October 11, 2006
Board Members Present: Bureau Staff:
Gloria Murawsky Paul Wittkamp
Steve Bane Ann
Moses
Brenda Fellenz Marianne Peck
Troy Haase Helen
Pullen
Cal Lintz LeeAnn
Cooper
Mark Fredrickson Nicky Symons
Joe Covelli Dan
Williams
Tracy
Aldrich Keith Wesley
Travis Teesch Cathy Etter
Tom
Brazelton Larry Gilbertson
Board Members Excused:
Ken Johnson
Steve Teale
Others in Attendance: Representing:
Kyle Marohl Plymouth Ambulance Service
Chuck Cady Physicians Advisory Committee
Gregory West Waukesha County Technical College
Barb Kuska Beloit Memorial Hospital
Joyce Anderson DHFS/DPH/MCH/EMSC
Cindy Lazorik WITC Ashland
Fred Hornby Bell Ambulance
John Schindler
Meda-Care Ambulance
Suzanne Martens Sheboygan County EMS
Jan Helton LJH Ambulance
Jean Green St. Nicholas Hospital
Carrie Meier Dane County EMS
Jeff Grimm Theda Star/STAC
Bob Nack Fox Valley RTAC
Ann Peggs PFFW
Nettie Jenkins Thedacare
Steve Stroman Aurora Bay Care/STAC
Dan Diamon Lake Superior RTAC
Jim Austad Oshkosh Fire Dept.
Brian Reynolds Milwaukee County EMS Council
Cinda Werner Children’s Hospital of
Wisconsin/EMSC
Linda Hale DHFS
Tom Fennell Gold Cross Mayo Medical Transport
Keith Kesler Douglas County Emergency Management
Jan Victorson Bayfield County Emergency Management
Laura Ahola Divine Savior EMS
Frank Koehn South Shore EMS
Judy Jones Luther Hosp Eau Claire/NWRTAC
Robert Ramerez Southeast RTAC
Beth Natter Mercy Hospital, Janesville
Terry Lucas Milwaukee Fire Dept.
Todd Van Langen West
Bend Fire Dept.
Jan Beyer UW EMS
Pam Fifer SOS Technologies
Terry Wise Baraboo Ambulance
Welcome and Introductions: Chair Steve Bane called the meeting to order at 1:00
PM at the Sheraton - Madison, WI. Steve welcomed everyone and asked the Board
and audience to introduce themselves.
1.
Approval of previous Board Meeting Minutes:
A Motion by Brazelton, second by
Covelli, to approve the minutes from the August 2006 meeting. Motion
Carried.
2.
Explanation of EMS Board priorities and structure
changes. Chairperson Steve Bane
advised the Board of the proposed changes to the structure of committee’s and
emphasis for committee agenda’s for the next year.
The
Board has proposed the four following committee’s and the initial work that the
committee will be engaged in:
u
EMS Education and Training
u
New EMT Basic Refresher
format and content
u
Instructor Evaluation
& Standards
u
EMS Administration & Management
u
Combining of EMS Rules
u
EMS Data Collection
u
CQI-Complete
templates–ad hoc committee
u
Sample utilization of
WARDS
u
Define mandatory
reporting requirement
u
Evaluate 24-hour
refresher
u
EMS Disaster Management
u
Triage Tags
u
Disaster Trailers
u
Disaster Templates
u
EMS System Development
u
EMS Funding
u
Leadership Program for
System Administration
u
EMS Office
process/workload
The
Board also specified their top six (6) issues to be dealt with this next year
and they are as follows:
n
Top six issues for next
year
u
EMS funding
u
EMS data collection
u
EMS disaster management
u
EMT basic refresher
rollout
u
Combining of rules
u
Development of EMS leadership program
The
below listed committee membership structure has been proposed to manage the
2006-2007 workload.
