Montgomery County Ambulance Association 345 VMSC Lansdale March 8 th, 2012 Lunch 1230 hours / Meeting 1300 hours

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1 2012 Officers Patrick A. Doyle Sr, President Kevin E. Bennett, Vice-President Kenneth J. Schauder, Secretary James Smale, Treasurer Mailing: Post Office Box #5 - Bryn Athyn, PA Montgomery County Ambulance Association 345 VMSC Lansdale March 8 th, 2012 Lunch 1230 hours / Meeting 1300 hours Squads present: Ambler, Bryn Athyn, Goodwill, Harleysville, Lower Fredrick, PennStar, Plymouth, Second Alarmers, Upper Perkiomen Valley, VMSC Lansdale, VMSC Narberth, Montgomery County EDS, Montgomery County EMS. President - Patrick Doyle, Sr. The meeting was called to order at 1300 hours by President Patrick Doyle, Sr. VMSC 345 was thanked for hosting the meeting and supplying lunch The January 12 th, 2012 minutes were approved as circulated. The normal order of business was suspended to allow a presentation by Chris Reif and others regarding the Public Safety Officers Benefits Improvement Act of The current legislation language has created some confusion and uncertainty regarding various benefit provision. Additionally, it excludes non-profit EMS providers, as well as air medics, from receiving Federal death benefits. The new act would create consistency, expedite processing and resolution of claims, and include EMS and air medic personnel as beneficiaries of Federal benefits. All public safety personnel should support this legislation, and contact their US Congressman and Senators to show support for HR 4018 / S Congressman Mike Fitzpatrick (Bucks) is very involved in this legislation, and can also help those wishing to support this bill. More information can be found at Vice President (Kevin Bennet): No report. Montgomery County Ambulance Association - Minutes of March 8 th, 2012 Page 1

2 Secretary (Kenneth Schauder): Secretary Schauder sends his apologies for missing meeting as he is on a family vacation. Treasurer (James Smale): The Statements were read by the President. They were scanned and sent encrypted to the executive Board and were given to Keith Cooper to bring to meeting tonight. The balances were read from the statements and are as follows: 8/31/11 - $1, Bank of America Final Statement Money moved to Susquehanna Bank 9/9/11 - $ $32.90 charge for check printing 10/11/11 $ No change 11/8/11 - $ $4.95 Charge for Billpayfee 12/8/11 - $ $4.95 Charge for Billpayfee 1/8/12 - $ $4.95 Charge for Billpayfee 2/8/12 $ $4.95 Charge for Billpayfee Mr. Smale spoke with Susquehanna Bank regarding the $4.95 monthly charge for Billpayfee. Since we pay all our bills by check, and not through on-line checking, this charge should not apply to our account. Susquehanna Bank will be refunding us these amounts. Committee Reports: Medical Command Committee (Kevin Thomas): The meeting was held last Tuesday, February 27 th at the Training Institute: Dr. Hoffman Montgomery County Coroner offered an explanation of his interpretation of a non-salvageable patient. If a patient is deceased and the family wants the patient transferred, leave the patient in place. If a patient is viable, then the EMS crew should do what they need to do. Dr Hoffman offered insight into new designer drugs such as K2 and Spice. These two drugs have resulted in 2 county fatalities so far this year. Marc Medori requested that Dr Hoffman forward any information on designer drugs to the EMS office for decimation. Montgomery County Ambulance Association - Minutes of March 8 th, 2012 Page 2

