Finger Lakes Regional EMS Council
July 15, 2010
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Good morning, everyone, and welcome to the Finger Lakes REMAC. It is Thursday, May 20th, and it's a little bit after 9 o'clock in the morning. Thursday, May 20th? How come I put Thursday, May 20th? It's not Thursday, May 20th. May 15th. July. What are you doing here? I grabbed the wrong ones. (____________) Correction, it is the 15th of July, 2010. Check your packet, you might have the right one in there. I put the wrong date on it, sorry. All right, so any way, with the exception of the incorrect date, let's call this meeting to order, and looking for approval of the minutes from the previous meeting. May 20th, 2010. (_____________) Thank you very much. We'll get right into reports. Program Agency Coordinator. Program Agency Coordinator. The protocols have been mailed to the Department of Health for inclusion in the October 2010 SEMAC and SEMSCo meetings. The packets were completed. They required - the State required two paper copies and one electronic copy. Those all went down. The first set went down FedEx and then revised change makers went down three days later via registered mail, and we have the receipt for the registered mail so everything is done in Albany for that. No educational opportunities over the summer. It's pretty much a slow time. The rest of the stuff I have will come under new business or discussion somewhere else. Very good. Donna? The summer classes are underway. We only have one refresher in the summer and then we have the paramedic program going on. Fall classes have been established for certified first responder up to critical care, and they are posted on the web and agencies have received two mailings, a third mailing will be going out next week _____. They will appear in the papers after the 1st of August for classes being offered. We have interest already. People calling about the various classes. That's where that sets. Training and Ed met last night. Ken can report on that. The sponsorship for the programs was due for renewal by July 1 of 2010 and that was sent to Andy Johnson of the State, Ross got the copy. He is coming on August 5th I think for the audit - Andy? No, Ross. He goes through - he can give you an idea of what he does as far as the audit goes. We have to do a five year audit and go back and take a look at all the monies that we received and how we spent it and everything like that to make sure that it was justifiable on what we spent it on and then also we had to prepare the packet which was all the policies and procedures ______, how we handle various situations and that type of thing. A couple of new things that have come out, Training and Ed is working with right now that came out after the packet was mailed. - (_________________) And it's well done. It's all put together and the policies and stuff __________ spot through a couple of files ____________. That's usually the last piece that ___________ Yes. Most of the sponsorships are done. _____________ based on what he's seen so far __________. I don't see any issues at all. ______________ In Training and Ed _______ various situations, I'm going to jump in here because you're the chair of it. I mean the issues that come up there, if there's things that the State questions ________ need to talk about this in Training and Ed, and that type of thing ______ a lot of writing over the last many years _________ (_________) paramedics coming out of the program ___________ Next year the college is ___________ college sponsorship. That would be a little easier though because that's - Right. On this one here, this is the first time that they have ever required an actual audit of the money expenses to prove where you spend your money. I have to go back five years. We offered in the last five years 261 classes. So I think it's hard - when people say they don't feel that we offer enough I think it's hard to justify when you look at that and they say that they can't get a class that they want, it's hard to swallow that when they call the office and say that. __________ So that's where we sit with that. Basically the big thing was _____ audit in August. We had one six or seven years ago by the State when we were at the Safety Training Building they came in and did an audit then. We didn't find anything ____ it was a clean audit so ________. All the classes are good. ______ and we'll forward from there. Very good. All right, I don't have much to report on. I think that most everything that I've been involved in has either been recorded ________ business _________. Actually if I recall over the past years ______ (____________) Program Training. (______________) as far as I know nothing __________ opportunity to jump back in and do some teaching in the last week or so _______. (_________) My answer to them is that's exactly what he needs to be. Well, unfortunately, I think all of us realize the hard ______ and because if it's a little bit tougher in school, you get a taste of reality a little bit sooner, but it makes it easier _______. I've got no problem with it being a little tougher. We had a couple that - I'm hoping we're going to get back, now that they realize what they need to do and how they need _______ and see how that works out for them. I think in the end we're going to have better medics. I just have a couple of things to add for the paramedic side. Actually one of the _____ we are having an instructors' update for all the Finger Lakes Regional EMS instructors and CLIs on August 11 here. That's an annual thing that we do every year. I bring out all the new policies _____ we review the student manual __________ everybody is kind of on the same page __________. What time does that start? 6:40. (_____________) same page, that is a recommendation from the State that we do that, but we've done that here for 10 years anyways, we try to do 2 a year, unless there's really something earthshaking it's not really worth doing 2 a year. Not anything against the State, but we don't ___ anybody together twice a day. It's hard enough to get them together once a year, but ____ inventory. We are having - notices have gone out, there will be a paramedic committee meeting on Thursday, August 19th. That's something __________. And then - so that will be there. That is a requirement for - actually the State would like us to have it that paramedic committee as well, but it's also a requirement in the accreditation process. That accreditation process has to be secured by December 31st, 2010, and the other thing is that the accreditation packet is well underway. We've been working on that. There are several things that we have to do as far as surveys for students and surveys for faculty and that type of thing that has not occurred yet, but we will be doing yet, and what's going to happen is I am hoping that this packet is going to be completed so that we can file it by mid '11, by next summer with folks so that gives them a year to get their on-site schedule. And probably what will happen, I'm not sure whether I am going to be able to wait until next August ___ to go over this packet, I may have to call for a special meeting of those on the committee that are available and review it. I'd like it reviewed before I send it so that we're all on the same page ____ start asking questions. I know Jack ______. So that's the process with moving forward with that. That committee, they're requiring several different arenas be in that. They would like law enforcement, they would like students, they would like safety, I have Bob Breen who has agreed to be on it, who is actually a retired lieutenant ____ Sheriff's _____ is still a certified paramedic and ____ Ontario County Safety Committee, because he is on the Town of Bristol supervisor, so I'm kind of hoping that I can do several people for different focuses. And just as a caveat to that, he and I went to the Safety Committee meeting at the Ontario County Supervisors meeting, Homeland Security, if you go on the Homeland Security web site you notice that 99.5% of all their classes happen in _____, that's where their headquarters are. There's very, very little, if anything, we got one three or four years ago that we offered here and the other place that it goes obviously is down towards New York City. We had several, many requests from folks to get some of that Homeland Security class done here. So between Dr. ___ from the College, Bob from the ____, for the County, Jeff ____ from the County Administrator, Jeff ____ from County Emergency Management Office, we drafted a letter and sent it to Homeland Security ____ asking if we could bring some of those classes this way. We have not heard a response yet. We're trying. And that's _____ Let's move onto old business, protocols. Bill is not here, but as Bob has already said, they were completed along with the changed matrix and submitted to New York State. We're hoping that we will be high on the list for review at the SEMAC and ______ first, then SEMAC and SEMSCo in October so I'm hoping that we would be on that list. (_________) So we should be in good shape for that. ___________ a lot of time spent on the revisions and everything ____________. Regionalization Committee. Jamie, do you want to talk about that? Yes. We kind of -- _______ initially, we split the workload into three main areas, each was ______ physician coordinator and then members of the committee. The three main groups that we split to were an initial certification group which was chaired by Dr. Beirnbaum and had three paramedics from the region. Their goals were to kind of develop some initial criteria or the concept of initial criteria that would include both agencies, to be an RSI agency and also individual medics to be RSI medics. They've been emailing back and forth like crazy. (_________) Essentially came up, for the individual paramedics, we all recognized that this is an individual - there is individual criteria so we have guidelines, but they're not strict criteria and then we come to the certification group to essentially say yes or no to individual medics, but in general the criteria ____ EMT-P _____, practicing as the ALS level for at least 20 hours a week on average, having 100 ALS workups per year, ACLS ___ certified and then letters of good standing from the medical director and ALS chief of the agencies. The reason that those numbers came up is we wanted essentially the career medics that were doing a lot of ALS work, that were going to be exposed to the potential intubations and RSIs to be the ones that have the ability to do and to kind of avoid ones that were maybe not getting too many exposure to the acute patients so that they need, since they probably should not be focusing on their RSI skills, they probably should be focusing on maintaining their ALS skills. So that's a discussion ________ finalize it. For the agency ___________ from the Department of Health and Finger Lakes to provide ALS care, essentially ____ agencies. And then they also obviously have to the ability to carry and administer controlled substances and have the ability to do use them. They have to sign off on __________ policies and procedures. They would have to agree to make their RSI medics available to the whole community, not just restricting them to their own practice area, essentially making them county-wide or REMAC-wide RSI agents. There's a lot of discussion on that point, just to say to you guys now. _____ three paramedics, one saying I don't like it, the other two saying we can't have it any other way, we do it this way, it's pretty interesting. So I think that point is going to come up, is going to have a lot of discussion. The one paramedic felt that, no, he felt that he or his RSI medics would only be available for his agency and the other people, including myself, felt that was a little shortsighted. That if a patient in the community needed an RSI _________ hospital, then that medic needed to help that patient and that there had to be an agreement. (_______________) RSI is only restricted to only one agency - And that was actually my final point saying, congratulations you do this, but you're only to get one a year and you've never going to get approved to do them so ____ that was before any emails went back and forth for literally for three days. It was actually great. I loved the discussion because they're now starting to get an idea of what regionalization actually is, and this concept that they don't live in their own little silos and their own little CONs areas, but the concept that you're a regional resource, not an agency resource. So it was interesting I think ________ concept of regionalization, slightly hard to struggle with, but once we get _______ so those findings are probably finalized ________ then bring them to the next REMAC. The second group was Jack's group and were focused on training and essentially Dr. Davidoff is going to be working with the Mercy Flight Central educators to figure out how to ____ the pre-existing Mercy Flight RSI training to the region. They were going to get some cost things and also investigate some on-line resources ______. I spoke briefly - Doug and I had actually spoken a couple of times and I think we've got a certain outline of what we want to do. ___ pull it out of a folder and email it to you right now ___. It will be able to be tied together in the next week ____. It's - we're not reinventing anything, it's already there. Right. And it's outlined that the people _______ summers things are tough. The final group was my group, and we took on the quality assurance aspect. Particularly we were looking to develop a time line for quality assurance and then also some criteria of how we were going to do it and generally the agreement - the first discussion that came up was whether there was going to be agency involvement ____________ directors. They universally said they wanted to be notified if there was an RSI, but were happy to immediately pass it onto the region to do it because that's the concept behind regionalization so everyone was kind of on board with __________ all of us abide by what they feel in their reviews so I mean that's regionalization starting to come through again. The timeline that was developed was notification of the QA team within 12 hours which falls into line with the _____ period on the charts, within 24 hours the PCR being available and within 96 hours an initial QA done by the committee and then either closing it out as being appropriate with no issues or ____ full review which then would involve ____ process. And I think that that timeline was pretty much agreed upon. There was also ____ to use the pre-existing RSI forms