Kansas Board of EMS Subcommittee Meetings December, 2013 Summary notes only. These are NOT the official minutes of the meetings. Reminder: These are NOT the official minutes and are provided courtesy of Region III for informational purposes only. For the official minutes, see the Kansas Board of EMS website www.ksbems.org. Planning and Operations 0900-1030 December 5, 2013 Refer to board packet for additional information 1. Standing Items a. KEMSIS Update Moreland No update or additional information b. Sample Protocol Whitlock Not yet completed no update or information 2. Old Business a. 109-2-2 Application for ambulance service permit and vehicle license/renewal Cromwell Public hearing was held Friday Nov 15, 2013. No comments were received. Requires roll call vote by board for adoption Motion and second to move forward to board meeting - passed b. Ambulance Staffing 109-2-7 Cromwell The AG s office has reviewed it and requests the removal of ACLS and PALS by adoption. New language was drafted and state process restarted. See board packet for revised language. Update from Dave Johnston met yesterday for review. Will be posted on Dec 12 for public comment for 60 days, comments will be reviewed at the April meeting. Once posted on the website, there is a portal to make comments Need clarification on a couple things Definition of certifying entity approved by the board on page 4 for advanced cardiac life support and pediatric advance life support as ACLS and PALS were too product specific. This language is designed to approve more than one curriculum or equivalent can be used. The board only wants to make sure someone has that advanced training. This allows local medical control to develop curricula to match local protocols for education at this level. Intention was not to require specific AHA courses or support specific organizations as these become quite costly. Work is continuing on the complete rewrite of this regulation and will have something to present at February meeting.
c. 109-2-11 and 109-2-13 Type V and standards for fixed wing Cromwell Both have passed the DOA after minor grammatical changes, AG s office has reviewed both documents and they are in state process. d. 109-3-5 AEMT authorized activities Cromwell An error was found on 11-6-2013 and corrected (Fentanyl was not moved into the opioids). All of the regulations listed are being sent through the state process together. These will be published Dec 12 for 60 days for public comment; comments will be reviewed at the April meeting 3. New Business 4. a. 109-2-8 Standards for ambulance equipment Cromwell A letter of support for opening 109-2-8 to revise and eliminate carrying short spine boards based on protocols from OPFD This would have to be removed from this regulation. This will require opening of the regulation and it will be posted for public comment. This will also allow a full look at this equipment list. A question was raised if a standard equipment list is really necessary or if equipment should be driven by local protocol Motion and second to open this will move to full board for vote to open. b. Managers Report Cromwell Inspections Vehicles remain the highest area of non-compliance. Overall, load lights and fire extinguishers are the highest but less than 2012 Interior unsecured items and interior lights out are the highest but still better than 2012 Discussion about inspections if the law says red lights visible in 4 directions but one bulb is not functioning in a lightbar with 8 bulbs, shouldn t be dinged when still in compliance with law. If things are immediately fixed, shouldn t show up in a letter to commissioners (example is spare bulb/batteries carried next to laryngoscope as it worked on daily check but didn t at inspection. Powerpoint can be requested by email.
5. Future Discussion 6. Member Comments Question on background checks Steve - Thought to have everyone that is initial new attendant. If they have been in the state 3 or 5 years? (residents). State background check for residents, State and National check for non-residents. Cost is $50 and that is a concern in trying to keep costs down. KANAAMS evaluation of level 4 trauma centers and the need to have a dedicated helipad gathering data at this time. Region 3 working with MMRS and Homeland Security acquired a command trailer and prime puller for the MERGe team, also acquired a Gator. Region 2 gearing up for the testing that will be happening in the next few weeks. Putting together an Educator Workshop, discussions on bringing MERGe in for a presentation Region 1 Absent Region 4 training in January with Bob Page KEMSA Dec 10 Billing Seminar at OPFD. Administrator workshop wrapped up and ended up with 19 in attendance. Just Culture workshop had 49 attendees hoping to bring more Just Culture to the state. Admin Society putting together a winter workshop. MARCER discussion on creating a protected route for discussion between EMS and hospital conversations. Community Paramedic one hospital has engaged an EMS service on re-admission data. STEMI Stroke data collection working to improve this process and protect information. KDHE half way thru grant year, hoping all will make use of the funds available. Looking for communication on intent to use funds. Need to know so funds can be utilized to full potential. EMSystems - trying to get a trauma page put on the site Trying to get all hospitals to add a landing site for larger helicopters for resupply or patient movement by larger helicopters. The Regions are struggling to meet federal requirements for grant reporting without a full time staff. If all the man-hours are going to meet paperwork, it isn t getting any preparedness done. Looking to see if there is a better way to do this. KEMSA Just received information Chy Miller bill, temp reg will be open for public comment shortly, hearing will be held for final. National Initiatives Interstate Compact project is to try to come up with a way for interstate EMS providers in other compact states so they can function with a
