Board Meeting Dr. Joel Hornung - Chair AGENDA Friday, June 2, :00 AM

Transcription

1 Landon State Office Building 900 SW Jackson Street, Room 1031 Topeka, KS Dr. Joel E Hornung, Chair Joseph House, Executive Director Board of Emergency Medical Services Board Meeting Dr. Joel Hornung - Chair AGENDA Friday, June 2, :00 AM Landon State Office Building 900 SW Jackson, Room 509; Topeka, Kansas I. CALL TO ORDER phone: fax: Sam Brownback, Governor II. APPROVAL OF MINUTES APRIL 7, 2017 III. COUNCIL / COMMITTEE REPORTS a. Planning and Operations i. Potential Action Item 1. Adoption of K.A.R b. Education, Examination, Training, and Certification i. Potential Action Item 1. Entrance requirements into an Instructor-Coordinator initial course. c. Investigations i. Potential Action Item 1. Adoption of Fine Schedule IV. OFFICE UPDATE a. May 9 th Legislative Meeting Overview V. PUBLIC COMMENT a. Public comment time on the agenda is limited to no more than 5 minutes by any one speaker. If an individual wishes to comment on an agenda item after board discussion but before a vote, the individual should notify the Chair prior to the start of the meeting. VI. ADJOURNMENT NOTES: Please remember to turn off all cell phones or place them on silent mode during the Board meeting. If it is necessary to accept the call, please step outside of the meeting room to continue your phone call. Additionally, the use of tobacco is not permitted inside this building.

2 Landon State Office Building 900 SW Jackson Street, Room 1031 Topeka, KS Dr. Joel E Hornung, Chair Joseph House, Executive Director Board of Emergency Medical Services Board Meeting Minutes April 7, 2017 Draft 04/07/2017 phone: fax: Sam Brownback, Governor Board Members Present Dr. Greg Faimon Sen. Faust-Goudeau Dr. Joel Hornung Comm. Ricky James Director Deb Kaufman Chief Shane Pearson Director Chad Pore Director John Ralston Comm. Bob Saueressig Director Jeri Smith Rep. Susie Swanson Attorney General Staff Sarah Fertig Board Members Absent Dennis Franks Rep. Henderson Dr. Martin Sellberg Guests Brandon Beck Kathy Dooley Kathy Coleman Charles Foat John Hultgren Dan Hudson John Cota Terry David Rosa Spainhour James Zeeb Jason White Chrissy Bartel Rob Boyd Gary Winter Ron Marshall Jeb Burress Kerry McCue Craig Isom Frank Williams Representing KEMSA/Region V Region II Region IV JCCC Dickinson Co. EMT Univ. of KS Hospital KCKFD Reno Co. EMS Kiowa Co. EMS KCKFD MARCER Norwich EMS Region II Region I KHA Butler College Ellis Co./Region I Med-Trans Corp KAMTS & Life Team Staff Present Joe House-Exec Dir Curt Shreckengaust-Dep Dir James Kennedy Suzette Smith Emilee Turkin James Reed Mark Willis Ed Steinlage Mark Grayson Nance Young Kim Cott Ann Stevenson Chrystine Hannon Call to Order Chairman Hornung called the Board Meeting to order on Friday, April 7, 2017 at 9:00 a.m. Dr. Hornung announced there are changes to the agenda for legislators with time commitments this morning. After approval of the minutes, KA.R and K.A.R will be addressed. At the end of the committee meeting reports and after the office update, Director Pore will give a presentation. There will be a short executive session after the meeting. Chairman Hornung called for a motion to approve the minutes. Director Ralston made a motion to approve the February 3, 2017 minutes. Director Kaufman seconded the motion. No discussion. No opposition noted. The motion carried.

3 Director Pore made a motion to approve K.A.R as revised. Director Kaufman seconded the motion. The motion carried. Roll call vote as noted: Dr. Faimon Aye Chief Pearson Aye Senator Faust-Goudeau Aye Director Pore Aye Mr. Franks (Absent) Director Ralston Aye Rep. Henderson (Absent) Comm. Saueressig Aye Chairman Dr. Hornung Aye Dr. Sellberg (Absent) Comm. James Aye Director Smith Aye Director Kaufman Aye Rep. Swanson Aye K.A.R is approved by the Board as revised on an 11-0 vote (11Yes; 0 No; 3 Absent). Director Pore made a motion to approve K.A.R as revised. Director Smith seconded the motion. The motion carried. Roll call vote as noted: Dr. Faimon Aye Chief Pearson Aye Senator Faust-Goudeau Aye Director Pore Aye Mr. Franks (Absent) Director Ralston Aye Rep. Henderson (Absent) Comm. Saueressig Aye Chairman Dr. Hornung Aye Sr. Sellberg (Absent) Comm. James Aye Director Smith Aye Director Kaufman Aye Rep. Swanson Aye K.A.R is approved by the Board as revised on an 11-0 vote (11Yes; 0 No; 3 Absent). Dr. Hornung provided the following MAC report to the Board: The AEMT Medication list was discussed. Dr. Hornung said it was Dr. Gallagher and Dr. Jacobson against him most of the time. Dr. Hornung was wanting to whittle down the medication list to what would be the most beneficial and helpful. Their response was all of them are beneficial; it is whether or not we can provide all the training that is needed. Dr. Hornung said they were at a standoff. The main comment was if we are going to be using these medications, we need to figure out a better way to verify the education on the

