Board Members present: Bureau Staff:
Joe Covelli Marianne Peck
Steve
Bane Bruce Gordon
Brenda
Fellenz Dan Williams
Troy
Haase Paul
Wittkamp
Cal Lintz
Ken Johnson
Steve
Teale
Travis
Teesch
Mark
Fredrickson
Gloria Murawsky
Board
Members Excused:
Tracy Aldrich
Others
in Attendance: Representing:
Ann Peggs PFFW
Jan Beyer UW EMS Program
Judy Jones Luther – Eau Claire
Fred
Hornby Bell
Ambulance
Pat
Padjen UW EMS Program
Suzanne
Martens Sheboygan
Co EMS
Mary
Austin Monroe Clinic
Tracy
Froiland Theda
Care/Fox Valley
Larry
Knuth Paratech Ambulance
Charles
Cady Physicians
Advisory Committee
Beth
Natter Mercy Hospital – Janesville
Bob
Nack Fox Valley RTAC Coordinator
Tom
Fennell Mayo Medical Transport
Jim
Swan Divine Savior Healthcare
Jan
Victorson Bayfield County Emergency Management
Keith
Kesler Douglas County Emergency Management
Kathleen
Crandall C&R
Midwest Associates, LLC
Robert
Stedman Waukesha
County Technical College
Tim
Hillebrand Dane
County EMS
Carrie
Meffert Dane
County EMS
Chair,
Steve Bane called the meeting to order at 10:00 AM at the Crowne Plaza,
Madison. Steve asked everyone in
attendance on the Board and the audience to introduce him or herself.
Motion by Lintz, seconded by
Teesch to
approve the April 2005 Board minutes. Motion
carried.
The 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.
1.
The
main committee did not meet.
EMS PARTNERS:
Cal Lintz, committee chair stated that the committee
reviewed the following issues:
Report:
Dan Williams, WI EMS Section Chief – discussed the status of Emergency Rule for WI HFS
113/First Responder in legislative process:
The rule was published June 6, 2005 subsequent to
line-item deletions by WI EMS Section to provide for the new advanced skills. Public
hearings regarding HFS 113 to be conducted in Madison on June 27th,
2005 from 1300-1500 hours at 1 West Wilson Street and 1600-1800 hours at Crowne
Plaza located at 4402 East Washington
Report: Cathy Etter, WI EMS Section ALS Coordinator – discussed EMS
Operational Plans as required by statute:
Review of EMS Operational Plans for all services
revealed that revisions or updates not accomplished on recurrent basis. Revisions
or updates to EMS Operational Plans are required each 2 years consistent with
the EMS relicensure cycle or whenever a change occurs.
Question:
What is the status of the WI DOT Ambulance Inspector? –
Response
from Dan Williams, WI EMS Section Chief:
·
Currently,
WI DOT Ambulance Inspector position remains vacant – internal posting for this
position is ongoing
·
In
the absence of WI DOT Ambulance Inspector – all new ambulance purchases must be
reported to the WI EMS Section via letter stating (1) make and model of new
ambulance, (2) VIN # of new ambulance and (3) the ambulance make/model that is
being replaced
Gloria Murawsky, committee chair reported the
following meeting topics.
EMT-B
Curriculum Review: Dan Williams discussed the
timeframe for curriculum completion. He has concerns about the current schedule
and would like to have the curriculum approved by the Board by the end of the
year, and rolled out in Feb 2006 at the statewide instructor’s conference. The committee may need to consider different
methods for the curriculum review process in order to have it completed in this
timeframe. A revised action plan is
needed to accomplish this goal. Gloria asked what format the State prefers for
the final curriculum. Dan indicated
that he would like to have the same format for all levels, the WIDS format is
not necessary for the State. Dan will
attend the Curriculum Review Committee meeting in August to discuss this
matter.
Dan discussed the need for the EMT-B refresher revision to be completed for implementation by July of 2006 to accommodate the plan to revise the refresher requirements, and possibly the licensure period, that is currently in process. The necessity to develop only the objectives and competencies versus the entire curriculum for refresher was discussed. Dan felt that the EMS office needed a standard refresher curriculum to assist in State approval of courses. Dan suggested the Committee consider using 1994 curriculum, which was diagnosis based, as a basis for the curriculum review instead of the current DOT curriculum.
Dan also handed out the draft scopes of practice for all levels. He noted that the EMT-B scope of practice has already been approved by PAC. The draft versions of the other levels will be used to provide direction and guidance until fully approved.
Stakeholder Survey Results: The results have been requested to be posted in some manner on the website. Jan will send a final version to the EMS Section.
