# Florida EMS Medical Director Pulls Certifications of 25 Paramedics



## VentMedic (Aug 26, 2009)

The comments at the end of the article also make some very good and some very bad points.

http://www.naplesnews.com/news/2009/aug/25/collier-ems-director-pulls-certification-25-parame/



> COLLIER COUNTY — Twenty-five North Naples firefighters are no longer allowed to work as paramedics because they haven’t met training requirements set by Collier County Medical Director Dr. Bob Tober.
> North Naples Fire Chief Orly Stolts said the move puts good medics out of commission and endangers residents.
> 
> “What he’s done is minimized the fire department’s ability to save lives,” Stolts said of Tober. “We’re going to have to stand there and wait to give life-saving medication until an ambulance arrives at the scene. That puts our guys in a pretty hard spot.”
> ...


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## medic417 (Aug 26, 2009)

VentMedic said:


> The comments at the end of the article also make some very good and some very bad points.
> 
> http://www.naplesnews.com/news/2009/aug/25/collier-ems-director-pulls-certification-25-parame/



Bravo.  I like a doctor that puts patients ahead of even powerful unions.  

These guys should have been studying as it happened before in Florida.  But hey I got the certificate now I get the pay raise with the fire department, wheres my recliner?  I get bored at work and study, often way above my level, so when I am questioned about something I can pass and more importantly I can provide my patients better care.  

So lesson learned is while relaxing at the station study rather than playing video games or pulling practical jokes.


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## MrBrown (Aug 26, 2009)

Well I praise the medical director involved here.  This whole thing seems bizzare to me.  The Fire Service Commission here it is against having firefighters trained to any level of medical capability beyond basic first aid and AED as it is not in thier, nor the ambulance services', and certianly the patients best interest as Fire is completely seperate but does operate first-response in a few very rural areas.

Could be high-time the IAFF pull thier heads out from up thier arses.


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## Akulahawk (Aug 26, 2009)

Actually, it appears that the Medical Director did exactly what he was required to do... decertify the Firefighters for not meeting the training requirements. Those responders should reasonably have known that they must meet specific on-going training requirements to retain their cert... and they should reasonably have known that if they do not meet those requirements, they lapse... and there's generally no grace period. Once the cert lapses, you can not work at that level as your cert isn't valid. 

If all those Firefighters take whatever training is required... chances are they'd be reinstated... IF the lapse isn't so great that they'd have to retake the whole coursework...

Politically unpopular? Probably. The right thing to do? Definitely.


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## VentMedic (Aug 26, 2009)

The thing that puzzles me is why some have been so slow to get the message that if you want to be a Paramedic, a little extra effort is required. You would think that after they have been placed under scrutiny by the M.D. and the public in the city meetings, they would have tried to "improve". They also made a public spectacle of themselves by picketing in public stating how unfair Dr. Tober was to the FFs because they were having to do extra training and being held accountable for things they should have known which come with wearing a Paramedic patch. 

The issue has been they believe the M.D. should cut them some slack since they are FFs working for a Fire Chief and should not be held to the same standards as Collier EMS Paramedics. Collier EMS has provided a decent service for many years and it was the FDs who later wanted to provide care at the Paramedic level. However, this is one bad example of how they thought just the patch was sufficient. This county has given the FDs that do provide decent ALS a black eye. I would like to see this "every FF be a Paramedic" thing disappear. I still believe the FD can do EMS but only those with an interest in being a Paramedic should wear the patch. Since almost every FF on these fire trucks are Paramedics, eliminating the deadbeats wearing the patch would hurt Patient care. It may mean there will only be 3 Paramedics on scene instead of 6 now. 

Again, this is not new as this issue has been present since the FDs got into EMS into that county. Two years ago Dr. Tober had enough of the poor quality and did something about it. Here is the article for those who are reading about Collier County for the first time.

