Live saving drugs pulled from fire truck in Naples, Florida

[Richard B the EMT]

I wish. In my area, any medical director who suggested such a test would be replaced before it could ever take place. Hell, they'd be replaced just for proposing the idea that they should be more than a signature on a supply order form.

Then, again, there are a few Doctors who care enough to practice "Tough Love", which may be the wrong label, but could describe what happened.

[letmesleep]

I once again post my position, admittedly without documentation to support, when an FD agency CHOOSES to increase their lifesaving efforts by including EMS, it usually is successful, but when others outside the agency TELL them they are to take on EMS responsibilities, due to resentment of being told what they "have to do", rebel in numerous ways against it.

Could this be why so many "failed" this test?

Actually, until such time as they get to the bottom of this failure rate, I agree with the OLMC doctor that pulling the meds is, regrettably, the proper course of action.

With all due respect Richard, would this just be making an excuse for this particular group of medic/ FFs? I'm not damning the system as a whole (at least here), just this group. What would be the difference if it was a FF test that they failed, in regards to this statement?

[letmesleep]

I wish. In my area, any medical director who suggested such a test would be replaced before it could ever take place. Hell, they'd be replaced just for proposing the idea that they should be more than a signature on a supply order form.

Why? What is wrong with a medical director insuring that those he/she are governing are up-to-date, educated, and for lack of a better term, at the top of their game? They are working under that medical directors license, so what is the harm done with this type of insurance? We do an annual skills review here and are tested on ACLS, airway, MEDS, and even assessment and back boarding, anything that we may do. If someone is having issues with a skill or "knowledge of" they are sat down and reeducated on it. Our medical director governs over multiple agencies county wide, this insures that we are all preforming on the same level and mutual aid runs smoothly, on top of other issues.

[Just Plain Ruff]

we need to look deeper into this. 12 of 14 medics who took this test failed. We need to take a step back and see if we need to go back to protocols that say, "if wheezes are present(those are high pitched sounds on either expiration or inspiration) then open the Red box and push the plunger of the syringe till it reaches the black line on the syringe"

Or maybe we need medics who actually know what they are doin. I'm sure these are competent medics but to fail a test you had one month to study for is just laziness. This is a discouraging turn of events.

My real question is this, why did they just give the test to these 14 people? Was it given on a station by station basis or what.

Sad sad sad

[txffemtp]

...I wonder how many calls these guys run? I see so many systems in the Dallas/Fort Worth area who have multiple "medics" on every firetruck, but they start an IV once every couple of months or worse...attempt a tube every few years. Why, so the publis is safer from guys with cute red patches on their shirt and then when they have to transport to the local ER, patients who are altered to the point of GCSs of 7 and 8, they dont even bother with little things like O2 therapy, much less IV sticks.

It is becoming more and more obvious that EMS has multiple layers...some folks do it because they care about caring, others are doing it just for the paycheck. It sucks. Nice job to the doc though...if you dont understand why you are doing something, why are you doing it? 12 of these medics didn't get it obviously.

[VentMedic]

Collier County EMS has had a good reputation for many years with Dr. Tober as the MD. He's done other noteworthy things in Collier County.

Collier EMS medical director to be in national TV spotlight

By LIZ FREEMAN (Contact)

10:07 p.m., Tuesday, November 6, 2007

http://www.naplesnews.com/news/2007/nov/06.../?breaking_news

I posted other merger articles earlier but this one does a good job at putting the differences in view.

Clash mars fire/EMS merger talks

By I.M. STACKEL (Contact)

10:19 p.m., Sunday, December 23, 2007

http://www.naplesnews.com/news/2007/dec/23...s-merger-talks/

Gail Dolan tried to mediate on Wednesday when fire chiefs and Emergency Medical Services Director Bob Tober verbally clashed.

“How about we focus less on training and focus on patient outcome?” asked Dolan, who is the Chief Operating Officer of NCH's North Naples hospital campus, and an EMS Advisory Council board member. “Then, you’ll see (the answer, which is) ‘how did patients fare?’ ”

Her suggestion came shortly after Tober yelled at Marco Island Fire Chief Mike Murphy for alleging bias against emergency workers with advanced life support training, but who weren’t shepherded by Tober.

