VTEMSD#3 Board Meeting Minutes, June 10, 2004  St. Michael’s College

Called to order at 1832 hrs by Chief O’Neil

Attendance:

Introductions: (O’Neil)

• Hilda Tomlinson, Vergennes Area Rescue Squad
• Kazmin Thibault, Charlotte Volunteer Rescue Squad
• Bob Hoag & <New manager>, Lamoille Ambulance Service
• Mike O’Keefe, Vermont EMS Training Coordinator

Minutes of May: (O’Neil)

Motion to approve meeting minutes (Ziter/Cluver).

Discussion:  motion was revised to reflect correspondence from LAS (discussion below).  Motion carried.

Correspondence: (O'Neil)

From Lamoille Ambulance Service, Bob Hoag (6/8/04) to VTEMSD#3

• Request that his letter be entered into the meeting minutes
• Request that the comments made by manager last month be stricken (Ziter/Valentine)
• Misstatement of agenda in Burlington
• Non emergent transfer is goal
• No intention of emergent transfer
• Upgrades are not predictable – result of change in pt status or misrepresentation of pt status
• Recorded message is :if this is an emergency….
• Dispatchers screen and redirect 911
• Letter suggested solution:  allow LAS to execute upgraded runs with VTEMSD#3 reviewing each case –
  • LAS licensed at emergent level
  • LAS crews run on other emergent services
  • Maintenance of skills
  • Perform at this level on long distance transfers
  • Asking for help with this issue, and cooperation

 From Essex Rescue, EJFD, ETFD (5/12/04) to VTEMSD#3

• Advises of operational agreement between transporting service and first responder services in that first response will be dispatched when another ambulance service is responding into Essex Rescue’s primary territory and at other times via the discretion of the crew chief.
  • (Ziter) What if responding from FAHC?  (Cluver) Crew chief will still dispatch first response.
  • (Malone) Why deviate from District policy?
  • (Webb) What does CCVFC do?  (Ziter)­ If CRS not in quarters – they go.
  • (O’Neil) Board needs another letter with specific contingencies. 

 Via e-mail from Howard Rice to Mike O’Neil

• Voiced concern about the immediate effective date of new policies.
• Need effective dates with signed hard copies distributed to all services.
• (O’Neil) Board agrees, formalize communication for policy changes.

 Treasury: (McCarthy)

• Motion to accept Treasurer’s Report (Arthuad/Kellogg).  Report distributed, no discussion.  Motion carried.
• District bills have been prepared – pick them up tonight here.

 Medical Director: (Weimersheimer)

C-Spine Assessment Protocol Information distributed

• Target date for training is next month.
• Teaching module (CD/powerpoint) with written assessment is under development.

 EMT-Intermediate/Transition Update

• EMT-I’90 will be phased out by June 05.  Any remaining EMT-I’90 providers will become EMT-B unless transitioned to I’03 curriculum.
• 5 EMT-I/Transition courses planned over next 12 months
• Services failing to stock appropriate drugs/equipmentàlose EMT-I license
• Comments welcomed

 Electronic Run Form Software Update

• Currently designing data set specific to VTEMSD#3
• User friendly, useful collection of data
• In process, working with Kirsten Jaquith, MHCIC
  • Chief O’Neil has met with FAHC leadership to integrate BFD informational technology; ongoing project
• Unexpected delays at FAHC interface
• Paperless system for individual services? (Ziter)
  • Any service may load locally
  • Accessible via computer in EMS room

 FAHC: (Helmken)

• Nothing from Kirsten/Radio Room
• Sorry about the bumps & bruises of the busy summer season with construction.
• (Ziter) Cervical collars not being returned?
  • If it has visible body fluids on it – it gets thrown away (Helmken)

 Training: (Ziter)

 TO Meeting - 6/24/04 @1830 at IREMS

• List of EMT-I members in need of transition, for planning courses
• List of area school vacations to plan testing dates
• Current contact data for TO’s

 Practical Instructors

• Need to expand the pool of practical instructors for VTEMSD#3.
• Experienced folks who TO would feel comfortable instructing

 IREMS (Malone)

• Spring EMT-B:  (Malone) 5 practical station failures; no written exam scores yet.  (McCarthy) 1 practical station failure; no written exam scores yet.

• Summer EMT-B:  (Malone) 18 started on 5/14/04; 60% through – good group, one or two on the line, but will likely finish well.  First course with policy that allows for Graduating HS student to participate with TO & parent sponsorship
  • 1 person in so far, from Shelburne, working well with parents & service
• Exam 7/1/04 @ 1900 hrs.  Need evaluators.

