,127 $ 306,127 FUND BALANCE - Beginning (306,127) FUND BALANCE - Ending $ The accompanying notes are an integral part of this statement. ion NORTH NAPLES FIRE CONTROL AND RESCUE DISTRICT Page 53 of 59 STATEMENT OF REVENUES, EXPENDITURES AND CHANGES IN FUND BALANCE - BUDGET AND ACTUAL - INSPECTION FEE FUND - SUMMARY STATEMENT Year Ended September 30, 2009 Inspection Fee Fund Variance Original Final Favorable Budget Budget Actual (Unfavorable) REVENUES Charges for services $ 700,000 $ 700,000 $ 461,231 $ (238,769) Miscellaneous: Interest 3,000 3,000 2,021 (979) Subtotal- revenues 703,000 703,000 463,252 (239,748) Cash brought forward 7,051 7,051 - (7,051) TOTAL REVENUES 710,051 710,051 463,252 (246,799) EXPENDITURES Current Public safety Personal services 687,370 687,370 295,845 391,525 Operating expenditures - - - Capital outlay - - - Reserves 22,681 22,681 22,681 TOTAL EXPENDITURES 710,051 710,051 295,845 414,206 EXCESS OF REVENUES OVER EXPENDITURES $ - $ - 167,407 $ 167,407 FUND BALANCE - Beginning (20,038) FUND BALANCE - Ending The accompanying notes are an integral part of this statement. $ 147,369 ion "_ NORTH NAPLES FIRE CONTROL AND RESCUE DISTRICT Page 54 of 59 STATEMENT OF REVENUES, EXPENDITURES AND CHANGES IN FUND BALANCE - BUDGET AND ACTUAL INSPECTION FEE FUND - DETAILED STATEMENT Year Ended September 30, 2009 EXPEND17F RES Inspection Fee Fund - Current Variance Original Final Favorable Budget Budget Actual (Unfavorable) REVENUES Salaries Fees: Regular 612,853 612,853 266,664 Inspection fees $ 700,000 $ 700,000 $ 461,231 $ (238,769) Miscellaneous: Profess ional/Iacentives and holiday pay 4,800 4,800 9,000 Interest _ 3,000 3,000 2,021 (979) Subtotal - revenues 703,000 703,000 463,252 (239,748) Cash brought forward 7,051 _ 7,051 (7,051 TOTAL REVENUES 710,051 710,051 463,252 (246,799) EXPEND17F RES - Current Public safety Personal services: Salaries Regular 612,853 612,853 266,664 346,189 Overtime - Profess ional/Iacentives and holiday pay 4,800 4,800 9,000 (4,200) Payroll taxes Social Security 50,391 50,391 20,181 30,210 Benefits Retirement - Health insurance - Disability insurance - - - Vacation - Sick leave 19,326 19,326 - 19,326 Unemployment compensation - - - - Workers compensation _ - - Subtotal- Personal services 687,370 _ 687,370 _ 295,845 391,525 The accompanying notes are an integral part of this statement. NORTH NAPLES FIRE CONTROL AND RESCUE DISTRICT STATEMENT OF REVENUES, EXPENDITURES AND CHANGES IN FUND BALANCE - BUDGET AND ACTUAL - INSPECTION FEE FUND - DETAILED STATEMENT (CONTINUED) Year Ended September 30, 2009 Operating expenditures: Uniforms Telephone Utilities Maintenance Contract labor Hydrant Supplies Office Miscellaneous Employee physicals Dues & subscriptions Fire prevention Training Miscellaneous Subtotal - Operating expenditures 1OH 4 Page 55 of 59 Inspection Fee Fund Variance Original Final Favorable Budget Budget Actual (Unfavorable) Capital outlay: Office facility - - Vehicles Subtotal - Capital outlay Debt service: Principal reduction - - - - interest and fiscal charges - - Subtotal - Debt service Reserves: _ 22,681 22,681 22,681 TOTAL EXPENDITURES 710,051 710,051 295,845 414,206 EXCESS OF REVENUES OVER (UNDER) EXPENDITURES $ - $ 167,407 $ 167,407 FUND BALANCE - Beginning FUND BALANCE - Ending The accompanying notes are an integral part of this statement. (20,038) $ 147,369 ADDITIONAL REPORTS OF INDEPENDENT AUDITOR I ON 14t °l InTUSCAN c9z 'Company, PA Certified Public Accountants & Consultants 1O'H Affiliations Florida Institute of Certified Puhlic Accountants Americau lostilule of Certified Puhlic Accomltuuts Private Companies Prsiice Section INDEPENDENT AUDITOR'S REPORT ON INTERNAL CONTROL OVER FINANCIAL REPORTING AND ON COMPLIANCE AND OTHER MATTERS BASED ON AN AUDIT OF BASIC FINANCIAL STATEMENTS PERFORMED IN ACCORDANCE WITH GOVERNMENT AUDITING STANDARDS 'I'as Division Page 56 of 59 Board of Commissioners North Naples Fire Control and Rescue District 1885 Veterans Park Drive Naples, Florida 34109 -0492 We have audited the basic financial statements of North Naples Fire Control and Rescue District as of and for the year ended September 30, 2009 and have issued our report thereon dated March 31, 2010. We conducted our audit in accordance with auditing standards generally accepted in the United States of America and the standards applicable to financial audits contained in Government Auditing Standards, issued by the Comptroller General of the United States. Internal Control Over Financial Reporting In planning and performing our audit, we considered North Naples Fire Control and Rescue District's internal control over financial reporting as a basis for designing our audit procedures for the purpose of expressing our opinion on the basic financial statements, but not for the purpose of expressing an opinion on the effectiveness of North Naples Fire Control and Rescue District's internal control over financial reporting. Accordingly, we do not express an opinion on the effectiveness of North Naples Fire Control and Rescue District's internal control over financial reporting. A deficiency in internal control exists when the design or operation of a control does not allow management or employees, in the normal course of performing their assigned functions, to prevent or detect misstatements on a timely basis. A significant deficiency is a deficiency, or a combination of deficiencies, in internal control that is less severe than a material weakness, yet important enough to merit attention by those charged with governance. INTEGRITY .— .... SERVICE .,., ... E%'PERIENCE 12621 'World Plaza Lane, Building 55 , Fort Nlyers, FL '33907 ^ Phone (23)) 333 -2090 ^ Fax: (239) 333 -2097 I-D Page 57 of 59 A material weakness is a deficiency, or combination of deficiencies, in internal control such that there is a reasonable possibility that a material misstatement of the basic financial statements will not be prevented or detected and corrected on a timely basis. Our consideration of internal control over financial reporting was for the limited purpose described in the first paragraph of this section and was not designed to identify all deficiencies in internal control over financial reporting that might be deficiencies, significant deficiencies or material weaknesses. We did not identify any deficiencies in internal control over financial reporting that we consider to be material weaknesses, as defined above. Compliance and Other Matters As part of obtaining reasonable assurance about whether North Naples Fire Control and Rescue District's basic financial statements are free of material misstatement, we performed tests of its compliance with certain provisions of laws, regulations, contracts and grant agreements, noncompliance with which could have a direct and material effect on the determination of basic financial statement amounts. However, providing an opinion on compliance with those provisions was not an objective of our audit, and accordingly, we do not express such an opinion. The results of our tests disclosed no instances of noncompliance or other matters that are required to be reported under Government Auditing Standards. This report is intended solely for the information and use of the Board of Commissioners, management, the Auditor General of the State of Florida, and other federal and state audit agencies. This report is not intended to be, and should not be, used by anyone other than these specified parties. 1 TUSCAN & COMPANY, P.A. Fort Myers, Florida March 31, 2010 TUSCAN zcz Company, PA Certified Public Accountants & Consultants A211MJJ Florida Institute of Certified Public Account ants American InstiIo1c of Certified Public Amon [ants Private Companies Practice Sec ion Tax Division Page 58 of 59 INDEPENDENT AUDITOR'S REPORT TO MANAGEMENT Board of Commissioners North Naples Fire Control and Rescue District 1885 Veterans Park Drive Naples, Florida 34109 -0492 We have audited the basic financial statements of North Naples Fire Control and Rescue District (the "District ") as of and for the fiscal year ended September 30, 2009 and have issued our report thereon dated March 31, 2010. In connection with our audit, we are submitting the following comments and recommendations in accordance with Chapter 10.550 "Rules of the Auditor General - Local Governmental Entity Audits" (Revised September 30, 2009) Rule 10.557(3) and Section 218.39(4), of the Florida Statutes. PRIOR YEAR COMMENTS THAT CONTINUE TO APPLY: No financially significant prior year comments were noted. CURRENT YEAR COMMENTS: No financially significant comments noted. We have included in this letter all comments which came to our attention during the course of our audit regarding items 1 through 7, as applicable, of the "Rules of the Auditor General -Local Governmental Entity Audits," Rule 10.554, Section (1)(i). In regard to Item 2, we represent that the District has complied with Florida Statute 218.415 regarding the investment of public funds. In regard to item 7(a), nothing came to our attention to cause us to believe that at any time during the year the North Naples Fire Control and Rescue District met any of the criteria for being in a state of financial emergency as defined in Florida Statute 218.503(1). In regard to item 7(c)(1), we applied financial condition assessment procedures pursuant to Rule 10.556(7) and noted no significant indications of deteriorating financial conditions. As such, we do not believe the District to be in a state of financial emergency as a consequence of conditions described in Section INTEGRITY ..,..... SERVICE ....,.. EXPERIENCE 12621 World Plaza Lane, Building 56 -Fort Myers, PL 33907 = Pilolw (?39) 333-2090 ^ Fax: (239) 333 -2097 1 O n Page 59 of 59 218.503(1) of the Florida Statutes. In regard to Item 7(b), we represent that the financial report filed with the Department of Financial Services, pursuant to Florida Statute 218.32(1)(a), is in agreement with the annual financial audit report for the same period. This report is intended solely for the information and use of the Board of Commissioners, management, the Auditor General of the State of Florida and other federal and state audit agencies. This report is not intended to be, and should not be, used by anyone other than these specified parties. TUSCAN & COMPANY, P.A. Fort Myers, Florida March 31, 2010 FM ft m 10fi I J 5 0 M .dontinzFS 1 J. Clu•istopher Lombardo, Chairman F + e lIIII5 Veterans Park Drive Margaret Hanson, Vice Chairman c s Paul J. Moriarty, Sr. Treasurer Naples, FL 34109 James Burke, Commissioner 'C'""^F,'fR= (239) 597 -3222 John O. McGowan, Commissioner rax (239) 597 -7032 Noirth Pqn pks F ire (Contrro� 2nd IR e5c ue District; April 8, 2010 Auditor General's Office Local Government Audits /342 Claude Pepper Building, Room 401 111 West Madison Street Tallahassee, FL 32399 -1450 We are pleased to note that the audit report for the fiscal year 2008/2009 reflected no current year or prior comments which require management's response. The Board of Fire Commissioners and management staff of the North Naples Fire Control & Rescue District have worked diligently to resolve past audit comments and address deficiencies in internal controls, and policy and procedures to insure the financial stability of the District. The audit report for the fiscal year ended September 30, 2009 reflects the commitment of the Board and staff to successfully resolve prior year issues. Sincerely, NORTH NAPLES FIRE CONTROL & RESCUE DISTRICT /24 ORL� .STOLT' Fire hief 6i5z_e_,� �"�' I—c_- REBECAH BRONSDON Assistant Chief of Administrative Services WEISS SEHOTA HELFMAN PASTORIZA COLE & BONISHE, P.L. 1ITCHELL BIERMAN, P.A. NINA L. BONISKE, P.A. MITCHELL J. SURNSTEM, P.A. JAMIE ALAN COLE, P.A. STEPHEN J. HELFMAN, P.A. GILBERTO PASTORIZA, P.A. MICHAEL S. POPOK, P.A. JOSEPH H. SEROTA, P.A. SUSAN L. TREVARTHEN, P.A. RICHARD JAY WEISS, P.A. DAVID M. WOLPIN, P.A. DANIEL L. ABBOTT GARY L. BROWN LYNN M,DANNHEISSER IGNACIO G. DEL VALLE ALAN L.'GABRIEL DOUGLAS R. GONZALES MATTHEW H. MANDEL BRETT J. SCHNEIDER LORI ADELSON* LILLIAN M. ARANGO' SHAWNTOYIA N. BERNARD JEFF P.H. CAZEAU ARTE P. CORBETT RAQUEL ELEJASARRIETA James V. Mudd County Manager Collier County 3301 E. Tamiami Trail, Naples, FL 134112 ATTORNEYS AT LAW A PROFESSIONAL LIMITED LIABILITY COMPANY INCLUDING PROFESSIONAL ASSOCIATIONS BROWARD OFFICE 200 EAST BROWARD BOULEVARD SUITE 1900 FORT LAUDERDALE, FLORIDA 33301 TELEPHONE 954-763-4P42 FACSIMILE 954764-7770 Www.WSH-LAW.COM MIAMI -DARE OFFICE 2525 PONCE DE LEON BOULEVARD • SUITE 700 CORAL GABLES, FLORIDA 33134 TELEPHONE 305- B54-OBOO • FACSIMILE 305 -854 -2323 -OF COUNSEL March 4, 2009 10 CHAD S. FRIEDMAN MACADAM J. GLINN R. BRIAN JOHNSON JOHN J. KENDRICK III HARLENE SILVERN KENNEDY KAREN LIEBERMAN' JOHANNA M. LUNDGREN KATHRYN M. MEHAFFEY HARRIS S. NIZEL ALEXANDER L. PALENZUELA-MAURI- MATTHEW PEARL DIANE P. PEREZ JOHN J. QUICK ANTHONY L. RECTO SCOTT A. ROBIN DANIEL A. SEIGEL GAIL D. SEROTA* JONATHAN C. SHAMRES ESTRELLITA S. SIBILA ANTHONY C. SOROKA EDUARDO M. SOTO MICHAEL L. SFINES NANCY STUPARICH' BLANCA M. VALLE GLORIA M. VELAZOUEZ- MEITIN CHRISTOPHER J. VOLK LAURA K. WENDELL* (1�JAMES E 3Ey /�s / - kMECEIVED OFFICE OF THE COUNTY" !:iANAGEP MAR .�- 9 2009 ACTION aCi•w: l � Re: Request for Applications for Certificates of Public Convenience and Necessity -North Naples Fire Control and Rescue District and East Naples Fire Control and Rescue District Dear Mr. Mudd: The undersigned serves as legal counsel for the North Naples Fire Control and Rescue District and the East Naples Fire Control and Rescue District (collectively, the "Districts "). The Districts desire to provide non - transport Advanced Life Support services in their respective I -ri lctiens, and thus, we are rleasesleguts know as applications for as possible so that weemay t tender associated with this request, p payment and begin the application process. Please feel free to call me if you have any questions or concerns. Very truly yours, Douglas R. Gonzales 1731.001 cc: Michael L. Brown, Fire Chief, North Naples Douglas E. Dyer, Fire Chief, East Naples -/ March 17, 2009 Douglas R. Gonzales Weiss Serota Helfman Pastoriza Cole & Boniske, P.L. 200 East Broward Boulevard Suite 1900 Fort Lauderdale, FL 33301 Dear Mr. Gonzales, I am responding to your March 4, 2009 request for information on applying for a Certificate of Public Convenience and Necessity in Collier County. The Certificate for Public Convenience and Necessity (COPCN) is issued by the Board of Commissioners following a public hearing and a finding based upon competent evidence that certain criteria as outlined in Collier County Ordinance No �� 'o� "Requirement for Board Approval in Granting Certificate" is satisf' I have attached a copy of the or n for your review. The information outlined in Section 5, "Procedures for Obtaining Certificate" may be placed on each of your client's letterhead as we will review these applications individually. If I may offer any additional information, or answer any questions, please do not hesitate to contact my office. I would request you send your application to: Mr. Dan E. Summers, Director, Collier County Bureau of Emergency Services, Collier County Administration Building, Suite 103, 3301 East Tamiami Trail, Naples, FL 34112. Sincerely, James V. Mudd County Manager cc: Scott Teach, Deputy County Attorney Dan Summers, Director Collier County Bureau of Emergency Services Chief Jeff Page, Collier County Emergency Medical Services --2 off 0�4 y, ^+° - °, ORDINANCE N0.2005 - 15 APR 2075 0442 J AMENDING NEr EXL D ENTITLED: NS AND C ONS FROM CERTIFICATE REQUIREMENT. REQUIREME 62 �ZZCZ OZE: WHEREAS, Collier County desires to make available to its .citizens safe, proCessiona emergency health care transportation services for the transfer of patients between and among local hospital racilides; and WHEREAS, Collier County desires to facilitate the provision of such services and has the - necessary equipment, training, expertise, professional certifications and licenses to do so; and WHEREAS, the amendment to Ordinance Number 04-12 results in a benefit to Collier County by reducing response times for certain transports and providing for the availability of more transport vehicles. THE BOARD `.. ` U NOW THEREFORE: BE IT ORDAINED BY rri� COMMISSIONERS OF COLLIER COUNTY, FLORIDA: - tnz �D B n� m Section 1: Purpose mT s This ordinance is adopted pursuant to Chapters 125 and 401, Florida te? THC O N purpose of this ordinance is to provide better protection for the health, safety and �e arc of the residents of Collier County, in ambulance and ALS matters, by establishing uniform county -wide standards for certification of ambulance or advanced life support or services, or operations by promulgating complete and clear rules and regulations for operation of all ambulance or rescue companies or services in Collier County. Section 2: Definitions A. Advanced Life Support (ALS) shall mean procedures conducted as defined in applicable Florida Statutes and Florida Administrative Code, Section 64E. B. Administrator shall mean the County Manager or his designee. C Ambulance means any privately or publicly owned land, air, or water vehicle that is designed, constructed, reconstructed, maintained, equipped or operated, and is used for or intended to be used for air, land, or water . transportation of persons, who are sick, injured; or otherwise helpless. D. Board shall mean the Collier County Board of County Commissioners. E. Certificate means a certificate of convenience and necessity as authorized in Section 401.25 (2)(d), Florida Statutes. F. Emergency Call shall mean the transit of an ambulance under conditions which warrants travel with flashing lights and siren operating. 14-3 10H G. operator shall mean any person, organization o, . governmental entity providing ambulance or ALS services. 11. Patient shall mean an individual who is ill, sick, injured, wounded, or otherwise incapacitated or helpless. I. Routine Call or Routine Transfer shall mean the transportation of a patient under non - emergency call conditions. ). Rescue Service shall mean first response treatment of patients but does not include Advanced Life Support (ALS) or transport. Section 3: Requirements For Certificate. It shall be unlawful for any person, firm, agency, or any other entity, including govemmental units, to provide an ambulance service or provide advanced life support without First obtaining a certificate therefore from the Board of County Commissioners of Collier County. Section 4: Exemptions and Exclusions From Certificate Requirement Certificates shall not be required for: A. Rescue Services. B. The use of a non - ambulance for any transport of a patient pursuant to the Good Samaritan Act, Section 768.13, Florida Statues. C. Vehicles rendering ambulance -type services when requested to do so by the Board of County Commissioners or County Manager in the event of a major catastrophe or other such emergency which requires more ambulances that are available in the county. D. Ambulances based outside the county which pick up a patient in the county and transport him out of the county, or which pick up a patient out of the county and transport him into the county. E. Vehicles used to transport persons for routine scheduled medical treatments. Vehicles transporting persons who require services en route are not covered by this exemption. Section 5: Procedure For Obtaining Certificate An applicant for a certificate shall obtain forms from the department to be completed and returned to the Division Administrator. Each application shall contain: A. The name, age, and address of the owner of the ambulance or ALS provider, or if the owner is a corporation, then of the directors of the corporation and of all the stockholders Words underlined added and words streek oxgh are deleted. z / / '7 10. holding more that 25% of the outstanding shares. For governmental units, this information shall be supplied for members of the governing body. B Tho boundaries of the territory desired to be served. C _ The number and brief description of the ambulances or other vehicles the applicant will have available. D. The address of the intended headquarters and any sub - stations. g. The training and experience of the applicant F. The names and addresses of three (3) Collier County residents who will act as references For the applicant. G A schedule of rates which the, service intends to charge. H. Such other pertinent information as the administrator may require. 1. An application or renewal fee of two hundred fifty dollars ($250.00). (Exception Collier County EMS.) J. Financial data including assets and liabilities of the operator. A schedule of all debts encumbering any equipment shall be included. Section 6: Review of Application The Administrator shall review each application and shall investigate the applicant's reputation, competence, financial responsibility, and any other relevant factors. The Administrator shall also make an investigation as to the public necessity for an ambulance or ALS operation in the territory requested, and shall then make a report to the Board containing his recommendation whether to grant a certificate to the applicant within sixty (60) days of the time the Administrator determines the application is complete. Section 7: Requirement For Board Approval In Granting Certificate The Board of County Commissioners shall not grant a certificate unless it shall find, after public hearing and based on competent evidence that each of the following standards has been satisfied: A. That there is a public necessity for the service. in making such determination, the Board Of County Commission shall consider, as a minimum, the following factors: (1) The extent to which the proposed service is needed to improve the overall Emergency Medical Services (EMS) capabilities of the County. (2) The effect of the proposed service on existing services with respect to quality of service and cost of service. Words underlined added and words stfa� are deleted. 3 IDIf ors (�) The effect of the proposed service on the overall cost of EMS service in the County. (4) The effect of the proposed service on existing hospitals and other health care facilities. - - (5) The effect of the proposed service on personnel of existing services and die availability of sufficient qualified personnel in the local area to adequately staff all existing services. B. That the applicant has sufficient knowledge and experience to properly operate the proposed service. C. That, if applicable, there is an adequate revenue base for the proposed servicc. D. That the proposed service will have sufficient personnel and equipment to adequately cover the proposed service area. Section g: Appointment of Hearing officer _. In making the determinations provided for in Section 7 above, the Board may, in its sole discretion, appoint a Hearing Officer to hold a public hearing and to make factual findings and conclusions as a result of the hearing. Should a Hearing Officer be appointed, said Hearing Officer shall render a written report to the Board within 30 days of the hearing, which report _ shall contain the officer's . findings and conclusions of fact, and a recommended order. The findings and conclusions of fact shall be binding upon the Board, but the recommended order shall be advisory only_ Section 9: Rights and Duties Granted By Certificate The certificate granted by the Board shall be valid for one calendar year and shall be personal to the applicant and not transferable. In the case of a corporation, if there occurs such a transfer of stock or other incidents of ownership as to change the majority or largest stockholder, EL new certificate must be applied for. Changes in the officers of the corporation will not require a new certificate. Acceptance of the certificate by the applicant shall obligate the applicant to: A. Service the entire zone granted to the applicant. B. provide coverage to adjoining zones, when requested to do so by Emergency Control for emergency calls when the certificate bolder for that zone is unable to respond C. Keep posted at his place of business a copy of the fee schedule, which must be filed with the Administrator (If applicable). Words underlined added a�=gf are deleted. - 4 arid words A - 6 1Ot D. Operate in accordance with the rules and.Tegulations adopted pursuant to this Ordinance and any applicable County Ordinances, and Chapter 401 Florida Statutes, and any administrative regulations adopted pursuant thereto. E. Employ at all times sufficient personnel experienced in operation and management of emergency medical services to ensure proper and efficient operation. Section 10: Renewal of Certificate Each certificate holder shall file within ninety (90) days of expiration, an application For renewal of his certificate. Renewals shall be based upon the same standards; as the granting of the original certificate along with such other factors as may be relevant. The renewal application shall be accompanied by a two hundred and fifty dollar ($250.00) renewal fee. The renewal certificate may be approved routinely by the Board, upon advice of the Administrator, or the Board may hold a hearing on same. Section 11: Emergency Provisions The Board may modify, suspend or revoke a certificate in the interest of the public health, safety and welfare, only at public hearing and after reasonable notice has been given to the certificate holder affected. However, if a situation exists which poses a serious threat that ambulance or rescue service will not be available to any certain area of Collier County, the Administrator 'shall have such temporary emergency powers as are necessary to provide that service. These temporary powers are intended to provide interim protection until such time as the Board meets to resolve the emergency. Section 12: Classifications of Certificates There shall be two (2) classifications of service in Collier County, as follows: A. Class 1: Collier County EMS: ALS Rescue: An EMS provider with the capability of rendering on the scene prebospital ALS services and who may or may not elect to transport patients. An Ems provider rendering this level of service for a governments] entity shall be. deemed to be operating under the Class 1 - ALS rescue certificate of public convenience and necessity held by the governments] entity. An EMS provider holding a Class. l ALS rescue certificate may provide post - hospital interfscility medical transfer services and routine ALS and BLS calls within the County. A Certificate of Public Convenience and Necessity must be obtained from the County before engaging in this level of medical service. Wards underlined added and words s REIsoasa are deleted. 5 - 7 10H g, Class 2: Collier County Hospitals: I. ALS Transfer: An EMS provider who renders ALS inlerfacility medical transfer services. An EMS provider who is awarded a Class 2 - ALS transfer certificate and does not possess a Class l - ALS rescue certificate shall not respond to an emergency call and provide ALS rescue services unless called upon by the appropriate Class I - ALS rescue provider to provide emergency backup service, in these instances, it shall be deemed to be operating under the Class) - ALS rescue certificate of the governmental entity requesting such emergency backup service. 2. Class 2 - ALS transfer certificate holders may provide post- hospital interfacility medical transfer services and routine ALS and BLS calls within the County but only to hospitals owned by the certificate holder, however, the Class 2 certificate holder may provide out -of- County transports. Unless an EMS provider possesses a Class 1 - ALS Rescue certificate issued by the County, a Certificate Of public Convenience and Necessity must be obtained from the County before engaging in this level of medical service. 3. Class -2 transfer certificate holders shall contract with the Class - 1 rescue - certificate holder's Medical Director for the performance of services set forth in - Florida Statutes, Section 401.265 and as specifically set forth herein as follows: a. He shall supervise and accept direct responsibility for the medical performance of the paramedics and Emergency Medical Technicians (hereinafter EMTs). b. He shall develop medically correct standing orders or protocols 'dating to life support system procedures when communication cannot be established with a supervising physician or when any delay in patient care would potentially threaten the life or health of the patient C. . He shall issue standing orders and protocols to ensure that the Class -2 transfer certifiesta holder transports each of its patients to facilities that offer a type and level of care appropriate to the patient's medical condition. d. He or his appointee shall provide continuous 24hour- per -day, 7- day -per -week medical direction which shall include, is addition to the development of protocols and stmmding orders, direction to the Class -2 transfer Wnrds underlined added and words gtpao r' eg' are deleted. 6 A-9 101. certificate holder's personnel as to the availability of "off- line" service to resolve problems, system conflicts, and provide services in an emergency as that term is defined by section 25234(3), Florida Statutes. e. He shall establish a quality assurance committee to provide for quality assurance review of all -EMTs and paramedics operating under his supervision. f. He shall audit the performance of system personnel by use of a quality assurance program that includes but is not limited to a prompt review of patient care records, direct observation, and comparison of performance standards for drugs, equipment, system protocols and procedures. He shall be responsible for participating in quality assurance programs developed by the Class -2 transfer certificate holder. g. He shall ensure and certify that security procedures of the Class -2 transfer certificate holder for medications, fluids and controlled substances are in compliance with chapters 401, 499 arid 893, Florida Statutes, and chapter IOD-45 of the Florida Administrative Code. h. He shall create, authorize and ensure adherence to, detailed written operating procedures regarding all aspects of the handling of medications, fluids and controlled substances by the EMS personnel and comply with all requirements of chapters 401,499 and 893, Florida Statutes. L He shall notify the Florida Department of Health, (hereinafter the "Department") in writing when the use of telemetry is not necessary. j, He shall notify the department in writing of each substitution of equipment or medication. k. He shall assume direct responsibility for the use by an EMT of an automatic or semi - automatic defibrillator; the performance of esophageal intubation by an EMT; and on routine interfacility transports, the monitoring and maintenance of non - medicated I.V.s by an EMT. He shall ensure that the EMT is trained to perform these procedures; shall establish written protocols for the performance of these procedures; and sball provide written evidence to the Florida Department of Health documenting compliance with the provisions of this paragraph Words underlined added and words �a�ar -uviff are deleted. --1 10H 1. He shall ensure that all EMTs and paramedics are trained in the use ethodologies as provided in sections 64E -2.017 of the of the trauma scorecard m F.A.C., for adult trauma patients and 64E - 2.0175, FA-C, for pediatric trauma patients. m. He shall participate as a crewmember on an EMS vehicle for a minimum of 10 hours per year and complete a minimum of 10 hours per year of continuing medical education related to pre - hospital care or leaching or a - combination of both. n. He shall ensure that all of the Class -2 transfer certificate holder's EMTs and paramedics have all proper certifications and receive all training necessary to maintain their certification. Section 13: Transfer Or Assignment of Certificates No certificate issued under this Ordinance shall be assignable or transferable by the _.. person to whom issued except unless approval is obtained from the Board in the same manner investigation, fees and public hearing as original and subject to the same application, jority transfer of shares or stock or interest of any person or applications for certificates. Any ma operator so as to cause a change in the directors, officers, majority stockholders or managers of such person or operator shall be deemed a transfer or assignment as contemplated in this Ordinance and subject to the same rules and regulations as any other transfer or assignment. Section 14: Revocation, Alteration Or Suspension Grounds A Every certificate issued under this Ordinance shall be subject to revocation, alteration and/or suspension of operation, by the Board, for a period of up, to one year, where it shall appear that: 1, The operator has failed or neglected for a period of thirty (30) days during any calendar year to render all services authorized by his certificate. 2 The operator has been convicted of a felony or any criminal offense involving, moral turpitude. 3. The certificate was obtained by an application in which any material fact was omitted or falsely stated 4.. The operator has knowingly permitted any of its motor vehicles to be operated in violation the laws which result to conviction of the driver or operator of a are deleted. 8 Words underlined added and words stgl' 44,9 ion! vI misdemeanor in mi the second degree or greater, or has knowingly permitted a driver with more than two previous convictions to operate emergency vehicles. 5. The operator has failed to comply with any of the provisions of this Ordinance. g. The public interest will best be served by revocation, alteration, or suspension of any certificate upon good cause shown. 7. The operator or his agent has demanded money or compensation other that that established and prescribed under this ordinance. (if applicable). S. The operator has without sufficient . justification failed or refused to Furnish emergency care and/or transportation promptly for a sick or injured person. 9_ The operator or his agent has been found guilty of malpractice or willful and wanton misconduct in the operation of its service. B. All complaints shall be investigated and a report thereon made to the Board, together with findings and recommendations, within fifteen (15) days. If revocation, suspension or alteration of any certificate appears warranted, the Board shall give notice to the operator holding the certificate that the same will be considered at a specific commission meeting, provided the date of such meeting shall not be less than five (5) days from the date of the notice. The Board shall thereupon consider the complaint and either revoke, suspend or alter the certificate or dismiss the complaint. section 15: General Operating Regulations All certificate holders, operators, and drivers shall comply with all state statutes and administrative regulations as following regulations: A. Twenty-four Hour Service. Every certificate holder shall be required to operate sufficient ambulances, as stated on the certificate of operation and determined by the Board, on immediate call at all times. B. prompt Service Required. Every call for ambulance service shall be answered promptly. Patients shall be loaded and transported without being subject to unreasonable delays. All calls for emergency assistance requiring over twenty (20) minutes from time of notification to arrival on scene shall be reported to the Administrator with complete -- documentation of the circumstances, which delayed the response. Those instances where more that three (3) minutes elapse between receipt of an emergency call and dispatch of an ambulance shall also be reported to the Administrator with documentation of circumstances. - words underlined added and words swdek >=o f,h are deleted 10H IN C. Bed Linens. Clean and sanitary bed linens shall be provided for each patient carried and -shall be changed as soon as practicable after the discharge of the patient. D. Daily Log. Every operator shall maintain in a daily log upon which shall be recorded the place or origin, time of call, time of dispatch, time of arrival at scene, time left for It and charges for each trip made and such other hospital, time of arrival at operating and patient information as may be required by Ordinance. Every operator shall retain and preserve all daily logs for at least two (2) years, and such logs shall be available for inspection by the Administrator. g, Communications. Each ambulance shall maintain two -way radio communication with the location of primary dispatch from which it operates, as well as any additional communication capabilities required by Ordinance or state law. F. Vehicles and Equipment. Each vehicle shall be equipped with the proper medical and emergency equipment as required by the laws of the State of Florida and shall be subjected to inspection from time to time to insure compliance with the laws of Florida and this Ordinance. G. Certification. In addition to the State of Florida Department of Health, Bureau of Emergency Medical Services requirements for certification, each paramedic must be certified by the County Medical Director. Each paramedic must work with a Collier County EMS ambulance for a sufficient length of time for the ambulance service medical director to properly judge his capability. At minimum, the paramedic must work in that capacity not less than one full month's work shift annually. Salaries of other than Collier County EMS paramedics will be paid by the agency seeking the Medical Director Certification. H: Application. Each ambulance or ALS service shall be subject to those rules and regulation as promulgated by Ordinances of the Board for the purpose of carrying out this ordinance. Section 16: Central Place of Business - Each operator shall maintain a central place of business which shall be entirely within his designated operating zone, at which place he shall provide two -way radio communication with his vehicles, the County Emergency Control Communications Center, and his place of business, a properly listed telephone for receiving all calls for service and at which central place of business he shall keep such business records and daily logs available for inspection or audit by Words underlined added and words g-- • - are deleted. 10 Z t�nt;�s1T IOH Rim shall keep on file with the Ad m inistrator and the County the Administrator. Every operator Emergency Control Communications Center a business address and telephone number a[ which the operator may be reached.at all times. This information will be maintained at the Emergency Control Center. Section 17: Records To Be Kept Every operator shall keep accurate records of receipts from operations, operating and other expenses, capital expenditure and such other operating and patient information as may be required by the Board. Section 18: Rates Every operator shall file with the Board a schedule of the rates. Such rates shall be filed as a part of each new or renewal application, and .a rate schedule shall also be filed when changes in rates are proposed., All such rates shall be subject to review and approval by the Board. _. Section 19: Operator's Insurance Every ambulance operator shall carry bodily injury and property damage insurance with solvent and responsible insurers authorized to transact business in the State of Florida to secure payment for any loss or damage resulting from any OccutTence arising out of or caused by the operation or use of any of the operator's motor vehicles. Each vehicle shall be insured for the sum of at least one hundred thousand dollars ($100,000.00) for injuries to or death of any one person arising out of any one accident and the sum of at least three hundred thousand dollars ($300,000.00) for injuries to or death or more than one person in any one accident and for the sum of at least fifty thousand dollars ($50,000.00) for damage to property arising from any one accident- They shall also have malpractice insurance. Every insurance policy or contract for - such insurance shall provide for the payment and satisfaction of my financial judgment entered against the operator and present insured or any person driving the insured vehicle. Such insurance shall be obtained and certificates or certified copies of such policies shall be filed with the Board. All such insurance policies, certificates thereof or certified copies of such insurance policies shall provide for a thirty (30) day cancellation notice to the Board. Section 20: conduct of Drivers And Attendants All drivers,. EMT,, and paramedics shall comply with the laws of the State of Florida, in order to meet the requirements set out in this Ordinance and no driver, EMT or paramedic . registered hereunder shalt: .,,..,..r.-_.. are deleted. 1 Words underlined added and words �gl' A-13 10H k A. Fail or refuse to promptly transport, if applicable, or attend. any sick or injured person after responding to a call. g. Demand or receive compensation other that that established and approved in accordance with this ordinance or fail to give a receipt for moneys received. (If applicable). reduced rate not provided in the C. Give or allow rebate, commission, discount or any established rate. (If applicable.) D At any tune induce or seek to induce any person engaging an ambulance or ALS service to patronize or retain the services of any hospital, convalescent home, mortuary, cemetery, attorney, accident investigator, nurse, medical doctor or other service occupation or profession. E. At any time release his patient from his ca until he is assured that some responsible re person is available to receive such patient. T. At any time use a siren or flashing red light unless on an emergency call. G. Disobey the lawful orders of the law enforcement officer at the scene of an accident, or y or at a fire scene, the fire officer in charge other similar such emergenc . H. Smoke while within the confines of an ambulance. 1. operate or ride in an ambulance without using seatbelts. (Personnel attending patients are exempt). - Section Zl: Passengers ulances when engaged in emergency or routine medical calls No.person shall be aboard amb except the following: A, Driver, attendants and fire or law enforcement personnel; B. Patients; or close friend of the patient, or if the situation warrants, the C. Not more that one relative paramedic in charge may authorize more than one passenger. - D. Physicians and nurses, _ capacity that arc being trained for ambulance or ALS service. g. Personnel in an Observing F. Operator's supervisory personnel. Section 22: Obedience to Traffic Laws, Ordinances or Regulations. A. The driver of an ambulance or ALS vehicle when responding to an emergency call or while trarvsporting a patient may exercise the following privileges when such driver has are deleted. 1 Z Words underlined added and words s� m.ta�-�' P ' 1Oi 4 reasonable grounds to believe that an emergency in fact exists requiring the exercise of such privileges: I Park or stand, irrespective of the otherwise applicable provisions of law, ordinance or regulations. 2 proceed past a red light or stop signal or stop sign, but only after slowing down as may be necessary for safe operations. 3_ Exceed the maximum speed limits permitted by law so long as he does not endanger life or property. 4. Disregard laws, ordinances or regulations governing direction or movement or turning in specified directions so long as he does not endanger life or property. B. The exemptions herein granted shall apply only when such vehicle is making use of audible and/or visible signals meeting the requirements of this Ordinance. C. The foregoing provisions shall not relieve the driver of a vehicle from the duty to drive with due regard for the safety of all persons, nor shall such provisions protect the driver from the consequences of his reckless disregard for the safety of others. Section 23: Violations In addition to the remedies provided herein, a violation of any provision of this ordinance shall be punishable as provided by law for the violation of County ordinances. Section 24: Uniformity of Application The Ordinance shall constitute a uniform law applicable in all of Collier County. Section 25: Authority To Enforce It is hereby declared to be the duty of the Board of County Commissioners of Collier County, its officers, agents, employees and other governmental agencies, the sheriff's department of Collier County, its deputies and agents, fire departments, as well as the police of the various municipalities falling under the provisions of this Ordinance to departments strictly enforce the provisions of this Ordinance. Section 26: Repeal and Codification Ordinance 75 -50 is hereby repealed. This Ordinance shall be codified in the Collier County Code as Chapter 4 of said Code, and said Code is hereby amended accordingly. Section 27: Conflict and Severability In the event this Ordinance should ever conflict with any other ordinance of Collier County, or applicable ordinance of any municipality. or other applicable law, rule or regulation, Words underlined added and words stall -t§raugb are deleted. 