# Live saving drugs pulled from fire truck in Naples, Florida



## VentMedic (Sep 13, 2008)

Live saving drugs pulled from fire truck in Naples

http://www.nbc-2.com/articles/readarticle.asp?articleid=21540&z=3

_Originally posted on: Thursday, September 11, 2008 by *Kara Kenney*_
_Last updated on: 9/11/2008 7:37:07 PM_ 





> LEE COUNTY: In an emergency, you trust paramedics will have the equipment and skills needed to save lives, but when members of the Naples Fire Department respond to their next call, many crucial tools won't be on their truck. We asked the fire chief and a paramedic whether your safety is at risk.
> 
> Many firefighters double as paramedics with skills and equipment to save your life.


 


> *Twelve of fourteen paramedics with the Naples Fire Department failed a test on drugs and their side effects.*
> 
> Because of that, a fire truck at the main station was stripped of medicines, IVs, breathing treatments, heart monitors and other advanced live saving equipment.






> *Tober says Naples paramedics had a month to prepare for the test.*
> 
> He decided to pull the drug boxes until paramedics learn how to use them.






> "I don't think it was fair," said paramedic Adam Nadelman.




http://www.nbc-2.com/articles/readarticle.asp?articleid=21540&z=3


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## el Murpharino (Sep 13, 2008)

I say good on this agency for assessing their employees and holding them accountable for their lack of knowledge.  I'm sure these medics will be cracking the books and taking their continuing education requirements more seriously.  It once again shows how important a proper education is in this field, and how detrimental a lack of one is.  

That same paramedic, Nadelman, states that they are putting lives in jeopardy and that the failure of the medics was a fluke.  First, one could potentially do more damage by giving the wrong medication than by giving nothing.  Second, 12 medics failing a test that they had a month to prepare for is no fluke.

**EDIT**  After rereading the article, I see it was the medical director who made the ultimate decision.  I still say good for all those involved for holding them accoutable.


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## VentMedic (Sep 13, 2008)

This is what happens when you memorize and don't LEARN pharmacology.  The medical director was probably testing for an understanding of the medications.   The month of studying probably consisted of pulling out the note cards and more memorizing.


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## boingo (Sep 13, 2008)

Sounds like the fire department should be responding as first responders, and leave the medicine for the full time paramedics.


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## Ridryder911 (Sep 13, 2008)

This is what happens when your career is not in healthcare. Sorry, I have yet seen but a very few and rare Fire Agencies that provide excellent care. It again goes to the main focus and expert is something other than medicine. 

R/r911


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## Flight-LP (Sep 13, 2008)

Does Naples also run EMS or is a bunch of hose monkeys playing with drugs? I thought Lee Co. was the exclusive provider................................


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## VentMedic (Sep 13, 2008)

Naples is in Collier county which has been trying to consolidate all EMS services provided in that county under Fire.  

Lee County is to the north of Collier.


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## pumper12fireman (Sep 13, 2008)

Regardless of whether the service is fire, private, public etc..I'm glad to see this taking place. If you don't know your stuff, you shouldn't be giving the drugs. It sounds like these guys are lucky to have their jobs still if the performance on the exam was that poor.


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## John E (Sep 14, 2008)

*It's not fair...?*

Crikey, I haven't heard that excuse for failing a test in a long time.

John E.


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## Airwaygoddess (Sep 15, 2008)

All I can say is wow..............


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## VentMedic (Sep 15, 2008)

Collier County EMS has had a good reputation over the past several years. Problems have arisen out of the many Fire/EMS mergers.

Dr. Tober has been Collier County's MD for many years and has done a lot of good for the community. 

Collier EMS medical director to be in national TV spotlight
By LIZ FREEMAN 10:07 p.m., Tuesday, November 6, 2007 
http://www.naplesnews.com/news/2007...director_be_national_tv_spotli/?breaking_news



> “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.


 

This is a good article. 
*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/clash-mars-fireems-merger-talks/

*Fire-ambulance consolidation talk still alive in Collier*

By I.M. STACKEL (Contact)
9:59 p.m., Saturday, August 23, 2008 

http://www.naples-daily-news.com/ne...mbulance-consolidation-talk-still-alive-coll/


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## VentMedic (Sep 24, 2008)

*More news from Collier County, FL*

http://www.winknews.com/news/local/29644764.html

*Eight emergency drugs removed from fire trucks*

*By Mike Essian, WINK News*


Story Created: Sep 23, 2008 at 7:19 PM EDT 
Story Updated: Sep 23, 2008 at 7:58 PM EDT 



> COLLIER COUNTY, Fla. - Eight potentially life-saving drugs have been ordered removed from all fire trucks in Collier County.
> 
> The EMS Medical Director Dr. Bob Tober says fire fighters don't need them, but fire fighters say, not having them puts you at risk.
> 
> Tober has already pulled advanced life support drugs from the city of Naples Fire Department because 12 of 14 fire fighters failed certification tests.


 


> "It's much safer to be given basic life support and wait for the next tier of medical expertise and training to come to you *than to hand you drugs that may be over your head*."
> 
> North Naples fire fighters welcome more training from Dr. Tober if he thinks it's necessary, but Tober says that would be over-training them, and instead, he's focused on keeping his 120 county paramedics qualified.


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## mikie (Sep 25, 2008)

I'm wondering, per the original article, if they passed the drug test the second time around.  