EMS
Education & Training
n
Gloria Murawsky-Chair
n
Tom Brazelton
n
Ken Johnson
n
Troy Haase
n
Cal Lintz
n
Steve Teale
n
Linda Pace
n
Don Kimlicka
n
Ken Sternig
n
Mike Jankowski
n
Jan Beyer
EMS
Administration & Management
n
Travis Teesch-Chair
n
Ken Johnson
n
Troy Haase
n
Cal Lintz
n
Joe Covelli
n
Tom Thrash
n
Barb Kuska
n
John Duffy
n
Ann Peggs
EMS Disaster Management
n
Mark Fredrickson–Chair
n
Brenda Fellenz
n
Gloria Murawsky
n
Tracy Aldrich
n
Tom Brazelton
n
Tracey Ellis
n
Open
n
Open
n
Open
EMS System Development
n
Joe Covelli-Chair
n
Tracy Aldrich
n
Travis Teesch
n
Brenda Fellenz
n
Mark Fredrickson
n
Tom Fennell
n
Lauryl Pukansky
n
Jeff Jensen
n
Jerry Miller
Ad-Hoc
Committees
CQI
n
Ken Johnson – Chair
n
Cinda Werner
n
Nettie Jenkins
n
Jess Robinson
n
John Schindler
n
Jan Beyer
Information Management
n
Ken Johnson
n
Joe Covelli
n
Troy Haase
n
Mark Fredrickson
n
Lauryl Pukansky
n
Jerry Miller
n
Tom Fennell
Proposed Committee meeting times:
n
Tuesday
0900-1050 EMS Disaster
Management
1100-1250
EMS System Development
1300-1450
EMS Education & Training
1500-1650
EMS Administration and Management
n
Wednesday
0830 -1000 EMSC
1030 -1230 STAC
1300 -
EMS Advisory Board
3.
Take action on EMS Board structure and committee
changes.
Motion by Haase, second by Covelli, to
revise the Standard Operation Guidelines& Procedures. The intent of the
motion is if the Board feels the need to adjust committee size the Board will
follow all current rules established. The rules state that the committee’s make
up will consist of a ratio of members with 1 more Board Member than At Large
member on each committee to maintain the correct structure & follow the
current procedure. Motion Carried.
Motion by Aldrich, second by Teesch to
strike “even numbered” from page 5 of
the Standard Operation Guidelines& Procedures.
Motion Carried.
Motion by Lintz, second by Fredrickson,
to adopt the revised structure, formation, membership and name changes to Board
Committee’s. Motion Carried.
Motion by, Teesch, second by Lintz, to
accept the new work assignments and committee membership as proposed.
Motion
Carried.
4.
Committee Updates:
EMS Education: Gloria Murawsky, committee chair reported on the
following meeting topics:
1.
The Committee reviewed the accomplishments of the past
year
o
Revised scope of
practice
o
EMT-I to EMT-P
transition course
o
Revised First Responder
advanced skill modules
o
Completed revision of
the EMT-B curriculum, rollout and pilot
2.
The assigned tasks of committee as determined at the
Board’s strategic planning session were discussed
o
EMT-B refresher pilot
and evaluation
o
Revision of EMT-B
refresher
o
Instructor evaluation
o
RN to EMT-B transition
course
3.
Linda Pace reported on the four EMT-Basic course pilot
programs that were recently completed.
The curriculum evaluation critiques that were submitted contained
favorable comments from instructors and students on organization of the content
– pediatric and geriatric material presented throughout rather than only one
module and the addition of critical thinking content. One of the courses reported a 100% pass rate on the National
Registry written exam. Refinements will
be made to the curriculum based on the experience and discussions with EMS-C
and it will be provided to the EMS Section for distribution.
4.
The EMT-B refresher pilot program proposal was
reviewed and revised. The final version
has been distributed to Board members for review. Remaining pieces to the program to be completed by January 1,
2007 are development of the abbreviated training plan, finalizing standardized
evaluation tools – written and practical, development of the skill evaluator
course and completion of the service and medical director course evaluation
being worked on by Systems. 10 pilot
programs will be allowed, 5 rural and 5 urban.
