Florida Officials Address Slow EMS Responses

Page, McInerny and Tober all concede there are long-term issues that still require work.


 
 

AARON HALE, Naples Daily News | | Monday, April 11, 2011


Following reports of some 15- to 20-minute ambulance response times for Naples emergencies, officials from Collier County and Naples have been scrambling to find solutions.

Their aim has been to stanch the loss of precious minutes during responses to medical emergencies — a time when those minutes can be the difference between life and death.

For now, Collier County EMS Chief Jeff Page and Naples Fire Chief Steve McInerny have worked out some short-term fixes to address concerns in Naples.

And Collier Emergency Medical Director Dr. Robert Tober this week initiated changes in countywide response protocol. The changes for now amount to placing a Band-Aid on the problem, but will involve sending ambulances to calls more often with lights and sirens blazing.

Page, McInerny and Tober all concede there are long-term issues that still require work with multiple agencies to ensure first-response times don’t start hemorrhaging minutes once again.

When a restaurant patron passed out with difficulty breathing at Ridgway Bar and Grill on Third Street South at lunch hour on March 28, an employee called 911.

It took a Naples fire engine, staffed with a paramedic, five minutes to arrive on scene. The 84-year-old man was suffering from low blood pressure, coming in and out of consciousness and vomiting, according to correspondence between city and county officials.

It took the Collier County EMS ambulance 21 minutes to get to the patient.

Dan Bowman, deputy chief of Collier EMS, reported that the Collier County Sheriff’s Office dispatch center sent the ambulance five minutes after the Naples dispatch center sent the city’s fire engine. A dropped call between the two dispatch centers lengthened the response.

Bowman also reported that heavy congestion slowed the ambulance and that paramedics were given the incorrect restaurant name “Rita Way Bar.”

Paramedics finally were guided to the correct location by a bystander. Reports suggest that Naples firefighters didn’t directly communicate with the ambulance to address the severity of the emergency.

The 21-minute response came less than two weeks after it took a county ambulance 16 minutes to respond to a medical call in Naples that ended with a fatal heart attack. In that response, paramedics initially went to the wrong part of a street that is divided by Goodlette-Frank Road.

Last week, Naples City Councilman Doug Finlay told the Daily News that he would explore the idea of creating a separate city ambulance service due to a troubling pattern with at least four late county ambulance responses in three months.

Tober, the medical director for the county’s ambulance service, responded to concerns this week by temporarily halting aspects of the county’s medical response protocol.

Recent incidents of delayed ambulance response were from calls coded “alpha,” or non-urgent medical calls by dispatch officers with the Collier County Sheriff’s Office.

On alpha calls, Collier ambulances don’t respond “hot” — using lights and sirens at intersections — but instead go “cold,” or roll with traffic.

EMS officials have argued that lights and sirens can endanger other drivers and it’s not worth the risk on minor calls such as sprains or dizziness.

But last week, McInerny criticized the “alpha” code response protocol for not giving patients the best response available.

“What happened to erring on the side of the patient and ensuring that you have done everything within your power to provide outstanding medical treatment and transport to the closest appropriate facility?” McInerny asked in an email to county officials.

Tober reversed his past position this week by temporarily suspending “cold” runs to minor calls, according to a letter he sent to the Collier County Commission.

Tober said there needs to be a review to ensure calls are correctly coded.

In a meeting Wednesday, Page and McInerny also addressed challenges that arise from the agencies using separate dispatch centers for the same emergency calls.

The Sheriff’s Office provides dispatch service to all first-response agencies in the county except for Naples municipal agencies, which are directed by a city of Naples dispatch center.

Tober explained that when 911 calls are placed in the city of Naples, the city’s dispatch first receives the call. The dispatcher immediately gets the address of the emergency and notifies the appropriate city agency — which in the case of medical emergencies are the Naples advanced life support fire engines.

Those firefighters immediately respond with lights and sirens to the address, Tober said.

In the meantime, the caller is transferred to the Sheriff’s Office dispatch center. A dispatch officer retrieves details of the emergency from the caller before coding the call’s priority (alpha, beta, Charlie, delta and echo) and dispatching an ambulance.

Sheriff’s Capt. Roy Arigo, a supervisor for the dispatch center, said calls are coded based on caller response to questions. The answers are entered into a software program that uses an algorithm for coding.

Tober said this process sometimes can take as many as five minutes.

In response, Page announced the county would install Naples dispatch radios in the Naples EMS stations. The move ensures that county EMS paramedics will get emergency call information at the same time Naples firefighters do.

In addition to the immediate changes, Tober also has suggested the dispatch center send ambulances first, and ask questions about coding later.

The medical director is calling for better communication between agencies countywide and a standardization in how each agency responds.

In his letter to commissioners, Tober wrote, “It is imperative that all agencies within the county are singing to the same hymn book and set of rules for consistency, safety and effectiveness.”



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