'Daily NewsMakers with Jeff Lytle' ... Collier County ambulance services

Collier County ambulance services get the whole 30 minutes on this week’s "Naples Daily NewsMakers with Jeff Lytle" program airing this morning at 10 on ABC7.

The director of a model system in Seattle, Jim Fogarty, joins Collier County Medical Director Dr. Robert Tober and North Naples Fire Chief Orly Stolts. Then two civic policy experts, Ed Morton and Janet Vasey, size up what they heard and where the issue goes from here — after the Collier County Commission rejected a referendum on consolidating ambulance and fire services countywide under the Sheriff’s Office.

Highlights are at naplesnews.com/newsmakers.

Here are excerpts:

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NewsMakers: EMS Panel, Part 1

Collier EMS' future is sized up.

NewsMakers: EMS Panel, Part 2

Collier EMS' future is sized up.

Jim Fogarty

Fogarty: The King County (Seattle) system is a tiered response system where there’s a very strong basic life support (BLS). The basic life support component of the medical system handles about 75 percent of all the calls. The EMTs (emergency medical technicians) who are part of that system are very practiced and very good at what they do.

Lytle: And ALS is the advanced life support ...

Fogarty: The ALS paramedics are very well trained. They are trained at a single location, Harborview Medical Center, and they’re held to a very high standard. There are only about 246 of them for the entire county ... just a little under 2 million people, about 2,100 square miles and of that entire area, we have a total of 26 medic units.

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Dr. Bob Tober

Tober: In reality, basic life support is where virtually all of the lives are saved. I’ve been trying for a long time to refocus this system to a basic life support first response of four minutes followed by advanced life support thereafter.

A lot of the argument ends up coming down to who is going to provide ALS; what kind of training and experience should they have to provide that ALS? In a system that has between 200,000 people in the summer and 350,000 people in the wintertime, we have almost as many ALS paramedics in Collier County as Jim has in Seattle. We’re about the same square mileage of territory, and he has somewhere around six or seven times the population.

Lytle: That statistic almost boggles the mind, and how is that possible? Why is it that way?

Tober: Well I think it’s that way because we don’t have a unified, consolidated system here. I don’t believe that everybody is, in the final analysis, rowing in the same direction with the same goal in mind. I’m not suggesting that everybody doesn’t have an interest in saving lives, but there isn’t a coordinated oarsman at the front of the boat with the gavel sounding out how we’re all going to row in one direction, because we have a lot of fragmentation and a lot of different systems in the community.

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Orly Stolts

Stolts: I actually ... we like the King County model very much. When the Blue Ribbon Committee starting looking at it, we did too. And what we found about the King County model is very interesting: it’s a heavily driven medical component that makes up the King County system, and I believe there are seven, I believe, different medical directors in King County that work together as a system.

There are 30 fire departments within King County; there are six ALS transport providers; five of those six are fire department-owned and -operated,

And we looked at that system, we thought, well, gosh, that system could work basically here in Collier County. We have a number of independent fire departments. We have city fire departments. They do, too, in King County. The King County Medic 1 system is an educational component with strong medical leadership at the top. And they contract with the fire departments to run the advanced life support.

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Now the piece that we’re missing here is the BLS (basic life support) transport. I think, Jim (Fogarty), you talked about 40 percent of the calls are ALS?

Fogarty: About 25 percent ... of all the calls that enter our 911 system, about 25 percent are triaged to advanced life support; 75 percent are basic life support.

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NewsMakers: Ed Morton and Janet Vasey

Collier EMS' future is sized up.

Janet Vasey

Vasey: We don’t like the fact that Emergency Medical Services and fire departments are constantly fighting. We don’t think it’s good for the public. We don’t think it’s good for the patient.

Our solution was to put it all under the sheriff, and then you have one person in control, knocking heads if necessary, to get the right solution.

And we believe ... I believe that a medical-based fire/EMS system is what’s needed. Because we have 36,000 medical calls a year and not very many fires. So, the control and the decision-making should be very much medically based.

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Ed Morton

Lytle: What are your impressions of the panel discussion (with Fogarty, Tober and Stolts)?

Morton: Well, I thought it was productive and touched on some of the more critical points. But I think one of the areas that was not highlighted and missed, frankly, by that panel was the criticality of standardization.

What didn’t come through is, you can have a rather disparate group of people. You can have 20 or 30 fire departments; you can have different ALS providers, but if they do not subordinate themselves to a single, standardized medical set of clinical protocols, then ambiguity is dangerous.

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