Vermont Emergency Medical Services

District #3 WebPage 

VTEMSD#3 Board Meeting Minutes for June 8, 2006

St. Michael’s College, Tarrant Center, Hall of Fame room @ 1835

INTRODUCTIONS (O’Neil)

• Charles Cashatt, Vergennes Area Rescue Squad – new T.O. & Rep

APPROVAL OF MINUTES  (O’Neil)
 

• Motion to approved May 2006 minutes as published (Jones/Baron).  Motion approved.

CORRESPONDENCE (O’Neil) 

• None

TREASURY (Danaher) 

• Treasurer’s report
  • Checking account:  $8,818.78
  • Merrill Lynch: no changes, awaiting statement
  • Bills will be sent out to VTEMSD#3 services soon.
• Motion to accept treasurer’s report as presented (Brent/Ziter).  Motion approved.

MEDICAL DIRECTION (James) 

• Online Medical Direction access has been an issue.  All attendings carry pagers and cordless phones in the ED, and can be overhead paged as well.  In the event that an attending cannot be reached, the ED Comm Center may defer to the Charge Nurse for online medical direction.  Please forward incidents of concern to Dr. James for review.
• Frequent encounters with same patient & ED Care Plans – If a service notes a pattern of 911 calls involving the same patient, please contact both the ED Nurse Manager (Robyn Joseph-Robar, RN) and Dr. James.  The first step in addressing inappropriate use of 911 services is notification to ED/Medical Direction.  Following chart review, the appropriate social services (or VNA, etc.) can be contacted.  An ED Care Plan can sometimes help provide guidance for EMS when called to the same patient repeatedly (i.e. – if vital signs are WNL, online medical direction can release EMS from scene).  Care plans take time to develop.  There are no quick fixes.  Continue to provide high-quality EMS care and document each call carefully.  Contact information for ED Nurse Manager Robyn.Joseph-Robar@vtmednet.org, 847-3645 and Medical Direction Wendy.James@vtmednet.org; provide patient MRN, dates of transport, patient’s chief complaint, and details supporting inappropriate use of 911 EMS.
• ALS Order clarification:  D₅₀ & Glucagon, ASA, IV fluid bolus
  • Order for IVP of 25 g D₅₀ includes order for 1 mg glucagon IM.  EMT-I should spend a maximum of 3-5 minutes attempting IV, and then administer glucagon.  Time = brain cell death.  Following administration of glucagon, EMT-I may resume attempts to establish IV and give dextrose IVP as the effect of glucagon is 15-25 minutes and dependent upon patient’s glycogen stores.  This will be clarified & emphasized by ED Comm Center staff when giving orders for D₅₀.
  • Questions have arisen regarding dosing & administration of ASA.  The goal is to give 325 mg ASA PO chewed to patients with ACS.  If the patient takes ASA 81 mg daily, then the emergent administration dose would be 240 mg (3 baby ASA) to total ~325 mg.  If the patient takes ASA 325 mg daily, and the ACS is late in the daily cycle, contact online medical direction.
  • For patients who meet the criteria for off line IV establishment and have systolic blood pressure </= 90 mm Hg, a fluid bolus of 500 ml normal saline will be added to the protocol.  EMS providers should reassess vital signs following IV fluid administration and report to online medical direction.  The new VTEMS protocols allow for 1L off line.  The revised District #3 protocol will be published promptly.
• EMS provider attire includes proper footwear.  Recently, a provider was noted to be wearing flip-flops when delivering patient to ED.  The second most common injury for EMS providers is to the ankle.  In addition, please consider wearing a nametag and displaying your certification level.  It helps facilitate positive communication between ED staff and EMS providers.
• Pulse oximetry for EMT-B is still in development.  The VTEMS Office recently indicated that this skill is provided for at the EMT-B level in the new protocols (Introduction, p. III).  The training program is complete and will be rolled out with the 12-Lead EKG training program for efficiency.  No EMT-B providers should be performing pulse oximetry to date.
• 12-Lead EKG project is progressing.  The project has formed a foundation named HeART (Heart Attack Response Trust), and has developed a working relationship with the American Heart Association.  Currently, folks are working on the details of data transmission via HEAR 2 with beta site (CRS).  Any service intending to update defibrillators should contact Dr. James to coordinate with the project.  Training of EMT-B/EMT-I providers is under development.
• Code 3 Committee has developed a survey questionnaire for VTEMSD#3 ambulance services.  Please complete and return to Craig Butkus at Essex Rescue by the July meeting.  This survey is vital to subsequent committee activity and is required of all transport services.  (Soons) Check with Mike O’Keefe at VTEMS regarding previous surveys? (James) Done.

FAHC (Jaquith) 

• (Ziter) New mop bucket needed for ambulance bay area
• (Ziter) Consider placing shredder in EMS room.  (Soons) All recycle bins are considered confidential and eventually shredded – but a shredder for the EMS room would limit rummaging.  (Jaquith) Can’t promise a shredder, but a secure-topped recycle bin would be possible.