4 medications to a certain level of competency. They will continue to work on the list, and so far they have not made any huge changes in the AEMT list. Planning and Operations Committee Chairman Hornung called upon Chief Pearson to give the Planning and Operations Committee report. Chief Pearson reported to the Board: KEMSIS Update: Director Pore reported there are over 100 agencies entering in the system and another 30 are submitting data of some sort. There have been some issues sent on to ImageTrend. On the state side, Director House and Director Pore have been receiving around 10 s per week between the both of them regarding issues or requests. There are issues with how the system is set up as a whole that they continue to work on with ImageTrend. Mr. Reed reported they have conducted 49 service inspections using the License Management System. They have had some technical difficulties with their tablets, but these will be corrected. Mr. Reed also reported they had completed 39 program provider audits, and it s going fairly well. Two variances were issued for lettering for loaner ambulances. The equipment regulation K.A.R is in the 60 day comment period. Nothing significant to report at this time. The public hearing is May 23rd at 9:00am in Room 509. Mr. Reed reported the service and vehicle renewal process started at the end of February. So far, 89 services have been licensed and 82 ground ambulance permits renewed. Currently there is same day processing. The Governor will be signing the EMS Week Declaration on April 28th at 9:30. Traffic Issue Management Training will be starting soon. This is a statewide effort with multiple agencies involved. The regions reported their meetings coming up over the next couple of weeks. Education, Examination, Training and Certification Committee Chairman Hornung called upon Director Kaufman to give the EETC Committee Report. Director Kaufman reported to the Board: Mr. Willis reported that there was one potential variance involving an attendant who was unable to renew due to having been in an accident. However, the attendant did not respond when contacted and will be going through the reinstatement process to regain certification. Rob Boyd provided a BLS Examination Vendor Report to the committee. He reported that between January 1st and March 31st, 153 students were tested and 129 of them passed. There were 148 EMT students and 5 EMR students to test, of which 20 were retests. The committee thanked them for their dedication to this process. At the February Board meeting the EDTF was asked to discuss the question regarding the certification of the Training Officer as currently viewed by regulation in Kansas. The regulations have been changed since the inception of the Training Officer certification. Those changes have resulted in the sponsoring organization having regulatory responsibility for continuing education conducted within the organization. No regulatory responsibility remained with the TO for education provided. The Training Officer role had been changed to one responsible for completion of paperwork. It became evident that we needed to change regulation to restore a larger role to the Training Officer or do away with the certification.

5 Dr. Charles Foat, EDTF Chair, reported an initial survey was distributed by the EDTF and the results were discussed during their Feb 23rd meeting. More issues were identified and a 2nd survey went out via the board portal. This resulted in over 1,000 responses. Among those who responded, we did identify a group of respondents who did not understand the question at hand or the ramifications for voting to retain or eliminate the TO certification. Due to the number of respondents, it was possible to look at the responses as a whole and also categorized into groups based on certification level and roles. The same percentages of responses were obtained in the group as a whole and within the sub-categories. There were 60% in favor of eliminating the certification requirement. Likewise, in answering the question regarding the expected change in education quality, 70% of respondents said they would anticipate it would stay the same or improve. During the March 30th EDTF meeting, the second survey results were reviewed. The EDTF members took a vote and the majority voted to eliminate certification for this role. They did want it to be clear that they were supporting education and training but not the certification of the individual in the role of completing paperwork for the sponsoring organization. Our committee had discussion regarding the impact of this change and points learned as a result of conducting this process. Many valid comments were received and we want to address those issues as we move forward. We do want to thank the EDTF and staff for addressing this issue as quickly and thoroughly as they did, and all those who answered the survey and provided input. We need to emphasize that eliminating the Training Officer certification would not take away the ability or limit services from offering training through a current long term program provider. An I/C would not be required as the program manager in those organizations. Following that discussion we heard a motion to no longer regulate or offer certification for the Training Officer level and we bring that forward as a motion to the full board. Director Kaufman made a motion to move forward to eliminate the TO certification. Director Ralston seconded the motion. After a brief discussion and no opposition noted, the motion carried. Mr. Willis will start the revision of the 18 initial regulations that have been identified and we will probably run into a few more. We will also have statute clean up at some point in the definitions in and c. We received a document from Colorado showing training administration course material used in their EMS Administrator Orientation Course. The staff, EDTF, and two colleges have offered to research resources that will be made available to assist with continuing education. The professional organizations and Regions will be asked as well. It was also suggested that we have a Frequently Asked Questions memo assembled on the questions we have fielded. We had discussion on the role of the program manager because of the upcoming changes needed in K.A.R Because that role reports to the sponsoring organization that has regulatory responsibility, the role will have no specific requirements. There are five regulations up for revocation that have been approved by the Department of Administration and will move forward through the regulatory approval process. Mr. Willis informed the committee that Wisconsin has given the Kansas Board of EMS permission to provide their training programs, presentations and model protocols for Naloxone to services and providers as a resource. Included is a BLS program and first responder program. This will be posted on the website as a resource. Local protocol with

