Commissioners remember the challenge, make sure that if you create the office as you effectively did today, that you give it the resources to succeed. Just creating it and not supporting it and helping it establish itself is a failure. With an apolitical (outside EMS or FIRE), system everyone can win.

Sorry if this is off topic. But can someone give me a coherent explanation why a person who falls ill at a third street restaurant gets not only an EMS vehicle but also a firetruck while the EMS was first on scene?

Dear savethewhalz,
That is a good question. It is to ensure that that person receives the best care possible.

It is better to have more hands available if that person were seriously injured or went into cardiac arrest. Sometimes it is necessary for one of the Firefighter Paramedic/EMT's to go with the Paramedic on the ambulance to help care for a critical patient.

It may be a bit preemptive, but it is better for the patient in crisis, rather than waiting for additional assistance to get there.

I do understand that in your case, you said EMS was already on scene, but a majority of the time the Fire Dept. does arrive first and they are trained to administer, at a minimum, basic life-saving measures.

I do help that this helps.

#2 Because in many cases it takes a lot of hands to provide quick and efficient emergency care to an individual. If EMS arrives on scene before fire, and do not need the extra help, they will cancel the fire unit. Many times EMS is out of zone so a fire unit will arrive first, and provide Emergency care to the pt. All Fire trucks have EMT's and many have Paramedics. That is the whole arguement about Firefighter/Paramedics being able to provide Advanced Life Support rather than Basic Life Support. Tober does not feel that the Fire/Medics do enough of the ALS in the field to provide this care to pt.s. Many of us in the fire department feel differently as there is only a handful of medications that ALS Fire trucks carry anyways opposed to 40 or 50 Meds carried on the ambulances. Collier County citizens regardless recieve very good care and these stories overshadow the quality of the training of both Fire and EMS agencies in this county. The inter feud between agencies would be solved and we would all be under one roof with the same training if there were a County wide consolidation.

Savethewhalez,
Sometimes callers dont always give dispatch the best infomation. "Falling ill" could be the flu, and it could be someone in cardiac arrest. While a two person ambulance can easily handle someone who has eaten a bad sashimi tuna at that 3rd street restraunt, a cardiac arrest call requires more emergency workers. CPR, autopulse, intubation, establishing an IV, pushing medications,defibrillation....Collier EMS often runs 2 man ambulances. When you consider that 1 of those two has to drive, you can understand why additional resources may be needed. Also, sometimes the nearest ambulance is on another call. When an ambulance comes from out of zone, the nearest firetruck will repond. Hope this helps.

Three answers within three minutes. How is that for fast response times.

I was just thinking the same same thing CVB...
but I guess what they say is true... Fire's faster, lol. I hope you are all having a good night.

To the commissioners, Dr Tober is the best thing you have going for you, don't mess it up.

Finally Dr Tober.You don't have to deal with Page and Danny boy any more.This is good for Fire and EMS.

I have spoken with many medical para-professionals, nurses, doctors, etc. and none of them have ever mentioned the attempt to cross train them in fire fighting.

And why are WE paying Dr.Tober a minimal $105,000?
What did the new turf cost at Naples HS?
Dr. Tober, ask for a raise!! a huge one!!

Perhaps bornfree1 you will be shown to be right. I hope so.
Having spent time in other parts of the State without as much infighting within the EMS/FF communities, I find it confounding here. Contentiousness seems to be the religion!

My wife worked ERs for years. She continues to marvel that this system functions at all. I caught a bit of an interview where Dr. Tober was stating that since (one group???which one???) was not using the drugs on board the ACLS trucks, he thought he should take away the drugs so they would not "fall into the wrong hands"!!! I was shocked by his mistrust of the paramedics of whom he spoke. My wife with her ER experience said she would rather have a paramedic/FF take care of her in a trauma than most any others (except for the staff of a major trauma center.) Since she once worked at a major trauma center...well, I trust her opinion.

Now, who can we trust here? Should we consider a tattoo across the chest saying "transport to TGH at all costs"?

Dr. Tober and Dr. Doug Lee. I couldn't think of a better team.

