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ALS Vote Stirs Anger In Florida County

Paramedics of the North Naples Fire Control and Rescue District scored a long-awaited victory after a shift in public safety policy from the Collier County Commission on Tuesday.

The County Commission voted to grant the fire district the ability to increase its level of care at on-scene medical emergencies - pending state approval - reversing an October vote that denied the request.

For the second time in three months, the commission heard an emotional discussion on the request from the North Naples fire district to receive a certificate of public convenience and necessity for nontransport advanced life support (ALS) services.

ALS certification allows a paramedic to use more potent drugs and enhanced medical tools in severe pre-hospital emergency situations. Under the current system, North Naples fire personnel often arrive on the scene before the county EMS ambulance service, which is authorized to give ALS care.

North Naples firefighter-paramedics have complained without ALS certification they have had to wait for Collier County Emergency Medical Service ambulances to arrive before being able to deliver necessary advanced care. That creates an unnecessary risk for patients, they argued.

In contrast, Collier County Emergency Medical Services officials said allowing the fire district to offer ALS service apart from the county's oversight could result in decreased patient care.

Both sides claimed the opposing view put the public's safety at risk.

This time the commission granted the certificate by a 3-2 vote. Commissioners Jim Coletta and Fred Coyle provided the dissenting votes.

With the certificate, North Naples fire district will now seek an ALS license from the state Health Department and work with county EMS officials in coordinating the new program. It could take several months before the fire district's ALS program would be operational, fire district officials said after the meeting.

If the district receives the license, North Naples will provide ALS at the scene of the emergency. However, EMS is still responsible for ambulance service throughout the county.

The request for the certificate came before the commission following the end of a previous fire-based ALS program that ended over a public dispute about training protocol between county Medical Director Dr. Robert Tober and North Naples fire officials.

In the past, the North Naples fire district has run an ALS program under Tober's medical license. However, Tober halted the program in 2009 because fire district paramedics were not meeting his training requirements.

Jorge Aguilera, deputy chief of the North Naples fire district, has said the medical director's requirements were logistically infeasible for the district.

Without following his training protocol, Tober said paramedics are susceptible to a deterioration of skills, which puts patient lives at risk. He said North Naples firefighter-paramedics misused ALS drugs on patients in the past.

If it receives its state license, the fire district could bypass Tober's license and put it under the fire district's own medical director, Dr. Jeffery Pannozzo.

Aguilera has long maintained an ALS program will increase public safety and allow fire district paramedics to augment the county's EMS operations.

Dan Summers, the county's emergency management director, argued against the certificate on the grounds that it would fragment the county's current pre-hospital system.

A number of county EMS paramedics backed up that argument during the public speaking portion of the hearing. They told commissioners ALS drugs and techniques without the proper training and experience are harmful to medical patients.

Aguilera promised commissioners the district would work with Tober to meet his protocol.



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