Also, I'm curious to know what drug they found (did it mention it?).  Some drug(s) I could understand (NOT JUSTIFYING IT AT ALL) whereas some, just  don't belong in Fire or EMS or pretty much anything...


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## VentMedic (Sep 25, 2008)

mikie333 said:


> I'm wondering, per the original article, if they passed the drug test the second time around.
> 
> Also, I'm curious to know what drug they found (did it mention it?). Some drug(s) I could understand (NOT JUSTIFYING IT AT ALL) whereas some, just don't belong in Fire or EMS or pretty much anything...


 
I don't believe they have scheduled their 40 hour review as of this time.  But, then, it will be a question of when and if all the ALS engines will get their drugs back.   I'm sure it will happen eventually as the FD takes over EMS totally and a new medical director is appointed who just signs the paperwork put in front of him with no questioning the Fire Chief's knowledge of medicine.


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## triemal04 (Sep 29, 2008)

While I agree that pulling the drugs from the Naples Fire Dept (the one that had almost all their paramedics fail a test on the drugs they carry) is absolutely appropriate, I think at this point it's getting to be more of a pissing match between Dr. Tober and the various fire chiefs in the region; just reading the various articles (some going back a couple of years) that starts to get pretty clear.

It's even more illustrated with the second set of articles that ventmedic posted; what exactly did North Naples Fire Dept do that caused them to get those drugs pulled?  Did they fail a test?  Are their training hours and standards not up to par and that just wasn't mentioned in the article?  Or did it really happen because "they aren't using them enough?"  Sorry, but that's not always a valid arguement.  Several drugs that are routinely carried by many services will be rarely used, which can be a problem for obvious reasons.  Of course, the way to offset this is to train and constantly be learning about them to ensure that when the need for the med comes up it will be given appropriately.  The same goes for many procedures.

Now, it very well may be that the various fire department affected by this don't keep up their education and train adequately, in which case this starts to become valid.  But based on the article alone, it is just an arbitary decision by a doctor that is in a feud with several agencies.


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## Anomalous (Sep 29, 2008)

If everything is as they say, I'm glad they took a stand, however, I suspect there is more to this story.  If they pulled "IVs, breathing treatments, heart monitors and other advanced live saving equipment", was that an appropiate response?  Maybe, maybe not.  Wouldn't you like to see the test?


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## VentMedic (Sep 29, 2008)

triemal04 said:


> Now, it very well may be that the various fire department affected by this don't keep up their education and train adequately, in which case this starts to become valid. But based on the article alone, it is just an arbitary decision by a doctor that is in a feud with several agencies.


 
That is why I posted several links. 

Collier EMS has has a great rep for over 25 years. When the FDs started getting into the ALS scene, they wanted to do all the protocols that the Paramedics did with CCEMS. But, their attendance for the training sessions by Dr. Tober with CCEMS was spotty at best. The chiefs have either not seen that the Paramedics are alloted time to attend or the Paramedics feel they do not need to attend until being made to do so by their chiefs. 

Some of the employees of both have taken their argument public in the comments section under some of articles which is almost embarrassing for the public to read the Fire vs EMS bash fest. 

It was well known what would happen when the FDs wanted ALL FFs to have the Paramedic cert. Many of the counties in Florida have already gone through this and are very familiar with the problems. Dr. Tober has also been very aware of the problems in the county on the East Coast across the state from him. 

Florida has proven that a state can offer ALS to nearly 100% of its residents. However, it may also show that the ways we have used to accomplish this or encouraged the "milling" of Paramedics at the request of the FDs are questionable. 

This is not the first incident that has brought this to public light. The below article concerns another Collier County FD. 

*Marco firefighter charged with falsifying documents to practice as paramedic*
By RYAN MILLS (Contact)
5:55 p.m., Monday, April 28, 2008 

http://www.naplesnews.com/news/2008/apr/28/former-marco-firefighter-charged-practicing-emt-pa/

If the FFs do not have their Paramedic upon hire, they have only 1 year to get the cert. 

After this came to light and some checking was done by the state of Florida, the state had to re-enforce the standards for ALS clinicals to be done on an ambulance that actually transports the patient and not an ALS engine that arrives and leaves when CCEMS shows up when could be before or a minute after the engine. Essentially there are Paramedics that have been allowed to write their ALS patient information for school with little patient contact. 

I have been part of the FD system and I know some can work better than others. I also know that the professional FFs have their concerns when people want a FF patch to become a Fire Medic. There is a concern that some of these individuals may not have their backs in a hazardous situation. 

Again, this is not meant to be Fire vs EMS but the public is now becoming more educated for the cost and the headlines have caused some taxpayers to get more involved. Unfortunately, I don't believe this is the public involvement that many in EMS envisioned as recognition for their profession. It distracts from the good parts of what EMS professionals do. 

*Guest commentary: MITA president dissects fire assessment fee*

*By FAY BILES, Ph.D. - President, Marco Island Taxpayers Association (MITA)*
*Tuesday, August 26, 2008 *
*http://www.marconews.com/news/2008/aug/26/guest-commentary-mita-president-dissects-fire-asse/*


BTW, Marco Island consists of newer development (less than 20 years) and is in the higher price range. It is not that busy of an area and is considered to be a nice place to be a FF for the non-fire type.


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## triemal04 (Sep 29, 2008)

Ventmedic-

Ok, that may be the case (lack of training).  But it wasn't captured in any of the articles that I read.  If it is true (and I do mean really true, not just based on what Dr. Tober says...more on that later) then yes, it was the right move to make.  

