By Liz Freeman
Naples Daily News
COLLIER COUNTY, Fla. — Eight medications used in emergency medical calls are being pulled from Collier County fire trucks with advanced life support.
It’s a decision made by the medical director of the county’s Emergency Medical Services amid friction about potential consolidation of EMS with the fire districts.
The medications are used to stabilize the heart, for asthma, seizures, psychotic episodes, fluid build up, high blood potassium and low blood sugar, said Dr. Robert Tober, medical director of EMS, who ordered the drug removal.
Seventeen medications remain on fire trucks offering advanced life support, which are sufficient because they cover the same medical conditions as the eight drugs, he said.
The difference is the ALS fire trucks have rarely used the eight medications and the drugs are more sophisticated in efficacy and side effects, and therefore should be administered by EMS paramedics who have more medical experience, Tober said.
Moreover, having fewer drug choices on the fire trucks reduces risk of medication errors, he said.
“I have enhanced the public safety and not compromised it,” Tober said. “What I am leaving on the fire trucks is every single drug they could possibly need in the first 15 or 20 minutes (on a call).”
Nothing’s changed with the fire trucks being able to provide advanced life support, he said.
Reaction has been varied to Tober’s directive with respect to impact to the public and to the consolidation proposal that’s being developed by the fire districts.
More than two years ago, the Collier County Commission asked the fire districts to explore consolidation with EMS to form one department covering all rescue, fire and emergency medical services.
Jorge Aguilera, North Naples Deputy Fire Chief of EMS, who was Tober’s chief paramedic trainer at the county for many years until two years ago, disagrees with Tober’s decision and says it is political because of the consolidation issue.
Tober didn’t share with the fire districts the drug utilization data from which he based his decision, Aguilera said.
In a letter last week to the fire chiefs, Tober said he reviewed the drug usage history from the last three quarters, from September 2007 through March 2008.
“If I did a spreadsheet, we would probably eliminate medicines in everybody’s boxes not being used,” Aguilera said. “I would hate to venture a decision was only based on three-quarters of a year of information.”
He also disagrees that the eight medications pulled are more sophisticated than the ones remaining on the ALS engines.
From a public safety standpoint, Aguilera said he has a concern the medications aren’t remaining on the ALS fire engines, but he wouldn’t say pulling them poses any threat to medical care provided at emergency scenes.
“I’m not going so far to say that. That would be irresponsible,” Aguilera said. “Anytime you make a decision to eliminate resources, it’s a problem.”
The North Naples fire district pulled the eight drugs from its ALS trucks after receiving Tober’s letter last week, Aguilera said.
That’s not the case with the East Naples Fire District, which is waiting for revised protocols for the medications that will remain on the trucks, East Naples Fire Chief Doug Dyer said.
Tober’s letter to fire chiefs said training sessions will be held soon to reflect changes for cardiac arrest protocols.
“I do not interpret it that way, that the drugs should have been pulled already,” Dyer said.
Dyer wouldn’t say whether he believes Tober’s action is because of the consolidation idea but said Tober’s decision came on the heels of the recent EMS-Productivity subcommittee meeting where removing two ambulances from the roads was discussed.
Likewise, he won’t question whether Tober’s reasons are legitimate from a medical standpoint.
“I would be reluctant to challenge a doctor who has been (doing this) 30 years,” Dyer said. “I’m not going to challenge him on that.”
City of Naples Fire Chief Jim McEvoy said there has been no impact in the city because one of his ALS trucks has an EMS paramedic assigned to it and so the eight medications remain on board.
Crew members with the other fire truck offering advanced life support are undergoing refresher training due to the recent testing failures under Tober’s paramedic certification standards.
McEvoy said he wouldn’t speculate if Tober’s move is because of consolidation.
Golden Gate Fire Chief Robert Metzger said he doesn’t believe Tober’s decision is associated with the consolidation issue. Golden Gate does not have any fire trucks offering advanced life support so they didn’t have the eight medications on board, Metzger said.
He, nevertheless, is concerned about improper restrictions being placed on fire department paramedics.
“I believe all paramedics in Collier County should receive the same training and same protocols,” he said. “They should have the same training and given the same medications if placed in a situation where it is needed.”
Tober said he faced political pressure a year ago to add more medications on the fire trucks and went along reluctantly. After reviewing which medications are being used, the eight were rarely administered by the ALS fire trucks.
“Occasionally they started an IV and occasionally they gave a couple of drugs like aspirin or nitroglycerin,” Tober said, adding that the eight drugs were used 30 to 40 times collectively out of thousands and thousands of calls.
Physicians and other medical personnel need training updates to stay on top and that is also the case with paramedics, especially if it is for certain medical care they provide infrequently, he said.
That’s why EMS paramedics loaned to the fire departments rotate back to ambulances every other month to stay on top of their skills, he said.