EMT-I to Paramedic
Transition Course: Cathy Etter presented a concept that has been
drafted by Judy Larsen. The group
discussed course hours, comparison to the full paramedic course and the skills
and competencies required. As of now,
only one technical college is interested in presenting the course. It is possible that this course could be
used to transition out-of-state
paramedics to a Wisconsin license. It
is felt that the difference between Wisconsin and other states is in critical
thinking.
Rural Health Flex
Grant: Cathy Etter reported that the committee has not met since the
last report. Dan and Cathy explained
that the focus of this grant is to investigate ways to more effectively provide
education to very rural areas. It is
anticipated that web-based training will be developed. WMD education is being looked at as a
pilot. This item will remain on the
Education Committee agenda for updates.
Wisconsin
EMS Emergency Preparedness Plan (WEEPP) Cathy reported that the WEEPP has been
completed. Plan education will be
accomplished through the use of a DVD and booklet. These will be made available through the RTAC’s. The training includes a 40 minute DVD which
explains the WEEPP, incident command, job action sheets, START and Jump
START. Patient scenarios and a mini
tabletop exercise are also included.
Each agency that trains 80% of personnel will receive $1400 (regardless
of size of agency). They ask that the money be used to improve response to
large scale incidents.
Travis Teesch, committee chair reported on the
committee meeting, which included:
HFS - 113. It was reported that the first responder rule is
partially in effect. The additional skills for the first responder were
successfully adopted. We are now in the midst of a 30-day comment period before
the rule is put into place for 150 days. After this 150-day period, the rule
will either have to become permanent or expire. There will be two public
hearings concerning this document held on June 27th in Madison.
First responder organizations that utilize additional skills must affiliate
with an ambulance service.
It was also suggested that a name change be
recommended to correspond with the National Scope of Practice document to
ensure greater continuity in terminology. The term used in this document is
Emergency Medical Responder (EMR).
National Scope of Practice. It was reported that there appeared to be far fewer
comments regarding this version of the document than the previous one. Even
with the latest revisions, it appears likely that Wisconsin will need to make
some important decisions concerning which direction they will take in relation
to this document.
EMSFAP. The revision to the long-standing language of fund distribution
continues to be a work in progress. It appears likely that the funding
allocation that has historically been utilized to fund initial EMT-Basic and
EMT-Basic refresher training through the technical colleges will now be
disbursed to each ambulance service. This translates to each service making
their own decision regarding how this funding will be used. The formula for
this disbursement has not yet been decided upon, however, there were three
different models that the PPC has reviewed and analyzed over the past two years
regarding this issue. It was suggested that the old formula for disbursement be
maintained for the non-training funds. This would equate to approximately $3588
for each ambulance service in the state. Then, another formula would be used to
disburse the remaining $800,000. It was suggested that a 1/3, 1/3, 1/3 formula,
utilizing a segment of all three models, would be the best and most logical
formula to use. Whatever formula is selected, and however it is applied, the
intent of the PPCs original motion was to keep ambulance services as whole, in
regard to overall funding, as was possible (PPC
Minutes of Jan 2004 and September 2003).
PPC
members are to continue to review and analyze the proposed formulas and be
prepared to make a decision as to which model to adopt by the next PPC meeting.
Refresher
Training. Dan gave a
synopsis of the special meeting held in Wautoma on May 3rd. Several
concepts were discussed and more meetings of the PPC regarding this issue will
be necessary to identify the details. The proposed timeline to accomplish this
task is by July 1, 2006. A special meeting is planned to continue to discuss
the FAP formula and the EMT Basic Refresher Course.
Database RFP Update: Dan Williams updated the membership on the current
status of the RFP. The process is moving along well and her work was recognized
by the group. The process will now move over to the state. At this point a
committee to review he responses to the RFP is being formed. It is the
intention of the state to include members with significant EMS experience in
this group. The next task for this group will to be to assist in the
implementation of this database.
Database Implementation: Discussion ensued regarding some of the potential
barriers to implementation. The first discussed was whether or not legislation
was required to make reporting mandatory. The current state code allows for
DHFS to require EMS agencies to submit data, so this was not felt to be
necessary at this point. Certainly the agencies can comply with this regulation
simply by sending in hard copy, but it is hoped that the system can be made
painless enough to encourage compliance.
The
rest of the discussion centered on how to roll the project out with such
potential issues as who to have trial it first. Various incentives were
discussed, including support, good feedback of useable information, performance
improvement programs and potentially tying FAP funding to utilization if
necessary. It was the uniform opinion of the group that positive reinforcement
was the most desirable way to roll out the implementation.
The
fact that it would be difficult to decide specific implementation issues until
the actual product is known it was felt that a meeting in July was not
necessary, so the next meeting of this committee will be in the fall, after the
vendor is known.
Brenda Fellenz,
committee chair reported on the following committee meeting actions.
