Agenda 03/03/2011 W
BCC
BLUE RIBBON PANEL
REPORT
WORKSHOP
AGENDA
MARCH 3, 2011
Blue Ribbon Panel Report
Workshop
Board of County Commission Chambers
Collier County Government Center
3299 Tamiami Trail East, 3rd Floor
Naples FL 34112
March 3,2011
9:00 AM
Fred W. Coyle - BCC Chairman; Commissioner, District 4
Jim Coletta - BCC Vice-Chairman; Commissioner, District 5; CRAB Vice-Chairman
Donna Fiala - BCC Commissioner, District 1; CRAB Chairman
Georgia Hiller - BCC Commissioner, District 2
Tom Henning - BCC Commissioner, District 3
AGENDA
Call to Order and Pledge of Allegiance - Chairman Coyle
1. Presentation of Public Safety Authority Concepts and Options by County Staff and
Blue Ribbon Panel Chair and Co-Chair
2. Presentation of other options
3. Board discussion
4. Public Comment
S. Adjourn
NOTICE: All persons wishing to speak on Agenda items must register prior to speaking.
Speakers must register with the Executive Manager. All registered speakers will receive up
to three (3) minutes unless the time is adjusted by the chairman.
EXECUTIVE SUMMARY .
Presentation of options for consideration regarding the establishment of a
Public Safety Authority as proposed in the Blue Ribbon Panel Report on the Pre-
Hospital Emergency Medical Treatment and Transport System
OBJECTIVE: To provide the Collier County Board of County Commissioners a range of options and
considerations regarding a Public Safety Authority structure.
CONSIDERATION:
On January 11, 2011, the Board received the final report from the Blue Ribbon Panel on Pre-Hospital
Emergency Medical Treatment and Transportation in Collier County. The Board directed the County
Attorney and County Manager to work with the leadership of the Blue Ribbon Panel to develop options
for the creation of a Public Safety Authority to carry-out the functions recommended in the Panel's report
and to present these options to the Board of County Commissioners in a publically noticed workshop.
Commissioner Hiller advised the Board during the January 11th meeting that she would be meeting with
interested stakeholders to develop options for presentation and discussion at the workshop.
The following options are provided for consideration:
1. Forming an Independent Special District
2. Forming a Dependent Special District.
3. Creating an Authority by lnterlocal Agreement within Chapter 163, F.S.
4. Transferring PEMTT related Fire and EMS functions to the Sheriffs Office either directly or
under contract to the Sheriff
5. Expand the Bureau of Emergency Services within the County Manager's Agency guided by an
appointed Advisory Board.
6. Re-constitute the existing and active EMS Policy Advisory Board into a Public Safety Authority.
(1). Forming an Independent Special District:
The State Legislature may create independent special districts. A special Act creating an independent
special district can be uniquely tailored to provide for the authority and organizational structure desired.
Since it is created by the State Legislature, it may only be amended by the State Legislature. Resources
and legislative efforts would be likely required to dissolve the current independent districts and re-form a
new special district. Issues of the timing, coordination process, referendum requirements if any and
millage structure have not been analyzed. .
(2). Forming an Dependent Special District:
The charter of a dependent special district is created by local ordinance, and the local government entity
that creates the dependent special district retains the ability to amend the charter. Dependent special
districts have at least one of the following characteristics:
· Its governing body members are appointed by the governing body of a single county or a single
municipality
· During unexpired terms, its governing body members are subject to removal at will by the
governing body of a single county or a single municipality
· Its budget requires approval through an affirmative vote by the governing body of a single county
or a single municipality
· Its budget can be vetoed by the governing body of a single county or a single municipality
Legislative resources for the independent districts to convert to a dependent district along with local
ordinance change efforts would be required to dissolve the current dependent/independent districts and re-
form a new dependent district. Issues oftiming and referendum requirements have not been analyzed.
(3). Creating an Authority by Interlocal Agreement within F.S. 163:
Part I, Chapter 163, Florida Statutes, would allow the County to create a Public Safety Authority by
entering into an Interlocal Agreement with the local municipalities and independent fire districts.
1. Any council established under the authority of this section shall be a corporation not for profit.
2. The representative from each member local government shall be the elected chief executive of said
local government.
3. The local government council shall have the power to:
· Study such area governmental problems as it deems appropriate, including but not
limited to matters affecting health, safety, welfare, education, economic conditions,
and area development.
· The council shall adopt bylaws designating the officers of the council and providing
for the conduct of its business. The council may employ a staff, consult and retain
experts, and purchase of lease or otherwise provide for such supplies, materials,
equipment and facilities as it deems desirable and necessary.
· The governing bodies of the member governments may appropriate funds to meet the
necessary expenses of the council. Services of personnel, use of equipment and
office space, and other necessary services may be accepted from members as part of
their financial support.
(4). Transfer Fire/EMS functions to the Sheriffs Office either directly or under contract to the
Board of County Commissioners - Broward County Model.
One of the PEMTT System organizational structures discussed by the Blue Ribbon Panel Report was the
Broward County model. This model is unique to Broward County, and was created by a 2003 Interlocal
Agreement between the Broward County BCC and the Broward County Sheriff. Pursuant to this
agreement, the Broward County Sheriff provides Fire/Rescue (including EMS) services to Broward
County, with a centralized 911 service. The agreement contemplates that the Sheriff will enter into
similar interlocal agreements with the incorporated areas of the County.
Careful analysis would be needed in the area of asset transfer, debt transfer as well as the role of the
elected officials within the independent fire districts.
Fire Code enforcement efforts are part of the Broward Sheriff model. Implications for the Collier
County/East Naples Fire Code Officials office have not been reviewed. To date, we have had no
discussions with the Sheriff to gauge what interest he may have in this model.
(5). Expand the Bureau of Emergency Services within the County Manager's Agency guided by an
appointed Advisory Board - TDC Model
Collier County's County Manager's Agency operates fire services as the dependent districts under the
Board of County Commissioners for Ochopee Fire Control and Isles of Capri Fire Department. EMS is
also operated by the County Manager's Agency under the General Fund. Agencies combine total of235
employees full and part-time. .
Collier County has administrative resources already in place such as: Human Resources, Purchasing, Risk
Management, Fleet, Legal, Facilities etc., for these day-to-day operations.
(6). Re-constitute the existing and active EMS Policy Advisory Board into a Public Safety
Authority.
The Board of County Commissioners could expand and modify the charter and enabling ordinance of the
current EMS Policy Advisory Board to conform to the proposed charter of the Public Safety Authority-
(PSA). The EMS Policy Advisory Board has a long history of effective involvement in countywide pre-
hospital emergency medical treatment and transport services, including policy and operational oversight.
This is an existing BCC advisory board that can be modified and continuously adopted by simple
resolution of the County Commission. As the roles and responsibility of the Public Safety Authority
expanded with the re-structure of the delivery of services some additional administrative support might be
anticipated during a transitional period. Such efforts may include audits, labor discussions, debt service
analysis, benefits analysis, procurement and equipment inventory to mention just a few.
BLUE RIBBON PANEL RECOMMENDATION: The Chair and Co-Chair of the Blue Ribbon Panel
have endorsed option # 6 as their preferred option as outlined in the attached letter.
FISCAL IMPACT: Fiscal Impacts have not been evaluated.
LEGAL CONSIDERATIONS: Formal legal considerations outside of the options and considerations
noted above have not been reviewed.
GROWTH MANAGEMENT IMPACT: Growth Management impacts have not been evaluated for the
various options and considerations noted above.
RECOMMENDATION: Reconstitute the existing and active EMS Policy Advisory Board into the
Public Safety Authority.
PREPARED BY:
Leo Ochs, County Manager and Jeff Klatzkow, County Attorney
The Blue Ribbon Panel offers the following discussion to supplement its report.
Feb. 13, 2011
Dear Mr. Ochs:
I am sharing this on behalf of the PEMTT Blue Ribbon Panel Chair, Geoffrey Moebius, and Co-Chair,
Edward Morton:
We thank you for taking the time to discuss and review various options for a Public Safety Authority
(PSA). After reviewing the options the Blue Ribbon Panel submitted and also the proposals from counsel
and staff, we support the option to re-constitute the existing EMS Advisory Board into the PSA (The
Authority). The Authority would report to the Board of County Commissioners which would retain
decision making approval.
There are several reasons that were obvious to us in making this recommendation:
1. The Board of County Commissioners can implement the changes quickly, monitor and
maintain oversight and approval of decisions pertaining to Pre-Hospital Care.
2. The Authority would have coordinating power but decision making power will remain with
the County Commissioners.
3. The existing EMS Advisory Board can be disbanded and re-constituted to provide input from
all stake-holders.
4. The Authority should be reviewed for performance annually and re-constituted as seen fit
by the County Commissioners.
5. The Chair of the Authority would report as needed, but at least quarterly to the Board of
County Commissioners findings and recommended actions.
We would suggest that the Chair of The Authority be an individual who can bring individuals and
organizations together to work on a common issue, continual improvement of pre-hospital care. This
individual must have the respect and admiration of all potential stake holders. This individual would
coordinate the activities of the Authority and report to the Board of County Commissioners on a
quarterly basis.
The Authority must be comprised of representatives from all stakeholders involved with the emergent
care of citizens and visitors to Collier County. These stakeholders include: the Collier County Medical
Director (1), Emergency Department Medical Directors of local hospitals (2), Trauma Director of local
Trauma Center (1), Hospital Administrative representatives from local hospitals (2), Fire (5), EMS (2),
Sheriff (1) representatives and community experts (3). We would suggest that the makeup of The
Authority not exceed 17 representatives, although that number is not cast in stone.
We would suggest that The Authority meet quarterly to address the Blue Ribbon Panel's
recommendations and to construct a process whereby the County Medical Director, Authority physician
members and other experts meet separately to develop prehospital patient protocols for first responder
personnel, other medical protocols. This group should also provide counsel to The Authority regarding
training, performance, testing and certification of all emergency responders.
We would further suggest that the County Medical Director report to The Authority, who, through the
Chair of The Authority, will report at least quarterly to the Board of County Commissioners.
Respectfully,
Michael V. Reagen
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Collier County Public Safety Emergency Medical Treatment and Transport
Authority
Purpose
Create a seamless system from the receipt of the 911 emergency calls through
the Emergency Room treatment process for all emergency medical services
within Collier County. This independent Authority will serve in an oversight and
advisory role to all agencies involved in the delivery of Advanced and Basic life
support, medical transportation services, first responder programs, training
programs, communication systems and funding.
Develop appropriate EMS standards of care and levels of service commensurate
with the needs of the citizens of Collier County and to collect data and analyze
trends to improve delivery and patient outcome.
Establishment
The Authority will be created by Ordinance by vote of the Board of County
Commissioners.
Develop the model for the Authority as an Independent Authority within one (1)
year. This may be a F.S.S. 163, Independent District, Authority. Transition this
Authority into a legislatively created body within one year. Funding to be
recommended by the Authority - once established.