Collier County has come up a whole lot it seems like in the last couple of years, with good and bad things coming from both sides (fire and EMS).  I understand that Tober feels very proprietary of the county EMS sytem, but even with that and the screwy way that Florida allows paramedics to get their certs, some of the things he's doing can be seen as being done because he's in a pissing match, and not because it's the right thing to do.


> North Naples fire fighters welcome more training from Dr. Tober if he thinks it's necessary, but Tober says that would be over-training them, and instead, he's focused on keeping his 120 county paramedics qualified.


Now, if that's accurate, and I'm willing to bet it is fairly (maybe not fully) accurate, that's rather disturbing.  The department recognizes that they have a problem and want to get it fixed, yet the medical director refuses because that would be "overtraining."  Seriously, what the :censored::censored::censored::censored:!?  The doc says they aren't trained enough and removes the drugs, but in the same breath won't allow for more training to fix the problem?  Uh...ok.

At this point both sides are having serious issues, and without changes at the top (both fire chiefs and medical directors) there won't be a real solution to the problem.  (no neccasarily removing anyone, but attitudes need to change on both sides.)


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## VentMedic (Sep 29, 2008)

Many of these medics were rapidly trained by the FD to begin with and are expected to work under his medical direction. Yet, the Fire departments still want to control the medical training for their FFs. The consolidation has brought over 100 more paramedics in addition to the 120 - 150 already working for CCEMS under his direction. Now, on almost every medical call in some parts of Naples and Marco Island you have 6 - 10 Paramedics on scene. The engines or ladders won't be the ones doing the transporting or even the ALS care for the patient majority of the time. 

Making everything ALS and everyone a Paramedic was not his idea and the logistics for the area made it very redundant.  This situation did not come from a need for more medical services but rather "We can do that too" because all the other FDs are doing it. 

On EMTcity I posted a detailed listing by station of all of the ALS vehicles we have in my area of Florida. But, not every area is going to need that many Paramedic vehicles running to every call.


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## triemal04 (Sep 30, 2008)

Ventmedic-
I'm not argueing that Florida is oversaturated with paramedic's (as are many cities/counties).  Not argueing that the way that Florida allows paramedics to become certified isn't screwy; it is (medic mills=worst idea ever).  

What bothers me here (besides the fact that once again the media is failing to accurately report all the facts associated with an issue) is that the situation involving Dr. Tober and the various fire departments has escalated to the point that both sides (though, at this point, as the media is reporting it, Tober is doing the most) are doing whatever they can to screw the other because they can.  If that contines, in the end everyone is going to lose.

You say that some fire department medics are undertrained?  They may be.  But then some won't be too.  And the same will go for private/third service paramedics too.  Unfortunately, that is beyond a local issue for Florida and more of a statewide issue it seems (and a national issue).  You say the fire departments in Collier want to control their own continuing education?  Well, it appears they have to since Tober is refusing to train and educate the paramedics there.

If you ever wanted a nice fubar'ed situation, this would be a great example.


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## VentMedic (Sep 30, 2008)

For the record, as he stated in the meetings which were published, he did NOT refuse to train anyone. This is not a new event. This has carried on since the ALS FD conversion started a few years ago. This is more than just getting continuing ed for their renewals. This is about the initial and ongoing training from Paramedic program to truck. The training sessions have been posted. If the medics do not choose to attend the meetings as required by their medical director for whatever reason, would you still wanting them to do RSI just because the recipe says they can by the "county" protocol? The FDs want it to be the same but different.

I believe that as a medical director, he should have some control over who does what under his license and not just sign off the paperwork. He is one of the feel medical directors that actually can recognize those working under his license because he has taken the time to be an active part of CCEMS training. What the FDs have failed to understand is that it takes more than just one or two short classes a year to keep up a good EMS reputation. It's a huge responsibility to be responsible for that many people as a MD when the FDs don't recognize the importance of ongoing medical training. Many feel the patch is enough as you should have read in at least a couple of the articles I posted. "A Paramedic is a Paramedic". Just passing a state exam does not necessarily make one a good Paramedic. 

I can not see why the medical director should continue to waste his time if the FD Paramedics have not taken an interest in participating in EMS training. It is just with the recent events that have shown that skills and knowledge can go to waste if one does not use them or at least take their certification serious enough to stay current. 

Even those of us on the East Coast have been impressed with some of Dr. Tober's training sessions for his Paramedics as some of them are published in the Florida Emergency Physicians update. So if we can hear about them, why can't the FD paramedics in the same county? 

I have posted numerous articles on both forums and still haven't skimmed the surface of what has been in the news over the past few years with this county and others. Broward EMS went Fire and then under the SO. Ocala's EMS went FD and that left a lot of great long term EMS employees with little choice but to become a FF to stay employed. Miami-Dade has consolidated almost all of their FDs. The same with Palm Beach County.

And, as I stated before, it works in some FDs better than others. Boca Raton FD stayed out of the Palm Beach County merger and has a rep of being a great example of providing EMS. Almost all of their FFs are Paramedics also.  But, they are smaller with only the City of Boca Raton to be concerned with.