with some modifications, just because ____ well-designed ___ form that will give us the QA aspects that we need and then the most recent discussion is the concept of ________ RSI _______, but I think that concept is ____. But one other thing that we're going to ask your committee to add in was we were essentially - we're going to mandate electronic PCRs. So we can review it. So we can review it quickly and consistently and I don't want to be stuck at 2:00 in the morning trying to decipher someone's handwriting about whether it's a 6 or a 2 and I think that there was kind of an agreement across the board that the electronic way is consistent, it's fast, it's easily accessible and it can __________ because we didn't want to get stuck in ____ electronic systems. (__________) what is - what are we saying is the time to start the PCR? Two hours. It's two hours. I could not remember ___________. (________________) Two and 12 has been Monroe-Livington's - (_____________) We set it at 4 and 24 _________. (_____________) ____ it needs to be locked in two hours. That's my answer, that's what I thought as well. This had to be started almost immediately and it had to get done within two. I don't care when we start it, I mean it's got to be locked in two hours. So part of the reason I bring this up it kind of ties into exactly what Jamie is saying _______ you want that PCR and you want it pretty damn quickly, you want to be actually get it and see it no matter where you are. I mean, you know, Jack it's your approval, if it's regionalized, you want to be able to at 1 in the morning get onto your computer and go okay, okay, talked to the medic, debrief everyone, give suggestions, give education. You don't want to ___ scramble and try somehow to get a paper or realize that they're not actually going to get it to you for six hours, ___________ We took the 4 and 24 as the initial step based on the recommendations from the commercial services. Right. Mostly from the Finger Lakes where they post and they're working a lot of calls back to back and it was felt that the 4 and 24 was generous and after a short review period we probably just kind of like squeak it down. (_________) Monroe Livingston has done, that 2 hour time range is where they are now. They started - (___________) They started much higher _____ discussion was here _______ and work towards that shorter time frame. When Monroe Livingston reinvented the wheel ______ the first they did was that anytime that an RSI was performed there was an immediate review from a physician. Correct. That's the initial QA process at that point and they want from that and pared it down into the _________. I think that's ___ function that I would prefer. (__________) time line for the PCR. It does and it doesn't. Right. __ QA in 24 hours ____________. I think that's a long time for a chart to come in. Yes, I'm just throwing it out there, but, you know, it's one of the things - I think an immediate phone call is what I would want if I was the doc on call because I would want to know how it went down and, you know, what meds they gave _______ Actually that was part of the RSI Committee. The RSI Committee could recommend that the services doing RSI, first of all, the committee has talked about making them all be electronic, but the RSI agencies, you could in theory tighten up their requirements and leave the requirement the way it is for the rest of the agencies submitting electronically. (___________) Go back about where the committee talked about the RSI paramedics that is going to be able to go all over. Explain to me what you're looking on that because I have a couple of questions on that. What it is is what we're going to do as a committee and again this has to go back to the committee and the committee has to agree something and then it has to come back here so it's really nothing official. This is just a discussion. ________ that if someone is not an RSI medic and someone in the county needs an RSI and they're the closest person to do it, sometimes the hospital is the closest person to do it and we always have to keep that in mind and that person should be dispatched to do the RSI. A great example ______ Wayne County, North Rose would be as far as we're going to receive a, you know, a patient unless they've had an RSI medic and ___ that would be a really good example because that would be a closest RSI medic, definitely closer than any hospital, if the patient needed it, then the RSI medic should be discharged to do the RSI, where they would meet up so for mutual aid. So my question is is that one in Walroth, is that an RSI, is that a Walroth medic so they're mutually aiding Walroth Ambulance or is that somebody that works for Finger Lakes that lives in Walroth? (_____________) First of all, they have to be actively working at the time - Irregardless of that, my question is where I'm looking at is liability - I don't see any liability _____ That would be the agency that would have to be dispatched ________ as far as that agency's vehicle to do that. Correct. If it's a Walroth medic, __________ Going to a mutual aid for an RSI. It's _____ I guess is the answer - No, it's never an individual practitioner. It's no different than saying we don't carry controlled substances now, we have a patient that's seizing - (__________) Actually that happens regularly. I didn't interpret that when you first said that. No, it can't be a person, you can't actually be a person that does RSI without an ambulance ______ (___________) called out to Sodus and saying, hey, that's _____ problem, that's not my problem, I'm not going out there to do an RSI, ______ Newark. The concept is you're an RSI medic, you're probably a service to the whole region, not just your ______ But it would have to be under a mutual aid agreement. Right. Well _________ right now, if someone is seizing and they don't have narcotics they call for narcotics. Right, mutual aid. We do that routinely now. Right, but when he first said that, that's not how it sounded. Right. I mean I was like - (___________) agencies is going to be able available to respond _________ And it's going to take a lot of fine tuning because ____ is not always going to have an RSI medic on board. It's probably good that maybe they've got a paramedic that can come out with Valium or morphine, but probably less of a chance that they're going to have an RSI medic. (____________) if your agency has an RSI tech off __________ Jim Lee is not here and we need to get the 911 Center involved because we've been through this before. They don't want those extra phone calls. No. Their computers aren't particularly set up for it right now so there are some issues there. It depends _________ The State ____________ Actually we were talking about that. That agreement would be between the ALS agencies where in fact that would be ______ Agency A ____ Agency B ___ BLS service ________ So this - Between the ALS agencies _______ All right, so BLS agency tech calls for an ALS agency from next door that doesn't have RSI, the ALS agency gets on scene - (_________) Well, BLS agency maybe realistically doesn't make a good call. Right. And they say I need ALS. They get ALS from next door, that gets on scene says the patient really needs RSI so can that ALS agency call for mutual aid ALS to back them up to do RSI, even though it's the BLS