Membership
All agency members will be appointed by their respective agency on an annual
basis. Citizen representation will be selected and appointed by the Authority on
an annual basis. Membership will consist of a fair representation of all agencies
and stakeholders involved in pre-hospital care as well as hospital receiving
facilities.
Physicians
Emergency Medicine Physician (2 - one from NCH and one from HMA)
Lee County Trauma Physician (1)
Collier County Medical Examiner (1)
Medical Directors of a licensed (C.O.P.C.N.) agency (Currently 2)
Commissioner/Council Person
County (1)
Municipal (2- one from Naples and one from Marco Island)
Independent Fire District (1)
2-24-11
1
Advanced Life Support
Collier County Paramedic (1)
Independent Fire District Paramedic (1)
Municipal Paramedic (1)
Basic Life Support
Independent Fire District providing Basic Life Support- E.M.I. (1)
Law Enforcement
Collier County Sherriff - (1)
Municipal Police Chief - (1)
Administration (non-field)
Hospital Administrator
County EMS Chief
Independent Fire District Chief
Municipal Fire Chief
Citizen Representation
(2) Members appointed by this Authority
Terms:
(1) All members will be reappointed by their appropriate agency on an
annual basis. Citizen members will be selected on an annual basis by
vote of the Authority.
(2) All members who have three (3) consecutive absences or misses four
(4) meetings in one (1) calendar year shall be automatically removed
as a member of the Authority. Automatic removal shall cause a
vacancy to exist in the membership of the Authority. However, the
automatic removal of a member shall not be deemed effective until the
member has received written notice from the Authority Chair or
designee of the reason for the action being taken to remove the
member. In the event a member is automatically removed, the
respective Agency will appoint a new individual and submit the name
to the Authority for recognition or recommend to the Authority that the
individual be reappointed when extenuating circumstances are found
to exist of the individual's absences.
2-24-11
2
(3) Vacancies shall be filled in the same manner provided for the original
appointments. An appointment to fill a vacancy shall only be the
remainder of the unexpired term being filled.
· A member of the authority may be removed from office with
cause by a majority vote of the Authority.
· Whenever a member of the authority shall fail to attend three
consecutive meetings without having been excused by the
chairman of the authority, the authority chairman shall promptly
certify in writing such absences to the representatives Agency.
Upon such certification the Authority may remove the defaulting
member until the representative agency fills that vacancy by
further appointment to that seat.
· The members of the authority shall select a chairman, a vice-
chairman, and such other officer(s) as deemed desirable by the
authority. Each officer should generally be appointed to a term
of at least one year. Each officer may be reappointed to his/her
same office, but no member shall serve in the same office for
more than two consecutive years and no member may be
appointed to an office that extends beyond his/her then
remaining appointment to the authority by the board.
· Minutes of each authority meeting shall be kept and prepared
under the general supervision and direction of the Clerk or
designee of the Clerk. Such minutes shall be kept on file by the
Authority and the Clerk.
. The Authority shall meet as often as necessary, but generally
not less often than once each month, to discharge its duties
pursuant to this article. Eleven members present constitute a
quorum. The affirmative vote of Eleven members is required to
take any action except to cancel or continue a meeting that has
no quorum.
. Subject to the county's budget, the county administrator will
provide clerical and public record recording assistance to the
Authority until the Authority is self funded.
Quorum
Fifty Percent of Appointed members
2-24-11
3
Functions:
· Protocol - review/recommend minimum medical protocol.
· Set Performance benchmarks (re: response times).
. Collect data and analyze trends.
· Act as COPCN administrator to review and recommend COpeN applications
to Board of County Commissioners.
· Medical Director to report to this Authority.
. Policy Compliance and Assurance Function.
· Public Policy - recommend public safety ordinances.
· Finance - review and recommend funding sources.
· Promote and sustain a cooperative environment among all providers and
stakeholders of Emergency Medical Services in Collier County
· Coordinate with agencies involved in EMS whether they're private, nonprofit,
government, quasi governmental, volunteer or any other such group, whose
interest is in preventing emergency medical care or emergency
transportation.
· Review all EMS, health and disaster related state statutes, administrative
rules, planning documents, and policies to determine their appropriateness to
the conduct of EMS in Collier County; based upon such reviews, report to all
agencies and recommendations for positive change.
· Review and evaluate programs, A.E.D., Pilot, etc.
. Training and personnel Development.
· Evaluate personnel integration and movement within system.
. Review 2007 EMS Strategic Report.
. Evaluate equipment, vehicles, and supplies for standardization.
· Communication and outreach to the public
· Mediate issues and grievances between agencies.
· Create the model independent Authority within one (1) year.
2-24- II
4
/ \
2/25/2011
Sub COfI1miU.,..
Indopeldem Aulho<Uy
Data and Treoo AnaIysls
Med~al Dher.tor Per.crmance
AuOIt/POlKy Compha"",
lotemg.erKy
UO/1/cooperanve/M<<1Ja
011
ProrOCDJ Rewew
2/25/2011
Performance
BendmldfGjE'valuation
Trallllng/?el=1ne1 dMOpmenl
PubliC PoIh:y OevcJopmenr
l>;lol Programs/ P"""'nel
lnteg""lOn
2007 EMS Strntl;glc
eport Review
COOllnut'tlty Outreach
BOTTOM-LINE RECOMMENDATIONS
FOR
PREHOSPITAL EMERGENCY MEDICAL TREATMENT AND TRANSPORT
(PEMTT) SERVICES
PREFACE
Collier County, Florida is one of the best places in America to live, work and visit.
Daily, we have at least 1,294 public safety professionals (662 Sheriffs Deputies in law
enforcement, 632 Fire Rescue and Emergency Medical Service Officers.. .246 of which are
Paramedics) on call to risk their lives to help, protect and serve us.
The Panel producing this report, over and over again during the past year of its study, was
impressed and regularly gratified by the evidence that all these professionals are dedicated,
focused, and conscientious. They work hard to immediately help us during our most vulnerable
moments.
The data shows clear results.
Our pre-hospital emergency medical treatment and transport (PEMTT) professionals enjoy
national praise. And, we enjoy living in one of the safest and healthiest communities in America.
National studies rank Collier County as the generally healthiest county in Florida. And, we have
the best cardiology services in Florida.
Moreover, Collier County residents have the highest life expectancy in Florida and the fourth
highest life expectancy in the United States.
And, we want to keep it that way.
The report is dedicated to praising our "best and brightest" PEMTT professionals and
recommending ways in which we can improve the system that supports them. Shifting
demographics, medical advances, technological leaps.. .all dictate that we craft our future by
expertly managing our resources. This report recommends ways in which we all, our
professionals and our citizens, together can continue to be an even healthier, safer community.
Page 10f5
RECOMMENDATIONS
1. The Board of County Commissioners should designate and delegate authority and
responsibility for all PEMIT services to a Public Safety Authority.
2. Reappoint the medical director to report to the designated Public Safety Authority. The
Panel strongly suggests that the medical director work closely with the leaders of the three
hospitals' emergency departments serving Collier County (NCH, PRHS, and Lee Memorial
trauma departments.)
3. Establish a PEMIT Council to report to the designated Public Safety Authority, chaired by
a hospital administrator. Under the guidance of the designated Public Safety Authority, the
medical director, in collaboration with the directors of the emergency departments of the
NCH, Lee Memorial Trauma Center and PRHS, will promulgate all PEMIT personnel
training, quality initiatives, credentialing and testing. Membership on the Council to include
representatives from fire districts, the public and outside independent experts.
4. Outsource all test design, administration, evaluation and dispute resolution to professionals
at a local college or university to insure independence and objectivity.
5. The designated Public Safety Authority should propose administrative procedures and
policy to the Board of County Commissioners after thorough vetting of such by the Council.
The Board of County Commissioners should set general policy; the designated Public Safety
Authority should implement and manage the system; The Board of County Commissioners
should evaluate the clinical and financial efficacy of all proposed procedures and policies.
6. With guidance and advice from the PEMIT Council and delegated authority and
responsibility from the Board of County Commissioners, the designated Public Safety
Authority should lead development of a five-year strategic plan...with a required three-year
audit provision... to provide collegial oversight for all involved in establishing a refreshed
PEMIT model for county-wide PEMTT services
7. Establish a two-tiered county-wide PEMIT model:
. Tier One = Timely delivery of Basic Life Support (BLS) Services
· Tier Two = Timely delivery of Advanced Life Support (ALS) Services
8. Mandate that all agencies providing ALS services also provide patient transport to
hospitals.
9. Establish a mandatory Automatic Electric Defibrillator (AED) placement and training
program for all staff at appropriate public locations. Effective and efficient AED execution
must be countywide priority involving all facets ofthe public and private sectors.
Page 2 of5
10. Encourage discussion of functional consolidation of fire service districts in Collier
County and expert reallocation of resources in response to current demographics and
professional standards, utilizing the county's Productivity Committee to comprehensively
study and review all costs and potential service enhancements.
11. Encourage consideration of a pilot project aimed at a functional integration of county
EMS personnel into the fire service districts. To do so, the pilot districts would utilize
position control administration to manage the optimal assignment of Paramedic and EMT
positions and also the possible use of smaller, lighter ambulances to be used in certain non-
ALS required response situations.
12. Encourage all PEMTT agencies within fire service agencies to collaborate in order to
develop common response protocols.
13. Encourage all PEMTT agencies to collaborate to designate one leader to be the one voice
for all PEMTT treatment and transport matters conducted BY fire services operating in
Collier County.
14. Mandate that all PEMTT vehicles be equipped with standardized life saving equipment
COMPATIBLE with AREA hospital emergency department equipment and supplies.
Page 30f5
The Panel
Geoffrey Moebius, Chair-Blue Ribbon Panel
Community Liaison and Past CEO, Physicians Regional Healthcare System
Edward A. Morton, Vice Chair-Blue Ribbon Panel
Partner & Managing Director, Wasmer Schroeder & Company, Inc.
Past CEO, NCH Healthcare System
Patricia Barton, Community Leader
Edward Boyer, Retired Healthcare System Executive
Russell Budd, President, Wall Systems Inc. of Southwest Florida
Joseph Gauta, M.D., Past President, Collier County Medical Society
Michael V. Reagen, Ph.D., President, The Greater Naples Chamber of Commerce
& Leadership Collier Foundation, Inc.
EMS and Fire Chiefs. Assistant Chiefs' and Firefie:hters
Jorge Aguilera, Deputy Chief of Medical Services and Community Relations
North Naples Fire Control & Rescue District
Dan Bowman, Deputy Chief, Collier County Emergency Medical Services
Chris Byrne, Deputy Chief, City of Marco Island Fire-Rescue District
Steve McInerny, Chief, City of Naples Fire District
Robert Metzger, Chief, Golden Gate Fire District
Jeff Page, Chief, Collier County Emergency Medical Services
Dan Summers, Executive Director, Collier County Department of Emergency Management
Eric Watson, Firefighter, Big Corkscrew Fire District
Wayne Watson, Deputy Chief, Collier County Emergency Medical Services
Page 40f5
Hospital Leaders
Joseph Bernard, Chief Operating Officer, Physicians Regional Healthcare System - Collier Boulevard
Phillip Dutcher, Chief Operating Officer, NCH Healthcare System, Inc.