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## VentMedic (Oct 29, 2008)

*The battle is heating up*

http://www.nbc-2.com/articles/readarticle.asp?articleid=22588&z=13

Battle between firefighters, medical director heating up

_Originally posted on: Tuesday, October 28, 2008 by *Kara Kenney*_
_Last updated on: 10/28/2008 6:35:21 PM_ 




> COLLIER COUNTY: The war of words between firefighters in Collier County and their medical director got nastier. Both sides are locked in a heated battle over how many life-saving medications should be allowed on the fire trucks.
> 
> The battle heated up with what some call a scathing letter from Collier County Medical Director, Bob Tober, to county commissioners.
> 
> Dr. Tober is saying firefighters should be less involved with saving lives - a notion that has firefighters fired up.


 
*MORE AT:*
http://www.nbc-2.com/articles/readarticle.asp?articleid=22588&z=13

*THE SCATHING LETTER*

http://www.nbc-2.com/Newslinks/CCEMS-Fire Letter to Commissioners October26 2008 (2).doc


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## reaper (Oct 29, 2008)

I love the stance he is taking, but it will do no good. The politicians will bow down to the fire Dept's, because they will threaten with votes for new commissioners!!

They do not really care about the citizens they serve!


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## John E (Oct 29, 2008)

*3 cheers for...*

Dr. Tober...

Hope the county commissioners stand by his directives.

John E.


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## medic417 (Oct 29, 2008)

Finally somebody putting patients first.  Fire needs to focus on fire, EMS needs to focus on medicine.


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## EMTinNEPA (Oct 30, 2008)

About time.  EMS =/= Firefighting, despite what laypersons watching Third Watch and Emergency! want to believe.

What the f:censored: was a fire department doing with drugs on their truck anyway?


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## VentMedic (Oct 30, 2008)

EMTinNEPA said:


> What the f:censored: was a fire department doing with drugs on their truck anyway?


 
This FD just wants to be like all of the other FDs in Florida. Almost all FFs are Paramedics in this state and engines/ladders are ALS.  Right or wrong, that's the way it has been for almost 30 years here in many of Florida's cities.


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## HotelCo (Oct 30, 2008)

I can't speak of other places but around here the FD has the ambulance... has the medics.. 

I say if they have the training, let them use the tools they are trained in to save a life. Obviously they do not use them as much as the EMS system, so they should be required to get more continuing education and be tested on their knowledge much more often.

If I were down and the truck was the first on the scene, I'd want them to be able to do everything possible to get me up.


-HotelCo


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## jrm818 (Oct 30, 2008)

Assuming "down" means "cardiac arrest," Dr. Tober proposed leaving Epi and Atropine (as well as benadryl) on the ALS rigs.  Actually he wanted to give them to the PD.

That aside, even if they didn't have those drugs, as long as you are getting good CPR and they have access to an AED, the few minutes difference between FD and EMS getting on scene aren't going to change the outcome.  Early CPR is really the key to making it out of an arrest alive....

Plus - what happens when the FD medic who hasn't tubed a pt. in ages misses and starts bagging your stomach?  Hopefully the ambulance gets there fast enough to recognize that... etc. etc.  Deficient skills can cause more harm than good.  Would you want joe the plummer to have "all the tools" too?  Of course not.  You want someone who knows what the heck they are doing, and has done it in...say...the past year.

As to more training...it sounds to me like the FD isnt' even OK with doing the same amount of training...never mind extra..


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## dmiracco (Oct 31, 2008)

I definately agree with the decsision made by the medical director in Naples. I also agree with most of the comments made on this thread. I think that to often we ALL see FF, Medics, etc. render care as clinicians in the prehospital setting that is questionable to say the least. I think that more than likely the biggest issue here as in MOST services, paid or volunteer, is the education or lack there of. 
I have worked for numerous services in numerous states and I have found that overall initial EMS education (the basics) as well as concurrent training is usually subpar and ofcourse it depends were you live. Some are worse than others and Im not saying that there isnt great learning institutions because there out there. What I am saying is that there needs to be more accountability for Educators throughout the EMS profession. 
So with that said, I pose a question to all of you,
How do you feel your initial and concurrent training is where you are employed and what do you feel could be improved? :blink:


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## cvb7873 (Nov 3, 2008)

VentMedic said:


> For the record, as he stated in the meetings which were published, he did NOT refuse to train anyone. This is not a new event. This has carried on since the ALS FD conversion started a few years ago. This is more than just getting continuing ed for their renewals. This is about the initial and ongoing training from Paramedic program to truck. The training sessions have been posted. If the medics do not choose to attend the meetings as required by their medical director for whatever reason, would you still wanting them to do RSI just because the recipe says they can by the "county" protocol? The FDs want it to be the same but different.
> 
> I believe that as a medical director, he should have some control over who does what under his license and not just sign off the paperwork. He is one of the feel medical directors that actually can recognize those working under his license because he has taken the time to be an active part of CCEMS training. What the FDs have failed to understand is that it takes more than just one or two short classes a year to keep up a good EMS reputation. It's a huge responsibility to be responsible for that many people as a MD when the FDs don't recognize the importance of ongoing medical training. Many feel the patch is enough as you should have read in at least a couple of the articles I posted. "A Paramedic is a Paramedic". Just passing a state exam does not necessarily make one a good Paramedic.
> 
> ...


I am a firefighter/paramedic in the Naples area. I find it funny you mention areas like Broward. Broward has about a dozen fire departments providing EMS services. They also have multiple medical directors, all working together to come up with one common protocol. Here, we have 1 medical director for the entire county. In December 2006, the Naples Daily News quoted Dr Tober stating "I have a hard enough time training the 111 medics I currently have working under me, how the hell am I supposed to train the other 100 fire medics that want the same protocols." He stated himself that he can not properly train all medics in this county, why he remains the only medical director is a mystery.

