Chair Dan Williams called the meeting to order, welcomed everyone, and meeting attendees introduced themselves. The minutes for the November meeting were approved.
Bill Perloff, chair of the EMSC Pediatric Protocol Task Force, passed out copies of 21 ALS pediatric protocols the committee has developed, with input from EMSC, pre-hospital providers, doctors, nurses, and the Physicians’ Advisory Committee (PAC). The protocols include general review and specific situation flow charts. They have been reviewed and approved by the PAC, and have two purposes:
A motion by Marv Birnbaum, second by Gloria Murawsky was made and passed to approve the protocols, send a letter of congratulations on them to EMSC, and send a copy of them to NHTSA. A motion By Marv Birnbaum, second by Cheryl Glomp was also made and passed that the protocols be reviewed by the Education Committee in the context of the current curriculum, and that the committee bring back a recommendation at the May Board meeting on what should be done with them.
Announcements
Dan Williams requested that minutes & agendas for the next meeting be sent in right away, with timelines and action plans. Mark DeGuire has regretfully resigned from the Board. As a result of that resignation Dan Williams has appointed Don Hunjadi to Chair the Data & Research Committee. Cheryl Glomp has been appointed as a member of the Policy & Practice Committee. The Governor’s office has called the Board and asked about appointments and reappointments, so some vacancies may be filled. Some chairs have been not showing up for their committee meetings; it was requested that they notify their members ahead of time, to avoid pointless travel. The chair suggested election of co-chairs, to avoid stopping the process.
Committee Updates
Standing Committees gave their reports. Included in each standing committee report was a report from any ad hoc committees that are assigned to the standing committee.
Data & Research Committee
Data Implementation ad hoc Committee
The Data & Research committee had not had a quorum, so Martha Florey reported on Ad hoc Data Implementation Committee progress. The committee is selecting a Minimum Data Set, following relevant national standards. Some elements will be required for the central system and some will be optional. Providers could add any other elements to their local systems that would be useful to them. Data specifications will be given to vendors, and the system will allow for multiple methods of submitting data.
The central system would be web-based to accept real-time data at the end of an ambulance run as part of the state Portal Project. This will allow surveillance and automated alarms for unusual patterns to be programmed. The system will be designed to allow linkage to other databases, such as the planned ED database. Goals are to take all stakeholders into account, and to analyze treatment as well as document it, so that quality improvement becomes easier for services, Best Practices can be developed, and local and state resource allocation and training can be made more effective.
A federal bioterrorism grant will probably open up in March or April; an application for those funds is planned. The committee is meeting every two weeks, and has two full-day sessions scheduled in February. It expects to have the dataset and dictionary done in February, and to be able to begin development in March, with completion in August, and implementation in September.
CQI Committee
The committee has been discussing element identification. What are the questions? What reports are needed?. This committee has also had member turnover. The chair will check on membership.
Education Committee
The committee has been working on First Responder curriculum for c-spine, epinephrine, and combitube. A transition committee report is planned for May, on feasibility and for whom. It is also working on evaluation of the education agenda for the future.
Policy and Practice
Goals and objectives have been set:
Systems Management: the basic EMT communicator curriculum has been drafted; it will include bioterrorism and HazMat. Many systems include more, so legislation needs to be written so that the curriculum can be added to. Development will have three stages: 1) upgrade the existing material, develop, install on the web, and test; 2) implement and pilot; 3) revise, present to Board, & open for general enrollment. The Board voted to approve the plan for the communicator course. The Committee really needs staff help to compile financial data.
CQI met to look at the NHTSA and Nebraska tools. They are good but didn’t meet our needs. Data collection and sharing will be aggregate; services can track individuals. Grandfathering was discussed. Terry Gonderzik will write a disaster plan on coordination & control, information & data, education, and team-building, and submit it to Chapin. CQI hopes to have a white paper ready by the next meeting, with two templates.
STAC
Meetings have been moved to the Comfort Inn in Madison, except for June and October, when they will be in Stevens Point. A year’s schedule is out now, and anyone who’d like to be on the mailing list can contact Marianne Peck, or can come to the meetings. STAC is moving ahead on RTAC planning, and looking at multiple funding sources. The governor is listening, and Sen. Jonsrud will resubmit the legislation. Dr. Chris Felton will speak at the next meeting.
A question was raised about how the RTAC regions compare to the HazMat regions, since it may be awkward if they aren’t coordinated. The RTACs don’t specify boundaries, organizations decide for themselves which one they should belong to. It was suggested that the issue be brought up at the next STAC meeting, with Emergency Management, which oversees HazMat, invited to come speak.