6 specific medical direction will have to be referenced when presenting the programs. We also need to update the education guidelines for EMR and EMT to include the addition of Naloxone in medication list and the administration routes for this medication. In his Education Manager s Report, Mr. Willis reported he continues to be impressed with staff working together to meet the challenges of processing education documents and responding to the EMS community with education support. He provided the committee with a written document highlighting recent activity of Board Staff. There have been 85 initial course requests for Between February 5th and April 3rd, there were 194 candidate written examination results processed. We viewed the 2016 State Annual Report from the National Registry of Emergency Medical Technicians. Mr. Willis briefly shared his experience from attending the 2017 NASEMSO Conference and enlightening presentations he observed. One of the presentations particularly stood out as a result of recent discussion of our pass/fail rate on the National Registry Exam at each level. It is a National problem, not just a Kansas problem, that pass rates are not as high as we would like them to be. Mr. Willis attended a presentation by David Page, Director of Prehospital Care Research Forum at UCLA, titled Recipe for 100% Pass Rates on National Registry EMT First Attempt. To mention a few of the highlights, he stressed preparing students to take a computer adaptive exam scenario to use in the classroom as a didactic event (replacing PowerPoint, reading the PowerPoints and lecturing), use of evidence based medicine and sample protocols as presented in the NASEMSO National Model EMS clinical guidelines, and utilizing progressive levels of questions designed with increase in difficulty to promote critical thinking in the class room. More ambulance clinical time is also important and time spent shows a direct correlation to passing the exam. Thank you to Mr. Willis for sharing the information. We appreciate the time he takes to identify issues with our current system and identification of resources to make available to the educators. Following the Education Manager s report, there was discussion on the AEMT courses offered in the State of Kansas as a follow up to the morning MAC meeting. Each level of certification is enhanced in Kansas over what is presented nationally as a minimum guideline. Dr. Sellberg shared the AEMT level is vitally important to our state. As we enhance the certification levels, we also have that responsibility to monitor and work to ensure the education is also adequate. Director Pore reported we are reviewing data on AEMT classes and will continue to do so as we monitor education for the Kansas certification levels. Executive Committee Chairman Hornung presented the Executive Committee report to the Board: There is nothing really new on the federal side. Director House reported on the current Kansas Legislation. House Bill 2076-The Seat Belt Safety Fund is sitting on the calendar on the Senate side. House Bill 2044-Medicaid Expansion was vetoed by the governor but still has possibilities to be resurrected. House Bill 2137-The County Commissioner/City Council Volunteer EMS/Fire ability to participate was sent to the governor for signature on April 5th. House Bill 2217-Access to Naloxone was sent to the governor for signature on April 4 th. The EMS REPLICA Multi-State Compact is set to gain its 10th state (Georgia) and go into effect July 1st. The Naloxone regulatory revision has already been voted on by the Board.

7 Kansas Revolving Assistance Fund- The KRAF Grant submission process had 58 requests for $1,082, The committee approved funding of around $380,000. Director Pore commented the committee did really good and he feels very confident with the recommendations. Dr. Hornung brought the committee s recommendation as a motion to approve the funding for the KRAF Grant. Director Pore seconded the motion. No discussion. No opposition noted. The motion carried. There was a brief discussion on the examination contract renewal for the BLS examination contract. This is an extension of the current contract. Dr. Hornung said the committee would recommend renewal of the contract for approval as a motion. Director Ralston seconded the motion. No discussion. No opposition noted. The motion carried. Dr. Hornung stated we have our first distributor approval for DNR identifiers. This was provided by StickyJ Medical ID. According to staff, the company did meet the qualifications for distributor as listed in the guidelines. The staff recommended this application be approved. Dr. Hornung stated the committee would recommend approval of this distributor as a motion. Director Ralston seconded the motion. No discussion. No opposition noted. The motion carried. Dr. Hornung said we have an audit policy that the staff has put together for a consistent plan for auditing each education service. The committee approved the plan and recommended using the policy. Dr. Hornung stated the committee would recommend approval of this policy as a motion. Director Pore seconded the motion. No discussion. No opposition noted. The motion carried. Investigations Committee Chairman Hornung called on Director Pore to give the Investigations Committee report. Director Pore reported to the Board: The committee heard 11 consent cases and they agreed with Board staff recommendations. Most of those were related to applications. People who had taken an EMT class had checked that they had legal issues. Some of these were old felonies such as DUI s. The committee agreed with Board staff recommendations. This included one applicant who was not allowed to reinstate due to current legal issues. The committee actually talked about and took other action on the following four cases: 1) A case which was held over from last time was a paramedic who practiced outside their protocol without any medical control. More information was requested and the committee accepted local action and closed the case. 2) An emergency order of suspension was put in for an attendant who was arrested for some person crimes. The District Attorney s office has dismissed any felony charges, but there are still some legal issues. The emergency order of suspension was lifted to