This test was given to only one fire department, The City of Naples. They failed the test miserably, and all fire departments had medications removed from their trucks. None of the other departments were tested on their knowledge. In fact, Collier EMS wasn't even given the test. North Naples Fire Rescue currently has dozens of former Collier EMS employees working for their department, including their Chief of emergency medicine Jorge Agiulara (who was Dr. Tober's #2 man at EMS just a few years ago). These experienced men and women apparently are no longer skilled, because the patch on their sleeve says fire department, not EMS.

We often arrive on scene first. Collier EMS runs non-emergency, interfacility transports in addition to emergency transports. This often causes trucks to end up all over the district, and ambulances often have to respond from other areas. There have been many times where we are on scene with no transport unit for up to ten minutes. We now have no anti-dysrhythmics, no more versed to treat seizures, no atropine. In fact Dr Tober wants to cut the medications in our box down to 4. Exactly how is this a progressive system? 

You mention training. The former head of EMS' training department now works for my fire department, and is in charge of training. We go through just as much training as Collier EMS. Dr Tober refuses to come in and train us on duty, though he has agreed to in the past. He just never would. We paid another physician to come in and do our training under Tober's protocols, Dr. Tober refuses to accept his training. 

This battle has nothing to do with patient care, it is strictly politics. There is no room for politics in patient care. Dr. Tober is trying to keep his kingdom, and this entire system is taking steps backwards.


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## VentMedic (Nov 3, 2008)

cvb7873 said:


> We paid another physician to come in and do our training under Tober's protocols, Dr. Tober refuses to accept his training.
> 
> This battle has nothing to do with patient care, it is strictly politics. There is no room for politics in patient care. Dr. Tober is trying to keep his kingdom, and this entire system is taking steps backwards.


 
And you haven't learned anything from the mistakes made in the other EMS/FD systems in Florida or other parts of the country? Sounds like you are a FF trying to help the FD to keep their own kingdom and pick their own Yes man for a doctor. Maybe he'll let you slide and just sign you off as too many have done in this profession already. 

If people abandoned their EMS position to go to the FD, then they probably were burnt out with EMS and no longer had an interest to be effective medical professionals. Riding an ALS engine is not the same as an EMS transport ambulance. 

Those that do use their skills and knowledge regularly have their reports used for review of their understanding of medicine. Wasn't there a part where the FDs used the excuse they didn't know how to do their reports because of a change in the system? 

If 12 out of 14 FF/medics failed the test miserably, what makes you think there will be better results in other stations? Did they just put all the incompetent or weaker medics at one station? Would you have preferred the headlines to read 54 out of 60 FF/medics failed even after given a month to prepare? If the people that were to be given the test didn't prepare during that month, what makes you think it would have been different in other stations? Do these paramedics not even recognize their own responsibilty for keeping current when they hold a medical license? Do they have to be spoon fed the test like they probably were in medic school? 

Dr. Tober has valid points and his interest is patient care. If the meds and skills are done so infrequently, there is little chance to maintain proficiency especially if their duties are divided with fire.

A severe problem was identified and dealt with. Dr. Tober has more of a responsibilty to the public than the egos of the FDs. 

Do a little research on Denver and Seattle. More does always not equal better.


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## cvb7873 (Nov 3, 2008)

VentMedic said:


> And you haven't learned anything from the mistakes made in the other EMS/FD systems in Florida or other parts of the country? Sounds like you are a FF trying to help the FD to keep their own kingdom and pick their own Yes man for a doctor. Maybe he'll let you slide and just sign you off as too many have done in this profession already.
> 
> If people abandoned their EMS position to go to the FD, then they probably were burnt out with EMS and no longer had an interest to be effective medical professionals. Riding an ALS engine is not the same as an EMS transport ambulance.
> 
> ...



I have not in any way bashed EMS, yet you feel compelled to bash fire departments. I do not know about Seattle and Denver, but I know about the fire-ems systems currently used in most of South Florida. Those systems eliminate duplications of services, and provide equal training for all medics, regardless of which truck they are on. 

12/14 failed for city of naples, an entirely different department. A department obiously lacking in the training department. In fact, they dont even fight fires well. They have poor staffing, and usually only save foundations. The fact that they are inept does not mean all departments are. Testing all departments would have proved that. 

As far as a yes man physician, we had a physician come in to train us. Why is that a problem? The medical director refused to come in to train us, so we looked elsewhere for training. Its called being proactive. We also had Tober's former head of training training our medics. He left that department, and now trains us. Perhaps if the City took training as seriously, they wouldn't have looked like fools. I know if we had been tested, this nonsense wouldn't be going on.

This wonderful, effecient system you speak of (but by no means know anything about) planned on laying off 24 medics just a few months ago, and planned on taking 4 emergency vehicles off the road. They have an unbelievably high turnover rate, thanks to management, not "burnout". They also run 1 medic, 1 EMT. Real progressive system. Curious, what do those dreaded fire/ems agencies run in Broward and Palm Beach? Most run 2 medic rescues, some 3. 

You sound like someone who is anti fire. I am not by any means anti EMS. I just think there is no room for politics in patient care. If you had any clue what was going on here, you wouldnt be quite so fast to bash me and support Tober.


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## VentMedic (Nov 3, 2008)

cvb7873 said:


> I have not in any way bashed EMS, yet you feel compelled to bash fire departments. I do not know about Seattle and Denver, but I know about the fire-ems systems currently used in most of South Florida. Those systems eliminate duplications of services, and provide equal training for all medics, regardless of which truck they are on.
> 
> 12/14 failed for city of naples, an entirely different department. A department obiously lacking in the training department. In fact, they dont even fight fires well. They have poor staffing, and usually only save foundations. The fact that they are inept does not mean all departments are. Testing all departments would have proved that.
> 
> ...


 
FireFighter, where do you think I am from and what my background is? Did you not read my earilier post? Don't spout off anti-fire crap to another Floridian who's been around for awhile. And don't make assumptions about other systems unless you have access to their QA/QI data. How many tubes or IVs do the 4 medics on an engine and/or ladder get per year? How many lawsuits were they able to dispose of under the state immunity statute? 

And don't live under a rock without knowing much about how other systems, EMS or Fire, have worked and have been proven to be effective? How could you not know about King County or even about Denver? Do you not read any literature in EMS? Any research on the latest equipment or protocols trialed? My expectations would be high if it was medical journals but at least the EMS and Fire rags that lie around a station.

How often will this Yes man physician be training you? How many calls are you running? How many patient contacts are they getting? Actual transports? How many live tubes and IVs are the paramedics getting? 

As far as some of the other systems you mentioned on the East coast, why are some communities now trying to get volunteer FDs established again and contracting AMR for their EMS?

If you want to have a civil discussion, great. But don't jump to conclusions or bash a system just because they are EMS either. This FD is the one that made national headlines. 

Layoffs? Where are you getting some of you information from? Sources? The only mention of layoffs at the meetings have been when the consolidation is complete and the FDs have ironed out the details of transport to where CCEMS Paramedics are no longer needed.


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## reaper (Nov 3, 2008)

I have seen Fire/rescue services all over FL for almost 20 years. This is not the future for EMS. They all have serious problems with this setup. I have nothing but respect for FF's, they do a much needed job. But, that is the job they need to concentrate on. They do not need to serve two masters.

I have seen Dept's that have ALS engines, work great. But, they are backing up a full service county EMS service. They may be on scene 5-10 minutes pta of EMS. They very rarely use any drugs above D50,Epi,Benadryl, or Albuterol.

EMS is changing and changing fast. The population is aging in greater numbers and Prehospital medicine is advancing rapidly. This needs Medics that have their full attention given to pt care.

I do not know your dept or your training. It may be great. But, I do respect a medical director that stands up for better training and keeping advanced medicine to the people that do it full time. I would rather have the FF's concentrate on their duties and not try to do two jobs. You may be an exception, but most fire/medics do not have their hearts in medicine. They want to be FF's and most were forced into medicine. This is not the best way to serve the public!


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## cvb7873 (Nov 3, 2008)

VentMedic said:


> FireFighter, where do you think I am from and what my background is? Did you not read my earilier post? Don't spout off anti-fire crap to another Floridian who's been around for awhile. And don't make assumptions about other systems unless you have access to their QA/QI data. How many tubes or IVs do the 4 medics on an engine and/or ladder get per year? How many lawsuits were they able to dispose of under the state immunity statute?
> 
> And don't live under a rock without knowing much about how other systems, EMS or Fire, have worked and have been proven to be effective? How could you not know about King County or even about Denver? Do you not read any literature in EMS? Any research on the latest equipment or protocols trialed? My expectations would be high if it was medical journals but at least the EMS and Fire rags that lie around a station.
> 
> ...



First, its fire medic, not firefighter. Second, we run all medical calls with the exception of interfacility transports. That was Tober's decision. As far as tubes, Dr Tober's own protocols call for a King Tube (unless contraindicated). You cant judge even their medics on the profeciency of endotracheal intubation, as our own protocols make them a rareity.

# of Patient contacts rival that of any on the medic unit. Contact time there is no comparison, as soon as they are stable we clear, they transport. They are gonna have us in that one. # of IV's, i dont know, many. Not sure what you want from me here.

As far as volunteer systems, two departments in all of Broward. One that had a volunteer system in place that was kicked out by the county, then reinstated. They now have AMR. Good for them. BSO should have never been there. BSO's nearest station outside of LBVS was about twelve miles away. When one unit transported, they had no coverage for awhile. Plantation has volunteer fire as well, look up what the city did to their EMS when they tried to unionize a while back. Real great place to work.

On to the layoffs. http://www.naplesnews.com/news/2008/feb/14/collier-ems-faces-24-million-budget-shortfall/  Hope that helps.

Again, as I said earlier. I have in no way bashed the current EMS system in place. You on the other hand attacked me, my ability, and firemedics in general. You seem to have an anti-fire agenda. Honestly, I could care less. There are anti-ems guys in my department too. You guys are all Dinosaurs. Fire/EMS agencies save tax payers money, and provide a more effecient system. In fact, Collier EMS medics in the field want consolidation to take place. We want it to take place. The commishioners want it to take place. Taxpayers want it to take place. The only people in SW Florida against it are Dr Tober, EMS(mis)management, and dinosaurs like yourself. Have a great day.


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## VentMedic (Nov 3, 2008)

Are you the one arguing with the citizens in the newspaper about taxes? Or arguing with the citizens at the protest lines? Real professional. It really makes for a great image for the rest of the FDs that do try to do a decent job in this country even in Florida. 