*Fla. firefighters sidelined from EMS calls after failing test*

http://www.ems1.com/ems-products/bo...-sidelined-from-EMS-calls-after-failing-test/



> COLLIER COUNTY, Fla. — It's back to the books for a dozen Naples firefighters who are no longer able to work as paramedics after failing a test to prove they could function under Collier County's medical protocol.
> 
> Until the firefighters complete a 40-hour remedial training course, the department has pulled paramedic equipment and medications off its fire engine at Naples Fire Station 1, 835 Eighth Ave. S.


 


> When Bowman met with McEvoy in December, he said he determined the Naples fire department hadn't made much progress and was not complying with training standards or completing trip tickets - the paperwork documenting medical calls.


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## firecoins (Aug 26, 2009)

starting IVs is a BLS skill?


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## Mountain Res-Q (Aug 26, 2009)

firecoins said:


> starting IVs is a BLS skill?



"setting up" IVs is not the same as starting... firecoins.  Any monkey can spike a bag and prep the gear for the Medic to put in an IV...  In fact, IMHO, starting an IV isn't exactely rocket science either...  LOL

and BRAVO to maintaining some type of standard and holding EVERYONE to it, Fire Medics included... they are not special and should not be held to a lower standard just because they have choosen to divide their time between Fire/Rescue and EMS...


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## PotatoMedic (Aug 26, 2009)

firecoins said:


> starting IVs is a BLS skill?


In the army it is!  Different states/counties/organizations may allow basics to start IV's.  


Who knows. sounds odd to me as well.


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## firecoins (Aug 26, 2009)

Mountain Res-Q said:


> "setting up" IVs is not the same as starting... firecoins.  Any monkey can spike a bag and prep the gear for the Medic to put in an IV...  In fact, IMHO, starting an IV isn't exactely rocket science either...  LOL
> 
> and BRAVO to maintaining some type of standard and holding EVERYONE to it, Fire Medics included... they are not special and should not be held to a lower standard just because they have choosen to divide their time between Fire/Rescue and EMS...



the point of setting up an IV if you can't start the IV is?


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## VentMedic (Aug 26, 2009)

firecoins said:


> the point of setting up an IV if you can't start the IV is?


 
There are still at least 1 - 3 other Paramedics on the engine even if the others are functioning at a BLS level. As well, the transporting ambulance will probably have at least one if not two Paramedics. 

And in Florida, if the EMT-B is working with a Paramedic, they can get trained to start an IV. However, I don't believe these FFs will be doing that since that will require a commitment to additional training.


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## firecoins (Aug 26, 2009)

so there are still firefighter/medics on scene.  okay.


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## VentMedic (Aug 26, 2009)

firecoins said:


> so there are still firefighter/medics on scene. okay.


 
Absolutely.  Florida provides ALS EMS to all of its citizens.   However, some might be better than others.  I am hoping that the remaining Paramedics do take their patch and responsibility seriously.   There are now more studies being published which indicate that the FDs' idea of having every FF be a Paramedic might not be the best idea.


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## JonTullos (Aug 26, 2009)

Bravo.  Glad that these guys are being held accountable for skipping out on training.  If you're going to be both a FF and a medic you should be able to do _both_ jobs.  If not, choose one or the other and stick to it.


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## Scout (Aug 26, 2009)

So they got the boot for not doing a shift every 3 months????

I'm surprised this is news worthy, or is it a case the FF have a good union with press links?


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## medic417 (Aug 26, 2009)

Scout said:


> So they got the boot for not doing a shift every 3 months????
> 
> I'm surprised this is news worthy, or is it a case the FF have a good union with press links?



Yes fire union is moving hard to get the Doctor fired for actually putting patients ahead of fire fighters pride.


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## rescue99 (Aug 26, 2009)

medic417 said:


> Yes fire union is moving hard to get the Doctor fired for actually putting patients ahead of fire fighters pride.



Yeah, well, I hope it makes front page news when the union fails! 

