Eric Voter

Agenda Item 1 - Introduction

    Meeting was called to order by Chairperson Dr. Cady at 11:00 hours.

Agenda Item 2 - Approval of August Meeting Minutes

    Unanimous approval after motion and second of motion.

Agenda Item 3 - New Business

        A. Pediatric IV-tech skills

Discussion focused on the scope of practice being consistent with recommendations by EMSC and PALS guidelines for inclusion of IO skills in the curriculum for Basic IV-tech at the EMS Training Centers.  However, Dr. Mark Schultz felt that finding time to do this teaching was becoming a burden without increasing the number of hours required for Basic IV-tech education.  Since the EMS Board has not yet formulated the scope of practice including the competencies for this level of education, it is clearly not a mandatory component of the curriculum at this time.  It was felt that if a training center desired to teach IO at this time as a component of the class with consultation with the medical directors in their area that they should do this on their own volition. Another aspect of training at this level was the integration of the PEP course materials per recommendations from EMSC.  It was pointed out that EMSC has made available the use of their PEP instructors by the training centers without charge but this does not address the likely need to increase the hours both for Basic and Basic IV-tech training.  PAC has taken the position that IO skills at the Basic IV-tech level of practice would be desirable and urged the EMS Board to deal with setting the scope of practice and competencies for this level of education ASAP during this next year. PAC did not make any recommendations concerning PEP. Whether the

 IO skill would be utilized in the field by all Basic IV-tech EMTs would still be at the discretion of the local EMS medical director.

        B. EMT-I use of lorazepam

A letter from Dr. Rommel Bote from Racine EMS was read by Dr. Cady urging the scope of practice for I-99 be expanded to include the use of lorazepam.  Dr. Bote was present at the meeting and expressed his interest in using this medication for both seizure control and sedation for chemical restraints.  Dr. Cady and Dr. Gordon were strongly in favor of adding this drug to the I-99 scope of practice and the PAC in general felt that it offered definite advantages over the current drug diazepam included in the I-99 scope of practice for seizure control.  However, it was noted that expanding the use of this drug for chemical restraints would require a more thorough review of the I-99 scope of practice by EMS Board rather than just the addition of lorazepam along with diazepam for seizure control.  Dr. Mark Schultz again vigorously raised the point that adding more pharmacology to I-99 training without addressing increasing the number of hours currently in the I-99 curriculum was not a good idea since there could be many more drugs on the horizon that could be considered beneficial at the I-99 level of practice.

A motion was made that the EMS Board amend the scope of practice of the I-99 EMT to include the use of lorazepam for seizure control as an alternative to diazepam. The motion was seconded.  The PAC passed the motion with Dr. Mark Schultz as the only dissenting vote.

Agenda Item 4 - Old Business

        A.  Updates

                1. Medical Director Course – CME

An extensive set of forms were reviewed from University of Wisconsin relating to fulfilling their requirements for granting CME Credits for the Online Medical Directors Course.  Dr. Brazelton who was online with the information at UW was able to confirm a large amount of the information was already entered.  He volunteered to work with Dr. Cady and the CME people at UW to assure that the form were appropriately completed to allow UW to be the vehicle for CME for the course.

Further discussion covered the need to thoroughly review the content materials currently used to make the Power Point slides in the course including the narration of the slides before release of the final product since there were major technical problems discovered when taking the course as now offered by several physician reviewers.  This original content is available in several locations in both electronic and written form (Nan Turner’s files). It was further decided that outside consultation as to the technical revision of the Power Point be requested with the permission of Meg Taylor at the Bureau of LHS &EMS.  Dr. Gordon who took the entire course felt that the PAC members and EMS Section staff who developed the content did an excellent job and that it was now time to insure a quality “technical” presentation to be offered to medical directors to encourage all WI EMS medical directors to take this free course since it was represents a high quality educational offering.  This matter will be discussed again at the Oct 21^st meeting in Madison.  Dr. Mark Schultz believed he has all of the original content in electronic format and would send it to PAC members so that they could review their respective presentations...