Guess where the EMS funds for Collier got diverted to? Think all taxpayers are pro-consolidation? Attend the meetings where the general public speaks their mind. Unfortunately the taxpayers that have tried to speak their mind in the newspaper comments section get bashed by firefighters. 

Seems like the FDs in the Naples area are having a difficult time just keeping track of who's licensed or not. Maybe once they get that figured out they can deal with some of their other issues. Unfortunately your bad press gives everyone in the FDs across the state of Florida a bad rep when in the national news all they hear is Florida. 

Are you counting the community in Broward that just went to volunteer FD and with AMR?

I'm glad you do agree that "Fire Medics" should be extinct with the dinosaurs. And speaking from a professional FF point of view, it is just down right dangerous to have half arsed "fire medics" watching your back at a fire scene. They do a little of this and a little of that while not doing anything 100%. There are a few exceptions to the rule but the majority of them will be honest and know where their weaknesses lie. Those that have the arrogant attitude of being great at all are just dangerous and get good FFs killed trying to watch them and their own back at the same time. 

At least the King tube is not too difficult but still require some skill and knowledge. You gotta give Dr. Tober credit for knowing the abilities of the people he supervises.

If you didn't have the FF patch would you really like being a just a Paramedic and not a "fire medic"?


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## cvb7873 (Nov 3, 2008)

VentMedic said:


> Are you the one arguing with the citizens in the newspaper about taxes? Or arguing with the citizens at the protest lines? Real professional. It really makes for a great image for the rest of the FDs that do try to do a decent job in this country even in Florida.
> 
> Guess where the EMS funds for Collier got diverted to? Think all taxpayers are pro-consolidation? Attend the meetings where the general public speaks their mind. Unfortunately the taxpayers that have tried to speak their mind in the newspaper comments section get bashed by firefighters.
> 
> ...


Again with the attacks. You just dont stop. I do attend County meetings, I have heard the taxpayers speak. Attended the meeting in support of the EMS workers about to lose their jobs. Thankfully, the County wouldn't allow that to happen. You mention professionalism, yet you continuously bash firefighters. Is that considered professional?

Look, I became a firefighter because I wanted to help people, same as anyone else. I became a paramedic to be able to provide the best possible service to the people of my community. Continue on with your anti-fire crusade, but leave me out of it. I tried to be civil, you obviously can not.


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## BossyCow (Nov 3, 2008)

> I'm glad you do agree that "Fire Medics" should be extinct with the dinosaurs. And speaking from a professional FF point of view, it is just down right dangerous to have half arsed "fire medics" watching your back at a fire scene. They do a little of this and a little of that while not doing anything 100%. There are a few exceptions to the rule but the majority of them will be honest and know where their weaknesses lie. Those that have the arrogant attitude of being great at all are just dangerous and get good FFs killed trying to watch them and their own back at the same time.




Wow.. pretty sad system that allows half arsed anything continue to practice. In our area the fire department is the only game in town. They are ALS. They are paid well, trained to a high standard and not only respond but transport as well. 

The issue here isn't fire departments or not.. the issue is a sytem allowing 'half arsed' as an acceptable standard.


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## cvb7873 (Nov 3, 2008)

BossyCow said:


> Wow.. pretty sad system that allows half arsed anything continue to practice. In our area the fire department is the only game in town. They are ALS. They are paid well, trained to a high standard and not only respond but transport as well.
> 
> The issue here isn't fire departments or not.. the issue is a sytem allowing 'half arsed' as an acceptable standard.


This system does not allow "half arsed" anything. One department was tested and obviously had half assed standards in terms of training. All departments had medications removed. I can speak only of my department, but I can assure you we are not "halfarsed" in terms of training.

This system, which everyone is quick to defend, is years behind those in place on the east coast of Florida. According to our protocols, a fire medic is no longer able to push antidysrhythmics to a patient in V-fib. We can not place a patient on a breathing treatment when they are suffering from asthma or COPD. We can no longer treat a patient suffering from chest pain with anything other then 02. We no longer can use Versed to treat seizures, or before we cardiovert. We can no longer give D50 to a patient with a diabetic emergency. How is this a step foward?

Dr Tober said the reason for this is he does not want the medications falling into the "wrong hands". Well, I gotta agree that The City of Naples (who bombed the test) shouldn't be in the ALS engine program. They obviously dont take training seriously. My department on the other hand takes training very seriously. Had we been given the opportunity to take the test, we would have proven that. We hired the head of EMS' training to advance our ALS engine program, had physicians come in to train us, and had firemedics do clinicals alongside physicians at physician's regional hospital.

This is strictly politics. It is about protecting kingdoms, not patients. We have never had a case where the wrong medication was given by a firefighter in this County, not even by the City. Dr Tober himself has admitted that there were times that the medications removed from the ALS engines were used by firefighters to help patients. Now, due to infighting among management, those potential life-saving medications will no longer be given in a timely manner. Dr Tober's once great system is no longer what it was.


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## boingo (Nov 3, 2008)

EMS is an easy target for the fire department.  Hell, cops can get there faster, use smaller more fuel efficient vehicles and don't need 4 to a car.  Hows that for a savings?  How would the fire department feel about that?  I don't think it would go over well because we are talking jobs and funds, not patient care.  EMS at the ALS level should be provided by a single mission EMS agency, not as an aside to fighting fires or locking folks up. :wacko:


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## BossyCow (Nov 3, 2008)

boingo said:


> EMS is an easy target for the fire department.  Hell, cops can get there faster, use smaller more fuel efficient vehicles and don't need 4 to a car.  Hows that for a savings?  How would the fire department feel about that?  I don't think it would go over well because we are talking jobs and funds, not patient care.  EMS at the ALS level should be provided by a single mission EMS agency, not as an aside to fighting fires or locking folks up. :wacko:



How busy is the cop shop compared to the fire station? Do you want to wait 25 minutes for a cop to show up on an EMS call?