8 allow the person to continue to work until the legal case has concluded. The case will be evaluated at a later date. 3) A service that had been having issues for a while received a letter requesting they appear before the committee to show cause on why they should not have to surrender their permit. Since the last meeting, the service has surrendered their permit. The case was closed. 4) A service changed Medical Directors and they both signed the forms, but forgot to send in the forms. They were found 4 months later under a stack on his desk. The forms were sent in and he filed a self-report. The committee logged that there was a violation, but since there was no ill intent no action was taken. The committee discussed a case afterwards. A person had just been arrested for some other person crimes. The crimes were three years old and he was never arrested. A new District Attorney reviewed the case and decided there was enough to arrest him and file charges. A summary proceeding order was issued for a temporary suspension until the legal case is finished. New Business Trooper Troy Setzkorn from the Kansas Highway Patrol Tactical Team presented a report to the Board. Dr. Allen is the director of the team. Special Troopers Julie Dorneker and Luka Henderson were also present. The mission of the special response team is to provide the Kansas Highway Patrol and municipalities, sheriff offices, rural agencies, and other entities with a highly trained, well-equipped team to assist in the completion of any critical incident quickly, safely and without collateral damage. A tactical medical position will be added to the special response team. Since current EMS systems cannot provide care in hot zones, the tactical team will provide advanced care in the hot zones of the special operation until the area has been cleared for EMS to enter or to extract them out to where EMS will be staged. Our special operations include high risk warrant service, barricaded subjects, hostage rescue, fugitive tracking, clandestine labs, civil disorder riot, marijuana eradication surveillance, VIP protection, crisis negotiation, bus and aircraft assaults, WMD response and CBRNE incidents. This is the first medic program of its kind in the state of Kansas. The Tactical Team is providing troopers advanced tactics training, and then training them up to the paramedic level. Because we operate across the entire state, we will be working with many different EMS systems each having varying levels of training capabilities. We are affiliated with KU Medical Center where our medics are working regular clinical rotations in the emergency room and in the cadaver labs to maintain high proficiency in our skills. We are currently working on protocols with Dr. Allen and are in the process of acquiring the appropriate equipment and supplies. Trooper Setzkorn thanked everyone for the opportunity to introduce their program and they welcomed any expert advice from the Board. Dr. Hornung said it sounds like a great project and we might have you come back in a year or so for an update on how the process is going. Office Update Director House, Deputy Director Shreckengaust and Mr. Willis attended the NASEMSO Conference the first week of March in New Orleans. There was a lot of information presented and it was a good opportunity to meet others and hear what is going on in other places.

9 Director House gave a slide show presenting the statistics that came out of KEMSIS and License Management System (LMS). Using the dashboard in LMS we can instantly pull up data such as the number of attendants and when they expire. The majority of the information presented was from January 1, 2016 thru December 31, Service Directors were informed that some of the usual information requested on their service renewals was removed because it is now available in the system. We project there will be about 400,000 calls across the state this year. Using KEMSIS information we are receiving data on about 50% of the calls. We have some extremely high volume services not reporting. Vendor issues are the biggest problem right now on trying to get those services reporting. When looking at inter-facility transfers, he reported that you can look at where the patient was picked up and where the destination was to determine what type of call it was. About 2,000 calls were reported as 911, but were pickups from a hospital with a drop off of a hospital. So from that we know we have some education to do to say that is not a 911 response. Director Pore stated that the billing world is driving this reporting, because if the transfer is to occur right now, it is considered an emergency. He emphasized that education is needed so it is reported in KEMSIS as a transfer, but can still bill as an emergency. We started collecting data in KEMSIS in 2008 for a partial year with 19,000 runs. Currently we are bringing in about 50,000 runs per quarter. Last year we were at our high with 193,000 events. In 2016 we broke the one million record mark. Director Pore reported that getting some of the larger services on will really boost the numbers and services such as Sedgwick County intent to upload data back through 2008 when they are linked. A review of the run data shows 52% of calls are for females and the most frequently seen age group is In the top ten pediatric impressions traumatic injury was 76.7% of the calls. In the top ten adult impressions traumatic injury was 60.6% of the calls. In the older adults (65 and over) traumatic injury was 62.9% of the calls. In clinical care we looked at a 12 lead being used for cardiac chest pain in patients 35 years and older and found it was documented as 33.6% of the time. While this percent is low, it does not take into account if it was written into a narrative. It does identify an opportunity for us to provide education on how to report usage to get more accurate data. Aspirin administration was reviewed under the same scenario and found it was reported in 35% of those calls. In 2017, Director House hopes to get 100% Kansas hospital participation, 90% of all calls submitted into KEMSIS, and 25% of the hospitals providing outcome data at least for the trauma patients through the hospital hub. The collected data suggests that we need to continue to work with our services on defining how to enter some of these runs. Director House said they will be looking at providing education to the Service Directors and IT staff to generate their own reports so they will have the ability to call out the anomalies. It is a whole lot easier for the services to draw out that data and address it locally than for a state report to be issued and they have to scramble to make corrections. Staff will provide education on how services can get this data. Director House asked the Board to let him know what other information they think we should be trending. Director Smith asked if the hospitals will have access to data on the hospital hub. Director House replied we have been working with ImageTrend to make this work.