13 A '1 section, sub - section, sentence, clause, phrase or portion of the more restrictive shall apply. If any this Ordinance is for any reason held invalid or uncodstitutional by any court of competent ch portion shall be deemed a separate, distinct and independent provision and such jurisdiction, su holding shall not affect the validity of the remainder of the Ordinance. Section 28: Effective Date ctive upon receipt of notice that it has been filed with This Ordinance shall become effe the Secretary of State* pASS.ED AND DULY ADOPTED by the Board of County Commissioners of Collier County, Florida, this 3 day of 2005. ATTEST: DWIGHT E. BROCK, Clerk By: ch sib ►tttest is to Cbat. �., n� . si9satrre 0411.x..........,, oF'•.. A wd'i� t %get+ Scott icacn •.�; Assistant County, BOARD OF COUNTY COMI fSSIONERS COLLIER COUNTY, FLOP DA j�^ By: Fr ed W. Coyle, Chatxman Thj; grdlnance filed with the �BG ta�Y of _st_at_e-s- AOffi day Of ocknowled9e-ent of taa fi 'received ibis gf 5 ! a o.n - Words underlined added and words s&aek -� are deleted. 14 10H A_/6 STATE OF FLORIDA) COUNTY OF COLLIER) I, DWIGHT E. BROCK, Clerk of Courts in and for the Twentieth Judicial Circuit, Collier County, Florida, do hereby certify that the foregoing is a true and correct copy of: ORDINANCE 2005 -16 Which was adopted by the Board of County Commissioners on the 23nd day of March 2005, during Regular Session. WITNESS my hand and the official seal of the Board of County Commissioners of Collier County, Florida, this 2Bth day of March, 2005. DWIGHT E. BROCK,,••''tgi Clerk of Courtsc Ex- officio to Q County Commis3�i r o�,� Q• Jym By: Linda A. Houfa Deputy Clerk R x 1 -t� - o HIS C ler C01414tY Bureau of Emergency Services September 24, 2009 J. Christopher Lombardo Chairman, Board of Fire Commissioners North Naples Fire Department 1885 Veterans Park Drive Naples, FL 34109 On September 19th I received your application and fee for a COPCN for the North Naples Fire Department. I will assume that any questions or concerns noted during our review may be directed to you at the address above. If you would prefer someone else in your organization to be the contact person, please feel free to call or write my office with the name of your designee. Respectfully, Dan E. Summers, CEM Director cc: Mr. Leo Ochs, Deputy County Manager Chief Jeff Page, Collier County EMS B=S 8075 Lely Cultural Par vw2y • Naples, Flonda 34113 • 239 -252 -3600' FAX 239 - 252 -3700 • www.colkerem.org P'/i 1 10 W 4s ■ Complete items 1, 2, and 3. Also complete item 4 if Restricted Delivery is desired. 'i n Print your name and address on the reverse: so that we can return the card to you., W Attach this card to the back of the mailpiece,. _ or on the front If space permits.` . -1. Article Addressed to: I J. Christopher Lombardo -- Chair, Board of Fire Commissioners ., North Naples Fire Department 1885 Veterans Park Drive Naples, FL 34109 I I 2. AkIcleNumber -7000 OSao- i _ :(Punster from seMce label) F PS Form 381.1; February 2004 Domestic F A. Abort I M C. D. Is delivery address dmeMM rrom nem i i If YES, enter delivery address below: 3:.. Service Type Wertified Mail ❑ Express Mail, ❑ Registered , ❑.Retum Rebeipt for Me e rchandis 0 Insured Mail ❑ C.O.D. 4..Restdcted Delivery? F-xtra Fee) ❑ Yes ooll, -[399 -25G�, atum Recelpt __ _ _ 102585 -02 -M154e fil/1 .S1 ru ru . a- 17 Postage E it D' i1l rrl Certified Fee Postmark Retum Receipt Fee He. ..0: -n ri Pidamement Requires) D Restricted neWery Fee In O (Endarsement Required) O M Total Postage i Fees ru ru LrI to J. Christopher Lombardo by mailer) o Chair, Board of Fire Commissioners 0 0 .North Naples Fire Department 0 0 1885 Veterans Park Drive -- - M1 M1 Naples, FL 34109 - ■ Complete items 1, 2, and 3. Also complete item 4 if Restricted Delivery is desired. 'i n Print your name and address on the reverse: so that we can return the card to you., W Attach this card to the back of the mailpiece,. _ or on the front If space permits.` . -1. Article Addressed to: I J. Christopher Lombardo -- Chair, Board of Fire Commissioners ., North Naples Fire Department 1885 Veterans Park Drive Naples, FL 34109 I I 2. AkIcleNumber -7000 OSao- i _ :(Punster from seMce label) F PS Form 381.1; February 2004 Domestic F A. Abort I M C. D. Is delivery address dmeMM rrom nem i i If YES, enter delivery address below: 3:.. Service Type Wertified Mail ❑ Express Mail, ❑ Registered , ❑.Retum Rebeipt for Me e rchandis 0 Insured Mail ❑ C.O.D. 4..Restdcted Delivery? F-xtra Fee) ❑ Yes ooll, -[399 -25G�, atum Recelpt __ _ _ 102585 -02 -M154e fil/1 10 M" Co per C ;ounty Bureau of Emergency Services. September 28, 2009 Mr. Richard Yovanovich, Esq. Coleman, Yovanovich & Koester, PA 4001 Tamiami Trail North Suite 300 Naples, FL 34103 RE: North Naples Fire Department — COPCN Via certified mail J_ r Dear Mr. Y ovic The Collier County Bureau of Emergency Services requests the following information in hardcopy, in conjunction with the NNFD -COPCN request, as noted under Section 5, paragraph E Copies of State Certificates and curriculum -vita for the following: o Chief Orly Stolts • James Cunningham • Becky Bronson • Jorge Aguilera o Michael Swanson You may send this information to my attention at the address listed below. Thank you for your time and attention to this matter. Sincerely, Dan E. Summers, CEM Director 1 8075 Lely Cultural Parkway • Naples, Florida 34113 •239- 252 -3600 • FAX 239- 252 -37D0 • www.colllerem.org �''ZD ION U, L, - ed by.(Printec r` Ln D delivery addiess'dif 1. Article Addresaed to: 117 11l N N it 0-' Postage S '.. tT' Er M m Certified Fee Postmark —D Retum Receipt Fee (FndorsemerR Required) Here ri C3 O - Restricted Delivery Fee M, p (Endorsement Require 0' = Tetal Postage & Pees N N .- ui Mr. Richard Yovanovich, Esq. eredcyreaner) 0 0 Coleman, Yovanovich &Koester, PA - - - -- 0 0 4001 Tamiami Trail North, Suite 300 — N Naples, FL 34103 r, I'l ■ Complete its me 1, 2, and 3. Also:complete item 4 if Restricted Delivery is desired....,, _ W Pent Y,Q6r name and,address on.the.reverse so that we can;return the card to you. A Sig L - ed by.(Printec - a Attach this card to the back of the mallpiede; or on the front if. space permits. D delivery addiess'dif 1. Article Addresaed to: If YES, enter delivery Mr. Richard Yovanovich; Esq. I. Coleman, Yovanovich & Koester, PA A( Name) C. Dete of /PL va No 4001 Tamiami Trail North, Su te 300 3. Service Type Naples, FL 34103 �1,Cert�ed Mail ❑Eicpress Mail ❑ Registered', ❑ Return Recelpt'for Merchandise I7. Insured Mail 11 % 4. Restricted Delivery? (Eextm Foe) ❑ Yes 2. Article. Number 1 %DD0 �016 (rransferfromservice labe0, DomesticAeturn Recel t 102595-02 M 1540 PS Form 3811, February 2004 p._ - - - -- -- - -'- -'-- Z Z ion C Aier C®unty Bureau of Emergency Services October 1, 2009 Mr. Richard Yovanovich, Esq. Coleman, Yovanovich & Koester, PA 4001 Tamiami Trail North, Suite 300 Naples, FL 34103 RE: North Naples Fire Department— COPCN Via certified mail Dear Mr. Yovanovich, The Collier County Bureau of Emergency Services requests the following information: o A copy of the current Organizational Chart for administration and operational divisions. You may send this information to: Mr. Dan E. Summers, CEM, Director Collier County Bureau of Emergency Services Emergency Services Center —Suite 445 8075 Lely Cultural Parkway Naples, FL34113 Thank you for your time and attention to this matter. Sincerely, Dan E. Summers, CEM Director B075 Lely Cultural Parkway • Naples, Florida 34113 • 239 - 252 -3600 • FAX 239- 252 -3700 • www.collierem.org �� �� o Z a Nil U 2952 66E`C 9'I00 0250 000E 2952 66E`C 9`000 0250 000E • _U Nt TN mo m o' N C O 6 m V l V) N m J Q r o' C 15 p 0 9 m��mg o z 0 9 E� N ❑> �a m�mi o m m T d m m F- G W N O an d j U • N LJl N C m i GT m T.I c 99 LL—`= a• a EEC «NO LL I f m IL m IL �v m P IL .• U a Z 'Do al - mry I x o U �c ¢ EE om ermn a • mI u5 ¢w i' U 2952 66E`C 9'I00 0250 000E 2952 66E`C 9`000 0250 000E • _U Nt TN 7 o' N C O 6 m V l ¢NHWxE wY� r r o' N m��mg o z 0 9 E� N ❑> m O N LJl N C m i GT m T.I c 99 e a• a EEC «NO LL o.e w Uma`OmQ �.p ard� m .. .• U a Z ti al - I l Goolper County Bureau of Emergency Services October 7, 2009 Mr. Richard Yovanovich, Esq. Coleman, Yovanovich &.Koester, PA 4001 Tamiami Trail North, Suite 300 Naples, FL 34103 RE: North Naples Fire Department — COPCN Via certified mail Dear Mr. Yovanovich, The Collier County Bureau of Emergency Services requests the following information: 1 " • All durable pre - hospital care equipment owned by North Naples Fire District which was NOT provided by Collier County EMS. Items such as cardiac monitors, defibrillators, CPR devices, and pulse oxygen sensors shall be listed by brand name, type, serial number, date of acquisition, and factory- authorized calibration. You may send this information to: Mr. Dan E. Summers, CEM, Director Collier County Bureau of Emergency Services Emergency Services Center —Suite 445 8075 Lely Cultural Parkway Naples, FL34113 Thank you for yourtime and attention to this matter. Sincerely, i� Dan E. Summers, CEM Director pES 8075 Lely Cultural Parkway • Naples, RaAa 34113 • 23 252 -3600 • FAX 239 -252 -3700 • wwu+.collierem.or9 V-Z5 NIB . b- I _ a Complete items 1, 2; and 3. Also complete Item 4 If Restricted Delivery is desired. A. X ❑ Agent Address e ■Print your name and.addressnn the reverse. so that we can return the. card to you, B , by Pri N C.. a of alive (( �� m ■ Attach this card to the back of the allpiece, 0" L; . or on the front if space permits. Is d ' ry a- d d' m Re `17 . s -1. Article Addressed tc: _ _ if YES, enter delivery address below: N Mr. Richard Yovanovich, Esq. r R r9 Certified Fee Coleman, Yovanovich & Koester, PA Postmark 4001 Tamiami Trail North, Suite 300 -n Rehm Receipt Fee Here F-dome em Requlreco Naples, FL 34103 s... Type Restricted Delivery Fee O kivice Certified Mail ❑ Express Mail I —. — — Red El Return Receipt for Mechandise 3 _ $ d. Total Postage & Fees j �4�R,�mtdl),lwery? ul Yes _I 2. Article Number. DO (37'7 - 2.571' o (lrarisia, from service 1abeQ tozsge-az M1s4o'cl- ° PS Form 3811, February 2004 Domestic Return Receipt ,, -1- -- 0 i o- b- v- Q- N i17 —_ N ru 0" Postage $ Q E' M M r R r9 Certified Fee Postmark -n Rehm Receipt Fee Here F-dome em Requlreco O O Restricted Delivery Fee O O (Endorsement Requlreco Ej M $ d. Total Postage & Fees j ru ru ul 1-1l 0 o Mr. Richard Yovanovich, Esq. 0 ED sm Coleman, Yovanovich & Koester, PA —' -- 4001 Tamiami Trail North, Suite 300 m to crq Naples, FL 34103 P.'2 A IOU ONCE OF THE COUNTY ATTORNEY MEMORANDUM TO: Dan E. Summers, Director FROM: Jennifer B. White, Assistant County Attorney DATE: November 20, 2009 RE: Application for Certificate of Public Necessity and Convenience North Naples Fire Control and Rescue District, RLS No. 09 -EMS -00203 This Memorandum is in response to RLS No. EMS -00203 regarding North Naples Fire Control and Rescue District's ( "Applicant ') application for a certificate of public convenience and necessity ( "COPCN" ). Your questions are below with each followed by our office's response. 1. Identify what level of general insurance or malpractice should be provided by the applicant According to the County's Risk Management Department Applicant must maintain in force at all times and with carriers acceptable to the County the following insurance coverage: Commercial General Liability Insurance with limits of not less than $1,000,000 per occurrence; $2,000,000 aggregate. Public Officials Errors and Omissions Insurance with limits of not less than $5,000,000 per occurrence; $5,000,000 aggregate. Employment Practices Liability Insurance with limits of not less than $5,000,000 per occurrence; $5,000,000 aggregate. Medical Malpractice Liability Insurance with limits of not less than $1,000,000 per occurrence; $2,000,000 aggregate. Workers' Compensation insurance covering statutory limits with Employers Liability insurance with limits of not less than $1,000,000. Business Automobile Insurance with limits of not less than $1,000,000 per occurrence $2,000,000 aggregate. If transport service is included in the COPCN, additional insurance may be required. A_Z% ion 2. Provide an opinion based on Collier County Ordinance No. 81 -75, as amended as to whether or not a public hearing is necessary. Yes, a hearing is required. Section 7 of Ordinance No. 81 -75, as amended ( "Ordinance ") provides, in part: "Section 7: Requirement for Board Approval in Granting Certificate The Board of County Commissioners shall not grant a certificate unless it shall find, after public hearing and based on competent evidence that each of the following standards has been satisfied...." (Emphasis Added.) If the COPCN is granted, it may be renewed without a hearing as set forth in Section 10 of the Ordinance. 3. Provide an opinion as to the utilization of taxes collected by North Naples Fire Control District being used for the delivery of emergency medical care under the COPCN request is within its statutory authority. The Special Act of the North Naples Fire Control and Rescue District appears to allow Applicant to utilize taxes collected to deliver emergency medical care. See Section 2 of the Special Act which is located behind Tab No. 3 of the COPCN application. 4. Identify what stipulations may be placed on the COPCN should Collier County elect to use the services provided by North Naples Fire Control District. At minimum, the COPCN should require that Applicant: a. apply for licensure pursuant to Section 401.25, Florida Statutes before offering service to the public. b. maintain in force at all times insurance coverage acceptable to the County and it's insurance carriers. Any other stipulations to be included should be reasonably related to ensure a high quality of patient care. c. Comment on the North Naples Fire Control District's ability to charge for services in the future and what pro -rata share of indigent care cost should be absorbed by the North Naples District either now or in the future. This question does not present any legal issues. If the question is refrained, we will reevaluate and respond accordingly. d.. Opine as to the completeness of the application based on references in the Ordinance and Chapter 401, Florida Statutes. P-Zl 10H The application is complete. This means that information necessary for staff to evaluate the COPCN application has been provided. See attached County Attorney Office review checklist. It is important to mention that Section 6 the Ordinance requires the County Manager or his designee make a report to the Board of County Commissioners that contains a recommendation as to whether to grant the COPCN. The report must be made within 60 days of the time that the application is deemed complete. Our office recommends that Applicant be advised in writing when the application is deemed complete and that the County Manager during his communications at the next Board meeting advise the Board that the hearing will need to be scheduled and that it has the option of hiring a hearing officer to conduct the hearing. This option of a hearing officer is set forth in Section 8 of the Ordinance. Our office will provide you, the County Manager, and the Commissioners with a separate Memorandum that more fully describes the hearing process. In the meantime, should you have any further questions, please contact Scott Teach or me. CC: Jeffrey A. Klatzkow, County Attorney Scott R Teach, Deputy County Attorney Leo Ochs, County Manager I / 09- EMS - 00203/4 ION County Attorney Review Checklist for COPCN Section 5, Sub- Paragraphs A - J of Ordinance No. 81 -75, as amended 00 The name, age and address of the owner of the ambulance or ALS provider, or if the owner is a corporation, then of the directors of the corporation and of all the stockholders holding A. more that 25 percent of the outstanding shares. For governmental units, this information shall be supplied for members of the governing body . �® The boundaries of the territory desired to be served. The number and brief description of the ambulances -or other vehicles the applicant will have available. �0 The address of the intended headquarters and any substations. The training and experience of the applicant. s and addresses of three Collier County residents who 7will act as references for the applicant. �0 A schedule of rates which the service intends to charge. ❑� FS uch other pertinent information as the administrator may e uire. An application or renewal fee of $250.00. (Exception Collier ❑� County EMS). Financial data including assets and liabilities of the operator. A J. schedule of all debts encumbering any equipment shall be included. 00 COLETMAN, YOVANOVICH & KOESTER, P.A. ATTORNEYS AT LAW Kevin G. Coleman Richard D. Yovanovich Edmond E. Koester William M. Burke Gregory L. Urbancic Matthew L. Grabinski Writer's Email: ryovanovich@cyklawfirm.com NoRTnERN TRuST BANK BUILDING 4001 Tamiami Trail North Suite 300 Naples, FL 34103 239 -435 -3535 239 - 435 -1218 Facsimile May 14, 2010 ion Linda C. Brinkman Craig D. Grider Matthew M. Jackson Alex R. Figares Jeffrey J. Beihoff Todd M. Rich Of Counsel: Kenneth R. Johnson RECEIVED OFFICE CF THE COUidT i'' fti7pp.;,4GEk' 14i ] 2640 a -,4g Mr. Leo Ochs County Manager 3301 Tamiami Trail East Naples, Florida 34112 Via: Hand Delivery A_ p RE: North Naples Fire Control and Rescue District Certificate of Need to Provide Advanced Life Support Non - Transport Services Dear Mr. Ochs, On September 17, 2009 the North Naples Fire Control and Rescue District ( "District ") submitted a Application for a Certificate of Need to Provide Advanced Life Support Non - Transport Services ( "Application "). On November 30, 2009, I sent you an e -mail requesting that the Application be placed on hold while the District attempted to work with County Staff to see if the Interlocal Agreement pertaining to Advanced Life Support (`ALS ") services could be amended to both parties satisfaction. Unfortunately, an amendment that satisfied both parties could not be negotiated. Accordingly, the District requests that the Application be scheduled for consideration by the Board of County Conmissioners as soon as possible. The District's Application is to provide supplemental ALS services to those ALS services currently provided by the County. The District is not attempting to replace the ALS services provided by the County. The County will remain the primary agency providing ALS services within the District. The intent of the District's Application is to allow state certified paramedics to provide ALS services in those instances where County EMS is delayed in arrival to a scene. In the majority of the calls County EMS personnel and the District personnel arrive close in time and prior to the need to provide ALS services. However, there are instances where, the District's paramedics have exhausted all basic life support (`BLS ") services and ALS service is warranted and County EMS is not yet on the scene. The District is willing to assist in providing the optimum level of medical care by employing paramedics to supplement the County's current ability to provide care to patients. P-51 May 14, 2010 2 ION Much has been made by certain individuals that BLS and not ALS should be the focus of the various Fire Districts in Collier County. As your Medical Director points out, the District does an excellent job in providing BLS services. The District's EMT's and Paramedics have been publicly recognized for saving many lives in Collier County. The District is committed to continuing to serve a vital role in bringing BLS services to its residents timely and by qualified individuals. The fact remains that providing ALS services to a patient when BLS services is not enough is also critical to the care of a patient. There is no argument that the sooner a patient receives ALS services after BLS services are no longer effective the better. The District is simply attempting to provide additional resources to its residents to improve the level of care they receive. The District's paramedics are state certified and are properly trained to implement the ALS protocols developed by the County's Medical Director. The County's ALS protocols will be the ALS protocols for the District. There will be no fragmentation of care. To assure proper training of the District's paramedics, the District has employed Dr. Jeffrey A. Ponozzo to train its paramedics to perform the protocols adopted by the County's Medical Director. Dr. Ponozzo is the Medical Director, Naples Emergency Physician/Physicians Regional Medical Center Emergency Department. As the Medical Director for one of the local emergency rooms he is extremely familiar with the need to provide proper care prior to a patient arriving at the emergency room. In addition, Dr. Ponozzo was a paramedic. He knows what a paramedic experiences in the field. Attached to this letter is Dr. Panozzo's Curriculum Vitae. Dr. Ponozzo has also prepared a process to certify the District's EMT's and Paramedics. The certification process assures that only qualified individuals will be providing ALS services. Attached to this letter is a copy of the certification process prepared by Dr. Ponozzo. The District is ready, willing and able to assist Collier County in providing the best available medical care to the residents of the District. The District recognizes that there needs to be uniform protocols througbout the County. The District will implement the protocols developed by the County's Medical Director. The County's Medical Director has expressed concerns with the technical abilities of the District's paramedics and has expressed concern about being liable for their actions under his license. To address both concerns, the District has engaged Dr. Ponnozzo and applied for a Certificate of Need to Provide Advanced Life Support Non - Transport Services ( "COPN "). Dr. Ponozzo is an experienced emergency room medical director and a former paramedic. He can properly train the District's paramedics in the County Medical Director's protocols. By issuing a seperate COPN to the District the County's Medical Director's concern regarding liability is also addressed. It will now by Dr. Ponozzo's license that will be on the line and not the County Medical Director's license. The District has provided excellent BLS services and ALS services to the residents within the District. Despite allegations to the contrary, the District and its paramedics have only one goal — provide excellent pre - hospital medical care. The District is qualified to provide ALS services and there is clearly a need for additional ALS service personnel within the District. Please include this letter and the attachments as part of the Application. n_ -4 > May 14, 2010 3 Please feel free to contract me if you have any questions. Sincerely, Richard D. Yovanovic Cc: Chief Orly Stoltz Dr. Jeffrey Ponozzo Assistant Chief Jorge Aguilera RDY /dls 10H JI x z 1OH Carrieuium Vitae Jeffrey A. Panozzo, D.O., FACEP 4726 Turnstone Court Naples, Florida 34119 239.592.6118 (h) 239,877.7778 (m) Email: JPDO(a).aol.com Jeff,paiio=o@pinc.hma.org Medical Doctor of Osteopathic Medicine 1989 The Chicago College of Osteopathic Medicine Chicago, Illinois Undergraduate Bachelor of Science 1981 Loyola University Chicago, Illinois Internship The Chicago College of Osteopathic Medicine 1989 -1990 Emergency Medicine Residency Cook County Hospital Chicago, Illinois 1990 -1993 Career Experiences Osteopathic Physician, State of Florida 2006- present. Board Certification, Emergency Medicine -ABEM, 1995 - present. Fellow, American College of Emergency Physicians, 1997 - present. Medical Director, Naples Emergency Physicians /Physicians Regional Medical Center Emergency Department, 2006 - present. Vice -Chief of Staff, 2009- present Chair of Bio- Ethics Committee Member of Credentials Committee Member of Utilization Review Committee Member of Physician's Leadership Council Clinical Instructor for EMS /Fire Developed Therapeutic Hypothermia Program A -3q 10H CA Assisted in implementing emergency cardiac care program (Cardiac Alert). Clinical Instructor for Nova— Southeastern Medical School. Previous Clinical Instructor, Emergency Medicine programs from the University of Chicago and Cook County Hospital EM programs. Extensive previous experience as senior staff member in Emergency Medicine. 3 EMS Committee Florida College of Emergency Medicine. Frequent lecturer on various emergency medicine topics. American College of Emergency Physicians Florida College of Emergency Physicians Prior Senior Staff Member E.R. Doctors, Ltd„ Gottlieb Memorial Hospital :• Assistant Director d• EMS Director Prior Paramedic /Firefighter /Fire Apparatus Engineer /CFF III, State of Illinois. Personal and professional references available upon request. � "3S 1OH On the Subject of Certification of North Naples Fire Control District EMTs and Paramedics Jeffrey Panozzo, D.O., FACEP North Naples Fire Department Medical Director The certification of our Department EMTs and Paramedics will occur under utilizing the rules found within the Florida Administrative Weekly & Florida Administrative Code Division 64J -1. The purpose of this paper is to outline the anticipated approach I would undertake when such certification becomes of interest to the Department. This document contains initial actions that would be anticipated; however additional resources would be utilized if this concept were to come to action. These additional resources include legal, administrative and consultants to the Department. Therefore changes are anticipated. 1. Initial Requirements; a. Individuals must have Florida Certification as EMT / Paramedic b. Graduates of Florida programs will apply for certification through the NREMTs c. Out of state applicants will follow the rules according to Florida DOH outline A "36 WHOM d. Current approved CPR /ACLS certification specific for each level of provider e. Successful completion of a Florida Department of Health examination within one year of completion of a EMT /Paramedic course f. Clearance according to Department standards regarding felony status. g. Letters of recommendation from training program, current or past medical directors, current supervisors h. Recognition that the Department Medical Director has full authority to accept or deny certification based on the current skill level of the candidate. The Medical Director will not be able to deny such candidates based on age, sex, etc. 2. Department Certification a. Candidates records will be reviewed by the Division of EMS and recommended or denied for Department Certification b. A completed file along with recommendation for Department certification will be forwarded to the Medical Director for review. c. The Medical Director will then evaluate the candidate utilizing a combination of vetting procedures which will include: d -3 7 10H i. Testing the candidates basic level of comprehension in EMS through a standardized test specific to the level the candidate has applied ii. Testing of candidate comprehension of the current medical protocols iii. An oral interview process iv. On -duty observations and reviews 3. Following initial certification a mandatory 90, 180 and 360 day provisional status will be made. a. Candidates will be assigned a shift mentor who reviews 100% of the calls candidates participate utilizing a standardized department form. b. The Division of EMS will review the QA and mentor reports weekly in order to compile a provisional candidate file. c. Following the completion of each provisional period or sooner if necessary, the candidate will meet with the division Chief and or Medical Director for review. d. Designation as Fire -Medic -EMT or Fire- Medic- EMT /P will follow successful completion of this schedule of certification. 4. Continuing education requirements fi "3 g 10H a. Monthly review classes will be arranged through the Division of EMS i. Participation is mandatory in order to maintain Department certification ii. Classes are designed to review the DOT curricula covering all areas in a period of 2 years. iii. Every 2 years the candidate will undergo recertification according to the same schedule delineated above iv. Periodic Protocol additions and reviews will require immediate candidate review as deemed necessary by the Davison of EMS and the Medical Director. S. Immediate suspension of Department Certification may result if the Fire -Medic EMT or Fire -Medic EMT -P fails to maintain certification or skill necessary for patient care. This suspension remains at the discretion of the Medical Director and is in effect until the Medical Director is satisfied that any remediation needed has been completed in an acceptable manner. � _11 M C0 L7er Cou -PMy Bureau of Emergency Services- June 1, 2010 Mr. Richard D. Yovanovich, ESQ Coleman, Yovanovich, Koester, P.A. Northern Trust Bank Building 4001 Tamiami Trail North Naples, FL 34103 RE: North Naples Fire Control and Rescue District- Certificate of Need to provide Advanced Life Support —Non Transport Services Dear Mr. Yovanovich, As Collier County continues to review your renewal of the COPCN referenced in your correspondence of May 14, 2010, the following is respectfully requested: Page 7 of the document titled on the Subject of Certification of North Naples Fire Control District EM-l's and Paramedics: Section 3a. Please describe the qualifications of a shift mentor and provide the standard form that is referenced. Please describe the contact, coordination, and approval for the County Medical Director to endorse or approve of a shift mentor. Page 5 and throughout the document: No reference is noted within the discussion or initial requirements for a North Naples Fire Department EMT /Paramedic to gain either initial training or recurrent training with additional patient contact experience as would be typical within the transport or clinical phase of the care. Please explain how you would meet the transport and clinical phases of patient contact and skill reinforcement. You may reply to me in writing at the address noted below. Sincerely, r� Dan E. Summers, Director, CEM cc: Mr. Leo Ochs, County Manager Mr. Scott Teach, Deputy County Attorney Chief Jeff Page, Collier County Emergency Medical Services Dr. Robert Tober, Collier County Medical Director 8075 Lely Cultural Parkway - Naples, Florida 34113 • 239 - 252 -3600 • FAX 23S-252-3700 • www.collierem.org # I ,#,f Cofer County Bureau of Emergency Services May 26, 2010 Mr. Richard D. Yovanovich, ESQ Coleman, Yovanovich, Koester, P.A. Northern Trust Bank Building 4001 Tamiami Trail North Naples, FL34103 RE: North Naples Fire Control and Rescue District- Certificate of Need to provide Advanced Life Support —Non Transport Services Dear Mr. Yovanovich, I received a copy of your letter.of May le to Mr. Leo Ochs, on May 17uvia interoffice mail. It is my understanding that this filing is intended to re -open our review of the COPCN Non - Transport application previously placed in "suspension' several months ago. I would respectfully request that since there has been a significant period of time since the previous application, along with numerous discussions, that my office is afforded the noted 30 days to review the previous application as well as supplemental submissions, once deemed complete by my office. In a review of the application and updated submittal correspondence dated May 10 1 am requesting additional information to address the following: Document titled On the Subject of Certification of North Naples Fire Control District EMI's and Paramedics Page 6 Section la. Describe the safeguards, policy or procedure currently used to prevent possibly fraudulent certifications or lapsed certifications from being used within this delivery system. Section f referencing felony standards. Please provide a Copy of your Department's felony status (Board or Fire Commission approved standard or policy with respect to felony standards.) 8075 LOO Cultural Parkway • Naples, Florida 34113.239- 252 -3600 FAX 239 - 252 -3700 • www.collierem.org A4 10H (.14 Letter to Richard D. Yovanovich, ESQ May 26, 2010 Page 2 Page 7 Section 3b "...QA review'. The discussion does not convey how QA issues are to be resolved, coordinated, and communicated with the County Medical Director with respect to the continuum of care between transport and non- transport interventions. Please describe how this will be accomplished. You may reply to me in writing at the address noted above. Sincerely, D�n '. 'ummers, Director, CEM cc: Mr. Leo Ochs, County Manger 1 Mr. Scott Teach, Deputy County Attorney Chief Jeff Page, Collier County Emergency Medical Services Dr. Robert Tober, Collier County Medical Director 0 - #?" 10 H 11" SummersDan ;rom: Richard Yovanovich [ryovanovich @cyklawfirm.com] ent. Tuesday. June 08, 2010 9:39 AM i0: SummersDan Gc: Jorge Aguilera Subject: Collier Cty Letter re: Advanced Life Support Dear Dan, \ Below is the District's and Medical Director's response to your additional questions: 1(a) The District utilizes a similar computer based record management system as does Collier County Emergency Medical Services to manage all employee records, especially the issuance dates and expiration dates of EMT, Paramedic and other certifications. The system as the one Collier County Emergency Medical Services uses provides both the system administrators and the certification holder 60 days notice prior to the expiration date of any certification with art expiration date (i.e. EMT, Paramedic, CPR and ACLS certification. The electronic reminders (notification) will continue until an updated certification is received by administration and the status is officially changed. In addition, the district performs an annual physical review of all personnel files to assure all require forms and certification are present. This is a same procedure Collier County Emergency Medical Services utilizes, and it is approved by the Office of the Medical Director. The District just uses a different software vendor. 1(f) As reference in the introduction of the Medical Directors correspondence, it clearly lltates that `the certification of our Department EMT's and Paramedic will occur utilizing 'he rules found within the Florida Administrative Weekly & Florida Administrative Code 647 -1" Such, the word "department" refers to the Department of Health Bureau of EMS. The "department" completes all necessary felony status checks at the point of initial certification. The district does have a code of conduct policy which covers felony issues but, this it is outside of the intent of Mr. Summer's question. In addition, the district on an annual base reviews official driving records from the Florida Department of Transportation for all district employees which operate district vehicles. Simply, to assure all employee are in compliance with not only district policies, but also Florida Statue 401. This policy is very similar if not the same as the one utilized by Collier County Emergency Medical Services Department and approved by the office of the Medical Director. 3(b) The District seeks to implement the same Quality Assurance Process (W) as Collier County Emergency Medical Service Department. A dual review of 100 percent of all patient care reports incorporating a computer assisted QA filters and a physical review of all Patient Care Reports, Any serious deviations in protocol shall be address by the District Medical Director in coordination with the office of The Medical Director. In closing, the District seeks to utilize as many of processes which are currently in place at Collier County Emergency Medical Services, and/or approved by Florida Bureau of Emergency Medical Service, and the office of The Medical Director; to ensure compatibility between the programs and continuity of patient care. I hope these answers are satisfactory. `the District would like the COPN Application scheduled before the BCC as soon as possible. Rich 1 10 Colter County Bureau of Emergency Services June 30, 2010 Mr. Richard Yovanovich, Esq. Coleman, Yovanovich & Koester, PA 4001 Tamiami Trail North Suite 300 Naples, FL 34103 RE: North Naples Fire Control and Rescue District COPCN Application Dear Mr. Yovanovich: Please allow this letter to serve as your notification that as of June 30, 2010 1 have deemed the application complete and will begin the review as set forth in the ordinance. I appreciate the assistance you have provided with my previous information request for the application. If you have any questions or concerns, please do not hesitate to call me. Respectfully, a Dan E. Summers Director cc: Mr. Leo Ochs, County Manager Mr. Scott Teach, Deputy County Attorney Chief Jeff Page, Collier County EMS e.. d o, � s.. � = .,. O NS 1S 8075 Lely Cultural Parkway • Naples, Florida 34113 • 239- 252 -360D • FAX 239-252 -3700 • w .collierem.org l 1 F Complete items 1, 2, and S. Also complete Rem 4 If Restricted Delivery is desired. ■ Print your name and address on the reverse so that we can return the card to you. I ■ Attach this card to the back of the maiipiece, I or on the front if space permits. 1. Article Addressed to: jMr. Richard Yovanovich, Esq, I Coleman, Yovanovich & Koester, PA 1 4001 Tamiami Trail North, Suite 300 1 Naples, FL 34103 r ru 7 m a M M C3 M 0 S rR rR 0 O r� 1 2, Article Number I (transfer from service label) PS Form 3811, February 2004 A, Signature I ❑ Agent X ❑ Addressee B. Received by (Printed Name) C. Date of Delivery I D. Is delivery address different from item 1? ❑ Yes If YES, enter delivery address below. 0 No 3. 1S,{ervice Type P! cerufled Mail ❑ Express Mail ❑ Registered ❑ Return Receipt for Merchandise ❑ Insured Mail ❑ C.O.D. 4, Restricted Delivery? (Extra Fee) ❑ Yes - 7D02'-ll`10 - cXOo--�- i3 Ys- a(- ) `I Domestic Return Receipt 102595 -02- M -154p Naples, FL 34103 M ra ri NnJ OFFICIAL USE LO ul S m S m - Postage $ Certified Fee m m Postmark O E3 Return Receipt Fee Here O 0 (Endorsement Required) O ED Restricted Delivery Fee ( Endorsement Required) O E2 � 9 ? r-9 Total Postage 8 Fees a santr° Mr. Richard Yovanovich, Esq. m m O 0 O o 19" Coleman PO B, Coleman, Yovanovich &Koester, PA ry or cl shi4001 Tamiami Trail North, Suite 300 ` - -- - -- Naples, FL 34103 M City of North Lauderdale v. SMM Properties, Inc., 825 So. 2d 343 - Fla: Supreme Court 2... Page I of 5 10H Web Images Videos Maps News Shopping Gm ill more ♦ Sion In GoOgle scholar Stl olaretl SU�olar Search SMM Properties Inc. v_City of.NOrthLaudeNa „Search "'. saoiarPMerencec Read this da ae. How cited City of North Lauderdale v. SMM Properties, Inc., 825 So. 2d 343 - Fla: Supreme Court 2002 825 So.2d 343 (2002) CITY OF NORTH LAUDERDALE, Petitioner, V. SMM PROPERTIES, INC., et al., Respondents. No, SC00 -1555. Supreme Court of Florida. August 22, 2002. 344 •34a Robert L. Nabors, Gregory T. Stewart, and Virginia Saunders Delegal of Nabors, Colin & Nickerson, P.A., Tallahassee, FL; and Samuel S. Goren and Michael D. Cirullo, Jr. of Josias, Goren, Cherof, Doody & Ezrol, P.A., Fort Lauderdale, FL, for Petitioner. Nelsen 0. Kasdin of Gunster, Yoakley & Stewart, PA., Miami, FL; and Edna L. Caruso of Caruso, Burlington, Bohn & Compiani, P.A., West Palm Beach, FL, for Respondents, Jamie A. Cole and Susan L. Trevarthen of Weiss, Berets, Heitman, Pastoriza & Guedes, P.A., Fort Lauderdale, FL, for The Group City Emergency Medical Service Coalition of Froward County, Florida, Inc., Amicus Curiae, Randall N. Thornton, Lake Panasoffkee, FL, for The Village Center Community Development District, Amicus Curiae. Frank A. Shepherd, Miami, FL, for Pacific Legal Foundation, Amicus Cudae. William Phil McConaghey, pro se, Pembroke Pines, FL, Amicus Curiae. QUINCE, J. We have for review a decision of the Fourth District Court of Appeal on the following questions, which the court certified to be of great public importance : DO EMERGENCY MEDICAL SERVICES (EMS) PROVIDE A SPECIAL BENEFIT TO PROPERTY? CAN A FIRE RESCUE PROGRAM FUNDED BY A SPECIAL ASSESSMENT USE ITS EQUIPMENT AND PERSONNEL TO PROVIDE EMERGENCY MEDICAL SERVICES FOR ACCIDENTS AND ILLNESSES UNDER LAKE COUNTY V WATER OAK MANAGEMENT CORP 695 So 2d 667 (Fla.1997)? SMM Properties Inc v City of N rth Lauderdale 760 So 2d 996 1004 (Fla 4th DCA 2000) en band We have jurisdiction. See art. V, § 3(b)(4), Fla. Const. For the reasons stated herein, we answer the certified questions in the negative and approve the decision of the district court. FACTUAL BACKGROUND At issue in this case is the validity of a special assessment imposed by the City of North Lauderdale (the City) on owners of improved property within the City for the purpose of providing an integrated fire rescue program.0 In June of 1995, the City adopted an ordinance which authorized and established procedures to fund the cost of an integrated fire 345 rescue and emergency medical services program through a special assessment levied on all -645 property owners in the City. The integrated fire rescue program included (1) fire suppression, (2) first- response medical aid, and (3) emergency medical services (EMS). A group of commercial property owners in Broward County (the Opponents) opposed the special assessment and filed a complaint requesting declaratory relief and an injunction against the City. The Opponents conceded that the fire services portion of the assessment, items one and two, conferred a special benefit on their properties, but sought a declaration that the portion of the assessment for emergency medical services (item three) was improper because the properties did not derive a special benefit from this service. The trial court granted partial summary judgment on behalf of the City, finding that the special assessment conferred a special benefit to property as a matter of law. On appeal, the Opponents argued the trial court erred because the assessment for emergency medical services provided a service to all citizens in the city and did not provide a special benefit to the assessed real property. See SMM Properties )no v City of North Lauderdale 76D So 2d 998 (Fla 4th City of North Lauderdale v. SMM Properties, Inc., 825 So. 2d 343 - Fla: Supreme Court 2... Page 2 of 5 ion DCA 2000) (en banc). The Fourth District agreed, concluding that the emergency medical services did not provide a special benefit to the assessed property because such services benefit people, not property. See id at 1 D04. The City seeks review of the Fourth District's decision. DISCUSSION In Lake County v Water Oak Management Corp., 695 So 2d 667 669 (Fla 1997) we reiterated the test for determining the validity of a special assessment: In reviewing a special assessment, a two -prong test must be addressed: (1) whether the services at issue provide a special benefit to the assessed property; and (2) whether the assessment for the services is properly apportioned. Sarasota County tv Sarasota Church of Christi 667 So 2d at 163; City of Baca Raton v. State. 