The ALS workers are licensed by the state.

“I didn’t bring this up as an ‘us against them’ issue, but I do believe we have opportunities (and should) seize opportunities to improve the system. We have rural areas of the county (and there’s) fragmentation on patient care,” Murphy said.

The inconsistency is due simply to the vehicle on which paramedics arrive and by which agency they are employed, Murphy said. Firefighter-paramedics in other jurisdictions are treated equally, but in Collier, they are not considered capable of the same duties, Murphy said.

Tober lashed back.

“This is the same exact nonsense about improving training. How much plainer do I have to be about this?” Tober asked, hollering.

“I have a right to question it,” Murphy said quietly.

“And I don’t have to listen to it,” Tober yelled.

The interaction was more public than usual, occurring at an EMS Advisory Council meeting, but it is the same fundamental debate that has mucked up efforts by Collier County fire chiefs and EMS to work out a platform for consolidation, as was requested in spring 2006 by Collier County commissioners.

Tober reiterated his rage in an e-mail on Thursday.

“You heard me yell because I had very, very good reasons to be outraged, and remain outraged. This is medical public policy that safeguards you and I, pitted against a very organized, national movement of fire departments (attempting) to take over county EMS organizations, regardless of the consequences,” Tober wrote to a Daily News reporter, who witnessed Wednesday’s outburst.

Wednesday’s exchange began at the Oct. 30 EMS Advisory Council meeting, when Murphy requested a Tober presentation on county emergency medical protocol, a program Tober designed in the late 1970s.

When Tober arrived in Naples in June 1978, Collier farmed out its transport service to American Ambulance.

On Feb. 2, 1979, Tober launched the first set of six ambulances, staffed by the 18 paramedics he trained.

“Over the years, these six ambulances have grown to 26 ALS units, and, in addition, the emergence of some ALS engines staffed by both EMS and fire departments,” Tober said. Differentiating between basic life support (BLS) and ALS, Tober noted that the system is inconsistent from one area to another.

Fire departments in Immokalee, Corkscrew, Golden Gate and Ochopee still only have firefighters skilled in basic life support, Tober said.

“I have increasingly heard the statement that a paramedic is a paramedic is a paramedic,” Tober said. “That is, all such medics from both the fire departments and EMS are state-certified and licensed, so why is there any difference in their protocols or clinical liberties? Why are they medically credentialed at different levels within our one protocol, and why do fire departments continue to hire and develop additional paramedics in their own systems? Collier County has but one single protocol.”

It is the one Tober created, he said.

“If I diluted this system down (to) another 80 to 100 paramedics, I would face serious skills and decision-making degradation,” Tober told the EMS Advisory Council board.

“I, personally, am insulted for all medics in Collier County, (that they should be forced back to) helper status,” said Murphy, an EMS Advisory Council board member.

But Tober had his defenders.

EMS Advisory Council Vice Chairman Nancy Lascheid, whose husband founded and operates the Neighborhood Health Clinic on Goodlette-Frank Road, said there’s no need to interrupt service protocol and she doesn’t think skill levels are equal.

Fellow EMS Advisory Council board member Jeffrey Panozzo both came to Tober’s defense but also questioned why ALS couldn’t be considered comparable to EMS.

Referring to Tober as his “mentor,” Panozzo — who is the director of Emergency Medicine for Physicians Regional Medical Center on Pine Ridge Road — said he worked as a firefighter during medical school.

“Medics can be firemen and firemen can be medics. We’re talking about enhancement of service,” Panozzo said. “I have zero personal bias, except that I'm interested in EMS (so) why don’t we allow the merging of these teams? You mentioned that 80 percent of calls are attended to by fire engines.”

Firefighters start the call, Tober stressed, noting his 26 ambulances are “the primary immersion method.”

“I don't need 60 ambulances,” Tober said.

“I think you underestimate firefighters,” Naples Fire Chief Jim McEvoy told Tober.

That was Diana Watson’s take, as well.

Once an EMS-employed paramedic, Watson is now an East Naples Fire Rescue chief.

An EMS paramedic may be fresh out of training, trying to guide a former EMS worker with 20 years of experience, Watson has said in the past.