Chris Lee, M.D., Associate Medical Director, Collier County Emergency Medical Services
Hospital Emereencv Department Physicians
Todd D. Bethel, M.D., Emergency Medicine, Naples Community Hospital
John P. Lewis, M.D., ER Physician Director, Naples Community Hospital
John W. Zelahy, M.D., Emergency Medicine/Internal Medicine
Physicians Regional Hospital- Pine Ridge Road
Robert Tober, M.D., Medical Director, Collier County Emergency Medical Services
Florida Gulf Coast University
Lisa Zidek, Ph.D., Associate Professor, Florida Gulf Coast University
Collier County Sheriffs Office
Jim Bloom, Chief of Operations, Collier County Sheriffs Office
Deborah Chester, Manager of Planning & Research, Collier County Sheriff's Office
Page 5 of5
BLUE RIBBON PANEL REpORT
FOR
COLLIER COUNTY, FLORIDA
BOARD OF COUNTY COMMISSIONERS
REGARDING
PREHOSPITAL EMERGENCY
MEDICAL TREATMENT
& TRANSPORT (PEMTT) SYSTEM
PRESENTED TO
COLLIER COUNTY, FLORIDA
BOARD OF COUNTY COMMISSIONERS
JANUARY 11, 2011
TABLE OF CONTENTS
Acknowledgments..................................................................................................................... .2
Executive Summary................................................................................................................ .11
History..................................................................................................................................... .13
Lessons Learned: A Reality Check for System Adjustments ..................................................16
The Current Local Scene.............. ............... ......... ......... ...... ................. ........... .......... ..17
Elements of a Refreshed Model................................................................. ............... ...18
Lessons Learned from King County, Washington.......................................................19
Lessons Learned from Broward County, Florida ........................................................21
Lessons Learned from V olusia County, Florida ......... .................................................23
Lessons Learned from Cities of Marco Island and Naples, Florida ............................24
The Panel's Recommendations............................................................................................... .25
B ibl iography .......................................................................................................................... ..31
Data Analysis
Blue Ribbon Panel Reportfor Collier County, Florida Board of County Commissioners regarding
Prehospital Emergency Medical Treatment & Transport (P EM7T) System
Page I of 32
ACKNOWLEDGMENTS
ACKNOWLEDGMENTS
The Blue Ribbon Panel wishes to acknowledge those individuals who participated in the review
and development of the proposal and recommendations being presented to the Collier County
Board of Commissioners.
The Panel
Geoffrey Moebius, Chair-Blue Ribbon Panel
Community Liaison and Past CEO, Physicians Regional Healthcare System
Edward A. Morton, Vice Chair-Blue Ribbon Panel
Partner & Managing Director, Wasmer Schroeder & Company, Inc.
Past CEO, NCH Healthcare System
Patricia Barton, Community Leader
Edward Boyer, Retired Healthcare System Executive
Russell Budd, President, Wall Systems Inc. of Southwest Florida
Joseph Gauta, M.D., Past President, Collier County Medical Society
Michael V. Reagen, Ph.D., President, The Greater Naples Chamber of Commerce
& Leadership Collier Foundation, Inc.
EMS and Fire Chiefs. Assistant Chiefs and Firefiehters
Jorge Aguilera, Deputy Chief of Medical Services and Community Relations
North Naples Fire Control & Rescue District
Dan Bowman, Deputy Chief, Collier County Emergency Medical Services
Chris Byrne, Deputy Chief, City of Marco Island Fire-Rescue District
Steve McInerny, Chief, City of Naples Fire District
Robert Metzger, Chief, Golden Gate Fire District
Jeff Page, Chief, Collier County Emergency Medical Services
Dan Summers, Executive Director, Collier County Department of Emergency Management
Eric Watson, Firefighter, Big Corkscrew Fire District
Wayne Watson, Deputy Chief, Collier County Emergency Medical Services
Blue Ribbon Panel Reportfor Collier County, Florida Board of County Commissioners regarding
Prehospital Emergency Medical Treatment & Transport (PEM7T) System
Page 2 of32
Hospital Leaders
Joseph Bernard, Chief Operating Officer, Physicians Regional Healthcare System - Collier Boulevard
Phillip Dutcher, Chief Operating Officer, NCH Healthcare System, Inc.
Chris Lee, M.D., Associate Medical Director, Collier County Emergency Medical Services
Hospital Emereencv Department Physicians
Todd D. Bethel, M.D., Emergency Medicine, Naples Community Hospital
John P. Lewis, M.D., ER Physician Director, Naples Community Hospital
John W. Zelahy, M.D., Emergency MedicinelInternal Medicine
Physicians Regional Hospital- Pine Ridge Road
Robert Tober, M.D., Medical Director, Collier County Emergency Medical Services
Florida Gulf Coast University
Lisa Zidek, Ph.D., Associate Professor, Florida Gulf Coast University
Collier County Sheriff's Office
Jim Bloom, Chief of Operations, Collier County Sheriff s Office
Deborah Chester, Manager of Planning & Research, Collier County Sheriffs Office
Blue Ribbon Panel Reportfor Collier County, Florida Board of County Commissioners regarding
Prehospital Emergency Medical Treatment & Transport (PEM7T) System
Page 3 of 32
Geoffrey Moebius
Chair-Blue Ribbon Panel
Community Liaison and Past CEO, Physicians Regional Healthcare System
Geoffrey Moebius serves as the Community Liaison for (the Physicians Regional Healthcare
System) Physicians Regional Medical Center. He came to Naples to oversee the completion of
Cleveland Clinic Florida Naples' new hospital and served as the hospital administrator until
Health Management Associates purchased the facility on May 1, 2006. In 2006, Mr. Moebius
became CEO of Physicians Regional Medical Center and served as CEO until retiring in
December, 2009.
Mr. Moebius has a Masters Degree in Health Specialties from Cleveland State University and a
Bachelor of Science from Lake Erie College. In addition, he completed the Kaiser Permanente
Executive Master Program at Stanford University during his tenure with Kaiser Foundation
Health Plan, Cleveland, Ohio.
Mr. Moebius' career began at Meridia Huron Hospital in Cleveland where he worked for five
years as the administrative director of operations. He held leadership positions in administration
with Kaiser Foundation Health Plan in Cleveland and was CEO of Deaconess Hospital of
Cleveland and Saint Michael Hospital, both owned by Primary Health Systems. Prior to joining
Cleveland Clinic Florida, he was the chief administrative officer at Deaconess Hospital LLC,
Cleveland.
He is a presently a member of the Collier Heart Walk Executive Leadership Team, Southwest
Florida American Heart Association Board and serves on the board of The Greater Naples
Chamber of Commerce.
Blue Ribbon Panel Reportfor Collier County, Florida Board of County Commissioners regarding
Prehospital Emergency Medical Treatment & Transport (PEM7T) System
Page 4 of 32
Edward A. Morton
Vice Chair-Blue Ribbon Panel
Partner & Managing Director, Wasmer Schroeder & Company, Inc.
Past CEO, NCH Healthcare System
Prior to joining Wasmer Schroeder & Company, Inc., Morton held the positions of Chief
Executive Officer, Chief Operating Officer and Chief Financial Officer for NCH Healthcare
System.
Morton received his under-graduate education at the University of Notre Dame where he
received a B.S. in Public and Managerial Accounting. Morton continued at the University of
Miami where he received his MBA and, most recently, his MS in Health Science from Florida
Gulf Coast University.
Currently, Morton's professional associations and affiliations include: Trustee, Florida Gulf
Coast University; Trustee, Quest Foundation; Member, Neighborhood Clinic Advisory
Committee; Immediate Past Chairman of the Leadership Collier Foundation; Chairman
Emeritus, Florida Gulf Coast University Foundation; Director, NCH Health System Foundation
and Trustee, Moorings Park Institute.
Former Associations include: Chairman, Naples Area Chamber of Commerce; Vice Chairman,
Florida Gulf Coast University Board of Trustees; Member, City of Naples Redevelopment
Advisory Board; Member, Collier County Board of Economic Advisors; Member, City of Naples
41-10 District Advisory Board; Member, Eagle Scout Selection Committee; Director, Economic
Development Council; Director, Barnett Bank of Naples; Active Duty Service, Captain, United
States Army 1969-1972, and Past Chairman, Education Foundation of Collier County and
Partners in Education.
Academic and professional achievements include a LIFE Award winner of Edison Community
College and was selected as the health representative to the General Electric Strategic Planning
Program for 2005.
Blue Ribbon Panel Reportfor Collier County, Florida Board of County Commissioners regarding
Prehospital Emergency Medical Treatment & Transport (P EM7T) System
Page 5 of 32
Patricia Barton
Community Leader
An alumni of Auburn University, Patricia Barton's involvement in the community is far
reaching, currently serving on several boards including the Juvenile Assessment Center (lAC)
Advisory Board, the Volunteer Collier Board, the PACE Center for Girls-Collier at Immokalee
Advisory Board and the Greater Naples Leadership Board. Past Board participation includes the
YMCA of Collier County, the David Lawrence Mental Health Center and Foundation Board, the
Naples Community Hospital Auxiliary, Edison Community College Foundation Board and the
Statewide Health & Human Services Board.
Her work in Drug Abuse Prevention includes founding member of the Naples Informed Parents,
founding member and Project Director of Florida Informed Parents (now Informed Families) and
Founding member of the National Federation of Parents for Drug-Free Youth (NFP, now
National Family Partnership). Ms. Barton has also been appointed to the Florida Substance
Abuse & Mental Health Corp.
Political activism includes committee member and Vice President for Naples Better Government
from 2002-2006 as well as Chair of numerous campaigns for city council, mayor, school board,
constitutional officer and active in various state and federal campaigns.
Ms. Barton is the recipient of numerous awards including the 2007 PACE State Award for Invest
in the Future and the Pioneer Award in 2010, the 2007 Youth Haven Frances Pew Hayes Child
Advocate of the Year Award as well as the 2007 AAUW Women of Achievement Award.
Blue Ribbon Panel Reportfor Collier County, Florida Board of County Commissioners regarding
Prehospital Emergency Medical Treatment & Transport (PEM7T) System
Page 6 of 32
Edward Boyer
Retired Healthcare System Executive
Boyer is a seasoned healthcare professional with more than 30 years experience. In his last
position as Senior Vice President of Corporate Services for Bon Secours Health System, Boyer
developed and implemented a system-wide supply chain and performance reporting system, an
offshore captive insurance company and created a new direction for information technology
services. Boyer was responsible for supporting the company's wide range of corporate services,
including information systems services, quality improvement, material management and
insurance and risk management.
Prior to joining Bon Secours, he served as a consultant for several years; first as a principal in the
Baltimore office of Arthur Andersen and then as a managing consultant in the Washington
offices of Towers Perrin. Before this, he acted as president of Maryland Health Care-System,
located in Baltimore, MD., a six-hospital consortium that provided its members with a range of
shared services, including strategic planning, systems engineering, purchasing and public
relations.
