More Worries Over Florida County's ALS Decision

Tober said he will continue his battle to ensure that all paramedics are properly trained before they deliver ALS.


 
 

AARON HALE, Naples Daily News | | Tuesday, February 1, 2011


The momentum shifted, leaving some to wonder whether the two sides could come together and cooperate for the public good. The scenario may sound familiar, but the shift isn't taking place on the national stage. Instead, it's about the issue of public safety in Collier County.

In a reversal of positions Tuesday, Collier County commissioners decided to grant a certificate of public convenience and necessity for non-transport advanced life support service to the North Naples Fire Control and Rescue District. Commissioners voted 3-2 to grant the certificate after an arduous, emotional hearing that lasted four-and-a-half hours with a couple of recesses.

The long-awaited victory for the fire district adds a new dimension to an ongoing, public feud between the district and Collier County Emergency Medical Services about how first responders should handle some emergencies.

The commission's decision, while supported by North Naples fire officials and paramedics as a way of increasing public safety, was opposed by Collier EMS staff and county Medical Director Dr. Robert Tober.

Tober has long argued that North Naples firefighter paramedics haven't been willing to meet the appropriate ALS training standards. ALS techniques are widely considered high-risk, high-reward measures to be used only as a last resort on acute patients. Their lack of proficiency, he has said, is a public safety hazard.

Pending a license approval by the state Department of Health, the result of the controversial decision will be that the North Naples fire district will control pre-hospital emergency operations within the district and provide ALS service independent of Tober's medical license.

Speaking to the Daily News days after the decision, the medical director still was fuming over the commission's decision and what he perceived as a tone of disrespect toward him by Commissioner Georgia Hiller.

Tober's position is supported by some in the Collier medical community. Dr. Joseph Gauta, a Naples obstetrician who attended Tuesday's meeting, complained that the commission's decision didn't appear to be "based on science." Tober said he will continue his battle to ensure that all paramedics are properly trained before they deliver ALS. He called the North Naples fire district "a rogue nation trying to declare their independence."

"This is round one, my friend," Tober said in the interview. "This will get uglier before it gets prettier."

Other officials expect the changes resulting from Tuesday's decision not only will alter emergency service delivery in North Naples, but also throughout the rest of the county.

While Tober has his view, officials from the fire district and EMS both say the challenge now is to put aside disputes of the past and work together to keep the citizens of Collier County safe.

In recent years, the North Naples fire district ran a fire engine ALS program under Tober's medical license. However, Tober pulled ALS drugs from North Naples engines in 2009 because fire district paramedics weren't meeting his training requirements. The fire district later withdrew from the ALS agreement.

Now that the fire district has its service certificate from the county, it will apply for a medical provider license from the Department of Health.

Dr. Jeffrey Pannozzo, an emergency room physician, would be the fire district's medical director. That application process is expected to take several months.

In the meantime, EMS and fire district officials already are making arrangements for the new system.

Jeff Page, chief of Collier EMS, said that once the North Naples fire district receives the license, the department will become the lead agency for pre-hospital emergency medical care in North Naples, replacing Collier EMS. If patient transport is necessary, Collier EMS still will be the sole provider of ambulance service in the district and throughout the county.

That's a similar system to some Lee County fire districts with a non-transport ALS program, such as the Bonita Springs Fire Control and Rescue District and the Estero Fire Control and Rescue District.

What that means is that the North Naples fire department will now be required to respond to all medical calls in the district.

"EMS would take direction from North Naples in the district," Page said. "They are in charge of the patient."

In fact, Page said, his agency has something to gain from the North Naples ALS program. He predicted that the fire department taking the lead on emergencies in North Naples could free county EMS personnel to be redeployed to eastern Collier County where emergency response times are higher.

"Now we're going to be able to count on them in a way we never had before," Page said.

Jorge Aguilera, deputy chief of medical services for the North Naples fire district, said fire officials and paramedics already are preparing for change. Aguilera said he has been communicating with EMS leaders on providing a smooth transition. In addition to reintroducing ALS training to its paramedics, agency representatives are ensuring that the North Naples engines carry the same medical supplies and its paramedics follow the same patient protocols as the county. That's to guarantee a seamless transition between on-scene care and patient transport. "(EMS officials) have been very helpful," Aguilera said.

He predicted the changes would "strengthen our relationship (with EMS) and revitalize the partnership that had taken a back seat."

County Commissioner Fred Coyle, however, was skeptical of that partnership. When explaining his vote Tuesday against the certificate, Coyle called it a "fantasy" to believe that the two agencies that have been fighting for years would suddenly be at peace.

"When you have North Naples providing ALS and EMS provides transport, there is going to be conflict and finger-pointing," he said.

Page said, like it or not, EMS officials have a responsibility to work with the fire district to ensure public safety. "I'm not going to let (North Naples) fail," Page said. "We are going to do everything we can to help them succeed."



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