agency's call. Not at that point. Right. At the point where the ALS guy takes over, guess what? ____________ Okay, so now it is the ALS agency, the first ALS agency that could institute mutual aid? But you also have to consider the time frame. First of all, how long has the ___ on scene waiting for ____________ So there is still some kind of discussion going on there, we didn't have any idea of who was going to be here or not be here ____, but clearly the plan is to meet again probably in the next month or so. ______ table ______ see where we are, figure out _____ to REMAC or if we need some more discussion time and then hopefully at the next REMAC in two months' time have some typed out recommendations, requests, proposals, protocols, whatever we do to get this thing rolling. What has happened though even without anything definite is that there has already been - the docs have already been talking about RSIs _________ cases, there's been actions taken and we're already moving in the right direction. Correct. Without having anything definite on paper or _______ And I think the fact that the major medical directors are all essentially regionalized already is really driving this process pretty well. So there's going to be a lot of logistical issues. There's are going to be some QA issues as well. ________ All right ___________ and I think this is a big step towards the rest of what we've been wanting to do in this region. That's pretty much - I don't there's really anything more to talk about the clearing process until we get this done. ___ heading in the same direction. The regional refusal form, I know I haven't done anything. We have a meeting in progress on that. If, Ken, if you could have Bill get in touch with me and forward the Finger Lakes' forms and I'll get in touch with Canandaigua and get their form. Don't any of you guys have a form ______. Okay. I will canvas the services and find out what there is and we'll start on that project again. ____________ EMS Charts, do you know if they've got anything, if they're talking about providing - I haven't talked to anybody from EMS Charts. I believe that with EMS Charts though you can import your form and you can scan it. Yes. But I was wondering if they were going to talk about a template or something already in the electronic - I know that there are several forms up on line ______ forms up on line that would probably be beneficial. I know a lot of services in the past have refused their forms as - I spoke to Greg the other day and I forgot to ask him. _________ physician credentialing process which we got everything out to folks _________ . All right, new business. Nothing is particularly new, new, but more ongoing. The med shortages, has everybody here been following med shortages? (_______) Yes, the list gets longer and longer every day. Any projections when it will be resolved ________ (_______________) The State has gotten my office involved and they want a response back by close of business on Monday. I've spoken to Finger Lakes - Bill assured me that _____ you guys have some issues with epi 1:10,000, that you're resolving that by using 1:1,000. We're using 1:1,000 ____ And diluting it. And Bill's response to me was that they don't anticipate any remedy in the near future. Mercy Flight, how are you guys fixed? It's the same way, we're using 1:1,000 __________ Okay. Epi is not one of our big used drugs. Significantly the two that I see - the three that I see on the list here were fentanyl and morphine and it's going to require the physicians to sign a new 222 form in order to use the substitute. Morphine and Narcan which we do use more frequently. Right, but two drugs, fentanyl and morphine are going to require physicians to sign a new 222 form to use the substitutes. Speak in English. If they're purchasing, they've got to sign a 222 form. We're already purchasing morphine and fentanyl so - If they're purchasing ______ from the manufacturer, yes. (__________) Most of the agencies get it from a hospital pharmacy or some of them. ________ (_____________) The 222 is the type of form _________. I know having come from Pennsylvania we purchase directly from the manufacturer who keep a 222 form. (____________) Our biggest problem is the paralytics in short supply. We've already - actually we've worked our way down the list _____ we're getting there so we're looking at using ______ which is about half way down the list of drugs. In fact ___ (___________) Most of the anesthesiologists in the region are like, wow, I haven't used _____ since I was in school. ________ Is that something that we're going to have to temporarily ______ (_____________) That's where I was heading to. There was a letter that came out from the State that said that we could expedite the process if we had to. (_________) Any idea how we expedite that process? My guess is _________ Okay, we decided we would go ahead and pursue that process just in case we don't get sux and the roc back in in regular supply, let's at least be ready. Otherwise ___ RSI is just a waste of time. So I guess what I'm hearing in my response to the State from the various agencies/region is going to be, yes, we are encountering problems, yes, there are some alternatives already be taken by agencies through the approval of their medical director? And we're exploring changing the formulary ___________ I would say ___________ problem with it at all, but if it's a process thing, I think we have to also say ________ and, you know, ________ 1:10,000 epi _______ already in the __________, you know, anytime _______, you know, I think there's probably some rapid way of just, that's okay with us, we're going to accept that in the short term to get that out because waiting every two months for REMAC to approve is not a recipe of success. I'm ____________, I mean it's not something that these guys are taught. To play devil's advocate, okay, this is the same as blood products. They're not taught this in paramedic -- ________ all right, there's the error. There's the chance of contamination. All right _______, are they using just - at the instance, or do some of these guys think, hey, I've got so much of this epi I'll keep it for my next patient. ___________ (___________________) Of course they will, they've already asked them, I guarantee it. Hopefully we haven't done any serious harm, but this - Can you reach out to Jim Hurley _________ Absolutely. (______________) shoot me an email. I need to make a response. I'd like to hear it word for word - I don't like to go over responses. I need to make a response to the Department, the Bureau of EMS by the end of close of business. Hopefully the email that you send from the State _______ Now, we alluded to some State stores of meds. Obviously we know that there's atropine stored. Is there any epi stored? (____________) Probably not the 1:10,000 and probably _________ I don't remember. I have a list of what's ______. (____________) It's not on our list here. (____________) Our hospital can get 1:10,000 epi, the mini-jets, which _______, but the issue that they're facing is ___________ so the next question is going to come up if it's available, but more expensive, are we going to allow agencies to make some dilute to save money or are we going to tell them that if it's available you have to use __________ at what point does a shortage because