Boyer received a Bachelor of Arts degree from the University of Maryland and an M.B.A. from
George Washington University.
Blue Ribbon Panel Reportfor Collier County, Florida Board of County Commissioners regarding
Prehospital Emergency Medical Treatment & Transport (P EM7T) System
Page 7 of 32
Russell Budd
President, Wall Systems Inc. of Southwest Florida
Russell demonstrates his belief in community service by his active participation local civic
associations. Junior Achievement of Southwest Florida named Russell a 2005 Laureate for his
entrepreneurial leadership skills. Russell is a graduate 2005-2006 Class of Leadership Florida.
Locally, Russell has served for many years with the Greater Naples Chamber of Commerce
including two years as the Chairman of the Board of Directors. He is also a graduate of
Leadership Collier, Class of '94 as well as the inaugural Leadership Institute Class of 2001 and
is a Past Chairman of the Leadership Foundation.
Russell also completed twelve years of service on the Collier County Planning Commission,
including three years as the Chairman. He is serving as a volunteer on the Selective Service
Board and was a Director for the Bank of Florida-Southwest. In 1993, he was elected to the
Board of Commissioners in the Golden Gate Fire Control and Rescue District and served a four-
year term, acting as Chairman for three of those years. He served for six years as a member of
the Board of Trustees for Seacrest Country Day School.
Russell is dedicated to his family that includes his wife, Dr. Katie Paschall, a professor at Edison
Community College, and their three children, Daniel, Rachael and Emily. His focus on family
serves as the force behind his commitment to the preservation of the Southwest Florida
environment and the improvement of our community.
Russell Budd, President of Wall Systems Inc. of Southwest Florida, founded the organization in
1986. Russell received a Bachelor of Building Construction from the University of Florida in
1981. He has held a Certified General Contractor (#CGC 021714) in the State of Florida since
1982 and is a licensed Real Estate Broker.
Blue Ribbon Panel Reportfor Collier County, Florida Board of County Commissioners regarding
Prehospital Emergency Medical Treatment & Transport (PEM7T) System
Page 8 of 32
Joseph Gauta, M.D.
Past President, Collier County Medical Society
Joseph Gauta, MD is a board certified gynecologist in Naples, FL. He has been practicing in
Naples since 1998 and founded Especially for Women in 2000 and the Florida Bladder Institute
in 2006.
His expertise includes all aspects of obstetrics and gynecology, with special training and
emphasis in urogynecology. Prior to moving to Naples, Dr Gauta finished his undergraduate
studies at Siena College in Albany, NY.
His medical degree was completed at Albany Medical College and finally specialty training at
Tulane University in New Orleans. Dr Gauta has been actively involved in the political welfare
of the patients and doctors of Florida.
He is the President ofthe Collier County Medical Society. He was on the Board of Governors of
the Florida Medical Association, currently a member of the Board of Governors of the Florida
Medical Association Political Action Committee, and on the Board of Leadership Collier. He is
also past-President of the Southwest Florida Physicians Association, a 600 member organization
of physicians in our local PHO. Lastly, he is a Board member of Ava Healthcare, Inc, a recently
launched health insurer in the state of Florida.
Dr Gauta has been married to Susan for 13 years, and has three children: Spencer, Stephen and
Samantha.
Blue Ribbon Panel Reportfor Collier County, Florida Board of County Commissioners regarding
Prehospital Emergency Medical Treatment & Transport (PEM7T) System
Page 9 of 32
Michael V. Reagen, Ph.D.
President, The Greater Naples Chamber of Commerce & Leadership Collier Foundation, Inc.
In June 2002, Reagen was named President of The Greater Naples Chamber of Commerce, the
largest of 25 Chambers in the five county SWFL region, and, according to the Florida
Association of Chamber Professionals, among the top seven of 300 chambers in Florida. He is
also President of the Leadership Collier Foundation.
Mike's extensive career has included key executive positions in metropolitan development,
higher education and state government where he was a cabinet officer for three state Governors.
Reagen is a 2003 graduate of Leadership Collier, a 2007 graduate of the Collier County Sheriff's
Citizen Academy and was a member of Collier County Habitat for Humanity. He has served on
Collier County's Freedom Monument Selection Committee and its Fiscal Stability Committee.
He has served on the advisory Boards of Edison College, Lorenzo Walker Technical Institute,
NapleslFort Myers Town Hall, the Rookery Bay Estuarine National Research Center and
Seacrest Country Day School. Mike also participated as a Panelist in the FCCMA Coaching
Program Webinar on Sustainability for Economic Development and is a Member of U.S. Senator
George LaMieux's Jobs Advisory Council.
Active in local affairs, Mike is advisor to the Council for International Visitors, the Civic
Information Center and the Naples Press Club. In 2006, he received The World Food Prize's
Iowa Founders Award; in 2008 he was named one of Gulfshore Life magazine's Men of the
Year, and in 2009 The Collier Education Foundation named him a 'Man of Distinction'. Mike
has served as a Member of the Governance Task Force of the Collier County School District;
Chair, Friendship Health Center Coordination Council; and the Facilitator, Collier County Pre-
Hospital Emergency Medical Services Study Group.
Blue Ribbon Panel Reportfor Collier County, Florida Board of County Commissioners regarding
Prehospital Emergency Medical Treatment & Transport (PEM7T) System
Page JOof32
EXECUTIVE SUMMARY
EXECUTIVES~Y
Blue Ribbon Panel Report
for
Collier County, Florida
Board of County Commissioners
regarding
Prehospital Emergency Medical Treatment & Transport (PEMTT) System
Encouraged by the Collier County Board of Commissioners (BCC), a citizen Blue Ribbon Panel
(the Panel) was assembled in September 2009 to study and review the elements of the continuum
of care (EMS, fire department, hospital emergency department physicians, police and
community) of pre-hospital emergency medical treatment and transport (PEMTT) system in
Collier County, Florida.
The Panel's charge was, after evaluating issues, proposals, and current relevant literature, to
recommend improving PEMTT service to assure all in Collier County are provided the highest
level of medically effective and efficient care.
Collier County has experienced significant population growth during the past 30 years. Its
338,000 citizens (both full time and part time) and nearly two million annual visitors have been
well served during that period by the dedicated professionals within EMS, the fire departments,
the sheriffs office and police departments, whose coordinated and integral response to medical
emergencies deliver timely and expert basic life support (BLS) and advanced life support (ALS)
services.
Blue Ribbon Panel Reportfor Collier County, Florida Board of County Commissioners regarding
Prehospital Emergency Medical Treatment & Transport (P EM7T) System
Page I J of32
Collier County citizens and taxpayers have never accepted average when it comes to community
services and healthcare; neither have the county's public safety forces. The Panel's
recommendations are meant to ensure that by working together, Collier County will continue to
be one of the safest communities in the nation.
In February 2010 the Panel presented preliminary thoughts to the BCC. After conducting its own
review of the academic literature (see bibliography) the Panel in June recommended establishing
a countywide, two-tiered PEMTT delivery model. Tier One would be charged with the delivery
of timely BLS services and Tier Two with the delivery oftimely ALS and transport services.
At that same meeting the Panel also suggested the following: the creation of a PEMTT Council
to refresh the currently standing county committee, as well as an objective review of all 911
dispatch data. The BCC responded by asking the Panel to continue its work and provided
$45,000 in funding for the 911 data review. Professional support to conduct the review was
provided by Florida Gulf Coast University.
This report contains the results of the 911 data review, along with system recommendations. In
addition, it provides a contextual comment on PEMTT history, lessons learned from other
jurisdictions, and specific recommendations for consideration.
Blue Ribbon Panel Reportfor Collier County, Florida Board of County Commissioners regarding
Prehospital Emergency Medical Treatment & Transport (PEM7T) System
Page 120f32
HISTORY
mSTORY
Hospitals and physicians have been involved with pre-hospital care at least since 1921 when Dr.
Claude Beck, an M.D. at Western Reserve University, Cleveland called the fire department so he
could apply a "pulmotor" (an artificial breathing apparatus) to help resuscitate victims who
stopped breathing.
In 1939 the Miami-Dade Fire Department provided first aid training for firefighters to treat
victims. Transport was done by the funeral homes.
The 1960s brought the development of the 911 system and Emergency Medical Services (EMS).
A variety of pre-hospital care delivery systems exist across the 3085 counties of the United
States. System makeup is largely based on the size and scope of local government; whether a
rural or urban setting; funding; and medical expertise. Consistently however, first responders for
pre-hospital care have been fire and sheriff departments. This is primarily due to their functional
organization and duty to respond to accidents, fires and rescue situations. Transportation of
victims has typically been provided by hospitals, private ambulance services, or through
government ambulances managed by fire or county-managed EMS corps.
America's most prestigious pre-hospital delivery systems average a seven-minute on scene
arrival time. Many research findings state the ideal on-scene" arrival goal as four minutes for
Blue Ribbon Panel Reportfor Collier County, Florida Board of County Commissioners regarding
Prehospital Emergency Medical Treatment & Transport (P EM7T) System
Page 13 of32
basic life support (BLS) services, especially for heart attack victims. Eight minutes is ideal for
advanced life support (ALS) services.
Heart attack (cardiac arrest) became a leading cause of death after the turn of the century and is a
key emergency services need in Collier County.
Humans have always suffered from cardiac problems, but they usually died from causes such as
infectious disease, long before reaching an age where heart problems threatened their life. As the
world of medicine has advanced and people are living longer, heart disease has become a serious
health issue.
Beck (1894-1971), a pioneer of heart surgery; focused on operations to improve circulation in
damaged heart muscles and developed ways to revive heart attack victims, including the
defibrillator and CPR.
In 1947 Beck successfully defibrillated his first patient, a 14-year-old boy whose heart went into
fibrillation after an operation. The defibrillator used on this patient was made by James Rand, a
friend of Beck. Nine years later (1956) Paul Zoll used a more powerful unit to perform the first
closed-chest defibrillation.
In Belfast, ambulance-transported physicians first achieved pre-hospital defibrillation in 1966.
Defibrillation by EMTs (Emergency Medical Technicians) without the presence of physicians
was first performed in Oregon in 1969.
Blue Ribbon Panel Reportfor Collier County, Florida Board of County Commissioners regarding
Prehospital Emergency Medical Treatment & Transport (PEM7T) System
Page 140f32
Today, all should reasonably understand that the use of Automated External Defibrillators
(AEDs) is a community responsibility. AEDs and people properly trained in their use should be
situated in easily accessible public places.
There are 1,587 AEDs registered in Collier County. That is a higher number per capita than
King County (Seattle, Washington), which is among the most prominent pre-hospital care
providers in America. The King County Dispatch Center is the repository for information on all
registered Public Access Defibrillators (PADs) or AEDs. When a call is received regarding a
possible cardiac event the caller is told the location of the closest PAD/AED.
In Florida, Broward County has mandated AEDs be available in all restaurants with specified
occupancies, as well as in airports and seaports. Mandatory staff training is provided by the
companies that sell the AEDs.