EMS Coordinators
The coordinators are meeting monthly; they plan to liaison with the WHA and possibly others, such as ENA, or ACEP. They are developing a webpage where they will post all EMS education and mentoring programs.
EMSC
EMSC will have five regional conferences, and will also discuss trauma, separate from the RTACs.
PAC and Medical Directors
PACs Protocols have been revised and approved to bioterrorism preparation, training & information, and substance management and treatment. The cellular death agents can’t be treated, so there’s been more focus on agents like atropine and valium. The interfacility document is ready to go out for reactions.
Medical Director course is almost done. Slides and test questions are ready. There are six chapters and about 300 slides. It can be done in parts or all at once. There will be pictures and professional narration. It needs a last minute accuracy check, and will be ready by summer. This will be for BLS and ALS directors; later there will be one for EMS communicator directors.
EMT-Intermediate-level sample protocols are being written now, P protocols will be next, and Best Practices. There were some problems with the IV Technician exam, but they are small and easily corrected.
Bioterrorism A brief practical course is needed fast, since providers are not prepared now. It should be required for all, as continuing education, at no cost to providers, from 4 – 6 hours, on bioterrorism and hazardous materials. It should cover when to go in, when not, and what can be treated. There is an OSHA HazMat requirement now. Gloria Murawsky noted that her department conducts Bioterrorism training as part of their refreshers at 3-4 hours. She advised the Medical Director that she would forward their curriculum to him for review.
The refresher course has 2 – 3 hours on domestic preparedness. Marv Birnbaum is going to a conference in St. Petersburg on weapons of mass destruction, and will see what is there.
Interfacility Transfer Guidelines
This began with a complaint that Terry Gonderzik investigated. He found that hospitals were not aware of the EMTALA guidelines, and providers didn’t know how to interpret them. Providers were unable to provide care and a patient died. 50% of HCFA’s complaint investigations are EMTALA related. He therefore talked to everyone, and made the existing document more specific.
Phase 1 There is an implementation plan for Medical Directors, a scope of practice for hospitals, and a curriculum, which will all go on the DHFS website for review next week.
Phase 2 WHA and rural hospitals will receive it as a tool for them to use. Penalties are high for EMTALA violations.
Legislation is needed for a critical care paramedic, to help physicians choose the right level of practitioner and avoid trouble. A Medical Director from HCFA (who is also an attorney) has reviewed this all the way. Hospitals are becoming involved, and recognizing the value of EMS. Comments will be collected, and brought to the Board at the May meeting.
The Board will need a 2 - 4 hour session at the March meeting to discuss the document further. The Policy & Practice Committee also wants to be present for the discussion. The Board should then be prepared to move forward in May.
A motion by Tim Bjelland, second by Cheryl Glomp was made and passed that the Board request that DHFS amend 146.50 as necessary to create a critical care qualified person, and HFS 112 be reopened as necessary. DHFS is further requested to report back to the Board on all issues still pending on these matters at the March meeting.
A motion was made and passed that the Board write a letter to DHFS, commending the work on the Interfacility Transfer Guidelines.
The State Plan is up for renewal. The Board and interested persons should look at it and comment now. There will be a hearing before the next Board meeting, with timelines the same now as six months ago. It will then be acted on at the Board meeting. Nan Turner has taken comments from the committees and will incorporate them into the document. Nan will send the revised draft to members by February 1. Board members should review the draft and send any suggestions to Nan Turner by Feb. 15. Nan will incorporate appropriate changes and send Board members and others a copy by February 23rd A hearing on the State EMS Plan will take place prior to the Board meeting and the final document will be discussed at the meeting.
There is unclear language in HFS 111. In one place it says that an Intermediate must always be present in an I-level service, and in another that an I must only be present when I-level care is provided. The Board agreed that this should be interpreted to mean that a service should be able to release I’s when they are clearly unneeded, so that they can be available for real need, if Medical Control approves.
Old/New Business
The FAP concerns that were discussed at the last Board meeting were investigated and the problem is less widespread than originally thought. Individual Technical College billing practices may be where the problem exists. The Board approved reimbursement at the higher rate this time only. Technical Colleges should read the contracts thoroughly in the future as to the terms of the contract prior to signing. The Board will be unwilling to bail them out a second time for what is clearly their responsibility. Steve Teale has requested copies of contracts when they are sent out by DHFS so that he can be part of the review process in an effort to reduce the problem in the future.
There will be an Executive Committee Meeting before the Board meeting in March. E-mails will be sent out to determine availability for executive committee conference call late February.
Renewals are out, and some large services are already done electronically.
Motion by Dick Collyard, second by Cheryl Glomp to adjourn. The meeting was adjourned at 12:30 PM.