There is a massive problem with CE's and course scams all over the country which is why I say we need to begin at the beginning before attempting to enforce more challenging standards. There is no one watching the store as it is. Making education and CE more challenging right now will in some ways, lead to bigger messes. A good many states (including Michigan) are left to police themselves creating an environment where the weasels are the ones watching the hen house! Not good, not good at all! It's always the one who uncovers the scam under attack. Glad to see a Doc sticking to his guns. Instructors and students don't seem to get anywhere in improving a bad system.


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## Hal9000 (Aug 26, 2009)

*Good*

It's good that someone is trying to advance (Or, in this case, keep it at the specified level.) the field.  There are people that dislike those sorts of directors, and those who appreciate the professional care that is being shown.  I don't have much fondness for those who fall into the former category, and I unfortunately work with a few that are like that.


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## medic_texas (Aug 26, 2009)

I hope more medical directors do this.  We all know someone that scares us with their assessment skills and treatments.  

Paramedics are working under this doctors license, they should understand that if they are not up to par they can be demoted to a lower level; regardless of their certification, union, and years of service.


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## 46Young (Aug 27, 2009)

They deserve what they got. How difficult is it to ride an ambulance once a quarter? They're lucky to still be employed. If you lose your cert over here, you're out of a job. Most houses up here will have the medics rotate between the engine and the medic unit each tour. We get roughly 50% ride time on each piece. An engine medic cannot possibly hope to keep up on their skills without actual ambulance shifts at least a few times a month.


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## VentMedic (Aug 27, 2009)

46Young said:


> They deserve what they got. How difficult is it to ride an ambulance once a quarter? They're lucky to still be employed. If you lose your cert over here, you're out of a job. Most houses up here will have the medics rotate between the engine and the medic unit each tour. We get roughly 50% ride time on each piece. An engine medic cannot possibly hope to keep up on their skills without actual ambulance shifts at least a few times a month.


 
They still have their Paramedic certs as far as the state is concerned but have had their wings clipped for practicing as a Paramedic under this medical director. This is one of those situations of recent times where the FD decided to do ALS and sent all of their FFs to the local medic mill for a quick cert or required all new hires to be Paramdic certified at hire or within one year. 

Dr. Tober and Collier County EMS have had a decent reputation for over 25 years and the Fire consolidations have brought on these problems. In Collier, Dr. Tober is now over EMS not only for CCEMS but for the FDs as well and each have their own personalities. In other parts of Florida the FD has had EMS for many years and function relatively well. However, in counties with the mega consolidations of over 30 departments and with 2 - 3000 FFs, most are required to be Paramdics, problems have surfaced.


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## daedalus (Aug 27, 2009)

The scare tactics in the comments section disgust me. How dare people use dying children as a way to appeal these firefighter's decertification. 

It is so simple. If a doctor, nurse, paramedic, whoever, does not meet decertification requirements, they will be decertified! And people are trying to suggest Dr. Tober is playing politics! I think that he and county EMS went above and beyond for reminding the department of the impending expiration of the licenses.


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## Dan Bowman (Aug 27, 2009)

*Thanks for the support*

Hello, My name is Dan Bowman and I’m the Deputy Chief at Collier County EMS. I work hand-in-hand with Dr. Tober in an effort to assure the highest level of pre-hospital care within our community. I'd like to thank all of you for your support and candor, and therefore ask for the membership's help.

Collier County EMS, along with Dr. Tober would first like to recognize that the problem that exists in our County is not a "firefighter" issue. As a matter of fact, I’m a full supporter of ALS within the fire service. All I and the OMD ask is there be adequate training and clinical exposure corresponding to the level of care expected of everyone operating  on any emergency scene. In other words, keep-up with your training, work on an ambulance “occasionally” in order to get more in-depth exposure to patients and be accountable for yourself, your department and the community. While our standards may seem simple and obvious to most, some people are struggling. You’re witnessing this play-out in our local media. What you don’t see are the department’s whose firefighter/paramedics are up to the task and working very hard and competently.

While we continue to move forward in our efforts, I would like to hear from any of you whose departments have been through similar circumstances. More specifically, I understood one of the posts indicated that within their department, they ride around 50% between transport and non-transport apparatus. I’d like more details similar to operations/standards such as this. Any other suggestions will be very appreciated.