10 Dr. Hornung asked if a service can call the Board to obtain information on how they are doing. Director House responded they just need to write a report and we can help them write it. Director Pore discussed a project that Butler County has been working on for about 2 ½ years to improve safety including the redesign of ambulances. Part of the process has been working with Ronald Rolfsen from Oslo Norway. Director Pore said they are currently using a Sprinter as a 911 ambulance. One of the biggest issues is the crew are not always sitting down and staying belted in. Their internal policy was changed to not allowing manual CPR to be given during transport. The ambulance will have to pull over to the side of the road if manual CPR is to be administered. Director Pore said they are building two ambulances: a medium height Ford Transit and a low top Sprinter. A device next to the steering wheel with controls is a new safety feature. The cockpit area will have forward facing seats with cabinetry built around the seats. Everything the technician will need when they sit down facing forward in the ambulance will be within reach so they should not have a reason to unlock their seat belt and stand up. They are going to try the low top ambulance because the high top makes it easier for attendants to stand up. The low top will force them to sit and that s where you want them. All of the controls will be in the cockpit area. The monitor will be on the opposite side within reach. The attendant will not have a reason to get up so they will have to stay engaged with the patient. They will have a full cabinet in the back to store equipment. A simulation made up of foam board had been made to determine the correct space requirements. Adjustments will be made if necessary. This will be the first low top Sprinter ambulance built in the United States. The cost of the low top Sprinter ambulance with powerload system is $135,000 to $140,000. The cost of the Transit with the powerload and medium height roof is $130,000. The Sprinter is 62 inches from floor to ceiling and the Transit is 68 inches from floor to ceiling. Dr. Horning stated: I move that we recess into executive session for a period of 15 minutes to discuss non-elected personnel in order to protect the privacy of those involved and that Sarah Fertig join the session. The open session will resume in the same place at 10:45. Motion was seconded and carried. The Board recessed. The Board reconvened. Director Pore moved for the chairman to begin the evaluation and compensation review process with the Executive Director. Director Smith seconded the motion. No discussion. The motion carried. Dr. Hornung adjourned the meeting at 10:50 am.

11 Standards for ground ambulances and equipment. (a) Each ground ambulance shall meet the vehicle and equipment standards that are applicable to that type of ambulance. (b) Each ground ambulance shall have the ambulance license prominently displayed in the patient compartment. (c) The patient compartment size shall meet or exceed the following specifications: (1) Headroom: 60 inches; and (2) length: 116 inches. (d) Each ambulance shall have a heating and cooling system that is controlled separately for the patient and the driver compartments. The air conditioners for each compartment shall have separate evaporators. (e) Each ambulance shall have separate ventilation systems for the driver and patient compartments. These systems shall be separately controlled within each compartment. Fresh air intakes shall be located in the most practical, contaminant-free air space on the ambulance. The patient compartment shall be ventilated through the heating and cooling systems. (f) The patient compartment in each ambulance shall have adequate lighting so that patient care can be given and the patient s status monitored without the need for portable or hand-held lighting. A reduced lighting level shall also be provided. A patient compartment light and step-well light shall be automatically activated by opening the entrance doors. Interior light fixtures shall be recessed and shall not protrude more than 1 1/2 inches.

12 K.A.R Page 2 (g) Each ambulance shall have an electrical system to meet maximum demand of the electrical specifications of the vehicle. All conversion equipment shall have individual fusing that is separate from the chassis fuse system. (h) Each ground ambulance shall have lights and sirens as required by K.S.A and K.S.A , and amendments thereto. (i) Each ground ambulance shall have an exterior patient loading light over the rear door, which shall be activated both manually by an inside switch and automatically when the door is opened. follows: (j) The operator shall mark each ground ambulance licensed by the board as (1) The name of the ambulance service shall be in block letters, not less than four inches in height, and in a color that contrasts with the background color. The service name shall be located on both sides of the ambulance and shall be placed in such a manner that it is readily identifiable to other motor vehicle operators. (2) Any operator may use a decal or logo that identifies the ambulance service in place of lettering. The decal or logo shall be at least 10 inches in height and shall be in a color that contrasts with the background color. The decal or logo shall be located on both sides of the ambulance and shall be placed in such a manner that the decal or logo is readily identifiable to other motor vehicle operators.

