Vermont Emergency Medical Services

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District Board Minutes

VTEMSD#3 Board meeting minutes for March 9, 2006 – held at St. Michael’s College, Tarrant Center, Hall of Fame room.  Meeting called to order @ 1834.  In attendance:
 

INTRODUCTIONS (O’Neil) 

• None.

APPROVAL OF MINUTES  (O’Neil)
 

• Motion to accept February 2006 minutes as presented (Baron/Kellogg).  Motion approved.

CORRESPONDENCE (O’Neil) 

• From Becca Webb:  FR-ECA course proposal, discussion under Training.

TREASURY (O’Neil) 

• No report.

MEDICAL DIRECTION (James)  

• Pulse oximetry at the EMT-B level will be instituted.  Policy read to group.  Motion to accept the policy as presented (Jones/Kellogg).  Discussion:  (James) The purpose of this policy is to assist EMT-Bs in the identification of patients who need advanced interventions and to facilitate an ALS intercept.  VT State EMS Division endorses.  Motion approved.  Clerk’s Addendum:  Each EMT-B will be required to complete the VTEMSD#3 pulse ox training program, with written assessment, prior to using pulse ox in the field.
• Medication Policy:  EMS Rules state that each service will have a medication policy, and this has been outlined in the new District policy.  Some services continue to be delinquent.  Dr. James contacting those services.

Medication Errors – very disappointed that medication errors continue.  Meds have been given and not documented, nor communicated to the ED provider.  It’s time to formalize individual EMS providers understanding of our protocols and policies.  A sign-off sheet will be generated by the Clerk for all VTEMSD#3 services to use.  Members of each service will have this policy acknowledgement with signature in their personnel file.  Medication errors must be reported.

·         Crew Staffing:

o       Crew Chief:  This should be the provider with the most experience and highest level of certification.  Crew chief needs to be aware of all possible options for treatment.  If the patient needs ALS, then an ALS intercept should be considered.

o       Legal Crew:  Clerk’s Addendum:  Per telephone conversation with Ray Walker at the VTEMS office on 4/7/06, a legal crew consists of one EMT-B providing patient care in the back of the ambulance and one FR-ECA >/= 18 yrs with valid driver’s license driving the ambulance.  The rules still state that there must be two EMT-Basic providers for every run.  Don’t rule out the option of intercept.  (Jones) Richmond has at least two members who have passed EMT-B, but still do not have cards from VT EMS x 2 months. (James) F/U with VT EMS.  (O’Neil) Good Samaratin Law does not cut it anymore.  Litigation happens more frequently than any of us are aware.  If there is any possibility of fall out, reconsider the crew.  In terms of the lag time obtaining certification cards, please email me with all cert issues and perhaps we can present them at once.  (Malone) Are you going to put the two fresh certs out there as a legal crew?  (O’Neil) Don’t lose focus – what is the best care for the patient?  (James) Did the patient get the best care possible?  (O’Neil) Service directors know their crews and know their membership – plan for absences and assure coverage.  (James) Develop a system for what you would do if you do not have a crew.

·         Ad Hoc Committee on Code 3 Ambulance Operations Feedback from the ED Comm Center indicates there is a problem with inappropriate code 3 transports.  Literature search completed.  Need four members to move forward. 

·         Q/A

o       Currently on the back burner, timeline is Memorial Day for start up.

o       Patient Follow Up – formal request for follow up will be made by the crew chief…ED Comm Center to pull blue ED sheet.  Crews should also be  contacting your service medical advisor for follow up education.  More to follow on this -

o       Medication use review – will publish results 

FAHC (O’Neil) 

• Not present.  (Ziter) I saw Gil in the ED, he said he had no issues and felt things were going smoothly.