595 So.2d 25 30 (Fla 199Z.1221 To resolve the issue in this case we must examine the first prong of the test and determine whether emergency medical services provide a special benefit to property. The City asserts that its special assessment confers a special benefit to real property because a logical relationship exists between the use and enjoyment of property and the emergency medical services provided by the fire rescue program. In making its argument, the City asserts that the facts of this case ft squarely within our decision in Lake County, which included a special assessment imposed for fire protection services?m The "fire protection services" at issue in Lake County were described by the district court as follows. Lake County provides a number of services under the umbrella of "fire protection services" such as fire suppression activities, first - response medical aid, educational programs and inspections. The medical response teams stabilize patients and provide them with initial medical rare. The fire department responds to automobile and other accident scenes and is involved in civil 346 defense. Fire *346 services are provided to all individuals and property involved in such incidents. Water Oak Management Core. v Lake County, 673 So2d 135 137 (Fla. 5th DCA 1996) quashed in part, 695 S0.2d 667 (Fla. 1997). The issue before this Court on a certified question was whether Lake County's fire protection services, funded by a special assessment, provided a special benefit to the assessed properties. We answered the certified question in the affirmative, finding the fire protection services did provide a special benefit to the assessed properties, because at a minimum, fire protection services provide for lower insurance premiums and enhance the value of property. Lake County, 695 So.2d at 669. In this case, the City argues that Lake County's fire rescue program is similar to its own program because both are consolidated programs funding more than fire protection and suppression activities. The Opponents respond that Lake County involved first- response medical aid, not emergency medical services, and thus is not directly on point. The Opponents also argue that since first- response medical aid is a function provided by firefighters as part of their normal duties, the property owners in Lake County were really only paying for fire protection, and the special assessment in Lake County did not assess property owners for services outside the firefighters' jobs, such as emergency medical services. We agree that the facts of this case do not fit squarely within Lake County. Although both programs are "integrated" programs encompassing more than fire suppression activities, the fire rescue program funded by the special assessment in Lake County did not include the provision of emergency medical services. The fire rescue program at issue in Lake County involved only first- response medical aid. The Fourth District recognized and explained the service thusly: Pursuant to Florida law, "first response medical aid" is considered one of the routine duties of a firefighter, and firefighters are required to take 40 hours of training of first response medical aid. See §§ 401.435(1), 633.35(2), Fla. Stat. (1997); Fla, Admin. Code R. 4A- 37.055(21). First response medical aid is routinely provided by policemen, firefighters , lifeguards, etc., as necessary "on- scene patient care before emergency medical technicians or paramedics arrive." § 401 435(l), Fla. Slat. The duties of the medical response teams in Lake County seem to fit precisely within the parameters of routine "first response medical aid" because the teams there had the duty to "stabilize patients and provide them with initial medical care " 695 Sci 667 -69; see aloe Water Oak Management Corp . v Lake County 673 So 2d 135 (Fla. 5th DCA 1996). There was no mention of the provision of comprehensive emergency medical transportation services as part of the integrated fire protection service discussed in Lake County, 760 So.2d at 1003. Emergency medical services, on the other hand, are defined in Florida as follows (3) "Emergency medical services" means the activities or services to prevent or treat a sudden critical illness or injury and to provide emergency medical care hftr, / /crhnlar rrnnrrla r•n.n /crhnlar raco7raca =1 A7Q 1 71 A 1070777Q GF.7RR n— CArfTrf4- T%TnTPI'tl R/1 ov,)n1n City of North Lauderdale v. SMM Properties, Inc., 825 So. 2d 343 - Fla: Supreme Court 2... Page 3 of 5 fu and prehospital emergency medical transportation to sick injured, or otherwise incapacitated persons in this state. § 401.107(3), Fla. Stat. (2000). Further, the legislative intent as to medical transportation services is outlined as follows: Legislative Intent —The Legislature recognizes that the systematic provision of 347 emergency medical services saves n47 lives and reduces disability associated with illness and injury. In addition, that system of care must be equally capable of assessing, treating, and transporting children, adults, and frail elderly persons. Further, it is the intent of the Legislature to encourage the development and maintenance of emergency medical services because such services are essential to the health and well -being of all citizens of the state. The purpose of this part is to protect and enhance the public health, welfare, and safety through the establishment of an emergency medical services state plan, advisory counsel, minimum standards for emergency medical services personnel, vehicles, services and medical direction, and the establishment of a statewide inspection program created to monitor the quality of patient care delivered to each licensed service and appropriately certified personnel. § 401.211, Fla. Stat. (2000) (emphasis added). Based on these factors, the medical services provided for in this case are clearly distinguishable from the ones present in Lake County. The special assessment here cannot be upheld, as the City contends, simply because it provides the same services as the assessment upheld in Lake County. To the contrary, the special assessment here provides emergency medical services, while the assessment in Lake County did not. The City, would have this Court extend the rationale of Lake County to apply to the instant case, arguing that a special assessment that provides a higher level of medical services is a natural and logical application of Lake County . Having concluded that the facts of the instant case differ from Lake County, we must determine whether the special assessment at issue here nonetheless meets the first prong of the special assessment test; in other words, whether the special assessment for emergency medical services provides a special benefit to the assessed property. We traditionally defer to the legislative body's determination of special benefits, See City of Boca Raton v. State. 595 Sa2d 25, 30 (Fla 1992) South Trail Fire Control Dist v State. 273 So.2d 360, 383 Fla.1973 (determination of special benefits is one of fact for legislative body and apportionment of the assessments is a legislative function), "Mhe standard is the same for ` both prongs; that is, the legislative determination as to the existence of special benefits and as to the apportionment of costs of those benefits should be upheld unless the determination is arbitrary.' Sarasota County v. Sarasota Church of Christ 667 So 2d 180 184 (Fla 1995). In this case, the Fourth District found "that the City's legislative determination that the assessment for emergency medical services conferred a special benefit on property was arbitrary." SMM Properties, 760 So 2d at 1004. The City now argues that the Fourth District erred because it did not make express factual findings of why the legislative declarations of special benefit were arbitrary. Additionally, the City argues that it made clear, detailed, and specific legislative declarations as to the special benefit to property from the fire rescue program, The City points to the Fire Rescue Assessment Ordinance (the Ordinance). Section 1.04. Legislative Determinations of Special Benefit. It is hereby ascertained and declared that the fire rescue services, facilities, and programs of the City provide a special benefit to property within the City that is improved by the existence or construction of a Dwelling Unit or Building based upon the following legislative determinations: 348 •348 (A) Fire rescue services possess a logical relationship to the use and enjoyment of improved property by (1) protecting the value of the improvements and structures through the provision of available fire rescue services; (2) protecting the life and safety of intended occupants in the use and enjoyment of improvements and structures within improved parcels; (3) lowering the cost of fire insurance by the presence of a professional and comprehensive fire rescue program within the City; and (4) containing the spread of fire incidents occurring on vacant property with the potential to spread and endanger the structures and occupants of improved property. (B) The combined fire control and emergency medical services of the City under its existing consolidated fire rescue program enhances and strengthens the relationship of such services to the use and enjoyment of Buildings within improved parcels of property within the City. (C) The combined fire control and emergency medical services of the City under its existing consolidated fire rescue program enhance the value of business and commercial property that is improved by the existence or construction of a Building which enhanced value can be anticipated to be reflected in the rental charge or value of such business or commercial property. The trial court agreed with these findings, and in its order granting partial summary judgment to the City found that the consolidated fire rescue service as described in the ordinance provided a special benefit to property. However, the Fourth District disagreed, finding the http: / /scholar.google.cori scholar case? case = 14791714197972235628 &q = SMM +Properti... 8/16/2010 City of North Lauderdale v. SMM Properties, Inc., 825 So. 2d 343 - Fla: Supreme Court 2... Page 4 of 5 I emergency medical services component of the fire rescue service was not a special benefit to 1 " -- property because there was no evidence in this record that the availability of emergency medical services decreased insurance premiums or enhanced the value of real property. On the whole, emergency medical transportation services benefit people, not property. Thus, we hold that the City's legislative determination that the assessment for emergency medical services conferred a special benefit on property was arbitrary, and we find that the assessment "has the indicia of a tax because it is proposed to support many of the general sovereign functions contemplated within the definition of a tax." Collier County, 733 So.2d at 1018. 769 So.2d at 1004. An examination of the record supports the Fourth Distnct's holding. Although the City did make general findings in the Ordinance that there was a special benefit to the assessed property, there is nothing more in the record to support these findings. We find, therefore, that competent, substantial evidence does not exist to support the City's findings of special benefit. There is no evidence of the type of benefits that inure to property from the provision of emergency medical services, no studies were conducted by the City documenting any specific special benefit, and there is no testimony or expert opinion indicating how the portion of the assessment providing for emergency medical services specially benefits real property. Moreover, a legislative body "cannot by its fat make a local improvement of that which in its essence is not such an improvement, and it cannot by its fiat make a special benefit to sustain a special assessment where there is no special benefit." South Trail Fire Control Dist. v State. 273 So 2d 380 383 (Fla 1973) (quoting 48 Am.Jur., Special or Local Assessments, § 29, at 569 (1943)). 349 '349 Since a presumption of correctness does not attach to the City's findings of special benefit, we adhere to a standard of review of the lower court's decision based on ordinary findings of fact The test for determining whether a special benefit is conferred to property was set out in Lake County. In evaluating whether a special benefit is conferred to property by the services for which the assessment is imposed, the test is not whether the services confer a "unique" benefit or are different in type or degree from the benefit provided to the community as a whole; rather the test is whether there is a "logical relationship" between the services provided and the benefit to real property. Whisnant v Stringfellow 50 So.2d 885 (Fla 1951); Crowder v Phillips, 146 Fla. _1 44q So 2d 629 (19411) (on rehearing). —'— Lake County, 695 So 2d at 669 (footnote omitted). Relying on Fire District No. 1 v Jenkins 221 So.2d 740. 741 (Fla 1959) we concluded there was a logical relationship between the fire protection services and the assessed property in Lake County, because 'fire protection services do, at a minimum, specially benefit real property by providing for lower insurance premiums and enhancing the value of the property ." 695 So.2d at 669. Before applying the test, however, we address the Opponents' argument that in Collier County v State 733 So 2d 1012 1017 (Fla 19991 we appeared to retreat from the "logical relationship" test and return to a requirement that the services funded by a special assessment provide a direct, special, or unique benefit. This argument is without meat. Although Collier County did not mention the term "logical relationship," we did not retreat to the "unique benefit" test as the Opponents claim. In Collier County, we rejected the county's theory that the "interim governmental services fee' at issue was valid as a special assessment. We applied the two-prong special benefit test to the interim fee, and in our discussion of the special benefit prong stated: We explained in Water Oak Management that the first prong requires that the services funded by the special assessment provide a "direct, special ber efr to the real property burdened. 695 S0.2d at 670. A majority of this Court concluded that the fire services funded by the assessment in Water Oak Management met this requirement by providing for lower insurance premiums and enhancing the value of property. Id. at 669. 733 So.2d at 1017 (emphasis added). The emphasized language ( "direct, special benefit") came directly from the discussion of the special benefit prong in Lake County. We also mentioned the "logical relationship" test in the recent case of Clty of tinter Springs v State 776 Sc.2d 255. 259 n 4 (Fla 20011 ( "Further, this Court has stated that, '[]n evaluating whether a special benefit is conferred to property ... the test is whether there is a logical relationship between the services provided and the benefit to real property. "'). Thus, the "logical relationship" test for determining whether a special assessment confers a special benefit to property remains the standard by which we judge the validity of the special assessment at issue in this case. The City argues there is a logical relationship between emergency medical services and a special benefit to property because these services protect the life and safety of intended occupants in the use and enjoyment of the assessed property. The Opponents argue that the portion of the assessment providing for emergency medical services must fail because there 350 is no logical relationship between the assessment, '350 treatment, and transport of sick or injured people and a special benefit to real property. Opponents contend this portion of the special assessment is an invalid ad valorem tax clothed as a special assessment. htto : / /SChnlnrannalPr.nm /cchnlar racp7 race= 1470171AIQ7Q7nI1C4 ') RR.,,_QKAhAiD.- ,...o.+: encnnln City of North Lauderdale v. SMM Properties, Inc., 825 So. 2d 343 - Fla: Supreme Court 2... Pe 5 o�f,]5 i/�'/� ,l In City of Boca Raton v State 595 So 2d 25 (Fla 1992) we explained the distinction between special assessments and taxes: [A] legally imposed special assessment is not a tax. Taxes and special assessments are distinguishable in that, while both are mandatory, there is no requirement that taxes provide any specific benefit to the property; instead, they may be levied throughout the particular taxing unit for the general benefit of residents and property. On the otherhand, special assessments must confer specific benefit upon the land burdened by the assessment. As explained in Klemm v Davenport, 100 Fla. 627, 631 -34, 129 Sc. 904, 9071930 : A tax is an enforced burden of contribution imposed by sovereign right for the support of the government, the administration of the law, and to execute the various functions the sovereign is called on to perform. A special assessment is like a tax in that it is an enforced contribution from the property owner, it may possess other points of similarity to a tax but it is inherently different and governed by entirely different principles. It is imposed upon the theory that that portion of the community which is required to bear it receives some special or peculiar benefit in the enhancement of value of the property against which it is imposed as a result of the improvement made with the proceeds of the special assessment. It is limited to the property benefitted, is not governed by uniformity and may be determined legislatively or judicially. Id. at 29 (emphasis supplied) (citation omitted)', see also Collier County 733 Se 2d at 1016- 17. Here, the emergency medical services portion of the special assessment has the indicia of a tax because it fails to provide a special benefit to real property. More specifically and according to the test set out in Lake County, there is no logical relationship between emergency medical services (the assessment, treatment, and transport of sick or injured people) and a special benefit to real property. Emergency medical services provide a personal benefit to individuals. There is no indication from the City or in the record how emergency medical services enhance the value of the property against which the assessment is imposed. The better argument made by the City is that the provision of emergency medical services has a logical relationship to property because these services enhance the use and enjoyment of property. See Meyer v City of Oakland Park 219 So 2d 417 (Fla 1969). As to the "use and enjoyment' argument, however, it does not follow that one has potential added or actual use and enjoyment of property because emergency medical services are provided to owners of that property . Although emergency medical services may provide a sense of security to individuals, neither the service nor the sense of security is provided to the property itself. CONCLUSION Accordingly, we answer both certified questions in the negative, find that emergency medical services do not provide any special benefit to property, and approve the decision of the district court It is so ordered 351 -351 ANSTEAD, C.J., and SHAW, HARDING, WELLS, and LEWIS, JJ., concur. PARIENTE, J., recused. fit The City Is a mun dipal mtporabon, oryanized and operating under the laws of the Slate of Rome, with home rule powea under aNtle VIII, section 2(b), Florida con tout- and additions 189.021 and 166.041, Fiords Statues (Oddly. Q The sewn pmrg of the special assessment test,'whether the assessment for the sen,usas Is properly apportioned." Is not at issue in this rase. r]3 Lake Countyalso invdved a visual assessment for solid waste disposal service, but Nis Court agreed with the disFCt .0 ,summary wr ion that the solid waste disposal zpeual assessment was valid. Go tc Goodle Home -About Goodie -About Goodie Scholar =010 Googla http : / /scholar.google.coria/scholar case? case = 1479171419797223569 .9&..n= RMM +Prnnart; Qfif�nnin 10H RECEI'V'ED OEFARTSiEi'T OF HE 1. MANSON LAW GROUP, P.h ITR _9 PH 2:23 Environmental Law OFFICE DF THE CLERK Laura Jacobs Donaldson 1101 W. Swann Avenue Douglas Manson Tampa, Florida 33606 Pamela Pfeifer* Ph.: 813- 514 -4700 Michael E. Wynn Fax: 813 -514 -4701 -Not Licensed to Practice Law April 7, 2010 Agency Clerk Florida Department of Health 4052 Bald Cypress Way, Bin #A02 Tallahassee, Florida 32399 -1703 VIA FEDERAL EXPRESS RE: Petition for Declaratory Statement Before the Department of Health Authority of the Emergency Medical Services' Medical Director Dear Agency Clerk of the Department of Health: Pursuant to section 120.565, Florida Statutes, the North Naples Fire Control and Rescue District ( "District "), an independent special fire control and rescue district in Collier County whose address is 1885 Veterans Park Drive, Naples, FL 34109, seeks a declaratory statement regarding the Department's opinion as to the authority of a medical director under chapter 401, Florida Statutes, and associated rules. The District is an affected person due to its inability to provide ALS services within its boundaries due to the actions of a medical director decertifying all 54 paramedics of the District to provide advanced life support ( "ALS ") services while employed by the District. In addition, the District has spent approximately $3 million over the last 10 years in training and equipment to provide ALS services in Collier County under Collier County's license. pursuant to an interlocal agreement. What is the permissibility of the following activities under chapter 401, Florida Statutes: 1. Under section 401.265, Florida Statutes, and chapter 64J- 1.004, Florida Administrative Code, may a countywide Medical Director (Collier County's ordinance provides that in order to receive a certificate of public concern and necessity ( "COPCN "), all licensees must contract with the County's Medical Director) require Agency Clerk April 7, 2010 Page 2 IN different standards for a paramedics based upon the employer for whom the paramedic is providing services on a particular day? In other words may a countywide Medical Director prohibit a paramedic from performing certain advanced life support services while working for one licensee on one day and then authorize the same paramedic to perform those .same prohibited services the following day while employed by another licensee, all while being a paramedic operating under the same Medical Director? 2. Under section 401.265, Florida Statutes, and chapter 64J- 1.004, Florida Administrative Code, may a countywide Medical Director discriminate against paramedics that work for a fire district within the county by categorically prohibiting their provision of advanced life support services while allowing fire paramedics from another county to provide the prohibited advanced life support services within Collier County for a licensee under his medical direction? 3. Under section 401.265, Florida Statutes, and chapter 64J - 1.004, Florida Administrative Code, is it an abuse of power of the countywide Medical Director to require a category of his paramedics to complete Medical Director identified training as a precondition for certificate holders to perform services when such training is unattainable due to the number of paramedics in the category, the availability of only one transport unit in which the training can occur dn, and the number of training rides that must occur within a specified period, which combined, results in the category of paramedics not being able to satisfy the training requirement? 4. Is it a violation of chapter 401, Florida Statutes, for the Medical Director to administrate any emergency medical services ( "EMS ") functions that are not related to protocols, Quality Assurance or training? . 5. Is it a violation of section 401.265, Florida Statutes, and chapter 64J- 1.D04, Florida Administrative Code, for a licensee to have a contract with a non - active corporation to serve as a medical director? 6. Can a licensee limit the authority of its medical director by providing that all training requirements must be jointly developed with another party? The countywide Medical Director has historically one a successful job with the provision of a high level of emergency medical service to the citizens within Collier County_ One of the reasons for the success of Collier ounty's EMS program is the supplementation of emergency medical services by the i dependent fire districts at no cost to the county government. However, due to confli s with the fire districts and a Agency Clerk April 7, 2010 Page 3 concern of consolidation of all the fire and emergency medical services under an independent fire district, the countywide Medical Director has taken actions to abuse his powers as a medical director under chapter 401, Florida Statutes. It is clear that a paramedic is disqualified from providing ALS services in Collier County if they are also employed as a paramedic of a fire district in Collier County. The District and its state certified paramedics are unable to provide life saving measures to their residents due to what appears to be the unbridled authority granted to the countywide Medical Director, which is being used to discriminate against an entire class of paramedics due to them being employed by the District.. If you have any questions, you may either contact Chief Orly Stolts or Deputy Chief Jorge Aguilera at (239) 597 -3222 (Phone) or (239) 597 -7082 (Fax). Sincerely, '; , ,, ga - Laura Jacobs Donaldson cc: Chief Orly Stolts John Bixler, DOH, Division of Emergency Medical Operations Michael Greif, DOH, Senior Attorney l�H MEMORANDUM Chapter 401, Florida Statutes, provides the requirements and procedures to provide basic Irfe support ( "BLS ") and advanced life support ( "ALS ") services within Florida. Section 401.265, Florida Statutes, provides that every provider must employ or contract with a medical director. The medical director is required to "supervise and assume direct responsibility for the medical performance" of paramedics providing services under the licensee. In addition, the medical director is required to advise, consult, train, consult and oversee the provision of emergency medical services. The medical director is also responsible for developing medically correct protocols. Section 401.23, Florida Statutes, defines a medical director as a "[p]hysician who is employed or contracted by a licensee and who provides medical supervision, including appropriate quality assurance but not including administrative and managerial functions, for daily operations and training pursuant to this part." {Emphasis added) In 2007, the Department of Health issued DOH 2007 -0102 addressing the scope of authority a licensee's medical director has over paramedics operating under the licensee ( "Declaratory Statement'). The Declaratory Statement provided that the medical director has supervisory authority necessary to ensure that the medical performance of the paramedics under his supervision is of a quality and. type that he is willing to take direct responsibility for such activities. The medical director is required to assess the medical performance of the paramedics operating under his supervision pursuant to chapter 64E- 2.004(4)(b), F.A.C. (now found in chapter 64J, F.A.C.). The Declaratory Statement provided that the medical director has the authority to "condition, limit, modify or suspend" a paramedic's medical performance while operating under a license in which the medical director has direct responsibility for. The medical director is authorized to require identified training as a precondition of a paramedic's medical performance while operating under the licensee. Under the interpretation of the Declaratory Statement and other declaratory statements by the Department of Health, it appears as though medical directors are granted unbridled authority over paramedics under his or her direct supervision. There does not appear to be any limitations on the power a medical director can exert over paramedics working for a licensee that he or she is serving as the medical director. Background Collier County's ordinance related to medical transportation services provides for two classifications of service in Collier County. See attachment #1. Class 1: Collier County EMS; ALS Rescue provides the requirements for the provision of emergency ALS services, with or without transport. A certificate of public concern and necessity 10 "Fl ( "COPCN ") is required to provide services under this category. Collier County's Emergency Medical Services Department ( "EMS ") is the sole ALS transport rescue service provider within Collier County under Class 1. Under Collier County's state license, North Naples Fire Control and Rescue District ( "District "), the East Naples Fire Control and Rescue District, the City of Marco Island, and the City of Naples, have the ability to provide ALS non - transport services within their jurisdictional boundaries pursuant to separate interlocal agreements. Until this past fall, the District has been providing ALS services pursuant to the interlocal agreement attached as attachment #t2. Collier County's Medical Director provides the protocols that the District and its paramedics operate under and prescribes training requirements. The interlocal agreement provides for a "swap" employee program allowing one District firefighter /paramedic to ride on an EMS transport unit and one EMS paramedic /firefighter to ride on a District fire vehicle. This "swap" program allowed additional training to the District's paramedics. Due to a unilaterally adopted new training requirement that the District's paramedics were unable to satisfy, all of the District's paramedics are currently prohibited from providing ALS services while employed for the District. Class 2: Collier County Hospitals provides the requirements for post - hospital interfacility medical transfer services. A COPCN is required to provide services under this category. There is one hospital network, with two hospitals, that has been granted a COPCN, and subsequently a state license, to provide for the interfacility of patients. As a requirement of the ordinance, the hospital network is required to hire Collier. County's Medical Director to be its medical director. Under the ordinance, the Collier County Medical Director is required to "supervise and accept direct responsibilities for the medical performance of the paramedics" of the hospital network. The Collier County Medical Director is also required to develop standing orders or protocols relating to patient care in potentially life or health threatened situations as well as providing training to the hospital network's paramedics. As a result of the ordinance, there is only one Medical Director for all of the state chapter 401 licensees in Collier County, ( "countywide Medical Director "). In order to practice under the countywide Medical Director, a paramedic is required to be certified by the Medical Director, which includes extensive training and testing. This requirement is regardless of employer or state license. There is adopted process or procedure that have been adopted that addresses how to recertify any paramedics that have been limited to only being able to provide BLS services. Activities Related to Questions Question 1: Under section 401.265, Florida Statutes, and chapter 64J- 1.004, Florida Administrative Code, may a countywide Medical Director require different standards for ION a paramedic based upon the employer for whom the paramedic is providing services on a particular day? Several of the District's paramedics are employed both by the District and the hospital network authorized to provide ALS services during interfacility transfers under its own license. Depending upon the paramedic's employer, the paramedic may or may not be able to practice ALS services in Collier County. On the days the paramedic is working for the District, the paramedic is not allowed to provide ALS services. This is due to the paramedic not being certified by the countywide Medical Director as a result of not meeting his training requirement. On the very next day, while employed as a paramedic by the hospital, the paramedic is authorized to provide ALS services as the paramedic is then certified by the countywide Medical Director. In other words, the countywide Medical Director prohibits a paramedic from performing certain advanced life support services while working for one licensee (under an interlocal agreement) on one day and then authorizes the same paramedic to perform those same prohibited services the following day while employed by another licensee. All of this occurs while the paramedic is operating under the same countywide. Medical Director. We recognize that there is an additional doctor, the patient's doctor, involved in interfacility transfers. However, the authority of the patient's doctor is whether the patient is to be transferred. Once the patient is within the transport vehicle, the protocols of the countywide Medical Director preempt and the paramedic in the transport vehicle is required to follow the countywide Medical Director's protocols in an emergency situation. At all times, the paramedic is under the direct supervision of the countywide Medical Director. In addition, the countywide Medical Director has taken steps to decertify paramedics as being unqualified due to them leaving the Collier-County EMS to work for the District. Although they were qualified on a Friday to provide ALS services, by Monday, the first day of employment with the District, the paramedic is no longer qualified to provide such services. Question 2: Under section 401.265, Florida Statutes, and chapter 64J- 1.004, Florida Administrative Code, may a countywide Medical Director discriminate against paramedics that work for a fire district within the county by categorically prohibiting their provision of advanced life support services while allowing fire paramedics from another county to provide the prohibited advanced life support services within Collier County for a licensee under his medical direction? The countywide Medical Director requires certification of all paramedics that work under him in order to provide ALS services. As discussed above, the District's paramedics are not authorized to provide ALS services on the days they are employed with the District due to losing their certification by the countywide Medical Director even though they are allowed to provide those prohibited services while employed by another licensee. This discrimination appears to be limited to those paramedics that are ion �Vl its paramedics comply with the one shift ride along every ninety days requirement, the countywide Medical Director increased the number of shifts required by the District's paramedics to a three shift ride along every ninety days in order for the District's paramedics to be recertified. Once again, this -ride along requirement is unachievable due to the number of District paramedics and the availability of only one specific vehicle in which the shift may be served on. This is an unrealistic training requirement due to the number of District paramedics. Due to the inability to satisfy this training requirement, negotiations regarding the recertification of paramedics have stopped. The District's paramedics are now only authorized to provide basic life support services. Question 4: Is it a violation of this section for the Medical Director to administrate any EMS functions that are not related to protocols, Quality Assurance or training? The countywide Medical Director is involved in more than the development of protocols, Quality Assurance and training in Collier County. For example, attached are a letter and the policy regarding the Medical Director's guidance in the implementation of a target Quick response by Collier County EMS department. See attachment #3. In addition, under the interlocal agreement, the countywide Medical Director had the authority to authorize non - licensed ALS response vehicles of the District. He also had the ability to provide written notice to the District of his intent to recommend that the Collier County Board of County Commissioners to terminate the interlocal agreement. In effect, the countywide Medical Director had the authority to prohibit nearly 80% of all fire ALS responders, including District paramedics, without these paramedics having the ability to retrain or have any input to the inabilities to meet changing requirements. In addition, due to the countywide Medical Director's declarations and misleading statistics regarding the ineffectiveness of the District providing ALS services, it has come to our attention that certain non - District paramedics working under the countywide Medical Director are now starting to dispatch that they are with an emergency medical call patient when they are not even at the location of the emergency. Question 5: Is it a violation of state law for a licensee to have a contract with a non - active corporation to serve as a medical director? Collier County has a contract with a corporation to provide medical direction, Robert Boyd Tober, Inc. See attachment #4. This corporation was involuntarily dissolved by the State of Florida in November 1985. See attachment #5. As a result, Collier County has an invalid contract since the corporation is not in existence. It appears that with the corporation being dissolved almost 20 years ago, Collier County has violated Florida law by not having a valid contract with a medical director. Question 6: Can a licensee limit the authority of its medical director by providing that all training requirements must be jointly developed with another party? 10H employed by a fire district in Collier County. Although countywide Medical Director certification is required to provide ALS services in Collier County, it appears that this certification can be waived if the paramedic is employed by a fire district outside of Collier County. All that is needed is a letter from another medical director even though the training requirements of that medical director are most likely substantially less than those required. by the countywide Medical Director. This ability to have a letter from a fire district's medical director is not an option for those fire districts in Collier County. The District's paramedics are required to go through extensive amount of additional training in order to be countywide Medical Director certified. This waiver may result in a paramedic with one year experience that works for a non - Collier County fire district being able to perform ALS services under the countywide Medical Director while a paramedic with 20 years experience that works for a Collier County fire district not being able to perform such services. Question 3: Is it an abuse of power of the Medical Director to require a category of his paramedics to complete Medical Director identified training as a precondition for certificate holders to perform services when such training is unattainable due to the number of paramedics in the category, the availability of only one ambulance in which the training can occur on, and the number of training rides that must occur within a specified period, which combined, results in the category of paramedics not being able to satisfy the training requirement? The "swap" program under the interlocal agreement gave an opportunity for District paramedics to have the opportunity to gain experience on an EMS transport unit. Participation by each District paramedic was not required. The countywide Medical Director created a training requirement that provided that every District paramedic is required to spend one shift (24 hours) on one specific Collier County EMS transport unit every three months. If the District only had a few paramedics, this requirement would not be difficult to accomplish. In fact, the two municipalities who provide ALS non - transport services were able to satisfy the requirement with 19 and 22 paramedics. However, with 54 paramedics who only work every third day and have vacations and sick leave, the District was unable to meet the countywide Medical Director's requirement to ride on this one specific vehicle. Recognizing the importance of the ride along requirement, the District did propose to satisfy the training requirement with several options including requesting the ability to have additional EMS transports units be available for the training. This request was denied. As a result, the District instructed its paramedics to no longer satisfy this requirement and all of its paramedics were decertified. In addition, after months of requesting the process to have the District's paramedics re- countywide Medical Director certified, the countywide Medical Director proposed a recertification process. Even knowing that the District was unable to have ION Section 4.2 of the interlocal agreement provides that the "[n)ecessary qualifications for both NORTH NAPLES and COUNTY firefighter /paramedics will be cooperatively developed and defined within the Collier County Fire Chiefs' Association (CCFCA) Firefighter Cross Training Program, and Collier County Medical Director's Paramedic Qualification /Certification Matrix." Although chapter 401, Florida Statutes, gives broad authority to a medical director, medical directors are either employees or contractors of a licensee. As a result, the licensee has the ability to dictate or restrict what a medical director can do or require. It appears that this may create some limitation on a medical director's authority. Conclusion Under chapter 401, Florida Statutes, and chapter 64J -1, Florida Administrative Code, a medical director is authorized to develop training requirements for the paramedics operating under the state license. The District does not dispute the ability to implement training requirements. However, this power appears to provide the opportunity to discriminate against a class of paramedics but creating training requirements that are not attainable. In addition, the District recognizes the important duty and responsibility of a medical director in ensuring that quality emergency medical services are provided. We realize that a licensee's medical director needs broad authority, including the authority to limit a paramedic's activities. The quality of services, in part, is tied to the licensee's medical director, training requirements and protocols. However, we also do not believe that this authority should support the bias that the countywide Medical Director has shown to the District and its paramedics. Although chapter 401, Florida Statutes, associated rules, and past Department declaratory statements, have granted a medical director unbridled discretion, we do not believe that this authority should be used to disenfranchise or discriminate against a class of paramedics. It is nonsensical to declare that a paramedic is only qualified when he works for a certain licensee or that he becomes unqualified due to a three day transition period between employment. As a result of this discrimination towards paramedics that work for the District, otherwise qualified paramedics are only allowed to provide BLS services on days while employed for the District. Overnight, the paramedic somehow becomes qualified and proficient as the paramedic is allowed to provide additional services the very next day while working for the hospital. Sadly, this behavior has resulted in harm to District residents who were unfortunate to have a District paramedic respond to the emergency, when had they met up with the same paramedic the very next day, additional medical tools would have been available to assist with the emergency medical issue. It also has resulted in the District from wasting revenues to implement an ALS service program that it no longer can provide. 