Collier Commission denies North Naples Fire's request for advance life support service

— The North Naples Fire Control and Rescue District’s mission to revive its advanced life support service on emergency medical calls is now itself on life support.

During an emotionally-charged Collier County Commission meeting on Tuesday, with many North Naples firefighter-paramedics and residents pleading with the commission to let firefighters “do their jobs,” commissioners voted 4-1 to deny the district’s request to provide advanced life support (ALS) service under its own medical director. Commissioner Donna Fiala was the dissenting vote.

That decision upholds the county’s current pre-hospital system in which the most advanced techniques of handling for medical emergency patients are handled by county Emergency Medical Services personnel. (The exceptions are in the City of Naples and Marco Island, where firefighters are approved to perform ALS. In Isles of Capri and Ochopee, EMS paramedics authorized for ALS ride on their fire trucks.)

The North Naples Fire District has been trying to bring back its ALS program, which would give its firefighter-paramedics the authority to use potent drugs and enhanced medical techniques in emergencies. Collier Emergency Medical Director Robert Tober pulled certifications for North Naples firefighters in 2009. At the time, he said they failed to meet training standards. The district applied for a certificate of public convenience and necessity from the county to provide its own ALS program through the fire district’s medical director, Dr. Jeffery Panozzo, essentially bypassing Tober’s license.

Tuesday’s hearing on the agenda item lasted more than three hours and created some heated — even tearful — moments.

Supporters of the fire department argued that, as first responders, qualified firefighter-paramedics should have all of the necessary tools at their disposal in order to save patients’ lives. Opponents, including Dr. Tober, argued that ALS techniques can be dangerous if not used by the most experienced paramedics and that the North Naples Fire District has refused to meet the county medical director’s training standards to maintain that high level of experience.

During the meeting, Tober laid out his current system for pre-hospital emergency care in Collier County in which first responders such as firefighters and Collier County Sheriff’s Office deputies are prepared to offer basic life support techniques, such as CPR and the use of automated external defibrillators. Tober argued that ALS drugs and techniques should be used by the most highly-trained paramedics, which in most cases would be with Collier County Emergency Medical Services.

Tober said the current “two-tiered system” in which North Naples firefighter-paramedics cannot perform ALS without the supervision of county EMS personnel was “far from broken.”

That’s a characterization that North Naples fire officials disputed during Tuesday’s meeting. Assistant Fire Chief James Cunningham said delayed EMS response time could jeopardize patient health.

According to North Naples Fire District reports, the department reached the scene of an emergency before county EMS 51 percent of the time in fiscal 2009-2010.

Cunningham said the fire department was on scene five minutes prior to EMS on 532 occasions and 10 minutes prior on 199 occasions.

Cunningham said “seconds count” in circumstances like an allergic patient suffering from a bee sting and suffering from a “closed airway” and a patient suffering a severe asthma attack.

He asked the commissioner “how many people need to die” before firefighters can be equipped to handle these emergencies.

Tober, on the other hand, touted that there has never been “a verifiable incident” of EMS delay harming a patient.

Jodi Van Sickle, a North Naples firefighter-paramedic disputed that claim.

Moved to tears at the podium, Van Sickle told the commissioners of one instance in which she claimed that a delay in response time caused the death of a heart attack patient.

She claimed that she and other firefighter paramedics exhausted all basic life support techniques on the man, but it was enough.

She said county EMS was too slow to arrive.

“He was alive when we got there,” she said. “We had to watch him die.”

After the meeting, Tober said that particular incident was under investigation and that he could not comment on it. Medical confidentiality laws prohibit providers from divulging details of medical emergencies. He did, however, call Van Sickle’s story “a distorted account.”

Before the vote, Commissioner Fred Coyle, who voted to deny North Naples’ request, said he would be open to revisiting the subject again once an independent blue ribbon committee concludes a current study of Collier County’s pre-hospital emergency system.

Then he proposed that one way he would support the North Naples Fire District getting ALS was to consolidate with the county’s other fire districts and “take over the entire EMS system.”

Coyle said the fire district’s current plan would “fragment the EMS system in Collier County” if it were granted its own program.

After the meeting, North Naples Fire Chief Orly Stolts said he was “disappointed, but not surprised” by the decision.

However, he added the department would not give up on ALS aspirations.

For now, he said, “We’re going to review all of our options.”

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