Vermont Emergency Medical Services

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District Board Minutes

VTEMSD#3 Board Meeting Agenda for January 11, 2007  St. Michael's College, Tarrant Center, Hall of Fame room @ 1831.  In attendance were:

INTRODUCTIONS (O’Neil)

• Mike Collins, Chief of IBM Fire & Rescue, as their representative

APPROVAL OF MINUTES (O’Neil)

• Corrections:  Aforementioned FR-ECA course listed Becca Webb as the coordinator – she is not, it is Brian Longe.
• Motion to accept the Jan 2007 minutes with the correction (Baron/Collins).

 CORRESPONDENCE (O’Neil)

• From VTEMS to District Chairs, District Medical Advisors and Service Directors:  correspondence via email regarding new Vermont State EMS defibrillation policy (link:  www.vermontems.org/dec06protocols).
• From Becca Webb:  correspondence via email regarding corrections to the December 2006 minutes.

TREASURY (Danaher)

• Treasurer’s report received via email:
  • Checking account $14,022.10
  • Merrill Lynch unchanged
• Motion to accept treasurer’s report as read (Baron/Lindquist).

MEDICAL DIRECTION (James)

        HeART Foundation – Timeline for rollout is as follows:

o       March for training

o       April for go live date

     (Brent) Which units are you looking at?  (James) Zoll & Medtronic.

        CPR/AED VTEMS Guideline update – get your defibs changed when you can.  Train up.  (Jones) Question about joule settings regarding range of joules for the biphasic.  (James) 200 joules for biphasic.  Transport after three shocks or 3 NSI.  Pack and go. (Lasker) Zoll 1600 units cannot be reprogrammed – what is your tolerance.  (James) Lenient.  (Jones) It’s a manual set.  (Brent) I have an email from Zoll that states they will not be reprogrammed and Zoll with offer a trade in special.  (O’Neil) We need to meet with the State to clarify.  (Helmken) If there is a concern about verification of the settings, we could explore the possibility of UVM TSP verifying our units.  We could also ask them to change the settings.  (Laskarzewski) What about PAD?  What about the existing units?  (Malone) UVM was investigating this and apparently locations are required to be either a licensed EMS provider or a VDH approved PAD site.  There are defib companies that will sell medical direction oversight with the PAD.  (O’Neil) There is something in the State statute – local EMS has to be contacted prior to purchase.

        DNR – legislative statute change listed in packet cover letter as well.  Roll out is unclear.  Continue on with our existing policy – if services encounter a patient in cardiopulmonary arrest with proper documentation of DNR status, contact On-line Medical Direction immediately for disposition.

        Crime scene statute in VT:  PD will determine if EMS is allowed into scene.  This is especially true for untimely deaths.  If services encounter challenges, they are asked to contact online medical direction.

        Intoxicated persons in custody:  non-injured patients in police custody do not required transport to the hospital.  Again, patients must be considered on a case-by-case basis.

        First responder noted by PD to be traveling 83 mph in a 35 mph zone.  Please use due regard – and affirm there is an actual EMS emergency.

        Code 2/3 study – big issues: 

o       few services perform a background check of a driver’s license

o       how is it determined who is using excessive speed (and when?),

o       there were a few examples of outstanding driver training manuals

o       is the health of driver determine prior to approving?

        Online medical direction feedback:  when requesting NTG, don’t forget ASA – therapeutic.  (Lindquist) If patient has taken ASA to equal 325 mg within a few hours, folks may not be requesting.  (James) Good – just communicate to Online Medical Direction.

        QA/QI - nothing

        Questions/issues for District Medical Advisor – none heard

FAHC (Helmken)

• Thank you for your hard work through the Holiday season.
• Occasionally the Charge RN will ask the ambulance to bring the patient to the Triage area.  Twice recently, the ambulance service argued against this decision.  If any ambulance service feels their patient is not appropriate for triage, then the assessment report should reflect this higher acuity.  Typically the reason for assigning an EMS patient to triage is a reflection of both a high census in the department, as well as the communication of a stable patient, suitable for Triage.  (Cross) If ALS interventions provided prior to arriving at the hospital – is triage ok?  (Helmken) Yes – not every time, but in some cases triage is appropriate.  An example would be N/V with an IV start.  Chest pain – no, that patient should go in.  (Lasker) One of our crews was asked if a patient could go to triage and our crew said no and gave a reason why.  The patient was non-ambulatory.  (Helmken) Inability to ambulate does not automatically exclude a patient from Triage.  Everyday folks arrive with maladies such as ankle injuries or N/V with weakness that are evaluated in a wheelchair in Triage.  We can help make sure a wheelchair is obtained.  (Jaquith) Make sure that you give your rationale as to why you feel your patient is not appropriate for Triage to the Triage RN.  (James) Is OK to be in triage and non-ambulatory, it happens frequently and that is why there is a stretcher and wheelchairs in triage.  (Helmken) Let’s follow up on these calls in a timely fashion – let’s talk about them.
• (Baron) Where do pick up our defib cards?  GIRS left one two weeks ago.  (Jaquith) They should never be left there.  (Baron) The Radio Room person didn’t know how to download it.  (Jaquith) They should page me and I will walk them through it.  It takes a very short amount of time – less time than it takes to document the call.
• (James) I caught an attending putting a dirty board in the rack – trying to do a good deed.  Immediate education occurred. (snicker snicker).