10H 4` It also does not make sense to allow paramedics working for other medical directors that have less training requirements to work under his direct supervision when it has been declared that a paramedic is only competent when they have completed a medical director's enhanced training and qualification requirements. The power of a medical director should not be used in a manner that potentially harms residents. Even if one can state that 95% of the time, a paramedic with ALS capabilities arrives on the scene within one or two minutes of a paramedic arriving on the scene with only BLS capabilities, what about the 5% of the times when this is not the case? Is a 5% statistical loss low enough to support activities that may have been avoided ?. In conclusion, the District is not seeking to provide ALS transport services. Nor is it seeking to charge Collier County government for the provision of supplemental ALS non - transport services. All we want to do is allow our paramedics to provide ALS services to its residents in conjunction with Collier County's provision of ALS transport services under the countywide Medical Director's protocols. We are unable to do so due to a personal dispute with the countywide Medical Director and there appears to be no recourse. IN ARTICLE III. - MEDICAL TRANSPORTATION SERVICES Page 2 of 10 Certificate means a certificate of convenience and necessity as authorized in F.S. § 401.25(2)(d). Emergency call shall mean the transit of an ambulance under conditions which warrants [ravel with flashing lights and siren operating. Operator shall mean any person, organization or governmental entity providing ambulance or ALS services. Patient shall mean an individual who is ill, sick, injured, wounded or otherwise incapacitated or helpless. Routine call or routine transfershall mean the transportation of a patient under nonemergency call conditions. Rescue service shall mean first response treatment of patients but does not include advanced life support (ALS) or transport. (Ord. No. 04 -12, § 2) Sec. 50 -53. - Requirements for certificate. It shall be unlawful for any person, firm, agency, or any other entity, including governmental units, to provide an ambulance service or provide advanced life support without first obtaining a certificate therefore from the Board of County Commissioners of Collier County. (Ord. No. 0442, § a) Sec. 50 -54. - Exemptions and exclusions from certificate requirement. Certificates shall not be required for. (t) Rescue services. (2) The use of a nonambulance for any transport of a patient pursuant to the Good Samaritan Act, F.S. § 768.13. (3) Vehicles rendering ambulance -type services when requested to do so by the board of county commissioners or county manager in the event of a major catastrophe -or other such emergency which requires more ambulances that are available in the county. (4) Ambulances based outside the county which pick up a patient in the county and transport him out of the county, or which pick up a patient out of the county and transport him into the county. (5) Vehicles used to transport persons for routine scheduled medical treatments. Vehicles transporting persons who require services an route are not covered by this exemption. (Ord. No. 0412, § 4; Ord. No. 0516, if 4) Sec. 50 -55. - Procedure for obtaining certificate. An applicant for a certificate shall obtain fors from the department to be completed and returned to the division administrator. Each application shall contain. (t) The name, age and address of the owner of the ambulance or ALS provider, or if the owner is a corporation, then of the directors of the corporation and of all the stockholders holding more that 25 percent of the outstanding shares. For governmental units, this information shall be supplied for members of the governing body. (2) The boundaries or the territory desired to be served. (3) The number and brief description of the ambulances or other vehicles the applicant will have available. (4) The address of the intended headquarters and any substations. http:// search. municode. cot n/ html /10575IIeVe13/PI_CSO_AIII.htm1 3/5/2010 ION ARTICLE III. - MEDICAL TRANSPORTATION SERVICES Page 3 of 10 (5) The training and experience of the applicant. (6) The names and addresses of three Collier County residents who will act as references for the applicant. (7) A schedule of rates which the service intends to charge. . (8) Such other pertinent information as the administrator may require. (9) An application or renewal fee of $250.00. (Exception Collier County EMS). (10) Financial data including assets and liabilities of the operator. A schedule of all debts encumbering any equipment shall be included. (Ord. No. 06 -12, § 5) Sec. 50 -56. - Review of application. The administrator shall review each application and shall investigate the applicant's reputation, competence, financial responsibility, and any other relevant factors. The administrator shall also make an Investigation as to the public necessity for an ambulance or ALS operation in the territory requested, and shall then make a report to the board containing his recommendation whether to grant a certificate to the applicant within 60 days of the time the administrator determines the application is complete. (Ord. Na 00 -12, § 6) Sec. 50 -57. - Requirement for board approval in granting certificate. The board of county commissioners shall not grant a certificate unless It shall find, after public hearing and based on competent evidence that each of the following standards has been satisfied: (1) That there is a public necessity for the service. In making such determination, the board of county commission shall consider, as a minimum, the following factors: a. The extent to which the proposed service is needed to improve the overall emergency medical services (EMS) capabilities of the county. b. The effect of the proposed service on existing services with respect to quality of service and cost of service. C. The effect of the proposed service on the overall cost of EMS service in the county. d. The effect of the proposed service on existing hospitals and other health care facilities. e. The effect of the proposed service on personnel of existing services and the availability of - sufficient qualified personnel in the local area to adequately staff all existing services. (2) That the applicant has sufficient knowledge and experience to properly operate the proposed service. (3) That, if applicable, there is an adequate revenue base for the proposed service. (4) That the proposed service will have sufficient personnel and equipment to adequately cover the proposed service area. (Ord. No. 04-12,4 7) Sec. 50.58. - Appointment of hearing officer. In making the determinations provided for in section 50 -57 above, the board may, in its sole discretion, appoint a hearing officer to hold a public hearing and to make factual findings and conclusions as a result of the hearing. Should a Hearing Officer be appointed, said hearing officer shall render a written report to the board within 30 days of the hearing, which report shall contain the officers findings and conclusions of fact, and a recommended order. The findings and conclusions of fact shall be binding upon the board, but the recommended http : / /search.nntnicodc.conm/html /10578 /level3 /PI_C50_AIII.htm1 3/5/2010 Ell ARTICLE ITI. - MEDICAL TRANSPORTATION SERVICES Page 4 of 10 order shall be advisory only. (Ord. No. 04 -12, § d) Sec. 50 -59. - Rights and duties granted by certificate. The certificate granted by the board shall be valid for one calendar year.and shall be personal to the applicant and not transferable. In the case of a corporation, if there occurs such a transfer of stock or other incidents of ownership as to change the majority or largest stockholder, a new certificate must be applied for. Changes in the officers of the corporation will not require a new certificate. Acceptance of the certificate by the applicant shall obligate the applicant. to: (1) Service the entire zone granted to the applicant. (2) Provide coverage to adjoining zones, when requested to do so by emergency control for emergency calls when the certificate holder for that zone is unable to respond. (3) Keep posted at his place of business a copy of the fee schedule, which must be filed with the administrator (if applicable). (4) Operate in accordance with the rules and regulations adopted pursuant to this article and any applicable county ordinances, and Chapter 401 Florida Statutes, and any administrative regulations adopted pursuant thereto. (5) Employ at all times sufficient personnel experienced in operation and management of emergency medical services to ensure proper and efficient operation. (Ord. No. 0442, § 9) Sec. 50 -60. - Renewal of certificate. Each certificate holder shall file within 90 days of expiration, an application for renewal of his certificate. Renewals shall be based upon the same standards, as the granting of the original certificate along with such other factors as may be relevant. The renewal application shall be accompanied by a $250.00 renewal fee. The renewal certificate may be approved routinely by the board, upon advice of the administrator, or the board may hold a hearing on same. (Ord. No. 04 -12, § 10) Sec. 50 -61. - Emergency provisions. The board may modify, suspend or revoke a certificate in the interest of the public health, safety and welfare, only at public hearing and after reasonable notice has been given to the certificate holder affected. However, it a situation exists which poses a serious threat that ambulance or rescue service will not be available to any certain area of Collier County, the administrator shall have such temporary emergency powers as are necessary to provide that service. These temporary powers are intended to provide interim protection until such time as the board meets to resolve the emergency. (Ord. No. 04 -12, § 11) Sec. 56 -62. - Classifications of certificates. There shall be two classifications of service in Collier County, as follows: -- (1) Class 1: Collier County EMS., ALS Rescue: An EMS provider with the capability of rendering on the scene prehospital ALS services and who may or may not elect to transport patients. An EMS provider rendering this level of service for a governmental entity shall be deemed to be operating under the littp : / /seai-ch- municode- coni /litml /10578 /level- /P] C50 AIII.Iltm] 3/5 /2010 10 t ARTICLE III. - MEDICAL TRANSPORTATION SERVICES Page 5 of 10 Class 1 —ALS rescue certificate of public convenience and necessity held by the governmental entity. An EMS provider holding a Class 1 —ALS rescue certificate may provide post - hospital interfacility medical transfer services and routine ALS and BLS calls within the county. A certificate of public convenience and necessity must be obtained from the county before engaging in this level of medical service. (2) Class 2: Collier County Hospitals: a. ALS transfer. An EMS provider who renders ALS interfacility medical transfer services. An EMS provider who is awarded a Class 2—ALS transfer certificate and does not possess a Class 1 —ALS rescue cerfificate shall not respond to an emergency call and provide ALS rescue services unless called upon by the appropriate Class 1 —ALS rescue provider to provide emergency backup service. In these instances, it shall be deemed to be operating under the Class 1 —ALS rescue certificate of the governmental entity requesting such emergency backup service. b. Class 2 —ALS transfer certificate holders may provide post - hospital interfacility medical transfer services and routine ALS and BLS calls within the county but only to hospitals owned by the certificate holder, however, the Class 2 certificate holder may provide out -of- county transports. Unless an EMS provider possesses a Class 1 —ALS Rescue certificate issued by the county, a certificate of public convenience and necessity must be obtained from the county before engaging in this level of medical service. G. Class -2 transfer certificate holders shall contract with the Class -1 rescue certificate holder's medical director for the performance of services set forth in F.S. § 401265 and as specifically set forth herein as follows: 1. He shall supervise and accept direct responsibility for the medical performance of the paramedics and emergency medical technicians (hereinafter EMTs). 2. He shall develop medically correct standing orders or protocols relating to life support system procedures when communication cannot be established with a supervising physician or when any delay in patient care would potentially threaten the life or health of the patient. 3. . He shall issue standing orders and protocols to ensure that the Class -2 transfer certificate holder transports each of its patients to facilities that offer a type and level of care appropriate to the patient's medical condition. 4. He or his appointed shall provide continuous 24- hour - per- day,-7- day - per -week medical direction which shall include, in addition to the development of protocols and _ standing orders, direction to the Class -2 transfer certificate holder's personnel as to the availability of "oH -line" service to resolve problems, system conflicts, and provide services in an emergency as that term is defined by F.S. § 252.34(3). 5. He shall establish a quality assurance committee to provide for quality assurance review of all EMTs and paramedics operating under his supervision. 6. He shall audit the performance of system personnel by use of a quality assurance program that includes but is not limited to a prompt review of patient care records, direct observation, and comparison of performance standards for drugs, equipment, system protocols and procedures. He shall be responsible for participating in quality assurance programs developed by the Class -2 transfer certificate holder. 7. He shall ensure and certify that security procedures of the Class -2 transfer certificate holder for medications, fluids and controlled substances are in compliance with chapters 401, 499 and 893, Florida Statutes, and chapter 10D -45 of the Florida Administrative Code. 8. He shall create, authorize and ensure adherence to, detailed written operating procedures regarding all aspects or the handling of medications, Fluids and controlled substances by the EMS personnel and comply with all requirements of chapters 401, 499 and 893, Florida Statutes. 9. He shall notify the Florida Department of Health, (hereinafter the "departmenfl in writing when the use of telemetry is not necessary. 10. He shall notify the department in writing of each substitution of equipment or medication. http : / /search.municode.com/11tn11 /1 05 7 8 /level3 /PI C50 AIILhtA 3!5/2010 ID l ARTICLE III. - MEDICAL TRANSPORTATION SERVICES Page 6 of 10 11. He shall assume direct responsibility for the use by an EMT of an automatic or semi- automatic defibrillator; the performance of esophageal inlubations by an EMT; and on routine interfacility transports, the monitoring and maintenance of non - medicated I.V.s by an EMT. He shall ensure that the EMT is trained to perform these procedures; shall establish written protocols for the performance of these procedures; and shall provide written evidence to the Florida Department of Health documenting compliance with the provisions of this paragraph. 12. He shall ensure that all EMTs and paramedics are trained in the use of the trauma scorecard methodologies as provided in sections 64E -2.017 of the F.A.C., for adult trauma patients and 64E - 2.0175, F.A.C., for pediatric trauma patients. 13. He shall participate as a crewmember on an EMS vehicle for a minimum of ten hours per year and complete a minimum of ten hours per year of continuing medical education related to pre - hospital care or teaching or a combination of both. 14. He shall ensure that all of the Class -2 transfer certificate holder's EMTs and - paramedics have all proper certifications and receive all training necessary to maintain their certification. (Ord. No. 04 -12, § 12) Sec. 50.63. - Transfer or assignment of certificates. No certificate issued under this article shall be assignable or transferable by the person to whom issued except unless approval is obtained from the board in the same manner and subject to the same application, investigation, fees and public hearing as original applications for certificates. Any majority transfer of shares or stock or interest of any person or operator so as to cause a change in the directors, officers, majority stockholders - or managers of such person or operator shall be deemed a transfer or assignment as contemplated in this artide and subject to the same rules and regulations as any other transfer or assignment. (Ord. No. Od -12, § 13) Sec. 50 -64. - Revocation, alteration or suspension grounds. (a) Every certificate issued under this article shall be subject to revocation, alteration and /or suspension of operation, buy [by] the board, for a period of up to one year, where it shall appear that: (1) The operator has failed or neglected for a period of 30 days during any calendar year to render all services authorized by his certificate. (2) The operator has been convicted of a felony or any criminal offense involving moral turpitude. (3) The certificate was obtained by an application in which any material fact was omitted or falsely stated. (4) The operator has knowingly permitted any of its motor vehicles to be operated in violation the laws which result in conviction of the driver or operator of a misdemeanor in the second degree or greater, or has knowingly permitted a driver with more than two previous convictions to operate emergency vehicles. (5) The operator has failed to comply with any of the provisions of this article. (6) The public interest will best be served by revocation, alteration, or suspension of any certificate upon good cause shown. (7). The operator or his agent has demanded money or compensation other that established and prescribed under this article (if applicable). (6) The operator has without sufficient justification failed or refused to furnish emergency care - and /or transportation promptly for a sick or injured person. (g) The operator or his agent has been found guilty of malpractice or willful and wanton misconduct in the operation of its service. http : / /scarch.municode.com/)itml /10578 /leve[3/PI_C50_AIII.html 3/5/2010 1OH M ARTICLE Ill. - MEDICAL TRANSPORTATION SERVICES Page 7 of 10 (b) Ali complaints shall be investigated and a report thereon made to the board, together with findings and recommendations, within 15 days. If revocation, suspension or alteration of any certificate appears warranted, the board shall give notice to the operator holding the certificate that the same will be considered at a specific commission meeting, provided the date of such meeting shall not be less than five days from the date of the notice. The board shall thereupon consider the complaint and either revoke, suspend or alter the certificate or dismiss the complaint, (ord. No. 04-12, § fa) Sec. 50 -65. - General operating regulations. All certificate holders, operators, and drivers shall comply with all state statutes and administrative regulations as following regulations: (t) 24 -hour service. Every certificate holder shall be required to operate sufficient ambulances, as stated on the certificate of operation and determined by the board, on immediate call at all times. (2) Prompt service required. Every call for ambulance service shall be answered promptly. Patients shall be loaded and transported without being subject to unreasonable delays. All calls for emergency assistance requiring over 20 minutes from time of notification to arrival on scene shall be reported to the administrator with complete documentation of the circumstances, which delayed the response. Those instances where more than three minutes elapse between receipt of an emergency call and 'dispatch of an ambulance shall also be reported to the administrator with documentation of circumstances. (3) Bed linens. Clean and sanitary bed linens shall be provided for each patient carried and shall be changed as soon as practicable after the discharge of the patient. -' (4) Daily log. Every operator shall maintain in a daily log upon which shall be recorded the place or origin, time of call, time of dispatch, time of arrival at scene, time left for hospital, time of arrival at hospital, and charges for each trip made and such other operating and patient information as may be required by ordinance. Every operator shall retain and preserve all daily logs for at least two years, and such logs shall be available for inspection by the administrator. (5) Communications. Each ambulance shall maintain two-way radio communication with the location of primary dispatch from which it operates, as well as any additional communication capabilities required by ordinance or state law. (6) Vehicles and equipment. Each vehicle shall be equipped with the proper medical and emergency equipment as required by the laws of the State of Florida and shall be subjected to inspection from time to time to insure compliance with the Laws of Florida and this article. (7) Certification. In addition to the State of Florida Department of Health, Bureau of Emergency Medical Services requirements for certification, each paramedic most be certified by the county medical director. Each paramedic must work with a Collier County EMS ambulance for a sufficient length of time for the ambulance service medical director to properly judge his capability. At minimum, the paramedic must work in that capacity not less than one full month's work shift annually. Salaries of other than Collier County EMS paramedics will be paid by the agency seeking the medical director certification. (S) Application, Each ambulance or ALS service shall be subject to those rules and regulation as . promulgated by ordinances of the board for the purpose of carrying out this article. ford. No. e4-12, § 15) Sec. 50 -66. - Central place of business. Each operator shall maintain a central place or business which shall be entirely within his designated operating zone, at which place he shall provide two -way radio communication with his vehicles, the county emergency control communications center, and his place of business, a properly listed telephone for receiving all calls for service and at which central place of business he shall keep such business records and daily logs available for inspection or audit by the administrator. Every operator shall keep on file with the administrator and the county emergency control communications center a business address and telephone number at which the operator may be reached at all times. This Information will be maintained at the emergency control center. http:/ Iseai-ch .municode.com /litmi/10578 /level VI'l— C50_AIlI.html 3/5/2010 ARTICLE III. - MEDICAL TRANSPORTATION SERVICES Page 6 of 10 (Ord. No. 04 -12, § 16) Sec. 50 -67. - Records to be kept. Every operator shall keep accurate records of receipts from operations, operating and other expenses, capital expenditure and such other operating and patient information as may be required by the board. (Ord. No. 04-12,117) Sec. 50 -68. - Rates. Every operator shall file with the board a schedule of the rates. Such rates shall be filed as a pad of each new or renewal application, and a rate schedule shall also be filed when changes in rates are proposed. All such rates shall be subject to review and approval by the board. (Ord. No. 04.12, § 16) Sec. 50 -69. - Operator's insurance. Every ambulance operator shall carry bodily injury and property damage insurance with solvent and responsible Insurers authorized to transact business in the Stale of Florida to secure payment for any loss or damage resulting from any occurrence arising out of or caused by the operation or use of any of the operator's motor vehicles. Each vehicle shall be insured for the sum of at least $100,000.00 for injuries to or death of any one person arising out of any one accident and the sum of at least $300,000.00 for injuries to or death or more than one person in any one accident and for the sum of at least $50,000.00 for damage to properly arising from any one accident. They shall also have malpractice insurance. Every insurance policy or contract for such insurance shall provide for the payment and satisfaction of any financial judgment entered against the operator and present insured or any person driving the insured vehicle. Such insurance shall be obtained and certificates or certified copies of such policies shall be filed with the board. All such insurance policies, certificates thereof or certified copies of such insurance policies shall provide for a 30 -d2y cancellation notice to the board. (Ord. No, 04 -12. § 10) Sec. 50 -70. - Conduct of drivers and attendants. All drivers, EMT's and paramedics shall comply with the laws of the State of Florida, in order to meet the requirements set out in this article and no driver, EMT or paramedic registered hereunder shall: (1) Fail or refuse to promptly transport, if applicable, or attend any sick or injured person after responding to a call. (2) Demand or receive compensation other that established and approved in accordance with this article or fail to give a receipt for moneys received (if applicable). (3) Give or allow rebate, commission, discount or any reduced rate not provided in the established rate (if applicable.) (4) At any time induce or seek to induce any person engaging an ambulance or ALS service to patronize or retain the services of any hospital, convalescent home, mortuary, cemetery, attorney, accident investigator, nurse, medical doctor or other service occupation or profession. (5) At any time release his patient from his care until he is assured that some responsible person is available to receive such patient. (6) At any time use a siren or flashing red light unless on an emergency call. (7) Disobey the lawful orders of the law enforcement officer at the scene of an accident, or other similar such emergency or at a fire scene, the fire officer in charge. (8) Smoke while within the confines of an ambulance. http: / /scarch.niunicode.com/litml /l 05781eveli/PI_C50_AIII.htnal 3/5/2010 10 f 4 1 t' ARTICLE III. - MEDICAL TRANSPORTATION SERVICES Page 9 of 10 (g) Operate or ride in an ambulance without using seatbelts (personnel attending patients are exempt). (Ord. No. 04-12,4 20) Sec. 50 -71. - Passengers. No person shall be aboard ambulances when engaged in emergency or routine medical calls except the following: (1) Driver, attendants and fire or law enforcement personnel; (2) Patients; (3) Not more that one relative or close friend of the patient, or if the situation warrants, the paramedic in charge may authorize more than one passenger. (4) Physicians and nurses; (5) Personnel in an observing capacity that are being trained for ambulance or ALS service, (5) Operators supervisory personnel. (Ord. No. 04 -12, § 21) Sec. 50 -72. - Obedience to traffic laws, ordinances or regulations. (a) The driver of an ambulance or ALS vehicle when responding to an emergency call or while transporting a patient may exercise the following privileges when such driver has reasonable grounds to believe that an e_ mergency in fact exists requiring the exercise of such privileges: (1) Park or stand, irrespective of the otherwise applicable provisions of law, orciinance or - regulations. (2) Proceed past a red light or stop signal or stop sign, but only -after slowing doom as may be necessary for safe operations. - (3) Exceed the maximum speed limits permitted by law so long as he does not endanger life or property. (4) Disregard laws, ordinances or regulations governing direction or movement or turning in _ specified directions so long as he does not endanger life or property. (b) The exemptions herein granted shall apply only when such vehicle is making use of audible and /or visible signals meeting the requirements of this article. (c) The foregoing provisions shall not relieve the driver of a vehicle from the duty to drive with due regard for the safety of all persons, nor shall such provisions protect the driver from the consequences of his reckless disregard for the safety of others. (Ord.. No- 04 -12, § 22) Sec. 50 -73. -Violations. In addition to the remedies provided herein, a violation or any provision of this article shall be punishable as provided by law for the violation of county ordinances. lord. No. 0442, § 271 Sec. 5D -74. - Uniformity of application. http: / /scarcll.niLinicode.com/lttml/ 1057 Mevel3 /PI_C50_AIII.htnil 3/5/2010 "I ARTICLE III. - MEDICAL TRANSPORTATION SERVICES 11 Pave 10 of 10 The article shall constitute a uniform law applicable in all of Collier County. (Ord. No. 04 -11. § 24) Sec. 50 -75. - Authority to enforce. It is hereby declared to be the duty of the Board of County Commissioners of Collier County, its officers, agents, employees and other governmental agencies, the sheriffs department of Collier County, its deputies and agents, fire departments, as well as the police departments of the various municipalities falling under the provisions of this article to strictly enforce the provisions of this article. (Ord. No. 04.12, § 25) Secs. 50 -76 -50 -100. - Reserved. h tto: / /search.mu nicode. cont/htm11105 7 8 /level 3 /PI_C 50_AII1.hhnl 3/5/2010 1OH 4UIl5�b UK. 4181 RetR' RECORDED la the oPPICIAL RGCORDS of WL1IE1 Call'" PL EEC RS 11.00 CLERK 70 THE ODARD CQTIES 9,00 IRTSROPPICE 4TH PLO01 09`132 ?41 et 10:SSAX DWIGHT E. 9EOCG. C1EEE EST 7240 iNTERLOCAL ACREEh1ENT ADVANCED LIFE SUPPORT PARTNERSHIP yy - ]L day of �P , 2007 ( "Effective THIS INTERLOCAL AGREEMENT, made and entered into this Date "), by and between the Board of Counry Commissioners, Collier County. Florida, a political subdivision of the DttSTR1CT, Florida. (hereinafter Sptcial D s nett created t under Chapter 61-202, Laws ofFlFl CONTROL and Ooperaat g Pursuant to chapter 191, Florida Statutes, and its codified cbarter provided for in Chapter 99 -d50, Laws of Florida, and its successors, (hereinafter "NORTH NAPLES'). PURPOSE The purpose of this Interlocal Agreement is to provide quality and cost effective fire rescue and emergency medical services to the residence oFNORTH NAPLES and COUNTY. The recognition and utilization of obfcg and future personnel skills, qualifications and resources is in the interest and benefit of both agencies and the p WITNESSETH WHEREAS, NORTH NAPLES and COUNTY seek to enhance emergency medical services f[at]ter through a continued partnership; and WHEREAS, the Advanced Lire Support (hereinafter "ALS ") Partnership provides for % to 0 NAPLES r o work FirefighterParamedic andror Firefighter/Emergency Medical Technician, (hereinafter "EMT"), a COUNTY ALS Transport Unit providing fvefighter I paramedic duties aad;or basic life support EMT duties; and ire WHEREAS, the ALS Partnership provides for a COUNTY Pamedic/Ffghter to work and train on an NORT m H NAPLES Fire - Rescue unit providing firefighting and paramedic duties; and WHEREAS, NORTH NAPLES and COUNTY work cooperatively to assure appropriate response of sufficient emergency medical resources. co On a ,T herein, �Ohe E in consideration NORTH of the N above pre ses, and the mutual covenants, terms, and provisions SECTION I: DEFINITIONS l.0 ALS means treatment of life - threatening medical emergencies through the use of card ac techniques monitoring. endotracheal intubarion, the administration of drugs or intravenous fluids, telemetry, and cardiac defibrillation by a qualified person, pursuant to rules of the COUNTY Medical Director 1.1 BLS means treatment of medical emergencies by a qualified splinting, obstetrical assistance,, bandaging, person patient assessment, cardiopulmonary resuscitation (CPR), p & performed under administration Of oxygen, and other techniques which have been approved and are conditions specified by rules of the COUNTY Medical Director. t�tb COUNTY [ means a Field Training Of is a m working Director as hav em s and experience nce train and direct medical approved medical protocols. 13 Oa�01 means a Quality Assurard monitors Improvement, which is the COUNTY lvl and Director approved program that assesses and monitors [he medical performance of Paramedics and Emergency Medical Technicians. chronicles medical patient. 1.a LS MO means a Iv emorandum of Unde standingbetween the and NORTH NAPLES. Attachment 92 ion OR; 4261 PG; 1136 1.6 Licensed means a non - transporting ALS fire apparatus and rapid response vehicle operating under the ALS license issued to COUNTY Emergency Medical Services (hereinafter "ENIS ") Department for the purpose of enhancing 911 medical responses. 1.7 Non- licensed means any response vehicle that is not required by State Statute to be licensed, but is authorized by the COUNTY Medical Director. SECTION 17: COUNTY'S RESPONSIBILITY The following specific services, duties, and responsibilities are the obligation of the COUNTY: 2.0 The COUNTY will provide through the County's EMS Department medical direction, medical protocols, training and quality assurance to NORTH NAPLES personnel at no cost to NORTH NAPLES. 2.1 The COUNTY will maintain at least one (1) ALS transport unit staffed by the COUNTY under COUNTY's authority pursuant to the current Chapter 401. Fla. Slat, and Subtitle 64E -2, Fla Admen. Code) at NORTH NAPLES Station 44 as a first- response apparatus on all medical incidents. 2.2 The COUNTY, as a sole licensed provider of advanced life support under Chapter 401. Fla Siat. and Subtitle 64E -2, Fla. Admen. Code, shall license a total of seven (7) NORTH NAPLES Fire apparatus or response vehicles as non - transporting ALS vehicle(s) under the COUNTY EMS license for the purpose of enhancing 91 1 medical responses. 2.3 The COUNTY will provide the initial ALS equipment and medical supplies to all County recognized NORTH NAPLES' licensed .ALS fire apparatus staffed 365 days per year, 24 hours per day stationed at the following locations: I. Engine (Ladder) 40, 1441 Pine Ridge Road, Naples 2. Engine 42, 7010 Immokalee Road, Naples 3. Engine (Ladder) 43, 16325 Vanderbilt Drive, Bonita Springs 4. Engine (Tower) 44, 8970 Hammock Oak Drive, Naples 5. Engine 45, 1885 Veterans Park Drive, Naples 6. Engine 46, 3410 Pine Ridge Road, Naples - 7. Engine 47, 2795 North Airport- Pulling Road, Naples 2.4 The COUNTY will license additional vehicles as non - transporting ALS vehicles, which have been mutually agreed upon, under the COUNTY EMS license during the term of this Interlocal Agreement. The COUNTY Medical Director shall authorize non - licensed ALS response vehicles upon receipt of written notification by NORTH NAPLES. 2.5 The COUNTY EMS Department will provide one (1) ParamediefFirefighter to NORTH NAPLES 365 days per year, 24 hours per day to be utilized on fire apparatus vehicle(s) located at NORTH NAPLES Station 44 that has been licensed as an non - transporting vehicle(s) under COUNTY's authority pursuant to Chapter 401, Fla. Stat. and Subtitle 64E -2, Fla. Admen. Code. 16 As pursuant to Chapter 401, Fla. Stat. and Subtitled 64E -2, Fla. Admen. Code, NORTH NAPLES may operate any of their licensed andior non - licensed ALS vehicles or apparatus as a BLS responder when a paramedic does not staff the vehicle. ?.' The COUNTY recognizes that NORTH NAPLES may substitute any licensed or non - licensed non transporting ALS vehicle in accordance with chapter 64- E2.007, Fla. Adman Code SECTION Ill: NORTH NAPLES' RESPONSIBILITY The following specific services, duties, and responsibilities will be the obligation ofNORTH NAPLES 3.0 NORTH NAPLES will provide Incident Command, incident safety direction, fire rescue standard operating _uidelines and training to COUNTY personnel at no cost to the COUNTY. 3.1 NORTH NAPLES will maintain seven (7) ALS apparatus, licensed and equipped by the COUNTY, at locations referenced in Section 23. These unit(s) witl be designated within the County Sherriff's Office Computer Aided Dispatch (CAD) program 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 andtbr fire suppression vehicle. 10H OR; 4221 PG; 1137 3.2 NORTH NAPLES will comply with medical protocol, and will participate in medical training and quality assurance programs in accord with the COUNTY. 13 NORTH NAPLES will provide one (I) Firefighter:' Paramedic or Firztighterr'EvIT to the COUNTY 365 days per year. 24 hours per day to be utilized on the ALS transport unit assigned to COUNTY Station 44. 3 NORTH NAPLES may provide at least one (1) MOU Training Coordinator, approved by the COUNTY Medical Director. to function as a Field Training Officer (FTO)/ Supervisor for NORTH NAPLES Paramedic and EMT [raining. 3.5 NORTH NAPLES will designate a COUNTY Medical Director approved Quality Assurance member to participate on the COUNTY ALS Non - Transport Quality Assurance Committee. 3.6 NORTH NAPLES may provide additional non - licensed ALS vehicles when paramedic staffing permits. 3.7 NORTH NAPLES may provide additional medical equipment and advanced service with the approval of the COUNTY. 18 NORTH NAPLES shal I be responsible for replacing expendable medical supplies and for the cost of repair and maintenance of all ALS equipment supplied by the COUNTY that are not located on County staffed vehicles. SECTION IV: MUTUAL CONVENANTS 4.0 The COUNTY in coordination with NORTH NAPLES will be responsible for verifying that NORTH NAPLES Firefighter/Paramedics and/or FirefighterfEMTs meet all requirements for State liceasure and recertification as Florida Certified Paramedics and/or EM[Ts. NORTH NAPLES in coordination with the COUNTY will be responsible for verifying that the COUNTY Paramedic'Firefighters meet all requirements for licensure and recertification as required by law (e.g., Florida Statutes, Florida Administrative Code, and rules and regulations of the Division of State Fire Marshall's Bureau of Fire Standards and Training.) 4.1 The COUNTY and NORTH NAPLES will provide each other's department employees similar training and internship programs as would be provided for a COUNTY or NORTH NAPLES employed Firetighter.Taramedic or Fire Fghter /EMT. 4? Necessary qualifications for both NORTH NAPLES and COUNTY firefighter),paramedics will be cooperatively developed and defined within the Collier County Fire Chiefs' Association (CCFCA) Firefighter Cross Training Program, and Collier County Medical Director's Paramedic QualiticationXertification Matrix. 4.3 The COUNTY and NORTH NAPLES will work cooperatively to identify and request appropriate a ants in order to improve the operations and service capabilities of both departments. 4,4 The operational decision to change the location of either apparatus assignment identified in sections 2.3 or 3.3 may be changed by mutual written consent between the Chief of the NORTH NAPLES FIRE or his designee and COUNTY's County Manager or his designee (e.g. Chief of EMS). SECTION V: OPERATING PROCEDURES 5.0 NORTH NAPLES Firefighter/Paramedics and Fire ftghter'EMTs will meet the same requirements and perform at the appropriate medical protocol as defined by the COUNTY Medical Director, standard operating procedures, quality assurance program, general orders and chain of command as employees of the COUNTY EMS Department. 5.1 NORTH NAPLES Firefighter:Paramedics shall be cenified'to perform as ALS Engine Paramedics under current medical protocol. The COUNTY Medical Director shall regularly evaluate the skills of NORTH NAPLES Paramedics for consideration of expanding the medical protocol under which they perform. :? The COUNTY ENIS Department Paramedic'Firefighters will meet the same requirements and perform under the same Fire specialized response protocols, standard operating procedures and chain of command as employees of NORTH NAPLES. 5.3 The ALS Partnership Operations Plan, Attachment A, may be revised by mutual written consent between the Chief of NORTH NAPLES and COUNTY's County Manager or his designee (e.g. Chief of EMS). Such rep isions must not conflict with the terms and standards set forth in this Interlocal Agreement. 5.4 Licensed and non - licensed ALS vehicles, programs, personnel or details may be developed and implemented by joint agreement and in cooperation between NORTH NAPLES and COUNTY. Such resources may no[ conflict with the standards set forth in this Interlocal Agreement. ion OR: 4281 PG. 1138 5.5 NORTH NAPLES and COUNTY ETAS will recognize the respective ranks and abilities of assigned personnel. 5.6 All discipline and investigations leading to discipline will be handled by the respective employing agency. :.' NORTH NAPLES and COUNTY EMS will utilize Command Staff and assets for logistical, support, and operational needs for national, state and local emergencies. 5.8 The State of Florida recognized Incident NTanagement System (PAS) is the standard for emergency operations. NORTH NAPLES shall assume command and control of all incidents where NORTH NAPLES is the agency having jurisdiction. In all instances where NORTH NAPLES has established command. COUNTY EVIS shall assume responsibility for, and be in charge of patient care. 5.9 The COUNTY and NORTH NAPLES will jointly develop medical recordkeeping procedures and 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 EMS will have jurisdiction of medical issues concerning appropriate patient care. 3. NORTH NAPLES will have jurisdiction of ftre:'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 deparRneat 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 TO This Interlocal Agreement supersedes the agreement titled "Interlocal Agreement Advanced Life Support Engine Partnership, between the NORTHNAPLES and COUNTY" dated April 26, 2005. 1.1 This Interlocal Agreement shalf remain in full, force from the Effective Date and shall terminate pursuant to sections 7.2 or 7.3. 7? This Interlocal Agreement shall be for a term of three (3) years. Ninety (90) days prior to the expiration of the term, it shall be reviewed and renegotiated as necessary. Absent termination or amendment to this hiterlocal .Agreement, the term of this Interlocal Agreement will automatically renew in three (3) year periods. Nothing within this Interlocal Agreement shall preclude review and amendment of any provision within die three (3) year period or successive renewal periods when such amendment is mutually agreed to in writing bN the COUNTY and NORTH NAPLES. 7.3 Either the COUNTY or the NORTH NAPLES may terminate this Interlocal Agreement after providing written notice of formal action by its governing board of its intent to terminate this Interlocal Agreement at least ninety (90) days in advance of the date of termination. 7.4 In the event that the COUNTY's Medical Director determines that NORTH NAPLES failure to fulfill any Of the obligations under this Interlocal Agreement adversely affects or may adversely affect the medical needs of the patient and'or responder safety, the COUNTY Medical Director may provide written notice to NORTH NAPLES of its intent to recommend that the COUNTY BCC terminate this Interlocal Agreement. The COUNTY BCC's consideration of termination of this Interlocal Agreement shall occur at the next available regular meeting of the COUNTY BCC that is at least two (2) weeks from the written notification bN the COUNTY Medical Director to NORTH NAPLES of its recommendation of termination. Two ('_) weeks advance notice of the BCC meeting date and agenda item must be provided to NORTH NAPLES. Nothing in this Agreement shall limit the authority of the Medical Director 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. ION - OR; 4281 PG; 1139 SECTION VIII: INSURANCE 8.0 NORTH NAPLES and COUNTY shall maintain insurance in the minimum amounts and types required by Florida State Statues. 3.1 NORTH NAPLES and COUNTY agree that either party may be self - insured on the condition that all self. insurance must comply with all Sate laws and regulations and must meet with the approval of the other part) to this Interlocal Agreement. 33 To the extent permitted by law and as limited by and pursuant to the provisions of Florida Statutes, Section 763.33, NORTH NAPLES 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 agreement that allows employees of the other to occupy and ride in each other's vehicles. Nothing is intended to alter either patty's immunity in ton or otherwise impose liability on NORTH NAPLES or the COUNTY when it would not otherwise be responsible. 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 the Interlocal Agreement, the party prevailing in said litigation shall be entitled to collect and recover from the opposite parry 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 NORTH NAPLES and COUNTY commencing with the work, services, duties and responsibilities described heretofore. 9.3 Prior to its effectiveness, this Interlocal Agreement and any subsequent amendments shall be fled with the -- Clerk of Courts for the Circuit Court for Collier County pursuant to FS 163.01 (II). The COUNTY shall file said agreement as soon as practicable after approval and execution by both parties. 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. BOARD OF COUNTY COMMISSIONERS OF COLLLER COUNTY, FLORIDA q�gDr By: 5 i tt 7 L'ut3tt�ea'' J Coletta., Chai man j�!/�G7 .Appruv, 11 as to form and legal NORTH NAPLES FIRE CONTROL AND sufficiency: RESCUE DISSRJCT - -... ' BLY-- fer A. Belp dio J-[ hFi-� ^yes'- •�+*�+��d"o,� airman .Assistant Counry .Attorney ��� 10H 1APF4 OR; 4281 PG. 1140 ATTACHMENT A COLLIER COUNTY EIrERGENCY MEDICAL SERVICES / FIRE DEPARTMENT .4ND NORTH NAPLES FIRE AND RESCUE DEPARTMENT ALS PARTNERSHIP OPERATIONS PLAN REFERENCE: ALS Program Interlocal Agreement 's pj, 11— 2007 PURPOSE: To provide quality and cost effective fire rescue and emergency medical services to the residents of NORTH NAPLES (NNFD) 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. 