By Ryan Mills
Naples Daily News
COLLIER COUNTY, Fla — Carrying signs reading "Help Wanted, New Medical Director," more than 60 Collier County firefighters marched in front of the Naples Beach Hotel on Thursday afternoon protesting recent decisions and public positions taken by the county's medical director, Dr. Robert Tober.
The hotel was the site of a two-day conference of the Florida Association of EMS Medical Directors.
Tober spoke to the group at 9 a.m. Thursday, laying out his position on a number of local issues such as the role of firefighters providing advanced life support, or ALS, services. He also asked for the association's support.
When asked about the protest, Tober said he believes the firefighters are "behaving like children," and said they have turned responsible medical oversight of Emergency Medical Services into a "three-ring circus."
The firefighters said they just want to be able to provide the advance life support services necessary to keep the public safe.
"By utilizing all the people in the system, we can provide better service to the people of Collier County," North Naples Fire Capt. James Cunningham said. "This is about the people. It's about the visitors and residents of Collier County."
Tober says the firefighter-paramedics at the four fire districts currently providing advance life support services — North Naples, the city of Naples, East Naples, and Marco Island — do not provide the advanced medical services often enough to maintain their skills.
Firefighters primary assignments, Tober said, are to fight fires and to be extrication and rescue specialists.
They also have a role performing basic life support and preliminary life support if they arrive on scene before an EMS ambulance. It is basic life support that saves most lives, he said.
"I really need outstanding basic life support delivered to everybody within five minutes," Tober said during his presentation.
But Tober said firefighters don't need the same training and clinical privileges of EMS medics.
More medics does not always mean better service, Tober said. If there are too many paramedics, the experience level of each paramedic declines, he said.
From June 2007 to July 2008, the 102 firefighter-paramedics in Collier County engaged in 162 encounters when they provided advanced life support treatment without EMS personnel on scene, Tober told the conference. EMS paramedics had about 43,000 advanced life support interventions during the same period, Tober said.
"You tell me who you want working on you and pulling out and using sophisticated medications," he said.
For the firefighters, just one incident is enough reason to justify providing the services.
"It is only appropriate that when fire is able to be on scene of an emergency ... that we have the ability, training and the equipment to provide that person with life-saving techniques," Cunningham said.
Tober recently pulled eight of 25 medications from Collier County fire trucks that he said were rarely used and more sophisticated in efficacy and side effects. Those medications should be administered by more experienced EMS paramedics, he said.
"Very, very few drugs were used in any of these departments," Tober said at the conference. "Fifteen doses of drugs were administered over thousands and thousands of medical calls by the fire departments."
Part of the reason of Thursday's protest was to have the medications reinstated on trucks, Cunningham said. Some of the firefighters wore handcuffs while marching in front of the hotel.
"We are handcuffed to be able to provide medical care to the residents of the county," Cunningham said. "We want Dr. Tober to put the medication back on the trucks so we can provide the essential medical care to the residents."
Cunningham compared the situation with advance life support to a high-rise fire. Though firefighters rarely encounter high-rise fires, they continuously train for the situation in case they are called to such a fire.
Firefighters aren't receiving the training they need, he said.
"He wants to take things off our trucks saying we're not trained in them. It's his job as medical director to provide that training," Cunningham said. "As a medical director, he needs to make everyone a specialist."
Tober said that continuous training is worthless without continuous experience.
Lives have been saved because firefighters had access to advanced life support medications, Cunningham said. However, Tober said the firefighters have what they need to continue to save lives.
"I've armed them with enough bullets in their guns to take care of any emergency in the first 15 to 30 minutes," Tober said. "That's never been enough for them. They want the same identical privileges as Collier County EMS medics."
At the end of the conference, the Florida Association of Medical Directors unanimously backed Tober's right, as Collier medical director, to make medical decisions for the community.
"The medical directors recognize the right of local officers and the local EMS system to determine their own challenges and solutions," Florida EMS Medical Director Dr. Joe Nelson said.
"But the Medical Directors Association also supports the right and responsibility of an EMS medical director to make decisions regarding patient care in the system."