state license in another state. Current is to only deal with EMT s and Paramedics that have taken the national exam. They would also have to have undergone a background check. They would function under their own protocols. Executive Committee 1100-1230 December 5, 2013 Refer to board packet for additional information 1. Legislative Packet a. Approval vote, discussion of public comments on final draft 2. MAC Report Line 248/249 clarification inserted language to allow TO to continue to participate in initial course of instruction, labs, etc. This language possibly is not needed as an IC can pull anyone in that is a subject matter expert (SME). Line 474 cardiac monitoring is not defined, should be defined to application of ECG leads to acquire rhythm strip. 109-3-3 says EMR can do cardiac monitoring, 65-6144 does not include it for EMR this will need clean up one way or the other. Motion to move forward as is to full board for vote tomorrow. Motion to have the spinal immobilization opinion posted on the board websitemotion passed. 3. Old Business a. KAR 109-16-1 Graduated Sanctions Roll Call Vote b. Strategic Planning Members of the strategic planning review committee to be determined and meeting to be scheduled to review current documents, revise as necessary and present to the Board for sanctioning No discussion c. AG Opinion Investigations Committee Meeting - PENDING 4. New Business
Education, Exam, Training, Certification Committee 1300 1500 December 5, 2013 Refer to board packet for additional information Standing Items a. Transition Update 6553 attendants currently certified: EMR (476), EMT (5440) AEMT (637) Approximately 1708 remaining to transition. Of the 1708, 770 must transition by the end of the year or lose certification (708 EMT-B and 62 FR). As of January 2014 5 FR remain to transition (4 by 12/2014 and 1 by 12/2015) 196 EMT remain to transition (104 by 12/2014 and 92 by 12/2015). 2014 begins the first year of transition or lose for EMT-I (265), EMT-I/D (46) and EMT-D (7) certifications. b. Transition Audit Update No courses have been found significantly deficient since the October meeting. All courses that were deemed to have been non-compliant in the year-to-date have been completed and documented the necessary corrective action. c. Regulations KAR 109-15-2 recognition of non-kansas credentials This regulation has been amended to allow current National Registry certification to suffice as documentation that the individual has completed coursework that is substantially equivalent to Kansas requirements and that the individual has taken the examination as prescribed by the board. This regulation also only allows individuals to receive legal recognition as one of the 4 new scopes (EMR, EMT, AEMT, or Paramedic) in the absence of National Registry certification. Current Status Heard by Joint Committee on Administrative Rules and Regulations on November 5, 2013 The committee had no comments. Public hearing scheduled for December 16, 2013 at 9 am. d. Variances The agency received a request to waive the requirement of a paramedic student to perform his/her field internship at a Type I ambulance service and to allow the student to complete this at a Type IIA ambulance service. The student cited family health concerns and infrastructure instability at the current Type I service the student
is scheduled to perform this internship with. The school, student, and Type IIA service assure they will have a paramedic preceptor available at all times with this student during internship if it is allowed to be performed through the Type IIA service. Agreed to approve e. BLS Exam Vendor Report 2 full weekends of testing Hays, Junction City, Overland Park, Andover. Sites limited to 65 candidates failing one station allows retest. Failure of two does not allow retest Regions need money sent in when names submitted to secure spot at test site. Looking for people to help at test sites f. Educator Proposal Implementation 1. Removal of statutory authority for training officer to coordinate initial courses of instruction. Staff was tasked with following through on recommendation of removing the statutory language allowing a Training Officer to coordinate initial courses of instruction. This language was proposed to the legislative review committee as reported in the Executive Committee KSA 65-6112 definitions. 2. Regulatory changes Training Officer All of these regulations were posted on the agency s website as proposed draft regulations with the ability for public comment to be received. These were for cleanup of Training Officer / TO I and TO II language. 109-9-1 Definitions general clean up 109-5-3 Con Ed approval for long term providers clean up Training Officer language 109-8-1 Examination general clean up 109-9-4 acceptance into an IC initial course of instruction clean up 109-10-1 Curriculum approval - clean up or discussion on revocation as this is addressed in other regs 109-10-1f Approved TO I standards to include the TOII initial course standards 109-10-1 g Approved TO II standards revocation 109-10-3 Late Enrollment delete references to TO II 10-10-7 Distance learning general clean up 109-11-1a EMR course approval language clean up 109-11-3a EMT course approval language clean up 109-11-4a AEMT course approval language clean up 109-11-6a Paramedic course approval language clean up 109-13-1 Training Officers language clean up Discussion to change 109-11-6a to allow FI with a Type 2a service under direct supervision of a paramedic motion, second and passed
Old Business a. Board appointment vacancy on EDTF Chris Cannon was notified of his appointment and all remaining candidates were sent notification of the appointment and asked to remain engaged in regional activities. Region meetings and times for the remainder of the year were provided to each. New Business a. KAR 109-10-2 Long term accreditation of training programs conducting initial courses of instruction. This regulation was last amended /revised in 1999 and contains language that pertains to accreditation by the committee on allied health education programs (CAHEP). Some of this language is redundant to language in 109-11-6a. Discussion as to whether this regulation is necessary. GCCC is the only entity that currently provides non-paramedic initial courses of instruction through this route. Cowley advises they use this process as well. It should be updated, but should stay. b. 109-11-1 Citations Effective March 15, 2013, 109-11-1 was