Now that Dr. Tober has been given the sink or swim scenario how has he done so far. WINK news had him on so he could once again insult FD paramedics and question thier compotentcy. He might be the best we got (for now) but keep him away from the news media or he will continue to ruin or EMS system. What of Dan (Dan Dan the Hurricane Man) Sommers where was he during the commission meet along with Mr (not a Chief) Paige, a responsible public servent would at least be present to answer question the public and other public servants might have. I am sick and tired of my tax money paying inept, possible corupt and definetly self serving ADMINISTRATORS to not do there job all because apparently or elected officials are afraid to admit a poor choice in that person . Wheres my $8,000,000 in uncollected revenue Jeff (not a Chief)? Hey Dan Dan why didn't you step in and get fat boy (not a Chief) off lord Tobers back? Bowman (Belly Rest Boy) should be the first one tested on ALS protocol. Message to the commissioners EMS is still broken and you can't fix it!!! Its not the feild personel FD or EMS thats broken its the administrators and they all need to go...

Thanks for all those who jumped in and explained why there is a fire department response along with EMS on most medical calls. I know I have explained that here before but still many do not seem to understand. Hopefully everyone will read this and come to understand that this type of response is to provide the best treatment of the patient.

I hope that our residents also understand that this infighting that you are seeing here is strictly at the administration level. There is no infighting at the street level and all the personnel from both the various fire agencies and EMS work well together on daily basis to provide the best care to the citizens they can.

Most of this infighting is cause by inept management at Collier EMS. I believer their main concern is they feel they are loosing control of the EMS business here as the consolidation issues is being debated. They know if there is a new organization formed they will most likely be on the outside (which would be the best thing for all concerned) looking in while a new management team takes over.

Ever since CCEMS was formed back in 1981 there has quite often been spats between the EMS management and the fire chiefs over just who should be allowed to administer certain level of care. Dr Tober has never been in favor of letting the fire agencies being allowed to provide ALS services. He has fought that from the very beginning.

The thing is that in many communities it is the fire department that provides the EMS services to the community. It only makes sense having one agency providing the same service rather than two different agencies.

The time has come for Collier County to get on board for a consolidated Fire/EMS agency. This would end a lot of the infighting between the managements of the various agencies. Having everyone under one agency working under one set of protocols will provide for the best service for the citizens.

It's time for all this political nonsense to end because that is all this amounts too, POLITICS!

Obviously there is a divided perspective as indicated above by erdoc (are you one...a real ER MD or DO with trauma training?) and the fellow/gal above angrytaxpyr with some insight into the inner workings.
I felt the comments that Dr. Tober made on camera about fire departments were unprofessional. Even if he felt strongly this was true, making that kind of statement in a news broadcast was insulting and divisive. Not a good beginning no matter how skilled he is in managing trauma and ACLS protocols. My wife was both ACLS and PALS certified. She worked with true professionals who respected one another and her boss was an ER doc who has more degrees, credentials and experience than most. The doc left Florida for the Washington DC area, or my wife would have never left her previous job. This doc had respect for EMS, but the system in that part of Florida was not dysfunctional. Why? They were too busy working hard to get into territorial turf battles.

I am concerned because IF/WHEN we need to call 911, I do not have the confidence in this system as a result of the problems both my wife and I see. At least I have a wife who is almost fully retired to know what to do for our family but perhaps I should find a way to get trained to care for her should she need help. HOW can anyone have confidence in anyone who would be so divisive?

I am not impressed by either hospital system here. One seems ill prepared to truly manage trauma in the ER (been there but not as a trauma)...and patient confidentiality despite HIPPA seemed non existent.

I observed both as a patient and as a visitor many violations of infection control protocols in all the systems. Guess we were fortunate to have had world class care in a more sophisticated area with a higher standard of care.

Dan Summers may have been the man in NC, but his management has not helped heal the problems here.

Let's see if the changes which are needed to heal the system get made, now. We need a fully functional EMS/FF system here and hospitals who understand infection control, biohazardous waste regulation, patient confidentiality and better security as well!

swfl_ff: I wish I had read your comments before I posted mine. I feel better as if the folks who work the field work well together as this is critical difference.

Appreciate your post!

Thanks BTV. This is nothing more that yet another turf battle. This is not the first time that there has been a turf battle but I hope it will be the last one as consolidation moves closer.

Hopefully a new consolidated agency will be an independent operation separate from the county government and all the politics there. It should be managed by professionals and not by politics.

It's time to put this petty stuff behind us and look to build a new agency that will provide equal fire and EMS services to the entire county operating as one instead of the fractured system that now exists.