3 Dr. Hoffman will research a Coroner s form to facilitate transfer of information between his office and EMS crews. Stephanie Fisher- Genentech presented a new, educational on line tool for EMS providers focused on diagnosis and treatment of stroke patients in the field. The program can be reviewed at The MAC inquired about the ability to acquire continuing education credits for this endeavor. Mrs. Fisher stated that at this time there is no continue education available. Kim Weaver stated that she will inquire with the Bureau of EMS and forward the information to the group. David Levine-Delaware Valley Stroke Council gave a brief presentation on the importance of Stroke Education. o In honor of stroke awareness month, his group will be providing stroke education at many locations on May 1 st. It is his hope that EMS stations will provide a venue for these activities. Staff will be supplied. o June 10, 2012 is the Strides for Stroke 5 K Race/Walk, the council would like to build an EMS Team for this event. I. County Medical Director s Report: State MAC Update DEA and controlled substances o Diversion is a persistent issue o The county will work with local squads to ensure safety / security o EMS bulletin on this issue is pending o Glass vials preferred as carpijects have proved to be easily tampered with o Ensure proper disposal / waste procedures o Each EMS squad needs a SEPARATE DEA number-deadiversion.gov It is dangerous to use a personal DEA for an EMS squad o NAEMSP and ACEP working at federal level to normalize / unify the DEA offices. Some local DEA offices have introduced troubling interpretations of law: In TX and NC local DEA offices have ruled ambulances as a dispensing point every ambulance a number KY told that standing orders not allowed must be patient specific PA monitoring, wait and see approach at this time Hand-offs / EMS hospital ED staff o NAEMSP, ACEP, NAEMT, ENA all on board now for this project o Nationwide white paper being drafted o Discussion DRAFT of new EMS regulations o Some public comments have been received, but fewer than previous o Process is still in progress Montgomery County Ambulance Association - Minutes of March 8 th, 2012 Page 3

4 o Hearing scheduled for March / April implementation no earlier then March days to become effective. Assume EMS Fellowship core content published on pre-hospital emergency care website o Draft of program requirements available o Public comment period to follow o ABEM Boards: application period end of 2012 with first test at end of 2013 Board certification will not limit the ability of being a medical director 5 year grandfathering period CARES project / CDC and Emory University project and cardiac arrest o Open to all agencies in PA o Please continue to encourage squads to enroll and join CDC / 2011 Field Triage guidelines o o Very similar to 2011 PA protocols CIRC NAEMSP o Manual CPR vs mechanical CPR / 4000 patients / 11% survival overall o Manual CPR = mechanical CPR o Mechanical CPR devices are ALS ONLY Trauma Systems report o Still working on the Level 4 trauma center process o Reviewing the new CDC guidelines to ensure PA consistent with nationwide guidelines o EMS personnel should follow EMS guidelines in protocols regardless of what each individual trauma center s criteria might be o If individual centers / medical command are not following EMS trauma criteria, please address/educate at the regional level and forward to the state if issue persists EMS-C report o No issues to report PEHSC o Critical care paramedic standards draft in active development o Will be an educational challenge, but foster stronger better medics o Intended scope of project: paramedics working on air/ground based critical care vehicles, less appropriate for 911 EMS operations o Discussion: Possible extension of medications Kevin Thomas presented a draft of the curriculum. This will distribute for review FPC, CCP, or CCEMT-P will qualify Montgomery County Ambulance Association - Minutes of March 8 th, 2012 Page 4

5 Old business o PEHSC supports the concept of 12 leads and pumps being mandated, but concern was raised over financial ramifications VTRs put aside for in-person discussion at next state MAC meeting Alternative: Changes VTRs from requirement to promotion /encouragement vs. change in implantation date State not taking position on which specific technology should be employed MAC s position: 12 leads should be mandatory / time frame = fiscal year Medical Command facilities should be able to receive EKG New business o Lactate / UPMC DE uses lactates as part of shock protocol / ED triage Trauma use? J trauma article % benefit over vital signs Critical illness? JAMA 2010 Lactate is an independent variable How to use the test is still unknown triage tool? Trending? No current stance on this currently / data is still too new o Taser probe removal Allentown has a protocol / questioning role PD and EMS Bureau of EMS stance --- police remove it, or EMS stabilizes it Discussion MAC agreed to a protocol review o Medication shortages Etomidate / benzos, other medications plans for alternate drugs? SARS advised will be out of anticonvulsants at the end of March Regional ALS Medication List adjusted to ease required drug on each vehicle. We will dynamically alter the medication quantity requirement as circumstances change. Dr. Usatch strongly advised squads not to share controlled substances. Bureau will monitor and make suggestions based on cases of severe / critical shortage Grey market -- speculators on meds causing artificial shortages / FDA is monitoring Duonebs are OK to carry Atrovent is optional Albuterol is still required CO2 filters crisis has been averted Montgomery County Ambulance Association - Minutes of March 8 th, 2012 Page 5