A
discussion was held to redefine the purpose of this committee: Several thoughts
and strategies were discussed and will be developed further. The committee is
in the process of redefining and exploring the future direction.
The
Committee established goals to make the link between public health and EMS
stronger and more meaningful. The committee also developed a model to Link EMS
& Public Health and established an action Plan to guide them with the
development.
SYSTEMS MANAGEMENT.
Cal Lintz, committee chair reported on the following topics.
The main topic of discussion is the issue of the relationship between EMS and free standing emergency departments. The committee will continue to define the issues and develop EMS protocols for the transport to these types of facilities. It was decided that inclusion and exclusion criteria were to serve as the backbone to the document. It is not anticipated that this will be needed often if ever but the EMS office has asked for assistance in the development of a protocol should an EMS provider be placed in a situation that this type of transport is being requested. The committee chair will develop a draft document to be review at the next meeting as a starting point document.
CQI
Ken Johnson, committee chair reported on the following issues.
The
pilot has been sent out to multiple services, along with a cover letter of
explaining the program. Follow up with these services was done, with
approximately 7 responding. Those that responded found the pilot project to be
easily used and straight forward. Many of these agencies are already doing some
form of CQI, many with computerized systems.
Based
on this information, there were not further suggestions for revision to the CQI
project and this will be forwarded to the board for final approval at the
August meeting before submitting to the state.
A
round table discussion ensued regarding some of the ideal components of such a program.
The primary function of PI is to help the individual to optimize the care that
they provide to each individual patient by looking at processes of care and
looking for areas of improvement. It should be stressed that 80% of all problems
identified on PI are systems problems and that a non-punitive approach should
be stressed, especially its use to help in guiding education and with
interactions with the medical staff.
The
consensus of the group after some discussion on future methods was that the
committee should develop 2 documents, one that outlines the ideal components of
a PI program. The second document would be a scenario based presentation
regarding how PI can help the individual provider. Jan Beyer agreed to create
rough draft of the second for the next meeting. Dr. Johnson agreed to draft an
outline of the former for distribution prior to the next meeting.
DISASTER:
No report.
Written report was submitted.
The
committee continued the review of the Interfacility Transport Guidelines and
worked through several areas. In the interest of time and many further issues
on the agenda the committee decided to continue to comment and review the
document among the PAC members by using e-mail. The process will continue with
an anticipated close to final product for the next full meeting.
The
review of the EMS report card for EMS services will continue to be reviewed by
Dr. Curtis with a report forthcoming.
The Medical Directors course is in final stages of
refinement and about ready to be placed on a State supported site. Further
enhancement has been discussed, but the current plan is to get the course
operational and then move for improved enhancements at a later date.
STATE MEDICAL DIRECTOR:
Dr. Gordon discussed several areas that he was
currently working on.
STAC REPORT:
A written Report was submitted that outlined the
various EMS related activities taking place within the RTAC’s
Dan advised the Board that he had developed a response to the scope and forwarded it on to the review committee within the deadline parameters.
Dan advised the Board of several bills that are moving forward.
AB 94,
AB 201
AB 306 SB
1. Wisconsin
Scope of Practice issues. Dan advised
the Board that draft scopes of practice had been distributed to the appropriate
committee to start the review and acceptance process. The current documents are
what is being used by the Department at this time to establish base scopes. It
is intended that the committees will have further review and revision to the
draft documents. This will be an ongoing project until completed. The current
thinking is that you first have to define the scope of practice and then assure
that the training programs are delivering the appropriate educational message.
1.
EMS Advisory Board Retreat. The EMS advisory will be
conducting their retreat September 12 & 13, 2005. The Board will review
operating procedures, committee workload review, committee structure etc. More
information will be made available as it is known.
2.
Physician Advisory Board
term expirations and seeking interested physicians to serve. Three positions on the
Physician advisory committee are up for appointment or re-appointment. The
Board is seeking interested physicians to submit a letter of interest and CV to
Dan Williams at the State EMS office. The Board will make its selection at the
October meeting. Any physician that is
interested in serving on this committee should send a letter of interest and
resume to Dan Williams at the address listed below by 4:30 PM Friday, September
2, 2005.
3.
Discussion on sub-committee
and Board minutes. It was decided that all sub-committee meeting minutes must be
submitted to Dan Williams 15 days after meeting occurs. This will allow for a
timely turn around.
4.
At large membership to EMS
Board sub-committee term expirations. It was noted that all at large committee member
will expire in September. If interested
please send a letter of interest and resume to Dan Williams at the address
listed at the end of this e-mail no later than 4:30 PM on Friday, September 2,
2005
Agenda item
# 9 Other Board Related Issues.
None.
Agenda item #10 Adjournment.
Motion by Teesch, second by Haase, to adjourn. Meeting adjourned at 11:20 AM.