QUOTE:
“The medical director is still going to be relying on the failed system we have today,” Cunningham told commissioners. That will persist “until we create a true office of a medical director.” It can be done: “It does work in many operations in other parts of the country,” Cunningham said.
What do you mean by “true office of the medical director”, one where you can replace Dr Tober with your own medical director?
“It does work in many operation in other parts of the country” – Yes, other parts of the country where the survival rate is less than 10%. In Collier County, the survival rate is 37%.
Why fix something that is not broken?

Outlaw,

The purpose of creating an office of the medical director is to improve care by removing the politics and concentrating on saving lives. The office of the medical director would be just that, Tober's office. He could further develop/tweak his protocols and have a staff, outside of EMS or fire, to do the training and make sure that everyone is prepared at whatever level is deemed appropriate. This is the best possible situation. By removing the medical director from EMS and giving everyone equal access, life gets better, care gets better and the politics (if they properly form and fund the office) die.

This is a win win. Tober can do what he feels is right and necessary and not worry about pleasing EMS and EM management. They can't hold the, 'we will just not renew your contract' crap over his head.

Post #2-
The answer to your question is simple. 80% of 911 calls are for medical services, not fire. Fire departments need to justify their existence, therefore they respond to medical calls.

However in Collier County Dr Tober has set the bar high, requiring additional training and oversight then what is required in other parts of the country. Many Fire Departments want to practice medicine under Dr Tober’s license, but they do not want to comply with his standards.

I believe Dr Tober supports all firefighters providing medical services, even at the level of county paramedics; as long as they comply with the training and quality assurance standards that he established.

Post #19

I also support the office of the medical director.

What I do not understand is what Cunningham meant by “true office of the medical director”. Is he referring to one that reports to the fire chiefs and not the BOCC?

Post #14
Quote SWFF_FF:

“The thing is that in many communities it is the fire department that provides the EMS services to the community. It only makes sense having one agency providing the same service rather than two different agencies”.

You are so right, but let’s not forget that Collier County EMS is not broken; it is the fire departments that are fragmented.

7 independent fire districts and 2 dependent districts provide various levels of services throughout the county, all with their own protocols, procedures, commissioners, fire chiefs, unions, and such. It is the fire departments that are in need of consolidation.

Collier County EMS is a nationally recognized, award winning EMS system. They provide a consistent service countywide.

Outlaw,

I suspect what Jamie was referring to, and was probably misquoted, was that unless the office is truly established nothing will change. Again I'm not sure what he was thinking, but these are my thoughts.

Allow me to explain. If you remove the medical director, but give him no resources, then where does he get his resources? Who does his training? How does he communicate with FIRE and EMS? Without resources, he requires EMS and EM staff to do this. What needs to happen, as I see it, is to remove training and compliance from EMS and give them to the 'office of the medical director'. This takes the politics out of saving lives, elevates medical care, and grants the medical director the ability to function properly without 'Mother May I's' to EMS for resources.

As for your quote, "Collier County EMS is a nationally recognized, award winning EMS system. They provide a consistent service countywide." - They were at one time.... when most employees spent their careers there and turnover was low. Now, due to change in focus, people leave. Good people leave. Some stay, but the level of experience on the street is not what it was when EMS was a 1999, 2000 world class system.

Collier EMS is broken, not fragmented.

Intell-

Well said regarding the office of the medical director. That makes sense to me.

Not sure if I agree with EMS being broken

why is not possible to consolidate all of the ems/fire into 1 dept....the number of vehicles responding to emergencies be they health or fire shoulf be streamlined in one functional operation...having lived here over 30 years... it seems people are more turf oriented than what we taxpayers can afford....consolidate....the savings would be 50% of what we spend today......with one chief not 11...

Let's put it this way NaplesOutlaw. EMS into it's self is not broken. The street level crews are doing the same great job they have always done. It is the EMS management that is broken and has been. That leadership needs to be replaced NOW.

As far as Tober goes I can tell you from being here the past 30 years that he has never been a big supporter of the fire agencies delivering medical care beyond basic life support. It has only been in the past few years that he has moved on this issue at all. And then only because of he had no real choice.

Tober is an excellent doctor and wants to set the bar high no argument there at all. I have seen him action and he is one of the best when it comes to patient care. He however is arrogant and egotistical in his approach to most things and has always been that way.

Hopefully if he can work independent of the EMS so called chiefs he will be able to properly control the training so it can be provided equally to all agencies involved.

