Emergency Medical Services Board Meeting

November 3, 2004 

 

 

Board members present:                              

Dan Williams                                                   

Cal Lintz                                                          

Gloria Murawsky                                             

Steve Bane                                                      

Don Hunjadi                                                    

Ken Johnson                                                   

Travis Teesch

Troy Haase

Gloria Wall

 

Bureau Staff present

Meg Taylor

Marianne Peck

Paul Wittkamp

LeeAnn Cooper

Nicola Stasny

Ann Moses

 

Others in Attendance:                                   Representing:

Mike Jankowski                                               Franklin Fire Dept.

Mary Austin                                                     Monroe Clinic

Jan Victorson                                                   Bayfield County

Keith Kessler                                                   Douglas County

Suzanne Martens                                              Sheboygan County EMS

Brian Litza                                                        Paratech Ambulance

Tracy Froiland                                                  ThedaCare

Vickkie Zietlow                                                MidState Technical College

Michael Petersen                                              Divine Savior Healthcare

Barbara Kuska                                                 Beloit Memorial Hospital

Sue LaFlash                                                     EMSC-DPH

Deb Crawford                                                  MATC-Madison

Tom Brazelton                                                  EMSC

Patricia Padjen                                                 UWHC

Gerry Isbell                                                      Orange Cross Ambulance

Tom Fennell                                                     Gold Cross Ambulance-Mayo Medical

Mark Fredrickson                                            Gold Cross Ambulance-Fox Valley

Chris Anderson                                                Bell Ambulance

Jeff Jenson                                                        Zoll Medical

Phil Doherty                                                     St. Joseph’s Marshfield

J. Tim Hillebrand                                              Dane County EMS

 

Agenda Item #1 Introductions

Dan Williams called the meeting to order at 10:00 AM at the Comfort Inn, Madison, WI.  Dan welcomed the

Board and Attendees: Everyone in attendance on the Board and the audience introduced himself or herself.

 

 

Agenda Item #2 Approval of past Minutes

Motion by Lintz, second by Bane to approve the minutes as presented. Motion Carried.

 

Agenda Item #3 Committee updates

 

Executive Committee - Did not meet.

 

Education Committee

Needs information on the Stakeholder survey.  Was it sent out?  Was the confirmation of the initial review sent out?  *EMS Section will verify and report back at next meeting.

 

EMT Basic Curricula- workgroup preparing objectives for each course.  They are also developing an action plan.  Committee had to modify the time line.  Model curriculum will be completed by 9/05, Roll out 2/06, Implementation 6/06.

They have a question about the core components of the courses.  Are the * items optional?  Asking the Board what is to be included in the Initial Basic as core: gave examples of CPAP, 12 lead.   The concerns are over the amount of material that is optional and how a person passes the NREMT.  Should they first teach to the NREMT, and then teach the optional?  Or, should they keep the flow of training and place the optional materials where they are most relevant?   It is confusing to the student because they don’t know what will be on the NREMT; They learn the optional material and then are not tested on it.  Could we make those advanced skills a separate course? It seems to be working however as we are currently seeing scores high in WI.  How does this relate to the hours?  PAC feels we should teach more in-depth physical restraint.  People are worried that we can’t keep adding material, but not increase the hours.  Students are forced to do more home activities, workbook training, interactive CDs, rather than Instructor taught material.   Board asked the committee to keep working on the curricula, include the optional, if the hours increase, and then bring it back.

 

Last item from Education was about what is the next curriculum they should review?  The group felt that Intermediate was next, but that they thought they needed to wait until the National model was completed.

 

Policy and Practice

Brought letter forward for discussion in opposition to the mandatory NIMS training. Will discuss further with the Disaster Management report.

Wanted status of HFS 113- will ask DPH to hire Larry Hartzke if necessary to get the rules completed in a timely fashion.

Refresher- discussion will follow from Partners.  Committee will take up work in February.

 

Information Enhancement

Viewed a PowerPoint presentation on the objectives to be considered for the future Ambulance Run Data System in their meeting.  They felt this was a worthwhile endeavor.  They will start by looking at various products and vendors.  Will distribute any dates for product review to the Board.

 

EMS Illness and Injury Prevention

Committee didn’t meet. They are continuing to define their role and have a separate meeting scheduled for December 1st.