actionable as well? ________________ I'm going to dilute, is that an acceptable reason or not. I'm not sure what the answer to that is. (_______) There's a little sandwich shop around the corner from the ______ (___________) there are essentially companies that have bought up large supplies and they're now reselling it back to the market at a profit. So it's available _________ (____________) The State Attorney General is involved in that ___________ They're doing it. (____________) I would say that if the services can get it that they should be buying it prepackaged. I don't see - I think the risk of contamination, making errors _____ (__________) One single error that gets picked up that becomes a lawsuit is going to far outweigh the initial cost. But if they don't have access, I mean maybe not everyone has access to the ____ supplies. If they don't have the stuff, I mean, the next best thing I guess is trying to dilute it, but if they have access to it- (____________) And the ones that I've seen do, and Finger Lakes does. It was reviewed with the employees and ____________ I think that's how it has to be to make it safe. (__________) I'll tell you what _______ That makes sense because then we're saying it's coming from us that we know that there's a shortage. Exactly. (_________) time frame on it, it's not a protocol ___ and then it sort of stays there forever so somewhere down the line, oh, gee, I forgot _________ I'll just dilute because I have got a protocol to do that. Right, we want it as a short term solution to a short term problem. (__________) We're diluting it. (___________) I mean it's the worse _____ maximal strength ______. Enough about meds. _____ programs. We've got one thing before. Are we still on new business or did we move onto - (____________) I need re- kind of like I guess I need a reaffirmation of a previous policy that was brought forth by the REMAC. I don't know if any of you saw this Governor Paterson signed legislation this past week that now permits paramedic to be drawing bloods for blood alcohol testing. It was the previous practice in the region through a REMAC advisory that the medics were not permitted to do that. ____ that goes way back before me to even - There needs to be training if these guys are going to do that. Right. ________ specifically you have to say well, you're doing it. Well - (_________) ________ to say we're not using an alcohol swab to clean the area before doing this blood draw, if you don't, you're going to get eaten in court _________ somebody has to say, it's usually the person who is drawing the blood and wiping the arm. It was the previous practice though established by REMAC that the medics in the region were not to do it. And I think we should continue it. (__________) I don't remember if it starts ________________ then you're okay with that. It doesn't it. I don't think it does either. (_____________) I don't know what the answer to that is. _____________ it would have to be under the direct supervision of a physician ____________ the doc's got to be standing and watching you do it. Well, _______ we talked about this the other day was, and it deals more with the volunteer services, not only in our region, but across the State, because the volunteer draws the blood, he gets subpoenaed into court, now he loses a day of work to go sit there and get badgered for 45 minutes or an hour or two hours on the witness stand, you know, only to have the case thrown out. (______________) There's a patient safety issue. What I don't want to happen because every time the police want a blood draw on scene, they ____ ambulance, an ambulance to the scene ___________, leave that region uncovered. So we need to look at the law and specifically see what it says and then how it relates ____ (______________) But this was not just for the volunteers when they make this decision. (_____________) You've got Finger Lakes, you've got whoever that takes the medic out of service to go to court for all day, Ken or whoever has got to pay that person to sit there all day, they've got to find a fill-in for them. I mean it's an expensive venture for him to have somebody go to court every other week because they've drawn blood for some drunk. (________________) The law allows emergency medical technicians to draw blood as evidence at the scene of fatal crashes. 1194(4) _______. I know the discussion many years ago when we did this was - (_____________) if you go to the legislative web site you do a search on S46-D I believe that's the ____. Ross, I guess, how did this slip through anybody on the legislative subcommittee at the State level recognizing this. Well, that would be the same way that __________ the same way epi pens went through _______________. Well, Dr. Syrett, this came about because the intermediate students are taught for blood draws, the paramedics part __________, but after that there's no area hospitals that use that blood _______ so the most part there are none, if very few, that even have the capability of drawing blood. And we went through this whole thing _______ at the time, but ____________. (____________) even have capability of drawing blood. We went through this whole thing ______ (__________) _____ came to New York State is, they were labeled, drawn, brought to the hospitals ______. (_______) It's not ____ Broome County - Susquehanna Region does not draw blood _______. But the whole thing on that was, when the agencies ________ come up with some kind of a CME or whatever ________. They did it in their ILS. They were trained how to do it, but it has gone by the wayside because it's what they're using in the field. So in the discussion many years ago, now you have to have ______ We came up with a similar issue at REMAC in MLREMS. The solution was ___ in the future, at a time yet to be determined develop a CME to allow the paramedics to fulfill the requirements _____. And we developed at CME ________ (__________) under the direct supervision - Of the physician. Of the physician. Right. (__________) And I'm thinking - I don't think you're going to see _______ (_________) one was drawn and another a protocol ________ so threw it out because the verbiage in the law ____ direct supervision, but if that's all changed now _________ so I don't know what's going ______ (__________) I haven't seen the law ______ (________) allows a physician, registered ___________ nurse practitioner or an advanced emergency medical technician as certified by the Department of Health to withdraw blood at the request of a police officer, under the supervision, direction of a physician, PAs, nurse practitioners and under the expressed consent of the person 18 years or older, laboratory tech, technologist, technician, phlebotomist and ______ so the police officer has the authority to ask the emergency medical technician withdraw blood. (______________) It doesn't say, however, it seems to me that if you don't comply with the request of a police officer they have a right - To arrest. If you don't have the material on board __________ (_____________) They carry those in their trunks, they all do. (____________) The standard evidence box like the State Police use. Right. So I think what we should probably do is to table this _______________ (_______________) Effective immediately, this is already in effect. This is not good. I actually