Physician Members Present
Mark Mirick
Bill Perloff
Ron Pirrallo
Jon Robinson
Keith Wesley
Mark Westphal

EMS Staff Present

Rick Barney, Jon Morgan, Mary Jean Erschen

Others Present:
Mike Kunesh, PFFW

Keith Wesley called the meeting to order at 10:20 PM at the State Office Building, 1 W. Wilson St., Madison, Wisconsin.

01. Minutes
Minutes from the April meeting were reviewed. Motion by Bill Perloff, seconded by Ron Pirallo to approve the minutes. All Present - Aye.

There was a follow-up discussion on several items from the last meeting:
Status of NAEMSP Medical Director workshop. Dr. Barney reported that the EMS Office has not heard back from NAEMSP, but it is likely that WI will not host a medical director workshop set-up by NAEMSP. This update led to a general discussion about requiring an MD workshop and the need to look at having multiple means to get MD education credit if a workshop becomes required. Discussion of having a read & self-assessment correspondence course or a web-based course. The EMS Office will again review the option of having a list serve.

Assignment for next meeting: all PAC members should bring resource/reference materials that would be helpful for a MD course.

Discussion on reimbursement. The EMS Office discussed their meeting with the Bureau of Health Care Finance on medicaid issues raised at the last PAC meeting. The meeting was a good informational session and there will be follow-up on reimbursement issues such as the definition of emergency, criteria for reimbursement, looking at new medicare criteria and the possibility of having similar criteria for medicaid.

02. Minimum EMT Treatment Guidelines
Review of sample protocols to use as templates for services looking for guidance in developing protocols for various conditions. Protocols were written as minimum guidelines to be adapted as necessary for local use. There was some discussion on edits that will be added for the final product.

03. Scope of Practice Update (all levels)
Dr. Barney discussed a draft of the proposed EMT education, license level and scope of practice in the near future. The proposal listed 6 potential levels: First Responder, EMT-basic with 3 new medications, EMT-basic/IV technician (current EMT-intermediate), new EMT-intermediate, EMT-paramedic, and a critical care level for interfacility transports. Providers and medical directors will be receiving updated information when plans are finalized. Material will be ready this summer.

Action items: Vote at next meeting on use of ET tube for proposed EMT-basic/IV technician level.
Question for next meeting: How many current EMT-I services intubate?

04. Enhanced EMT-Intermediate Protocols - - Valium, Adenosine
Enhanced EMT-intermediate protocol issues. Pilot projects are submitting protocols and the State Office would like clarification on acceptable dosage for adenosine and valium. Recommendations were made and will be shared with pilot ambulance service providers.

05. DNR Update
Issue of do-not-resuscitate orders for children in the prehospital setting. The discussion
suggested 3 follow-up options: list DNR options in protocol guidelines, letter from MD & PAC with summary of current practice, and look at a standardized form.

06. Medical Director Update
Covered in previous discussions.

07. Other Business
Bill Perloff highlighted recent EMS-Children products, including a CD-rom of the EMT-basic curriculum with pediatric training slides, a national EMSC CD-rom with pediatric question and answer scenarios, guidelines for pediatric equipment that were sent to clinics and an update on chest compression use for pediatric patients.

Keith Wesley raised the question of monitoring drug use and accounting for all controlled substances. Mike Kunesh will get a sample system from a fire department for PAC members to review. A copy of an Iowa law spells out how drugs can be managed for EMS services. That law will be reviewed and looked at for possible introduction as statutory language in WI.

Motion by Jon Robinson, seconded by Mark Mirick to adjourn. All present - Aye. Meeting adjourned at 1:20pm