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EMERGENCY
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CITY COUNCIL
WORKSHOP MEETING
CITY OF PALM BEACH GARDENS
JUNE 81 1992
The Workshop Meeting of the City Council of the City of Palm
Beach Gardens, Florida, was called to order by Mayor Martino at
7:30 P.M., in the Assembly Room of the Municipal Complex, 10500
North Military Trail, Palm Beach Gardens, Florida.
Present were Mayor Martino, Vice Mayor Russo, Councilman Aldred,
and Councilwoman Monroe. Vice Mayor Russo arrived at 7:40 p.m.
Councilman Kiselewski was not in attendance as he was out of
town.
Mayor Martino stated the purpose of the workshop was to have an
educational session on the Emergency Medical Services Program
in Palm Beach County. The Mayor introduced Ms. Linda Rasmussen,
Emergency Medical Services Specialist with the Palm Beach County
Department of Public Safety; and Ms. Heather Edwards of Inter -
City Emergency Medical Services. The Mayor noted Councilwoman
Monroe had asked for the meeting.
Councilwoman Monroe requested Ms. Rasmussen give an explanation
of the relationship between Emergency Medical Services and
private ambulance companies, and which organizations are legally
required to respond to emergency calls.
Mr. Orr clarified that the first - response memorandum he
distributed pertained only to sick calls being handled by Inter-
CITY COUNCIL WORKSHOP MEETING - JUNE 8, 1992
Page 2
City with all other agencies responding to accident -type calls.
Ms. Rasmussen stated the major laws regarding emergency medical
services (EMS) overall are Federal and State. She said State
Statutes 401 and 10(D)66 are the statute and rules governing
emergency medical services in the State of Florida. She gave
a detailed explanation of how Palm Beach County's EMS ordinance
is a miniature version of the State law but also has additional
rules and regulations. She explained the State requires an
emergency service within a county to have a certificate of
necessity to operate within the County in which it will be doing
business. She stated the office of Emergency Medical Services
issues all certificates for operation of emergency services in
Palm Beach County and regulates and inspects ambulance,
paramedic, and fire - rescue services. She explained Palm Beach
County has a two - tiered system which means the Fire Departments
for the most part provide the advance life support, and the
ambulances are considered a secondary responder to the emergency
and are only required to be BLS (basic life support) permitted.
She further explained a paramedic unit requires only two people,
an EMT (emergency medical technician) and a paramedic. Ms.
Rasmussen had additional comments as follows: In Palm Beach
County there is a Trauma Transport Ordinance which requires an
ALS (advance life support) truck to have three people on board.
In Palm Beach Gardens there is a private primary provider under
contract to provide ALS because the Fire Department does not
CITY COUNCIL WORKSHOP MEETING - JUNE 8, 1992
Page 3
perform this function. She explained the County's ordinance
requires Palm Beach County to assure there is basic life support
ambulance service available to all citizens in Palm Beach County
regardless of where they are. The provision of advance life
support is believed to be between the councils or commissions
and the citizens. Thus, there is no interference in the contract
between Palm Beach Gardens and Inter -City because it is a private
matter. Emergency Medical Services' role is to monitor the
services being provided by the private ambulance service to
ensure they are in accordance with State statute and County
ordinance.
Ms. Rasmussen continued with the following statements: Palm
Beach Gardens is contracted with Inter -City to provide advance
life support response. Inter -City is the transport agency for
Zone 2 of which Palm Beach Gardens is a part. Inter -City is
required by ordinance and their certificate to respond to 95 per
cent of all emergency calls within the boundaries of Zone 2 on
a monthly basis, and she is responsible for ascertaining that
all criteria required by statute and ordinance are met. In the
event all the Inter -City trucks are busy and there is a call,
a backup agency is usually sent in by the County Dispatch Center
(Med Com). The advance life support provider must have another
advance life support agency provide backup. She mentioned mutual
aid agreements, if desired, are between agencies; and Emergency
Medical Services does not require knowledge of such agreements
CITY COUNCIL WOR�<SHOP MEETING - JUNE 8, 1992
Page 4
between agencies.
Responding to questions from Council regarding response time,
Ms. Rasmussen had comments as follows: Emergency Medical
Services has no way of knowing when any city receives a 911 call
until the call is transferred to Med Com which dispatches the
appropriate service. Some municipalities which have the 911
system and need an ambulance will call directly to their ALS
agency which has interaction with Med Com, emergency rooms, each
other's dispatch centers, etc. In Palm Beach Gardens, as soon
as a 911 call is answered and is ascertained to be an emergency,
it is transferred to Med Com which takes the information and
immediately contacts Inter -City. From the time Med Com receives
the call from Palm Beach Gardens, it is being tracked in their
system, and this is how response times are determined. The
County's ordinance requires the ambulance services and the
paramedic agencies meet certain criteria. The fire rescue
agencies are required by law to provide their own tracking. If
there are complaints to EMS concerning response times, they will
perform a statistical analysis using information from the past
month to see if they are meeting the requirements of the
ordinance. For advanced life support, it is required that the
unit be on the scene in seven minutes after receiving the call
although this may change when a new ordinance is implemented
later this year. For ambulances, the time is ten minutes from
receipt of the call with some exceptions. Concerning a method
CITY COUNCIL WORKSHOP MEETING - JUNE 8, 1992
Page 5
to confirm the ambulances are actually on the scene at the time
they report they arrived, she stated her experience has been
other units will let them know of any discrepancies. It is very
common and acceptable for ambulances to report they have arrived
on the scene when they gain visual contact. Heavy radio traffic
can delay a unit in reporting its arrival time for a few minutes.