TRAINING (Ziter) 

• Course updates

• FR-ECA (Webb) – Testing complete for Modules 1 & 2, Module 3 begins in July.
• EMT-B Summer (Malone) – Half way through with 20 students; going well.
• EMT-I (Goss) – Final stretch, with mega-lab on Sunday.
• Course proposals
  • EMT-B Refresher (Soons) – cancelled due to lack of interest.  Fall course planned, as usual.
  • EMT-I Fall 06 (Malone) – For EMT-B providers with NREMT-B scores <80, the VTEMSD#3 entrance exam for the fall EMT-I course will be held on June 29^th at 1700 in Rowell (prior to testing).  Call 656-3489 and leave voicemail for Pat, or Patrick.Malone@uvm.edu, to reserve exam.
  • (Malone) Courses for the upcoming academic year presented for Board approval:
    • EMT-Basic @ UVM – same format as previous years
      • Fall 06 (2 nights/week)
      • Spring 07 (“    “    “)
      • Summer 07 (compressed schedule)
    • EMT-Intermediate @ UVM – same format as 05-06 presentation
      • Fall 06
      • Spring 07, beginning in April

Motion to accept five course proposals as presented (Adams/Brent).  (Jones) Any changes in course fees?  (Malone) EMT-Intermediate program is very expensive.  Current fee is $650 and there is a possibility that it will increase to $675.  Motion approved.  (Ziter) There will be a District #3 EMT-Basic course that meets once a week as well.

• Upcoming trainings opportunities
  • NECEMS MCI Course in Hartford, CT June 24^th, contact Jason Ziter for more information at ziterj@msn.com
• Certification/recertification issues
  • EMT-B & -I certification testing with EMT-B recert on 6/29/06 at 1800 in Rowell.  Many helpers will be needed.

RESOURCE MANAGEMENT (Adams)  

• Committee convened prior to Board meeting tonight.
• MCI
  • (Adams) MCI Plan review begun.  Investigating alternate forms of MCI plans from other states.  Will institute a rolling review that allows for more frequent update.
  • (Adams) METTAG Drill, July 1-7, 2006 – Plan is to utilize METTAGs for one full week in July in order to improve proficiency.  This is also an opportunity to use up old METTAGs.  Motion to purchase ~$300 worth new METTAGs to provide to EMS crews for replacement of tags used when dropping off patients during tag drill week in July (Adams/Ziter).  Motion approved.
  • (Laskarzewski) Burlington International Airport Annual MCI Plan Review is scheduled for Monday July 11, 2006 at 1900 and will focus on the recommendations listed in the RedBird 05 After Action Report.
  • (Jones/Goss) Richmond MCI Drill review – heavy rain adversely affected METTAGs, consider newer tags.
  • (Adams) Pandemic Flu Exercise 07/06 – no reps from State of VT (VDH, HSU).  (Ziter) Update from JStolz, HSU via email; will forward to list serv.
  • (James) IMAT – Immediate Medical Assistance Team under Vermont Emergency Management (VEM).  Can be requested through VEM to respond to initial phase of MCI events to provide critical care by MDs, PAs, RNs, EMTs and others.  Pamphlet explaining scope of practice and deployment in the works.
• HSU/Grants (Jenkins) – not present.

ADMINISTRATION (Soons) 

• Outstanding quarterly reports – help is available, if needed
  • Reports needed from:  Essex Fire Dept, FACT, Lamoille Ambulance, South Burlington Fire Dept, South Hero Rescue.
• Next round of quarterly reports due at July meeting (7/13/06) and include April, May, and June 2006.
• VTEMSD#3 Contacts – not presented at meeting.

PUBLIC INFORMATION (Ziter) 

• EMS Week was excellent.  Free CPR courses were held at Colchester Rescue, Milton Rescue, Richmond Rescue, and Essex Rescue.  South Burlington Fire Dept. will present a CPR course following the completion of their station.  Kid’s Day on the Waterfront in Burlington was very soggy and wet, but the junior EMT Badges were a hit.  Thanks to all who participated and helped!  (Soons) Colchester Rescue’s family fun night was outstanding.  (Ziter) ~500 people attended, and 200 bike helmets were distributed in 23 minutes!  This year, it was combined with the PD.  Great success.

OLD BUSINESS  (O’Neil)
 

• (O’Neil) District goal review – tabled to next month.  Clerk to provide goals from March 04 meeting for review and discussion in July 06.
• (O’Neil) Non-transport forms – tabled to next month.  Clerk to provide copies of Colchester Rescue’s non-transport form as example of compliant form.  (Baron) VT EMS sent 25 to GIRS and advised they have a limited supply.  (James)  Remember, individual services forms must be the same or better than VT EMS form.

NEW BUSINESS (O’Neil) 

• (Danaher) Essex Rescue and the Champlain Valley Exposition First Response anticipate a very busy month at the CVE Fairgrounds.  Area services should anticipate increased activity in Essex.  Three events in particular will bring large quantities of people to the area:
  • 7/9/06             WOKO Round Up
  • 7/12/06           Phish & Grateful Dead members performing (IMAT to attend)
  • 7/19/06           BMW Motorcycles
• (Adams) On June 14^th, Milton Rescue and Fire Dept will switch to new frequencies.  Area services will be advised.

Motion to adjourn at 1928 (Adams/Ziter).  Motion approved.  Next meeting on July 13^th at 1830, at SMC Tarrant Sports Center, Hall of Fame Room. 

Respectfully submitted on June 15, 2006, 

Kate Soons

VTEMSD#3 Clerk

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Last updated: July 11, 2006