Members present:                                        

Rick Barney                                                    
Charles Cady                                                  
Mike Curtis
Franz Keilhauer
Suzanne Martens         
Mark Schultz
Mark Westfall
Keith Wesley  

Bureau Staff:
Nan Turner
Jon Morgan

Others in Attendance:                                   Representing:
Steve Stroman                                                  Aurora Bay Care
Bruce Gordon                                                  WI Rapids – Riverview Hospital
Jay Gordon                                                      Stevens Point Fire Dept
Ken Johnson                                                    Brown Co EMS
Kevin Thornton                                                Ashland Hospital
Chris Sorrells                                                    Aurora Bay Care
Jerry Jones                                                       Waupun Hospital
Wade Woelfle                                                  Fort Atkinson Hospital 

Agenda item I - Introductions

Keith Wesley called the meeting to order at 12:10 at the Bridgeport Resort, Sturgeon Bay.  Everyone in attendance introduced himself or herself.

Agenda item II -Approval of July Meeting Minutes

Motion by Keith Wesley, seconded by Suzanne Martens to approve the July PAC minutes.  Correction: Mike Curtis not at July meeting.  All Present – Aye.

Agenda item III - Old Business

Trauma Forum – Keith Wesley asked for a moment of silence for Jim Berner.   Motion by Keith Wesley, seconded by Mike Curtis to post the memorial statement for Jim Berner in the PAC minutes (See end of minutes) and that the EMS MD internet course be dedicated in his honor.   All Present – Aye.

There was a brief summary given on the September 2^nd Trauma forum attended by the Surgeon General.

A.  Medical Director Course

Ψ      Reading Assignments – no discussion

Ψ      Short demonstration and update

Nan Turner showed a module from the web-based Medical Director course that will be posted for WI EMS medical directors.  PAC members had some questions about how this will be rolled out.  One of the issues was to have a mechanism for discussion groups for users and whether that will be “moderated” by PAC members.   The PAC members will test the course once it is posted.

Ψ      Disaster/WMD chapter

Mike Curtis will send completed module to Nan Turner.

B.     EMS Report Card

Mike Curtis summarized the Report Card, which has been modified into Clinical and Administrative sections and added accreditation of ambulance standards and information from the EMS Agenda for the Future.  The document is meant to be used as a self-assessment tool for the ambulance service.  PAC Members should review the revised document for discussion at December meeting.  EMS Board to review Administrative section (Part II), PAC will review Clinical section (Part I) plus Administrative Component E – Resource Hospitals.

C.  CPAP study materials – comments

The CPAP materials are awaiting DHFS internal approval.  There was agreement that the materials are well done and minor modifications should be made to the variables list in  and other minor edits in the draft document.  A question was asked whether the State of Wisconsin has a standard cost of intubation and cost of hospital stay that could be used as a means of comparison of cost savings for CPAP patients.

The number of pilot services needs to be evenly distributed.  Suggestion was to pick a set number of services from each of the nine regional trauma areas.   Recommendation that all EMT-basic services be allowed to enroll in CPAP pilot if they apply by January 1, 2004.  Also noted was the need for EMT-I and EMT-P services to supply CPAP data.  The question being addressed by the pilot: Can EMTs-basic apply CPAP as safe and efficacious as ALS providers?  The bureau will determine next steps to inform providers and determine participants.

Agenda Item IV - New Business

A.     Review STAC major trauma classifications

The committee reviewed the trauma protocol drafted by the Statewide Trauma Advisory Council using American College of Surgeons guidelines.  PAC supports the trauma protocol as written.

2. Final EMT-Basic protocol guidelines

The committee reviewed the EMT-basic protocol guidelines.  PAC members should review and get comments back to Nan Turner by October 1, 2003.

3. EMT-basic scope of practice review

Moved to November meeting.  Nan Turner will get draft document to PAC members prior to the meeting.

D.  Selective Spinal Immobilization Protocol

The issue is whether selective spinal immobilization assessment is within the scope of practice for EMTs-basic and EMTs-basic IV personnel.  Review of standard texts indicates there are criteria that can be used by EMTs-basic to selectively use spinal immobilization.  The question is whether EMTs will properly assess and apply guidelines to use immobilization.  The consensus was that selective spinal immobilization is possible with the caveats that EMTs need proper and consistent training and medical oversight and that there are holes in those two areas, which may make this dangerous.  It was suggested that services could submit an education package with a standard protocol, and QA plan for approval to ensure safety.   Motion by Mark Westfall, second by Charles Cady, that selective spinal immobilization be in the EMT-basic scope of practice.  All Present – Aye. 

E.   Mike Curtis handed out a CD from the Central Wisconsin Disaster Management Group that shows training for disaster planning & response. 

Next meeting: November 20, 2003 at 1 W. Wilson, B141 10:00 – 12:00.

Motion by Keith Wesley, seconded by Suzanne Martens to adjourn.  All Present – Aye.  Meeting adjourned at 2:45.

Agenda Item V - State EMS Medical Director Report

Medical Director Report

The Medical Director report was given to the larger medical director meeting for Paramedic Systems of Wisconsin.  Dr. Barney reported that this meeting is his last meeting before he ends his term as State EMS Medical Director.  He outlined a number of issues he would like to see addressed in the near future.

1)      Data Collection – services will need to contribute to data collection in the near future.

2)      Protocols – recommended that services should have protocols for patient restraint and pain management.

3)      Continuing education needs to be revamped for relicensure, both the time period (2 years) and method and content of instruction.

4)      Lack of medical direction in some parts of the state or the degree of medical oversight for some services.  The EMS MD Course will help, as will sharing of medical expertise regionally.

5)      Trauma – Services and medical directors need to be involved in regional trauma discussions and continue to pursue statewide funding, which needs to be linked to EMS funding.

6)      Interfacility transport – waiting for meeting with the Wisconsin Hospital Association after the recently released EMTALA federal guidelines are reviewed..

7)      Review the need for standardized statewide protocols, particularly at EMT-basic and EMT-basic IV.

8)      Review the need for bridge courses.

The Requests for Proposals for the State EMS Medical Director has been released and applications will be accepted through October 10, 2003.

FOLLOW-UP: