By I.M. Stackel
Naples News
Copyright 2007 Naples News
COLLIER COUNTY, Fla. — It was somewhat of philosophical debate in the 1990s.
With unrestrained growth in the eastern and northern portions of Collier County in the past decade, some county leaders say fire district consolidation— and absorption of ambulance service — is now a necessity.
From July 1, 2006, to July 1, 2007, Florida’s population grew by 194,000 to 18.3 million, according to U.S. Census spokesman Robert Bernstein.
While fresher numbers will be released in March, Collier County saw a 25.2 percent population hike between July 1, 2000, and July 1, 2006, from 251,377 to 314,649 residents.
Consolidation of services is hardly a new concept.
Nationwide, more often than not, fire and emergency medical service coexist in one department, although there are some counties that choose to keep fire rescue and EMS services separate.
According to a joint position paper prepared in 2007 by the Florida EMS Advisory Council, it was only about 35 years ago that advanced life support paramedics began performing life-saving services in a pre-hospital setting.
Miami was a forerunner, providing documented accounts that show as far back as 1941 rescue trucks were so utilized, according to the state report.
“The shortage of paramedics is a nationwide problem that transcends traditional borders of paid vs. volunteer, fire-based v.s. third service, private vs. public, or basic life support (BLS) vs. advanced life support (ALS,”) states the position paper, which was endorsed by the Florida Ambulance Service, Florida Association of County Emergency Medical Services, Florida Fire Chiefs Association, Florida Association of EMS Educators, Florida Professional Firefighters, Florida Association of EMS Medical Directors, EMS Providers of Florida and Florida Association of Rural EMS Providers.
While Collier County’s independent and city-run fire districts are working hard to address these issues — at the request in 2006 by county commissioners — meeting regularly for consolidation committee and subcommittees, EMS officials are flailing against the possible takeover of ambulance and EMS services.
In the past few weeks, EMS Medical Director Bob Tober has raged against fire departments proposed absorption of EMS and ambulance service, claiming lack of clinical skills, even bashing some of the paramedics that he trained who are now with fire departments.
“Fire wants EMS. EMS and the ambulance service are one and the same. Ask the question: Why can’t the (fire departments) simply consolidate and leave us alone?” Tober asked in a Christmas Day e-mail to a Daily News reporter. “They bring nothing to the table. What they take from the table is revenue from transport.”
“Somehow, providing BLS and the initial ALS (which is all they are really trained to do) is not enough for them because of 1) control, 2) power, 3) influence, 4) some revenue from transport, 5) justification of their existence,” Tober wrote. “Do not forget that 90 percent of what fire (rescue) does is medical. Since EMS is the medical specialist job description in our county, why is it never discussed that EMS take over fire?”
When asked if he raised these issues with county commissioners 18 months ago when they asked fire districts to consolidate, Tober said, “No.”
“I have not yet addressed this with the Board of County Commissioners. I had no idea that their first move would be to demand equality with EMS paramedics,” although Tober acknowledged that ambulance and EMS is one service, that one can’t be managed without the other.
“I struggle ... to keep up the skills of 111 medics and another 22 in training and they are running all of the calls. What the hell am I supposed to do with another 100 medics that want the same protocol? First, and foremost, (it) was their desire to get the fire departments to consolidate among themselves. The idea was that perhaps if they were offered EMS, this might be the push they need to consolidate.
“My question is why should they get EMS in the first place. Why in the hell do we still have nine independent fire districts in 2008? Is this Mars? That is nine fire commissions and nine bureaucracies with nine fire chiefs; nine assistant fire chiefs etc. No wonder they want EMS. They don’t have anything else to do!”
Fire commissioners, chiefs and firefighters have remained relatively quiet during this dispute, paying more attention to analysis of each district’s resources, the means to consolidate and equitably distribute fire and EMS services to all county residents. Currently, here are the agencies that provide fire rescue and/or basic life support or advanced life support services. The latter is a certification bestowed by the state, although not necessarily recognized by Tober.
City of Naples, City of Marco, Big Corkscrew, East Naples, Golden Gate, Immokalee, North Naples, Isles of Capri, Ochopee, and EMS.
According to the preface of the draft consolidation plan, issued two weeks ago, some fire districts have implemented their own advance life support emergency medical response capabilities to support EMS, including East Naples, Marco and North Naples.
“This enhancement in local service is intended to improve the quality of pre-hospital care provided to local residents (although) these enhanced services do no exist countywide,” the report states.
Currently, fire operation chiefs are studying placement and staffing of apparatus, using existing vehicles, stations and personnel. Minimum safe staffing levels would be established at three workers for engines/pumpers, three for aerials/trucks, and two for transport units.
The numbers reflect the current minimum safe staffing levels in a number of organizations, and will not represent a reduction in service in any part of the county.
The operations committee began by examining the locations of each fire and/or EMS station within the county, and identified the apparatus assigned to each station. The committee also determined the number of workers employed by each agency, and the total number of workers per unit.
“Across the county, the total number of personnel currently utilized to staff all the units making emergency responses is 151 daily,” the report states. “This number represents only those people assigned to shift responsibilities, meaning that they work a 24-hour schedule. It includes shift supervisory personnel, through the rank of battalion chief.”
“There is a significant disparity in the current daily staffing of 151 (workers) and the proposed minimum safe staffing of 164. The committee (members) believe that these numbers can readily be resolved through a relocation of fire and medic unit assets,” the report states. “For example, a number of stations house two engines which are currently staffed fulltime. There are also five locations where two medic units share quarters....In a countywide system, available daily shift staffing (in excess of) 155 could be assigned to provide three people on rescue units, place an additional engine or transport vehicle in service in rural or areas of need, place brush trucks in service without affecting engine staffing, etc.”
Overall, there are a total of nine fire-only stations, 16 combination fire/EMS stations, and four EMS-only stations. The latter are close to fire stations.
Apparatus countywide is 25 engines, seven aerial ladders, five water tenders, two crash fire rescue (CFR) trucks, and 26 medic-staffed ambulances. These numbers represent units that are staffed at all times.
“There is an undetermined number of reserve apparatus used for back-up, which are not staffed unless they are placed in service,” states the preliminary consolidation report.
One consolidated countywide district would enable rescue leaders to explore alternative revenue sources.
Currently, here is a fast snapshot of the cost of fire services to various areas of the county, of available money, and how they could be combined and equalized.
-- Collier FD 1 charges $1.94 per $1,000 worth of property, bringing in $547,389.
-- Isle of Capri charges $1.49 per $1,000 worth of property, bringing in $1.28 million.
-- Ochopee charges $3.69 per $1,000 worth of property, bringing in $1.78 million.
-- Immokalee charges $2.73 per $1,000 worth of property, bringing in $1.86 million.
-- Big Corkscrew charges $1.83 per $1,000 worth of property, bringing in $4.8 million.
-- Golden Gate charges 92 cents per $1,000 worth of property, bringing in $8.4 million.
-- East Naples charges $1.34 per $1,000 worth of property, bringing in $14.4 million.
-- North Naples charges $1 per $1,000 worth of property, bringing in $28.8 million.
Marco, Naples and EMS are not included in the above because as divisions of larger governments, all pass-throughs, subsidies and loans from other department funds could not accurately be accounted for. As Ave Maria University in eastern Collier, the Immokalee Fire Department will be responsible, in part, for providing fire-rescue service to the new town.
Also, as residential and commercial development continues along U.S. 41 East — beyond the turnoff to Goodland — East Naples, Golden Gate and Ochopee will have to provide fire and rescue service. Golden Gate and Ochopee firefighters do not have ALS divisions.