 Proposed Programs (distributed to reps): (Malone)

o       EMT-I:  schedule is tentative.  Greg/Maureen will co-coordinate.  IREMS under new financial rules, UVM must approve budget before class is a go.  Last class was $525 with book donation.  Very expensive course - > 1,000.00 for catheters alone.  Expect increase.  Will not include text.  Greg/Maureen developed new schedule for delivery:  Monday lecture, Wednesday, lab.  Proposed schedule is September 04 until May 05.  New delivery mode allows for increased class size.  Still need NREMT-B score greater than 80 or pass entrance exam (>80%) – scheduled to be given on July 1 during certification testing.  To schedule another opportunity for entrance exam call Pat at IREMS (656-3489) and complete exam by 8/1.  Get apps in soon – will open up to other districts 8/1.  Greg’s app distributed – make sure they are complete, signed and include payment.  (Ziter) One year-long class for two reasons: schedule more accommodating for success, openings for more candidates.

• EMT-I/T:  Five sets of dates circulated; first course in August, 3-day course will have openings and will be held at BFD Station #2.  Jackie and BFD Chief Williams have tentatively agreed on dates, need to confirm.  second course on 3 Saturdays as a part of the Fall EMS Academy.  Third course on Mondays January/Feburary 05.  Fourth course at the VTEMS Conference 05.  Fifth course in April-May 05.  Adequate opportunities for all VTEMSD#3 EMT-I’s to transition by June 05 deadline.  Please be mindful:  application deadlines will be enforced strictly and remaining slots will be opened up for extra-district folks.  (Valentine) If you miss these you cannot be an EMT-I in VTEMSD#3? – O’Keefe confirms; Medical Direction prerogative.
• EMT-B Refresher:  Lots of requests and not a lot of registrants.  Chris & Kate will coordinate during Fall EMS Academy.  Fee break down to come.  (McCarthy) There will be one course in the coming year – that’s it.  Fall 04, but none in spring 05.  Please plan accordingly.
• EMT-B:  Lots of discussion regarding the one evening per week course.  Chris & Kate willing to coordinate based on need.  Geared toward fire service.  Let us know…or speak to Jason on 6/24 to assess need.  There will be a traditional fall/spring Monday/Wednesday EMT-B course beginning 8/30/04 with testing 12/13&14/04.  Application deadline is 8/01/04.
• Practical Instructors needed; hourly wage & cool shirt.
• Unable to provide financial information for course – can wait until July for Board approval.  EMT-I is the big unknown, mostly due to disposables and relationship with FAHC.  (O’Neil) Suggest approval with cost ceiling.    Motion to approve IREMS courses as presented discussion (Adams/Rimmer).  Motion carries.

 Modules (Webb)

• Module 3 - 6/21 still space
• Module 1 & 2 tests Monday 6/14
• First Responder Class 7/20-9/2, Tuesday/Thursday, 49 hours (40 required) at CVFRS.  1830-2130, $50 plus text; open to CPR certified individuals.  Information and syllabus will be posted on EMSTRAIN tomorrow by Becca.  Motion to approve (Arthaud/Valentine).  Motion carries.

 Chittenden County Regional Planning Commission (Adams) 

• 6/9/04 Planning commission gathered chiefs of fire, rescue, police
• Presented with three topics in small group discussion
  • communication, central dispatch
  • risk assessment discussion (vulnerable populations or structures? à both)
  • type of exercise, duration, etc.
    • (Ziter) multiple smaller exercises, utilizing several agencies
    • (Dusha) Regional Planning Commission:  great meeting, great networking, great communication
      • planning
      • risk assessment
      • emergency response plan for all branches of emergency response
      • exercise:  one size does not fit all – need to plan appropriate & real issues for services
      • Volunteers solicited for subcommittees
        • Risk Assessment
        • Exercise Development
        • Infrastructure Protection (primarily law enforcement)
        • Communication
      • VT Homeland Security & Emergency Mgmt:
        • making goals/objectives for exercises
      • Issues recognized
        • individual pockets of planning
          • need cooperation across party lines
        • Communications
          • matrix developed, will be sent
          • need updated list of contacts à use EMSISSUES
      • O’Neil – very positive, very productive.

 Licensing:  (O’Neil) 

Two applications received, one by the Champlain Valley Exposition for first response service & one by South Burlington Fire Department for ambulance service.  Motion to discuss applications (Adams/Laskarzewski). 

• License Committee (Lee Jones) reviewed applications.  SBFD app received 6/9/04 and has not been reviewed by Medical Direction or the Chair.

