EMS: "A Foundational Breakdown'
By Rick Outzen
For 90 minutes on Thursday, May 2, the Escambia Board of County Commissioners discussed Emergency Medical Services with Dr. Rayme Edler, the county’s medical director, at its agenda review. The topic was whether the county should hire a vendor to retrain its EMS staff, but the discussion provided the public a view into the communications and training issues in the department.
Dr. Edler was somewhat hampered in her responses because of the state’s investigation of EMS that was disclosed last month by county officials. Inweekly has interviewed the family members of patients who have died while being transported by EMS or shortly after reaching the hospital.
When questioned by the commissioners, the medical director assured the board that the state had been given “substantial evidence” of problems in the department.
“What you have is a foundational breakdown in EMS,” said Dr. Edler. “So, we need to redo the entire structure. Chief Nail (the recently resigned fire chief) and myself have been trying for months and months—and I can show you the emails—to try to do a reorganization with the management.”
She continued, “Because what you have is very poor management with your emergency medical services. With that being said, your leaders are poor leaders, and that is trickling downhill.”
Edler said the training shouldn’t be seen as a punishment but an opportunity to get more hands-on education. She said, “These EMTs and medics, we’ve got a great team—I’m not saying that they’re poor by any means. But they’ve been craving that attention to even have in-services and help. When Steve White was brought in as a (EMS) chief, he eliminated all that, and everything went to modular training, meaning you had to look at a computer.”
The medical director stated that she had discovered “some unethical behavior with those certifications.” She told the commissioners, “The way the training center was being run by one of these individuals was not being followed by the AHA guidelines.”
According to Edler, EMS medics have come to her with concerns about the validity of their certifications.
“Now, do I think these people are competent enough to do what they’re doing? Absolutely. But are we following what needs to be done by the guidelines and their operation procedure manual?” said Edler. “Not necessarily, and that had to be fixed because the AHA (American Hospital Association) can come in and say, ‘You guys haven’t been following this step by step, so we’re going to take it away.’ But again, do I feel like the majority of these medics could run a code and take care of me? Absolutely. There’s no doubt in my mind, but we do have to follow those guidelines to keep those credentials.”
Dr. Edler, who was hired as medical director in May 2018, said she has been working for months on “trying to redesign and revamp all the entire protocols.”
“We haven’t had policy updates since 2011, 2013,” she said. “I’m sitting across from a supervisor and having to explain to him that he shouldn’t be asking me to pronounce somebody dead after he watched him bleed to death. We’ve got issues.”
Edler confirmed that the certifications of five employees were the ones in question. Commissioner Lumon May questioned whether it was wise to recertify all 260 employees if only five are the issue.
Dr. Edler asked the board to support a full training program because the proposed plan would get “certifications on track because our training center for the AHA has been completely disorganized.”
“If the AHA comes in, and they decide that they’re going to shut us down—because the word that I have is that they have very low tolerance right now for dealing with anything that could be potentially a mess up—then you’re looking at spending over a $100,000 every two years just to get everybody certified, to keep their certifications in place,” she told the board.
Commissioner Steven Barry asked Edler about the delays in updating the protocols. Dr. Edler said it took three months for IT to install the necessary software (Vizio) so that she could adopt similar protocols used by the Cleveland Clinic and other agencies. She said the jail policies have been in place and updated regularly, but that hasn’t been the case at EMS.
“EMS has been behind,” said Edler, but she also wanted to reassure the board and public that things have improved. “We haven’t had as many issues over the last year. We have a very strong team. We’re still trying to pull a team together over at EMS that can function as well as we do at the correctional center.”
Commissioner Doug Underhill supported the move to more hands-on training.
“The military led the way on computer-based training for decades. We drove it home, and we started pushing computer-based training on everything,” said Underhill. “What we found was that our ability to perform in a crucible dropped considerably.”
While the commissioners agreed that EMS training needs to improve, there were concerns over the procurement process.
Interim County Administrator Amy Lovoy said the certification issue was brought to her attention in January when Edler and Fire Chief Nail brought forth a proposal to hire Rescue Company 1, an Orlando-based company.
“I talked to the purchasing manager who agreed and even suggested the firms to get the quotes from,” said Lovoy. “When it became clear that they wanted training no more than $50,000, I suggested to expedite this. They should get three quotes for abbreviated ones to take care of the five people in question, which would have been way less than $50,000.”
Tamika Williams, the Public Safety business operations manager, gave the commissioners a timeline of the solicitation process. The emergency PO was brought to her attention on Jan. 30. After meeting with Lovoy and Senior Purchasing Coordinator Paul Nobles, the decision was made for Nail to seek additional quotes from nonprofit organizations since the quote was $125,000. On Feb. 15, Chief Nail said he would get additional quotes, but Williams never heard back from him.
Dr. Edler explained that during that timeframe, she was working with Baptist Hospital and Pensacola State College to get quotes. On April 10, after Public Safety Director Mike Weaver resigned, Lovoy and Coughlin asked Williams to get the bidding process complete. Rescue Company 1 was the only submittal.
“On April 22, I received a revised quote for Rescue Company 1 in the amount of $51,300, and that was at the reduced training just to get it done,” she said. “At that time, I closed it on vendor registry and made a statement that due to the fact that it was over $50,000, it will require a full solicitation.”
Williams advised Edler, Nail, Coughlin and other county officials that she would not personally be contacting the vendor asking them “to circumvent the process to get it under 50 because I said it was illegal to do so.” She said, “However, later on that day, I received a revised quote of $49,550.”
The commissioners felt the modification of the quote after the bid had closed eroded the public’s trust in the process. They directed staff to rebid it but didn’t blame Edler for the breakdown.
“I think this also plays into an overall concern saying that we are not providing our directors and high-level employees the proper training and going through a procurement process,” said Commissioner Robert Bender. “Dr. Edler has been here almost a year and doesn’t know the process. In procurement, we need to make sure we are training them on our expectations, and this even has to go with HR and employee performance.”
Commissioner Jeff Bergosh wanted to re-enforce Dr. Edler’s comments about the competence of the current EMS staff.
“To the public, I just wanted them to know one thing when they watch this meeting,” said Bergosh. “The people that come to your emergency are qualified; the people that work for Escambia county are committed; people that work here are highly skilled. Any organization, a large organization, you’re going to have a percentage at the bottom, where there’s gonna be challenges.”