1. QUALIFICATION REQUIREMENTS a. COLrNTY Paramedic/Firefighters utilized oa designated fire apparatus must maintain the following valid and current qualifications: i. Florida Bureau of Fire Standards and Training Certificate of Compliance for Minimum Standards (Firefighter II); ii. Florida Bureau of Emergency Medical services and Community Health Resources Paramedic Certification; iii. Emergency Vehicle Operator Certification in accordance with F.A.C. Chapter 64E; iv. Collier County Medical Director's Paramedic Certification/Qualification Matrix Rescue Paramedic and; v. Collier County Fire Chiefs' Association Firefighter Cross Training Certification. b: NNFD Firefighters utilized on the County Medic unit must maintain the following valid and current qualifications: i. Florida Bureau of Fire Standards and Training Certificate of Compliance for Mlinimum Standards (Firefighter II); ii. Florida Bureau of Emergency Medical services and Community Health Resources EMIT or Paramedic Certification; iii. Emergency Vehicle Operator Certification in accordance with F.A.C. Chapter 64E and; i ,. OR; 4281 PG; 1141 iv. Collier County Medical Director's Orientation, as referenced in the Collier County Medical Director's Paramedic Certification/Qualification Matrix C. At least one NNFD Firefighter /Paramedic utilized on licensed NNFD ALS apparatus or vehicle must maintain the following valid and current qualifications; i. Florida Bureau of Fire Standards and Training Certificate of Compliance for .Minimum Standards (Firefighter II); ii. Florida Bureau of Emergency Medical services and Community Health Resources Paramedic Certification and; iii. Emergency Vehicle Operator Certification in accordance with F.A.C. Chapter 64E and; iv. Collier County Medical Director's Paramedic Certifrcation/Qualificatiod Matrix Engine Paramedic Certification or above. d. NNFD Firefighter/Paramedics utilized in non - licensed apparatus or as must maintain the following valid and current qualifications; i. Florida Bureau of Fire Standards and Training Certificate of Compliance for Minimum Standards (Firefighter Il); ii. Florida Bureau of Emergency. Medical services and Community Health Resources Paramedic Certification and; iii.. Emergency Vehicle Operator Certification in accordance with F.A.C. Chapter 64E and; iv. Collier County Medical Director's Paramedic Certification/Qualification Matrix Engine Paramedic Certification or above. 2. SCHEDULING AND POSITION ASSIGNMENTS a. The COUNTY and NNFD Chiefs or their designee, must approve all Exchange Program participants. b. The COUNTY Battalion Chief 80 and NNFD Battalion Chief 40 will consult openly in order to assure continuity and efficiency. c. The COUNTY will continuously provide NNFD with one [1] COUNTY Paramedic.'Firetighter as qualified within Section La. for use on a designated ALS apparatus or vehicle. d. N, NFD will continuously provide the COUNTY with one [1] NNFD Firefighter as qualified within Section Lb. for use on the appropriate designated apparatus or vehicle, e. Exchange Program participants will participate in appropriate on -duty training, station duties and unit assignments in accordance with assignment and rank. H RI OR; 4281 PG; 1142 L it is recognized by COUNTY and NNFD that harmonious and productive relationships between all personnel are necessary-. Teamwork and cooperation is encouraged and expected. e. applicable COUNTY and/or 'NORTH NAPLES policies, practices, procedures; standard operating guidelines, general orders, protocols andlor applicable Bargaining Unit Contract language will be observed. I COMMUNICATION AND DISPATCH a. COUNTY and NNFD 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 (EIwtD) Models shall be designed to assure the initial response of appropriate ALS licensed apparatus. ii. COUNTY and NNFD chief officers will utilize available NNFD licensed resources to assure ALS coverage is continuously maintained within NORTH NAPLES. iii. COUNTY- and: NNFD chief officers will assure licensed and non- [icensed ALS 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 NORTH NAPLES 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 ALS unit will document each patient contact in a hand -written Patient Care Report (PCR). 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 -rith State paramedic or ENfT license numbers. 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 EiMS representative. b. Before the end of shift, an accurate and complete EMS2000 report will be electronically transmitted for each patient contact 1D0% of the time. All BLS /ALS procedures performed by the personnel assigned to the ALS response will be fully documented. "CHART" format with documented "BSF is required. 10H OR; 4281 PG; 1143 c. Prior to 0900Itrs, or as call volume permits, Battalion 40 or designee must fax or email a complete ALS Engine Staffing 'Report to Battalion 81's office. An updated report will be provided to Battalion 81 prior to or at the end of shift to reflect staffing chances during that tour. Battalion 81 will fax a complete EMS Staffing report to Battalion 40's office. ?. QUALITY ASSURANCE a. NNFD will appoint a Medical Director approved `Quality Assurance (QA) member to participate on the ALS Non - Transport Quality Assurance Committee, and ,ill be granted privileges to enable them to review their department's EMS 2000 PCRs. b. At the discretion of the Medical Director or designee, routine or informational QA Review may be handled by the NNFD member. The QA Committee will provide the member with appropriate documentation detailing the area of interest. The member shall review and complete the material with the NNFD personnel and return all necessary documentation to the ALS Non - Transport QA Committee within thirty [3 01 calendar days. c. 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. TRk[NNG a. NNFD will appoint a Medical Director approved "EMS Training person(s)" to work as an adjunct for the Collier County EMS Training Center so to instruct NNFD personnel in pre - hospital medicine and protocol. b. The NNFD Training person(s) is qualified to instruct NNFD firefighter paramedics or EbITs Medical Director approved in- services, certifications, classes, etc. C. Any curriculum taught by the NrNFD EMS Training person(s) must be submitted with a complete student roster to the 14edical Director in order to qualify for County accreditation. In addition, the EMS Training person(s) will be granted privileges to ENIS 2000 to accurately record continuing education hours of any personnel completing their training. d. l'NFD will provide to the State Fire College appropriate approved training documentation for recognized State approved fire classes. ' 07-EMS--J1, )si 2 IOU r..; 1 1 Good afternoon, As most of you certainly realize, our department is suffering from the current state of our economy. During these difficult times, we have developed many Innovative solutions - some of which are behind the scenes and meant only to reduce expenses. While other initiatives, such as the MedCom program, EMS Focused Dispatching and EMSCOMM have proven themselves as enormous strides towards improving our efficiency while escalating our effectiveness. Beginning next week, we are taking another step forward: After countless months of intense research, analysis and best practice modeling conducted by our own CCEMS TARGETED RESPONSE TASKFORCE, along with the guidance of Dr. Tober, CCEMs is again moving ahead — "leading the pack ". A new component of our continually developing tiered response system is being introduced. We are creating a leaner, quicker, versatile EMS framework meant to address all of our needs— the patient being our priority. Throughout the nation, statistics have proven that the overwhelming majority of medical emergencies do not need ambulances as the primary or first responder. Even when considering most severe incidents, a typical patient needs only BLS provisions within the first several minutes. ALS is usually not necessary until several BLS treatments have been successfully administered. While ambulances will always be a mandatory component of an EMS system, they should not be the foundation necessary to provide skilled BLS orALS care. An ambulance is only required if the patient eventually needs transport to the hospital. The standard EMS system model that uses only a single resource: ambulances, is very expensive and obviously unnecessary. In fact, a patient simply needs a rapid response from a provider who can offer immediate BLS attention and possibly, in a minority of cases, also provide competent ALS treatment. The days of the aver - deployment of cumbersome and sometimes numerous apparatus racing through the streets to every call are probably long behind all of us. What is needed are safer vehicles staffed by dependable experienced and clinically practiced paramedics capable of getting to a patient's side ua ickly. Attached is an SOG for the new Quick Response Paramedic BETA Program. The "QRP" coupled with the extraordinarily successful MedCom program will provide a reliable safety-net necessary In order to cover areas in the county void of ambulances and also provide quicker response to critical patients. If you are interested in filling this exciting and demanding role, read over the attachments and contact your Battalion Chief — We begin the program on March 03". Attachment #3 Mm COLLIER COUNTY EMS / FIRE DEPARTMENT STANDARD OPERATING GUIDELINES TITLE: QUICK RESPONSE PARAMEDIC (QRP) EFFECTIVE DATE: March 01, 2010 TERM: BETA PROGRAM RESPONSIBILITY: ALL DEPARTMENT EMPLOYEES Purpose The primary purpose of the Quick Response EMS Paramedic (QRP) Program is to help further develop a prudent operational model that appropriately utilizes qualified paramedic resources in areas of need. Secondarily, the Program may become a means of reducing the utilization of redundant resources. Scope The role is dynamic and requires an individual who is proven to be overwhelmingly medically competent, able to make sensible decisions — then take immediate action, appropriately delegate authority, manage emergency medical scenes /resources sensibly and is team oriented- The QRP's responsibilities include that they. • recognize and respond to medical incidents when they are the closest county certified paramedic practitioner or as dispatched — provide BLS /ALS first response; • recognize and provide coverage in areas void of county certified paramedic practitioners (ex done roserage); report to hospital emergency rooms (as directed by command staff) during peak hours when acceptable turn -out times for ambulances are delayed —in an effort to release otherwise out -of- service ambulances, the QRP will accept responsibility for stable padent(s) until an ER bed is available and; •:. fill any /all fret responder and general operational needs as directed by command staff. While on- scene, the QRP may either directly administer or delegate appropriate treatment through the principles identified in the. Emergency Medical Care Delegation Standard Operating Guideline and the Collier County Office of the Medical Director's Common Medical Protocol The QRP will work only within their certified scope of practice. The ORP's role is not to be confused with the elevated scope of practice of a Rescue Paramedic II / MedCom" The QRP does not have supervisory functions. - Judgment should be exercised when responding to calls Nvhen multiple fast responders have either been dispatched or are already on- scene. In general, the QRP should not respond to calls when a MedCom or Battalion Chief is also responding. Discretion should be applied in cases when multiple calls are dispatched within the same nrnximitv —rh, OPTI ;�....e....._a._.i-- __ - -.. .... . Procedures Communications Communication procedures fall under the provisions of the current Communications Standard Operating Guideline. Radio identifiers include "Lieutenant 80 (LT80)" and "Lieutenant 81 (LT81) ". 2. Vehicle assignment Assigned by EMSCOMIA. A Vehicle log is completed at the beginning of the shift assignment. Inventory is -- completed at both the beginning and end of the shift assignment. QUICK RESPONSE PARAMEDIC (QRP) —BETA Page 1 oft 10 vi¢' COLLIER COUNTY EMS/ FIRE DEPARTMENT STANDARD OPERATING GUIDELINES TITLE: QUICK RESPONSE PARAMEDIC (QRP) EFFECTIVE DATE: March 4 2010 TERM: BETA PROGRAM RESPONSIBILITY: ALL DEPARTMENT EMPLOYEES 3. Assignment Unless otherwise directed by EMSCOlvIIv1: Lieutenant 80: EMS Headquarters by 0830hrs and report to Chief 83 for du y assignment. Deployment hoots will typically exist between the hours of 0830 — 1730hrs. At the conclusion of the deployment, LT80 may be reassigned by EMSCOMM to a front -line ALS apparatus until the conclusion of the department's standard. shift. Lieutenant 81: EMS Headquarters by 1030hrs and report to Chief 83 for duty assignment. Deployment hours n-M typically exist between the hours of 1030 — 2030hrs. At the conclusion of the deployment, LT81 may be reassigned by EMSCONN to a front -line ALS apparatus until the conclusion of the department's standard shift. 4. PCR Entry I. Call Cancelled =No electronic PCR 2 Arrive on Some prior to EMS Unit = PCR shall be completed 3. Arrived on scene after an EMS Unit and ONLY provided non - medical support such as loading patient or equipment = No electronic PCR 4. Arrive on a scene in order to assist the first response unit and performed medical procedures = PCR shat be completed S. Uniform /PPE Uniform standards are in accordance with the Bargaining Unit Contract, Personal Protective Equipment and Personnel Accountability System Standard Operating Guideline. - G. Minimum Qualifications The position does not need to be staffed by a ranking Lieutenant. All positions are assigned by command staff based on personal performance and Quality Assurance considerations. As directed by command staff, the individual will be expected to be unimpeded be traditional parameters and encouraged to work within a team environment in order to assist in developing a Beta Program into a resource which may become a standard within the depruunen['s operations. QUICK RESPONSE PARAMEDIC (QRP) — BETA Pale 2 of 2 10H COLLIER COUNTY EMERGENCY SERVICES MEDICAL CONSULTANT CONTRACT THIS MEDICAL CONSULTING CONTRACT made this 1- _ day of 2001 by and between ROBERT BOYD TOBER, INC., hereinafter referred to as Consultant, and COLLIER COUNTY, FLORIDA, hereinafter referred to as the County. WITNESSETH WHEREAS, the County is responsible for emergency services in COLLIER COUNTY, Florida; and WHEREAS, Emergency Medical Services, (hereinafter "EMS "), are a logical extension of existing health care services performed by the County in the above described geographic area; and WHEREAS, Consultant ROBERT TOBER, M.D., a duly licensed physician in the State of Florida who is specially trained in the field of emergency medicine; and WHEREAS, the County and Consultant have previously entered into a Medical Consulting Contract dated June 18, 1996 which provides for automatic renewal pursuant to certain conditions; and WHEREAS, said conditions have been met for renewal of the contract and the parties hereto manifest their mutual desire to renew same with certain changes contained herein; and NOW THEREFORE, in consideration of the promises and the mutual covenants hereinafter set forth, the parties hereto agree as follows: 1• LICENSE: ROBERT TOBER, M.D. is at the present time a duly licensed physician in the State of Florida and he has agreed to maintain his license in full force and effect during the term of this contract. If for any reason during the term of this Contract, the County no longer contracts with DR. TOBER, or if DR. TOBER should lose his license to practice medicine, this contract shall immediately become null and void Attachment #4 ION 2• GENERAL DUTIES: Consultant shall be an independent contractor and shall be directly responsible to the Division Administrator of the Emergency Services Division for the performances of services as Medical Director as more specifically defined in this agreement and as set forth in Section 401.265, Florida Statutes. The Consultant shall be responsible for the implementation of such planning and coordination as may be necessary to deliver advanced life support by Paramedics (including EMS and Fire District personnel) trained to the level of advanced and basic medical technicians, which may require intravenous administration of emergency resuscitative drugs and the performance of sophisticated technical emergency procedures. 3. TERM OF CONTRACT: The initial term of this contract shall be from October 1, 2000 to September 30, 2001. The parties agree that the term of the Contract shall be automatically renewed on a yearly basis from October 1, through September 30 with the same terms, conditions and obligations as set forth herein, unless terminated by County upon sixty (60) days written notice to Consultant. 4. COMPENSATION: The County shall pay to the Consultant the sum of $50,000 per annum, as full compensation for the services rendered herein and no other compensation. The County will pay the cost of the professional liability insurance. The Medical Director shall not be eligible for any employee benefits other than this compensation. This sum shall be paid to the Consultant in twelve (12) equal monthly payments commencing with the effective date of the Contract, with each monthly payment being payable by the 10th of each month. The Consultant will be entitled to a 5% annual increase beginning October 1, 2001 upon written notification by the Emergency Services Administrator by September 15`h of each year, beginning on September 15, 2001, and upon approval by the Board of County Commissioners. 5. PATIENT RECORDS: The County shall make available, within two days of request, any and all medical records, reports, documents and other relevant materials, including 2 f I i VA Ion audio and visual tapes requested by the Consultant. This includes all run reports, medical test results, recordings on tape and any otherreasonably available similar information. 6. CONFIDENTIAL COMMUNICATIONS: Except as may be ,provided by general law, the County agrees to keep all medical records confidential and allow no communication of records or patient information without a written release from the patient or the Consultant. 7. REPORT: The County agrees to give the Consultant full and detailed reports regarding any case which it reasonably believes has the potential for legal action against the County or its employees pertaining to EMS. 6. DISCIPLINARY ACTIONS: The County agrees to give the Consultant a full written report of any and all Emergency Medical Services personnel who are known to have violated any standing or verbal orders. Consultant shall be given full support for removal of any program participant as provided for in State regulations governing Advanced Life Support Providers. 9.. DUTIES AND RESPONSIBILITIES OF THE CONSULTANT: - a. He shall be from a broad -based medical specialty such as emergency medicine, internal medicine, anesthesiology, or other surgical specialty, with demonstrated experience in pre - hospital care and hold an ACLS certificate of successful course completion or be board certified in emergency medicine. b. He shall demonstrate and have available for review documentation of active participation in a regional or statewide physician group involved in pre - hospital care, C. He shall supervise and accept direct responsibility for the medical performance of the paramedics working for Collier County EMS. d. He shall develop medically correct standing orders or protocols relating to life Support system procedures when communication cannot be established with a 3 ion supervising physician or when any delay in patient care would potentially threaten the life or health of the patient. e. He shall issue standing orders and protocols to Collier County EMS to ensure that it transports each of its patients to facilities that offer a type and level of care appropriate to the patient's medical condition if available within the service region. f. He or his appointee shall provide continuous 24- hour - per -day, 7- day - per -week medical direction which shall include, in addition to the development of protocols and standing orders, direction to Collier County EMS personnel as to the availability of "off -line" service to resolve problems, system conflicts, and provide services in an emergency as that term is defined by section 252.34(3), Florida Statutes. g. He shall establish a quality assurance committee to provide for quality assurance review of all paramedics operating under his supervision. h. He shall audit the performance of system personnel by use of a quality assurance program that includes but is not limited to a prompt review of patient care records, direct observation, and comparison of performance standards for drugs, equipment, system, protocols and procedures. He shall be responsible for participating in quality assurance programs that may be developed by the department. i. He shall ensure and certify that security procedures of the Collier County EMS for medications, fluids and controlled substances are in compliance with chapters 401, 499 and 893, Florida Statutes, and chapter IOD -45 of the Florida Administrative Code. j. He shall create, authorize and ensure adherence to, detailed written operating procedures regarding all aspects of the handling of medications, fluids and controlled substances by the EMS personnel and comply with all requirements of chapters 401, 499 and 893, Florida Statutes. 4 IN k. He shall notify the Florida Department of Health, (hereinafter the "Department') in writing when the use of telemetry is not necessary. I. He shall notify the department in writing of each substitution by Collier County EMS of equipment or medication. m. He shall assume direct responsibility for the use by a Collier County paramedic of an automatic or semi - automatic defibrillator and the performance of esophageal intubation, and on routine interfacility transports, the monitoring and maintenance of non - medicated IN.s. He shall ensure that the paramedic is trained- to perform these procedures; shall establish written protocols for the performance of these procedures; and shall provide written evidence to the department documenting compliance with the provisions of this paragraph. n. He shall ensure that all paramedics are trained in the use of the trauma scorecard methodologies as provided in sections 64E -2.017 of the F.A.C., for adult trauma patients and 64E - 2.0175, F.A.C., for pediatric trauma patients. o. He shall participate as a crewmember on an-EMS vehicle for a minimum of to hours per year and complete a minimum of 10 hours per year of continuing medical education related to pre - hospital care or teaching or a combination of both. P. He shall ensure that all Collier County paramedics have all proper certifications and receive all training necessary to maintain their certification. 10. ADDITIONAL DUTIES• Consultant shall also be responsible for assisting in the following additional duties: a. Consultation in the planning for Emergency Medical Services Department to be provided by the County, including the design of vehicles, equipment, supplies, distribution resources, emergency medical services personnel ,training and medical policy, protocol, planning and development. 5 10H b. Consultation in the coordination of training of paramedical personnel, including the determination of training criteria for certification. c. Organizing, coordinating and participating as an instructor in the in- service education programs and quality control of the patient care in day -to -day delivery of emergency medical services by the County. d. Serving as a liaison between the County and the appropriate community hospitals, medical societies, practicing physicians and training facilities in the area. e. Providing such assistance as may be required in the preparation and administration of any grant programs for the establishment and improvement of the system. f. All duties outlined in Rule 64 -E Florida Administrative Code for Emergency Medical Services Medical Director that are not specifically set forth herein and as may be changed from time to time by the department.. g. He shall keep adequate records and supporting documentation, which concern or reflect his services under this Contract. h. Consultant represents that it presently has no interest and shall acquire no interest, either direct or indirect, which would conflict in any manner with the performance of services required hereunder. 11. LIABILITY AND REMEDIES IN BREACH OF CONTRACTS: It is recognized that the provision of advanced life support services requires that the County have a Medical Director. Accordingly, the Consultant shall not refuse to perform these services during the terms of this Contract so long as it is able to so perform, and the County shall have the right to specific performance of the provisions of this contract, In addition, the Consultant shall be liable to the County for his unreasonable failure or refusal to perform the services required hereunder. t� ion V - `" No modification, or change in this Agreement shall be valid or binding upon the parties, unless in writing, and executed by the party or parties intended to be bound by it. Unless otherwise specified, the laws, rules and regulations of the State of Florida shall govem this Agreement. Any suit or action brought by either party to this Agreement against the other party relating to or arising out of this Agreement must be brought in the appropriate Florida State Court in Collier County, Florida. 12. CONFLICTING EMPLOYMENT OR CONTRACTUAL RELATIONSHIP: Nothing in this Contract shall be interpreted as preventing the Consultant from operating any other business or being similarly employed with any other emergency medical service that is lawfully licensed by the County (within Collier County, Florida) and the State. However the Consultant shall not accept any employment or enter into any contractual relationship that would create a conflict between such interest and the performance of its duties hereunder. Nothing in this Contract shall be interpreted as preventing the Consultant, a contractual employee of the County, from being employed in any other capacity, including, but not limited to the operation of a medical practice, the employment as a staff member bf any hospital, or the serving as a medical director for any other emergency medical service which is lawfully licensed by the County (if located within Collier County) and the State. 13. SUCCESSOR: The Contract shall be binding upon the successors of the County. This Contract shall not be assignable by the Consultant. 14. TERMINATION: This Contract may be terminated by either party, with or without cause, upon sixty (60) days written notice to the other party of such party's intention to terminate the Contract. 15. PRO - RATIONS UPON TERMINATION: In the event of the termination of this Contract, the Consultant's compensation due under Paragraph 4 shall be prorated on the basis ION of the number of days elapsed from the effective date of the Contract, divided by three hundred sixty -five (365). 16. MANUALS: All manuals of procedure and instructional material, which are created or prepared by the Consultant, shall be and remain the property of the Consultant. 17. ADDITIONAL LICENSES• Consultant agrees to obtain and maintain throughout the period of this Agreement, all such licenses as are required to do business by the Consultant in the State of Florida and in Collier County, Florida, including, but not limited to, all licenses required by any State Boards or other Governmental agencies responsible for regulating and licensing the professional services to be provided and performed by the Consultant, pursuant to this Agreement, 18. INSURANCE: The County shall, pay for, and maintain, during the life of this agreement, professional liability insurance. Collier County shall be named as an additional insured on the certificate of insurance for the policy. n 10g IN WITNESS WHEREOF, the parties have executed this agreement as of the date first written above. ATTEST.. DWIGHT E: $ROCK, CLERK .of Courts i C �tt/ltµit.t0 Ckdiraan's slgeatare only, Witnessed b Approved as to form and Legal Sufficiency: BOARD OF COUNTY COMMISSIONERS OF COLLIER COUNTY, FLORIDA i • ROBERT BOYD TOBER, INC. ROBERT BOYD TOBER, PRESIDENT C LINE ARD ROBINSON `�- ssistant County Attorney H/Juckic/EMS Contraurrober Medical Cw " c12001- Revised V www.sunbiz.org - Departm. _../f State Home Contact Us E•Fliing Services Document Searches Forms Previous on List Next on List Return To List Events No Name History Detail by Entity Name ^� Florida Profit Corporation ROBERT BOYD TOBER, INC. Filing Information Document Number 630937 FEUEIN Number 691920023 Date Flied 07126/1979 State FL Status INACTIVE Last Event INVOLUNTARILY DISSOLVED Event Date Filed 11/01/1985 Event Effective Date NONE Principal Address 260 TAMIAMI TRAIL NORTH NAPLES FL 33940 Changed 040/1963 Mailing Address 260 TAMIAMI TRAIL NORTH - NAPLES FL 33940 Changed 04121/1983 Registered Agent Name & Address TOBER, ROBERT BOYD 2231 FORREST LANE NAPLES FL 33940 Address Changed: 06/0511984 Officer /Director Detail Name & Address Title PD TOBER, ROBERT B. 696 FOUNTAINHEAD WAY NAPLES Fl- Title D TOSER. ANDREA STONE 696 FOUNTAINHEAD WAY -- NAPLES FL Tide D ION Page l of .2 Help Entity Name Search Submit http:/ fwww .sunbiz.org/scripts /cordet.exe ?action =D ETFI L &inq_doc_number= 630937 &inq_,.. 4.11/2010 Attachment #5 www.sunbiz.org - Departmen` "State age'2 0 ASHLEY, DONALD W. 3201 TAM. TR. NO. NAPLES FL Annual Reports Report Year Filed Date 1982 03/2611982 1983 04/21/1983 1984 06/091984 Document Images No images are available for this filing. Note: This is not official record. See documents if question or conflict. Previous on List Next on List Return To List Entity Name Search Events No Name History Submt I Home I Contact us I Document Searches I E- Filing Services I Forms I Help I Copyright and Privacy Policies Copyright 0 2007 State of Florida, Department of State. STATE OF FLORIDA DEPARTMENT OF HEALTH Vi IN RE: Miami -Dade Fire Rescue ION Petition for Declaratory Statement. DOH 2Out -0102 FINAL ORDER GRANTING PETITION FOR DECLARATORY STATEMENT On July 27, 2007, Miami -Dade Fire Rescue ( "MDFR ") filed the attached Petition for Declaratory Statement ( "Petition ") pursuant to section 120.565, Florida Statutes and chapter 28 -105, Florida Administrative Code. Department deems the facts as asserted by MDFR in the Petition sufficient to trigger this Declaratory Statement. PRELIMINARY COMMENTS A. The answers here do not address the relationship between the Medical Director and the licensee. B. Though each question was limited to physicians licensed under Chapter 458, such distinction is irrelevant to the answers. Therefore the questions are addressed below as solely regarding Medical Directors as defined in section 401.23(15), Florida Statutes, C. The questions use terms such as "medical practice privileges ", "medical practice ", "medical procedures ", "medical supervisory authority', "competency" and "competency deficit." These are not terms present in either Part III, Chapter 401, Florida Statutes, or Chapter 64E -2, Florida Administrative Code. To avoid unintentionally creating new nomenclature, the answers avoid the use of these terms. Page 1 of 4 ION pwill r-- FINDINGS OF FACT A. Petitioner is a licensee as defined in section 401.23(13), Florida Statutes. B. Petitioner seeks to understand the scope of authority a licensee's Medical Director has over Paramedics and Emergency Medical Technicians operating under the licensee (hereinafter "Certificate holders ") by the questions stated in the attached petition. CONCLUSIONS OF LAW A. The Medical Director has direct responsibility for the medical performance of all Certificate holders operating for the licensee. §401.265(1), F.S. B. The obligation of direct. responsibility is accompanied by the supervisory authority necessary to require that the medical performance of the Certificate holders is of a quality and type for which the individual Medical Director is willing to take direct responsibility. id. The exercise of this supervisory authority by the Medical Director is a mandatory part of the job. Id. Consistent with that supervisory authority, the Medical Director advises, consults, trains, counsels and oversees services. Id. The oversight of services includes, but is not limited to, appropriate quality assurance programs, Id. C. The Medical Director must develop medically correct standing orders and protocols. 64E- 2.004(4)(a), F.A.C. D. The Medical Director must assess the medical performance of the Certificate holders. 64E- 2.004(4)(b), F.A.C, To gather data in aid of assessment and as part of general quality assurance, which includes the continuous improvement of performance for individuals, services and the industry, the Medical Director audits the performance of all system personnel. Id. This audit includes, but is not limited to, Page 2 of 4 , ion review of patient care records, direct observation, and comparison of performance standards for drugs, system protocols and procedures. Id. E. The Medical Director must supervise the medical performance of the Certificate holders operating for the licensee. §401.265(1), F.S. Supervisory authority enables the Medical Director to condition whether and how Certificate holders perform medically upon assessment of the Certificate holder's potential ability to comply with requirements, including standing orders and protocols, developed or adopted by the Medical Director, as well as the Certificate holder's actual compliance with such requirements. Id. Based upon the above, the questions are answered together as follows: The Medical Director has the authority to condition, limit, modify or suspend the Certificate holder's medical performance white operating for the licensee consistent with the Medical Director's direct responsibility for the medical performance of all Certificate holders operating for the licensee. Such conditioning, limitation, modification or suspension of a Certificate holder's medical performance while operating for the licensee can include requirement of completion of Medical Director identified training as a precondition for some or all parts of the Certificate holder's medical performance while operating for the licensee, DONE AND ORDERED this day of , 2007. .1'S. ( KL- L. Kline, R.N., B.S.N., M.P.H. puty Secretary for Health State Public Health Nursing Director Florida Women's Health Officer Page 3 of 4 Attachment Copies to: Tarlesha W. Smith, Esq. Human Resources Division Manager Miami -Dade Fire Rescue 9300 NW 41 Street Doral, FL 33178 -2414 Michael A. Greif, Senior Attorney Office of the General Counsel Department of Health 4052 Bald Cypress Way, Bin A -02 Tallahassee, FL 32399 -1703 NOTICE OF RIGHT TO JUDICIAL REVIEW A PARTY ADVERSELY AFFECTED BY THIS FINAL ORDER IS ENTITLED TO JUDICIAL REVIEW PURSUANT TO SECTION 120.68, FLORIDA STATUTES. A REVIEW PROCEEDING IS GOVERNED BY THE FLORIDA RULES OF APPELLATE PROCEDURE, A PROCEEDING IS COMMENCED BY FILING A NOTICE OF APPEAL WITH THE CLERK OF THE DEPARTMENT OF HEALTH AND A COPY ACCOMPANIED BY THE FILING FEE WITH THE DISTRICT COURT OF APPEAL IN THE APPELLATE DISTRICT WHERE THE PARTY RESIDES OR THE FIRST DISTRICT COURT OF APPEAL. A NOTICE OF APPEAL MUST BE FILED WITHIN 30 DAYS OF THE FILING DATE OF THIS FINAL ORDER CERTIFICATE OF SERVICE I CERTIFY that a copy of the foregoing FINAL ORDER has been sent by U.S. Mail, inter - office mail, or by hand delivery to each of the above -named persons this I day of �)r.Vl?_nrY' r , 2007. Deputy Agency Clerk Department of Health Central Records 4052 Bald Cypress Way, Bin COI Tallahassee, Florida 32399 -3251 Phone(950)245 -4121 0811W Agency Clerk Page 4 of 4 110tH ion Miami -Dade Fire Rescue Department 9300 N. W. 41 sr Street Coral, Florida 33176 -2414 T 766. 331 -5000 A/wayr andx rrpW ro tern S r pnn W miamidade,gov Dad, C-- ',aod h wuNquMb d: A.mWq 6,1 F4diain a+r HN Wm stemma Pan July 25, 2007 Dud PI A Awida oir R. Samuel Power comet xun Agency Clerk's Office Central Records Unit Hiak,h ca,em, Department of Health wn In a 4052 Bald Cypress Way, Bin C01 ma,ncm.. Tallahassee,FL3Z39 &3251 41aMa Min Re: Petition for Declaratory statement Mipni Gvdenu Dear Mr. Power, MiillY' ulllfn Enclosed please find a Petition for Declaratory Statement to the Bureau HuM a,vni,6r e of Emergency Medical Services. I am respectfully requesting review by the Nu,h MiaN aforementioned agency. Your prompt attention to this Hunh umi matter is greatly appreciated. Thank you In advance for your time and cooperation. M Eeuch 0p 4d Respectfully submitted, Pinvml Swig Mimi � �� smny Icln sudo- Tarlesha W. Smith, Esq. e. w.Nw Human Resources Division Manager Miami -Dade Fire Rescue Wg inia GaNem We -1m IOR plVillil July 25, 2007 ,... Miami -Dade Fire Rescue Department _-. 9300 N.W. d 41 st Street "'c',' r]Fp Dora, Florida 33178.2414 4RTMENT a r = ;, ) N»',o's aeadp head ro Serve CiEFIK (!TV ri.FFt!d T 786. 331 -5000 ma. rniami dade.gov /) ^ •f coWnr, °e uK MwkW111i" efi Mmnwe Petition for Declaratory Statement Before the a,l1UAlOW Department of Health, Bureau of Emergency Medical en".ae, tWd, Services a"`""LftY I, Human Resources Division Manager, Tarlesha W. Smith, Esq., of Miami -Dade Fire Rescue, am seeking a declaratory statement under Rules 28- 105.001 and 28- 105.002, F.A,C, ei w,�a `i" a and Section 120.565, F.S., relating to the supervisory relationship between an emergency medical technician (EMT) or paramedic to a physician who is a medical director pursuant to 401.255 F.S.. cwdM Hoch ch "i,4,^u,at , 1 Does a physician licensed under chapter 458, F.S., who is serving as an emergency medical services (EMS) medical director Pursuant to 401.265, FS., have the authority to remove medical ractice P privileges from an EMT or paramedic (practicing under said physician) that the physician concludes has a deficiency in any area of medical practice? 2. Does a physician licensed under chapter 458, F.S., who is serving EMS as an medical director pursuant to 401.265, F.S., have the authority to limit the medical procedures performed by an individual EMT or paramedic practicing under the My S^qq medical supervisory authority of the Physician? "dm a.rvni,a° 3. Does a physician licensed under chapter 458, F,S., who is serving as an EMS medical director pursuant to 401.265, FS., have the authority to require specific training In protocols, proscribe and / or prescribe practice of procedures, or require medical training foranEMTor �{ paramedic 7 4. Does a physician licensed under y^ °° chapter 458, F.S., who is serving as an EMS medical director Pursuant to 401.265, r;wm F.S., have the authority to require an EMT or paramedic demonstrate S.1h Mimi competency through a Process defined by the Physician, in any area of medical practice when the Physician concludes the EMT s.,ny 10" or paramedic has a competency deficit? weal. Should you require additional information, please do not hesitate to call me at 786 - 331 -4608. Respectfully submitted, W. Tarlesha W. Smith, Esq. Human Resources Division Manager _ Miami -Dade Fire Rescue July 25, 2007 STATE OF FLORIDA DEPARTMENT OF HEALTH IN RE: North Naples Fire Control and Rescue District Petition for Declaratory Statement. 0� Final Order NO D0 ;1 I� - Ib FILED DATEent of Health Dcpartm BY' Do Y Agency Clcrk DOH 2010 -0040 On April 9, 2010, North Naples Fire Control and Rescue District ( "District ") filed the attached Petition for Declaratory Statement ( "Petition ") pursuant to section 120.565, Florida Statutes, and chapter 28 -105, Florida Administrative Code. PRELIMINARY COMMENT Any references herein to "this part" refer to Part III of Chapter 401, Florida Statutes. FINDINGS OF FACT A. The District is a licensee as defined below. B. The District shares a medical director with other licensees. C. The District seeks to understand the scope of authority of the District's Medical Director regarding the following questions, summarized where possible to avoid matters beyond the scope of the Department's declaratory statement authority: 1. May the District's Medical Director prohibit a paramedic from performing certain advanced life support procedures while working for the District on one day and then authorize the same paramedic to perform those same procedures the following day while working for another licensee for which the District's Medical Director is also medical director? 2. May the District's Medical Director categorically prohibit paramedics working for the District from performing advanced life support while permitting other Page 1 of 6 10H paramedics not employed by the District to perform advanced life support while working for other licensees for whom the District's Medical Director is also medical director? 3. May the District's Medical Director create a training program for paramedics working for the District as a condition for their delivering advanced life support that is difficult to achieve, not due to the rigor of the program, but due to the limited access to the training program? 4. May the District's Medical Director administer any emergency medical services functions not related to protocols, quality assurance or training? 5. May the District contract with a non - active corporation as medical director? 6. Can the District limit the authority of its Medical Director by providing that all training requirements must be jointly developed with another party? CONCLUSIONS OF LAW D. "A declaratory statement is a means for resolving a controversy or answering questions or doubts concerning the applicability of statutory provisions, rules or orders over which the agency has authority." Ch. 28- 105.001, F.A.C. E. "A petition for declaratory statement may be used to resolve questions or doubts as to how the statutes, rules or orders may apply to the petitioner's particular circumstances." Id. F. "A declaratory statement is not the appropriate means for determining the conduct of another person." Id. G. "'Licensee" means any basic life support service, advanced life support service, or air ambulance service licensed pursuant to this part. "' §401.23(13), F.S. H. ""Advanced life support" means treatment of life- threatening medical Page 2 of 6 ION emergencies through the use of techniques such as endotracheal intubation, the administration of drugs or intravenous fluids, telemetry, cardiac monitoring, and cardiac fibrillation by a qualified person, pursuant to rules of the department. "' §401.23(1), F.S. I. "'Medical director" means a physician who is employed or contracted by a licensee and who provides medical supervision, including appropriate quality assurance, but not including administrative or managerial functions, for daily operations and training pursuant to this part. "' §401.23(15), F.S. J. "Paramedic" means a person who is certified by the department to perform ... advanced life support pursuant to this part. "' §401.23(17), F.S. K. "The medical director must perform duties including advising, consulting, training, counseling, and overseeing of services, including appropriate quality assurance but not including administrative and managerial functions." §401.265(1), F.S. L. 'The medical director must be a licensed physician; a corporation, association or partnership composed of physicians; or physicians employed by any hospital that delivers in -house emergency medical services and employs or contracts with physicians specifically for that purpose." Id. M. ' "In construing ... (Florida) statutes ..., where the context will permit: * * * The word "person" includes individuals, ..., corporations, and all other groups or combinations. "' §1.01(3), F.S. N. A medical director is a person. §§1.01 (3), 401.265(1), F.S. O. 