 

Systems Management

Disaster Management Committee prepared a letter that they want Systems to approve as well.  Cal read the letter to the group.  NIMS training is excessive and cost prohibitive.  We will lose many of our volunteers, which is not what we want.  The training for EMT’s is being discussed at 12 hours, managers training is 30 hours.  It is unclear about whether there is a requirement for a Refresher. Committee approved the letter and added other organizations that should receive it: WEM, OJA.  Submit the letter to the EMS Board.

 

EMT-B Refresher Training- Course Frequency and Length.  Will be tabled and put back on the agenda after Policy and Practice completes its work.

 

Ambulance Transport to UCC or Free Standing ED’s.

  1. Sheboygan still is an issue.  Told that they will have an answer about approval within six months.

  2. Gloria Murawsky had provided a document that they could be used as criteria for Inclusion and Exclusion.  Members thought that it might confuse EMT’s.  Using this as an example.  It was approved with extensive QA. 

  3. Resolution:

a.       EMS Section will contact the Bureau of Quality Assurance to review the status of the Sheboygan issue and will ask the staff to attend the next meeting.

b.      EMS Section will provide the group the information they have on the Lake Geneva/Janesville Pilot that was approved by BQA.

c.       The group was asked how they felt about the issue- they agreed that we should enforce the statues as they are currently written.  Ambulances should transport to a hospital

d.      EMS Section will ask PAC to prepare a statement on this issue.

e.       EMS Section will draft answers to the questions raised on the handout

 

CQI

Finalized second pilot project, defined the services, finalized the distribution of materials, there will be two months of chart review data, they will then review the tool, and revise as necessary.  This pilot project is on Chest Pain and Respiratory.  Should they then develop more modules or wait until we have an electronic system?  What were the results of the original review?  Not enough data to give us information.

 

Disaster Management

Letter related to Policy and Practice and Systems discussion.  Suzanne read the letter for the group.  Recommends that the Board send the letter or allow that NIMS become part of the Refresher.  Motion by Hunjadi, second by Murawsky to approve letter as written. Motion carried.

Discussion: How does the money flow related to this training?  Homeland Security says states must comply or no federal money. WEM feels the number of people to train is enormous.  No curriculum exists.  ICS training is the first step of compliance.  Basic is 12 hours, there is a 4 hour online Introduction Management course.  A Letter was sent to every Governor which says ICS should be done.  Training will be paid for; there is “complete cost recovery”.  So it shouldn’t be a burden to pay for the class.  There is money available for career people to attend as well and money for backfill.  But, this does not include volunteers at this time.  We should cc Congressmen from WI, WEM, OJA, Governor, Sec. Nelson, This does seem time sensitive.  It would have more weight if other groups were to sign on.  We should move forward and ask others to take a stand.

 

Suzanne Martens asked about the second part of their recommendation related to using NIMS as the Refresher Course.  It was decided to send that question to Policy and Practice.

They did feel that we needed to be careful because there is money tied to this.  Need to keep it on the agenda.

 

Final question was related to First In document- wanted to know if it had been distributed by EMS Section, answer was no.  That is good because it is not completed as of yet.

 

EMSC

EMSC would like to integrate more with the EMS Advisory Board. They would like more of EMSC members on Board committees. Motion by Gloria Wall, second by Teesch, that as they are able EMSC members should attend and submit their names to join our committees. Motion Carried.  Dan added that all meetings are open, and they should feel free to participate.  Susan LaFlash will take this back to EMSC. TRANS 309- at the last revision accidentally removed infant car seats out of the requirement for an ambulance.  Need to communicate desires to the Board.

 

PAC

Would like to see a protocol for Physical Restraints included in the Scope of Practice at all levels. There is a concern about the general creep of the I-99 Intermediate level. Education has raised several questions about hours of training.  There was a discussion about Ativan and use. PAC wants input on all Scope of Practice issues. PAC also sent a letter to the Governor voicing their concern with the recent appointments to the Board in the fact that there have not been the recommended physician appointments.

 

Medical Director

National Initiative on Dispatchers and Wireless 911- need money and definition.  EMD legislation- where is it?  Senator Lazich worked on it, but it was never introduced.  Move this to the Systems Committee.