We are very proud of our paramedics and EMTS within all of Collier County. We’ve won numerous State and National awards, have a phenomenal save-rate and recently Dr. Tober was awarded the Florida State Medical Director of the Year. We’re confident with our mission and anticipate that eventually, those administrations who seem to be lagging behind will eventually catch up with the standard we’ve set. 

Feel free to _contact me via PM_. You’re support is appreciated.

Thanks.

Dan


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## vquintessence (Aug 27, 2009)

daedalus said:


> The scare tactics in the comments section disgust me. How dare people use dying children as a way to appeal these firefighter's decertification.
> 
> 
> 
> ...


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## MrBrown (Aug 27, 2009)

My five observations on Fire-based EMS

1.  Thy is either a Firefighter *or* a Paramedic, not both
2.  "Education" does not equate to the local crash course medic mill
3.  Paramedics belong in an ambulance, not a fire truck
4.  One does not require a Paramedic card to be a Firefighter
5.  Quit caving to whatever the IAFF says; they do a pretty good PR spin, heck, might even rival the Nazi's!


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## triemal04 (Aug 27, 2009)

Scout said:


> So they got the boot for not doing a shift every 3 months????
> 
> I'm surprised this is news worthy, or is it a case the FF have a good union with press links?


There have been ongoing problems between the Naples FD, North Naples FD and I believe some others and Dr. Tober.

While many of the articles left out rather pertinent info and raised more questions than they answered, this one really does a decent job of shedding light on the current situation.  So screw 'em.  24 hours on an ambulance every 3 months...it's not that much, if they can't live up to the standards expected of them...screw 'em.  This isn't something that excuses can be made for.


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## PotatoMedic (Aug 27, 2009)

Like I said before I am happy what the director did.  The standards are the standards and they should be met no matter who you are.  I can understand that scheduling can be hard to handle but that is the unions problem so they need to re work it to make it easier to get time in the box.  On a side note Portland Fire has a paramedic on just about every rig with no ALS or BLS units, and they seem to do just fine so I wonder why he is requiring time in the box truck?  (not that I am opposed to ambulances).




MrBrown said:


> My five observations on Fire-based EMS
> 
> 1.  Thy is either a Firefighter *or* a Paramedic, not both
> 2.  "Education" does not equate to the local crash course medic mill
> ...



Oh and I'm calling Godwin's law on #5.


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## triemal04 (Aug 27, 2009)

FireWA1 said:


> Like I said before I am happy what the director did.  The standards are the standards and they should be met no matter who you are.  I can understand that scheduling can be hard to handle but that is the unions problem so they need to re work it to make it easier to get time in the box.  On a side note Portland Fire has a paramedic on just about every rig with no ALS or BLS units, and they seem to do just fine so I wonder why he is requiring time in the box truck?  (not that I am opposed to ambulances
> .


You don't know much about Portland Fire, do you?  SOME do ok, others do not.  SOME provide good, high quality care, others...what I've heard scares me...a lot.  It's unfortunately a system problem their, as well as a cultural problem, and not likely to be fixed anytime soon.


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## PotatoMedic (Aug 27, 2009)

I have not heard much about Portland so yah I am not sure of all their problems.  Personally I am not a big fan of their system.  I feel if you have medics or basics then you should have aid and medic units for them to drive.  Not just put them on the engine.  And I don't like Medic on engines,  Major waste of resources.  Not only does it pull and engine out of service but it also separates the crew if the medic has to go with the aid car and transport..  But yes I don't know of any of Portlands problems.  But that is just because of a lack of research on my part.

I just hope the guys in Florida can sort things out and I really hope the director does not get the boot.  It will be interesting to watch and see what happens.