                2. EMS Report Card

Dr. Curtis has talked with EMS Board Chairperson Dan Williams about Dr. Curtis and Dr. Wesley taking back the administrative portion of the Report Card for review and have the Board place their review on hold pending a full Report Card presentation including the administrative section by PAC at a future Board meeting. Mr. Williams was in complete agreement with this approach to EMS Report Card...

Further discussion covered the taking of this Report Card to members of NAEMSP currently working on similar projects for comments concerning development of “National” standards. Dr. Westfall from Gold Cross in the Fox Valley was very enthusiastic about beta-testing the Report Card as soon as it became available and that benchmarks for ambulance services could eventually be created.

Dr. Curtis felt that an on-line version should be available including methods of obtaining comparison reports for comparable areas or levels of service or even individual areas of interest within the Report Card.

This item will continue to appear on subsequent agendas for updating.

4.1.3                        3. CPAP for WI Basic EMTs

Dr. Westfall has not been getting any run data from this project at this time.  It is unclear who is handling process of the enrollment of services at the Bureau/Section at this time.  More information as to the status of this project needs to be made available at the Oct 21 meeting.

Dr. Westfall offered to have data sent directly to him at his home address if this would facilitate moving the project onward.

                                    Dr. Mark Westfall

                                    2413 Woodland Terrace

                                    Neenah, WI 54956

       B. Due Process Document

After a final review by Dr. Westfall in hopes of  finishing the seeming constant “ping ponging” between legal opinions and PAC opinions, the current status of this document is unknown and it needs to appear on the Oct 21st agenda with specific comment from Meg Taylor as to it eventual adoption.

       C. Mark I Protocol

Mark I kits are now in the possession of the EMS services with a basic protocol for use also sent with the kits.  It was brought up that more extensive long term dealing with use of this “rescue” kit have yet to be addressed since there is confusion as to its use on patients which exceeds the scope of practice of EMT-Bs  rather than being used as auto-injectors for HAZMAT protective measures for EMS personnel. Other issues as to inadequate numbers of kits to actually cover all EMS first responders at risk, replacement of outdated kits, relationships to law enforcement and fire first responders and the appearance of the new Chem Pack units now being distributed to also address nerve agent and organophosphates poisoning were discussed.  It was decided that all of these issues must eventually be addressed by the Bureau/Section.

Agenda Item 5 - State EMS Medical Director Report

General comments about the EMSC Strategic Planning meeting earlier this month were given since EMSC it is now included in a Bureau other than LHS & EMS and information flow to PAC may be impaired.  It is the feeling of the members of EMSC that they must become regular participants at the committee meeting of the Board to be true developers of pediatric oriented EMS education and direct patient care planning.

It is the intention of the Medical Director to give the concerns about the Mark I kit as it relates to the scope of practice of EMT-Bs to the education committee of the EMS Board.

A revision of the Pediatric Algorithm for State Pediatric Defibrillation Guidelines has been written by Dr. Perloff and will be available for the next PAC meeting to review and offer advice to the EMS Section as to a new Guidelines release.  Extensive discussion of the deviation of the Pediatric AED protocol from manufacture’s guidelines is clear as is the variance with current joules/kg recommendations for defibrillation by other than an AED. There is clearly local medical director liability in this issue and the options of local directors to exclude use of AEDs for pediatric patients < 8 y.o. is a reality.  This item deserves more review by PAC in the future.

Dr. Gordon will continue to be a part of PAC, EMS Board, STAC, EMSC and the day to day consultion for the Bureau of LHS & EMS in attempts to facilitate good communication between these groups.

Agenda Item 6 - Other Business

        A letter from the new DPH Director Herb Bostrom addressed to the PAC was read.

Agenda Item 7 - Next Meeting

The next meeting will be October 21, 2004 at the EMS Offices, 1 West Wilson. Dr. Cady received suggestions for agenda items for that meeting.

Meeting adjourned at 3:00.