'The Department ... may reprimand or fine any licensee, certificateholder or other person operating under this part ...." §401.411(1), F.S. P. A medical director for a licensee performs a statutory role created by this part. §§401.23(13), §401.265(1), F.S. Like the licensee, the paramedic, and the Page 3 of 6 D V 4 f4 emergency medical technician, the medical director does not exist independently of this part. Id. Accordingly, a person operating as a medical director to achieve purposes under this part is a "person operating under this part." §401.411(1), F.S. Q. The grounds for sanction for "persons operating under this part" include violation of any rule of the department, provision of this part or unprofessional conduct. §401.411(1)(a), (g), F.S. R. Each licensee is statutorily authorized to choose whether to employ or to contract with a medical director. §401.265(1), F.S.t S. Corporations in Florida appear to be governed by Chapters 607 and 617, Florida Statutes. The Department of Health has no authority to issue a declaratory statement interpreting those chapters of Florida Law. Ch. 28- 105.001, F.A.C. THE PETITION IS ANSWERED AS FOLLOWS: T. Questions C.1 -4 concern the actions of a person other than the District. A Declaratory Statement is not the appropriate means to determine the conduct of another person. Ch. 28- 105.001, F.A.C. Therefore the petition, as regards these questions, is DENIED. U. Question C.5 requires an interpretation of corporate law, a matter over which the Department of Health has no authority. Id. Therefore the petition, as regards this question, is DENIED. V. Question C.6 inquires as to whether the District can limit a medical director's authority by providing that all training requirements be developed with a third party. The petition regarding this question is GRANTED. The answer is NO. The ' Sarasota Alliance for Far Elections Inc v Kurt Browninp, 28 So.3d 880, 885 -888 (Fla. 2010)(Discussing preemption and conflict analysis regarding the interplay between local government enactment and state law). Page 4 of 6 Nrl!!�i statutory authority is the medical director's alone and is not shared or limited by external agreements. As stated in In re: Miami -Dade Fire Rescue, Petition for Declaratory Statement, DOH 2007 -0102 (attached): "The Medical Director has the authority to condition, limit, modify or suspend the Certificate holder's medical performance while operating for the licensee consistent with the Medical Director's direct responsibility for the medical performance of all Certificate holders operating for the licensee. "Such conditioning, limitation, modification or suspension of a Certificate holder's medical performance while operating for the licensee can include requirement of completion of Medical Director identified training as a precondition for some or all parts of the Certificate holder's medical performance while operating for the licensee." , DONE AND ORDERED this 12 day of W 2010. Shain urner, M.D., M.P.H. Deputy Secretary for Health Director of Minority Health Attachments Copies to: Laura Jacobs Donaldson, Esq. Manson Law Group, P.A. 1101 West Swann Avenue Tampa, FL 33606 Michael A. Greif, Esq. Office of the General Counsel Department of Health 4052 Bald Cypress Way, Bin A02 Tallahassee, FL 32399 -1703 Page 5 of 6 NOTICE OF RIGHTS This is final agency action. Review of final agency action may only be had by filing notices of appeal in both the appellate district where the petitioner resides and with the clerk of the Department within 30 calendar days after the date of execution. §120.68, F.S.; Fla. R. App. P. 9.110. CERTIFICATE OF SERVICE I CERTIFY that a copy of the foregoing FINAL ORDER has been sent by U.S. Mail, inter -office mail, or by hand delivery to each of the above -named persons this day of Eck_ \ 1 2010. _WIN I KEW •'a; Department of Health Central Records 4052 Bald Cypress Way, Bin C01 Tallahassee, Florida 32399 -3251 Phone (850) 245 -4121 Page 6 of 6 loft STATE OF FLORIDA DEPARTMENT OF HEALTH Page 7 of 7 110 IN ARTICLE III. - MEDICAL TRANSPORTATION SERVICES Page 1 of 10 Collier County, Florida, Code of Ordinances >> PART I - CODE» Chapter 50 - EMERGENCY SERVICES >> ARTICLE III. - MEDICAL TRANSPDRTATION SERVICES >> IARTICLE III. - MEDICAL TRANSPORTATION SERVICES Editor's note —Ord. No. 04.12, § 26, adopted Feb. 24, 2004, repealed diva. 1 and 2 of art. III, §§ 50- 51- 50 -68, 50- 76- 50 -86, In their entirely. Sections 1 -25 of said ordinance enacted similar provisions to read as herein set out Cross reference— Buslnessas, ch. 22; health and sanitation, ch. 66. State law reference — Medical transportation services, F.S. § 401.2101 et seq. Sac. 50.51. - Purpose. Sec. 50x4 - Revocation alteration or suspension gmUnds, Sec. 50 -55. -General operating rear latims Sac. 50.66. - Central place of business Sec. 50-67. - Records to be kept Sec. 50 -68. - Rales. Sec 50 -69.- Operalors insurance See 50 -70. - Conduct of drivers and attendants Sec. 50.71.- Passeramm - Sec 50 -72. - Obedience to traffic laws ordinances or reoulations Sac 50-73. - Violation. Sec. 50.74. - Uniformity of application Sec. 50 -75. - Authority to enforce Secs. 50- 76- 50.100. - Reserved. Sec. 50 -51. - Purpose. This article is adopted pursuant to F.S. chs. 125 and 401. The purpose of this article is to provide better protection for the health, safety and welfare of the residents of Collier County, in ambulance and ALS matters, by establishing uniform county -wide standards for certification of ambulance or advanced life support or services, or operations by promulgating complete and clear rules and regulations for operation of all ambulance or rescue Companies or services in Collier County. (Ord. No. 04 -12, § 1) Sec. 50.52. - Definitions. The following words, terms and phrases, when used in this article, shall have the meanings ascribed to them in this section, except where the context clearly indicates a different meaning: Advanced life support (ALS) shall mean procedures conducted as defined in applicable Florida Statutes and Florida Administrative Code, Section 64E. Administrator shall mean the county manager or his designee. Ambulance means any privately or publicly owned land, air, or water vehicle that is designed, constructed, reconstructed, maintained, equipped or operated, and is used for or intended to be used for air, land or water transportation of persons, who are sick, injured or otherwise helpless. Board shall mean the Collier County Board of County Commissioners. http : / /scai-ch.municode.coiiVhtn11 /1 0 5 7 5 /level3 /Pl C50 ATII.html ^3,/512010 Attachment 91 MH 71 i Charlie Crist Ana M. Viannonte Ros, M.D., M.P.H. Governor State Surgeon General July 9, 2009 Dr. Robert B. Tober, M.D., FACEP Medical Director Collier County EMS C�gM�rQ Collier County EMS /Fire 8075 Lely Cultural Blvd Suite 267 IUL 13 20 Naples, FL 34113 DOP "' Dear Dr. Tober., EMS Please find, attached, a copy of a November 2007 Declaratory Statement addressing the scope of authority of a Medical Director in Chapter 401.265, Florida Statutes, and Rule 64J- 1.004, Florida Administrative Code. I believe testing and re- testing competencies of EMS personnel who operate under your medical supervision fall within the scope of authority described in the Declaratory Statement. If you have any questions, please contact me at (850) 245 -4028 or at the address below. ry, Richard McNelis Assistant General Counsel Burmu of En=V acy Medical Services 4052 Bald Cypress Way, Bin C -18• Tallahassee, FL 32399 -1738 ION (I$ ypv.. a .Miami -Dade Fire Rescue Department i.' --_. �_' 9300 N, W -- 41st Street DEPARTMENT 01- = 4''r Doral, Florida 33178.2414 r. I.ITv ^J'71 T786- 331 -5D00 uw.y. J!"dli ved r. Sm. C� . D miamidade -gov sa.+nau.1.,,,paa.d a[E '�?, O? Dads Canty and 16e Petition for Declaratory Statement Before the MgMUry Department of Health, Bureau of Emergency Medical r,i wdw, Services a .YM- k I, Human Resources Division Manager, Tarlesha W. Smith, Esq., of Miami -Dade o.,,t Fire Rescue, am seeking a declaratory statement under Rules 28- 105.001 and El 28- 105.002, F.A.c, and Section 120.565, F.S., relating to the supervisory Mna� relationship between an emergency medical technician (EMT) or paramedic to a physician who is a medical director pursuant to 401.265 F.S.. Cu W ar.cl, K.** Cdr. I. Does a physician licensed under chapter 458, F.S., who is serving as an emergency medical services (EMS) medical director pursuant to 401.265, FS„ have the authority to remove medical practice ,.man cN°E EMT or paramedic p privileges from an P (practicing under said physician) that the physican concludes has a deficiency in any area of medical practice? July 25, 2007 Does a physician licensed under chapter 458, F.S., who is serving as an waM C.,d.n. EMS medical director pursuant to 401.265, F.S., have the authority to M1.M lain limit the medical procedures performed by an individual EMT or Paramedic practicing under the medical supervisory authority of the physician? MUai 5peiry7 3. Does a physician licensed under chapter 458. F.S., who is serving as an NnM MUni EMS medical director pursuant to 401.265, F-S, have the authority to require specific training in protocols, proscribe and / or prescribe N.h p4ami r.,cn practice of procedures, or require medical training for an EMT or paramedic? op. «b 4. Does a physician licensed under chapter 458, F.S., who is serving as an EMS medical director pursuant to 401.265, F.S., have the authority to require an EMT or paramedic demonstrate competency through a SW@ W1m: process defined by the physician, in any area of medical practice when the physician concludes the EMT or has SrM, kti paramedic a competency deficit? Should you require additional information, please do not hesitate to call me 786 - 331 -4608. at S..an.aN. mgin. c.a.m Respectfully submitted, wa Mum `' V Tarlesha W. Smith, Esq. Human Resources Division Manager Miami•Dade Fire Rescue July 25, 2007 W r rl" Miami•Dade Fire Rescue Department _.- 9300 N.W. 4151 Street Doral, Florida 33178 -2414 T 786.331.5000 Alwap keadn r.oW To Serve miamidade.gov 5--Yj U,AAI p..I,d Cad, C.ty and dre M,.mAdwdua nr: AMrWq Ad Halves. bar Hake Eland: ilk nrHY July 25, 2007 Dory n Fbnal rlwrm coo R. Samuel Power caa. m.eM1 Agency Clerk's Office Central Records Unit HoW" � Department of Health Wu M 4052 Bald Cypress Way, Bin COl W4. cram Tallahassee, FL32399.3251 nlardia MMler Re: Petition for Declaratory Statement M'ymi Gudem MI'm4'" Dear Mr. Power, anwml Snum M,um SPA., Enclosed please find a Petition for Declaratory Statement to the Bureau of lar \11 NyeM 1af,Y Emergency Medical Services. I am respectfully requesting review by the aforementioned agency. Your prompt attention to this matter is N" MiaN greatly appreciated. Thank you in advance for your time and cooperation. N,nM1 w.,mi eearM1 Dpa -Inds Respectfully submitted, SoreA Miami � � /� Surm,nlrs svn, v Tarlesha W. Smith, Esq. sr..m..rN Human Resources Division Manager Miami -Dade Fire Rescue Yy;inia Grdan \Yry Miimi ion STATE OF FLORIDA DEPARTMENT OF HEALTH DG IN RE: Miami Dade Fire Rescue BY oc Petition for Declaratory Statement. DOH 2Out -0102 FINAL ORDER GRANTING PETITION FOR DECLARATORY STATEMENT On July 27, 2007, Miami -Dade Fire Rescue ( "MDFR ") filed the attached Petition for Declaratory Statement ( "Petition ") pursuant to section 120.565, Florida Statutes and chapter 28 -105, Florida Administrative Code. Department deems the facts as asserted by MDFR in the Petition sufficient to trigger this Declaratory Statement. PRELIMINARY COMMENTS A. The answers here do not address the relationship between the Medical Director and the licensee. B. Though each question was limited to physicians licensed under Chapter 458, such distinction is irrelevant to the answers. Therefore the questions are addressed below as solely regarding Medical Directors as defined in section 401.23(15), Florida Statutes. C. The questions use terms such as "medical practice privileges ", "medical practice ", "medical procedures ", "medical supervisory authority ", "competency" and "competency deficit." These are not terms present in either Part III, Chapter 401, Florida Statutes, or Chapter 64E -2, Florida Administrative Code. To avoid unintentionally creating new nomenclature, the answers avoid the use of these terms. Page 1 of 4 10H FINDINGS OF FACT A. Petitioner is a licensee as defined in section 401.23(13), Florida Statutes. B. Petitioner seeks to understand the scope of authority a licensee's Medical Director has over Paramedics and Emergency Medical Technicians operating under the licensee (hereinafter "Certificate holders ") by the questions stated in the attached petition. CONCLUSIONS OF LAW A. The Medical Director has direct responsibility for the medical performance of all Certificate holders operating for the licensee. §401.265(1), F.S. B. The obligation of direct responsibility is accompanied by the supervisory authority necessary to require that the medical performance of the Certificate holders is of a quality and type for which the individual Medical Director is willing to take direct responsibility. Id. The exercise of this supervisory authority by the Medical Director is a mandatory part of the job. Id. Consistent with that supervisory authority, the Medical Director advises, consults, trains, counsels and oversees services. Id_ The oversight of services includes, but is not limited to, appropriate quality assurance programs. Id. C. The Medical Director must develop medically correct standing orders and protocols. 64E- 2.004(4)(a), F.A.C. D. The Medical Director must assess the medical performance of the Certificate holders. 64E- 2.004(4)(b), F.A.C. To gather data in aid of assessment and as part of general quality assurance, which includes the continuous improvement of performance for individuals, services and the industry, the Medical Director audits the performance of all system personnel. Id, This audit includes, but is not limited to, Page 2 of 4 10fi review of patient care records, direct observation, and comparison of performance standards for drugs, system protocols and procedures. Id. The Medical Director must supervise the medical performance of the Certificate holders operating for the licensee. §401265(1), F.S. Supervisory authority enables the Medical Director to condition whether and how Certificate holders perform medically upon assessment of the Certificate holder's potential ability to comply with requirements, including standing orders and protocols, developed or adopted by the Medical Director, as well as the Certificate holder's actual compliance with such requirements. Id. Based upon the above, the questions are answered together as follows: The Medical Director has the authority to condition, limit, modify or suspend the Certificate holder's medical performance while operating for the licensee consistent with the Medical Director's direct responsibility for the medical performance of all Certificate holders operating for the licensee. Such conditioning, limitation, modification or suspension of a Certificate holder's medical performance while operating for the licensee can include requirement of completion of Medical Director identified training as a precondition for some or all parts of the Certificate holder's medical performance while operating for the licensee. DONE AND ORDERED this 3o'`day of 2007. L L. Kline, R.N., B.S.N., M.P.H. 06puty Secretary for Health State Public Health Nursing Director Florida Women's Health Officer Page 3 of 4 Attachment Copies to: 10H Tariesha W. Smith, Esq. Human Resources Division Manager Miami -Dade Fire Rescue 9300 NW 41 Street Doral, FL 33178 -2414 Michael A. Greif, Senior Attorney Office of the General Counsel Department of Health 4052 Bald Cypress Way, Bin A -02 Tallahassee, FL 32399 -1703 NOTICE OF RIGHT TO JUDICIAL REVIEW A PARTY ADVERSELY AFFECTED BY THIS FINAL ORDER IS ENTITLED TO JUDICIAL REVIEW PURSUANT TO SECTION 120.68, FLORIDA STATUTES. A REVIEW PROCEEDING IS GOVERNED BY THE FLORIDA RULES OF APPELLATE PROCEDURE. A PROCEEDING 1S COMMENCED BY FILING A NOTICE OF APPEAL WITH THE CLERK OF THE DEPARTMENT OF HEALTH AND A COPY ACCOMPANIED BY THE FILING FEE WITH THE DISTRICT COURT OF APPEAL IN THE APPELLATE DISTRICT WHERE THE PARTY RESIDES OR THE FIRST DISTRICT COURT OF APPEAL. A NOTICE OF APPEAL MUST BE FILED WITHIN 30 DAYS OF THE FILING DATE OF THIS FINAL ORDER. CERTIFICATE OF SERVICE 1 CERTIFY that a copy of the foregoing FINAL ORDER has been sent by U.S. Mail, inter - office mail, or by hand delivery to each of the above -named persons this I day of r- -r , 2007. C amla Deputy Agency Clerk Department of Health Central Records 4052 Bald Cypress Way, Bin COI Tallahassee, Florida 32399 -3251 Phone (850)245 -4121 Page 4 of 4 Deputy Agency Cierl OMCK OF THE COUNTY ATTORMY INTEROFFICE MEMORANDUM Received TO: Dan Bowman, Division Chief, Emergency Managemen Services MAR Z 7 2007 FROM: Jennifer A. Belpedio, Assistant County Attorney EMS Dept, DATE: March 21, 2007 RE: North Naples Fire Control and Rescue District Advanced Life Support Operations, RLS # 07 -EMS -00073 You have advised that North Naples Fire Control and Rescue District ( "NNFD ") apparatus identified as "MedCom 45" and "Captain 41" has responded to 911 emergency calls in lieu of Advanced Life Support ( "ALS ") apparatus that has obtained a permit under § 401.26, Florida Statutes. As requested by Emergency Management, each conclusion as set forth in the RLS, has been evaluated for legal accuracy. Each conclusion is stated below with our response immediately following each conclusion. 1. Any apparatus /personnel responding as first -due apparatus must be permitted as identified by the County. In regard to permitting, first response vehicles are not treated differently than other vehicles. Subject to very limited exceptions, Collier County Emergency Management Services ( "EMS "), as an ALS licensee, is required to possess a valid permit for each transport vehicle, advanced life support nontransport vehicle, and aircraft in use under its license. A permit is not required for an advanced life support nontransport vehicle that is intended to be used for scene supervision, incident command, or the augmentation of supplies. A permit is also not required for a vehicle that is used to temporarily replace a permitted vehicle that is out of service for routine maintenance or repairs. See, 64 -E- 2.007, F.A.C. EMS is further required to provide documentation that each vehicle for which a permit is sought meets the appropriate requirements for a basic life support or ALS service vehicle, as applicable. § 401.26, F.S. 2. Collier County and/or the Medical Director have operational authority over all ALS services within its jurisdiction. The Medical Director for Collier County has the sole operational authority over the services provided under the ALS license issued to EMS. Such authority is set forth in § 401.265, F.S. which requires a medical director to supervise and assume direct responsibility for the medical performance of the emergency medical technicians and paramedics operating for that emergency medical services system. 3. Any changes to the Interlocal Agreement must be included within an amended Agreement approved by the Board of County Commissioners. Jon "Mm The Board of County Commissioners ( "Commission ") on behalf of Collier County may approve terms of an amended Interlocal Agreement at a regularly scheduled noticed Commission meeting. 4. Interpretation of applicable State Statutes or Rules is left to the recognized Emergency Service Provider (County) and/or the Medical Director, NNFD does not have authority to operate outside the State's provisions and/or County's discretion. It is reasonable to conclude that the Medical Director must construe Florida Statutes and Administrative Code provisions in order to comply with his duties and responsibilities. Among his other duties and responsibilities, the Medical Director is required to: 1) ensure and certify that security procedures of the EMS provider for medications, fluids and controlled substances are in compliance with Chapters 499 and 893, F.S., and Chapter 64F -12, F.A.C. and 2) ensure that all EMTs and paramedics are trained in the use of the trauma scorecard methodologies as provided in 64E- 2.017, F.A.C, for adult trauma patients and Rule 64E- 2.0175, F.A.C., for pediatric trauma patients. See, 64E -2.004 (4), F.A.C. It follows that without interpreting the Florida Statutes and Administrative Code provisions governing ALS, the Medical Director could not be able to fulfill the requirements of 64E -2.004 (4), F.A.C. ALS Services provided by NNFD under the Interlocal Agreement for Advanced Life Support Engine Partnership, must comply with the protocol established by the Medical Director which is presumably consistent with the Florida Statutes and Administrative Code provisions that govern ALS services. See, 64E- 2.004, F.A.C. 5. Any violations of State provisions /rules caused by NNFD subject the County to possible disciplinary action. A violation by NNFD personnel of Florida Statutes and Administrative Code provisions governing ALS service may subject EMS to disciplinary action by the State Department of Health. In any given case, whether the State Department of Health would pursue disciplinary action against an ALS licensee for actions or omissions of personnel working under a mutual aid agreement with the ALS licensee largely depends on the facts that are discovered as part of an investigation.' Should you have any additional questions, please do not hesitate to contact me. CC: David C. Weigel, County Attorney Michael W. Pettit, Chief Assistant County Attorney Dan Summers, Director, Emergency Management Jeff Page, Chief, EMS I The State Department of Health may take action against the ALS licensee suspend or revoke an ALS rescue license at any time if it determines that the licensee has failed to comply with the requirements prescribed for operating a basic or ALS service. § 401.25, F.S. The State Department of Health may deny, suspend, or revoke a license, certificate, or permit or may reprimand or fine any licensee, certificate holder, or other person operating acting under Chapter 401, Part III (Medical Transportation Services). § 401.411, F.S. I-O " 1 401.33 Exemptions. 37 assessing, treating, and transporting 38 children, adults, and frail elderly 2 401.34 Fees. 39 persons. Further, it is the intent of the 40 Legislature to encourage the 3 401.345 Emergency Medical Services 41 development and maintenance of 4 Trust Fund. 42 emergency medical services because 43 such services are essential to the health 44 and well -being of all citizens of the state. 5 401.35 Rules. 45 The Legislature also recognizes that the 46 establishment of a comprehensive 6 401.38 Participation in federal 47 statewide injury- prevention program 7 programs. 48 supports state and community health 49 systems by further enhancing the total 8 401.41 Penalties. 50 delivery system of emergency medical 51 services and reduces injuries for all 9 401.411 Disciplinary action; penalties. 52 persons. The purpose of this part is to 53 protect and enhance the public health, 10 401.414 Complaint investigation 54 55 welfare, and safety through the I 1 procedures. establishment of an emergency medical 56 services state plan, an advisory council, 57 a comprehensive statewide injury- 12 401.421 Injunctive relief; cease and 58 prevention program, minimum standards 13 desist notice; civil penalty; enforcement. 59 for emergency medical services 60 personnel, vehicles, services and 14 401.425 Emergency medical services 61 medical direction, and the establishment 15 quality assurance; immunity from 62 of a statewide inspection program 16 liability. 63 created to monitor the quality of patient 64 care delivered by each licensed service 17 401.435 First responder agencies and 65 and appropriately certified personnel. 18 training. 66 History. - -ss. 3, 25, ch. 82 -402; ss. 1, 19 401.445 Emergency examination and 67 13, ch. 83 -196; s. 3, ch. 84 -317; s. 53, 20 treatment of incapacitated persons. 68 ch. 86 -220; s. 12, ch. 89 -275; s. 10, ch. 69 89 -283, ss. 2, 36, ch. 92 -78, s. 35, ch. 21 401.45 Denial of emergency treatment; 70 2004 -350. 22 civil liability. 71 401.23 Definitions. - -As used in this 23 401.465 911 emergency dispatcher 72 part, the term: 24 certification. 73 (1) "Advanced life support" means 25 401.2101 Short title. - -This part maybe 74 treatment of life- threatening medical 26 cited as the "Raymond H. Alexander, 75 emergencies through the use of 27 M.D., Emergency Medical 76 techniques such as endotracheal 28 Transportation Services Act." 77 intubation, the administration of drugs or 78 intravenous fluids, telemetry, cardiac 29 History.--s. s. 1, ch. 92 -78. ry 79 monitoring, and cardiac defibrillation by 80 a qualified person, pursuant to rules of 81 the department. 30 401.211 Legislative intent: -The 31 Legislature recognizes that the 82 (2) "Advanced life support service" 32 systematic provision of emergency 83 means any emergency medical 33 medical services saves lives and 84 transport or nontransport service which 34 reduces disability associated with illness 85 uses advanced life support techniques. 35 and injury. In addition, that system of 36 care must be equally capable of Page 6 of 37 1 (3) "Air ambulance" means any fixed - 2 wing or rotary-wing aircraft used for, or 3 intended to be used for, air 4 transportation of sick or injured persons 5 requiring or likely to require medical 6 attention during transport. 7 (4) "Air ambulance service" means any 8 publicly or privately owned service, 9 licensed in accordance with the 10 provisions of this part, which operates 11 air ambulances to transport persons 12 requiring or likely to require medical 13 attention during transport. 14 (5) "Ambulance" or "emergency medical 15 services vehicle" means any privately or 16 publicly owned land or water vehicle that 17 is designed, constructed, reconstructed, 18 maintained, equipped, or operated for, 19 and is used for, or intended to be used 20 for, land or water transportation of sick 21 or injured persons requiring or likely to 22 require medical attention during 23 transport. 24 (6) "Ambulance driver" means any 25 person who meets the requirements of 26 s. 401.281. 27 (7) 'Basic life support" means treatment 28 of medical emergencies by a qualified 29 person through the use of techniques 30 such as patient assessment, 31 cardiopulmonary resuscitation (CPR), 32 splinting, obstetrical assistance, 33 bandaging, administration of oxygen, 34 application of medical antishock 35 trousers, administration of a 36 subcutaneous injection using a 37 premeasured autoinjector of epinephrine 38 to a person suffering an anaphylactic 39 reaction, and other techniques 40 described in the Emergency Medical 41 Technician Basic Training Course 42 Curriculum of the United States 43 Department of Transportation. The term 44 "basic life support" also includes other 45 techniques which have been approved 46 and are performed under conditions 47 specified by rules of the department. 48 (8) 'Basic life support service" means 49 any emergency medical service which 50 uses only basic life support techniques. 51 (9) "Certification" means any 52 authorization issued pursuant to this 53 part to a person to act as an emergency 54 medical technician or a paramedic. 55 (10) "Department' means the 56 Department of Health. 57 (11) "Emergency medical technician" 58 means a person who is certified by the 59 department to perform basic life support 60 pursuant to this part. 61 (12) "Interfacility transfer" means the 62 transportation by ambulance of a patient 63 between two facilities licensed under 64 chapter 393, chapter 395, chapter 400, 65 or chapter 429, pursuant to this part. 66 (13) "Licensee" means any basic life 67 support service, advanced life support 68 service, or air ambulance service 69 licensed pursuant to this part. 70 (14) "Medical direction" means direct 71 supervision by a physician through two - 72 way voice communication or, when such 73 voice communication is unavailable, 74 through established standing orders, 75 pursuant to rules of the department. 76 (15) "Medical director" means a 77 physician who is employed or 78 contracted by a licensee and who 79 provides medical supervision, including 80 appropriate quality assurance but not 81 including administrative and managerial 82 functions, for daily operations and 83 training pursuant to this part. 84 (16) "Mutual aid agreement' means a 85 written agreement between two or more 86 entities whereby the signing parties 87 agree to lend aid to one another under 88 conditions specified in the agreement 89 and as sanctioned by the governing 90 body of each affected county. 91 (17) 'Paramedic" means a person who 92 is certified by the department to perform 93 basic and advanced life support 94 pursuant to this part. Page 7 of 37 1110V 1 (18) 'Permit' means any authorization 2 issued pursuant to this part for a vehicle 3 to be operated as a basic life support or 4 advanced life support transport vehicle 5 or an advanced life support nontransport 6 vehicle providing basic or advanced life 7 support. 8 (19) 'Physician" means a practitioner 9 who is licensed under the provisions of 10 chapter 458 or chapter 459. For the 11 purpose of providing "medical direction" 12 as defined in subsection (14) for the 13 treatment of patients immediately prior 14 to or during transportation to a United 15 States Department of Veterans Affairs 16 medical facility, "physician" also means 17 a practitioner employed by the United 18 States Department of Veterans Affairs. 19 (20) 'Registered nurse" means a 20 practitioner who is licensed to practice 21 professional nursing pursuant to part I of 22 chapter 464. 23 (21) "Service location" means any 24 permanent location in or from which a 25 licensee solicits, accepts, or conducts 26 business under this part. 27 History.--s. 3, ch. 73 -126; s. 3, ch, 76- 28 168; s. 248, ch. 77 -147; s. 1, ch. 77 -347; 29 s. 1, ch. 77 -457; ss. 1, 4, 10, ch. 79 -280; 30 s. 257, ch. 81 -259; ss. 2, 3, ch. 81 -318, 31 ss. 4, 24, 25, ch. 82 -402, ss. 2, 12, 13, 32 ch. 83 -196; s. 4, ch. 84 -317; s. 54, ch. 33 86 -220; s. 1, ch. 89 -283; ss. 3, 36, ch. 34 92 -78, s. 42, ch. 97 -237; s. 107, ch. 35 2000 -318; s. 72, ch. 2006 -197; s. 50, ch. 36 2008 -6. 37 401.24 Emergency medical services 38 state plan. - -The department is 39 responsible, at a minimum, for the 40 improvement and regulation of basic 41 and advanced life support programs. 42 The department shall develop and 43 biennially revise a comprehensive state 44 plan for basic and advanced life support 45 services, the emergency medical 46 services grants program, trauma 47 centers, the injury control program, and 48 medical disaster preparedness. The 49 state plan shall include, but need not be 50 limited to: 51 (1) Emergency medical systems 52 planning, including the prehospital and 53 hospital phases of patient care, and 54 injury control effort and unification of 55 such services into a total delivery 56 system to include air, water, and land 57 services. 58 (2) Requirements for the operation, 59 coordination, and ongoing development 60 of emergency medical services, which 61 includes: basic life support or advanced 62 life support vehicles, equipment, and 63 supplies; communications; personnel; 64 training; public education; state trauma 65 system; injury control; and other medical 66 care components. 67 (3) The definition of areas of 68 responsibility for regulating and planning 69 the ongoing and developing delivery 70 service requirements. 71 History. - -s. 4, ch. 73 -126; s. 3, ch. 76- 72 168; s. 1, ch. 77 -457, ss. 5, 10, ch. 79- 73 280; ss. 2, 3, ch. 81 -318; ss. 5, 24, 25, 74 ch. 82 -402; ss. 3, 13, ch. 83 -196; s. 5, 75 ch. 84 -317; s. 55, ch. 86 -220; ss. 4, 36, 76 ch. 92-78; s. 9, ch. 2004-259. 77 401.243 Injury prevention. - -The 78 department shall establish an injury- 79 prevention program with responsibility 80 for the statewide coordination and 81 expansion of injury- prevention activities. 82 The duties of the department under the 83 program may include, but are not limited 84 to, data collection, surveillance, 85 education, and the promotion of 86 interventions. In addition, the 87 department may: 88 (1) Provide communities, county health 89 departments, and other state agencies 90 with expertise and guidance in injury 91 prevention. 92 (2) Seek, receive, and expend funds 93 received from grants, donations, or 94 contributions from public or private 95 sources for program purposes. Page 8 of 37 ion 0H 1 (3) Develop, and revise as necessary, a 46 (f) Providing a forum for planning the 2 comprehensive state plan for injury 47 continued development of the state's 3 prevention. 48 emergency medical services system 49 through the joint production of the 4 (4) Adopt rules governing the 50 emergency medical services state plan. 5 implementation of grant programs. The 6 rules may include, but need not be 51 (g) Assisting the department in 7 limited to, criteria regarding the 52 developing the emergency medical 8 application process, the selection of 53 services quality management program. 9 grantees, the implementation of injury- 10 prevention activities, data collection, 54 (h) Assisting the department in setting 11 surveillance, education, and the 55 program priorities. 12 promotion of interventions. 56 (1) Providing feedback to the 13 History.--s. 36, ch. 2004 -350. 57 department on the administration and 58 performance of the emergency medical 14 401.245 Emergency Medical Services 59 services program. 15 Advisory Council.- - 60 0) Providing technical support to the 16 (1) There is hereby created an advisory 61 emergency medical services grants 17 council for the purpose of acting as the 62 program. 18 advisory body to the emergency medical 19 services program. The duties of the 63 (k) Assisting the department in 20 council include, but are not limited to: 64 emergency medical services public 65 education. 21 (a) Identifying and making 22 recommendations to the department 66 (I) Assisting in the development of the 23 concerning the appropriateness of 67 department's injury prevention and 24 suggested changes to statutes and 68 control program. 25 administrative rules. 69 (2)(a) No more than 15 members may 26 (b) Acting as a clearinghouse for 70 be appointed to this council. Members 27 information specific to changes in the 71 shall be appointed for 4 -year terms in 28 provision of emergency medical 72 such a manner that each year the terms 29 services and trauma care. 73 of approximately one -fourth of the 74 members expire. The chair of the 30 (c) Providing technical support to the 75 council shall be designated by the State 31 department in the areas of emergency 76 Surgeon General. Vacancies shall be 32 medical services and trauma systems 77 filled for the remainder of unexpired 33 design, required medical and rescue 78 terms in the same manner as the 34 equipment, required drugs and dosages, 79 original appointment. Members shall 35 medical treatment protocols and 80 receive no compensation but may be 36 emergency medical services personnel 81 reimbursed for per diem and travel 37 education and training requirements. 82 expenses. 38 (d) Assisting in developing the 83 (b) Representation on the Emergency 39 emergency medical services portion of 84 Medical Services Advisory Council shall 40 the department's annual legislative 85 include: two licensed physicians who 41 package. 86 are "medical directors" as defined in s. 87 401.23(15) or whose medical practice is 42 (e) Providing a forum for discussing 88 closely related to emergency medical 43 significant issues facing the emergency 89 services; two emergency medical 44 medical services and trauma care 90 service administrators, one of whom is 45 communities. 91 employed by a fire service, two certified Page 9 of 37 I paramedics, one of whom is employed 2 by a fire service; two certified 3 emergency medical technicians, one of 4 whom is employed by a fire service; one 5 emergency medical services educator; 6 one emergency nurse; one hospital 7 administrator; one representative of air 8 ambulance services; one representative 9 of a commercial ambulance operator; 10 and two laypersons who are in no way 11 connected with emergency medical 12 services, one of whom is a 13 representative of the elderly. Ex officio 14 members of the advisory council from 15 state agencies shall include, but shall 16 not be limited to, representatives from 17 the Department of Education, the 18 Department of Management Services, 19 the State Fire Marshal, the Department 20 of Highway Safety and Motor Vehicles, 21 the Department of Transportation, and 22 the Department of Community Affairs. 23 (c) Appointments to the council shall be 24 made by the State Surgeon General, 25 except that state agency representatives 26 shall be appointed by the respective 27 agency head. 28 (3) Any Emergency Medical Services 29 Advisory Council member shall be 30 removed from office for malfeasance; 31 misfeasance; neglect of duty; 32 incompetence; permanent inability to 33 perform official duties; or pleading guilty 34 or nolo contendere to, or being found 35 guilty of, a felony. 36 (4) The council shall hold meetings at 37 the call of the chair, upon the written 38 request of five members of the council, 39 or at the call of the staff director of the 40 emergency medical services program 41 office. A majority of the members of the 42 council shall constitute a quorum. 43 Minutes shall be recorded for all 44 meetings of the council and shall be 45 maintained on file in the emergency 46 medical services program office. 47 (5) The department shall adopt rules to 48 implement this section, which rules shall 49 serve as formal operating procedures 50 for the Emergency Medical Services 51 Advisory Council. 52 (6) There is established a committee to 53 advise the Department of Health on 54 matters concerning preventative, 55 prehospital, hospital, rehabilitative, and 56 other posthospital medical care for 57 children. 58 (a) Committee members shall be 59 appointed by the State Surgeon 60 General, and shall include, but not be 61 limited to, physicians and other medical 62 professionals that have experience in 63 emergency medicine or expertise in 64 emergency and critical care for children. 65 (b) Appointments to the committee shall 66 be for a term of 2 years. Vacancies may 67 be filled for the unexpired term at the 68 discretion of the State Surgeon General. 69 The members shall serve without 70 compensation, and shall not be 71 reimbursed for necessary expenses 72 incurred in the performance of their 73 duties, unless there is funding available 74 from the Federal Government or 75 contributions or grants from private 76 sources. 77 History. - -ss. 4, 13, ch. 83 -196; ss. 14, 78 56, ch. 86 -220; s. 5, ch. 88 -186; s. 13, 79 ch. 89 -275; s. 11, ch. 89 -283; ss. 1, 2, 3, 80 ch. 92 -46; s. 36, ch. 92 -78; s. 7, ch. 92- 81 174; s. 76, ch. 95 -143; s. 791, ch. 95- 82 148; s. 45, ch. 95 -196; s. 43, ch. 97 -237; 83 s. 422, ch. 2003 -261, s. 51, ch. 2008 -6. 84 401.25 Licensure as a basic life 85 support or an advanced life support 86 service.— 87 (1) Every person, firm, corporation, 88 association, or governmental entity 89 owning or acting as agent for the owner 90 of any business or service which 91 furnishes, operates, conducts, 92 maintains, advertises, engages in, 93 proposes to engage in, or professes to 94 engage in the business or service of 95 providing prehospital or interfacility 96 advanced life support services or basic 97 life support transportation services must 98 be licensed as a basic life support 99 service or an advanced life support 100 service, whichever is applicable, before 101 offering such service to the public. The Page 10 of 37 1UH JOE "r? 1 application for such license must be 51 (3) The department may suspend or 2 submitted to the department on forms 52 revoke a license at any time if it 3 provided for this purpose. The 53 determines that the licensee has failed 4 application must include documentation 54 to maintain compliance with the 5 that the applicant meets the appropriate 55 requirements prescribed for operating a 6 requirements for a basic life support 56 basic or advanced life support service. 7 service or an advanced life support 8 service, whichever is applicable, as 57 (4) Each license issued in accordance 9 specified by rule of the department. 58 with this part will expire automatically 2 59 years after the date of issuance. 10 (2) The department shall issue a 11 license for operation to any applicant 60 (5) The requirements for renewal of any 12 who complies with the following 61 license issued under this part are the 13 requirements: 62 same as the requirements for original 63 licensure that are in effect at the time of 14 (a) The applicant has paid the fees 64 renewal. 15 required by s. 401.34. 65 (6) The governing body of each county 16 (b) The ambulances, equipment, 66 may adopt ordinances that provide 17 vehicles, personnel, communications 67 reasonable standards for certificates of 18 systems, staffing patterns, and services 68 public convenience and necessity for 19 of the applicant meet the requirements 69 basic or advanced life support services 20 of this part, including the appropriate 70 and air ambulance services. In 21 rules for either a basic life support 71 developing standards for certificates of 22 service or an advanced life support 72 public convenience and necessity, the 23 service, whichever is applicable. 73 governing body of each county must 74 consider state guidelines, 24 (c) The applicant has furnished 75 recommendations of the local or 25 evidence of adequate insurance 76 regional trauma agency created under 26 coverage for claims arising out of injury 77 chapter 395, and the recommendations 27 to or death of persons and damage to 78 of municipalities within its jurisdiction. 28 the property of others resulting from any 29 cause for which the owner of such 79 (7)(a) Each permitted basic life support 30 business or service would be liable. The 80 ambulance not specifically exempted 31 applicant must provide insurance in 81 from this part, when transporting a 32 such sums and under such terms as 82 person who is sick, injured, wounded, 33 required by the department. In lieu of 83 incapacitated, or helpless, must be 34 such insurance, the applicant may 84 occupied by at least two persons: one 35 furnish a certificate of self- insurance 85 patient attendant who is a certified 36 evidencing that the applicant has 86 emergency medical technician, certified 37 established an adequate self- insurance 87 paramedic, or licensed physician; and 38 plan to cover such risks and that the 88 one ambulance driver who meets the 39 plan has been approved by the Office of 89 requirements of s. 401.281. This 40 Insurance Regulation of the Financial 90 paragraph does not apply to interfacility 41 Services Commission. 91 transfers governed by s. 401.252(1). 42 (d) The applicant has obtained a 92 (b) Each permitted advanced life 43 certificate of public convenience and 93 support ambulance not specifically 44 necessity from each county in which the 94 exempted from this part, when 45 applicant will operate. In issuing the 95 transporting a person who is sick, 46 certificate of public convenience and 96 injured, wounded, incapacitated, or 47 necessity, the governing body of each 97 helpless, must be occupied by at least 48 county shall consider the 98 two persons: one who is a certified 49 recommendations of municipalities 99 paramedic or licensed physician; and 50 within its jurisdiction. 100 one who is a certified emergency Page 11 of 37 I medical technician, certified paramedic, 2 or licensed physician who also meets 3 the requirements of s. 401.281 for 4 drivers. The person with the highest 5 medical certifications shall be in charge 6 of patient care. This paragraph does not 7 apply to interfacility transfers governed 8 by s. 401.252(1). 9 History.--ss. 5, 16, ch. 73 -126; s. 3, ch. 10 76 -168; s. 249, ch. 77 -147; s. 1, ch. 77- 11 457; s. 19, ch. 78 -95; ss. 6, 10, ch. 79- 12 280; ss. 2, 3, ch. 81 -318; ss. 6, 24, 25, 13 ch. 82 -402; ss. 5, 13, ch. 83 -196; s. 54, 14 ch. 83 -218; s. 6, ch. 84 -317; s. 57, ch. 15 86 -220; s. 14, ch. 89 -275; s. 12, ch. 89- 16 283; ss. 5, 36, ch. 92 -78; s. 29, ch. 99- 17 397; s. 423, ch. 2003-261. 18 401.251 Air ambulance service; 19 licensure. -- 20 (1) Each person, firm, corporation, 21 association, or governmental entity that 22 owns or acts as an agent for the owner 23 of any business or service that 24 furnishes, operates, conducts, 25 maintains, advertises, engages in, 26 proposes to engage in, or professes to 27 engage in the business or service of 28 transporting by air ambulance persons 29 who require or are likely to require 30 medical attention during transport must 31 be licensed as an air ambulance 32 service, before offering such service. 33 (2) The application for this license must 34 be submitted to the department on 35 forms provided for this purpose. The 36 application must include documentation 37 that the applicant meets the appropriate 38 requirements for an air ambulance 39 service as specified by rule of the 40 department. 