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City of Marco Island Ambulance Service –
Is now the time?
(NOTE:  The views and opinions expressed in this communication are personal to me, Charlette Roman, and do not necessarily reflect the opinions of the City or your City Council.)
   
     For decades, Marco Islanders have been provided excellent ambulance service by Collier County EMS. In June 2017 Marco Island city council voted to submit a Certificate of Public Convenience and Necessity (COPCN) application for a Marco Island-run ambulance service. I was the only councilor who voted no. Two major reasons why I did not then support that proposal were:
  1. Staff could not define the problem that the City was trying to solve by undertaking such a major endeavor, and
  2. Staff could not provide the data required for the rigorous analysis to show that Marco Island running its own ambulances would improve on the service already provided by Collier County.
     I explained that vote in more detail in my Summer 2017 Update newsletter; click here to view it.  My fellow councilors addressed some of my concerns by saying that we don't have to use the COPCN license "right away," and added that Marco Island could "keep it in the desk drawer" until we needed it. So, why are some counselors and the Fire Chief suddenly talking about implementing the city ambulance service by May 2019 if voters approve the referendum this month?

     I did support working with Collier County to get a second full-time ambulance, something that Marco Islanders have wanted for years. During the discussion of the COPCN license, the County offered Marco Island a cost-sharing proposal for that second County ambulance. Surprisingly, the council decided not to return to the negotiating table and pursue this option.

     Council also wanted to pursue an additional avenue to obtain the license and asked our legislative delegation for help to change State law. I attended the legislative delegation session in November 2017 when our representatives established conditions for such assistance, which included giving the voter a voice with a referendum, now scheduled for August 28. Later, the delegation came to the council requesting that we submit the COPCN license application to Collier County before the legislative session began in Tallahassee. I voted to support the delegation's request, and staff submitted the application in December 2017.

     As our license application made its way through the County process, I attended meetings with the Emergency Medical Authority. In the end, Marco Island received a 4-1 vote from the Board of County Commissioners recommending approval of our city transport license to the State. As part of this approval process, city staff has drafted an inter-local agreement with the County should the State license be granted. Now it is time for voters to make their voices heard.
      Here are some questions voters should be asking when considering their vote:
  1. Is now the time for the City to establish and run its own emergency ambulance service? We have been without a qualified, experienced city manager for several months, and staff sections are still overwhelmed with the demands of post-Irma repairs combined with normal seasonal construction projects.
  2. What is the implementation plan for establishing the ambulance service?
  3. What is a realistic time-line for it?
  4. With no experienced city manager at the helm of operations, who will oversee the implementation plan?
      As fortunate as the City is to have an immensely qualified and experienced Fire Chief, I feel that implementing a new city ambulance operation is too complex and important to our citizens' safety for him to implement alone.  There are requirements that must be added that are outside the fire department's purview, such as the billing function – do we add staff or contract it out? Under the current proposal, a medical director must be hired to oversee medications, protocols, and training. Will the search procedure for a medical director be as problematic as the one for a city manager? Will the City's liability increase with an ambulance service? The local union for Marco Island professional firefighters has been silent on the ambulance subject. With their union contract up for negotiation this year, I think that, if they get new duties, understandably they will want more money.

     The City contemplates hiring an additional twelve firefighter-paramedics to begin the service. WiII twelve be sufficient? They will be working 48-hour shifts, rather than the 24-hour shifts that the Collier County EMS personnel work. Wait times to offload a patient at the hospital in season can take up to an hour, in addition to travel time from Marco Island. Will our ambulance personnel working 48 hour shifts get enough sleep to adequately function with these new ambulance transport demands? The plan is to start with three ambulances - will that be enough without the robust County-wide EMS system as back-up?

     The City is currently building a new Fire Station 51 to replace the one damaged by lightning and a subsequent fire. Council is also considering funding the replacement of Fire Station 50 after years of delay. How will the additional start-up costs of a new ambulance service affect current and future budgets? And, notwithstanding the estimate on the ballot, your taxes?
      The impact of future population growth in eastern Collier County could stretch County resources to the point that, someday, Marco Island may need to start its own ambulance service in order to maintain the high quality of service the County provides islanders today. By then, we should have a qualified, experienced city manager at the helm overseeing City operations, one who will be able to effectively guide and direct staff.

     Make sure you voice is heard at the polls!  Early voting begins on August 18.  Election Day is August 28.
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