13 K.A.R Page 3 (3) Each ground ambulance initially licensed by the board before January 1, 1995 that is identified either by letters or a logo on both sides of the ground ambulance shall be exempt from the minimum size requirements in paragraphs (1) and (2) of this subsection. (k) Each ground ambulance shall have a communications system that is readily accessible to both the attendant and the driver and is in compliance with K.A.R (a). (l) An operator shall equip each ground ambulance as follows: (1) At least two annually inspected ABC fire extinguishers or comparable fire extinguishers with at least five pounds of dry chemical, which shall be secured. One fire extinguisher shall be easily accessible by the driver, and the other shall be easily accessible by the attendant; (2) either two portable, functional flashlights or one flashlight and one spotlight; (3) one four-wheeled or six-wheeled, all-purpose, multilevel cot with an elevating head and at least two safety straps with locking mechanisms; (4) one urinal; (5) one bedpan; (6) one emesis basin or convenience bag; (7) one complete change of linen; (8) two blankets;

14 K.A.R Page 4 (9) one waterproof cot cover; (10) one pillow; and (11) a no-smoking sign posted in the patient compartment and the driver compartment; and (12) mass-casualty triage tags. (m) The operator shall equip each ground ambulance with the following internal medical systems: (1) An oxygen system with at least two outlets located within the patient compartment and at least 2,000 liters of storage capacity, with a minimum oxygen level of 200 psi. The cylinder shall be in a compartment that is vented to the outside. The pressure gauge and regulator control valve shall be readily accessible to the attendant from inside the patient compartment; and (2) a functioning, on-board, electrically powered suction aspirator system with a vacuum of at least 300 millimeters of mercury at the catheter tip. The unit shall be easily accessible with large-bore, nonkinking suction tubing and a large-bore, semirigid, nonmetalic nonmetallic oropharyngeal suction tip. (n) The operator shall equip each ground ambulance with the following medical equipment:

15 K.A.R Page 5 (1) A portable oxygen unit of at least 300-liter storage capacity, complete with pressure gauge and flowmeter and with a minimum oxygen level of 200 psi. The unit shall be readily accessible from inside the patient compartment; (2) a functioning, portable, self-contained battery or manual suction aspirator with a vacuum of at least 300 millimeters of mercury at the catheter tip and a transparent or translucent collection bottle or bag. The unit shall be fitted with large-bore, nonkinking suction tubing and a large-bore, semirigid, nonmetallic oropharyngeal suction tip, unless the unit is self-contained; and (3) a hand-operated, adult bag-mask ventilation unit, which shall be capable of use with the oxygen supply; (4) a hand-operated, pediatric bag-mask ventilation unit, which shall be capable of use with oxygen supply; (5) oxygen masks in adult and pediatric sizes; (6) nasal cannulas in adult and pediatric sizes; (7) oropharyngeal airways in adult, pediatric, and infant sizes; (8) a blood pressure manometer with extra-large, adult, and pediatric cuffs and a stethoscope; (9) an obstetric kit with contents as described in the ambulance service s medical protocol;

16 K.A.R Page 6 (10) sterile burn sheets; (11) sterile large trauma dressings; (12) assorted sterile gauze pads; (13) occlusive gauze pads; (14) rolled, self-adhering bandages; (15) adhesive tape at least one inch wide; (16) bandage shears; (17) one liter of sterile water, currently dated or one liter of sterile saline, currently dated; and (18) currently dated supplies, medications, and equipment as authorized by the scope of practice and protocols, in accordance with the applicable list of supplies, medications, and equipment approved by the medical director. (o) The operator shall equip each ground ambulance with the following patienthandling and splinting equipment: (1) If required by protocol, a long spinal-immobilization device, complete with accessories to immobilize a patient; (2) a set of extremity splints including one arm and one leg splint, in adult and pediatric sizes; (3) a set of rigid cervical collars in assorted adult and pediatric sizes; (4) if required by protocol, foam wedges or other devices that serve to stabilize the head, neck, and back as one unit; and

17 K.A.R Page 7 (5) patient disaster tags. (p) The operator shall equip each ground ambulance with the following bloodborne and body fluid pathogen protection equipment in a quantity sufficient for crew members: (1) Surgical or medical protective gloves; (2) protective goggles, glasses or chin-length clear face shields; (3) filtering masks that cover the mouth and nose; (4) nonpermeable, full-length, long-sleeve protective gowns; (5) a leakproof, rigid container clearly marked as Biohazard for the disposal of sharp objects; and (6) a leakproof, closeable container for soiled linen and supplies. (q) (p) If an operator s medical protocols or equipment list is amended, a copy of these changes shall be submitted to the board by the ambulance service operator within 15 days of implementation of the change. Equipment and supplies obtained on a trial basis or for temporary use by the operator shall not be required to be reported to the board by an operator. (Authorized by K.S.A Supp ; implementing K.S.A Supp and K.S.A ; effective May 1, 1985; amended, T-88-24, July 15, 1987; amended May 1, 1988; amended July 17, 1989; amended Aug. 16, 1993; amended Jan. 31, 1997; amended Jan. 27, 2012; amended Feb. 13, 2015; amended April 29, 2016; amended P-.)