 

EMS Partners

 

Instructor Certification

            Discussion around the Instructor Annual Course was as follows:

31/2 days is too long, Takes too much time away from job- must take vacation, only offered once a year, many of the topics could be taught at the training centers, course is not cost effective- salary, travel, meals, lodging.  This message was clarified to not include the cost of the actual training. The course does not address all of the issues for a new instructor, training Centers are not able to hire out of state people because EMS Section requires that an Instructor must complete this course prior to any classroom work, Technical Colleges are asking why EMS Instructors are treated differently from their other Instructors

History - There has been a MOA in existence since 1978 between the Technical Colleges and the Division of Health.  The language was then inserted into Stats. 146.5. Training the numbers of Instructors on a one to one basis became too much, so a course was developed.  There is no valid reason whey this can’t be done at the District level- it just hasn’t been done that way so far.  The requirements can be waived if it is an impediment to hiring.  The course has some similarity to the DOT training.  A Course Instructor is different from an Instructor Coordinator- which has a statutory definition. 

 

Resolution:

a.       DPH will review the Statutory Language and prepare potential modifications

b.      DPH will review the Administrative Rules and prepare potential modifications

c.       DPH and Steve Teale will review the MOA and prepare new draft language for approval.  It will include modifying the responsibility for Instructor certification move to VTAE with a culpability clause.  Waiver will remain at DPH.

d.      DPH will review all outstanding Instructor Certification issues and bring them back to group for discussion.

e.       VTAE should develop a modular course

f.        There should be a Regional Instructor Training pool

g.       The course should be similar to the 2002 National Guidelines

 

Expansion of the re-licensure cycle

 

Discussion:

  1. Can’t base the decision on what an EMT learns in their Refresher in 30 hours.  What about quality?  So they learn more in the In-service, at conferences, hospitals, etc.?  What about geographic limitations?

  2. Shouldn’t we support continuous training?

  3. Could the training be completed in a 3 year cycle to get 30 hours?

  4. What impact will NIMS have?

  5. Bioterrorism is now on-going, how will that affect the hours?

  6. It might be better to keep licensure at 2 years, but offer alternate methods of training

  7. NREMT certification is an issue- that is a 2 year cycle

  8. Record keeping for continuous training could be an issue

  9. Define the EMT competencies we are striving for and then allow different ways of getting it done

  10. We should be looking at Web-based training or Video conferencing

  11. One size does not fit all

 

There was no resolution to the issue.

  

Agenda Item #4 Pediatric IO and IV Tech Courses

Dan gave a background of the issue.  The PAC wanted IO to be approved as part of the IV Tech course. Medical Director thought is should also be taught. Board did not agree.  Final resolution cloudy from EMS Section perspective.  Some feel IO is mandatory.  Policy and Practice looked at it again- voted no change.  Need an official EMS Section stand and reiteration from the Board.  Motion: Reiterate that IO is an optional skill, it is not mandatory and IO skills should not be a mandatory part of IV Tech training. Motion carried.

 

Agenda Item #5 EMS HRSA Plan

Discussion of the objectives that the Board must complete.  EMS Board is charged by the HRSA grant to develop a Disaster Plan that for the potential of large groups of the population that may be injured in Bioterrorism event. Need committee membership.  Gloria Murawsky offered to Chair the committee.

 

Agenda Item #6 State Communication Issues

Paul Wittkamp the EMS Section Communications Coordinator addressed the Board with the concerns that he has seen throughout the State. The Board appreciated the information and will continue to monitor the progress.

 

Agenda Item #7 Legislative Issues

None.

 

Agenda Item #8 State office update

It was announced that Dan Williams had accepted the position as the new EMS Section Chief of Emergency Medical Services for the State. The other two openings will hopefully be filled sometime in January.

 

Because Dan is the Chair of the Board and he will have to resign when he takes the State position, how does the Board want to handle chair role. Travis Teesch suggested that this was not on the agenda, so we should take nominations at the next meeting and then vote on a Chair.  Dan suggested that the Board should do this annually and everyone agreed.

Discussion also mentioned that Dan’s leaving would mean another vacancy on the Board that would need to be filled. It was also noted that Dan was the Board representative on the STAC. Motion by Lintz, second by Johnson that the EMS Advisory Board Chair also be the representative to STAC. Motion carried.

 

Agenda Item #9 Adjournment

Motion by Johnson, second by Hunjadi to adjourn. Motion carried.