TRAINING (Ziter)

• Course updates

• EMT-B (Malone) – going well, 25 students, midpoint
• EMT-B (Ziter) – going well, finishing slope
• EMT-B Summer (Malone) – Start date is May 12 and certification date is June 29.  Applications due at April Board meeting; 8-10 out of 18 taken.  Waiver available for students who will turn 18 and graduate from high school prior to completion of the course.  Patrick.Malone@uvm.edu; 656-3489
• Course proposals
  • FR-ECA (Webb) - Proposal received for FR-ECA Modules 1-6 and soft copy distributed via list serv.  Motion to approve course as presented (Laskarzewski/Kellogg).  Course approved.
  • EMT-I Spring (Malone/Goss) -
    • Half of needed applications received; last day for applications is March 23, 1800 at recert night.  Cost is $650.  Begins April 6^th, Mondays and Thursday nights, plus two full weekends.  Certification exam is June 29^th.  It is a compressed course.  Participants need to be aware of the time commitment:  110 hours classroom, 30-40 hours clinical ED time, plus studying.  No one sits for the certification exam without payment of the course fee.
    • Entrance exam scheduled for Thursday March 23, 1800 at recert
      • Alternate date for entrance exam can be scheduled at any of the evening EMT-B classes, contact Patrick.Malone@uvm.edu or 656-3489 leave voicemail
  • CPR Instructor Course:  April 5/6, 12/13 (evenings).  Contact Jason Ziter at ziterj@msn.com or Scott Flieger, or call Colchester Rescue CPR Training Center 655-3555.  (Rimmer) Does this include the new curriculum?  (Ziter) No, but we will pull all instructors together for instructor updates.
• Upcoming trainings opportunities
  • VT EMS Conference
    • New England Council on EMS Management Training Course (3/29-30 at VT EMS Conference, pre-conference programs).  This course is designed to provide EMS service leaders with information needed to direct both paid and volunteer services.  Many topics will be presented, including human resources.  Scholarship available.  Contact Patrick.Malone@uvm.edu; or 656-3489.
    • Driver Training Course, Fireground Ops Course and Ropes Rescue Course all need participants or will be cancelled.
• Certification/recertification issues
  • (James) It appears that all levels of certification are required to take a recert exam, with practical evaluation with the exception of the EMT-Intermediates.  In light of numerous medication, assessment and treatment errors, VTEMSD#3 will require recertification assessment of all Intermediate providers beginning July 1, 2006.  The exam will consist of:
    • Documentation of 10 clinical IV starts
    • Demonstration of IV start on IV arm
    • Written assessment that covers policies, protocols, etc.
  • (Ziter) Can we discuss this and look at what alternative means of assessment exist?  (Malone)  Recert testing is an absolute nightmare.  Can we look at this in terms of alternatives?  (Jones) We are there until 9-10 pm.  (Soons) Table it to Training Committee.  (Goss) Does everyone agree on the concept?  This does not affect your certification; it is validating your license to practice, which ultimately falls under Dr. James’ license.  All members agree the concept is appropriate, but should be investigated further.
  • EMT-B Recertification – contact VT EMS to register, 863-7310; exam coordinator is Jason Ziter, ziterj@msn.com
    • Monday March 20^th @ 1800 – UVM/Rowell
    • Thursday March 23^rd @ 1800 – UVM/Rowell
    • March 14/Tue, 15/Wed, 16/Thu @ 1300; at BFD Station #2
      • If you are available for daytime hours, please contact the exam coordinator.

RESOURCE MANAGEMENT (O’Neil) 

• MCI Plan Review – no report
• LEPC (Barber)
  • PDA – custodial agreement to be distributed via list serv.
• VCOMM (Brent) - Chief Brent represents fire chiefs on this board.  Original plan was cost prohibitive.  Project has been completely revamped and focus is much more fundamental.  Following 9/11/01, the FCC made several channels available “we call/you call” - 6 VHF, 6 UHF – at VCOMM website DPS – link VCOMM mutual aid.  The plan now is to hire an individual to visit all EMS, FD, & PD to confirm frequency capabilities.  If a service does not have radios – they will provide.  Goal is to put radios in the hands of all first responders.  Next step – dispatch centers talking to each other.  Erecting towers is way too expensive.  Focus now is to ascertain which state/municipal/department towers can be utilized for coverage – use what is currently available.  Map on website shows tower coverage.  Much more practical approach. 
• HSU/Grants
  • (Ziter) NIMS – If you are applying for any grants, your service must be NIMS compliant.  (O’Neil) Governor signed declaration, VT will comply.  Howie Rice at the Fire Academy is doing a course for NIMS Instructor.  Contact through Jason Ziter.  If you take the training, you will be asked to teach all over VT.
  • (O’Neil) Let rep know about study:  Vermont State House of Representatives discussed HSU money.  Fire service members made pitch about recruitment and retention issues within the fire service.  50 K appropriated for study.  Took from HSU.  O’Neil asked, then ought to be doing it for EMS…just as big and perhaps bigger.  Interrelated as a result of co-competition.  Need to make some noise.  Get in touch with state and local reps and make them aware of EMS needs.  Please also list NIMS issue – can’t send in your NIMS compliance paperwork b/c no one in the state can handle it.  (Malone) Is this attached to a bill?  (O’Neil) They took it from HSU money. (Thweatt) Formal committee name?  Call, don’t write – bring it to the surface – very vague.  Get out in front of the issue.  (Malone) This issue has been brought up in the past - Do we have a recruitment or retention problem?  (Rimmer) The problem is retention & advancement.  (Primiano) Two college services put a lot of people through the course and then graduate ~25% of their membership annually. (Malone) Day 2 of Management Course will focus on human resources.  (Thweatt)  Education of managers has been sorely underserved.  (Malone) NECEMS identified this as a need. (O’Neil) Yes – this along with the proposal to allow for single EMT-B crew.  Like to see this District lead the way in voicing collective concerns of EMS in Vermont.