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## boingo (Nov 3, 2008)

BossyCow said:


> How busy is the cop shop compared to the fire station? Do you want to wait 25 minutes for a cop to show up on an EMS call?




No, I wouldn't want to wait 25 minutes, but just because the fire is busy doing nothing is no reason for them to dabble in EMS.  Let them direct traffic, man crosswalks, or shovel asphalt, all of those functions are necessary and don't require constant experience to excel at.  I know it doesn't get them headlines or stroke their ego's, but medicine has NOTHING to do with fighting fires, much like law enforcement has NOTHING to do with medicine or fire fighting.  How come you don't see fire departments trying to dabble in law enforcement?  Because the Police departments are well established and just as politically connected.  EMS is not, and as a result tends to be at the mercy of the fire/IAFF agenda.  
.
End of rant.


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## VentMedic (Nov 3, 2008)

cvb7873 said:


> This system, which everyone is quick to defend, is years behind those in place on the east coast of Florida. According to our protocols, a fire medic is no longer able to push antidysrhythmics to a patient in V-fib. We can not place a patient on a breathing treatment when they are suffering from asthma or COPD. We can no longer treat a patient suffering from chest pain with anything other then 02. We no longer can use Versed to treat seizures, or before we cardiovert. We can no longer give D50 to a patient with a diabetic emergency. How is this a step foward?


 
Stop with making it sound like the patients aren't getting any care. They still have ALS from EMS. 

Stick to fighting fires well and don't screw that up while trying to take on another profession that is medical. Don't get your own firefighters killed because you want to win a peeing match with a doctor while letting your fire fighting skills go to crap.


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## BossyCow (Nov 3, 2008)

So, because some systems are crappy, we need to paint all fire department based systems with the same brush. If you have an issue with a crappy department, deal with it.. but to broaden that into the assumption that all fire based EMS systems are crappy isn't logical.


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## VentMedic (Nov 3, 2008)

BossyCow said:


> So, because some systems are crappy, we need to paint all fire department based systems with the same brush. If you have an issue with a crappy department, deal with it.. but to broaden that into the assumption that all fire based EMS systems are crappy isn't logical.


 
Over the past 30 years since we've been mandating all FFs to be Paramedics and EMS Paramedics to become FFs if they want a job, I've seen alot of half arsed so called fire medics. It is no more fair to the professional FF than it is to the professional Paramedic. Not all FFs want to be Paramedics and shouldn't have to be. Unfortunately, the goal to have as many Fire medics on every truck has weakened the FDs in many ways.

I would prefer my loved ones not to be put in danger because of people who want to do it all but truthfully can barely do one thing well enough to be called a professional at it. Thus, they work for Fire only departments even though they had once been "fire medics" themselves. They understood the responsibities of doing fire fighting correctly. They also knew that even though most of the "skills" of a medic are relatively easy and it only takes a 700 hour certificate to get the patch, you must still have some desire beyond the patch and the name "fire medic" to do justice to the Paramedic profession.

For many of these "fire medics" it is an ego trip and has nothing to do with patient care. If they were told they would split the department into Fire and EMS as some departments have, which side do you think the majority of them would head? I seriously doubt it would be toward the ambulance.


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## fma08 (Nov 3, 2008)

Bottom line, that crew :censored::censored::censored::censored::censored::censored: up, and now they're paying for it. It is their responsibility to know their tools, regardless of if it is a drug or the jaws, inside and out, when they can't do that anymore, they need to step down to get training till they can.


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## triemal04 (Nov 3, 2008)

cvb...don't even bother argueing...seriously, it's pointless this time, last time, and will be in the future.  It's nice to see someone who is local who ACTUALLY KNOWS WHAT IS REALLY HAPPENING THERE speak out (even to say similar things to me that were clear from 3000 :censored::censored::censored::censored:ing miles away) but the responce is, and always will be for some people, the same.

Pretty sad when you think about it.


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## tydek07 (Nov 3, 2008)

First off, I am glad that they are actually doing something about it. Its better to take the drugs away from them, before someone makes a mistake and kills or further harms a pt. 

I am not even going to get into the whole "fire department/ems" issue. I have my own thoughts about it, just as everyone else does.

So, thumbs up to the medical director on making this decision... I hope that department hires competent medics or retrains their current medics soon, so the public doesn't have to suffer from this.

Take Care,


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## cvb7873 (Nov 3, 2008)

triemal04 said:


> cvb...don't even bother argueing...seriously, it's pointless this time, last time, and will be in the future.  It's nice to see someone who is local who ACTUALLY KNOWS WHAT IS REALLY HAPPENING THERE speak out (even to say similar things to me that were clear from 3000 :censored::censored::censored::censored:ing miles away) but the responce is, and always will be for some people, the same.
> 
> Pretty sad when you think about it.


You're right, thanks. Like I said earlier, dinosaurs. We have anti-ems dinosaurs on our department, just like the anti-fire dinosaurs here.


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## ffemt8978 (Nov 3, 2008)

There's no need to toss insults around.


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