signed ________________ I don't think people will come out and tell us specifically what we're suppose to do. (_______________) (________________) It would seem that the thing to do, really in my opinion, is that we mandate that our paramedics do not comply with this. That will push the cops into a corner they don't want to be in. Do I be nasty to the paramedics who are here to help or should I be nasty to the drunk guy? (________________) I think if we make the mandate that the paramedics don't draw the blood __________ (______________) But our primary purpose at a scene is to care for our patients. Right. Now, if we're already doing - we're not drawing blood, the only thing we're going to be doing is starting an IV and most of our paramedics use alcohol swabs, not Betadine so it's going to change the process, it's going to be a delay in starting the IV. If the patient needs an IV, they don't need a delay in starting the IV. You take the risk of losing the IV by drawing the blood through it. If we draw blood through an IV, will that be accepted in court. No. (___________) Actually it's a direct needle draw. _____________ And we were ____ our patients not having two sticks or more than two sticks for their IVs. If they take one stick for a blood draw, we're taking that stick away which can be a lifesaving IV. (_________) So I think we _____ policy. (____________) I would love to have the State _____ and tell the REMAC, give me the authority ____, but they now can't ___ so I would love to see that happen. (______________) if you want to make a motion to go forward with that - (___________). Right, we've reviewed that - (___________) We have a policy, we've reviewed it. (___________) Exactly. (_____________) Then I think you ought to reissue that. We're going to issue it. We've got a list of REMAC advisories that we're going to reissue. (_____________) ______ I know a lot of law enforcement officers and I work fire/EMS, but you get the guy, the police officer, who says don't go anywhere I want to talk to him and now, you hear don't go anywhere I want you to draw his blood. So there you sit on scene until they complete their investigation, then they hand you their kit so they've held you on scene and in part and parcel - (____________) We could also make that a policy that the police officer has to apply pressure to that wound and come with the patient to the emergency room ____________. (_____) that's part of the issue because if they -- _______________ that's why this becomes so important __________________. The law should have read police officers can drawn their own blood. (___________) (______________) (____________) educated guess. (____________) (____________) Except that this rule is now in effect. (_____________) I think we need to reissue that advisory __________ some medics in the region that are going to jump right on it ________ (____________) (______________) (__________) My guess is __________ I don't have the vote for the Assembly. (___________) I would say ____ 0601B. (_________) I'm not sure how our legislators _________ (_____________) you're right __________. Moving on. CME approval _______ We've got a lot of PAD programs and they're just real quick. We don't really even have to approve them. First of all, as a point of reference, Soldiers and Sailors Hospital ___ now has a new medical director, a physician by the name of ____________ I guess you need to send her a letter inviting her to attend REMAC. Western Presbyterian Church has filed a PAD with - who's the doc on this? Louis Sulik as the physician. Empire Safety Products on behalf of and in conjunction with Midstate REMSCo, they have done multiple sites, some PAD application for Regal Cinemas I guess for the entire State. We have Regal Cinemas in our area. Victor Preserving Company has updated their PAD application through Stat Pads, they're actually going to a management company. Finger Lakes Gaming with Dr. Geraci, they've updated their - no, they're doing an epi-pen, which they're now required to do by the new State statute. Wayne County Public Health Service with Dr. Beirnbaum is doing a PAD application and Stat Pads is doing an update for KM Davies Corporation and _____ Fire Department is updating their BLS/FR packet and has also submitted a new PAD application and Dr. ___ is going to be the doc of record on their PAD application. And that's it. (___________) We've tabled the two CMEs from the last time. You know, I looked for those over, actually, and they don't _____, we discussed that these were not emergency physicians, not EMS physicians, however - Not physicians. They're actually not licensed ___________ They're physicians in India. In India, so they're not licensed to practice. It doesn't matter. You can have non-physicians ________. (________) done by paramedics - Yes. The programs looked okay to me, but that's my personal opinion. I had an issue on some of the cardiac stuff, other than it was okay. ________ Where are they going to offer this? It was going to be offered at North Seneca _________ if it's going to be offered through the region I can go back and tell the folks that, hey, it's fine if you want to offer it through the region - offer it through North Seneca, but the region's not going to give you the CME time for it. I think that's more appropriate. ___________ very careful _________ if they don't have licenses at all to practice you can get in a lot of trouble with that. I think the people at North Seneca just need to realize that. (_____________) (_____________) (_____________) They could use it under the other. (__________) Sounds good to me. That's all I've got. I don't think I have anything else. Does anybody else have anything they want to talk about? I do have a couple of things. There is a disappearing mandate. There was a REMAC advisory on the web site that disappeared. It was the ALS response ______ a couple of years ago, it has just disappeared, I don't know where it went, but it's gone. (__________) It just disappeared. It's not there _____________ I don't know what happened, it fell off the web site. (____________) (_________) I didn't remove anything. But with, you know, through routine web maintenance ________. My gut feeling is that there's an active advisory _______ until we take it off so that should probably come back to REMAC. That was the one on _____ Yes. FYI, to all the members of REMAC here, you probably all heard _______ that I have suspended the RSI program ___________ regionalization ____________ Wayne County area. At night after 10:00 we may have to ____________ essentially the only RSI provider in Wayne County and that capability is gone. So is the hospital. So is the hospital. Essentially after Wayne County ALS _________ (__________) helicopter. So the answer has to be __________ is the closest RSI person and they always forget about the hospital. (______________) One thing that I wanted to kick around a little bit was, my personal feeling, we've had a couple of QA issues for, John, you've requested access _______ and I think that, the physicians at the REMAC are all on the same page with QA, we all talk to each other. I don't think there's any sneakiness or anything, I think we all have valid complaints and the one thing I wondered was whether physicians from REMAC should _______ PCRs for the region. They do _________. I'm finding now