6 o Ensure that etomidate reports are sent to Bureau quarterly as required by protocol Next meeting : Face-Face meeting March 6 th / Regional Directors meeting / TBD II. Controlled Substance Policies-best practices- Tom Trojansky 1. Chief Trojansky shared some of the past controlled substance diversion incidents that have led to Plymouth Ambulance s current Controlled Substances Policy/Procedure 2. Knox Boxes are used on each vehicle to secure the controlled substances a. Of note: Knox Box is listed on the EMSOF funding list 3. Medications are signed off with in the first 15 minutes of the shift a. Information is immediately downloaded to a dedicated laptop computer 4. Three officers only have access to the controlled substances and the access codes III. Transfer of Patient Care Form: Dr. Usatch requested the group prepare the providers to utilize a version of the state form. This is a not a mandatory item from the state. But will be in the future. IV. Committee Reports 1. County Protocols State will be updating, revisions should be delivered to Ed. 2. Field Representative Report o Fresh Duo Dotes has arrived to replace the regional bundle packs. o The three packs Duo Dotes for the ambulance will be replaced sometime this summer. o April Statewide Ambulance Strike Team Drill o Heart Rescue Project Update-Ed Ambler Community Ambulance is signed on and using CARES along with Abington Hospital 3. Cardiac Arrest o PI 2nd 169 o YTD. -PI 120-PI 2nd Etomidate o No uses for the first month and half of the year. Ed Martin requested a fresh committee be formed. Requested that any QA Coordinator or Medical Advisor interested should Ed Martin. V. Preceptor Applications Jennifer Hart Approved Montgomery County Ambulance Association - Minutes of March 8 th, 2012 Page 6

7 VI. MAC Education Day Bucks County will not host Montgomery County MAC will consider hosting We are looking for Physicians to present lectures We can host at a local hospital VII. Skills Verification MAC would like to host skills verification for ALS providers Sting support to keep skills verification at the local squad level MAC will develop a standard check list of what is needed to be reviewed every year for all the medical advisors. Ed Martin, Dr Usatch and Dr Neubert will create a list and it to the group VIII. Helicopter Utilization Needs to be approved by the Trauma Centers, not the local hospitals IX. Deputy Dir. Field Services discussion points: 1) Medical supply use on animals-process: No policy required 2) Out of state transports into PA: We use our local policy s 3) Hospital destination selection parameters: o Decision: Parameters should remain with the local squads, no county MAC policy required 4) Institute control of lights and siren utilization by private transport companies by providing county incident numbers: MAC will support a policy: o Decision: The MAC approved a policy of contacting the center to obtain a county run number if lights and sirens are needed.- UHF radios in private services: Radios are already in place 5) Prohibition against pictures at scenes unless medically relevant Decision: Policy that states the following: Share appropriately Properly encrypted Medical relevant Appropriately Distributed Modified at the squads level X. New Business Marc Medori inquired on what other agencies are doing with background checks Send out to all the Squads and get a consensus Dr Lucas presented the concern that Mercy Suburban Hospital was not receiving PCR s to medical records. Decision: Ed Martin will compile an updated list of the fax numbers Montgomery County Ambulance Association - Minutes of March 8 th, 2012 Page 7