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19 Landon State Office Building 900 SW Jackson Street, Room 1031 Topeka, KS Dr. Joel E Hornung, Chair Joseph House, Executive Director Board of Emergency Medical Services MEMORANDUM phone: fax: Sam Brownback, Governor TO: Education, Examination, and Training Committee Dir. Kaufman, Chair Dir. Ralston, Vice-Chair Dir. Pore Dr. Sellberg Comm. James Dir. Smith Rep. Swanson FROM: Mark Willis, Education Manager RE: Interim guidelines for acceptance into Instructor-Coordinator Courses DATE: May 16, 2017 As discussed at the April meetings, we will need to provide interim guidance for prospective instructor-coordinator (IC) candidates given the fact the Training Officer (TO) certification has been proposed for elimination by the end of this year. As identified in (a)4c, the I/C candidate must either possess a current Kansas BOE teaching certificate, or be currently certified as a training officer. Given the fact the certification is proposed for elimination, there will likely not be additional Training Officer courses conducted, as it seems counter-productive to require these courses only for the sake of meeting pre-requisites for admission into future I/C courses. Although I can t provide a specific ratio, a good number of Training Officer course attendees enroll in the course specifically for meeting I/C admission criteria; I utilize the term counter-productive as the same course materials covered in the TO course are repeated in the Instructor/Coordinator training curriculum. The primary motivation for the proposed elimination of the Training Officer certification has been to allow local control in the selection and utilization of those delivering and managing EMS educational offerings and programs. The challenge now lies in ensuring future Instructor/Coordinators are qualified and motivated with coordinating and instructing initial courses of EMS instruction. Our current model appears rigorous; however, our collective results do not bear out we are effective in these selection and training processes, based on our below average results in comparison with other states National Registry certification examination results. I am respectfully requesting the EETC give this matter consideration and be prepared to provide guidance to BEMS staff regarding an approved process to enable qualified candidates, who are not certified as Training Officers, be accepted into Instructor- Coordinator programs. For your consideration, I have enclosed all relevant regulations pertaining to IC standards, selection, and certification. I have also attached an excerpt from the Educator Proposal submitted by the EDTF to the Board in 2011.

20 You will note the EDTF made recommendation that Educators have substantive patient contacts in a field or clinical setting, which they further define as 100+, they have a minimum of 2 years experience (as opposed to one in current regulation), submit 3 professional reference letters, demonstrate competency in a skills assessment, then sit before an interview panel of which the composition and questions presented are outlined and set by the Board of EMS. Commentary/Staff Recommendation BEMS Staff recommendation is the EETC consider elimination of the requirements specified in (a) & (b), and modify sections (c) & (d) to require the I/C candidate successfully pass the National Registry EMT cognitive assessment, and successfully pass all components of the Kansas EMT practical skills examination. It is our belief this method would most effectively affirm competency of the prospective instructor of initial courses of education. This recommendation is aligned with the current requirements of the regulation. The current cognitive and skills examinations are more informal, and do not utilize the validation methods and metrics as compared to the National Registry examination. Though this may be perceived as a more rigorous entry process, the recommended evaluation processes are aligned with establishing minimum competency of certified attendants in Kansas, thus it seems fair and reasonable we would have the same expectation of those providing initial courses of instruction. Desired Outcome of June EETC Meeting The EETC should give consideration to the issue, reach consensus on IC course acceptance requirements not presently defined in KAR , and determine whether BEMS Staff is authorized to approve IC course applicants who do not meet current regulatory requirements until KAR is revised. Provided there is Board approval of these directives and standards, a timeline will need to be established to consider further regulatory revisions to uphold their desired standard. Respectfully submitted, Mark C. Willis, Education Manager Kansas Board of EMS Enc: KAR KAR (pending revision) KAR e EDTF Educator Proposal p. 15 (submitted June 2011)

21 Requirements for acceptance into an instructor-coordinator initial course of instruction. (a) Each applicant for initial training as an I-C shall apply to the executive director using forms approved by the board. Only a complete application shall be accepted. A complete application shall include the following documentation: (1) Proof that the applicant is currently certified or licensed and the applicant has been certified or licensed for at least two years as any of the following: (A) An attendant; (B) a physician; or (C) a professional nurse; (2) proof that the applicant has at least one year of field experience with an ambulance service; (3) a letter from a certified I-C verifying the I-C's commitment to evaluate the applicant on the competencies of the assistant teaching experience defined in K.A.R ; and (4) proof that the applicant has met the following requirements: (A) Has current approval as a cardiopulmonary resuscitation instructor at the professional rescuer level. This approval shall be by the American heart association, the American red cross, or the national safety council; (B) has instructed at least 15 hours of material; and (C) possesses a current teaching certificate granted by the Kansas state

22 board of education or is currently certified as a training officer II (b) If an applicant does not meet the requirement of paragraph (a)(4)(c), the applicant may satisfy the requirement by establishing that the applicant possesses both of the following: (1) Authorization by any state or territory of the United States to be a primary instructor of EMS initial course of instruction at or above the level of EMT; and (2) (A) A baccalaureate, master's, or doctorate in education conferred by an accredited postsecondary education institution; (B) certification as a fire service instructor by the national board on fire service professional qualifications or the international fire service accreditation from the national fire academy; or (C) certification by any United States military organization verifying successful completion of any United States military instructor trainer course that is substantially equivalent to the United States department of transportation national highway traffic safety administration emergency medical services instructor training program: national standard curriculum,'' as identified in K.A.R (c) Each applicant who meets the requirements in subsection (a) and, if applicable, subsection (b) shall successfully complete an evaluation of knowledge and skills as follows: (1) A written medical knowledge examination at the EMT level The boardapproved EMT cognitive assessment; and