that if somebody opens up an electronic PCR for a mid level review _____________. (___________) I spoke with Greg Howard from EMS Charts yesterday or the day before and Greg said that there are some times where the charts have to get past a certain level. Yes. (__________) called the user addendum, in other words, every agency has a choice of how they want it set up, their access. I mean you should have ______ this level so you should be able to see everything for the region. Except it's got to be done at the agency level. They actually have to give you permission. So when ___ get back in touch with each of the agencies, that should have been one of the things that we had impressed upon them when they first came to _____. (__________) But we just didn't realize _________. You're getting locked out. You're going to be my resource. I'm going to run an email, say, Bob, can you give me the PCR on this, this, this _________ I'm finding the same thing. I'm doing reviews on some of these charts and I'm getting locked out. I'm asking permission and I don't think that there's anyone at the other end sometimes getting the request. (____________) I just give it to him. I mean it's ridiculous. They don't have the option. (___________) In order to do something we have the ability to. Newark never set up their options. No one ever even set up those options so they defaulted, okay, which we actually reset those yesterday or the day before. But the other agencies need to be contacted and they need to allow us that access at all levels. Except I don't - I really personally don't want to go ___________ and get it that way _____ almost one contact. And the next thing is that some times you don't even need the graphics, you just need the chart, the EMS Charts would allow him to black-out exact graphics to review the record. Exactly, and that's what I want. Plus this way we kind of have a record ________ I agree. I can do - (____________) I can ask for it at a QA level and it leaves the name and address and all of that out. Excellent. So you can tell them ________ (____________) I think that's ___________________. (______________) And I may have an issue then with a vendor because I'm currently - well, not in a heated discussion, I'm in a discussion with North Seneca Ambulance's vendor about the way, ____ Solutions, about the way they do their data dump every month and they keep it passworded and it comes to me in a zipped file that's passworded and I have to go to an FTP site above and away from the actual - it's a couple of steps, while it's inconvenient ____ (_________) was to make it easier. If they're making it harder, make them go back to paper. (__________) And I brought that to their attention yesterday in a conversation ______ in the conversation that I had with them yesterday they said well, we'll go back to the vendor and talk to the vendor, and I'm wondering if ____ doesn't even own their own _____ (____________) situations is that July 15th ______________ I hate that we have to come across that strong, but the reality is that they don't have any choice ___ this is an expectation. The policy is pretty clear __________ It would not hurt me to see ___________ EMS Charts. It makes, you know, what we did for Newark is that all the physicians and the mid levels ____ Hospital access ___________. (_____________) (_______________) The hard part is there are no PCRs because nobody starts them which gets us pretty frustrated. Which goes back to the point ________ is if I'm taking care of somebody ______ and sometimes you don't get everything, I'd like to see vitals ______, I kind of like to see everything so you get a good verbal hand-off, but I like to read a little bit so do a lot of people in our department and I can't think it's our department only ________ (____________) I would have to say that 4 and 24 isn't working for us at Newark. This is why ____________ even 2 hours is still a long time. In two hours _____________ And also you ________ that they are able to - that the PCRs aren't there yet so you have hospitalists who admit a patient 12 hours later and there's nothing and that's bad care so I make a recommendation that we start to tighten those hours. I'm not saying we should jump right to ____, but I think that we need to tweek them down to maybe 2 and 12 and slowly start doing this so people get used to them. (____________) Yes, because everything's time stamped. (____________) (__________) that's okay. (_________) if I fail to get a chart during that 4 hours, there's got to be an issue there. For these guys, you know, you may go six hours without seeing your computer again ____ which case that's okay there's a reason why it happened, multiple ___ there's a reason why it happened. I'm a volunteer, I had to go back and milk the cows, I don't want to hear that as an excuse. You've got to get the chart done. I'm sorry. (__________) (___________) they're either headed to the barn or coming away from the barn as a group. (_____________) Do the QA at the County level, do the summary of minutes and then have everything forwarded to ___________. (__________) One thing and it's a complaint from Macedon Town, the feeling that EMDs still in Wayne County is markedly - sometimes they're ________, they're using what they call the modified EMD and _____ and it's confusing at a base level on what they're suppose to be doing so the reality is what they just started doing is ________ trust ________, I let Wayne County 911 know, but you know, at the REMAC level is pretty concerning. What is happening? They're suppose to have gone to EMD and EMD to me is a pretty straight forward thing, in fact, I don't care if you're calling it by the Greek letters or calling 1 through 4, I don't really care, they're doing random. Either they're not using it at all or you'll get, we think this is an ALS call. (_________) And then the response which is great and I've told my corps is, okay, what level is this. (__________) Are decisions being made that anyone that complains of any chest pain regardless of whether you're 1 or 100, even though it may be coded out wrong, ________ they will get full lights and sirens, ALS red or BLS red response. (___________) using EMD. (____________) It's an alpha 5 or something. And I think even more concerning when you look at the tapes that come across, you know, all I can tell you is about Macedon Town because I decided to go through them, 30% of them aren't coded at all. Now that to me - I mean I would rather - I understand that it is a learning experiencing, I get that, this is relatively new in this region, but if they're not doing it at all I have a problem and the second thing is, and I don't know how many people's desks this hits, there is a signed letter from 11 of the dispatchers at Wayne County 911 saying they are - they think that it is unsafe and they're not willing to use it. So I have two issues, I have the letter, two issues. My first issue is - (_______) I know, as the chair of the department, and you know my other issue is that I'm also the medical director for Wayne County Public Health and now this becomes a public health issue. (________) I mean this is nationally accepted ______ What can REMAC do at this point to move this in the direction it needs to go and that's my question _______ (_________) Unfortunately and this has been discussed at _______ SEMAC as well ________ I would love to hear - typically and generally _________ And I think Jim's in a very difficulty position, he is telling them this is the expectation, they're unionized and so, you know, all of us have been in situations where you have an expectation and some people, you know, decide that that's not what they're going to do. I don't necessarily think it's the union though. Ontario County has EMD, but they don't do what we're asking for either. They don't code their calls? No. No. (__________) (_________) Like I'm sitting here, and I think, so if REMAC has really no authority, I know who does, so I think it's just going to go to the next level for Wayne County. I didn't know if you wanted it in the minutes that I'm going to be meeting with the Chairman of the Board for Wayne County and then Wayne County Administrator because of this issue because it is public health safety issue. My concern is that what they're recommending for patients since they're not using EMD, if it's wrong, even 10% of the time, we have a problem. I'm not familiar with what the EMD dispatching system really is. That's basically part of the computerized - It is _______________ this is one of the _______ (___________) There's no effort. They showed me this ___________, where are the cards, well, we have the cards _________. And the just paid millions of dollars to get that put in. The Federal Government paid millions of dollars to get that in. _____ so, all right, so REMAC doesn't have any authority ________ REMAC does the authority to voice concern that the responding paramedics may be inappropriately responding lights and sirens and they are not required to. (________________) Wouldn't that letter actually have to come from the ___ medical directors? (_____________) Actually I can tell you, I will - I have a meeting on the 26th with the County Administrator and Chairman of the Board of Wayne County so I will try and get a form letter and send an email to everyone because if I can bring __ sign it and scan it to me or get it to me and I can bring a stack of letters saying we have some concerns. That's part of the reason why I'm meeting. (_________) Broome County, the dispatch center, wasn't given any - they were told, you know, this is the dispatch, this is the way it is to be done. By whom? I believe Brett Chellis told them. Brett is? Brett is the head of the 911 Center. (_________) And was backed by the County Administrator. I know Yates County doesn't do it, but I don't know about Seneca County. No. No, I don't think they do. (____________) I've actually sat in at a dinner meeting with people from all the dispatch centers this past spring and I asked them about EMD and they said, yes, we have EMD and do you use it the way it's intended to and not a once of them said that they did. (________________) Niagara County has had the cards for years ___________ recommendation BLS, ALS ____________ That's it. (___________) And I think that's great. I think the hard part is that the State does _____ at all because it's not _________ (__________) was there what's called the ___________ Council __________ (_____________) This ____ coming up any way. (__________) It's just frustrating ___________ (______________) the answer is going to be because 911 told me to do it. That's one concern and the other concern in the other direction is not sending the appropriate level. (________________) They can run either way. I did a call yesterday morning from Middlesex for mutual aid when the call came to us from Yates County as unresponsive chest pain possibly unresponsive, and we got there and the lady met us at the door. Yes, but all they get is the information so they should still code them appropriately and what people, you know EMD is meant to code it based on the information that you have so you can still meet someone at the door who is awake, alert and fine and the information that you received made that an emergent call and that's appropriate. You still treat that patient based on the information you received. I guess what throws me is this is not a new system. (______________) so we can see how all the acute chest pains are managed by searching by code rather than just guess. (_____________) there's a program now that can actually send you the call on your cell phone. It depends on which agency. Yes. (___________) It's cool. It is. This thing here is the greatest example we just got dispatched, possible ALS for complaint of other, that's what came across ________ Jack, so what I would tell the agency, you dispatch that ALS and you get there and I don't know what other means, and it could be bad. (_____________) Quite honestly the information that comes through dispatch is pretty much useless, ____ right address _____, get there and figure it out _________ (_____________) You know, if ALS is available, bring them. If they're not available, there's not much you can do. You know what it is, it's pure frustration. Unknowns are, you just never know. The worst sounding call turns out to be nothing. You just don't know and that's not the dispatcher's fault, it's the people calling it in. People have figured it out that if they mention a couple of cue words, chest pain - Chest pain, short of breath. Unresponsive, it's a child, it's a pregnant female. These get care faster. In fairness though, EMD is nationally validated __________ I think EMD, I've been a supporter of EMD since it first came out. I made a trip to Salt Lake City because I wanted to see where it was first instituted and spend time with Salt Lake City 911 Center just because I wanted to see where it was first used and - (___________) It really was. It was a neat trip __________ One thing that it has done, is in Monroe County is dropped the amount of lights and sirens responses significantly, particularly for these ________ other ones _________. Monroe County has got a little tighter control over the 911 Center, and they've also got a progressive 911 Center and 911 Director. Yes, yes. John Merklinger is nationally recognized. Yes, he's fantastic. (______________) I happen to like Jim in Wayne County. Murray is a nice guy in Ontario County, and I don't know who it is in Seneca, but they have their own way of doing things and they do not want to hear anyone else's way of doing things. And you know what's interesting, I think, that would be somewhat helpful _____ ours, Monroe-Livingston _________ where or they allowed to _______. Because they're trying to unload some of the stuff that - because the hospitals were getting so overloaded and actually pretty successful ______ It is a miserable failure. (__________) But it was a miserable failure because the paramedics _______ there were involved wanted it to fail. If you've got a choice of having a two hours of break in between patients and 15 minutes and it's 90 degrees outside ______ (_____________) Because when it started I had to approve it as the chief at St. Mary's. Right. We were averaging 6 to 8 patients a day which is great. Yes, the medics just didn't - It just petered right out. (___________) (__________) So there were a lot of reasons. The concept I think is still useful, is used in other areas successfully. So we have no control over 911. (___________) All right, that's all I had. All right, motion to adjourn? So moved. Adjourned. Thank you all. See you in September.