If complaints are received about a particular service or a
pattern develops, those services are investigated and watched
more closely. However, for the most part, Palm Beach County
simply does not have that kind of problem, she stated.
Ms. Rasmussen then gave an overview of the various state and
local requirements the services must meet in order to become
and remain operational within the County. She stated all her
records are open to the public and available for copying.
In response to a question from Councilwoman Monroe concerning
exterior markings on ALS and BLS vehicles, Ms. Rasmussen had the
following comments: The law does not allow a BLS vehicle to have
any wording or graphics on it to indicate it is a paramedic
service if, in fact, it is not. There is a State sticker in the
front windshield on the passenger side which indicates whether
it is BLS or ALS. It is legal for BLS backup trucks to replace
an out -of- service ALS vehicle provided it is logged into their
books and the proper paramedic gear and personnel are transferred
to the replacement truck. Ms. Heather Edwards further explained
how Inter -City has equipment available in the station ready for
CITY COUNCIL WORKSHOP MEETING - JUNE 8, 1992
Page 6
transfer to vehicles in order to answer ALS calls.
Ms. Rasmussen continued with her comments as follows: Changes
are now being proposed in the County's draft ordinance, and the
State has issued a legal opinion which, if it later becomes a
rule, will greatly affect Palm Beach County. This opinion states
in order to put an ALS patient on an ambulance, it must be an
ALS permitted ambulance.
Councilman Aldred asked if it is a violation of Federal, State,
or County rules and regulations for a member of the Palm Beach
Gardens Fire Department to disable an ALS vehicle using a stink
bomb. Ms. Rasmussen responded it is against the law to
interfere with on -duty emergency vehicles or personnel.
Councilman Aldred then urged Council to request the City Manager
to provide them with the minutes of the Merit Board meeting.
Mayor Martino asked for the meeting to remain educational and
referred to the structure of the Emergency Medical Services
Division. Ms. Rasmussen responded as follows: the Public Safety
Department of Palm Beach County has several divisions, one of
which is the Emergency Management Division; and Emergency Medical
Services is under this division. Palm Beach County Fire Rescue
is another entity altogether. All rules which apply to Inter -
City also apply to Fire Rescue. Inter -City is a private company
and is not a part of Palm Beach County government. Palm Beach
County Emergency Medical Services investigates complaints against
the emergency agencies as well as Fire Rescue.
CITY COUNCIL WORKSHOP MEETING - JUNE 8, 1992
Page 7
Mayor Martino asked for an explanation of the number of personnel
required on the vehicles to which Ms. Rasmussen responded three
personnel are required on the truck only if it is a trauma
transport, otherwise two people are required. On an ALS truck,
a paramedic and an EMT are the basic minimum requirement for
personnel. One of those is the driver with the paramedic tending
the patient. It was noted by Mayor Martino that all Inter -City
vehicles are ALS.
Mayor Martino asked if the City of Palm Beach Gardens paramedics
who are licensed and certified would be allowed to work for
Inter -City on their days off. Ms. Rasmussen responded this
would be an agency decision, but EMS would have no problem with
that. He stated he believes Palm Beach Gardens is receiving
service from Inter -City which is superior to that of a public
agency.
Ms. Edwards addressed the Council concerning the inspection
process for Inter- City's vehicles and records by Emergency
Medical Services, stating that spot checks are performed
unannounced. She stated the results of these inspections are
public records. Ms. Rasmussen stated if Council would like to
have copies of any of these records they may send her a letter
of request. Councilwoman Monroe suggested asking the City Manger
to request quarterly reports of Inter- City's inspections.
However, Ms. Rasmussen stated it was not unusual for three to
four months to pass before she performs an inspection because
CITY COUNCIL WORKSHOP MEETING -- JUNE 8, 1992 Page 8
of the number of trucks involved.
Ms. Edwards stated the State recently performed unannounced
inspections on Inter - City's vehicles, and they were given an
excellent rating because they exceeded County and state
requirements.
Ms. Rasmussen and Ms. Edwards mentioned there are certain areas
such as the Acreage within Zone 2 which are very difficult to
reach by emergency vehicle which can naturally result in high
response times.
