Guest commentary: Medical Community recommendation ignored in NNFD /COPCN issue.

Gauta

Gauta

Talano

Talano

We are all so fortunate in this community to have such well trained and dedicated individuals serving our emergency medical needs. From the phone dispatcher, to the fire and emergency medical services (EMS) personnel, to our emergency physicians and hospitals, we are indeed far above the national average in the quality of care we provide our citizens.

Collier County is rated as having the longest survival statistics in Florida.

Our EMS program is partially responsible for those achievements.

In spite of our paradoxical recognition as a "great" place to have a heart attack, there is always room for improvement. That was the goal of the Blue Ribbon Panel (BRP) and our county commissioners last week — to improve EMS in our county. Unfortunately, we fell short of this goal by allowing the North Naples Fire Department (NNFD) request for a separate EMS.

Here is why:

1) We know that synchronization and system-wide coordination, not fragmentation, of EMS produces better results to patients with greater long-term survival rates. We moved towards fragmentation.

2) We know that EMS leadership comes from many different avenues — fire, EMS, emergency medicine — but that coordination of medical care must be the responsibility of a medical doctor. Only physicians have the needed level of training to coordinate all aspects of the care provided. There can be more than one physician coordinator within a community, but only one physician within a community should be responsible for the oversight of all the other physician coordinators. More than one captain sinks a ship.

3) Opinion trumped science. In our efforts to provide better care to our community, we allowed unsupported opinions and anecdotes instead of known medical facts to decide upon a Certificate of Public Convenience and Necessity (COPCN) for the NNFD. Eighteen months of fact-finding and research by the Blue Ribbon panel were disemboweled by the county commissioners in a matter of minutes. We were led to believe that adding more ALS providers with potentially different training standards will improve response times. Response time is only one important aspect of the ultimate goal of EMS — patient survival. Quality of care and continuum of care are of utmost importance, and that is only achieved through experience and standardization of the care community-wide. Fragmentation of care breeds inconsistencies within the system that can be deadly.

The BRP recommended one county medical director working with hospital emergency dept directors and trauma director of Lee Memorial, NCH Emergency Physicians and Physicians Regional Medical Centers emergency personnel. This was to maintain consistent quality and service for all of Collier County; since we have now abandoned the BRP recommendation what is the plan for the future? According to the Seattle model, we cannot see how cardiac arrest survival rates will improve by adding more paramedics and diluting EMS personnel experience even further.

4) One of the most dangerous times of the emergency situation occurs during hand-offs of the patient from one medical service to another, e.g. —- first responder to the transport team or transport team to the ER department. NNFD will arrive at the scene and will have to hand-off the patient to EMS. Two different emergency response groups, with two different medical standards and with a history of resentment towards each other, will now be responsible for handing off the patient at the scene. Getting there quickly is important; keeping the patient alive is more important.

5) We did not provide for any yardsticks to measure our success. Implementation of any new plan must have measurable parameters so we can determine whether to extend those plans into the long-term future. The NNFD request was granted for one year. What set of metrics will help us decide for or against continuation?

6) Lastly, as the Blue Ribbon Panel recommended, we should have objective medical experts form a Patient Safety Authority to study all of these issues and make solid scientific recommendations to the county commissioners. Face it; we are talking about human life as it relates to the prescription of emergency care. Only citizens unencumbered by the burdens of departmental quarreling, subjugation of power, or tax money should be part of this group that helps our Commissioners make the non-medical decisions of transfer of tax dollars and legislation.

We applaud the NNFD, CCEMS and our commissioners for wanting to make our EMS even better. It is only through non-biased, scientifically based decisions that we will reach this goal. We should not make our own mistakes, but use those of other communities with successful EMS systems to continue to strengthen our nationally recognized EMS. Politics plays an important role in the implementation of our ideas, but not in the life-or-death decisions needed at the time of an emergency. We recommend that the Board of County Commissioners recall their vote until more study on this important matter can be completed.

Dr. Gauta is immediate past president of the Collier County Medical Society and a member of the Blue Ribbon Commission on Emergency Medical Services; Dr. Talano is president of the Collier County Medical Society.

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