EMERGENCY MEDICAL SERVICES PHYSICIANS ADVISORY COMMITTEE
Members Present:
Tom Brazelton
Charles Cady
Mike Curtis
Franz Keilhauer
Suzanne Martens
Halim Hennes
Mark Westfall
Bureau Staff:
Dan Williams
Brian Litza
Cathy Etter
Members Absent
Mark Schultz
Eric Voter
Agenda Item 1 - Introduction
EPAC began at
Agenda Item 2 - Approval of December Minutes
Minutes from the December meeting were approved with Dr. Cady’s changes.
Agenda Item 3 - New Business
A. Meeting dates/locations confirmed as follows:
October Meeting cancelled
December Meeting cancelled
B. Free Standing ED complaints
No one was available from the Bureau of Quality Assurance, so Dan Williams advised the committee that BQA would like to be
able to utilize the expertise of the PAC for advice in situations that involve free standing Emergency Departments. Dan
Williams will convey the message that the EPAC is available to discuss EMS related issues and offer advise, should that be
requested.
As discussed in
prior meetings, PAC strongly supports a well-defined scope of practice for each
individual level of provider. DHFS will
closely monitor requests for skills outside of the recommended scope of
practice agreed upon by
1. Minor clarifications were made to the EMT-Basic Scope of Practice. “12-lead” was removed from ECG Monitoring; “Tracheal” was added to the intubated patient for monitoring ETCO2; “Medication Administration Routes” text box was added.
2. First Responder Scope of Practice
a. Discussion continued regarding the First Responder Scope of Practice. Specifically, the use of long-board immobilization was debated. It was decided that the First Responder curriculum includes teaching this skill to assist another provider and should be allowed at this level.
3. EMT-Basic IV Technician Scope of Practice
a. Discussion continued regarding the EMT-Basic IVT Scope of Practice. The following changes were made to the draft for the EMT-B IVT level:
· Epinephrine statements were combined into one statement to encompass both Auto-injector and SQ administration.
· Removed “for asthma” following Atrovent
·
Removed “0.9%” before
· Removed “pulse oximetry from skills as it is already mentioned under Airway sections
· Removed “12-lead” before ECG monitoring
4. EMT-Intermediate (formerly I99) Scope of Practice
a. Several services have requested and/or been given permission for skills not currently accepted as being within the Intermediate Scope of Practice. It was unanimously agreed that the following changes and revocations be made immediately:
Etomidate, Succinycholine, Adenosine, Romazicon, Versed are to be removed from any current protocols.
The following would be allowed to remain in current protocols, but would not be approved in new protocols or upon request of current services:
Benadryl, Fentanyl
The decision to allow a pilot program comparing the use of Morphine and Fentanyl was approved. Dan Williams will be handling this request.
Post meeting correction regarding the adenosine. PAC determined the adenosine is approve for the intermediate.
b.
Cardioversion and Transcutaneous pacing
at the Intermediate level was debated. Dr Martens suggested these skills be
approved only for the unstable patient, as described by the current AHA, ACLS
guidelines. It was unanimously agreed the scope of practice of the Intermediate
should reflect this decision.
The use of Amiodarone was discussed. It was agreed that only the two doses of Amiodarone be administered by the Intermediate in the unstable patient only. The initiation of an Amiodarone drip will not be allowed.
The use of Lorazepam and Diazepam will be allowed for seizures only. These may not be used for sedation purposes.
5. EMT-Paramedic Scope of Practice
The Paramedic scope of practice was reviewed. It was agreed that the EMS Service Medical Director could broaden the Paramedic’s scope of practice, including the addition of medications. All changes and additions would continue to require the approval of the Bureau and an update to the current Operational Plan.
Agenda Item 4 - Old Business
A. Interfacility Transport Guideline Draft
1. Discussion continues on this project. Dr. Cady made changes to the document that were reviewed and approved by PAC members.
2. Staff from DHFS will compare the Scope of Practice for each EMT level and compare these to the document for accuracy and corrections based on the earlier discussions. The corrections will be made and electronically sent to PAC members for review.
B. Medical Director’s Course
1. Updates and content are on-going.
2. Hosting: Meg Taylor from the DHFS has the information submitted at the last meeting and is checking with the department on hosting this on the States website.
3. PAC approved the use of the Medical Director’s Course as a requirement for Service Medical Director’s.
C. Call and Pump Program
1. Dr. Keilhauer reported on the success of the “Call & Pump” program currently in a pilot program in Rock, and Walworth counties. Early numbers have shown a 17% success rate when compared to other standard forms of cardiopulmonary resuscitation. A video was viewed and it is hoped this video will be approved for showing in such arenas as airplane flights.
Agenda Item 5 -