A New Perspective: EMS, fire: turf battle just gets uglier

What started with pea shooters, moved to guns, and now grenades are being used in the continuing turf war between EMS and local fire departments.

You'll notice in the front page story that Collier County medical director, Dr. Bob Tober, took away the right for 45 of North Naples Fire District's 50 certified paramedics to perform Advanced Life Support.

Tober maintains they aren't qualified to dispense ALS drugs. The district says they are and so it goes, round after round.

After 30 years, it looks as if NNFD is ready to give up on trying to work with EMS. They are going to the county commission, asking the board to keep its agreement or give them the right to regulate their own training to better serve their district.

What we have is arguably one of the foremost experts in medical procedures, Dr. Tober, who literally wrote the book on medical field techniques for EMS across the country. He is required to certify all who want to perform ALS and he sets the bar pretty high. We've received quite a bit of correspondence from him and other department members, defending his position.

Tober maintains that fire personnel just don't use ALS enough to be good at it and that responsibility should remain with EMS. He isn't being nasty, he really believes this. He has spent the last 30 years engrossed in these issues. But, his perspective is overly protective, according to most.

Tober points to statistics that show EMS personnel perform thousands more ALS procedures than fire personnel; therefore, it is dangerous to allow fire paramedics to use ALS, as they don't have the experience.

Those statistics can never change if fire personnel aren't allowed to perform the services. They can never be as skilled as EMS staff, because they aren't allowed to administer ALS. Tober definitely has control issues.

In the meantime, all across the nation, we have ALS procedures being performed under stringent guidelines. The fire departments also want stringent guidelines, but they don't want over-the-top guidelines that are forever changing to keep them out of the ALS business.

Adding to the fight is disagreement over an EMS swap that allowed fire districts to provide ALS services by trading an engineer for an EMS paramedic, thus providing a Tober-certified paramedic on their fire trucks. Like the training issues, the swap agreement became a battleground and some of the larger fire districts began to create their own EMS departments, hiring away some of Tober's top officials to head them.

After all, if a Tober-certified official isn't good enough to train others, then who is?

The situation has led to more duplication of services. Money is tight, and we have to question if duplicating ALS is appropriate, just because one person has higher expectation than most of the rest of the country.

Hopefully, calmer heads will prevail at the commission level when NNFD brings their case before county commissioners. The train wreck has happened, now it's time to pick up the pieces and put things together in a more progressive