Makesense,

It is only now that the financial hangover is upon us, as well the change in guard with regard to local fire chiefs, that most everyone is in agreement that a consolidated system is the direction to proceed in.

For years, 30+ and counting, the issues from the different fire districts' taxpayers have been that they wanted to pay for what they thought they needed. On one hand this makes good sense, and is the basis of good government. Figure out what level of service you want and pay for it. This portion works for roads, for medians, and for other items, but not public safety. If you live in North Naples, at some point you travel to or through another area of the county, Alligator Alley for example. While you live in NN and pay for NNFD, you will be serviced by GGFD, ENFD, or Ochopee if you have an issue on the alley. CCEMS will be the ultimate medical provider regardless, but a good portion of your services will be from another district than that in which you pay taxes. So as a citizen, I want a universal response, FIRE and EMS. I want the same services and abilities regardless of where I am in the county. The only answer to this question is consolidation.

So your turf observation was correct, sort of. The savings, well 50% is extraordinarily off base. Most of the operational costs of departments (FIRE or EMS) are salaries. Yes in consolidation you can streamline, and yes there will be redundant positions, no need for multiple head chiefs, but those positions do not necessarily go aware, they just morph as there is more to do and you still need people to do it.

swfl_ff, funny that you mention Tober's ego getting in the way. Others I know with other agencies have found him impossible and that is too bad.
Having lived in a community with a consolidated fire/medic program I felt more secure than I do here even if the folks in the field are working well together. I have met a few and feel good about them, however, I am glad I am a healthy person. Time to go work out so I can stay that way.

NaplesOutlaw, just let you know, EMS and fire operate under the same protocol in Collier County as there is only one medical director in this county. Maybe you are trying to get at the SOP's/SOG's of the different fire departments in Collier County. I couldn't agree with you more in that. Everything from manning on fire trucks to what is done on the fire ground to wrecks to fire preplans to etc. Everybody should be on the same page with the same amount of manpower available.
I can't say I agree with all of your comments, but I will keep my mouth shut on the disagreements I have with them.

Thank goodness for Dr. Tober, if it wasn't for him, we would not have all the advance care that is provided to the community. Dr. Tober has always provided and taught best practices for our patients.
I miss him dearly, he is one of the best physicians that i have ever worked with.

Hey RN if Lord Tober is so great why in nearly 30 years has he not figured out how to provide his ALS protocol training to all area FD & EMS paramedics? What did he do for that $105,000? I know what, reduce the level of service countywide, call FD paramedics incompotent and he provided an example of how a proffesional should not act. On the front page of this same paper Commissioners praise Mudd for his fiscal managment and leadership (better than sliced bread) of the County. What county are they talking about? $100,000,000 for a water park that will never produce positive revenue, million dollar medians, and can't get department administrators to attend public meetings. Those same B.E.S. administrators Dan (Dan Dan The Hurricane Man) Sommers, Mr. (not a Chief) Paige, Dan (the Belly Rest Boy) Bowman have a lot to do with the EMS / Fire consolodation road block. Here's a suggestion for Mr. Windy (hurricane man), take the two units that are supposed to be removed from service, cut the roofs off and turn them into "mobile medians" and let the unemployed medics and EMT's operate and maintain them until your Tober Certified medics give up those certs, seniority, security and leave for a slim job market but definitely better treatment. Lets look at some the real issues here: FD & EMS consolodation if done correctly will provide better service and reduce the finacial burden on me (angrytxpyr) the big question is what organization is better suited to form and administer this new entity. According to this paper the FD districts budgets are in, all are balanced (some more than others) and some have even increased service levels with less $$$. NNFD: 6 years ago they were nearly bankrupt and under state and federal investigation. Now look $10,000,000 in reserves, lower milage rate, a clean (nearly immposible) financial audit, administrators who demonstrate (daily) thier public accountability and they can buy a new grocery getter A.K.A. an engine. GGFD: New (real Chief) Chief, new stations, new trucks, top of the line lawn service and a UNION body that accepted no wage increases. ENFD: balanced budget and no service reduction. City of Naples: plumbing works good! Lights not so good! and Chief (he's a Chief) Mcevoy would be gone if it didn't work right. EMS: Still bleeding top employees, reduction (by two future mobile medians) of apparatus, employees being cut, administrators who play hide & seek with the public, and they can't seem to find that $8,000,000 in lost revenue even though they hired an outside firm to look for it. My question is, Why would any Fire District want to take over EMS in its present condition. Here's some suggestions Dan (Dan Dan The Hurricane Man) to the North Sewer plant, he could be Mudds #2 or "Sliced Crap". Mr. (not a Chief)Paige to C.A.T. to once again be Flaggs Pee on. Dan (Belly Rest Boy) to C.A.T. as a bus monitor, between him and Don (back stabber) Deteso they might find a spine and common lack of ethics.