8 Of ER & medical records of all the hospitals. The MAC will forward a letter to the squads and the hospitals to enforce this issue. Joe Canale requested a secure fax number at the hospitals EMS Council (James Smale): The EMS Council Meeting was held yesterday, March 7 th at the Training Institute: Reviewed most of the same items of the MAC report. 3 new members to the EMS Council have been appointed, however they have not yet been approved by the County Commissioners. The EMSOF disbursements are awaiting approval in Harrisburg Communications - Rick Lohwasser/John Geib: Mr Geib was unable to attend, as EDS is in the process of interviewing 427 applicants for Dispatcher positions. Rebanding: The radios were received in damaged condition, as weel as some being missing. They are asking Sprint/Nextel to bench test all the radios, or give us new ones. The project is delayed until this matter is resolved. Narrow Banding: Hopefully the project will be completed by June. Some current pagers may have difficulty being reprogramed for narrow banding. Others can t be reprogramed, but seem to accept pages anyway. Paging: EMS paging on high band may be done on a separate frequency. Project could be completed quickly, depending on what capabilities we are looking for. If we only want Station Alerting capability, the system can be completed quickly. If we want on-the-hip, building penetration, that will take longer. Lohwasser & Doyle will be sending out a survey to determine the needs. The County Commisioners have appointed a committee to evaluate our needs for the 800 mhz radio system, and whether we sould upgrade the current system, or get a completely new system. The Committee has recommended a vendor/consultant to evaluate our needs, and the Commissioner are set to approved this consultant. The vendor will meet with various groups to determine our needs and wants, and then recommend upgrade or replacement. Mr Bruce Castor is hoping to have this process completed by June. A question was raised concerning the possibility of an extra I-mobile license per station. Mr Geib is aware of this, but is trying to get settled into his new job. There would be additional cost involved, however. The question about EMS being allowed to put Police Regions in their radios was raised again. Even if an EMS agency gets a letter of approval from all police chiefs in that region, we are still Montgomery County Ambulance Association - Minutes of March 8 th, 2012 Page 8

9 being denied. There are differing opinions on who is denying these requests. EDS believes ALL police must approve, not just the regions involved. We reviewed the concerns previously expressed by police. However, now that there have been some changes at EDS, we may want to revisit this issue. Mr Doyle will contact John Scholly (spelling?) to see if a meeting can be arranged. EMS Office (David Paul Brown): EMSOF : All EMSOF applications have been received and reviewed. Tim Dunigan has conferred with the three Council review members-james Smale, Rich Brady and John Hill. The committee has reviewed the funded projects by service and agrees with the proposed funding decisions. There were several detailed questions that were sent to the State Bureau of EMS for clarification. The final step before contracts are completed is for the Bureau of EMS office to approve the final recommended distribution list. The list has been sent to Harrisburg and it is expected to be approved this week. MDC Project: As of the last meeting all the installs had been completed, there were 2 services that had raised concerns about installations, 328 and 345. Rick Lohwasser from the Dispatch Services Division has been following up to correct and/or propose solutions to ensure success of the project. We are awaiting some final details and agreements with two agencies 308 and 345 to complete every service using the MDCs. All other units are actively using the mobile data computers with marked success. The remaining two agencies have been contacted and it is expected that their units will be operative soon. Select & Recommend Policy: With a key staff member-sean Petty, departing the Dispatch Services Division at the end of 2011, the ability to implement the technology to utilize select and recommend has been delayed. The original plan was to utilize select and recommend in the first week of February 2012 for a five month trial period. At the January 2012 Ambulance Association meeting it was determined that the EMS Communications Manual would be altered removing the select and recommend language and resubmitted for approval. The sections on use of mobile data computers and other sections were still valuable to move forward. The section on determining backup ambulance agencies will remain as it currently is, using lists contained in the computer aided dispatch system. Statewide Strike Team Drill-April 2012: The Commonwealth Bureau of EMS and all regional EMS Councils as well as Strike Teams from each region will hold a drill on April 20, 21, and 22. The drill is titled Operation April Storms. All Montgomery County EMS Strike Teams are required to participate, on April 3rd, with the Medical Surge Equipment Cache (MSEC) or on April 20, 21, and 22, the full field exercise. MCEMS staff will also be active in the drill. A scenario is has been formulated that will stretch the limits of the EMS system and require a strike team response. Teams and ambulance units along with base camp supplies will be deployed to eastern Pennsylvania and involve two overnight stays and two six hour operational periods. Other strike teams will deploy a medical Surge equipment Cache (MSEC) to a County based facility to setup and simulate running a 53 bed portable treatment center. The MSEC trailer and supplies are designed to setup on a standard basketball court. There have been several planning meetings with the strike teams to prepare for this drill, any questions should be directed to Ed Martin or David Brown. Montgomery County Ambulance Association - Minutes of March 8 th, 2012 Page 9