Champlain Valley Expo First Response Application 
 

• (Penchini) App should be at EMT-I, but applied at EMT-B
• Rules & regulations for first responders – LPN is not certified as EMT and thus, should not be included in roster
• Dispatch policy confusing and redundant.
• (Webb) What about 24/7 – 365?
• (O’Keefe) Similar to ski patrol – respond when patients present
• (Hoag) Is the idea to replace ERS?
• (Cluver) ERS has not provided CVF coverage directly….Fair has been coordinating EMS coverage for some time. 
• (Ziter) ERS won’t be on site all the time; what will you do when ERS is at the hospital for something like anaphylaxis?  EMT-Intermediate license needed.
• (Penchini) EMT-I originally sought.  Most FR services are EMT-B, thus going for that.  Ultimate goal is intermediate – but will respect VTEMSD#3 wishes.  
• (Cluver/Weimersheimer) Dr. James wasn’t comfortable with it, but she wasn’t clear on rules.  She would like EMT-I level, per Helmken from conversation today. 
• (O’Neil), need forms corrected first.  (Weimersheimer) Get approval at EMT-I, correct forms.  Motion to revisit application following completion/correction of data (Arthaud/Hoag).  Motion carried.
• (Rice) Wants to hear how EJFD feels – (Kellogg) 100% backing, we can’t cover it totally.
• (Rice) See how it works and review it for next year.
• (Malone) As a resident of the area, disagrees with expansion of EMS in new ways versus bolstering system to accommodate transient load.  Example:  BFD and a new service to cover July 4^th events.  Unfair without consulting municipal officials.  Lots of unanswered questions.  EJFD, ERS, and village manager had discussions – moved forward.  (Malone) Town of Essex was unaware until read in Free Press.
• (Penchini) This service is not being created just for the fair; but for all large events at the Champlain Valley Exposition.
• (Malone) UVM is a big place the four Saturdays before Christmas, July 4^th in Burlington is huge….we don’t create new services transiently.  We should collaborate the existing resources.  EPD deputizes officers for the fair coverage and pays them hourly.
• (Webb)  We have covered this:  volunteers maxxed out and liabilities with performance.
• (Malone) Vermont City Marathon – covers folks.  Fair pays PD – pay the EMTs.
• (Cluver) Funds not available, per fair.
• (Penchini) Fair week 1700 person-hours; we have lots of volunteers and they were coming from other districts – Dr. James/ERS we’ve been meeting all year going through several different scenarios..no one was willing to accept the insurance responsibility….no one wanted to over see the volunteers from outside services.
• (O’Neil) This process has been examined thoroughly and discussed extensively.  At this point, the Fair is approaching quickly.  Fair revenues are high; and the lead recommendation for EMT compensation needs to come from the municipalities; this Board cannot mandate this.
• (Howie)  Normally when license is circulated, members are listed.  How many do they have?
• (Penchini) 20 new apps.
• Motion for friendly amendment to motion: conditional license for this year’s fair and reevaluate before next year (Ziter/Shea).
• (Ziter) So this service will respond to soccer games, craft fairs, all fair events?
• (Penchini) The Fair will let us know when they want the FR Service.
• Motion on the floor:  To approve recommendation in support of license to Vermont Department of Health pending complete/corrected application for Champlain Valley Exposition First Response.  Motion carries 9/5.

• (Weimersheimer)  Application should go through the committee before being brought to the Board.  O’Neil met with Lee yesterday AM.

• Motion to table discussion until app is complete & reviewed by committee (Laskarzewski/Cluver).
• (Wheel) Letter from Doug Brent – apologies for not attending tonight (family).
• Timeliness of app was recommended by Dan Manz as this submission date was needed for VDH lead time.
• Appreciate Dr. Weimersheimer’s concerns, but no intent to circumvent process.
• O’Neil corroborates; received phone call from Dan Manz regarding same.
• (Webb) We’ve known about this for a long time.
• (Ziter) Had to be approved by the city May 18^th, 2004; no Board meeting since and hire date is FY05 start (7/01/04).
• (Malone) Upgrade of license?
• (O’Keefe) New license as ambulance service.
• (Rice) Not new level of service (EMT-I), new transport mode.  What is the purpose of a one person review
• (O’Neil) App still needs MD signature, as well as completion.  Review process is a topic intended for discussion under new business tonight, actually.
• (Wheel) Incomplete data are personnel…
• (O’Neil) Verification of vote…  Evidence of public notice…
• Motion not carried unanimously.
• (O’Neil) New motion needed…
• Motion to make recommendation in favor of support of application for license to the Vermont Department of Health (Ziter/Adams).­  Motion carried.