23 (2) a practical board-approved psychomotor skills examination assessment at the EMT level. (d) (b) An applicant meeting the requirements in subsection (a) and, if applicable, subsection (b) may be approved by the executive director for training accepted into an instructor-coordinator initial course of instruction based upon the following criteria: (1) A score of at least 80% on the written medical knowledge examination described in paragraph (c)(1) passing score in each area of the board-approved EMT cognitive assessment; and (2) a passing score for each practical skill board-approved psychomotor skills assessment station described in paragraph (c)(a)(2). (Authorized by K.S.A , K.S.A Supp ; implementing K.S.A , K.S.A Supp , and K.S.A b; effective, T , Jan. 19, 1989; effective July 17, 1989; amended Feb. 3, 1992; amended Jan. 31, 1994; amended Nov. 12, 1999; amended Nov. 9, 2001; amended Sept. 2, 2011; amended P-.)

24 Requirements for acceptance into an instructor-coordinator initial course of instruction. (a) Each applicant shall successfully complete an evaluation of knowledge and skills as follows: (1) The board-approved EMT cognitive assessment; and (2) a board-approved psychomotor skills assessment at the EMT level. (b) An applicant may be accepted into an instructor-coordinator initial course of instruction based upon the following criteria: (1) A passing score in each area of the board-approved EMT cognitive assessment; and (2) a passing score for each board-approved psychomotor skills assessment station described in paragraph (a)(2). (Authorized by K.S.A , K.S.A Supp ; implementing K.S.A , K.S.A Supp , and K.S.A b; effective, T , Jan. 19, 1989; effective July 17, 1989; amended Feb. 3, 1992; amended Jan. 31, 1994; amended Nov. 12, 1999; amended Nov. 9, 2001; amended Sept. 2, 2011; amended P-.)

25 Executive Summary Fine Schedule Passage of Senate Bill 224 of the 2016 Kansas Legislative Session granted the Board the authority to issue civil fines and penalties as an additional tool within the disciplinary action toolbox. With the additional tools, it is imperative that the Board remain consistent in its approach to disciplinary action and a step towards maintaining that consistency is through the creation of a fine schedule. This schedule provides a framework for a consistent manner for which the fine amount for violations is determined. There are 3 proposed fine schedules Attendant, Operator, and Instructor-Coordinator. This is consistent with the 3 categories within our graduated sanctions. Each schedule contains a fine amount for each sanction level within our graduated sanctions (Levels 1 through 6) and then list out an amount for a 1 st violation, a 2 nd violation, and a 3 rd violation. There is also a penalty amount listed for when aggravating factors are present. Each fine schedule reaches the maximum allowable amount at a Level 6 infraction. The intent for this schedule is not to fine the Respondent in the case for each violation, but rather to consider the case in its entirety and base any fine on the single most significant violation. The Board s Investigation Committee is reviewing this schedule and has this item upon their June agenda for consideration and possible recommendation. For your quicker reference, the following are defined within K.A.R (Graduated Sanctions). Sanction level 1 the local action taken is approved and accepted by the board s investigation committee. Sanction level 2 modification of a certificate or permit by the imposition of conditions. Sanction level 3 limitation of a certificate or permit. Sanction level 4 suspension of a certificate or permit for less than 3 months. Sanction level 5 suspension of a certificate or permit for 3 months or more. Sanction level 6 revocation of a certificate or permit. Also attached to this are K.A.R (in its entirety) and each of the 3 documents adopted by reference that list out the table of graduated sanctions.

26 Attendant Fine Schedule Level First Violation Second Violation Third Violation Level Violation # Minimum Maximum Aggravating Total 1 $25.00 $ $ $50.00 $ $ $25.00 $75.00 $50.00 $ $ $75.00 $ $ $25.00 $ $50.00 $ $ $ $ $ $25.00 $ $50.00 $ $ $ $ $ $ $ $50.00 $ $ $ $ $ $ $ $50.00 $ $ $ $ $75.00 $ $ $ $ $75.00 $ $ $ $ $75.00 $ $ $ $ $75.00 $ $ $ $ $75.00 $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ Levels 2 and 3 the fines increases $25.00 at each level. Level four, and with a possible suspension up to 90 days, the fine doubles up to the maximum allowed. Levels five and six, with a possible suspension of not less than 90 days, the fine doubles at each level up to the maximim allowed. Maximum fine per violation is $ Second violation fine will increase $75.00 at each level up to maximum fine. Third violation fine will increase $ at each level up to maximum fine. The Aggravating Factor Fine is suggested when circumstances are appropriate.