This Panel recommends Collier County consider establishing a similar program. Collier County
should also, in establishing this plan, coordinate community AED services and create training for
sheriff and county services staff. Additionally, the county along with the sheriff's office should
implement an automated tracking system to identify AED locations, usage time and other
pertinent data. The Collier county Sheriffs Office should continue to pursue the necessary
legislative changes to implement the above recommendations.
Blue Ribbon Panel Reportfor Collier County, Florida Board of County Commissioners regarding
Prehospital Emergency Medical Treatment & Transport (PEM7T) System
. Page 150f32
LESSONS LEARNED:
A REALITY CHECK FOR SYSTEM ADJUSTMENTS
LESSONS LEARNED: A REALITY CHECK FOR SYSTEM ADJUSTMENTS
The Panel reviewed multiple white papers, community structures, sta~e and local blue prints for
developing integrated pre-hospital care systems (see bibliography). Several counties have
exceptional programs evidencing best practices which the Panel recommends Collier County
carefully consider as follows: King County (Seattle), Washington; Broward County, Florida;
Volusia County, Florida, and the Cities of Marco Island and Naples, Florida:
King County is known for medical leadership and structure, expertise in pre-hospital cardiac
care, cost-effective use of resources, and regionalized fire and EMS services.
Under the leadership and command of the Broward County Sheriff, Broward County has
developed a functionally impressive organizational structure, medical leadership, and EMS and
fire cooperation.
Volusia County, like Collier County, has multiple fire districts and a county-wide EMS.
Consequently it has service coordination, leadership challenges, potential cost, and structural
issues it is attempting to address.
The City Fire and Rescue Departments of Marco Island and Naples have good interagency
experiences working closely with Collier County EMS that may be replicated.
Blue Ribbon Panel Reportfor Collier County, Florida Board of County Commissioners regarding
Prehospital Emergency Medical Treatment & Transport (PEM7T) System
Page 16 of32
THE CURRENT LOCAL SCENE
All involved in Collier County's system are dedicated, loyal to their professions, community-
spirited and hard working. All, however, are effaced by the currently conflicted dysfunctional
rhetoric that springs from national system-change-angst which has become extraordinarily
personal.
Although outside this Panel's focus, it is obvious that the functions of fire services in Collier
County should consider consolidation and that resources, given modern needs, be professionally
reallocated. Fire Services PEMTT should work to share common protocols for responding to pre-
hospital medical treatment and transport calls. Fire Services PEMTT leaders should at the very
least collaborate on establishing one voice, one leader, for all PEMTT matters.
Collier County's EMS is centrally run, uniformly well trained, dedicated, and loyal to its
distinguished medical director, Dr. Robert Tober. All involved in Collier County appreciate the
historical and present professional contributions of Dr. Tober. All praise and recognize his
competence.
The current PEMTT system in Collier County, however, is now racked by the regular exchange
of personal, ideologically-based arguments that need to cease. Private professional discussions,
of course, should be encouraged; public attacks should end immediately. All energy, passion and
professionalism should be re-channeled into resetting current operations into a new delivery
model.
Blue Ribbon Panel Reportfor Collier County, Florida Board of County Commissioners regarding
Prehospital Emergency Medical Treatment & Transport (P EMTT) System
Page 17 of32
ELEMENTS OF A REFRESHED MODEL
The start of a refreshed PEMTT model needs to focus on who arrives on scene quickest with the
highest level of training and expertise in order to begin treatment that will quickly prepare the
patient for transport. This is the crux of the issue that led to the Panel's recommendation of a
two-tiered BLS and ALS model.
All citizens want the best emergency services. It is common sense to have a paramedic with
EMT support first on scene for those cases that require a high level of service (ALS).
A number of factors complicate immediate support response: lengthy distances; extended and/or
protracted response times to hospital; density of an aging population and other demographics;
high-rise residential towers challenging access and other extenuating circumstances.
Clearly, the number of medics and equipment on scene should be determined by the acuity ofthe
incident versus the complications noted above. Low acuity may range from no transportation
required to an ambulance or other transportation. High acuity episodes (heart attack/stroke or
traumas for example) may need to include additional manpower and multiple pieces of
equipment. This should be determined by centralized PEMTT management based on geography,
community expectations, population demographics, available staffing resources and treatment
protocols set by the medical director.
Blue Ribbon Panel Reportfor Collier County, Florida Board of County Commissioners regarding
Prehospital Emergency Medical Treatment & Transport (P EM7T) System
Page /80f32
LESSONS LEARNED FROM KING COUNTY
The Panel is impressed with the King County program which was started in 1969 by physicians
Drs. Leonard Cobb (cardiologist) and Michael Cop ass (Emergency Director Harborview Medical
Center) and Seattle Fire Chief Gordon Vickery. The focus was to provide the highest level of
pre-hospital care to the community with highly trained paramedics and EMTs.
Collier County (338,000 residents) presently has 259 trained paramedics within EMS (113) and
fire departments (146). King County (population 1.9 million) has a total of approximately 250
paramedics. Michele Plorde, Director for King County (PEMTT), says initial and ongoing field-
based training of an elite, select group of paramedics is critical to maintenance of a highly
proficient PEMTTcare service. King County standards exceed Washington State's training
requirements by two times, requiring 2,500 hours of training to become a paramedic.
King County coordinates all initial and ongoing training for EMTs and paramedics from Fire and
EMS, medical direction, strategic planning, placement of units and individual fire department
services with ALS and BLS protocols, promulgated by King County's Medical Director.
The King County EMS Advisory Committee model is worthy of Collier County's consideration.
The Advisory Committee membership appears to be inclusive and could be a model for Collier
County. A PEMTT Council for Collier County could consist of the following entities: medical
director; hospital emergency department directors; hospitals administrative staff; the sheriff or
Blue Ribbon Panel Reportfor Collier County, Florida Board of County Commissioners regarding
Prehospital Emergency Medical Treatment & Transport (PEM7T) System
Page 19 of32
designee; EMS and fire department; and community leaders who help with communication and
planning.
This PEMTT Council could be ably and professionally facilitated by the designated public safety
authority with directly delegated authority and responsibility from the Board of County
Commissioners. It should meet to address, for example, paramedic related issues; clinical issues
such as cardiac stroke programs; community education; the county-wide AED program; and
education for all first responders.
The King County medical director conducts a quarterly meeting with the system's six medical
directors, EMS director, and other administrative staff (all involved in coordination of the
medical protocols for personnel training, QI and QA, credentialing, and reviewing of medical
pre,.hospital care). As a model for Collier County, the translation would include the opportunity
for a Collier County medical director to meet with hospital emergency room directors to discuss
medical related services including expanding hospital involvement in training and educational
semmars.
Similar to King County, cardiac survival rates should be a base starting point for monitoring and
reporting. Additionally, stroke and trauma survival rates should be reviewed.
Blue Ribbon Panel Reportfor Collier County, Florida Board of County Commissioners regarding
Prehospital Emergency Medical Treatment & Transport (P EM7T) System
Page 20 of 32
LESSONS LEARNED FROM BROW ARD COUNTY. FLORIDA
Broward County, Florida has a unique PEMTT management system, aspects of which might well
serve Collier County.
Broward County started reviewing its interagency PEMTT issues in 1992. The review resulted
in transference of all Fire and EMS PEMTT services to the management of the sheriff in 2003.
All municipalities combined Fire and EMS. All Fire and EMS personnel are considered equal
with medics in both EMS and fire. This integration was considered a critically necessary
improvement in the pre-hospital care system. Since all Broward County PEMTT personnel
report through the sheriffs office there is a chain of command that uniformly manages all local
PEMTT issues. All fire and EMS vehicles are equipped with standardized life saving equipment
consistent with Broward hospitals emergency departments' equipment and supplies.
There are 31 municipalities within Broward County. Professional flexibility in accordance with
different city needs is vital. For example, while the Fort Lauderdale FirelEMS Service is now
exploring BLS transport, it does not send fire engines to transport situations. Broward County's
medical director also serves as the medical director for Ft. Lauderdale and works collegially with
the 31 municipalities, 21 of which provide independent safety services. Some also have medical
directors who set, based on Florida's minimum requirements, local protocols. All medical
directors within Broward County meet monthly in collaboration with the sheriff's office.
Blue Ribbon Panel Reportfor Collier County, Florida Board of County Commissioners regarding
Prehospital Emergency Medical Treatment & Transport (PEM7T) System
Page 21 of32
Broward County's Advisory Committee facilitates the resolution of issues between the county's
medical director and the independent municipality fire districts and other agencies, including
training. Training in Broward County occurs through a variety of venues utilizing the hospitals
as well as the scheduling of fire paramedics on ambulances for vacation/staffing shortage days.
Broward County believes collaborative experience-based field training is critical to keeping up
technical proficiencies.
Note that in both Broward and King counties some hospitals, not all, help provide medical
direction. The directors of the emergency departments within the separate jurisdictions work
collaboratively with the county medical director. Their input is critical for all PEMTI personnel
training and community programs. All hospitals flag cases for review and share data on trauma
cases.
Blue Ribbon Panel Reportfor Collier County, Florida Board of County Commissioners regarding
Prehospital Emergency Medical Treatment & Transport (PEM7T) System
Page 220f32
LESSONS LEARNED FROM VOLUSIA COUNTY. FLORIDA
Volusia County, Florida recently conducted a study worthy of note. Volusia has experienced
issues similar to those now challenging Collier County, including increasing costs associated
with fire and EMS services. The Halifax Area Civic League submitted to the county in July
2010 a report titled, "Possibilities of Fire and Rescue Service Consolidation in Volusia County."
As a frame ofreference there are 16 incorporated cities or towns in the county. Combined with
unincorporated Volusia County, the population is approximately 507,000. There are 13 separate
governmental fire/rescue services.
The study's recommendation is to merge the fire and rescue services, which can easily be
accomplished through inter-local agreements. Through attrition, overall savings would be
roughly $5.7 million per year. Collier County Commissioners may wish to consult with their
peers in Volusia County.
Blue Ribbon Panel Reportfor Collier County, Florida Board of County Commissioners regarding
Prehospital Emergency Medical Treatment & Transport (P EM7T) System
Page 23 of32
LESSONS LEARNED FROM CITIES OF MARCO ISLAND AND NAPLES. FLORIDA
The collaboration between Marco Island and Naples Fire Departments and Collier County EMS
seems to yield positive results. The three agencies have progressively worked well together in
education, community involvement, AED use, American Heart Association basic life support
programs, and a host of safety programs. The collaboration has fire engine paramedics (ALS
trained staff) which take into account the aspects of both cities. Expanding this collaboration to
other areas of Collier County should be considered wherever feasible.
Blue Ribbon Panel Reportfor Collier County. Florida Board of County Commissioners regarding
Prehospital Emergency Medical Treatment & Transport (P EMTT) System
Page 24 of32
THE PANEL'S RECOMMENDATIONS
THE PANEL'S RECOMMENDATIONS
The Panel believes the Board of County Commissioners should investigate the potential
economic savings and clinical enhancements associated with coordinating and regionalizing all
PEMTT services under a unified public safety concept. In turn, the medical director should
report to the designated public safety authority. Because of the multiple layers of organizational
structures within the fire departments and EMS in Collier County there is no local county-wide
managed authority to address system management complaints or issues. The benefits of better
integration are obvious:
I. All pre-hospital care services would be under one management structure.
Standardization can be achieved of units, supplies, management and personnel, and
potential cost savings with direct and indirect administrative and non-service related
personnel in pre-hospital care services and other safety related services.