TRAINING (Malone)

• Course Updates:
  • FR-ECA/Modules (Longe) – 17, began last week.  (Butkus) The orientation required by the State was completed today.
  • Spring EMT-B twice weekly (Malone) – full with 25 + waiting list.
  • EMT-B once weekly (Ziter) ongoing
  • Spring EMT-I (Malone) registration status – in progress
    • Entrance exam:  0900 on 1/13 at Rowell.  Get applications in pronto.  (Lindquist)  Folks that cannot be there?  (Malone) Have service director or training coordinator contact me for alternative testing opportunities
• Course Proposals: none
• Upcoming Training Opportunities:
  • Tuesday 2/20 at 1900 SMF&R Mike Chiarella from Richmond has arranged to have the Incident Commander from the Greyhound bus incident in eastern NY will to review & discuss
• Certification/Recertification:
  • Saturday January 13 0900:  Modules (4), EMT-B (13/18), & EMT-I (13/16) practical exam.  Again, these EMT-B classes will be the first to take the online NREMT-B exam.  There are ongoing problems with the registration process and VT EMS is working with NREMT to fix it.
  • FR-ECA (Webb):  9 of 11 completed practicals, with 2 airway failures.  Re-test will be scheduled soon.
  • EMT-B Recertification Spring:  Considering offering a Saturday in March with two sessions:  AM & PM. 
• Other:
  • AED update (see correspondence & medical direction)
  • Pulse Ox roll out – (James) Previously planned to marry with EKG, now looking at bringing in professional trainer from out of town for EKG project, so re-working the educational roll out of this topic.  In review of run sheets, found one service using it at the basic level….not acceptable as this has not been rolled out.
  • EMT-I Course (Malone):  Heard issues about cost, clinical requirements, entrance exam, and State testing process.  If folks could collect comments and forward to me – we can present collectively to the State.  (Soons) Ventilation requirement.  (Malone) Entrance exam?  (Phelps) Big change in District #7 – better success rate.  (MAkerlind) Have you seen changes in District #3?  (Malone) We implemented this change prior to the curriculum change and have noted a improvement in our success rate (Soons 20+ %).
  • EMT-B Candidate Prep (Malone):  Call received about not preparing students for certification exam.  Reminder that this is a team effort and the sponsoring services should help support candidate preparation.
  • (Jones) EMT courses are not on the website.  (Soons) Looking at revising the website, perhaps relocating server.

RESOURCE MANAGEMENT (Lindquist)

• No meeting this month – individual committee members have homework.

• MCI – put a plan in every agency location that is updated and task oriented for that particular agency
• Code 3 – crunching data
• Grants (O’Neil) – Some info out there.  Is there a RedBird or tabletop this year?  There is money available for exercises.  (Barron)  Education for Shelter in Place grant.

ADMINISTRATION (Soons)

• 4^th quarter 2006 (Oct-Nov-Dec) OOS/ALS reports due
• EMT-I Document draft review – not ready for review.
• Clerk’s new email:  katesoons@comcast.net      
• FR-ECA Policy (Lindquist) – In December, the Board approved a change that allows VT EMS I/C to coordinate a FR-ECA.  The State would like any VT EMS I/C desiring to coordinate a FR-ECA to be oriented to the FR-ECA curriculum.  (Butkus) The problem, as seen by the State, is that the course is FR-equently taught beyond the curriculum.  The orientation is to confirm that the proposed instructor will adhere to the FR curriculum.  (Lindquist) <changes read aloud> These changes were accepted by the state.  Motion to accept policy with the changes as presented (Baron/Cashatt).  Motion approved.  Final draft to be circulated via list serv and posted on the District website.

PUBLIC INFORMATION (Soons)

• http:/www.acep.org/webportal/Advocacy/EMS/Week/default.htm
• Assemble committee members for 2007 (May 20-27, 2007) – no interest voiced.

OLD BUSINESS (O’Neil)

• None

NEW BUSINESS (O’Neil)

• Motion to adjourn at 1924 (Jones/Brent).
• Next meeting Thursday February 8, 2007 @ 1830 – same location.

Respectfully submitted on February 5, 2007,

Kate Soons, VTEMSD#3 Clerk

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Last updated: February 20, 2007