Collier ready to try out new guidelines for sending out EMS, fire units

Dr. Robert Tober on NewsMakers

Dr. Robert Tober on NewsMakers

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— When someone dials 911 for a medical emergency, the last thing on the caller’s mind is the process for how help arrives.

That process, though, is critical in determining who responds to the patient, how fast they get there and how they’re equipped.

After gaps in ambulance response times in the Naples area this year led to concerns for public safety, leaders in emergency services met to find ways to make the system work better.

This week, emergency service providers are rolling out a new set of guidelines aimed at simplifying a convoluted system. The goal is quicker response times and a better synchronized system.

However, some worry the downside of the new guidelines is a system that’s less cost-effective and attached with its own public safety risk.

Though there have been discussions for years about updating response guidelines, it was slow response times this spring that became the catalyst for change, admitted Dr. Robert Tober, Collier’s emergency medical director.

“It kind of all blew up with a few delayed calls in the city (of Naples),” Tober said.

Those mismanaged calls pointed to deeper flaws in Collier’s EMS system, Tober said, namely that first-response units weren’t being sent to emergencies quickly enough and the system lacked some countywide standards on who responds to medical emergencies.

There are three cogs that make Collier’s pre-hospital medical system tick: Collier County EMS (the only ambulance provider in the county), Collier’s nine fire-rescue agencies (which provide medical response support) and the Collier County Sheriff’s Office (which runs the countywide emergency dispatch center).

Those cogs agreed to two major changes to improve response times:

■ First, Collier sheriff’s dispatch officers will immediately send ambulance and fire-rescue units once the location of the emergency is pinpointed rather than gathering additional information first.

Before, dispatchers would ask a series of questions in order to diagnose the type and severity of the emergency before sending an ambulance.

The reason for the questions were, at least in part, to avoid needlessly sending too much equipment and staff to minor calls.

The downside to that process was slower response times for crew members who were receiving news of emergencies sometimes minutes later than the call was received.

Collier County Sheriff Kevin Rambosk said the new dispatch guidelines will result in time savings. Once dispatch officers send an ambulance and fire-rescue unit to the emergency, they will remain on the line to diagnose the call and send additional information to responders.

■ The second major change is to introduce uniformity to firefighters’ response to medical emergencies.

Under the new guidelines, all fire-rescue agencies will roll out with emergency lights and sirens, at least initially to all medical calls.

Here are the agencies that respond to medical emergency calls and the respective elected government bodies that oversee them.

■ Collier County Sheriff’s Office: The Sheriff’s Office manages the dispatch office that directs most emergency calls in Collier County. Deputies, trained in basic life support techniques, will also respond to medical calls.

Elected leader: Collier County Sheriff Kevin Rambosk.

■ Collier County Emergency Medical Services: The county EMS runs ambulance service for the entire county under the medical license of Dr. Robert Tober.

Elected leaders: Tober and EMS staff report to the Collier County Commission.

■ Fire districts: Firefighters throughout the county respond to medical emergencies, although each district sets a different protocol on the types of emergencies they respond to.

Elected leaders: Municipal fire districts (Marco Island and Naples) report to their respective city councils. Independent fire districts (Big Corkscrew Island, East Naples, Golden Gate, Immokalee and North Naples) report to their respective boards of fire commissioners. The dependent districts of Ochopee and Isles of Capri report to the Collier County Commission.

Before the changes, Collier’s various fire agencies differed in what kinds of medical calls they went to in their boundaries. Some fire-rescue agencies refused to respond to 911 calls coming from medical clinics or nursing homes where doctors were already present, while others would respond to every call regardless of severity or location.

Recently retired EMS Chief Jeff Page said that lack of uniformity among fire districts created a "disjointed" level of care in Collier.

While the new guidelines could lead to faster response times, there are questions about the safety and effectiveness of the new system.

In the past, Tober has said there are increased traffic risks in having more emergency vehicles speeding to the scene.

“Any time you run lights and sirens, you are a hazard to the public,” he said.

Deputy EMS Chief Dan Bowman, who helped strike the deal for new guidelines, conceded the new system could be “burdensome” on the EMS system in the long run.

By sending an ambulance to every call, he said, there is a risk of “over committing the resources.”

For every minor emergency a Collier County ambulance is going to, he explained, there could be a major emergency for which it won’t be available.

The same is true for fire engines, North Naples Fire Chief Orly Stolts said.

He estimates the new guidelines could have his fire district running on 2,000 more calls per year.

Stolts said the guidelines could shave minutes in response time, which could be critical in major medical emergencies. Still, he said, “In my opinion, this is not the best use of resources.”

Bowman and Stolts said they hope the new guidelines could be a first step to building a better system.

Both said the new guidelines should only be temporary, as the agencies work toward getting more sophisticated communication equipment and building more sophisticated guidelines aimed at both increasing cost efficiency and reducing response times.

Rambosk said his department is looking at new programs and software for aiding 911 dispatch.

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