BEMSIP Staff Present
Rick Barney
Terry Gonderzik
Ann Moses
Members Absent
Bill Perloff
Mark Merick
Dr. Keith Wesley called the meeting to order at 10:00 a.m. in Room B145 at 1 West Wilson Street, in Madison.
1.0. Introductions - Also present were Greg Konop from University Information Technology, Regina Keller, and Martha Florey from DOT.
2.0. Approval of December meeting minutes
Minutes from the December 20, 2002 meeting were reviewed and unanimously approved
3.0. Latex Allergy - Regina Keller, RN
Ms. Keller discussed the increase in latex allergy and distributed handout materials, including a sample protocol for removing latex from ambulances. She noted that latex is easily aerosolized, and that many people, both patients and especially health care workers, are allergic or becoming sensitized, but don’t yet know it. Motion by Ron Pirrallo, seconded by Mark Westfall, that the PAC should recommend that ambulance services review their equipment lists and seek to reduce or eliminate latex-containing materials as far as possible, that services should revise their protocols to reflect this, and that DHFS should recommend to DOT that the next revision of Trans 309 require this. The motion was adopted.
Further discussion points were that latex gloves are almost gone now except in the training centers, that putting on gloves before arriving at the patient’s side raises the probability of perforation drastically, and that this is another opportunity to communicate. Terry Gonderzik invited Ms. Keller to submit an article to the Bureau newsletter.
4.0. Medical Director’s Course Update – Dr. Wesley
Dr. Wesley has made their submitted revisions. Greg Konop, from University Information Technology, talked about Web CT, which can be used to present training material on the internet. Web CT includes content presentation; several forms of assessment, such as self-assessment, surveys of users, and quizes; communication tools such as discussion groups; video and audio, which would allow course developers to narrate their parts; and image databases. A wrong answer on a quiz can lead to presentation of the correct information, and links can be added to other sites with more detailed information. Other modules and courses can be added later. For narration, he said that it is best to have a script, and stick to it. Then there will also be a written transcript for DHFS to review.
The committee would like the trainee to be able to print out a certificate of completion when the course has been completed satisfactorily. Mr. Konop will prepare an cost estimate, including a scope statement and discussion, with several options, for PowerPoint, audio, and both, and will send it to Nan Turner. The course developers will each bring a transcript of their narrative to the April meeting.
5.0. Protocol Development – Dr. Martens
Dr. Martens handed out a model protocol. She mentioned that the Bureau website should say to whom protocols should be sent. Protocols should be sent to the coordinator for each area, except that ALS protocols should be sent to Nan Turner now. Porters is a program that writes protocols, with information about it available at www.emsprotocols.com. Visio has also been used for flowcharts. Other sample protocols on the web are at the Maryland, Regents’ (St. Paul), or www.mayo.edu sites. Wisconsin could put sample or standard protocols on its website by summer.
6.0. Due Process, Medical Director Contract – Terry Gonderzik
After discussion, the Committee decided that the contract is necessary, but it needs to be taken back to Legal Services, to a labor law specialist.
7.0. Ambulance Run Database – Ann Moses
Ann briefly discussed work with the ad hoc data committee on the new database, and asked for the Committee’s input on: a) the appropriateness of the elements and options in the draft data dictionary, b) which reports they would like to see built into the system, and c) their suggestions for epidemiological surveillance alarm triggers. She will e-mail the questions to the Committee, and will come back to the April meeting. Martha Florey said that she would like more guidance from the parent data committee.
8.0. Hyperventilation Before Inserting Combitube – Dr. Barney
The training centers are teaching hyperventilation before inserting combitubes, although it isn’t recommended any more because of gastric distention. It should be hyperoxygenation or pre-oxygenation, and no delay in chest compressions. Dr. Barney will write a recommendation from the PAC that prior to placement of an advanced airway, the EMT should preoxygenate at 100% flow every 3 seconds for 30 seconds.
9.0. Priorities -
10.0. Inter-Facility Transfers – Terry Gonderzik
Terry has been talking to groups and legal reviewers. Although this is the hospital’s responsibility, they often think it is the physician’s. We need a licensure level for critical care (or specialty care) to be introduced by a legislator. The new rules need to be applied to the patient care, not to the vehicle. A flow chart of which patients go where would help small hospitals assess the resources needed. Staffing costs can be kept down by keeping nurse/paramedics who can work wherever they are needed. Comments on the document need to be to Terry by the end of March. He will redo it for the April PAC meeting. Forty other states are interested in our inter-facility policy.
11.0. Standards & Procedures - Terry Gonderzik
The Standards & Procedures is a vocational technology document, but they are introducing it as endorsed by the PAC and EMSIP, although it is not endorsed by either. Motion by Dr. Wesley, seconded by Dr. Pirrallo, that “The PAC does not consider this to be the standard of care for EMS providers in the State of Wisconsin.” Motion unanimously adopted. Terry will tell the Education Committee next week.
12.0. BioTerrorism Funding - Terry Gonderzik
Mark 1 kits can be bought for the ambulances, containing atropine and 2-pan, 10 doses per ambulance. There will need to be a Rule change allowing this. Veterinary drugs can be bought cheaply, to be used in exigent circumstances. Nerve agents don’t require as much as organophosphates. The PAC does not support including valium or amyl nitrate. It does support four positive air pressure (PAR) masks per vehicle, and possibly detectors and thermal imaging cameras.
13.0. Portal Project – Terry Gonderzik
The DEG analysts and programmers were free in the beginning. In October Terry began working full-time to put all bureau business on the internet. Registration and training will be all entered directly, with no paper. There can be a standard Basic protocol on the website by the end of the month. There was discussion of how much flexibility should be allowed in protocols; the committee felt it should be maximal at the paramedic level, and that guidelines should be recommended otherwise, leaving specifics to medical directors and online medical control. While anything outside the scope of practice is experimental, the committee felt that there needs to be an optional mechanism for allowing some minimal amount of flexibility, which does not exceed the EMTs’ scope.