revoked; however, regulatory citations exist pointing to 109-11-1 as reference for course curricula in 109-10-7, 109-11-3a, 109-11- 4a, and 109-11-6a. These four regulations have pending proposals for the implementation of the TO portion of the Educator Proposal and the regulatory citation can be revised to accurately reflect. c. AEMT Educational Standards Changes in the AEMT scope of practice, particularly a change in authorized medications, has prompted the need to review the Kansas AEMT educational standards to ensure that the standards ensure education is present regarding the intended scope of practice for the AEMT. Discussion pertaining to how this should occur and whether the EMR, EMT and Paramedic levels need to be included in the review/update. In the November MAC teleconference, the MAC endorsed and supported the enhancement of the EMT curricula to bridge the gap. d. 109-11-10 EMT-basic bridge course approval As of January 1, 2014 only 5 individuals would qualify to take a course that meets this approval. With the move to the new scope of practice, it is proposed this regulation be revoked. The new scope of practice was designed where each level of skill expands upon the base level in depth and breadth of knowledge and skills. In lieu of revocation, this regulation would require revision. Motion and second to revoke passed e. Paramedic field internship Discussion as to whether the requirement for a paramedic student to complete their internship with a Type I service is necessary or if the regulation should allow the ability
EDTF for a paramedic student to complete field internship at any permitted Kansas service as long as the service provides ALS care and the student has a direct paramedic preceptor for the entire duration of their scheduled field internship. 109-11-6a is the regulation requiring a Type I service. This regulation is currently pending revision for language changes for TO. f. Retroactive CE vs Prior-approved CE Discussion in regards to items listed in 109-5-1 (c) that are considered forms of priorapproved CE. Confusion is present between 109-5-1 and 109-5-2 regarding whether CE is automatically granted to courses in 109-5-1 (c) because of 109-5-2 or whether it must be received through either a prior approval or retro-active approval CECBEMS courses are not currently approved in Kansas without prior approval. Much discussion followed on this Curt Shreckengaust will provide an update from EDTF on each of these items a. NREMT Proposed continued competency program December 2013 Received support letters from professional organizations, regions, ff b. Scenario development ongoing Development continues to ensure that scenarios are developed that work for testing as well as having additional scenarios available. c. Educator Proposal Implementation Plan ongoing Development is progressing Announcements a. Online attendant renewal port opened Sept 23. Attendant renewal packets were mailed out USPS the same week. As of Nov 20, 1458 attendants had renewed certification and 3590 remained to renew this year. b. Board Staff Vacancy
KBEMS Board Meeting 0900-1200 Dec 6, 2013 1. Call to Order New member welcome Dennis Franks (Hospital Administrator), Dr Denise Miller (Physician Representative) 2. Approval of Minutes 3. Committee Reports and Possible Action 4. a. P/O see committee meeting for notes i. KAR 109-2-2 Vehicle Maintenance Program by roll call vote b. EETC see committee meeting for notes Motion to open 109-2-8 Equipment list for discussion Motion to proceed with regulations that need clean up Motion to revoke 109-11-10 Bridge Course c. Executive i. KAR 109-16-1 Sanctions Motion to move forward Motion Passed ii. 2014 Legislative Packet Discussion to strike cardiac monitoring from EMT as it is a non-invasive skill and all providers should be able to apply leads and acquire a strip. Concern is current language of cardiac monitoring implies interpretation and EMT or EMR is not educated to this level. Change wording to lead application and acquisition. If EMR can apply and acquire, this language should be moved to EMR level as statute does not say cardiac monitoring so it supports regulatory language. Motion to remove cardiac monitoring from EMT level and change wording to lead application/acquisition and place in EMR level Motion to move legislative package forward incorporates changes with the omission of background stuff. Jason White comments cost factor of background checks student, KRAF grant, organizations? New applicant background checks are
5. Office Update 6. Public Comment totally separate from existing technicians where is the line for existing applicants? What do we tell existing technicians if 1100 currently certified have felonies? Hospitals require background checks for people doing clinicals, a lot of services require pre-hire background checks. how many do we have to do? We don t have reports of people doing horrible things to people in ambulances. What problem are we trying to solve? Terry David Sarah Fertig says the state organization has no liability for certifying a felon the local service has that liability for not fully vetting. Cost is huge. This cost should not be borne by individuals or volunteers or services. If it is that important, the state of Kansas needs to pay for it. MAC update discussion on report from MAC on spinal immobilization. Motion passed yesterday to post the position statement on the website. No additional discussion on background checks Met with some supporting agencies in the state to deal with vacancies. DOA advised if KBEMS changes to job description to only Fiscal Officer, DOA will provide HR support by contract for $500 / month. Will not be able to hire IT person for what they were paying Jean Claude. If state handles it, it will be minimal tech, not as sophisticated as it was. Terry Image Trend program was great. Image Trend representative was engaged and cleared up every question. Rice County was looking at a different software prior to that and now is very happy with it and will stay with Image Trend. Kudos to Joe Moreland for putting this session together. There does need to be User Group that meets periodically as well as that group can be a support group for each other. 7. Executive Session Move to executive session