FL Firemonkeys Attempt to go around Medical Director

[Dustdevil]

http://www.ems1.com/fire-ems/articles/814807-Medics-to-provide-advanced-life-support-techniques-to-patients-in-Fla/

May 3, 2010

Medics to provide advanced life support techniques to patients in Fla.

Advanced life support techniques offer paramedics a larger complement of tools and techniques for an emergency situation than basic life support techniques

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.

[Kiwiology]

Disgraceful

[Kaisu]

administering powerful drugs during serious heart attacks

What, as opposed to the non-serious heart attack?

North Naples officials cited "logistical" problems in scheduling its almost 50 paramedics in the required number of shifts.

Yeah, its difficult all right, to get fat asses outta the chairs long enough to run a minimal amount of med calls.. although its probably good for the patients that those aholes aren't out there sticking powerful drugs into veins.

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.

It remains uncertain if the district will be able to start that engine anytime soon.

I certainly hope so. Go Dr. Tober Go.... You are a hero to those of us in EMS that care about delivery of medical services in prehospital environments.

[46Young]

If scheduling 50 firemedics for ambulance poses "logistical" problems, that can be easily solved by making everyone dual role.

Just kidding

Seriously, if ALS first response in a relatively densely populated area is unnecessary like Dr. Tober says, then can't EMS admin go above the fire admin to the Board of Supervisors (or whatever the local governing body is)? Having unnecessary ALS surely costs the county a pretty penny. Speak actual dollars and cents and you have a shot at cutting through the FD propaganda. Espacially if the county has implemented any tax hikes to cover basic services.

[emtannie]

From original article:

“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….”

“North Naples officials cited "logistical" problems in scheduling its almost 50 paramedics in the required number of shifts.”

So, if they are “firefighter-paramedics,” what is the problem? I suspect that part of the problem is that they are FIREFIGHTERS… they only got their medic designation so they could work for that service, but they don’t really want to be medics… they want to be FIREFIGHTERS… they want to respond in the big shiny truck, not the ambulance. They don’t really want to deal with medical or trauma emergencies, but want to deal with cutting apart cars and spraying foam and water on fire.

Logistical problems – nice excuse. If they truly wanted to provide quality care, they would have made it happen.

46Young, I agree with your dollars and cents approach – many services only want to deal with the bottom line, and I think this is one of them – they obviously don’t want to meet the criteria for quality care, so arguing the financial aspect may work.

CrapMagnet – I LOVE your response. You hit the nail on the head!

It seems like more and more I am seeing articles about fire departments wanting to provide EMS services, but aren’t willing to meet the requirements. They want to be able to say they provide EMS services, but want to shortcut on training and service. To me, that just proves that fire departments aren’t in EMS in order to provide patient care. If the tables were turned, and an EMS service wanted to provide fire services, but didn’t want to meet all the training requirements or skills requirements, I suspect that the IAFF would have an awful lot to say about it.

[Dustdevil]

It would be interesting to see an audit of the department's training records to see how often they have "logistical problems" keeping up with their fire training.

I'm betting it doesn't happen. Nuff said.

[Kiwiology]

It would be interesting to see an audit of the department's training records to see how often they have "logistical problems" keeping up with their fire training.

I'm betting it doesn't happen. Nuff said.

Testify brother

I bet these "logistical problems" come in two flavours

1. "I don't want to work on the ambulance bitch bitch bitch, Ima stay here and watch telly" or

2. "Oh lord not those bloody Firemedics again, they're shyte, we don't want them on our trucks"

[BushyFromOz]

Testify brother

I bet these "logistical problems" come in two flavours

1. "I don't want to work on the ambulance bitch bitch bitch, Ima stay here and watch telly" or

2. "Oh lord not those bloody Firemedics again, they're shyte, we don't want them on our trucks"

My experience with "logistical problems" is that they are only really a problem when people could not be bothered to put in the effort or the cash.

[spenac]

My experience with "logistical problems" is that they are only really a problem when people could not be bothered to put in the effort or the cash.

What makes it sadder is they were going to be paid to go get the time on the ambulance. They were not volunteering to do it free.

[EMSPROFESSIONAL]

I applaud Dr Tober and hope this idiotic attempt to avoid education and practice keeps this group of fire fighters from having access to advanced procedures.