10 Strike Team Award-Hurricane Irene: In January 2012 the Strike Team from VMSC-Narberth was honored for their response to Hurricane Irene and service to the citizens of New Jersey. President David Zaslow accepted the award presented by Deputy Director David Brown. The award and statement of gratitude was signed by the Commonwealth Secretary of Health, and the Deputy Secretary of Health. Southeast Pennsylvania Task Force Update-County Projects: MCEMS has been working several projects to enhance our homeland Security response. Develop, procure and distribute tactical medical kits for individual police officers. Personal kits would include SWAT-T, trauma dressing and occlusive dressing for every officer. Larger kits would be developed for police vehicles with multi-packs for supervisors or SWAT teams. A proposal is being submitted for an updated flight of the County using Pictometry, this can be extremely helpful in developing pre-plans and visual intelligence during actual incidents. A proposal for an additional Gator or similar vehicle to assist at incidents and special planned events. A proposal for another round of protective CO meters. There have been several incidents where these have saved lives of responders and civilians, MCEMS is requesting that each emergency ambulance be equipped with 2 CO meters. Southeast Pennsylvania Task Force-EMS ESF-8 Workgroup: The task force workgroup comprised of EMS, hospitals, and Public Health representatives are working on the following projects: Within the last thirty days the work groups have been advised to expend their monies allocated for 2008, and 2009 by June 30, and September This includes antidotes, additional SmartTag supplies, additional POD trucks and boxes, and other supplies to bolster the response capabilities of the EMS area. Hospitals are expending funds for a forklift truck to move and setup their portable hospital system more effectively, they have also purchased a 16 seat bus that can transport personnel and patients in a modified format. Public Health continues to augment pharmaceutical supplies and have developed the frame of a five County mass fatality plan. Training Updates: Montgomery County Community College has committed to funding the EMS training programs through June 30, MCEMS is looking to continue the relationship with the College, and discussing strategies to continue current and future funding. MCEMS has recently completed three training classes for EMTs with classes finished or soon finishing at Villanova, Training Campus and Skippack. The Training Institute will soon be inspected for CoAEMSP accreditation. This is required by National Registry and the Commonwealth to continue to train and certify Paramedics. Part of the process involves setting up a Training Advisory Council to meet on the same day as the EMS Council Montgomery County Ambulance Association - Minutes of March 8 th, 2012 Page 10