I have lived down here for the past 19 years. I have watched the bantering that goes on in the newspaper between EMS and Fire departments. I have read many articles over the years which tell of Dr. Tober’s many accomplishments and oversight in medical care to the citizens of Collier County. One question that I have never seen asked that I would like to know. If all the reading I have done it seems that most will agree that bulk of the emergency calls are medical, greater than 70 percent. If this is the case then why do I keep reading Fire departments should run EMS and not EMS run EMS. A EMS system that has a fire component. Just because it done that way elsewhere why do Fire Departments need to be in charge of the medical aspect? For example I would by a product from a company that makes that product, not from a company that makes a part of that product.

It seems to me all the fighting begins when the fire departments do not want to due what EMS or Dr. Tober would like to due when it comes to medicine.

I don't know all the answers, but I do know a bad one decision when I see one. If Dr. Tober's in charge, he shouldn't be required to take direction from the Collier County Commission.

Fake News Flash: Front page today " Hero at the Wheel" Dan (Dan Dan the Hurricane Man)Sommers has ordered Mr. (not a Chief) Paige to file a complaint with the State regarding the bus driver not following Tober cert protocols for bus drivers. Although the maneuver was sucesseful and the childs life was saved the driver did not follow the Tober protocol, these claims are said to be in the complaint. Its rumored that the driver didn't praise Tober enough when she saved the childs life. What are the protocols? He has not made them up yet and won't share them when he doe's. Its just a guess but they may require a bad hair piece, inncoherant babbleing and the words "Praise Tober".
In order to stay consistent with bus drivers and FD paramedics restrictions, Lord Tober has directed that all bus drivers shall have thier hands tied behind thier backs prior to operating thier assigned apparatus (buses).
Additionally the impending reassignment of Dan (Belly Rest Boy)Bowman to C.A.T. will be altered and he will be reassigned as bus monitor for the school system so he can sneak around and report any suspected breaches in Tober Protocol.
Mr. Windies reassignment to the North Sewer plant is on hold but he has been assigned the title of "sliced Crap" or #2, Mr. (not a Chief)Paige will stay put because he is just as ineffective anywhere he's put.
In a not surprising move the County Commision is looking to make the School Board answer to them (like they need more incompotence)so future mistakes like this can be avoided or covered up.

My concern is that the County's elected leaders are abrogating their responsibilities to specify the appropriate levels of emergency medical service; they appear to be slowly ceding this authority to Dr. Tober. Dr. Tober's role is clear to me: he facilitates the delivery of emergency medical services by certifying the training of the EMS personnel and providing expert advice, as required. He is not a policymaker.

However, Dr. Tober's recent actions look increasingly like policy: he unilaterally decided to reduce the county's emergency service capacity by stripping drugs from FD paramedics. Had he acted in accordance with his charter, he should have recommended to the EMS Director and fire chiefs to remove the drugs. There are numerous measures he could have taken if the chiefs refused to comply.

Instead, Dr. Tober decided to act on his own. Now the county’s leaders have made the problem worse by making the doctor a direct report to them. This is a mistake. The commissioners don’t have the time and energy to manage Dr. Tober in addition to their other tasks. This move has effectively removed what little oversight there was previously.

The article also points to a larger failure of the EMS consolidation effort. The article contained a remark that is worthy of everyone’s attention:

There are allegations that some of the fire districts are not adhering to training protocol,” Coyle said, adding that fire districts “feel they’re not getting necessary access” to Tober.

This may be the canary in the coal mine: by streamlining things and retaining one medical director, the county may have divested itself of the necessary resources to keep all of its EMS personnel certified. Quality of service will slowly slip.

My recommendation: put the county medical director back up under the EMS chief as an advisor and have him help define the training requirements necessary to keep enough medics trained to maintain an appropriate level of service. If Dr. Tober stands in the way, fire him and replace him with another advisor – even if it costs more.