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## medic417 (Aug 27, 2009)

Dan Bowman said:


> Hello, My name is Dan Bowman and I’m the Deputy Chief at Collier County EMS. I work hand-in-hand with Dr. Tober in an effort to assure the highest level of pre-hospital care within our community. I'd like to thank all of you for your support and candor, and therefore ask for the membership's help.
> 
> Collier County EMS, along with Dr. Tober would first like to recognize that the problem that exists in our County is not a "firefighter" issue. As a matter of fact, I’m a full supporter of ALS within the fire service. All I and the OMD ask is there be adequate training and clinical exposure corresponding to the level of care expected of everyone operating  on any emergency scene. In other words, keep-up with your training, work on an ambulance “occasionally” in order to get more in-depth exposure to patients and be accountable for yourself, your department and the community. While our standards may seem simple and obvious to most, some people are struggling. You’re witnessing this play-out in our local media. What you don’t see are the department’s whose firefighter/paramedics are up to the task and working very hard and competently.
> 
> ...



Welcome to the site.  I hope the fire unions fight to remove Dr. Tober loses.  

I do disagree with fire being ALS as they are divided.  EMS and fire are 2 very different monsters and need people to specialize so patients do not suffer.  

I applaud Dr. Tober for standing up for what is best for patients.


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## 46Young (Aug 27, 2009)

Dan Bowman said:


> Hello, My name is Dan Bowman and I’m the Deputy Chief at Collier County EMS. I work hand-in-hand with Dr. Tober in an effort to assure the highest level of pre-hospital care within our community. I'd like to thank all of you for your support and candor, and therefore ask for the membership's help.
> 
> Collier County EMS, along with Dr. Tober would first like to recognize that the problem that exists in our County is not a "firefighter" issue. As a matter of fact, I’m a full supporter of ALS within the fire service. All I and the OMD ask is there be adequate training and clinical exposure corresponding to the level of care expected of everyone operating  on any emergency scene. In other words, keep-up with your training, work on an ambulance “occasionally” in order to get more in-depth exposure to patients and be accountable for yourself, your department and the community. While our standards may seem simple and obvious to most, some people are struggling. You’re witnessing this play-out in our local media. What you don’t see are the department’s whose firefighter/paramedics are up to the task and working very hard and competently.
> 
> ...



Requiring 1-2 years (or more depending on the qualified applicant pool) of prior FT single role medic employment as a hiring requirement would be a great idea. I understand that there is an overabundance of ALS certified individuals in FL, so this shouldn't be to difficult to implement. 

Fairfax County FRD includes a 16 week field ALS ambulance field internship prior to beginning the suppression academy. 4 hours weekly of lecture and skills testing during this period are also included.

The majority of houses rotate the medics between the engine and medic at a 50/50 ratio. Most stations have medic units, and all 37 have ALS engines. Some officers are dual hatters, so the medic at that house may get less suppression time as a result, if staffing is lacking that day. There usually is a dedicated engine medic spot (left bucket), so the engine medic will be pulled as a last resort to fill a medic unit.

We go to quaterly ConEd sessions quaterly, on duty, for 8 hours each time. We also include EMS drills with our monthly mandatory training matrix. This makes it easy to get in our CEU's, as they're all done on duty.


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## Dan Bowman (Aug 27, 2009)

medic417 said:


> Welcome to the site.  I hope the fire unions fight to remove Dr. Tober loses.
> 
> I do disagree with fire being ALS as they are divided.  EMS and fire are 2 very different monsters and need people to specialize so patients do not suffer.
> 
> I applaud Dr. Tober for standing up for what is best for patients.




Thank you for the support.


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## Dan Bowman (Aug 27, 2009)

46Young said:


> Requiring 1-2 years (or more depending on the qualified applicant pool) of prior FT single role medic employment as a hiring requirement would be a great idea. I understand that there is an overabundance of ALS certified individuals in FL, so this shouldn't be to difficult to implement.
> 
> Fairfax County FRD includes a 16 week field ALS ambulance field internship prior to beginning the suppression academy. 4 hours weekly of lecture and skills testing during this period are also included.
> 
> ...



Ironically, several years ago, we modeled our initial cross-training program based on some of your department’s standards.
Please PM me an email address. I’d like to ask you a few questions and get some advice.


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