2. Simplification and standardization of dispatch codes and protocols can be realized.
Plus, the elimination of district boundaries and possible improvement of response times
can only assist with public service.
3. The PEMTT Council could support the contiguous coordination and, where reasonable,
possible integration of County and City of Naples 911 Dispatch Centers, including
community AED program. This would help ensure standardization of 911 codes and
protocols across Collier County and ensure that all potential fire and EMS first
responders covered under a mutual aid services agreement are initially notified by the
dispatch center.
Blue Ribbon Panel Reportfor Collier County, Florida Board of County Commissioners regarding
Prehospital Emergency Medical Treatment & Transport (P EMTT) System
Page 25 of 32
The lack of consistent, centralized, positive management for EMS, fire, hospitals and emergency
department physicians also allows for disagreements in process and functional issues to reach
outside organizations before any resolution can be obtained.
Placing all PEMTT services eventually under a well-managed and highly professional public
safety authority could have many positive, service-enhancement results for all Collier citizens.
The Panel did not focus on the consolidation of fire services in Collier County. However, the
Panel does recommend that Collier County comprehensively study PEMTT organizational
collaboration similar to that done by the Civic League Study in Volusia County in June 2010. To
that end:
The PEMTT should study the cost implications of fire and EMS services throughout the county
and potential savings, direct and indirect, of regionalizing such services under one management
structure. To start, the PEMTT Council should review recommendations of the 2007 EMS
Strategic Report and ensure recommendations have been implemented or justify why they have
not.
Provided the study supports increased collaboration under a unified PEMTT management
(coordinated public safety concept), the Panel suggests the following steps toward developing a
regionalized pre-hospital care system: County EMS personnel could be integrated within the Fire
Departments.
Blue Ribbon Panel Reportfor Collier County, Florida Board of County Commissioners regarding
Prehospital Emergency Medical Treatment & Transport (PEMTT) System
Page 260f32
1. If the aforementioned steps of regionalizing and consolidating services for pre-hospital care
demonstrate cost savings and increased cooperation between fire and EMS, the Panel
suggests initiation of a pilot program with a fire district for the functional integration of
emergency ALS medical services including emergency ALS transportation services. This
program will be monitored by the PEMIT Council and fire district representatives to
ensure quality, training, cost management, expertise and service.
2. EMS services would be managed by the fire district, including among other things,
personnel and equipment. The fire district would integrate existing EMS equipment and
staff. The district would report quarterly to the PEMTT Council on specific
measurement criteria developed by the designated public safety authority, the medical
director and fire district.
The Panel recommends that any such reorganization of PEMTT services in Collier County
should be part of a five-year strategic plan that takes into account the men and women who have
provided excellent service to Collier County in the past, as well as consideration of the
referendum ballot in November 2010.
The five-year strategic plan should consider reviewing and reasonably implementing the Marco
Island paramedic staffing of fire engines and ambulances across Collier County. The use of ALS
engines to support the ambulance service with concurrent calls and back up on high priority
medical rims will help on-scene as first responders and may reduce call time for medical
personnel to ensure that the highest level of medical personnel respond to emergencies. County
Blue Ribbon Panel Reportfol' Collier County, Florida Board of County Commissioners regarding
Prehospital Emergency Medical Treatment & Transport (P EMTT) System
Page 27 of32
safety services could initiate an educational program to improve basic information from citizens
calling into 911 such as location and symptoms of victim, as well as an educational program to
inform drivers to move out ofthe path of ambulances, fire and police vehicles.
The five-year strategic plan ought to also incorporate provisions for a system audit every three
years which would focus on analyses of core business models that could be integrated and
regionalized where possible to reduce or avoid costs to taxpayers. This would allow Collier
County to develop a more cost- and resource-efficient response to low acuity patients and in the
future explore use of contract ambulance or transport services for low acuity or out-of-county
transport (similar to Broward and King County models).
The Panel suggests the Board of County Commissioners offer to initiate this process with .certain
fire districts which can and will work with the currently constituted Office of the Medical
Director to ensure that there is no degradation in training, expertise and quality within the
provision of pre-hospital care to the citizens and visitors within Collier County.
A positive step would entail the use of ALS fire engines and the emergency transportation
services within these fire districts. The fire districts would develop a management process for
position control that would professionally manage the number of paramedics and EMT positions
within the district to ensure quality and expertise through field training. The fire districts could
also evaluate the possible opportunity for the use of smaller, lighter ambulances, such as Ford F-
Blue Ribbon Panel Reportfor Collier County. ,Florida Board of County Commissioners regarding
Pl'ehospital Emel'gency Medical Tl'eatment & Transport (PEMTT) System
Page 28 of 32
350 and F-450 vehicles to be used in certain transportation situations that do not require ALS
services.
The fire districts would, of course, agree to follow the recommendations of the newly designated
public safety authority, working with the reassigned yet currently constituted Office of the
Medical Director and the revamped PEMTT Advisory/Council. A hospital administrator should
chair the PEMTT Advisory Council to assure that all proper processes are initiated and
completed and that emergency department directors of the NCH Healthcare System, The Lee
County Memorial Hospital Trauma Center and the Physicians Regional Healthcare System are
all robustly involved.
The Panel is biased that the new PEMTT Advisory Council, ably and professionally facilitated
by the designated public safety authority, should be chaired by a hospital administrator. The
Panel also strongly believes that one medical leader for the county, working with hospital
medical emergency department leaders, can provide a higher standard of care for the county with
overall superior service. The designated public safety authority, with appropriate guidance and
advice from the PEMTT Council and obviously in accordance with law and germane
professional standards, should develop procedures to address grievances between fire and EMS
on a local basis prior to grievances being sent to the state.
Blue Ribbon Panel Reportfor Collier County, Florida Board of County Commissioners regarding
Prehospital Emergency Medical Tl'eatment & Transport (P EMTT) System
Page 29 of 32
This new model should improve communications, improve fire districts' management of their
dispatched equipment and prompt significantly more involvement from Collier County hospitals
in training and coordination of all county safety services.
The Panel also strongly suggests that all personnel training, quality initiatives and assurance,
credentialing and testing be centrally overseen and coordinated through the PEMIT Council,
facilitated by the designated public safety authority with the cooperation of the medical director
in collaboration with the directors of the emergency departments of Collier County hospitals to
ensure' standards are maintained at a consistently high level.
The Panel recommends that all testing services be contracted to testing professionals at a local
college or university which can maintain the integrity and professional demeanor that is expected
of safety forces.
Members of the Panel appreciate the opportunity afforded to them by the Board of County
Commissioners to study the PEMIT System. The Panel stands ready to respond to any future
questions.
Respectfully submitted,
Geoffrey Moebius, Chair
Blue Ribbon Panel Reportfor Collier County, Florida Board of County Commissioners regarding
Prehospital Emergency Medical Treatment & Transport (P EMT7) System
Page 30 of32
BIBLIOGRAPHY
Bibliography
1. Carney, C.l (1999). Pre-Hospital Care - A UK Perspective. British Medical Bulletin
(Volume 55, Issue 4, pp. 757-76). Oxford University Press.
2. City of Houston, Texas Fire Department. Assistant Chief William Barry. Retrieved
from: http://www.houstontx.gov/fire/.
3. Emergency Services Consulting, Inc, (2007). Collier County Florida, EMS System
Master Plan 2007.
4. Cohen, H. (2010, July). Possibilities of Fire and Rescue Services Consolidation in
Volusia County. Submitted to Halifax Area Civic League.
5. Goodwin, J. (2010, August). Best Practices in Emergency Services: Integration: The
New Frontier? Retrieved from:
htto:/ /www.emergencvbestoractices.com/CurrentIssue/tabid/225/ctl/ Archive View/mi
d/573/month/8/vear/20 1 O/Default.aspx.
6. Gueugniaud, P.Y., David, lS., Chanzy, H., Dubien, P.Y. et. al. (2008, July 3).
Vasopressin and Epinephrine vs. Epinephrine Alone in Cardiopulmonary
Resuscitation. The New England Journal of Medicine 359, 21-30.
7. Henry, G. (2010). ACLS: Close the Drug Box. Emergency Physicians Monthly.
Retrieved January 20, 2010 from: http://www.eomonthlv.comlindex.oho?
option=comcontent&task=view &id=64 3 &Itemid=91
8. Herhold, S, (2010, September). Herhold: Why Emergency Medical Costs Spiral out of
Control. Mercury News.
9. National Association State EMS Officials. (2008, July). State Emergency Medical
Services Systems: A Model.
10. Nielsen T. (2009, November). Exploring Closest Unit Response to Fire and Medical
Emergencies in Spokane County. Spokane County Fire Protection District Eight.
Spokane, WA.
11. Office of Pre-Hospital Care - University Emergency Medical Services, Wyoming-
Erie New York, Office of Pre-Hospital Care, Buffalo NY. Retrieved from:
http://www.opcems.org/.
12. Olson, L. (2000). San Mateo County Pre-Hospital Advanced Life Support Services.
Blue Ribbon Panel Reportfor Collier County, Florida Board of County Commissioners regarding
Prehospital Emergency Medical Treatment & Transport (PEM7T) System
Pagdlof32
13. Pratt, F./MD, Pepe P./MD, Katz S./MD, FACEP, EMT-P, Persse, D./MD, EMT-P,
FACEP. (2007). Pre-Hospital 9-1-1 Emergency Medical Response: The Role of the
United States Fire Service in Delivery and Coordination.
14. Public Health Seattle and King County. (2009, November). Medic One/Emergency
Medical Services, 2008-2013; Strategic Plan Revised November 2009. Retrieved
from: http://www.kingcounty.gov/,
15. Public Health Seattle and King County. (2010, September). Public Health- Seattle &
King County Division of Emergency Medical Services 2010 Annual Report.
Retrieved from: htto://www.kingcountv.gov/.
16. Public Health Seattle and King County. (2010, September). Saving Lives: An
Innovative and Efficient King County Emergency Medical Services. Retrieved from:
http://www .kingcounty .gov lhealthserviceslhealthlnews/20 1 0/1 009030 l.aspx.
17. Sampson, D. (2008, April). Regionalizing Fire Services and Breaking Home Rule.
18. Schaitberger H. Emergency Medical Services, A Guidebookfor Fire-based Systems
(4th Edition).
19. Seattle Fire Department-Emergency Response Totals 2005-2009. Retrieved from:
http://www.seattle.gov.
20. Stiell, LG., Nesbitt, L.P., Pickett, W., Munkley, D., et al. (2008), The OPALS Major
Trauma Study: Impact of Advanced Life Support on Survival and Morbidity.
Canadian Medical Association Journal, 178 (9), 1141-1150.
