Editor’s note: This story may prove to be interesting as it continues to evolve. EMS exists as a nexus of public safety, health care, and public health — how much of each sphere it incorporates depends upon the region’s philosophy on providing prehospital care. At times, these areas collide, creating tense situations such as these. I hesitate to gaze into a crystal ball — politics often interferes with common sense and reasonable approaches supported by data. Let’s hope that I’m wrong. Please share your thoughts below.
Art Hsieh, EMS1 Editorial Advisor
By Aaron Hale
Naples Daily News
NAPLES, Fla. — Diplomacy failed, a North Naples fire official says, so the department is moving ahead on its own.
The North Naples fire district has chosen to resume its effort to provide advanced life support emergency services through its own medical director, Deputy Chief Jorge Aguilera said.
The advanced life support program was suspended last year for the district when the medical director for Collier County Emergency Medical Services (EMS) pulled certification for firefighter-paramedics. The program had allowed certified fire district paramedics to provide advanced life support techniques to patients before Collier EMS took over to transport patients to the hospital.
Advanced life support techniques offer paramedics a larger complement of tools and techniques for an emergency situation than basic life support techniques, including starting IVs and administering powerful drugs during serious heart attacks and allergic reactions.
Dr. Robert Tober, the EMS medical director, pulled the certifications of previously approved North Naples Fire paramedics, as well as those in East Naples, citing a failure to meet training requirements.
Currently, only fire departments in the city of Naples, city of Marco Island and Ochopee offer advanced life support in Collier County. The rest, including North Naples, give only basic life support, which includes techniques such as CPR, until Collier County EMS paramedics arrive.
Aguilera, who oversees the North Naples fire department’s medical services, has argued advanced life support techniques are essential for providing the best safety to the people of North Naples.
“The inability of North Naples to be able to augment the first response is without a doubt a detriment to the citizens,” he said. “They would be served at a higher level of medical service.”
To have its advanced life support program reinstated, the district applied for a certificate of need in November, Aguilera said. The move would have the state certify the district’s own medical director, Dr. Jeffery Panozzo, and would bypass the need to go through Tober, he explained.
The North Naples application would have to be approved by the Collier County Commission, Aguilera said, before it goes to the state for final authorization.
That application had been put on hold for months, Aguilera explained, because the district had hoped to negotiate new terms for advanced life support with Tober.
Attempts to negotiate failed to give the district what it wanted, he said.
Keep life-saving skills fresh
Tober’s primary justification for taking away advanced life support certifications from North Naples and East Naples last year was failure to participate in a swap program with Collier County EMS. Under that program, fire paramedics were required to work in EMS ambulance shifts several times a month.
The program was meant to give fire paramedics continuous hands-on experience in emergency situations, Tober said, and to keep their life-saving skills fresh.
North Naples officials cited “logistical” problems in scheduling its almost 50 paramedics in the required number of shifts.
When North Naples fire officials tried to negotiate new requirements to meet Tober’s concerns about training and the district’s concerns about logistics, Aguilera said Tober wouldn’t budge.
For his part, Tober said disputed training requirements aren’t the only reason North Naples paramedics are without the desired certifications.
“I definitely believe the fire districts don’t need (advanced life support) service,” Tober said, “particularly if their districts are not in places that are geographically remote.”
Tober argues for a tiered pre-hospital medical system in which advanced life support is left to county EMS and agencies such as fire departments and the Sheriff’s Office should focus on quick and proficient basic life support services.
That model earned Tober recognition with the Journal of Emergency Management Services recently, when it named him one of the top 10 innovators in EMS for 2009.
It also was supported in February by a panel of community leaders who are looking into pre-hospital EMS and fire services in Collier County.
That committee is led by retired Physicians Regional Healthcare System CEO Geoffrey Moebius and includes representatives from various county agencies. The panel’s recommendation prompted the East Naples fire district to formally vacate its advanced life support program in March.
An uphill battle
The North Naples fire district may face an uphill battle if it is relying on county commissioner support to bypass Tober.
Fred Coyle, chairman of the Collier County Commission, said he was skeptical of the approach by the North Naples fire district to establish its own advanced life support program through the state certification.
“The (commission) in the past has been reluctant to create multiple standards of EMS tiers in Collier County,” he said.
Coyle offers an “if it ain’t broke, don’t fix it” argument for pre-hospital care in the county.
“We have an award-winning EMS system that is nationally recognized,” he said. “They do a wonderful job, and one of the reasons we have such a record is because there is centralized control.”
He said North Naples’ approach would fragment the current system.
For now, the North Naples fire district continues its business as if it will have its advanced life support program reinstated.
Even since losing certification last year, the district has maintained paramedics and trainers on its staff.
The district continues training programs so that, as Aguilera puts it, “we just have to turn the key” to restart the program.
It remains uncertain if the district will be able to start that engine anytime soon.
Copyright 2010 Collier County Publishing Company