A report released Thursday by a group that was commissioned to study issues of pre-hospital emergency medical care is recommending Collier County move toward creating a public safety authority that has oversight of all field-based medical care and ambulance service to hospitals.
A citizen-based Blue Ribbon Panel recommends the county create a council that reports to the public safety authority, and recommends the council be chaired by a hospital administrator.
The group also suggests that current EMS medical director, Dr. Robert Tober, should be reappointed to report to the public safety authority and work closely with the NCH Healthcare System, Physicians Regional Health System and the trauma unit at Lee Memorial Hospital.
All told, the group is offering 14 bottom-line recommendations, which includes launching a pilot program for integrating EMS into fire service districts to achieve “functional integration.”
The panel of citizens was put together by the Greater Naples Chamber of Commerce in 2009 to examine issues surrounding emergency medical response, treatment in the field and transport to hospitals.
The Collier County Commission is scheduled to talk about the group’s report at its Jan. 11 meeting.
At issue is an ongoing turf dispute between some of the independent fire departments and the county’s EMS over the level of medical care that fire department personnel should be allowed to provide in the field involving injuries or medical distress.
The county and some of fire departments, namely North Naples and East Naples, have been embroiled in a debate about potential consolidation of fire and EMS and if it would reduce costs.
The blue-ribbon panel recommends a two-tiered system of care be established, one for basic life support services and the second for advanced medical life support services. However, the panel said that all agencies involved in advanced medical care should be required to provide patient transport to hospitals.
Some of the other recommendations include having the medical director establish all personnel training, quality initiatives, credentialing and testing in collaboration with the hospital emergency departments.
At the same time, the panel suggests outsourcing all test design administration, evaluation and dispute resolution to a local college or university to insure independence and objectivity. The testing issue addresses the cheating accusations that Tober has lodged at North Naples and East Naples firefighters on his medications’ protocol exams and which the fire departments have denied.
The group also recommends all personnel in the fire districts that are involved in providing medical care collaborate to develop common response protocols and designate one leader to be their voice for all field-based medical care and transport matters.
Dan Summers, director of the county’s Bureau of Emergency Services, received the report late Thursday and said he needed time to digest it before commenting. He did say he thought he and his staff would have had the chance to review a draft of the report first for their input before it was finalized.
“Hopefully the group will convene again,” Summers said. “I never saw a draft. I had the impression we would have had some discussion on key points. I’m hoping there is an opportunity to have some clarification.”
Chiefs for the North Naples and East Naples fire departments are on vacation and unavailable for immediate comment.
Commission Chairman Fred Coyle said the county had nothing to do with creating the blue ribbon panel and it has been working independently.
“The blue ribbon committee is not working for us, so there was no reason to give us an advance copy,” he said. “I think it is doing the right thing.”
Coyle agrees with the group’s recommendation that any agency involved in advanced medical care needs to do transport to the hospital.
“It is always a bad strategy to separate transport from advanced life support,” he said.
The recommendation about one medical director raises issues over North Naples Fire wanting to hire its own medical director and receive a certificate to independently run its own advanced medical support program, he said. The county commission is supposed to be addressing North Naples’ request for a certificate of need for an ALS program later in January.
The panel examined local 911 dispatch data and looked at what other high-performing EMS agencies elsewhere have experienced. In particular, the group looked at what’s done in Broward and Volusia counties in Florida and King County in Washington State.
The group also examined the collaboration between the county’s EMS and the cities of Marco Island and Naples which has “yielded positive results.” The three agencies have worked well together on education, use of automated external defibrillators, and with basic life support programs, according to the report.
“The collaboration has fire engine paramedics (advanced life support trained staff) which takes into account the aspects of both cities,” the report said. “Expanding this collaboration to other areas of Collier County should be considered wherever feasible.”
The blue ribbon panel is headed by Geoffrey Moebius, former chief executive officer of Physicians Regional Health System. Other members includes Edward Morton, former chief executive officer of the NCH Healthcare System; Adria Starkey, president of The Naples Trust; Michael Reagen, president of the Greater Naples Chamber of Commerce; Dr. Joseph Gauta, past president of the Collier County Medical Society; Russell Budd, president of Walls of Southwest Florida; Patricia Barton, a longtime civic leader; and Edward Boyer, a retired health-care system executive.