21. West, G. (2007, April). Integrating Emergency Medical Services in the Fire
Department, Fire/EMS First Responders: It's Just a Matter of Time.
22. Wikipedia. (2008) Seattle Fire Departments
23. Wolcott, M.D., Foelker, T. (2009). Evaluating the Impact: Fire services Provision of
Advanced Life Support. A report to V olusia County, Florida.
Blue Ribbon Panel Reportfor Collier County, Florida Board of County Commissioners regarding
Prehospital Emergency Medical Treatment & Transport (P EMT7) System
Page32 of 32
DATA ANALYSIS
EVALUATION OF DATA
REGARDING
EMERGENCY RESPONSE IN COLLIER COUNTY
As Presented to:
Collier County, Florida
Board of County Commissioners
January 11,2011
Data Compiled and Reviewed By:
The Collier County Sheriff s Office
Data Review and Approval Completed By:
Dr. Lisa Zidek, Associate Professor
Academic Program Director
V.A. Whitaker School of Engineering
Florida Gulf Coast University
~G~k-
PRE-HoSPITAL CALLS FOR SERVICE:
RESPONSE TIMES AND LOCATIONS
As Presented to:
Collier County, Florida
Board of County Commissioners
January 11, 2011
Prepared By:
The Collier County Sheriffs Office
3301 Tamiami Trail East, Bldg J
Naples, Florida
PRE-HOSPITAL CALLS FOR SERVICE: RESPONSE TIMES AND LOCATIONS
DECEMBER 2010
Data and Methodology
Data were pulled from Computer Aided Dispatch (CAD) for a one-year time period (July 2009
through June 2010) in order to identify response time to medical-related calls for service. The final
sample of data includes calls for service that had a coded response or transport to a hospital, and
were identified as highest priority in C'\D (lor 2). 'Ibis was done to capture the most serious calls;
as such, this selection assumes incidents falling into these criteria, requiring mvel or response to a
hospital at some point during the call, represent serious medical-related calls. Only reactive, citizen-
generated calls for service were included in order to more accurately identify response to a call
(compared to proactive calls for semce recorded in CAD). Finally, to eliminate extreme values and
outliers, calls with a response time longer than 30 minutes were removed,1 The final number of calls
for service selected is 17,604. EMS/Fire calls account for 94 percent. Collier COWlty Sheriff's
Office (SO) had 1,038 calis meeting these criteria and Marco Island Police (MPD) had 21 calls.
The final number (17,604) of calls includes duplicates due to the structure of the CAD. Each time
an agency is dispatched, a unique call is created. Therefore, if EMS/Fire and SO are both
dispatched to a call, this will result in two unique calls for service in the CAD data. In addition, it is
important to note that based on this methodology, the nature of calls for sheriff's office/police is
very different thao EMS/Fire. General descriptions of call types by agency illustrate this point. The
majority (92 percent) for Fire/EMS are described, in gene.ral, as cardiac or medical calls.J For the
SO, the same medical call categories represent only 13 percent of selected calls. For Fire/EMS,
vehicle accidents represent 6.2 percent, and crime/disorder-related represent 1,6 percent of calls.3
The highest incident type category for the SO is suicidal or mentally-ill person (30 percent); another
23 percent are traffic accidents and 32 percent of calls are crime or disorder-related.
Fire/EMS %. SO 'y.. MPD %
Accidents 1021
Mum 18
Crimc/Disorder 262
F~ 21
Medical 15198
Oili~ 6
Suicidal /Mentilly ill Person 19
6.2 236 22,:- 2 9.5
0.1 0 0.0 0 0.0
1.6 335 323 - 33.3
0.1 0 0.0 0 0.0
91.9 136 13.1 6 28.6
0.0 19 1.8 1 4.8
0.1 312 30.1 5 23,8
~ 16545 1011 103g lfJ.lI 21 101)
Because Fire/EMS is involved in all medical calls requiring transport to a hospital, these data are
included in analysis below. This is done to avoid including duplicate calls, which can produce
misleading results, In addition to the duplicate call issue, the numbers for SO, and particularly for
f\.1P> are small for a ooe-year period, which makes it difficult to determine patterns and trends.
Finally, as discussed above, the nature of law enforcement calls selected with these criteria are much
different for police agencies than Fire/EMS,
1 This only removed a very small percentage (0.9) and is necessary due to the structure of CAD data; for instance, on
occasion calls do not get closed properly, or are closed at a later time due to system updates or other reasons. When this
happens the time field cannot be alteredj therefore, the time entered can misrepresent actual response.
2 Medical category includes cardiac call, medical alarm, medical call, and person down.
3 Crime/disorder categoq includes assault/battery, criminal mischicf: robbery, butghuy, trespassing, disturbance,
suspicious incidents. etc.
EMS/Fire Pre-Hospital Calls For Service - Calliel: CoWlt; Sheriff's Office - December 2010 - Page 1
Descriptive Statistics - Fire/EMS Calls
Call frequen~ by weekday - Saturda.y and Sunda.y had few-et calls than weekdays. Monday had the
highest number of calls during the week; the largest difference in calls by day of week was 278 calls.
D.ll> Fh'llHNln.' P"r~cm
Sun 21 'I: 13.3
Mon 15,0
Tue 14.6
Wed 14.8
Thu 14.0
Fri 14.8
Slit 13.6
'" .., T. .... ... M ..
Call frequenc:,v by month - January shows the highest frequency by month; however, by daily
average the highest frequency is February. Overall, most calls occUtted December through March,
!'.10mb FreqllellC~ rJcfl=<;n~ A~'g pCt D-.1Y
Jao
Feb
Mat
Apt
May
JUD
Jul
Aug
Sep
Oct
Nov
Dee
1653
1529
1612
1329
1336
1175
1189
1168
1264
1398
1374
1518
lV.v
9.2
9.7
8.0
8.1
7.1
,.2
';',1
7.6
8.4
8.3
9.2
52.7
54.6
52.0
44.3
43.1
39.2
38.4
37.7
42.1
45.1
45,8
49.0
l'(JuJ 16::45 tOlW >JS3
Monthly Trend by Number and Average Calls per Day, J0I2009 - Jun 2010
1700 11163 r
54,8
1600 49.0
SO.O
16DD 1511: 40.0
1400
30.0
1300
20.0
1200
1100 1-lIIi- Frequency - Avg/Day I 10,0
1000 .0
.I'm Feb Mar API" May Jun Jul Au; $top Oct Nav Dee
EMSjFire Pre-Hospital Calls For Service - Collier County Sheriffs Office - December 2010 - Page 2
Call frequency by week - the number of calls ranged from 398 in week 10 (early March) to week 28
(mid July) with 228 calls; this represents a maximum difference of 170 calls by week. However, in
order to determine patterns throughout the year, such as call volume by week and month, it is
preferable to use more than one year's worth of data points.
400"
300"
200'
1""
1 3 5 7 9 11 13 16 17 19 21 23 25 V 29 31 33 35 37 39 41 43 45 47 49 51
Call frequency by hour - Call frequency was higher during daytime hours; 71 percent of the calls
occuned from 8:00 a.m. to 8:00 p.m.
- -
Hom Fn:qu\'o~\' r~ccnt Hour FrcqucuL-y Percent
8
9
10
11
U
1
2
3
4
5
6
431
343
386
362
307
319
410
566
785
994
1003
1084
2.6
2.1
2,3
2,2
1.9
1.9
2.5
3.4
4.7
6.0
6.1
6.6
12
13
14
15
16
17
18
19
20
21
22
2.~
969
954
946
926
867
848
811
843
709
600
5:'5
50'?
5.9
5.8
5.7
5.6
5,2
5.1
4.9
5.1
4,3
3.6
3.5
3.1
:
EMS/Fire Pre-Hospital Calls For Service - Collier Count;. Sheriffs Office - December 2010 - Page 3
1:
::::I
o
o
o 1 2 3 4 5 6 7 B 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23
hour
Call frequenc;r by time of day and day of week - the below chart shows patterns by day of week and
time of day. The darker shades on the grid lines represent higher values. On average, the highest
frequency of calls occurred earlier in the week during the midday hours.
Man
Tue
Wed
Thu
Fri
Sat
o 1 2 3 4 5 6 7 8 9 10 11
Sun
17 18 19 20 21 22 23
I Cl 0-50 IJ SO-100 W 100-150 .150-200 I
EMS, Fire Pre-Hospital Calls For Service - Collier County Sheriff's Office - December 2010 - Page 4
Response Times
Overall response time is defined by when a call is created to when Fire or EMS first arrived on scene
(cteate-to-atrival). This can be separated into two time categories: when the call was created to
when it was dispatched to an agency (create-to-dispatch) and when a call was dispatched to when an
agency arrived on scene (dispatch-to-arrival).
For these data, the overall create-to-a.t:ri\-al response time was on aVe!age 8.5 minutes. The median
response time was 8.2 minutes, indicating that 50 percent of the calls had EMS/Fire on scene in 8,2
minutes or less. The create-to-dispatch time averaged 2,0 minutes, with a median of 1.9 minutes,
The dispatch-to-arrival averaged 6.5 minutes, v;ith a median time of 6.1 minutes.
1,50
1,00
~
c
CI)
::s
D"
e
LL
Create-to-Arrival Ave
5
o
o
5
10
15
RTminutes
20
25
EMS/Fire Pre-Hospital Calls For Service - Collier County Sheriff's Office - December 2010 - Page 5
~'\verage Response Time by Day of Week
There were no differences in average create-to-lll:Jiv-al response time by day of week.
en
.;
c
'E!!
Ii:
m
:e
b,S
7.
Sun
Man
Tue
Wed
Weekday
Thu
Fr.
Sot
Average Response Ttmes by Month
By month, there were small differences in response times (ranging ftom 8.3 to 8.7 minutes).
However, as discussed above, to determine patterns by month, more than one year's data. is
preferable.
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EMS/Fire Pre-Hospital Calls For Service - Collier County Sheriff's Office - December 2010 - Page 6
Ave~e Response Time by Time of Day
These data show differences in average response time by hour, ~-ith shorter response times
occurring during the daytime hours. The range from create-to-atrival response time by hour is 8.1
to 10.3, a difference of2.2 minutes,
The dispatch-to-arri'Val response time showed a simila.r pattern of shorter response times during the
daytime hours; the range was from 6.0 to 8.3 minutes on average, The create-to-dispatch response
time did not show a similar pattern (average times ranged from 1.9 to 2.1) by time of day.
11.
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hour
EMS/Fire Pte-Hospital Calls Fot Service - Collier County Sheriff's Office - December 2010 - Page 8
Ave~ Response Time by Hour and Day ofWee~
The following chart shows the pattern of average create-to--anival response time by hour and day of week.
The darker shades represent higher response times, in this case from around midnight through 7:00 a,m, The
average response times ofl0-11 minutes occurred more often from Monday through Wednesday during the
eady moming hours.