Courses must be held between January 1 and November 30, 2007. Thanks to the committee for all of the hard
work in developing the pilot program.
Motion by Murawsky, second by Covelli to
approve the EMT-B pilot program as presented. Motion Carried.
EMS Policy and Practice Committee: Travis Teesch, committee chair reported the following
meeting topics:
1.
Ambulance
reports for hospitals. Dr.
Stroman informed the committee of the current problems regarding Trauma
coordinators not receiving pre-hospital EMS provider’s information in a timely
fashion. The problem exists when patients are transferred from hospital to
hospital. Certain data elements are needed by the trauma coordinators and are
lost in the paperwork shuffle. It was suggested that the committee work on a
patient information sheet that can be left at the hospitals. Included on the
information sheet would be data elements for the Coordinators and important
patient care information.
2.
Narrative
vs. Algorithm Protocols. Problems
exist in multiple level response protocols. PAC is working on this issue and
developing sample protocols of both types. This committee was asked to evaluate
the impact of changing protocol styles on services. When PAC has a finished
product they will bring it back to the Board to be assigned to a committee for
follow up.
3.
Verification
of Training. The EMS office is working on an evaluation competency
check sheet that when completed will need to be reviewed for input. The check
sheet development and review need to be completed by the December meeting to be
put in place for the Pilot refreshers that may be beginning in early 2007.
4.
Board
Strategic plan report. Travis
reported the proposed changes to committee format, structure and membership. He
outlined the specific change to the committee name and workload emphasis for
the rest of 06 and the future projects for 07.
EMS Information Management: Troy Haase reported on the committee meeting for Dr.
Johnson who chaired the meeting but was unable to attend the Board meeting.
1.
The committee has
been rolled into the new EMS Administration & Management Committee. In
addition to the change in direction it was realized that the data/WARDS system
would have some impact to all committees’ activities in the future.
2.
The previous
Information Management Committee will now be an ad-hoc Committee so that it can
continue to finish the following issues that still need resolution.
a.
Voluntary reporting compliance beginning 1/1/2007
b.
Mandatory reporting compliance beginning 1/1/2008
c.
Define the reporting requirements.
d.
Determine minimum acceptable data elements acceptable
for the short term and when and how many will be required for a future date to
also be determined.
3.
The committee also
reviewed some sample reports to begin and will begin to devise a way to show
the usefulness of the program to the EMS agencies. It is the committee’s belief
that once the agencies see what that can use in the program we will then have
more universal buy in.
4.
Ann Moses reported
that.
a.
New agencies are joining on a weekly basis.
b.
The system has approximately 13,000 calls that have
been submitted.
c.
Still in the process of working with reporting systems
to link with WARDS. Outside vendors are creating new software to accomplish
this task.
CQI – Sub-Committee. The following report was provided by various committee
members on behalf of the committee.
1.
The committee will continue to work on and has a
completion date for the CQI power point and educational program for services
that are working to develop a comprehensive CQI program. There will be at least
three different power point presentations developed. One to provide an
understanding of why CQI is important. Another to show them how to develop
their own program and then another that actually takes them through the process
of evaluating several different type of issues that a CQI process can be used
for.
EMS Public Health: Brenda Fellenz, committee chair reported on the
following meeting topics:
1.
The committee did not meet this time in anticipation
of a change in direction or disbanding the committee would occur. It was felt
that the committee had struggled with its agenda’s and needed further
direction. It was determined that Public Health would be a consideration in all
of the newly formed committee’s future activities.
Disaster – Sub-Committee Mark Fredrickson, committee chair, reported on the
following meeting topics.
1.
Mark held a discussion on the development of and use
of the Triage Tuesday model that has been established. The program is going
well as initially designed. It was brought up that there may be other and
potentially better ways of identifying disaster victims and the committee will
continue to evaluate that process and discuss potential future modifications.