41 (3) An applicant who seeks licensure as 42 an air ambulance service must: 43 (a) Submit a completed application to 44 the department on such forms and 45 including such information as specified 46 by rule of the department. 47 (b) Submit the appropriate fee as 48 provided in s. 401.34. 49 (c) Specify the location of all required 50 medical equipment and provide 51 documentation that all such equipment 52 is available and in good working order. 53 (d) Provide documentation that all 54 aircraft and crew members meet 55 applicable Federal Aviation 56 Administration (FAA) regulations. 57 (e) Provide proof of adequate insurance 58 coverage of not less than $100,000 per 59 person and $300,000 per incident, or a 60 greater amount if specified by rule of the 61 department, for claims arising out of 62 injury or death of persons and damage 63 to property of others resulting from any 64 cause for which the owner of such 65 business or service would be liable. 66 Self- insurance is an acceptable 67 alternative as specified in s. 68 401.25(2)(c). 69 (f) Specify whether the service uses 70 either fixed- winged or rotary- winged 71 aircraft, or both. 72 (4)(a) If a service provides interhospital 73 air transport, air transport from hospital 74 to another facility, air transport from 75 hospital to home, or similar air transport, 76 the service must provide evidence that it 77 has employed or contracted with a 78 medical director to advise the service on 79 the appropriate staffing, equipment, and 80 supplies to be used for the transport of 81 any patient aboard an air ambulance 82 and must provide information to 83 referring physicians regarding special 84 medical requirements and restrictions 85 when transporting by air ambulance. 86 (b) If the air ambulance service uses 87 rotary- winged aircraft in conjunction with 88 another emergency medical service, the 89 air ambulance service must meet the 90 provisions of this section and must meet 91 separate basic life support and 92 advanced life support requirements 93 unique to air ambulance operations as is 94 required by rules of the department. 95 Such service is subject to the provisions Page 12 of 37 I of s. 401.25 relating to a certificate of 2 public convenience and necessity; 3 however, a service may operate in any 4 county under the terms of mutual aid 5 agreements. 6 (c) Unless, in the opinion of the 7 attending physician, the patient has an 8 emergency medical condition as defined 9 by s. 395.002, the service must provide 10 each person using the service, before 11 rendering the service, a written 12 description of the services to be 13 rendered and the cost of those services. 14 (5) In order to renew a license for air 15 ambulance service, the applicant must: 16 (a) Submit a renewal application to the 17 department not more than 90 days nor 18 less than 60 days before the license 19 expires. 20 (b) Submit the appropriate renewal fee 21 as provided in s. 401.34. 22 (c) Provide documentation that current 23 standards for issuance of a license are 24 met. 25 (6) Any advanced life support service 26 licensee may engage in air ambulance 27 operations by complying with the 28 appropriate provisions of this section 29 and requirements specified by rule of 30 the department. 31 History: -ss. 11, 13, ch. 83 -196; s. 1, 32 ch. 91 -169; ss. 27, 36, ch, 92 -78; s. 73, 33 ch. 92-289. 34 Note. -- Former s. 401.48. 35 401.252 Interfacility transfer. -- 36 (1) A licensed basic or advanced life 37 support ambulance service may conduct 38 interfacility transfers in a permitted 39 ambulance, using a registered nurse in 40 place of an emergency medical 41 technician or paramedic, if: 110 n 42 (a) The registered nurse holds a current 43 certificate of successful course 44 completion in advanced cardiac life 45 support; 46 (b) The physician in charge has granted 47 permission for such a transfer, has 48 designated the level of service required 49 for such transfer, and has deemed the 50 patient to be in such a condition 51 appropriate to this type of ambulance 52 staffing; and 53 (c) The registered nurse operates within 54 the scope of part I of chapter 464. 55 (2) A licensed basic or advanced life 56 support service may conduct interfacility 57 transfers in a permitted ambulance if the 58 patient's treating physician certifies that 59 the transfer is medically appropriate and 60 the physician provides reasonable 61 transfer orders. An interfacility transfer 62 must be conducted in a permitted 63 ambulance if it is determined that the 64 patient needs, or is likely to need, 65 medical attention during transport. If the 66 emergency medical technician or 67 paramedic believes the level of patient 68 care required during the transfer is 69 beyond his or her capability, the medical 70 director, or his or her designee, must be 71 contacted for clearance prior to 72 conducting the transfer. If necessary, 73 the medical director, or his or her 74 designee, shall attempt to contact the 75 treating physician for consultation to 76 determine the appropriateness of the 77 transfer. 78 (3) Infants less than 28 days old or 79 infants weighing less than 5 kilograms, 80 who require critical care interfacility 81 transport to a neonatal intensive care 82 unit, shall be transported in a permitted 83 advanced life support or basic life 84 support transport ambulance, or in a 85 permitted advanced life support or basic 86 life support ambulance that is 87 recognized by the department as 88 meeting designated criteria for neonatal 89 interfacility critical care transport. 90 (4) The department shall adopt and 91 enforce rules to carry out this section, Page 13 of 37 1 including rules for permitting, equipping 2 and staffing transport ambulances and 3 that govern the medical direction under 4 which interfacility transfers take place. 5 History.--ss. 7, 25, ch. 82 -402; s. 13, 6 ch. 83 -196; ss. 6, 36, ch. 92 -78; s. 792, 7 ch. 95 -148; s. 44, ch. 97 -237; s. 108, ch. 8 2000 -318. 9 401.26 Vehicle permits for basic life 10 support and advanced life support 11 services. -- 12 (1) Every licensee shall possess a valid 13 permit for each transport vehicle, 14 advanced life support nontransport 15 vehicle, and aircraft in use. Applications 16 for such permits shall be made upon 17 forms prescribed by the department. 18 The licensee shall provide 19 documentation that each vehicle for 20 which a permit is sought meets the 21 appropriate requirements for a basic life 22 support or advanced life support service 23 vehicle, whichever is applicable, as 24 specified by rule of the department. A 25 permit is not required for an advanced 26 life support nontransport vehicle that is 27 intended to be used for scene 28 supervision, incident command, or the 29 augmentation of supplies. 30 (2) To receive a valid permit, the 31 applicant must submit a completed 32 application form for each vehicle or 33 aircraft for which a permit is desired, pay 34 the appropriate fees established as 35 provided in s. 401.34, and provide 36 documentation that each vehicle or 37 aircraft meets the following 38 requirements as established by rule of 39 the department; the vehicle or aircraft 40 must: 41 (a) Be furnished with essential medical 42 supplies and equipment which is in good 43 working order. 44 (b) Meet appropriate standards for 45 design and construction. 46 (c) Be equipped with an appropriate 47 communication system. 48 (d) Meet appropriate safety standards. 49 (e) Meet sanitation and maintenance 50 standards. 51 (f) Be insured for an appropriate sum 52 against injuries to or the death of any 53 person arising out of an accident. 54 (3) The department may deny, 55 suspend, or revoke a permit if it 56 determines that the vehicle, aircraft, or 57 equipment fails to meet the 58 requirements specified in this part or in 59 the rules of the department. 60 (4) A permit issued in accordance with 61 this section will expire automatically 62 concurrent with the service license. 63 (5) In order to renew a vehicle or 64 aircraft permit issued pursuant to this 65 part, the applicant must: 66 (a) Submit a renewal application. Such 67 application must be received by the 68 department not more than 90 days or 69 less than 30 days prior to the expiration 70 of the permit. 71 (b) Submit the appropriate fee or fees, 72 established as provided in s. 401.34. 73 (c) Provide documentation that current 74 standards for issuance of a permit are 75 met. 76 (6) The department shall establish 77 criteria and time limits for substitution of 78 permitted vehicles that are out of service 79 for maintenance purposes. 80 (7) The department shall adopt and 81 enforce rules necessary to administer 82 this section. 83 History. - -s. 6, ch. 73 -126; s. 3, ch. 76- 84 168; s. 250, ch. 77 -147; s. 1, ch. 77 -457; 85 s. 19, ch. 78 -95; ss. 7, 10, ch. 79 -280; 86 ss. 2, 3, ch, 81 -318; ss. 9, 24, 25, ch. 87 82 -402; s. 13, ch. 83 -196; s. 56, ch. 83- 88 218; s. 8, ch. 84 -317; s. 58, ch. 86 -220, 89 ss. 7, 36, ch. 92 -78; s. 19, ch. 98 -151. Page 14 of 37 ion 1 ion 1 401.265 Medical directors. -- 54 emergency medical technician or 55 paramedic a copy of the report of the 2 (1) Each basic life support 56 disciplinary concern and documentation 3 transportation service or advanced life 57 of the specific acts related to the 4 support service must employ or contract 58 disciplinary concern. If the department 5 with a medical director. The medical 59 determines that the report is insufficient 6 director must be a licensed physician; a 60 for disciplinary action against the 7 corporation, association, or partnership 61 emergency medical technician or 8 composed of physicians; or physicians 62 paramedic pursuant to s. 401.411, the 9 employed by any hospital that delivers 63 report shall be expunged from the 10 in- hospital emergency medical services 64 record of the emergency medical 11 and employs or contracts with 65 technician or paramedic. 12 physicians specifically for that purpose. 13 Such a hospital, physician, corporation, 66 (3) Any medical director who in good 14 association, or partnership must 67 faith gives oral or written instructions to 15 designate one physician from that 68 certified emergency medical services 16 organization to be medical director at 69 personnel for the provision of 17 any given time. The medical director 70 emergency care shall be deemed to be 18 must supervise and assume direct 71 providing emergency medical care or 19 responsibility for the medical 72 treatment for the purposes of s. 20 performance of the emergency medical 73 768.13(2). 21 technicians and paramedics operating 22 for that emergency medical services 74 (4) Each medical director who uses a 23 system. The medical director must 75 paramedic or emergency medical 24 perform duties including advising, 76 technician to perform blood pressure 25 consulting, training, counseling, and 77 screening, health promotion, and 26 overseeing of services, including 78 wellness activities, or to administer 27 appropriate quality assurance but not 79 immunization on any patient under a 28 including administrative and managerial 80 protocol as specified in s. 401.272, 29 functions. 81 which is not in the provision of 82 emergency care, is liable for any act or 30 (2) Each medical director shall establish 83 omission of any paramedic or 31 a quality assurance committee to 84 emergency medical technician acting 32 provide for quality assurance review of 85 under his or her supervision and control 33 all emergency medical technicians and 86 when performing such services. 34 paramedics operating under his or her 35 supervision. If the medical director has 87 (5) The department shall adopt and 36 reasonable belief that conduct by an 88 enforce all rules necessary to administer 37 emergency medical technician or 89 this section. 38 paramedic may constitute one or more 39 grounds for discipline as provided by 90 Histo ss. 6, 25, ch. 82 -402; ss. 12, ry 40 this part, he or she shall document facts 91 13, ; s. 8, ch. 88-186; s. 15, 41 and other information related to the 92 ch. 89-275; s. 13, ch, 89 -283; s. 70, 89- 75 s. 42 alleged violation. The medical director 93 89 -374; ss. 8, 36, ch. 92-78; s. 34, h. 43 shall report to the department any 94 93 -211; s. 793, ch. 95-148; s. 45, ch. 44 emergency medical technician or 95 97 -237; s. 3, ch. 98 -87; s. 20, ch. 98- 45 paramedic whom the medical director 96 151. 46 reasonably believes to have acted in a 47 48 manner which might constitute grounds for disciplinary action. Such a report of 97 401.268 Protocols with regional 49 disciplinary concern must include a 98 poison control centers.--By October 1, 50 statement and documentation of the 99 1999, each licensee shall implement a 51 specific acts of the disciplinary concern. 100 prehospital emergency dispatch protocol 52 Within 7 days after receipt of such a 101 with the regional poison control center 53 report, the department shall provide the 102 established pursuant to s. 395.1027. 103 The prehospital emergency dispatch Page 15 of 37 1 protocol shall be developed by the 2 licensee's medical director in 3 conjunction with the designated regional 4 poison control center responsible for the 5 geographic area in which the licensee 6 operates. The protocol shall define toxic 7 substances and describe the procedure 8 by which the designated regional poison 9 control center may be consulted by the 10 licensee. If a call is transferred to the 1 1 regional poison control center in 12 accordance with the protocol 13 established under this section and s. 14 395.1027, the regional poison control 15 center shall assume responsibility and 16 liability for the call. 17 History.--s. 2, ch. 98 -7. 18 401.27 Personnel; standards and 19 certification.— 20 (1) Each permitted ambulance not 21 specifically exempted from this part, 22 when transporting a person who is sick, 23 injured, wounded, incapacitated, or 24 helpless, must be occupied by at least 25 two persons, one of whom must be a 26 certified emergency medical technician, 27 certified paramedic, or licensed 28 physician and one of whom must be a 29 driver who meets the requirements for 30 ambulance drivers. This subsection 31 does not apply to interfacility transfers 32 governed by s. 401.252(1). 33 (2) The department shall establish by 34 rule educational and training criteria and 35 examinations for the certification and 36 recertification of emergency medical 37 technicians and paramedics. Such rules 38 must require, but need not be limited to: 39 (a) For emergency medical technicians, 40 proficiency in techniques identified in s. 41 401.23(7) and in rules of the 42 department. 43 (b) For paramedics, proficiency in 44 techniques identified in s. 401.23(1) and 45 in rules of the department. 46 (3) Any person who desires to be 47 certified or recertified as an emergency loff 1419 48 medical technician or paramedic must 49 apply to the department under oath on 50 forms provided by the department which 51 shall contain such information as the 52 department reasonably requires, which 53 may include affirmative evidence of 54 ability to comply with applicable laws 55 and rules. The department shall 56 determine whether the applicant meets 57 the requirements specified in this 58 section and in rules of the department 59 and shall issue a certificate to any 60 person who meets such requirements. 61 (4) An applicant for certification or 62 recertification as an emergency medical 63 technician or paramedic must: 64 (a) Have completed an appropriate 65 training course as follows: 66 1. For an emergency medical 67 technician, an emergency medical 68 technician training course equivalent to 69 the most recent emergency medical 70 technician basic training course of the 71 United States Department of 72 Transportation as approved by the 73 department; 74 2. For a paramedic, a paramedic 75 training program equivalent to the most 76 recent paramedic course of the United 77 States Department of Transportation as 78 approved by the department; 79 (b) Certify under oath that he or she is 80 not addicted to alcohol or any controlled 81 substance; 82 (c) Certify under oath that he or she is 83 free from any physical or mental defect 84 or disease that might impair the 85 applicant's ability to perform his or her 86 duties; 87 (d) Within 1 year after course 88 completion have passed an examination 89 developed or required by the 90 department; 91 (e)1. For an emergency medical 92 technician, hold either a current 93 American Heart Association Page 16 of 37 1 cardiopulmonary resuscitation course 2 card or an American Red Cross 3 cardiopulmonary resuscitation course 4 card or its equivalent as defined by 5 department rule, 6 2. For a paramedic, hold a certificate of 7 successful course completion in 8 advanced cardiac life support from the 9 American Heart Association or its 10 equivalent as defined by department 11 rule; 12 (f) Submit the certification fee and the 13 nonrefundable examination fee 14 prescribed in s. 401.34, which 15 examination fee will be required for each 16 examination administered to an 17 applicant; and 18 (g) Submit a completed application to 19 the department, which application 20 documents compliance with paragraphs 21 (a), (b), (c), (e), (f), (g), and, if 22 applicable, (d). The application must be 23 submitted so as to be received by the 24 department at least 30 calendar days 25 before the next regularly scheduled 26 examination for which the applicant 27 desires to be scheduled. 28 (5) The certification examination must 29 be offered monthly. The department 30 shall issue an examination admission 31 notice to the applicant advising him or 32 her of the time and place of the 33 examination for which he or she is 34 scheduled. Individuals achieving a 35 passing score on the certification 36 examination may be issued a temporary 37 certificate with their examination grade 38 report. The department must issue an 39 original certification within 45 days after 40 the examination. Examination questions 41 and answers are not subject to 42 discovery but may be introduced into 43 evidence and considered only in camera 44 in any administrative proceeding under 45 chapter 120. If an administrative hearing 46 is held, the department shall provide 47 challenged examination questions and 48 answers to the administrative law judge. 49 The department shall establish by rule 50 the procedure by which an applicant, 51 and the applicant's attorney, may review ilofl 52 examination questions and answers in 53 accordance with s. 119.071(1)(a). 54 (6)(a) The department shall establish by 55 rule a procedure for biennial renewal 56 certification of emergency medical 57 technicians. Such rules must require a 58 United States Department of 59 Transportation refresher training 60 program of at least 30 hours as 61 approved by the department every 2 62 years. The refresher program may be 63 offered in multiple presentations spread 64 over the 2 -year period. The rules must 65 also provide that the refresher course 66 requirement may be satisfied by passing 67 a challenge examination. 68 (b) The department shall establish by 69 rule a procedure for biennial renewal 70 certification of paramedics. Such rules 71 must require candidates for renewal to 72 have taken at least 30 hours of 73 continuing education units during the 2- 74 year period. The rules must provide that 75 the continuing education requirement 76 may be satisfied by passing a challenge 77 examination. 78 (7) A physician, physician assistant, 79 dentist, or registered nurse may be 80 certified as a paramedic if the physician, 81 physician assistant, dentist, or 82 registered nurse is certified in this state 83 as an emergency medical technician, 84 has passed the required emergency 85 medical technician curriculum, has 86 successfully completed an advanced 87 cardiac life support course, has passed 88 the examination for certification as a 89 paramedic, and has met other 90 certification requirements specified by 91 rule of the department. A physician, 92 physician assistant, dentist, or 93 registered nurse so certified must be 94 recertified under this section. 95 (8) Each emergency medical technician 96 certificate and each paramedic 97 certificate will expire automatically and 98 may be renewed if the holder meets the 99 qualifications for renewal as established 100 by the department. A certificate that is 101 not renewed at the end of the 2 -year 102 period will automatically revert to an Page 17 of 37 1 inactive status for a period not to exceed 2 180 days. Such certificate may be 3 reactivated and renewed within the 180 4 days if the certificateholder meets all 5 other qualifications for renewal and pays 6 a $25 late fee. Reactivation shall be in a 7 manner and on forms prescribed by 8 department rule. The holder of a 9 certificate that expired on December 1, 10 1996, has until September 30, 1997, to 11 reactivate the certificate in accordance 12 with this subsection. 13 (9) The department may suspend or 14 revoke a certificate at any time if it 15 determines that the holder does not 16 meet the applicable qualifications. 17 (10) The department may provide by 18 rule for physically disabled persons to 19 take and be provided with the results of 20 the written portion of the emergency 21 medical technician certification 22 examination or paramedic certification 23 examination. However, such persons 24 may not receive any special assistance 25 in completing the examination. An 26 individual who achieves a passing grade 27 on the emergency medical technician 28 certification examination or paramedic 29 certification examination may be issued 30 a limited emergency medical technician 31 certificate or a limited paramedic 32 certificate. An individual issued a limited 33 certificate may not perform patient care 34 or treatment activities. 35 (11)(a) A certificateholder may request 36 that his or her emergency medical 37 technician certificate or paramedic 38 certificate be placed on inactive status 39 by applying to the department before his 40 or her current certification expires and 41 paying a fee set by the department not 42 to exceed $50. 43 (b)1. A certificateholder whose 44 certificate has been on inactive status 45 for 1 year or less following the date his 46 or her emergency medical technician 47 certificate or paramedic certificate 48 expired may renew his or her certificate 49 pursuant to the rules adopted by the 50 department and upon payment of a late 51 renewal fee set by the department not to 52 exceed $100. 53 2. A certificateholder whose certificate 54 has been on inactive status for more 55 than 1 year may renew his or her 56 certificate pursuant to rules adopted by 57 the department. To renew, the 58 certificateholder must pass the 59 certification examination and complete 60 continuing education requirements and 61 a field internship. 62 (c) A certificate which has been inactive 63 for more than 6 years automatically 64 expires and may not be reinstated. 65 (12) An applicant for certification who is 66 an out -of -state trained emergency 67 medical technician or paramedic must 68 provide proof of current emergency 69 medical technician or paramedic 70 certification or registration based upon 71 successful completion of the United 72 States Department of Transportation 73 emergency medical technician or 74 paramedic training curriculum and hold 75 a current certificate of successful course 76 completion in cardiopulmonary 77 resuscitation (CPR) or advanced cardiac 78 life support for emergency medical 79 technicians or paramedics, respectively, 80 to be eligible for the certification 81 examination. The applicant must 82 successfully complete the certification 83 examination within 1 year after the date 84 of the receipt of his or her application by 85 the department. After 1 year, the 86 applicant must submit a new application, 87 meet all eligibility requirements, and 88 submit all fees to reestablish eligibility to 89 take the certification examination. 90 (13) The department shall adopt a 91 standard state insignia for emergency 92 medical technicians and paramedics. 93 The department shall establish by rule 94 the requirements to display the state 95 emergency medical technician and 96 paramedic insignia. The rules may not 97 require a person to wear the standard 98 insignia but must require that if a person 99 wears any insignia that identifies the 100 person as a certified emergency medical 101 technician or paramedic in this state, the Page 18 of 37 M 1 insignia must be the standard state 2 insignia adopted under this section. The 3 insignia must denote the individual's 4 level of certification at which he or she is 5 functioning. 6 History.--s. 7, ch. 73 -126; s. 3, ch. 76- 7 168, s. 251, ch. 77 -147; s. 1, ch. 77 -257; 8 s. 2, ch. 77 -347; s. 1, ch. 77 -457; s. 19, 9 ch. 78 -95; ss. 2, 3, ch. 81 -318; ss. 10, 10 24, 25, ch. 82 -402; ss. 6, 12, 13, ch. 83- 11 196; s. 9, ch. 84 -317; s. 1, ch. 86 -74; s. 12 59, ch. 86 -220; ss. 9, 36, ch. 92 -78; s. 13 794, ch. 95 -148; s. 46, ch. 97 -237; s. 30, 14 ch. 99 -397; s. 18, ch. 2001 -53; s. 42, ch. 15 2004 -335; s. 49, ch. 2005 -251, s. 1, ch. 16 2007 -145. 17 401.2701 Emergency medical 18 services training programs. -- 19 (1) Any private or public institution in 20 Florida desiring to conduct an approved 21 program for the education of emergency 22 medical technicians and paramedics 23 shall: 24 (a) Submit a completed application on a 25 form provided by the department, which 26 must include: 27 1. Evidence that the institution is in 28 compliance with all applicable 29 requirements of the Department of 30 Education. 31 2. Evidence of an affiliation agreement 32 with a hospital that has an emergency 33 department staffed by at least one 34 physician and one registered nurse. 35 3. Evidence of an affiliation agreement 36 with a current Florida - licensed 37 emergency medical services provider. 38 Such agreement shall include, at a 39 minimum, a commitment by the provider 40 to conduct the field experience portion 41 of the education program. 42 4. Documentation verifying faculty, 43 including: 44 a. A medical director who is a licensed 45 physician meeting the applicable 10H O 46 requirements for emergency medical 47 services medical directors as outlined in 48 this chapter and rules of the department. 49 The medical director shall have the duty 50 and responsibility of certifying that 51 graduates have successfully completed 52 all phases of the education program and 53 are proficient in basic or advanced life 54 support techniques, as applicable. 55 b. A program director responsible for 56 the operation, organization, periodic 57 review, administration, development, 58 and approval of the program. 59 5. Documentation verifying that the 60 curriculum: 61 a. Meets the course guides and 62 instructor's lesson plans in the most 63 recent Emergency Medical Technician - 64 Basic National Standard Curricula for 65 emergency medical technician programs 66 and Emergency Medical Technician - 67 Paramedic National Standard Curricula 68 for paramedic programs. 69 b. Includes 2 hours of instruction on the 70 trauma scorecard methodologies for 71 assessment of adult trauma patients 72 and pediatric trauma patients as 73 specified by the department by rule. 74 c. Includes 4 hours of instruction on 75 HIV /AIDS training consistent with the 76 requirements of chapter 381. 77 6. Evidence of sufficient medical and 78 educational equipment to meet 79 emergency medical services training 80 program needs. 81 (b) Receive a scheduled site visit from 82 the department to the applicant's 83 institution. Such site visit shall be 84 conducted within 30 days after 85 notification to the institution that the 86 application was accepted. During the 87 site visit, the department must 88 determine the applicant's compliance 89 with the following criteria: 90 1. Emergency medical technician 91 programs must be a minimum of 110 Page 19 of 37 1 hours, with at least 20 hours of 2 supervised clinical supervision, including 3 10 hours in a hospital emergency 4 department. 5 2. Paramedic programs must be 6 available only to Florida - certified 7 emergency medical technicians or an 8 emergency medical technician applicant 9 who will obtain Florida certification prior 10 to completion of phase one of the 11 paramedic program. Paramedic 12 programs must be a minimum of 700 13 hours of didactic and skills practice 14 components, with the skills laboratory 15 student -to- instructor ratio not exceeding 16 six to one. Paramedic programs must 17 provide a field internship experience 18 aboard an advanced life support 19 permitted ambulance. However, a 20 portion of the field internship experience 21 may be satisfied aboard an advanced 22 life support permitted vehicle other than 23 an ambulance as determined by rule of 24 the department. 25 (2) After completion of the site visit, the 26 department shall prepare a report which 27 shall be provided to the institution. Upon 28 completion of the report, the application 29 shall be deemed complete and the 30 provisions of s. 120.60 shall apply. 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 (3) If the program is approved, the department must issue the institution a 2 -year certificate of approval as an emergency medical technician training program or a paramedic training program. If the application is denied, the department must notify the applicant of any areas of strength, areas needing improvement, and any suggested means of improvement of the program. A denial notification shall be provided to the applicant so as to allow the applicant 5 days prior to the expiration of the application processing time in s. 120.60 to advise the department in writing of its intent to submit a plan of correction. Such intent notification shall provide the time for application processing in s. 120.60. The plan of correction must be submitted to the department within 30 days of the notice. The department shall advise the applicant of its approval or la4h 53 denial of the plan of correction within 30 54 days of receipt. The denial of the plan of 55 correction or denial of the application 56 may be reviewed as provided in chapter 57 120. 58 (4) Approved emergency medical 59 services training programs must 60 maintain records and reports that must 61 be made available to the department, 62 upon written request. Such records must 63 include student applications, records of 64 attendance, records of participation in 65 hospital clinic and field training, medical 66 records, course objectives and outlines, 67 class schedules, learning objectives, 68 lesson plans, number of applicants, 69 number of students accepted, admission 70 requirements, description of 71 qualifications, duties and responsibilities 72 of faculty, and correspondence. 73 (5) Each approved program must notify 74 the department within 30 days of any 75 change in the professional or 76 employment status of faculty. Each 77 approved program must require its 78 students to pass a comprehensive final 79 written and practical examination 80 evaluating the skills described in the 81 current United States Department of 82 Transportation EMT -Basic or EMT - 83 Paramedic, National Standard 84 Curriculum. Each approved program 85 must issue a certificate of completion to 86 program graduates within 14 days of 87 completion. 88 History. - -s. 31, ch. 99 -397. s. 1, ch. 89 2009 -181. 90 401.271 Certification of emergency 91 medical technicians and paramedics 92 who are on active duty with the 93 Armed Forces of the United States; 94 spouses of members of the Armed 95 Forces. -- 96 (1) Any member of the Armed Forces of 97 the United States on active duty who, at 98 the time he or she became a member, 99 was in good standing with the 100 department and was entitled to practice 101 as an emergency medical technician or 102 paramedic in the state remains in good Page 20 of 37 I standing without registering, paying 50 emergency medical technicians and 2 dues or fees, or performing any other 51 paramedics must provide proof of 3 act, as long as he or she is a member of 52 completion of training conducted 4 the Armed Forces of the United States 53 pursuant to this section. The department 5 on active duty and for a period of 6 54 shall accept the written affirmation of a 6 months after his or her discharge from 55 licensee's or a department- approved 7 active duty as a member of the Armed 56 educational program's medical director 8 Forces of the United States. 57 as documentation that the 58 certificateholder has completed a 9 (2) The department may adopt rules 59 minimum of 30 hours of recertification 10 exempting the spouse of a member of 60 training as provided herein. 11 the Armed Forces of the United States 12 on active duty from certification renewal 61 History. - -s. 32, ch. 99 -397. 13 provisions while the spouse is absent 14 from the state because of the member's 62 401.272 Emergency medical services 15 active duty with the Armed Forces. 63 community health care.- - 16 History.--s. 2, ch, 91 -145, s. 795, ch. 64 (1) The purpose of this section is to 17 95 -148. 65 encourage more effective utilization of 66 the skills of emergency medical 18 401.2715 Recertification training of 67 technicians and paramedics by enabling 19 emergency medical technicians and 68 them to perform, in partnership with 20 paramedics: - 69 local county health departments, 70 specific additional health care tasks that 21 (1) The department shall establish by 71 are consistent with the public health and 22 rule criteria for all emergency medical 72 welfare. 23 technician and paramedic recertification 24 training. The rules shall provide that all 73 (2) Notwithstanding any other provision 25 recertification training equals at least 30 74 of law to the contrary: 26 hours, includes the performance 27 parameters for adult and pediatric 75 (a) Paramedics or emergency medical 28 emergency medical clinical care, and is 76 technicians may perform health 29 documented through a system of 77 promotion and wellness activities and 30 recordkeeping. 78 blood pressure screenings in a 79 nonemergency environment, within the 31 (2) Any individual, institution, school, 80 scope of their training, and under the 32 corporation, or governmental entity may 81 direction of a medical director. As used 33 conduct emergency medical technician 82 in this paragraph, the term "health 34 or paramedic recertification training 83 promotion and wellness" means the 35 upon application to the department and 84 provision of public health programs 36 payment of a nonrefundable fee to be 85 pertaining to the prevention of illness 37 deposited into the Emergency Medical 86 and injury. 38 Services Trust Fund. Institutions 39 conducting department- approved 87 (b) Paramedics may administer 40 educational programs as provided in this 88 immunizations in a nonemergency 41 chapter and licensed ambulance 89 environment, within the scope of their 42 services are exempt from the application 90 training, and under the direction of a 43 process and payment of fees. The 91 medical director. There must be a 44 department shall adopt rules for the 92 written agreement between the 45 application and payment of a fee not to 93 paramedic's medical director and the 46 exceed the actual cost of administering 94 county health department located in 47 this approval process. 95 each county in which the paramedic 96 administers immunizations. This 48 (3) To be eligible for recertification as 97 agreement must establish the protocols, 49 provided in s. 401.27, certified Page 21 of 37 ion 1 policies, and procedures under which 2 the paramedic must operate. 3 (3) Each medical director under whose 4 direction a paramedic administers 5 immunizations must verify and 6 document that the paramedic has 7 received sufficient training and 8 experience to administer immunizations. 9 The verification must be documented on 10 forms developed by the department, and 1 1 the completed forms must be 12 maintained at the service location of the 13 licensee and made available to the 14 department upon request. 15 (4) The department may adopt and 16 enforce all rules necessary to enforce 17 the provisions relating to a paramedic's 18 administration of immunizations and the 19 performance of health promotion and 20 wellness activities and blood pressure 21 screenings by a paramedic or 22 emergency medical technician in a 23 nonemergency environment. 24 History.--s. 1, ch. 98 -87. 25 401.273 Emergency medical 26 technician and paramedic registry for 27 disasters and emergencies. -- 28 (1) The department shall include on its 29 forms for the certification or 30 recertification of emergency medical 31 technicians and paramedics who could 32 assist the department in the event of a 33 disaster a question asking if the 34 practitioner would be available to 35 provide health care services in special 36 needs shelters or to help staff disaster 37 medical assistance teams during times 38 of emergency or major disaster. The 39 names of the emergency medical 40 technicians and paramedics who 41 answer affirmatively shall be maintained 42 by the department as a registry for 43 disasters and emergencies. 44 (2) A certificateholder may perform the 45 functions of an emergency medical 46 technician or paramedic in a special 47 needs shelter or as a member of a 48 disaster medical assistance team, 49 provided that such functions are 10fl 50 performed only under the medical 51 direction of a physician who is licensed 52 under chapter 458 or chapter 459 and 53 who has complied with the formal 54 supervision requirements of s. 458.348. 55 History.--s. 18, ch. 2000 -140. 56 401.281 Drivers.— 57 (1) Each licensee is responsible for 58 assuring that its vehicles are driven only 59 by trained, experienced, and otherwise 60 qualified personnel. The licensee must, 61 at a minimum, document that each of its 62 drivers: 63 (a) Is at least 18 years of age; 64 (b) Certifies under oath that he or she is 65 not addicted to alcohol or any controlled 66 substance; 67 (c) Certifies under oath that he or she is 68 free from any physical or mental defect 69 or disease that might impair his or her 70 ability to drive an ambulance, 71 (d) Upon initial designation as a driver, 72 has not, within the past 3 years, been 73 convicted of driving under the influence 74 of alcohol or controlled substances and 75 has not had a driver's license 76 suspended under the point system 77 provided for in chapter 322, 78 (e) Possesses a valid driver's license 79 issued under chapter 322, is trained in 80 the safe operation of emergency 81 vehicles, and has completed an 82 emergency vehicle operator's course or 83 the reasonable equivalent as approved 84 by the department; however, this 85 paragraph applies only to a driver of a 86 land vehicle; 87 (f) Possesses a valid American Red 88 Cross or National Safety Council 89 standard first aid course card or its 90 equivalent, and 91 (g) Possesses a valid American Red 92 Cross or American Heart Association 93 cardiopulmonary resuscitation card. Page 22 of 37 1 (2) The department shall periodically 2 inspect licensees for verification of 3 compliance with this section. Services 4 that are unable to verify compliance are 5 subject to disciplinary action as provided 6 in this part. 7 History.--ss. 11, 25, ch. 82 -402; ss. 8, 8 13, ch. 83 -196; s. 10, ch. 84 -317; s. 60, 9 ch. 86 -220, s. 56, ch. 89 -282; ss. 10, 36, 10 ch. 92 -78; s. 796, ch. 95 -148; s. 2, ch. 11 2009 -181, 12 401.2916 Automated external 13 defibrillators.--It is the intent of the 14 Legislature that an automated external 15 defibrillator may be used by any person 16 for the purpose of saving the life of 17 another person in cardiac arrest. In 18 order to achieve that goal, the 19 Legislature intends to encourage 20 training in lifesaving first aid and set 21 standards for and encourage the use of 22 automated external defibrillators. 23 (1) As used in this section, the term: 24 (a) "Automated external defibrillator" 25 means a device as defined in s. 26 768.1325(2)(b). 27 (b) "Defibrillation" means the 28 administration of a controlled electrical 29 charge to the heart to restore a viable 30 cardiac rhythm. 31 (2) In order to promote public health 32 and safety: 33 (a) All persons who use an automated 34 external defibrillator are encouraged to 35 obtain appropriate training, to include 36 completion of a course in 37 cardiopulmonary resuscitation or 38 successful completion of a basic first aid 39 course that includes cardiopulmonary 40 resuscitation training, and demonstrated 41 proficiency in the use of an automated 42 external defibrillator. 43 (b) Any person or entity in possession 44 of an automated external defibrillator is 45 encouraged to notify the local 46 emergency medical services medical 10 tN 47 director of the location of the automated 48 external defibrillator. 49 (c) Any person who uses an automated 50 external defibrillator shall activate the 51 emergency medical services system as 52 soon as possible upon use of the 53 automated external defibrillator. 54 (3) Any person who intentionally or 55 willfully: 56 (a) Tampers with or otherwise renders 57 an automated external defibrillator 58 inoperative, except during such time as 59 the automated external defibrillator is 60 being serviced, tested, repaired, 61 recharged, or inspected or except 62 pursuant to court order; or 63 (b) Obliterates the serial number on an 64 automated external defibrillator for 65 purposes of falsifying service records, 66 67 commits a misdemeanor of the first 68 degree, punishable as provided in s. 69 775.082 or s. 775.083. Paragraph (a) 70 does not apply to the owner of the 71 automated external defibrillator or the 72 owner's authorized representative or 73 agent. 74 (4) Each local and state law 75 enforcement vehicle may carry an 76 automated external defibrillator. 77 History. - -s. 1, ch. 97 -34; s. 3, ch. 2001- 78 76, s. 1, ch. 2005 -109; s. 1, ch. 2006- 79 206; s. 1, ch. 2008 -101. 80 401.2916 Educational campaign.- - 81 The Department of Health shall 82 implement an educational campaign to 83 inform any person who acquires an 84 automated external defibrillator device 85 of the scope and limitations of the 86 immunity from liability provided under s. 87 768.1325. 88 History. - -s. 5, ch. 2006 -125; s. 2, ch. 89 2006 -206. 90 401.30 Records. -- Page 23 of 37 1 (1) Each licensee must maintain 2 accurate records of emergency calls on 3 forms that contain such information as is 4 required by the department. These 5 records must be available for inspection 6 by the department at any reasonable 7 time, and copies thereof must be 8 furnished to the department upon 9 request. The department shall give each 10 licensee notice of what information such 11 forms must contain. 12 (2) Each licensee must provide the 13 receiving hospital with a copy of an 14 individual patient care record for each 15 patient who is transported to the 16 hospital. The information contained in 17 the record and the method and 18 timeframe for providing the record shall 19 be prescribed by rule of the department. 20 (3) Reports to the department from 21 licensees which cover statistical data 22 are public records, except that the 23 names of patients and other patient - 24 identifying information contained in such 25 reports are confidential and exempt from 26 the provisions of s. 119.07(1). Any 27 record furnished by a licensee at the 28 request of the department must be a 29 true and certified copy of the original 30 record and may not be altered or have 31 information deleted. 32 (4) Records of emergency calls which 33 contain patient examination or treatment 34 information are confidential and exempt 35 from the provisions of s. 119.07(1) and 36 may not be disclosed without the 37 consent of the person to whom they 38 pertain, but appropriate limited 39 disclosure may be made without such 40 consent: 41 (a) To the person's guardian, to the 42 next of kin if the person is deceased, or 43 to a parent if the person is a minor, 44 (b) To hospital personnel for use in 45 conjunction with the treatment of the 46 patient; 47 (c) To the department, 10H 48 (d) To the service medical director, 49 (e) For use in a critical incident stress 50 debriefing. Any such discussions during 51 a critical incident stress debriefing shall 52 be considered privileged communication 53 under s. 90.503; 54 (f) In any civil or criminal action, unless 55 otherwise prohibited by law, upon the 56 issuance of a subpoena from a court of 57 competent jurisdiction and proper notice 58 by the party seeking such records, to 59 the patient or his or her legal 60 representative; or 61 (g) To a local trauma agency or a 62 regional trauma agency, or a panel or 63 committee assembled by such an 64 agency to assist the agency in 65 performing quality assurance activities 66 in accordance with a plan approved 67 under s. 395.401. Records obtained 68 under this paragraph are confidential 69 and exempt from s. 119.07(1) and s. 70 24(a), Art. I of the State Constitution. 