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April 30, 2011

Emergency response protocol reviewed in Fla. city

Naples Daily News

NAPLES, Fla. — Growing concerns about slow ambulance response times in the city of Naples prompted rapid changes in recent weeks.

Now emergency service agencies throughout the county are vowing to review their own emergency response methods in an effort to improve patient care.

Orly Stolts, the fire chief of the North Naples Fire Control and Rescue District, said ambulance delays are not unique to Naples, though he declined to give specific examples from within his own.

This week, agencies responsible for medical dispatch, on-scene emergency care and patient hospital transport agreed to work to improve emergency response calls in the rest of Collier County.

Representatives from Collier County EMS, North Naples Fire Control and Rescue District and the Collier County Sheriff's Office told the Collier County Commission they would look to review their response protocol to provide better delivery of patient care.

County Emergency Medical Director Dr. Robert Tober said the move could allow agencies often publicly at odds over strategies in emergency care to work together to improve the outcome for patients.

The announcements came after recommended changes from Tober in how first response agencies throughout the county should react to medical emergencies.

In March, Collier County EMS ambulances arrived more than 15 minutes after the initial 911 call in at least two medical emergencies.

In one of the two instances, the ambulance driver went to the wrong address, but Naples Fire Chief Steve McInerny said there were larger issues that needed to be addressed.

Ambulance personnel are learning of medical emergencies sometimes minutes after the city of Naples Fire Rescue Department. That's because 911 calls in Naples are first patched through to the Naples Police Dispatch Office before the Sheriff's Office. While Naples dispatch officers immediately send a fire truck to any medical emergency, Sheriff's dispatch personnel ask 911 callers a series of questions before notifying Collier EMS.

Officials also pinpointed a lack of urgency for calls diagnosed as "low priority" and poor communication between responding agencies as reasons for delays as system-wide issues.

In a letter to county commissioners, Tober called for county-wide improvement of communication between first-response agencies, faster dispatch of ambulances from the Collier County Sheriff's Office and standardization in responses throughout the county.

"I'm trying to turn this into an opportunity with the Sheriff Office, fire (departments) and EMS, so we can finally come together and iron out these difficulties once and for all," he said at the commission meeting Tuesday.

Under Collier's emergency-response system, the Sheriff's Office dispatch handles 911 calls. Dispatch officers send fire rescue units and Collier EMS ambulances to medical emergencies with firefighters typically arriving on scene first.

However, EMS Chief Jeff Page said each fire department responds in different ways depending on the type of medical emergency.

North Naples firefighters do not respond to low priority calls in nursing homes within its boundaries, Page said, and other districts consistently do not respond at all to some medical calls. Meanwhile, the Naples Fire Rescue Department sends firefighters to every medical emergency.

In Tober's letter, he called for consistency in what calls firefighters go to.

On Tuesday, commissioners considered whether to immediately implement Tober's recommendations, but fire officials from North Naples Fire Control and Rescue District requested input on proposed changes.

Stolts called for all first-responding agencies to meet to discuss changes in protocol before a making a final decision.

Kingman Schultz, deputy chief of operations at the East Naples Fire Control and Rescue District, said all fire departments respond differently depending on demographics and resources.

He said every department has to weigh what it can send to emergency calls and what's in the best interest of their citizens.

Both Schultz and Stolts said they welcome working with Tober and Collier EMS to address possible changes in protocol.

The mood of cooperation comes after years of feuding between some independent fire districts and county-run EMS.

The North Naples fire district waged an ongoing dispute with Tober over training requirements for the fire district's paramedics. At times, the dispute spawned publicly delivered personal attacks between officials.

That feud ended with the fire district receiving certification to hire its own medical director to set standards for its paramedics.

Moving forward, Stolts said, fire district officials would "work as professionals" with Tober and Collier EMS to address concerns.

Tober's letter to commissioners also called for the Sheriff's Office dispatchers to more quickly notify county EMS personnel of medical emergencies.

Under the current system, he said, dispatchers ask a series of questions to 911 callers before a computer program determines how first responders should be sent to scene. That process can take several minutes before an ambulance unit is sent, he said.

Instead, Tober said that once the dispatcher knows the location of a medical emergency, EMS should be notified before the dispatcher gets more information from the caller.

At Tuesday's meeting, Capt. Roy Arigo told commissioners the Sheriff's Office was "committed to reducing response time" through its dispatch office.

He said the Sheriff's Office is currently reviewing how it handles medical 911.

Sheriff Kevin J. Rambosk in an emailed statement said his agency has been looking to improve services in recent years, but offered no specifics on changes until a forthcoming "presentation" in response to concerns.

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