2.
Mark announced that OJA has hired an individual that
will be responsible as part of the grant to inventory all disaster trailers and
help to provide input on the purchase of the proposed new trailers. Mark and
Dan will be meeting with this person in the next few weeks to start the
process.
3.
Disaster Master Template. The committee met on Sept.
20th and had a very productive meeting. They developed a very
comprehensive document that will now be revised. The committee will meet again
between Board meetings and should have a document to present to the Board at
the December meeting.
EMS Systems: Cal Lintz, committee chair reported on the following
meeting topics:
1.
The committee will be working in conjunction with the
Education committee on the details of the new refresher course. The committee
developed an extensive evaluation form that was reviewed and revised that will
be used to evaluate virtually every aspect of the proposed EMT-Refresher pilot
programs. They will evaluate the refresher; the
services involved and ask the service Medical Director to evaluate the training
from their perspective.
Incremental
follow up evaluation will also be completed at 30 and 90 days post course
completion by the Service Director to determine level of retention. The Service
Director will also advise as to their opinion of the impact that was made on
service by having this type of non-traditional training.
EMS-C: Dr. Tom Brazelton reported on the EMSC meeting.
1.
The committee reviewed and evaluated the Federal
performance measures that they are required to meet to assure that Wisconsin’s
efforts are in compliance with grant requirements.
2.
The group is also working to determine other
educational and EMSC related activities to move forward with and is interested
in a more formal relationship with the EMS Advisory Board.
PAC: Dr. Charles Cady, PAC chairperson reported on the
following.
1.
The committee reviewed the information it had on the
RAD 57, which is carbon monoxide monitor. It was decided that this device has
limited utility in the EMS setting for ongoing patient care and cannot be
recommended as a part of EMS care, but this device may have benefit in the use
of fire ground medicine and further evaluation in this capacity can be
supported.
2.
The committee was concerned about the proliferation of
CPAP devices being introduced and the impact it has EMS services. The following
criteria were established for what devices must have to be allowed to be used
by EMS providers and individuals.
Acceptable
devices should have:
a.
Safety relief valve which will allow only for a safe
maximal pressure.
b.
An accurate pressure gauge.
c.
An ability to easily, quickly, and reliably change
pressure.
3.
PAC discussed extensively the issue of the AHA 2005
guidelines and the impact that it will have on EMS providers as well as the
impact on AED requirements. PAC’s recommendation is that services upgrade as
soon as possible, ideally by developing a transition plan including a
deadline. Until everyone is up-to-date,
providers should follow the prompts of the AED being used regardless of their
training. If more than one AED is
available at the patient’s side, or becomes available, the updated/new AED
should be used as soon as possible. PAC
further recommends that services should be using up-to-date equipment including
defibrillators. We would define
up-to-date equipment as that which has current manufacturer support. By default, most, if not all, of these
devices will be biphasic.
4.
PAC is working to update a standardized set of
protocols for the Basic EMT Services. The goal is to have a set of standardized
State protocol examples up to the EMT-basic level and do the following:
a.
Update what is currently available on Web
b.
Update what is currently on file in office
c.
Complete set of protocols filling in those that we
feel are necessary as a recommended minimum set of protocols for any given service.
5.
Dan asked PAC to once again review the King LT airway
based on the fact that there is a new version of the airway and we still do not
have an adequate training program in place for this device. It is different
enough from the combi-tube to require its own training curriculum. The PAC still feels that this airway may represent an
acceptable alternative to the Combitube as a valid “non-visualized” airway
allowed in the scope of practice.
However, as before, it is essential that implementation of this device
be accompanied by an adequate training curriculum. The experience in the office so far is that services presenting a
plan have not included an adequate curriculum. The PAC supports the office in putting a hold on all approvals to use
the King LT until an adequate standardized curriculum is developed.
State Medical Directors’ Report: State EMS Medical Director, Dr. Keith Wesley gave the
following report.
1.
