For the last 30 years, I have worked to make pre-hospital medical care the best it can be. We have won state and national awards attesting to the success of our efforts.
For the majority of that time, fire departments/districts have supported EMS in a first response role of providing rescue, fire suppression and extrication during accidents and basic life support (basic first aid) if EMS was delayed.
As early as 1981, I asked the Collier County Commission to consolidate all fire and EMS services under one county management. This was not greeted well by the independent fire districts in our county. However, I still support consolidation of fire and EMS under the county so that we maintain patient care excellence, with fire chiefs directing fire operations and physicians directing medical operations.
In December, a proposal was made by North Naples Fire District (NNFD) and two city fire chiefs for separate fire departments/districts to take over EMS transport services in the city of Marco Island, the city of Naples and in North Naples. The city fire departments would take over EMS hospital transportation in their cities and NNFD would provide ambulance transport in their area.
This proposal would not consolidate service, it would fragment it.
But why would you want to make this change? It is not for patient care excellence. That is already being provided.
Follow the money.
They want county property tax EMS money — $10 million of it — for their proposed ambulance operations, leaving $2 million in tax revenue, plus whatever transport billing fees can be collected, to pay for EMS operations throughout the rest of the county.
In Collier County, we have about 25 significant fires per year. These fires, plus the first response to alarms, accidents and 911 calls, cost county taxpayers about $63 million per year — for fire service countywide, including the city fire departments. EMS runs 36,000 medical calls per year, costing taxpayers $12 million annually plus ambulance transport revenue that is billed separately.
Clearly the primary need in this county is for medical response. In spite of the enormous fire budgets already in place in Collier County, that transport revenue is being eyed enviously by fire interests.
Let's take the North Naples Fire District proposal for example. This year, they are paying an average of $141,000 in pay and benefits for their operations, but they would have you believe that they can provide EMS transport services better and save money, even through their personnel costs are 30 percent higher than EMS and the Collier County Sheriff's Office. Do you really expect such a high cost organization to suddenly become cost effective?
Providing the service better is also highly questionable since EMS has the experience doing hundreds of medical procedures over and over while NNFD paramedics only perform those functions infrequently. People perform best what they perform most often and EMS paramedics, making many advanced medical decisions, are all very practiced and skilled.
A few years ago, the Collier County commissioners said "no consolidation of EMS and fire until fire service is consolidated." Instead of following that guidance, fire organizations keep chipping away to fragment services. Last year, the NNFD asked for and received permission to perform paramedic services independent of EMS oversight and said they were not interested in performing hospital transport.
One year later, they are back, now with the cities, looking for approval to provide hospital transport countywide.
The last thing we should be considering is fragmenting the delivery and transport of patients into first two, three or more entities throughout our county. It is a terrible step backwards and runs against last year's recommendations of the Blue Ribbon Committee; it runs against the best benchmark systems in the country (like King County, Washington) and it runs against the recommendations of the Collier County Medical Society.
Collier County Commissioners have scheduled a workshop on Thursday to discuss these issues. Hopefully, rational minds will prevail.
Please stay tuned to see how this evolves.