Mm
Tue
Wed
lhu
Fri
-Sat
.~ SUn
o 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23
Ie 8.~9.00 il9.00-10.00 Ia 10.00-11.00 I
Average Response Time for Vehicle Accidents
Vehicle accidents represent a small portion of these calls (6.2 percent); however, due to the different
nature of these types of calls, response time and location information are included in this report
Vehicle accidents, based on the data selection criteria, were all identified as priority one calls; for
other medical cills, 56 percent were priority one and 44 percent were coded as priority two.
Response times for vehicle accidents were shorter, on average by almost two minutes, than other
medical-related calls. The average response time was 6.7 minutes for vehicle accidents and 8.6
minutes for other medical-related calls.
P~r<:cnlilc~
Type of Call
Vehicle Accident
Other Medical
N 'Mean 5
1,019' 6.7 2.6
15,526 8.6 4.5
10
3.5
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4,6
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50
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7.6
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10.3
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14,4
13.9
EMS/Fire Pre-Hospital Calls For Service - Collier County Sheriff's Office - December 2010 - Page 9
Ave.ra,ge Response Time h.:y Area
CAD data captures areas identified by Fire districts/stations; the following chatt shows the average
response time for identified ~eas.
25.
20.
15.
10.
5.
o.
North Naples Fire Department (NNFD) accounts for 33 percent of these calls; followed by East
Naples Fire Department (ENFD) with 29 percent and Golden Gate Fire Department (GGFD) \'\~th
13 percent.
tE
10%
BCFD
2"/.
OFD
1%
MFD
5%
M'lFD
32%
Fin'Dj'mkt Numfwr "';' ofe.llls
Tor.ll Itl~4.'i IlIU'\,
Big Corkscrew / BCFD
East Naples I ENFD
Immokalee I IFD
North Naples / NNFD
Marco Isl2Dd / MFD
Ochopee I OFD
Golden Gate / GGFD
Isle of Capri / ICFD
ritv of NQ!11e' ll\.lF
341} 2%
rff~ 29%
1242 8~'<>
5411 33%
794 5%
133 J""o
2090 13%
82 00'
,D
166Q
10'%
EMS/Fire Pre-Hospital Calls For Service - Collier County Sheriffs Office - December 2010 - Page 10
Location of Calls
Density Methods Used
Nearest Neighbor Hierarchical Clustering (NN) was used to identify groups of incidents that are
spatially close. This is a hierarchical clustering routine that groups points together based on certain
criteria,4 The clustering is repeated until all points are groups or the clustering criteria fails (based on
threshold distance, minimum points per cluster, and standard de-riations for ellipses, for instance),
The results are ellipses used to identify groups of points spatially close to each other. In addition
kernel density spatial analysis was used, which estimates density over a continuous service; this
method shows how density varies and is distributed over space. In this case, areas of high
concentration of calls will stand out on the density ma.ps. This is useful for visualizing aggregated
crime patterns in and across defined boundary' areas, and for obtaining a genera! picture of the
o~erall spatial distribution of calls for service. In both cases, these areas that appear as hot spots
represent locations with a greater than average number of calls for service.
Limitations
Density and hot spot spatial analysis is very useful, particularly to identify places with higher
concentration of activity in cases with large numbers such as these calls for service. However, it is
also important to outline limitations with these procedures. The NN technique can be somewhat
arbitrary due to the minimum points role. For instance, the user is required to define a meaningful
cluster size. .Although the results are based on empirical groupings, this is not a statistical way for
defining regularity (although such pattems are a human way to define patterns and trends).5 Two
different users may interpret the size of a hot spot differently in addition to other parameter
variability. For instance, in one geographical jurisdiction, 40 incidents mar be considered high
activity, while in another area, this may not be unusual and different parameters would be set to
identify a hot spot in this location. As such, output will be different depending on the geographical
level, the number of the data involved and the parameters set by the user. Kernel density
calculations face similar limitations; the technique is dependent on an arbitrarily-defined interral size.
The advantages to spatial analysis can be overcome by running statistical tests when possible, and by
using more than one hot spot or density calculation, In this case, in addition to the significance
testing, both kernel density and NN spatial analysis techniques were used to add confidence to
findings,
Oveniew of Maps included
The following pages show maps ofEIvIS zones, Fire districts and station locations. Pin maps and
density maps countywide and by geographical areas 'within the county are included, Many of these
maps include layers of kernel density and nearest neighbor ellipses to show locations with higher
than ayerage calls. Call frequency and average response times identified within nearest
neighbor/high acti.nty groups are provided in addition to specific locations, mostly medical and
senior living facilities, which represent a high numbers of calls. _ \ map of vehicle accident locations,
identifying locations (intersections) of calls is included. Finally, maps shoving calls relative to
straight line distances from Fire and ars stations are included,
~ Discussion of spatial analysis methods used in this report, including lldvanmges and limiNtions of nearest neighbor and
kemcl density techniques, are from various National Institute of Justice l112pping publications; for instance, an overview
of hot spots and rechniques can be found in the NIl report Mapping Crime: Understanding Hot Spots available at
www.ojp.usdoj.gov/nij
5 Discussion of limitations on NN and kernel density techniques from the National Institute of Justice l112pping
publications, particularly as outlined in NIJ-sponsored CrimeStllt publications from Ned Levine & Associ2tes
EMS/Fire Pre-Hospital Calls For Service - Collier Count)"' Sheriff's Office - December 2010 - Page 11
. .
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EMS Zones and Stations
Dee 2010
lj,
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Fire Districts and stations
Dee 2010
i'Q
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EMSiFire Pre-Hospital Calls For Service - Colliej: County Sheriff's Office - December 2010 - Page 12
Fire Distric1s and EMS Zones
Legend
o e.lSZenl!S
PlJd)lstrIds
DISTRICT
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EMS/Fire Pte-Hospital CaIls FOI Service - CollieI County Sheriff's Office -December 2010 - Page 13
This pin map identifies the high-priority, pre-hospital call locations countywide. Locations of fire
and EMS stations are included.
Colier County
Hi~ Priority Hospital CFS
JuI2009. Jun 2010
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EMS/Fire Pre-Hospital Calls For Service - Collier County SherifPs Office - Dec=ber 2010 - Page 14
The following map shows density countywide, with the darker shades representing more calls. Fi1:st-
order nearest neighbor dusters, calculated with a minimum of 200 points per duster, are represented
by the blue ellipses on the map. The lighter dots on the map represent locations of ca1ls.
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High Priority Pre-hospital Calls for Service
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The nearest neighbor first-order ellipses identified 16 groups of spatially close calls countywide that
met the minimum criteria of 200 points per duster, Combined, these ellipses represent 37 percent
of the calls. Overall, the average 8.S-minute response time for calls in these locations was the same
as the countywide average create-to-arnval response time,
"IN ChL~H'r NUll1h"r 1\, "ra~t; RT
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EMS/Fire Pre-Hospibl Calls For Serru:e - Collier County Sheriffs Office - December 2010 - Page 16
The following map sho~"S the highest concentration of calls along the coast/western part of Collier
County. The nearest neighbor ellipses identify clusters of calls with a minimum of 200 calls; the
shaded areas on the density scale represent higher concentration of calls in that particular location,
The maps include the point layer to show locations of calls for service across the county.
Legend
FirelEMS CFS
o NN ellpses
- mejor streets
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EMS/Fire Pre-Hospital Calls For Service - Collier County Sheriff's Office - December 201 0 - Page 17
This map identifies locations of places identified as ha'ffilg a high frequency of calls (the number of
calls range from approximately 70 to 200 calls); these tend to be medical-related or senior living
facilities.
Legend
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EMS/Fire Pre-Hospital Calls For Service - Collier County Sheriff's Office - December 2010 - Page 18
This map shows call point locations and density of calls in the North Naples area; the number of
calls in the identified NN ellipses are labeled on the map. Fire and EMS station locations are
included,
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afS/Fire Pre-Hospital Calls For Service - Colliet County Sheriff's Office - December 2010 - Page 19
This map sho\\'S call point locations and density of calls in the East Naples area; the number of calls
in the identified NN ellipses are labeled on the map. Fire and EMS station locations are included,
Legend
RI8EMS CFS
o NN BIllies
A. EM> b:lIlIl105
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EMS/Fire Pre-Hospital Calls For Service - Collier County Sheriff's Office - December 2010 - Page 20
This map shows call point locations and density of calls in the East Naples/Golden Gate City area;
the number of calls in the identified NN ellipses are labded on the map, Fire and EMS station
locations are included.
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Legend
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E!\fS,'Fire Pre-Hospital Calls For Service - Collier County Sheriffs Office - December 2010 - Page 21
This map shows call point locations and density of calls in the lmmokalee area; the number of calls
in the identified NN ellipses are labeled on the map. Fire and EMS station locations are included.
m mokalee Area
High Priority Hospital CFS
Jul 2009 - Jun 201 0
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EMS/Firc Prc-Hospital Calls For Service - Collier County Sheriffs Office - December 2010 - Page 22
This map shows call point locations and density of calls in Marco Island; Fire and EMS station
locations are included,
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EMS/Fire Pre-Hospital Calls For Service - Collier County Sheriff's Office - Dccember 2010 - Page 23
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This map sho'ws call locations, including deosity and NN clusters (a minimum of 25 calls in each
group), of vehicle accident locations. Countywide, there were 1,019 vehicle accident calls meeting
the data selection criteria and accounts for 6.2 percent of the total calls used in this report.
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EMS/Fire Pre-Hospital Calls For Service - Collier County Sherifrs Office - December 201 0 - Page 24
Calls within one mile of Fire and EMS station locations:
There were 6,349 calls located within one mile of an EMS station and 8,145 calls located within one
mile of a fire station. Combined, this number represents 9,269 calls located within one mile of either
a fire or EMS station; this accounts for 56 percent of the total calls. The average create-to-a.trinl.
response time for calls within one mile of Fire and/or EMS stations was 7.8 minutes, with a median
response time of 7.4 minutes. The average create-io-dispatch rime was 2.0 minutes and the average
dispatch-to-ani.aI response rime was 5.8 minutes.
Calls more than one mile from Fire and EMS station locations:
There were 7,276 calls located outside of a one-mile radius from an EMS or Fire station. The
average create-to-arrivaI response time for these calls was 9.4 minutes. The average create-to-
dispatch response rime was 2.0 minutes and the a,erage dispatch-to-arrivaI response time was on
average 7.4 minutes.
Rre and EMS locations
One Mile Buffer
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EllIS/Fire Pre-Hospital Calls For Sernce - Collier County Sheriff's Office - December 2010 _ Page 25
This map shows the straight line distance from EMS statioos to the CFS acti'rity; ea.ch cooceotric
circle represents one mile out from the EMS station. EMS zone boundaries, call location points and
density layers are included on the map.
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EMS/Fire Pre-Hospit2l Calls For Service - Collier County Sheriffs Office - December 2010 - Page 26
1bis map shows the straight line distance from FiIe stations to the CFS activity; each concentric
circle represents one mile out from the Fire stations, Fire district boundaries, caJ11ocation points
and density la:rers are included on the 1Dap.
EMS/Fire Pre-Hospital Calls For Service - Collier County Sheriffs Office - December 2010 - Page 27