71 72 This subsection does not prohibit the 73 department or a licensee from providing 74 information to any law enforcement 75 agency or any other regulatory agency 76 responsible for the regulation or 77 supervision of emergency medical 78 services and personnel. 79 (5) The department shall adopt and 80 enforce all rules necessary to administer 81 this section. 82 History.--s. 10, ch. 73 -126; s. 3, ch. 76- 83 168; s. 254, ch. 77 -147; s. 1, ch. 77 -457; 84 ss. 2, 3, ch. 81 -318; ss. 12, 24, 25, ch. 85 82 -402; s. 13, ch. 83 -196; s. 11, ch. 84- 86 317; s. 40, ch. 87 -225; s. 17, ch. 90 -344; 87 ss. 12, 36, ch. 92 -78; s. 5, ch. 94 -260; s. 88 1058, ch. 95 -148; s. 233, ch. 96 -406; S. 89 21, ch. 98 -151; s. 33, ch. 99 -397. 90 401.31 Inspection and examination. -- 91 (1) In order to carry out the 92 requirements of this part, the 93 department shall periodically and 94 randomly inspect licensees for Page 24 of 37 1 compliance with the requirements of this 2 part and departmental rules. The 3 department shall conduct inspections 4 without impeding patient care. 5 (2) The department shall, in the course 6 of the inspections provided for in 7 subsection (1), determine the continuing 8 compliance of each business, service, 9 ambulance, and piece of vehicle 10 equipment and all personnel with the I 1 requirements of this part, the rules of the 12 department, and the applicable vehicle 13 safety requirements of chapter 316 14 relating to: 15 (a) Exhaust system; 16 (b) Exterior lights; headlights, high and 17 low beam; turn signals; brake lights; 18 taillights; and red emergency lights; 19 (c) Horn; 20 (d) Windshield and windshield wipers; 21 (e) Mirrors; 22 (f) Tires; and 23 (g) Siren. 24 (3) The refusal of a licensee to allow an 25 inspection is a ground for revocation of 26 the licensee's license. 27 (4) Upon completion of an inspection, 28 the department may request an 29 inspection corrective action statement 30 from a licensee stating that any violation 31 found during the inspection has been 32 corrected. The department shall adopt, 33 by rule, procedures which provide for 34 categories of violations, the type of 35 violations in each category, the time for 36 correcting violations in each category, 37 and the time for returning the inspection 38 corrective action statement to the 39 department. Failure of a licensee to 40 submit the inspection corrective action 41 statement within the required time is a 42 ground for discipline under s. 401.411. 10"41 43 History. - -s. 11, ch. 73 -126; s. 3, ch. 76- 44 168; s. 255, ch. 77 -147; s. 3, ch. 77 -347; 45 s. 1, ch. 77 -457; ss. 8, 10, ch. 79 -280, 46 ss. 2, 3, ch. 81 -318; ss. 13, 24, 25, ch. 47 82 -402; ss. 12, 13, ch. 83 -196; s. 12, ch. 48 84 -317; s. 61, ch. 86 -220; ss. 13, 36, ch. 49 92 -78. 50 401.321 Transferability of license; 51 effect of sale, transfer, assignment, 52 or lease of service. -- 53 (1) Each license is valid only for the 54 licensee to whom it is issued and is not 55 subject to sale, assignment, or other 56 transfer, voluntary or involuntary. A 57 license or permit is valid only for the 58 service location for which it was 59 originally issued. 60 (2) A license will automatically expire 61 when a licensee changes his or her 62 service location or service name as 63 registered with the department. The 64 expired license must be surrendered by 65 the licensee, and the department shall 66 issue a new license for the balance of 67 the term under the expired license upon 68 receipt of a completed application and a 69 fee of $30. 70 (3) An application for a new license is 71 required when: 72 (a) A majority of the ownership or a 73 controlling interest of a service is 74 transferred or assigned; and 75 (b) A lessee agrees to undertake or 76 provide services to the extent that legal 77 liability for the service rests with the 78 lessee. 79 80 The application for a new license 81 showing such change must be 82 submitted so as to be received by the 83 department at least 60 days prior to the 84 date of the sale, transfer, assignment, or 85 lease. 86 History.--s. 13, ch. 84 -317; s. 1, ch. 85- 87 65; s. 49, ch. 85 -81; ss. 14, 36, ch. 92- 88 78; s. 797, ch. 95 -148. Page 25 of 37 1 401.33 Exemptions.--The following are 2 exempt from this part: 3 (1) A privately owned vehicle not 4 ordinarily used in the business of 5 transporting persons who are sick, 6 injured, wounded, incapacitated, or 7 helpless. 8 (2) A vehicle rendering services as an 9 ambulance during a major catastrophe 10 or emergency when ambulances with 11 permits based in the locality of the 12 catastrophe or emergency are 13 incapacitated or insufficient in number to 14 render the services needed. 15 (3) Any ambulance service provider 16 licensed in another state or territory of 17 the United States, except that any such 18 provider receiving a person within this 19 state for transport to a location within 20 this state must comply with this part. 21 (4) Any ambulance owned and 22 operated by the Federal Government. 23 (5) A vehicle under the direct 24 supervision of a licensed physician and 25 used as an integral part of a private 26 industrial safety or emergency 27 management plan within a privately 28 owned and controlled area, which 29 vehicle may from time to time be used to 30 transport persons in need of medical 31 attention, but which is not available to 32 the public and which does not routinely 33 transport patients. 34 History. - -s. 13, ch. 73 -126; s. 1, ch. 74- 35 334; s. 3, ch. 76 -168; s. 1, ch. 77 -457; s. 36 12, ch. 79 -280; s. 258, ch. 81 -259; ss. 2, 37 3, ch. 81 -318; ss. 14, 24, 25, ch. 82 -402; 38 s. 13, ch. 83 -196, s. 42, ch. 83 -334; s. 39 14, ch. 84 -317; s. 67, ch. 86 -220; ss. 15, 40 36, ch. 92 -78. 41 401.34 Fees. -- 42 (1) Each organization or person subject 43 to this part must pay to the department 44 the following nonrefundable fees: 45 (a) Basic life support service license 46 application: $660, to be paid biennially. 47 (b) Advanced life support service 48 license application: $1,375, to be paid 49 biennially. 50 (c) Original or renewal vehicle permit 51 application for basic or advanced life 52 support: $25, to be paid biennially. 53 (d) Emergency medical technician 54 certification examination application: 55 $40. 56 (e) Emergency medical technician 57 original certificate application: $35. 58 (f) Emergency medical technician 59 renewal certificate application: $20, to 60 be paid biennially. 61 (g) Paramedic certification examination 62 application: $40. 63 (h) Paramedic original certificate 64 application: $45. 65 (i) Paramedic renewal certificate 66 application: $45, to be paid biennially. 67 0) Air ambulance service application: 68 $1,375, to be paid biennially. 69 (k) Original or renewal aircraft permit 70 application for air ambulance: $25, to be 71 paid biennially. 72 (2) Fees collected under this section 73 must be deposited to the credit of the 74 Emergency Medical Services Trust 75 Fund and must be applied solely for 76 salaries and expenses of the 77 department incurred in implementing 78 and enforcing this part. 79 (3) A volunteer emergency medical 80 services provider licensed by the 81 department and persons actively serving 82 with the provider without pay are not 83 required to pay any of the fees set by 84 the department for licensure, vehicle 85 permits, or personnel certification. A Page 26 of 37 IDH 1 licensee that charges any service fee is 2 not entitled to this exemption. An 3 emergency medical technician or 4 paramedic certificate issued in 5 accordance with this volunteer fee 6 exemption provision is invalid while the 7 certificateholder is performing his or her 8 duties in a paid capacity. 9 (4)(a) If a certificate, license, or permit 10 issued under this part is lost or 11 destroyed, the person or entity to whom 12 the certificate, license, or permit was 13 issued may, upon payment of a fee to 14 be set by the department not to exceed 15 $10, obtain a duplicate, or substitute 16 thereof. 17 (b) Upon surrender of the original 18 emergency medical technician or 19 paramedic certificate and receipt of a 20 replacement fee to be set by the 21 department not to exceed $10, the 22 department shall issue a replacement 23 certificate to make a change in name. 24 (5) The department may provide same - 25 day grading of the examination for an 26 applicant for emergency medical 27 technician or paramedic certification. 28 The department must provide 29 procedures for implementing same -day 30 grading in its rules. 31 (6) The department may by rule offer 32 walk -in eligibility determination and 33 examination to applicants for emergency 34 medical technician or paramedic 35 certification who pay to the department 36 a nonrefundable fee to be set by the 37 department not to exceed $65. The fee 38 is in addition to the certification fee and 39 examination fee. The department must 40 establish locations and times for 41 eligibility determination and 42 examination. 43 (7) The cost of emergency medical 44 technician or paramedic certification 45 examination review may not exceed 46 $50. 47 History.--s. 14, ch. 73 -126; s. 2, ch. 74- 48 334; s. 3, ch. 76 -168; s. 1, ch. 77 -174; s. 49 4, ch. 77 -347, s. 1, ch. 77 -457, ss. 2, 3, 50 ch. 81 -318; ss. 15. 24, 25, ch. 82 -402; 51 ss. 7, 12, 13, ch. 83 -196; s. 15, ch. 84- 52 317; s. 62, ch. 86 -220; ss. 16, 36, ch. 53 92 -78; S. 798, ch. 95 -148. 54 401.345 Emergency Medical Services 55 Trust Fund.-- 56 (1) There is created the Emergency 57 Medical Services Trust Fund in the 58 State Treasury, which shall be used 59 exclusively for those purposes provided 60 by law. 61 (2) Any funds appropriated in the 62 General Appropriations Act for functions 63 related to emergency medical services, 64 and any other funds that become 65 available for functions related to 66 emergency medical services, must be 67 deposited in the Emergency Medical 68 Services Trust Fund, 69 History.--s. 17, ch. 92 -78. 70 401.35 Rules.--The department shall 71 adopt rules, including definitions of 72 terms, necessary to carry out the 73 purposes of this part. 74 (1) The rules must provide at least 75 minimum standards governing: 76 (a) Sanitation, safety, and maintenance 77 of basic life support and advanced life 78 support vehicles and air ambulances. 79 (b) Emergency medical technician, 80 paramedic, and driver training and 81 qualifications. 82 (c) Ground ambulance and vehicle 83 equipment and supplies at least as 84 comprehensive as those published in 85 the most current edition of the American 86 College of Surgeons, Committee on 87 Trauma, list of essential equipment for 88 ambulances, as interpreted by rules of 89 the department. 90 (d) Ground ambulance or vehicle 91 design and construction at least equal to 92 those most currently recommended by 93 the United States General Services Page 27 of 37 1OH f 10H t ( 1 Administration as interpreted by rules of 42 (d) A description of each vehicle to be 2 the department. 43 used, including the make, model, year of 44 manufacture, mileage, and vehicle 3 (e) Staffing of basic life support and 45 identification number (VIN); the state or 4 advanced life support vehicles. 46 federal aviation or marine registration 47 number, when applicable; and the color 5 (f) Two -way communications for basic 48 49 scheme, insignia, name, monogram, or 6 life support services and advanced life 50 other distinguishing characteristics to be 7 support services. used to designate the applicant's vehicle 51 or vehicles. 8 9 (g) Advanced life support services 52 (e) The service location from which the equipment. 53 service will operate. 10 (h) Programs of training for emergency 54 (f) A statement reasonably describing 11 medical technicians and paramedics. 55 the geographic area or areas to be 56 served by the applicant. 12 (i) Vehicles, equipment, 13 14 communications, and minimum staffing 57 (g) A statement certifying that the 15 qualifications for air ambulance services. 58 applicant will provide continuous service 59 24 hours a day, 7 days a week, if a 60 basic life support service license or an 16 Ambulance driver qualifications, 0) q 61 advanced life support service license is 17 training, and experience. 62 sought. Such service must be initiated 63 within 30 days after issuance of the 18 (k) Optional use of telemetry by 64 license. 19 licensees. 65 (h) Such other information as the 20 (1) Licensees' security and storage of 66 department determines reasonable and 21 controlled substances, medications, and 67 necessary. 22 fluids, not inconsistent with the 23 provisions of chapter 499 or chapter 68 (i) An oath, upon forms provided by the 24 893. 69 department which shall contain such 70 information as the department 25 (2) The rules must establish application 71 reasonably requires, which may include 26 requirements for licensure and 72 affirmative evidence of ability to comply 27 certification. Pursuant thereto, the 73 with applicable laws and rules. 28 department must develop application 29 forms for basic life support services and 74 (3) The rules must establish 30 advanced life support services. An 75 specifications regarding insignia and 31 application for each respective service 76 other ambulance identification. Any fire 32 license must include, but is not limited 77 department may retain its fire 33 to: 78 department identity and may use such 79 color scheme, insignia, name, 34 (a) The name and business address of 80 monogram, or other distinguishing 35 the operator and owner of the service or 81 characteristic that is acceptable to the 36 proposed service. 82 fire department for the purpose of 83 designating its vehicles as advanced life 37 (b) The name under which the applicant 84 support vehicles. However, those 38 will operate. 85 advanced life support service /fire rescue 86 vehicles or ambulances operated by fire 39 (c) A list of the names and addresses of 87 departments which were purchased in 40 all officers, directors, and shareholders 88 whole or in part with federal funds must 41 of the applicant. 89 comply with federal regulations Page 28 of 37 1 pertaining to color schemes, emblems, 2 and markings. 3 (4) The rules must establish 4 circumstances and procedures under 5 which emergency medical technicians 6 and paramedics may honor orders by 7 the patient's physician not to resuscitate 8 and the documentation and reporting 9 requirements for handling such 10 requests. 11 (5) The rules must establish 12 requirements for licensees and 13 certificateholders with respect to 14 providing address information to the 15 department, requirements for 16 examinations, grading, and passing 17 scores for certification, and 18 requirements for determining whether a 19 convicted felon whose civil rights have 20 not been restored is eligible for 21 certification or recertification. 22 History.--s. 15, ch. 73 -126; s. 3, ch. 76- 23 168; s. 257, ch. 77 -147; s. 5, ch. 77 -347; 24 s. 1, ch. 77 -457; ss. 8, 10, ch. 79 -280; S. 25 259, ch. 81 -259; ss. 2, 3, ch. 81 -318, ss. 26 16, 24, 25, ch. 82 -402; ss. 9, 12, 13, ch. 27 83 -196; s. 16, ch. 84 -317; s. 63, ch. 86- 28 220; ss. 18, 36, ch. 92 -78; s. 34, ch. 99- 29 397; s. 27, ch. 2000-242. 30 401.38 Participation in federal 31 programs.--The department shall 32 develop federal funding proposals and 33 apply for all federal funds available to 34 carry out the purposes of this part. The 35 department is authorized to participate 36 in those federal programs aimed at the 37 development of an integrated system of 38 emergency medical service delivery to 39 include injury control, rural system 40 development, training, trauma system 41 development, maternal and child health, 42 highway safety, and the delivery of basic 43 life support service and advanced life 44 support service. 45 History.--s. 19, ch. 73 -126, s. 3, ch. 76- 46 168, S. 1, ch. 77 -457; ss. 8, 10, ch. 79- 47 280; ss. 2, 3, ch. 81 -318; ss. 17, 24, 25, 48 ch. 82 -402, S. 13, ch, 83 -196; s. 64, ch. 49 86 -220; ss. 19, 36, ch. 92 -78. 50 401.41 Penalties. -- 51 (1) Any person who: 52 (a) Uses or attempts to use a 53 certificate, license, or permit that has 54 been suspended, revoked, or 55 terminated; 56 (b) Practices or holds himself or herself 57 out as an emergency medical 58 technician, paramedic, or ambulance 59 driver without being so certified; 60 (c) Knowingly conceals information 61 relating to violations of this part, or 62 (d) Knowingly makes false or fraudulent 63 claims to procure, attempt to procure, or 64 renew a certificate, license, or permit 65 66 is guilty of a misdemeanor of the first 67 degree, punishable as provided in s. 68 775.082 or s. 775.083. 69 (2) Whoever willfully and with intent to 70 defraud obtains or attempts to obtain 71 services from a licensee is guilty of: 72 (a) A misdemeanor of the second 73 degree, punishable as provided in s. 74 775.082 or s. 775.083, for the first 75 offense; and 76 (b) A misdemeanor of the first degree, 77 punishable as provided in s. 775.082 or 78 s. 775.083, for any subsequent offense. 79 (3) Whoever summons any emergency 80 medical services vehicle pursuant to this 81 part or reports that an emergency 82 medical services vehicle is needed 83 when he or she knows or has reason to 84 know that the services of the vehicle are 85 not needed is guilty of: 86 (a) A misdemeanor of the second 87 degree, punishable as provided in s. 88 775.082 or s. 775.083, for the first 89 offense; and Page 29 of 37 ion 1 (b) A misdemeanor of the first degree, 2 punishable as provided in s. 775.082 or 3 s. 775.083, for any subsequent offense. 4 (4) Each day that a violation of this part 5 is committed or permitted to continue 6 constitutes a separate and distinct 7 offense under this section. 8 History. - -s. 22, ch. 73 -126; s. 3, ch. 76- 9 168; s. 1, ch. 77 -457; ss. 2, 3, ch. 81- 10 318; ss. 18, 24, 25, ch. 82 -402; ss. 12, 11 13, ch, 83 -196; s. 73, ch. 91 -224; ss. 20, 12 36, ch. 92 -78; s. 799, ch. 95 -148; s. 7, 13 ch. 96-293. 14 401.411 Disciplinary action; 15 penalties. -- 16 (1) The department may deny, 17 suspend, or revoke a license, certificate, 18 or permit or may reprimand or fine any 19 licensee, certificateholder, or other 20 person operating under this part for any 21 of the following grounds: 22 (a) The violation of any rule of the 23 department or any provision of this part. 24 (b) Being found guilty of, or pleading 25 nolo contendere to, regardless of 26 adjudication in any jurisdiction, a crime 27 that relates to practice as an emergency 28 medical technician or paramedic, or to 29 practice in any other occupation, when 30 operating under this part. 31 (c) Addiction to alcohol or any 32 controlled substance. 33 (d) Engaging in or attempting to engage 34 in the possession, except in legitimate 35 duties under the supervision of a 36 licensed physician, or the sale or 37 distribution of any controlled substance 38 as set forth in chapter 893. 39 (e) The conviction in any court in any 40 state or in any federal court of a felony 41 unless the person's civil rights have 42 been restored. 43 (f) Knowingly making false or fraudulent 44 claims; procuring, attempting to procure, 45 or renewing a certificate, license, or 46 permit by fakery, fraudulent action, or 47 misrepresentation. 48 (g) Unprofessional conduct, including, 49 but not limited to, any departure from or 50 failure to conform to the minimal 51 prevailing standards of acceptable 52 practice as an emergency medical 53 technician or paramedic, including 54 undertaking activities that the 55 emergency medical technician or 56 paramedic is not qualified by training or 57 experience to perform. 58 (h) Sexual misconduct with a patient, 59 including inducing or attempting to 60 induce the patient to engage, or 61 engaging or attempting to engage the 62 patient, in sexual activity. 63 (i) The failure to give to the department, 64 or its authorized representative, true 65 information upon request regarding an 66 alleged or confirmed violation of this part 67 or rule of the department. 68 (j) Fraudulent or misleading advertising 69 or advertising in an unauthorized 70 category. 71 (k) Practicing as an emergency medical 72 technician, paramedic, or other health 73 care professional operating under this 74 part without reasonable skill and safety 75 to patients by reason of illness, 76 drunkenness, or the use of drugs, 77 narcotics, or chemicals or any other 78 substance or as a result of any mental 79 or physical condition. 80 (1) The failure to report to the 81 department any person known to be in 82 violation of this part. 83 (2) A suspension or revocation of a 84 license or certificate is for all 85 classifications unless the department, in 86 its sole discretion, suspends or revokes 87 one or more classifications thereof. 88 (3) One year after the revocation of a 89 license or certificate, application may be 90 made to the department for Page 30 of 37 11H 1 reinstatement; and the department may 2 authorize reinstatement. 3 (4) Any charge of a violation of this part 4 by a licensee affects only the license of 5 the service location from which the 6 violation is alleged to have occurred. 7 Another license may not be issued to 8 the same licensee for a new service 9 location in the same county or any other 10 county for a period of 3 years from the 11 effective date of revocation. 12 (5) If the department finds that the 13 terms of any such suspension have 14 been violated, it may revoke such 15 suspension immediately. 16 (6) If a person whose license, 17 certificate, or permit has been 18 suspended is found by the department 19 to have violated any of the other 20 provisions of this part, the department 21 may revoke the license, certificate, or 22 permit. 23 (7) In addition to any other 24 administrative action authorized by law, 25 the department may impose an 26 administrative fine, not to exceed $1,000 27 per violation of this part or rule of the 28 department. Each day of a violation 29 constitutes a separate violation and is 30 subject to a separate fine. In 31 determining the amount of a fine, the 32 department shall consider the following 33 factors: 34 (a) The gravity of the violation, including 35 the probability of death or disability as a 36 result of the violation. 37 (b) Any actions taken to correct the 38 violation. 39 (c) Any previous violations committed 40 by the violator. 41 (8) All amounts collected under this 42 section must be deposited into the 43 Emergency Medical Services Trust 44 Fund, 45 History. - -ss. 19, 25, ch. 82 -402; ss. 12, 46 13, ch. 83 -196; s. 17, ch. 84 -317; ss. 21, 47 36, ch, 92 -78; s. 2, ch. 98 -87. 48 401.414 Complaint investigation 49 procedures. -- 50 (1) The department shall cause to be 51 investigated any complaint that is filed 52 before it if the complaint is in writing, 53 signed by the complainant, and legally 54 sufficient. A complaint is legally 55 sufficient if it contains ultimate facts that 56 show that a violation of this part, or of 57 any rule adopted by the department, has 58 occurred. The department may 59 investigate or continue to investigate, 60 and may take appropriate final action 61 on, a complaint even though the original 62 complainant withdraws his or her 63 complaint or otherwise indicates a 64 desire not to cause it to be investigated 65 to completion. When an investigation of 66 any person is undertaken, the 67 department shall notify that person of 68 the investigation and inform him or her 69 of the substance of any complaint filed 70 against him or her. The department may 71 conduct an investigation without 72 notifying any person if the act under 73 investigation is a crime. 74 (2) The department shall expeditiously 75 investigate each complaint. When its 76 investigation is complete, the 77 department shall prepare an 78 investigative report. The report must 79 contain the investigative findings and 80 the recommendations of the department 81 concerning the existence of probable 82 cause. 83 (3) The complaint and all information 84 obtained in the investigation by the 85 department are confidential and exempt 86 from the provisions of s. 119.07(1) until 87 10 days after probable cause has been 88 found to exist by the department, or until 89 the person who is the subject of the 90 investigation waives confidentiality, 91 whichever occurs first. This subsection 92 does not prohibit the department from 93 providing such information to any law 94 enforcement agency or any other 95 regulatory agency. Page 31 of 37 ION 1 History. - -s. 18, ch. 84 -317; s. 1, ch. 85- 2 65; s. 5, ch. 89 -162; s. 18, ch. 90 -344; 3 ss. 22, 36, ch. 92 -78; s. 800, ch. 95 -148; 4 s. 234, ch. 96 -406. 5 401.421 Injunctive relief; cease and 6 desist notice; civil penalty; 7 enforcement. -- 8 (1) The State Surgeon General may 9 cause to be instituted a civil action in 10 circuit court for preliminary or permanent 1 I injunctive relief to remedy or prevent a 12 violation of this part or any rule adopted 13 by the department under this part. 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 (2)(a) If the department has probable cause to believe that any person not licensed by the department has provided prehospital or interfacility advanced life support or basic life support procedures or transportation services in this state not specifically authorized by law, the department may issue and deliver to such person a notice to cease and desist from such services. For the purpose of enforcing a cease and desist order, the department may file a petition, in the name of the state, seeking issuance of an injunction or a writ of mandamus against any person who violates any provisions of such order. (b) In addition to or in lieu of any remedy provided in paragraph (a), the department may seek the imposition of a civil penalty by the circuit court for any violation for which the department may issue a notice to cease and desist under paragraph (a). The civil penalty must be no less than $500 and no more than $5,000 for each offense. The court may, in addition to any other remedy it finds appropriate, award to the prevailing party court costs and a reasonable attorney's fee, and, if the department prevails, the court may also award reasonable costs of investigation. All amounts collected by the department under this paragraph must be deposited into the Emergency Medical Services Trust Fund. 10 fl I t 50 History.--ss. 10, 13, ch. 83 -196; ss. 23, 51 36, ch. 92 -78; s. 52, ch. 2008 -6. 52 401.425 Emergency medical services 53 quality assurance; immunity from 54 liability. -- 55 (1) As used in this section, the term 56 "emergency medical review committee" 57 or "committee" means a committee of: 58 (a) An emergency medical service 59 provider, a local or regional trauma 60 agency as provided in s. 395.401, a 61 quality assurance committee as 62 provided in s. 401.265, or a local 63 emergency medical services advisory 64 council; 65 (b) A hospital licensed under chapter 66 395 which is directly responsible for a 67 licensed emergency medical service 68 provider; or 69 (c) The department, or employees, 70 agents, or consultants of the 71 department. 72 (2) An emergency medical review 73 committee may review and evaluate the 74 professional medical competence of 75 emergency medical technicians and 76 paramedics under the jurisdiction of 77 such committee. 78 (3)(a) There shall be no monetary 79 liability on the part of, and no cause of 80 action shall arise against, any person, 81 including any person acting as a 82 witness, incident reporter to, or 83 investigator for, an emergency medical 84 review committee for any act or 85 proceeding undertaken or performed 86 within the scope of the functions of any 87 emergency medical review committee if 88 such action is taken without intentional 89 fraud or malice. 90 (b) The provisions of this section shall 91 not affect the provisions of s. 768.28. 92 (4) Except as provided in subsection 93 (3), this section shall not be construed to 94 confer immunity from liability on any Page 32 of 37 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 person while performing services other 56 or her as a result of participating in than as a member of an emergency 57 activities conducted by a committee. medical review committee, or upon any person acting as a witness, incident 58 (6) If the defendant prevails in an action reporter to, or investigator for, an 59 brought by a health care provider emergency medical review committee 60 against any person who initiated, for any act or proceeding undertaken or 61 participated in, was a witness in, or performed outside the scope of the 62 conducted any review as authorized by functions of such committee. 63 this section, the court shall award 64 reasonable attorney's fees and costs to (5) The records obtained or produced 65 the defendant, by a committee providing quality assurance activities as described in 66 (7) For the purpose of any disciplinary subsections (1) -(4) are exempt from the 67 proceeding conducted by the provisions of s. 119.07(1) and s. 24(a), 68 department, the department shall have Art. I of the State Constitution, and 69 the power to issue subpoenas which committee proceedings and meetings 70 shall compel the production of regarding quality assurance activities 71 information, documents, or records from are exempt from the provisions of s. 72 an Emergency Medical Review 286.011 and s. 24(b), Art. I of the State 73 Committee. Challenges to, and Constitution. The investigations, 74 enforcement of, the subpoenas and proceedings, and records of a 75 orders shall be handled as provided in s. committee providing quality assurance 76 120.569. activities as described in subsections (1) -(4) shall not be subject to discovery 77 History.--s. 16, ch. 89 -275; s. 14, ch. ry' or introduction into evidence in any civil 78 892 s. 71, ch. s. 1, ch. 90- action or disciplinary proceeding by the 79 192; s. 72, 289 s.; s. ; s. 2, ch. 93-12; s. department or employing agency arising 80 -1 s. 1, 801, 95 -148; s. 1, ch. ; s. 235, out of matters which are the subject of 81 ch. 96 -406; s. 127, ch. 96 -410. 6-4 -410. evaluation and review by the committee, and no person who was in attendance at a meeting of such committee shall be 82 401.435 First responder agencies permitted or required to testify in any 83 and training.- - such civil action or disciplinary proceeding as to any evidence or other 84 (1) The department must adopt by rule matters produced or presented during 85 the United States Department of the proceedings of such committee or 86 Transportation Emergency Medical as to any findings, recommendations, 87 Services: First Responder Training evaluations, opinions, or other actions of 88 Course as the minimum standard for such committee or any members 89 first responder training. In addition, the thereof. However, information, 90 department must adopt rules documents, or records provided to the 91 establishing minimum first responder committee from sources external to the 92 instructor qualifications. For purposes of committee are not immune from 93 this section, a first responder includes discovery or use in any such civil action 94 any individual who receives training to or disciplinary proceeding merely 95 render initial care to an ill or injured because they were presented during 96 person, other than an individual trained proceedings of such committee nor 97 and certified pursuant to s. 943.1395(1), should any person who testifies before a 98 but who does not have the primary committee or who is a member of such 99 responsibility of treating and committee be prevented from testifying 100 transporting ill or injured persons. as to matters within the person's knowledge, but, such witness shall not 101 (2) Each first responder agency must be asked about his or her testimony 102 take all reasonable efforts to enter into a before a committee or information 103 memorandum of understanding with the obtained from or opinions formed by him 104 emergency medical services licensee Page 33 of 37 10fi I within whose territory the agency 2 operates in order to coordinate 3 emergency services at an emergency 4 scene. The department must provide a 5 model memorandum of understanding 6 for this purpose. The memorandum of 7 understanding should include dispatch 8 protocols, the roles and responsibilities 9 of first responder personnel at an 10 emergency scene, and the 1 I documentation required for patient care 12 rendered. For purposes of this section, 13 the term "first responder agency" 14 includes a law enforcement agency, a 15 fire service agency not licensed under 16 this part, a lifeguard agency, and a 17 volunteer organization that renders, as 18 part of its routine functions, on -scene 19 patient care before emergency medical 20 technicians or paramedics arrive. 21 History.--s. 24, ch. 92 -78; s. 11, ch. 95- 22 408. 23 401.445 Emergency examination and 24 treatment of incapacitated persons. -- 25 (1) No recovery shall be allowed in any 26 court in this state against any 27 emergency medical technician, 28 paramedic, or physician as defined in 29 this chapter, any advanced registered 30 nurse practitioner certified under s. 31 464.012, or any physician assistant 32 licensed under s. 458.347 or s. 459.022, 33 or any person acting under the direct 34 medical supervision of a physician, in an 35 action brought for examining or treating 36 a patient without his or her informed 37 consent if: 38 (a) The patient at the time of 39 examination or treatment is intoxicated, 40 under the influence of drugs, or 41 otherwise incapable of providing 42 informed consent as provided in s. 43 766.103; 44 (b) The patient at the time of 45 examination or treatment is 46 experiencing an emergency medical 47 condition; and 48 (c) The patient would reasonably, under 49 all the surrounding circumstances, 50 undergo such examination, treatment, or 51 procedure if he or she were advised by 52 the emergency medical technician, 53 paramedic, physician, advanced 54 registered nurse practitioner, or 55 physician assistant in accordance with 56 s. 766.103(3). 57 58 Examination and treatment provided 59 under this subsection shall be limited to 60 reasonable examination of the patient to 61 determine the medical condition of the 62 patient and treatment reasonably 63 necessary to alleviate the emergency 64 medical condition or to stabilize the 65 patient. 66 (2) In examining and treating a person 67 who is apparently intoxicated, under the 68 influence of drugs, or otherwise 69 incapable of providing informed consent, 70 the emergency medical technician, 71 paramedic, physician, advanced 72 registered nurse practitioner, or 73 physician assistant, or any person 74 acting under the direct medical 75 supervision of a physician, shall proceed 76 wherever possible with the consent of 77 the person. If the person reasonably 78 appears to be incapacitated and refuses 79 his or her consent, the person may be 80 examined, treated, or taken to a hospital 81 or other appropriate treatment resource 82 if he or she is in need of emergency 83 attention, without his or her consent, but 84 unreasonable force shall not be used. 85 (3) This section does not limit medical 86 treatment provided pursuant to court 87 order or treatment provided in 88 accordance with chapter 394 or chapter 89 397. 90 History.--s. 17, ch. 89 -275; s. 15, ch. 91 89 -283; s. 3, ch. 89 -336; s. 1, ch. 90- 92 192; s. 25, ch. 92 -78; s. 3, ch, 93 -12; s. 93 25, ch, 93 -39; s. 802, ch. 95 -148; s. 1, 94 ch. 2007-176. 95 401.45 Denial of emergency 96 treatment; civil liability.-- 97 (1)(a) Except as provided in subsection 98 (3), a person may not be denied needed 99 prehospital treatment or transport from Page 34 of 37 M I any licensee for an emergency medical 2 condition. 3 (b) A person may not be denied 4 treatment for any emergency medical 5 condition that will deteriorate from a 6 failure to provide such treatment at any 7 general hospital licensed under chapter 8 395 or at any specialty hospital that has 9 an emergency room. 10 (2) A hospital or its employees or any 11 physician or dentist responding to an 12 apparent need for emergency treatment 13 under this section is not liable in any 14 action arising out of a refusal to render 15 emergency treatment or care if 16 reasonable care is exercised in 17 determining the condition of the person 18 and in determining the appropriateness 19 of the facilities and the qualifications and 20 availability of personnel to render such 21 treatment. 22 (3)(a) Resuscitation may be withheld or 23 withdrawn from a patient by an 24 emergency medical technician or 25 paramedic if evidence of an order not to 26 resuscitate by the patient's physician is 27 presented to the emergency medical 28 technician or paramedic. An order not to 29 resuscitate, to be valid, must be on the 30 form adopted by rule of the department. 31 The form must be signed by the 32 patient's physician and by the patient or, 33 if the patient is incapacitated, the 34 patient's health care surrogate or proxy 35 as provided in chapter 765, court- 36 appointed guardian as provided in 37 chapter 744, or attorney in fact under a 38 durable power of attorney as provided in 39 chapter 709. The court- appointed 40 guardian or attorney in fact must have 41 been delegated authority to make health 42 care decisions on behalf of the patient. 43 (b) Any licensee, physician, medical 44 director, or emergency medical 45 technician or paramedic who acts under 46 the direction of a medical director is not 47 subject to criminal prosecution or civil 48 liability, and has not engaged in 49 negligent or unprofessional conduct, as 50 a result of the withholding or withdrawal 51 of resuscitation from a patient pursuant 52 to this subsection and rules adopted by 53 the department. 54 (c) The department, in consultation with 55 the Department of Elderly Affairs and 56 the Agency for Health Care 57 Administration, shall develop a 58 standardized do- not - resuscitate 59 identification system with devices that 60 signify, when carried or worn, that the 61 possessor is a patient for whom a 62 physician has issued an order not to 63 administer cardiopulmonary 64 resuscitation. The department may 65 charge a reasonable fee to cover the 66 cost of producing and distributing such 67 identification devices. Use of such 68 devices shall be voluntary. 69 (4) Any licensee or emergency medical 70 technician or paramedic who in good 71 faith provides emergency medical care 72 or treatment within the scope of their 73 employment and pursuant to oral or 74 written instructions of a medical director 75 shall be deemed to be providing 76 emergency medical care or treatment 77 for the purposes of s. 768.13(2)(b). 78 (5) The department shall adopt and 79 enforce all rules necessary to implement 80 this section. 81 History. - -s. 26, ch. 73 -126; s. 3, ch. 76- 82 168; s. 1, ch. 77 -174; s. 1, ch. 77 -457; 83 ss. 2, 3, ch. 81 -318; ss. 24, 25, 27, ch. 84 82 -402; s. 13, ch. 83 -196; ss. 26, 36, ch 85 92 -78; s. 8, ch. 99 -331; s. 5, ch. 2000- 86 295. 87 401.465 911 emergency dispatcher 88 certification. -- 89 (1) DEFINITIONS. - -As used in this 90 section, the term: 91 (a) "911 emergency dispatcher" means 92 a person employed by a state agency or 93 local government as a public safety 94 dispatcher or 911 operator whose duties 95 and responsibilities include answering 96 911 calls; dispatching law enforcement 97 officers, fire rescue services, emergency 98 medical services, and other public Page 35 of 37 The State of Pre - Hospital Emergency Medical Care within Collier County, Florida Presented by Robert Boyd Tober, M.D., FACEP Collier County Office of the Medical Director For over 30 years, the citizens of Collier County have been served by a nationally award winning EMS system managed by the Board of County Commissioners 1994 - Florida EMS Medical Director of the Year 1999 - State of Florida EMS System of the Year � 2000 - National EMS System of the Year o 2001 - Physician of the Year, NCH Healthsystem 2009 - Florida EMS Director of the year (second award) 2009 - American Heart Association, Golden Stethoscope 2009 Florida Medical Association, Lifetime Achievement r 2010 )EMS National "EMS 10" - Innovators in EMS 10/26/2010 Ag .-66(ed. 1 Throughout the nation, the industry of "EMS" (Emergency Medical Services) is still considered to be in its infancy Approximately 45 years ago, most communities had little or no organized EMS service. In the late 1960s, the federal government began to mandate EMS provisions focused at traffic accident & trauma victims. The TV show "EMERGENCY" debuted in the early 1970s. At the time, there were less than 12 paramedic units within the entire United States. Throughout the following 20 years, the scope of EMS grew precipitately, based on a goal to assure any service found in an emergency room can be brought to a patient's side. In the past several years, evidence based medicine has shown that many untested EMS theories of the 1 970s and 80s are vastly unnecessary and dangerous. 110/ /226/2010 9 41V'D fy 2 Abundant peer- reviewed articles, studies and position papers support today's science . Journal of the American Medical Association (JAMA) New England Journal of Medicine . American Academy of Emergency Medicine . American College of Emergency Physicians Resuscitation Outcomes Consortium . Journal Of Emergency Medicine (JEMS) National Association of EMS Physicians . International Anesthesia Research Society Emergency Medicine News Pre - hospital Emergency Care Magazine Etc... In September 2010, a report titled "EMS Field Experiments" was published . The study was based on staged drills - not evidence based. Does not measure medical treatment's effectiveness or necessity. r Does not factor a participant's competency. . The study is already being used by some to justify an expansion of resources and manpower. P Asks the reader to assume that more paramedics can provide quicker ALS treatment and that quickerALS treatment could be better for the patient. . Primary participants are members of the International Association of Firefighters (IAFF); fire union. , Ignores a rich collection of "real- world" data gathered throughout North America over the past decade - Collier Counri 10/26/2010 6t f- 1b If 3 NNFD Competency Report October 01 - December 31, 2006 BLS Incidents (1 86) ALS Incidents within Medical Protocol (9) ALS Incidents outside Medical Protocol (16) Collier County Office of the Medical Direaor paramedic.' MEDIATION ADM N15TRATION Repoli July 2007 - June 2009 NOrt.Mwlw rtyemtTV Owmq qr pnan- xwowrrMn�MVnpbyn rlmmvaxgvmgkaMOn WrIy eMYxM yuwrv. Nn Mprtmvnt Iumneh whin. m}Mt dl mgmmr olmrwpM emm n FMS griM/uwpmrua 110/26/2010 V 26 rd Collier County Office of the Medical [»rector Pammedtcs' PRt7Cr, Dt a5S Report July 2007 -June 2009 rvorz. m. wwn Tw....�n. w.,w.- w•ew.w- «aawN..n...n<... row. onm -m.ea�..e;�rw <.m,�.. e�n�c ✓. M.wwo,u.. r�,. orymmem wmm.ae rdu+ rcAn+nrc w�enn pe yam.ee wn. m Frnz o..:u/..uupenvo Medications "Time -to -Use" June 2007 - 2009 = -13 minutes to administration • June 2009 - 2010 = -13 minutes to administration 10/26/2010 x -# fof' 5 Collier County EMS "'2070 and beyond" 10/26/2010 *(DL' M. 1 %010 10/ /2266/2J010 l� Currently, the average response time in Collier County is over 8 - 9 minutes. This is unacceptable and must be corrected. Collier County Office of the Medical Director Response -Time Benchmarks 2010 Standards concur with the latest guide lines recommended by the American Heart Association, the National Fire Protection Aoencv and the Lournal of the American Medical Association 10/26/2010 C� fb tt- X 10/26,2010 'Ifl/oA- 10 Questions? 10/26/2010 11 %lro U cn :-, U C � U � CZ CL• L O n W .�I � �- O O z E � a UU 0. j o O °0 cn (� N U v CL ' a� z 0 U O z � m L- ' L- 0 aD 0) CU `� m o 0= O C V U X U -C N .— N-0 m � C N C C N cA O N O U U) Q �... 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