ADMINISTRATION (Soons) 

• Committee met this evening and worked on the following:
  • Annual License Review Policy development continues.  Only one Board representative sent in feedback regarding the “out of service” issue.
  • Pulse Oximetry for EMT-B Providers drafted.  Following signature, will be posted.  Training Coordinator to develop curriculum, with Dr. James.
• First quarter reports due at April meeting:
  • Out of Service Log
  • ALS Interventions
• ‘Annual’ Meeting of VTEMSD#3 Board next month, elections scheduled
  • (Butkus) Nominations Committee (ad hoc) – nominations can be made now or next month.  Information received from the existing District officers, as well as new interest –
    • Chair – O’Neil
    • Vice-Chair – Adams
    • Training Coordinator – Ziter
    • Treasurer – McCabe: Peggy communicated that she does not feel she has been able to cover the needs of the District, but will continue if the District so desires; Karen Danaher, from Essex Rescue, Inc. has expressed an interest in serving as treasurer, and is a CPA.
    • Clerk - Soons

PUBLIC INFORMATION (Ziter) 

• EMS Week 2006 is May 14-20, 2006 à Burlington Kid’s Day is Saturday May 20
• http://www.acep.org/webportal/Advocacy/EMS/EMSWeek/default.htm

OLD BUSINESS  (O’Neil)
 

• (O’Neil) Regarding a letter of concern sent by Chief O’Neil – response received on 12/13/05 – topic was VT EMS & public health preparedness.  On behalf of the Governor, a staffer suggested a meeting between VT Dept of Health leaders and Fire/EMS leaders to discuss communication & support issues from VT EMS.  We have not heard a reply from VT EMS as of today….let your legislator know that EMS services need more support from their State agency.  There is a movement for EMS to be somewhere other than VDH – perhaps under a response agency such as Dept of Public Safety.  For example, regarding Bird flu protection….no info from VDH or VT EMS; information obtained from other sources.  Need to address shortfalls.

NEW BUSINESS (O’Neil) 

• (James) 12-Lead EKG coming grant through FAHC cardiology.  Training and transmission issues to be resolved.  If option is to read versus transmit, which is preferred?  Transmission could be an technical issue.
• MMRS has absorbed IMAT.  Now, VT State Response Team For Medical Emergencies.  MMRS looking for more volunteers:  EMTs, logistics, RRT, docs…if interested, contact Dr. Bushnell or talk with Dr. James or Jackie Goss.  Initial response is within 90 minutes.  Vermont is the only state with immediate medical strike team.  (Ziter) Potential for team to go out of country?  (James) No, this is the local stop-gap until federal assistance DMAT arrives.
• (Brent) NIMS certificates arrived in one week from VSFA.

Motion to adjourn at 2000 (Brent/Kellogg).  Motion approved.  Next meetings:

• VTEMSD#3 Board: Thursday April 13, 2006 at 1830 – same location.
• Administration Committee:  prior to Board meeting at 1730 – Tarrant Sports Center (this is a change).
• Training Committee:  TBA
• Resource Management Committee:  TBA

Submitted to VTEMSD#3 list serv on 4/09/06 by KSoons, Clerk

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Last updated: May 26, 2006