 Old Business

 Inaugural EMT-I’03 State Exam Results (Malone)

• 100% passed Practical Exam
• 7/25 failed Written Exam

(O’Keefe) Discussion:

• Thank you to all who participated – students were informed that they were guinea pigs.  Especially glad that Greg Thweatt was involved – well done and lots of good information/feedback in focus group will be studied for improvement.
• Apologize:  one mistake on key – scores adjusted; no pass/fail status changed.
• Construction and or analysis?  (Malone) Analysis
• (O’Keefe) 72% of students passed; consistent with previous years
• Each question evaluated; statistically beaten to death.
• Performance of question (high versus low scoring students) reviewed
• Validity of question reviewed
• Part of problem was small statistical group (25 candidates)
• 2 questions no one got right; 15 questions everyone got right.
• 80 or better on registry?  Only one failed EMT-I03
• Recert exam – 80 or better?  Only one failed EMT-I03
• Identified Problem Theme #1 – Bill Brown, Exec Dir NREMT:  Problem of basics knowing when to ventilate patients with pulse.
• Identified Problem Theme #2 – Neurogenic and cardiogenic shock still troublesome.
• 1/3 of questions from previous EMT-I’90, Combitube, EMT-I/T exams; i.e. 1/3 of questions have been previously validated.
• Passing score was 70.
• Consistency:  All EMS exams will have a pass rate of 70%.
• (Pare) With 100% pass on practical exams, are they valid/difficult enough?
• (O’Keefe) Five folks have retested and passed, making cumulative pass rate of 80% of students.
• Course Exam – assesses course completion.  Certification Exam – assesses ability for clinical decision making and helping people.  Test writing and test analysis are incredibly complex and meaningful.  We will continue to refine the exam.  We are satisfied with the results.  Most of the failures were within only a few points.
• (Ziter) Was the State exam similar to the Course exams?
• (O’Keefe) I did not review the Course exams prior to writing the State exam because I was concerned about contaminating the new State exam.
• (Ziter) Similar knowledge base?
• (O’Keefe) Yes.
• (Webb) Cover the learning objectives, do your best – there is a difference in the way we all write questions.  We do our best to teach students the objectives.

 Infection Control Officer Manual (O’Keefe)

• New edition coming out; meant as a resource for ICO’s.
• FAHC Infection Control folks receiving grant money to help EMS services!
• More about airborne pathogens; aids to meeting requirements.
• VTEMS does not implement nor enforce – VOSHA/OSHA.

 New Business

Committees (O’Neil)

• Propose ad hoc committee of 3-5 members to review current line up of standing committees and efficacy.
• Motion to the above effect (Ziter/Shea).  Motion carried.
• Ad Hoc Committee Members:
  • Greg Cluver
  • Darren Adams
  • Colin Shea
  • Pat Malone (historic perspective, host & lunch provider)
  • Chris McCarthy

Motion to adjourn (McCarthy/Cluver) at 2030 hrs.  Motion passed.

Respectfully Submitted,

Kate Soons

VTEMSD#3 Clerk

Addenda:

UVM Officers

• DO – Ginny Pelletier
• TO – Jes Buck àVTEMSD#3 Board Rep
• VO – Pete Duffy
• Finance O – Geoff Frattalone
• EO – Mike Morwood
• PRO – Heather Friend à VTEMSD#3 Board Alt
• PO – two positions, currently open

 Letter from LAS 6/8/04

 To all members of District 3:

As president of Lamoille Ambulance Service, Inc. (LAS), I’d like to enter this statement into the minutes of last month’s meeting to replace any statements made by LAS personnel last month regarding transportation issues.

First, LAS came to District 3 for the purpose of doing non-emergent transports, although the license that we hold is no different than the license that all District 3 providers have.  It is the intention of LAS to transport non-emergency patients leaving local squads to better handle their local 911 calls.  When you call our 800 number, you receive a recording stating that if this is an emergency please hang up immediately and dial 911.  Should the caller make it through to our dispatcher, the dispatcher asks numerous questions in order to determine that this is not a 911 call and that this call is a medically necessary transport.  Not all the time is the dispatcher given correct information, so that when the crew arrives on scene the status of the patient may be different than reported.  The crew will then make an assessment of the patient’s condition and will transport in the appropriate manner which in some cases upgrades the transport to ALS.  This is never premeditated.  If the patient’s condition is determined to be more than the crew feels comfortable with, we immediately call 911.

Because of these few transports and the associated controversies, we continue to strive to find ways of making this situation better for all concerned.  One clear way would be for District 3 to permit our crews to handle these infrequent ALS upgrades and give us the benefit of District 3’s critiques on each upgraded transport.  Because we are a transport service and at any time we could have a patient go sour on us, it is very important that our personnel be ready and able to react in that time of emergency.

Thank you for your time and consideration in this matter.

Sincerely,

Robert V. Hoag, President

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Last updated: June 21, 2004