“Your most experienced medic may not be from EMS,” Watson said Wednesday.

“Now, my certification is lower than it was at EMS?” she asked.

She called for parity and recourse.

“We want to provide ALS engines for our people, but Collier County holds the ‘certificate of necessity.’ I still consider myself a paramedic,” Watson said.

EMS Advisory Council board member Dolan said she began her career as a nurse, and there needs to be a committee to talk out these issues.

“Bob Tober could go to Tahiti tomorrow. Then what? Things change. In my mind, the patient is No. 1. We need to try to change the system to work together,” Dolan said.

But, that’s already happening.

Thursday, the Collier County Fire Chiefs Association rolled out the first, very rough, draft of a consolidated, countywide district, which would erase political and geographic boundaries.

Representing 10 public fire-rescue districts, including the county-run EMS, assistant chiefs of operations for several districts hammered out a flow chart and plan that will be reviewed in January by the Fire Chiefs Steering Committee.

The consolidated fire districts would become one single entity responsible for all fire-rescue and emergency medical responses throughout the county, and would be independent of the Collier County commissioners who suggested it.

The position of medical director would be established as a contract employee, reporting to the top fire chief.

Former EMS Chief Jorge Aguilera, who moved over to North Naples Fire last year, said the operations team looked at strengths, weaknesses, opportunities and threats.

First off, elimination of political and district boundaries will result in better response time to people who need help, he said, although those response time calculations won’t be completed until all the research is finished.

Also, there will be one manual, with one single standard of operating guidelines, he said.

“There will be a single ALS protocol, countywide,” Aguilera said.

While taxpayers will not see immediate savings in the first few years of consolidation, that will eventually follow.

Likewise, the disparity in benefits from one fire district to another will dissolve, as there will be one labor union.

Thursday, fire chiefs said their unions continue to talk about merging, and those discussions are moving along nicely, although no details were immediately available.

North Naples Fire Chief Mike Brown observed that districts, alone, can’t push ahead with consolidation, that public support is essential.

“This has to gain a constituency unto itself. It is going to require public relations, newspapers, and a lawyer or two. This is just step one,” Brown said. Also, Brown said he doesn't want to send out a message leading county residents to believe the system is broken.

It is not broken, he said.

“This will just improve our system for decades to come,” Brown said.

[Asysin2leads]

See, all the media ever does is report the negative. They don't mention that there was a 100% pass rate on the grueling "Kitten in a tree" scenario.

[okmedic]

See, all the media ever does is report the negative. They don't mention that there was a 100% pass rate on the grueling "Kitten in a tree" scenario.

LOL

[Richard B the EMT]

Fellow EMS Advisory Council board member Jeffrey Panozzo both came to Tober’s defense but also questioned why ALS couldn’t be considered comparable to EMS.

Perhaps it is my bumbling around, but the last time I checked, ALS was one of three levels of care in EMS, the others being First Aider/First Responder and Basic Life Support (BLS).

This leads me to question "EMS Advisory Council board member Jeffrey Panozzo's" medical knowledge, as ALS is not a parallel universe from EMS, but an integral part of it.

Also, I think the reporter is also lacking in that knowledge, otherwise that reporter might have questioned the board member's statement similarly to my questioning of it, and probably others on the EMT City site.

[VentMedic]

Perhaps it is my bumbling around, but the last time I checked, ALS was one of three levels of care in EMS, the others being First Aider/First Responder and Basic Life Support (BLS).

This leads me to question "EMS Advisory Council board member Jeffrey Panozzo's" medical knowledge, as ALS is not a parallel universe from EMS, but an integral part of it.

Also, I think the reporter is also lacking in that knowledge, otherwise that reporter might have questioned the board member's statement similarly to my questioning of it, and probably others on the EMT City site.

You would have to understand a Florida Fire-based system. We have "ALS" everything here with FDs from engines to golf carts. The term ALS also refers to a lot of services that cannot tranport such as the ALS engines. They have very minimal patient contact or even a continuance of treatment.

The EMS system being referred to is Collier County EMS (similar to Lee County EMS) which has strict medical oversight and is a full service provider of patient care.