Ms. Edwards had additional comments as follows: On certain
emergency calls they are advised the scene is not secure, meaning
it is not safe to enter the area. In such instances, the
vehicles stop at a "staging" area to await instructions from the
law enforcement agencies. She noted in such cases the emergency
vehicles are not always visible to bystanders. Ms. Edwards
brought out these additional facts: a backup vehicle is always
moved into Palm Beach Gardens as calls are received in order to
have an ALS vehicle available should another call be received;
last year Inter -City vehicles placed fourth in a national
competition, with those placing first and second being from out
of state; and Inter -City is a training facility for CPR.
Mayor Martino inquired if the "heart monitor" insignia is being
placed on the units being upgraded from BLS to ALS. Ms. Edwards
responded they will have an identifying sticker in the front
window. Further discussion followed concerning various
CITY COUNCIL WORKSHOP MEETING - JUNE 8, 1992
Page 9
identifying markings on emergency vehicles.
Councilwoman Monroe asked for clarification of "first responder"
qualifications, the proposed legislation, and the term first
provider. Ms. Rasmussen stated there are no regulations
concerning first responders. She further stated the only
proposed regulation she is aware of at this point is that cities
will have to put in writing who their first responders are, such
as police officers, and what equipment they will be carrying.
City Manager Orr stated it will also be put into writing that
when an ALS unit responds to a sick call, the Fire Department
will respond as backup only if called by the ALS unit.
Councilwoman Monroe asked if it would be advantageous for the
`J Fire Department to respond to a potential drowning to which Ms.
Rasmussen and Ms. Edwards responded such a victim is considered
a trauma victim and requires special procedures.
Councilwoman Monroe asked how the Council could know if they want
to stay strictly with Inter -City for all calls or if they have
something to gain by having the Fire Department be a first
responder. Ms. Rasmussen gave a further explanation of her
definition of a first responder and mentioned where classes are
taught on the subject.
Councilwoman Monroe stated if there were qualified people
available who could respond to a call before Inter -City arrives,
she would like to have the City Manager provide Council with more
information for discussion later.
CITY COUNCIL WORKSHOP MEETING - JUNE 8, 1992
Page 10
City Manager Orr stated he would recommend that the Police
Department be first responder. Councilman Aldred agreed and
stated he would be very uncomfortable having Fire Department
personnel at the scene. He stated there were some employees he
feels were psychologically immature; and based on the scheduling
of the workload, he had no doubt they would be on duty when the
call came in. He further stated he believed some employees were
incapable of performing satisfactorily. Councilwoman Monroe
stated if there is a problem with an employee then it should be
handled. Councilman Aldred stated, "If the people who work with
the employee Councilwoman Monroe was referring to do not deem
it appropriate to clean up the department because of that
individual, then I deem them to be just as guilty and immature."
Councilman Russo stated it is very rare that Fire Departments
are not the first responders. Mr. Orr stated that in some of
those cities their Fire Rescue service is part of the Fire
Department; however, Palm Beach Gardens does not have a fire
rescue service.
Ms. Rasmussen stated if Fire Department personnel have EMT
training and are EMT licensed, it might be a good idea to look
into what Palm Beach Community College teaches as first responder
standards. She also suggested setting guidelines for what the
Palm Beach Gardens Fire Department does on all medical calls.
Mayor Martino stated it would be appropriate to discuss this
another time after having the administration refresh the City
CITY COUNCIL WORKSHOP MEETING - JUNE 8, 1992
Page 11
Council as to why it chose the direction it is going. He said
the administration should suggest any improvements needed in the
operation of the Fire Department and be recognized by the union
before taking any drastic measures or before Council discusses
this further. Mayor Martino further stated the City is not
sacrificing any levels of service and perhaps is even giving a
better level of service than some of the public agencies.
Ms. Edwards stated in previous years Inter -City has had good
rapport with the Fire Department, has given lectures, worked with
them on in -house training, and encouraged them to accompany them
on calls.
Mayor Martino asked the City Manager if the City's Newsletter
could be used to educate the public in a positive way about the
role of Emergency Medical Services in the monitoring of private
and public emergency agencies and show how the rules and
regulations are enforced the same for both. Mr. Orr responded
if the human nature aspects can be resolved, he has no problem
with how the City responds. He stated patients will not be
sacrificed because of internal problems, and this is why they
have taken this particular course of action.
Mayor Martino stated he hears nothing but endorsements for the
emergency services given to the City. He also stated the City,
in general, provides the very best in a creative and conservative
way and needs to continue to do this. He stated that some of
the suggestions received from persons attending recent Council
CITY COUNCIL WORKSHOP MEETING - JUNE 8, 1992
Page 12
meetings perhaps are not valid and should be answered that way.
Ms. Edwards suggested Council also look at the legal aspects and
ramifications of being the first responder.
ADJOURNMENT: There being no further business, the meeting was adjourned at
9:20 p.m.
APPROVAL:
Mayor Martino, Councilman Aldred
1 l LIs
1i0€ a 96sso Councilwoman Monroe
Councilman Kiselewski
J c ie Holloman
Ad'imfnistrative Secretary