11 meetings. If you have an interest in EMS education and would be interested in serving, please contact Kim Weaver or David Brown. The Training Institute will be hosting the first ever EMS course at The Eastern Center for Arts and Technology, there will also be an accelerated EMT course this summer. An EMS Instructor course will be held in May, and a CPR Instructor course will be held at the end of April, if you are interested in attending, teaching, or assisting, please contact the MCEMS Training office. Ambulance Licensure Spot Inspections: On January 18, 2012 MCEMS staff were requested by the Commonwealth Bureau of EMS to conduct unannounced inspections of ambulances across the County. Teams conducted inspections at multiple sites and were reviewing critical equipment that is to be carried under the State licensure program. Key items that were evaluated included, on board and portable oxygen and suction systems, automatic defibrillators, crew members certifications, and the heating system in the patient compartment area being able to properly provide heated air to a temperature of sixty-eight degrees. Several units inspected in Montgomery County were found to have one or more deficiencies and across the State there were 335 inspected and 36 found to have one or more pieces of missing/inoperative equipment. The most common deficiencies were missing portable oxygen or suction units, lack of a required AED, and no on board oxygen. Agencies were sent letters that had ambulances that were inspected. Agencies that had issues had five business days to correct issues and undergo a re-inspection. Strike Team Leader Class-May 16 & 17: MCEMS will be hosting a Strike Team Leader class for 2 days in May. This class will be the second one held for those within our strike teams that would be requested to become unit leaders or supervisors of multiple strike team units. The class is conducted by TEEX-Texas A & M, and a successful course was held last year. Interested persons from EMS Strike Team agencies should contact Ed Martin or David Brown. CARES-Heart Rescue: The CARES data project is well underway with meetings and agencies registering to enter their data on line. Pennsylvania is one of five states collecting data on sudden cardiac arrest (SCA). It is important that we measure current success to determine ways to enhance survival rates. The data needs to be entered by EMS agencies and hospitals on SCA, onto a secure web based portal in order to analyze data and make enhancements. If your agency has signed up, THANK YOU, if you have any questions or need more information, please contact Ed Martin. State EMS Planning: The planning documents and rollout were delayed for a few months and it is projected now that materials will be ready for April of Each EMS office will be required to meet with agencies and stakeholders to determine steps forward in developing a new regional plan. The new plans need to be submitted to the EMS Bureau by October of Over the next few months there will be multiple forums to provide input and recommendations to assist in writing our new plan. House Resolution 315: There has been a proposal by the House of Representatives to study the funding of the EMS System in the State. HR315 requests that the legislative Budget and Finance Committee review the entire system of regional councils, PEHSC, state office and funding revenues, and distribution. There will be much more to follow, please review the resolution. Montgomery County Ambulance Association - Minutes of March 8 th, 2012 Page 11

12 EMS Week 2012: EMS Week is slated for May 20-26, 2012 and features a theme of: EMS-More than a job.. A Calling. MCEMS has been planning activities for the week and also interested in printing a schedule of events EMS agencies may have planned at their stations. Please contact us with your ideas and activities. EMS Memorial Bicycle Ride-Muddy Angels May 23rd: The annual event will be traveling through Montgomery County on May 23 rd and through Chester and Lancaster Counties on May 24 th. The general route will be from Bucks County from the Horsham area south to the Montgomery County Community College and onto Station 385, continuing through the area of Eagleville and onto Chester County past Valley Forge National Park. More details to follow, if you have an interest in riding register at muddyangels.com and if you have an interest in supporting the ride, please contact the MCEMS office. Mr. John Geib is now in charge of EDS incident reports/complaints. The EMS Office fax # has been discontinued. Phillies tickets are available for the 4/2/12 game. Contact David Paul Brown. Mr Brown presented a hand-out on Chemical Suicides, which will also be forwarded to all Squads. The FBI will be presenting a program on IED and Overseas Threat awareness on 4/12/12 at Limerick Fire Company. Preregistration is necessary at Special Projects Ken Davidson/David P. Brown: No report Old Business: None New business: Next Meeting: June 14 th, Skippack Area EMS Dinner at 1830 Meeting at Question raised about patient transfers from Montgomery Hospital to the new Einstein facility. Mr. Doyle would like to speak to Chief 308 regarding this. Question raised as to why EMS is dispatched to lift-assists even when EMS refused. Some police departments will not do lift assists, due to possible legal and liability issues. This matter has been previously discussed, also. 345 reported they are having a problem with Private Transport services monitoring the radios, and jumping on EMS dispatches. In one instance, the private company told police to cancel the EMS agency, as they could handle the call. The EMS office should be made aware of these incidents. In addition, since the Municipalities determine who their EMS providers are, the Municipality may need to write a cease and desist letter to the company. Montgomery County Ambulance Association - Minutes of March 8 th, 2012 Page 12

13 The Meeting was adjourned at 1515 Hours. Respectfully submitted, Keith Cooper Acting Secretary Montgomery County Ambulance Association - Minutes of March 8 th, 2012 Page 13