Dr. Tober Honoured in Floridia!

[Dustdevil]

And the monkeys keep on whining!

http://www.ems1.com/ems-advocacy/articles/813064-Fla-officials-honor-EMS-director-for-award/

April 29, 2010

Fla. officials honor EMS director for award

Robert Tober's innovation, according to journal, is a 'tiered medical care program'

By Aaron Hale

Naples Daily News

COLLIER COUNTY, Fla. — Add another trophy to the mantel.

Dr. Robert Tober, medical director of Collier County Emergency Medical Services, was honored by the County Commission on Tuesday morning after being named a 2009 EMS 10 Innovators recipient by the Journal of Emergency Medical Services.

The award comes after Tober was named the state medical director of the year by the Florida Department of Health for 2009. It was his second time to receive that honor.

Tober's innovation, according to the journal, is a "tiered medical care program," which promotes basic life-support skills for most of the county's first responders and advanced life support only for the most experienced and well-trained paramedics.

That system has created controversy in Collier County, particularly after Tober pulled advanced life support certification from firefighters in North Naples and East Naples last year. He cited inadequate training standards for firefighter paramedics in that district and, in some cases, cheating on medical tests.

Dr. Wayne Lee, charter president of the Florida Association of EMS Medical Directors, presented a trophy to Tober for his achievement on Tuesday.

Lee, a medical director in Broward County, said the numbers for Collier County EMS speak to Tober's success with innovation.

"My survival rates are not the same as his," Lee said. "His are better."

In the article, the Journal of Emergency Medical Services credits Tober for creating "a program that has decreased paramedic skill degradation and increased ROSC (return of spontaneous circulation) rates."

"Return of spontaneous circulation" is a term for when a heart attack victim is able to get a pulse back. The journal cited a 53 percent ROSC rate in Collier County in 2008.

The tiered system, as Tober explains it, works this way: In cases of medical emergency, initial lifesaving steps should be taken by the first on the scene, whether it is police, parks and recreation staff or firefighters in the form of basic life-support techniques.

The second tier, advanced life support, should be reserved for experienced and well-trained paramedics who may reach the scene later than basic life-support responders, Tober explained.

Advanced life-support techniques include defibrillation, the administration of emergency drugs and setting up IV lines in patients.

Tober said most responders do not need advanced life-support training and equipment, and, in fact, the infrequent use of such technique leads to a degradation in skills. Those tough pre-hospital decisions, he said, should be left to the most qualified responders.

Tiered medical services are nothing new, Lee said. Tober's focus on rapid basic life support as the backbone to the system is the innovation.

Despite the recent honors, not everyone approves of the job Tober is doing.

Jorge Aguilera, deputy chief of medical services at North Naples fire district, said Tober's decision to pull advanced life-support certification for North Naples firefighter-paramedics was harmful to the community.

Aguilera argues the fire district should get its certification back.

"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 better served at a higher level of medical service."

[Lone Star]

Without getting into the whole fire department bashing aspect of the original post, it's nice to see Dr. Tober being awarded for his innovation and active participation in the EMS system.

If more systems in the U.S. were as carefully monitored as Dr. Tober's is, we would actually be taking a step forward in advancing this profession.

[JakeEMTP]

Hey DC Aguilera, quit your bitchin'! The numbers don't lie, 53% ROSC is great. AHA says "early CPR and Early Defib" which you could use your AED for, is the key to ROSC. Leave the other interventions to the folks that know what they're doing. Kudos to Dr.Tober! Congratulations on the award and for sticking to your guns. All that BS last year from the FD means nothing now.

That is all.

[DwayneEMTP]

Holy shit. That is too cool for school.

Congrats to the doc and those that had his back.

Dwayne