Working with PAC on the protocol project and it is
expected to be completed by early 2007. He would like to develop 14 – 16 Key
protocols that all Basic EMT service should have.
2.
Dr. Wesley is working on a complete re-edit of the
Medical Directors course and will have it completed by years end and on the new
Medical Director Web site.
3.
Dr. Wesley will be working on determining the next
course of action in response to the IOM report and what the Wisconsin impact
will be as a result of that reports finding.
4.
Dr. Wesley also advised that he is involved with a
national effort to create an EMS museum to provide a method to archive the
history of EMS and those who have played a prominent role in the its
development.
State Trauma Report: Dr. Steve Stroman provided a
report from the STAC meeting.
1.
Dr. Stroman reported that the bulk of the STAC meeting
was used to further define the evaluation forms and how they will be used in
upcoming trauma designation follow up inspections.
2.
Dr. Stroman also reported that Ed Mishefske had
resigned from STAC and the Department will be starting the process to find a
replacement. Dr. Stroman verbalized the significant role that Ed played in
getting the funding of the Trauma system moved forward this past year.
Legislative Issues: Dan Williams advised the Board.
No
legislative issues were identified due to the fact that the Legislature was on
summer recess.
State Office Issues: Dan Williams, EMS Chief reported:
1.
Dan advised the Board that a significant change is
occurring in the Bureau with regards to funding. The First Responder
Coordinator position was eliminated because the position was funded with funds from a Federal Preparedness grant, which
has no EMS funding for 2007. The Medical Director is under contract until the
end of January 2007 and is funded out of the same Federal Preparedness grant
that has no EMS funding for 2007. The EMS office has 6 positions that are
funded by a Federal Prevention Block grant. The Federal budget was submitted
with “0” support for 2007. Both the Senate and the House have submitted a
proposed amount that is 10% less than the previous year and there is no
guarantee that it will be approved at that level or supported at any level. The
Trauma Coordinator is funded by the Wisconsin DOT. Our office requested DOT to
fund another $40,000.00 to support the Trauma system. That request was turned down.
Future data related projects like WARDS and the Trauma Registry may be
difficult to support without a stable funding source. Support for these systems
has come from a variety of Federal grants. Finally, there are 4 GPR positions
that may be subject to a 10% reduction.
The
EMS Board responded to this information with a statement it may be time to make
an effort to educate the Legislature on the importance of providing a stable
funding source for EMS in Wisconsin.
2.
The office was continuing to process renewal
applications. He indicated that as predicted a significant number of individual
and service applications were received by the office in the last week of June
which has created a significant workload slowdown.
Old Business:
No
old business.
New Business:
1.
Physician Advisory Committee Terms.
a.
The following positions on the Physicians Advisory
Committee are up for either re-appointment or replacement. Dr. Michael Curtis
and Dr. Charles Cady have terms that are expiring. Also there is a need to
replace Dr. Tom Brazelton due to his recent appointment to the EMS Advisory
Board.
Dan
received letters of interest and CV’s from the following. Dr. Charles Cady; Dr.
Scott Carpenter; Dr. Michael Curtis; Dr. Bruce Gordon; Dr. Christopher Sorrells
and Dr. Ernest Stremski. There was an opportunity for Board members and the
audience to speak on behalf of any of the candidates. There were no nominations
from the floor.
b.
PAC Voting. Secret Ballots were cast and the results
of the voting are as follows. Dr. Charles Cady, Dr. Scott Carpenter and Dr.
Christopher Sorrells were elected to serve on the PAC with terms that expire in
2009.
Other Board Related issues:
1.
As a result of
the change in Committee structure and membership we have some vacancies on the
Disaster Management committee. Interested individuals should send their letter
of interest, and CV to Dan Williams at the EMS office so that they can be
considered for the openings at the December EMS Advisory Board meeting.
Adjournment: Motion by Teesch, second by Covelli, to adjourn. Motion carried. Meeting adjourned at 3:05 PM.