FIRESCOPE EMS Specialist Group San Diego Meeting September 15-16, 2014 Attendance: Ed Gandara LAC Jim Marugg SMG Mike Giannini MRN Greg Reynar LFD Pete Roebuck - CHO Ron Vega - CNT Bill Garrison LAC Scott Zeller - VNC Steve Pendergrass KRN Bill Lockhart - ORC September 15, 2014 Meeting called to order at 0900. 1. Introductions, Roster Review, Plan of Work Review Gandara Roster revisions, Plott & Nuckols removed from the rosters. Send Gandara any corrections. 2. Task Force Report Gandara Tactical Law Enforcement Document TF reviewed and was generally pleased with the work. Gandara is completing revisions with Stratton. Gandara has requested the TF to provide briefings from the FIRESCOPE representative to the State TEMS Advisory Committee to be disseminated to the appropriate specialist groups. FEMT Curriculum TF is pleased with the work. Waiting for approval from the TF to send draft curriculum to the list of SMEs. 3. Stakeholder Reports Giannini Funding for EMSA is stable. Ebola virus discussion and how to potentially manage Ebola pushed out to LEMSA s. SB 556: Identification of health care providers. Private vs. public health care providers. The private provider may need to be identified as private no resolution at this point. SB 1438: Narcan bill. Push down to the EMT scope of practice. The LEMSA Medical Director would decide if it would be utilized in their area. New DEA ruling that will require oral narcotics to be moved into Schedule 2 category. This will require that EMT Scope of Practice regulations be opened up to allow utilization of Narcan by EMT s. This may provide an avenue to also include FEMP s to provide OTC medications. AB 1598: Active Shooter Legislation. Enrolled to governor s desk. Unknown status at this point. AB 2536: Protects workers from employer retribution when working as a disaster worker. AB 2577: Interfacility Transport Reimbursement. Possible substantial additional revenue for fire service agencies. Community Paramedicine: Hearings are going on at this time with a total 90-day review. Late fall for OSHPD to decide on whether to move forward with pilot programs. o Pilot projects will be from 1-2 years. Page 1 of 5
o When pilot projects are in place, the State will be working on legislation to support this program if the decision supports a move in this direction. o Some opposition from nurse & physician groups. o From the hospital s perspective, they generally support a move in the direction of acceptance of Community Paramedicine. Hopeful outcome is lower number of readmissions and lower first-time admissions (capacity issue). Public Safety First Aid Regulations: Law Enforcement included requiring AED training. May be implemented by January 2015. Health Information Exchange (HIE) HIE summit at the LA Westin November 17-19, 2014. Wall-Time Tool Kit: Package to utilize in a system to reduce wall time. Will be reviewed in October and sent out. E-Cigarettes Nicotine bottles have no safety caps. Children have OD d on nicotine. An issue to start following. 4. FEMT Curriculum Vega Reviewed the three formatted curriculum documents. The content of the documents are the same. The documents are formatted differently based on current or new templates from State Fire Training. Discussion on the need to include first aid/emt content in the curriculum. Decision made not to include first aid/emt content except appropriate references to dehydration and Rhabdomyalosis. Additionally, include case studies of incidents focusing on how the FEMT managed the event or injury rather how to treat the injury. Discussion on SME review. Waiting for TF approval to send out curriculum for SME review. Discussion to develop a comment sheet for reviewers to compile edits or comments rather than track-change format. Vega to draft comment sheet. Gandara expressed the need to include a cover or instruction sheet for the SMEs to be included with the correction sheet and curriculum. Discussion on including a companion PowerPoint presentation as an instructor s aid for the lesson plan. This would be a generic presentation that would provide an instructor with a foundation to start with if the instructor had no slides or add an instructor s own slides to build on the presentation. Vega & Marugg to develop a presentation module. Gandara discussed the need to complete the curriculum project and for the group to begin assisting Vega with reviewing the three curriculum documents for edits or comments. This project will be a priority for the remainder of the year. Vega to draft Comment Sheet for the group & SMEs to provide their review comments or corrections for the FEMT curriculum documents. Gandara & Vega to draft a cover letter for SME review. Vega & Marugg to complete document formatting & collect slides for PowerPoint presentation. 5. Over-The-Counter (OTC) Medication Giannini Discussion by the group describing the problem with FEMTs/FEMPs making available OTC meds on the fireline. Discussion that this scenario is no different than OTC meds being provided for station personnel through a fire station cabinet for personal use, or strike team personnel stopping at a local drug store to purchase on their way to an assignment, or picking up OTC meds from the Incident Medical Unit before leaving for their assignment. The FEMT/FEMP should be considered an extension of the Medical Unit, providing OTC meds for personal use so line Page 2 of 5
personnel do not have to leave their assignment to pick up OTC meds that they normally would pick up from the drug store or Medical Unit. Discussion regarding options for how the group should pursue the implications of doing nothing and continuing the current practice vs. drawing support for addressing the issue and seeking approval from the stakeholder regulatory stakeholders (EMSA/LEMSA). Is there a legislative route that can be pursued if there is a negative impact from the regulatory stakeholders? Discussion that the EMS SG should draft a problem statement that adequately describes what the OTC medication is and what it is not, and what the group sees as options or solutions. Then the group can then request approval from the TF to start seeking support from stakeholder groups (EMSAAC, EMDAC, EMSA, Cal Chiefs) for officially addressing the issue through LEMSA policy or possibly by regulatory means (Scope of Practice) depending on how the regulatory stakeholders view this issue. Discussion on revising the OTC Medication language in the Plan of Work to better reflect providing or making available for personal use rather dispensing OTC medication by FEMTs & FEMPs. Giannini to begin drafting problem statement for group comment & discussion, then submit to the TF for approval to begin seeking outside support for solutions for the OTC medication issue. Gandara to discuss with Stratton revising the OTC Medication language in the Plan of Work. 6. Tactical Law Enforcement Document Revision Gandara Gandara reviewed the current document status and the two revised document versions that the TF requested to review. Discussion on three items that were revised that Gandara provided comments regarding the need to be re-addressed with the TF because the revisions changed the meaning and intent of the original content. The group is waiting for TF direction on proceeding. Discussion on some formatting issues that were identified by the TF. Gandara to work with Zeller on the minor revisions. 7. December Meeting Gandara Discussion on the December 3 (afternoon) and December 4 San Francisco meeting. Giannini reported that the EMSA annual EMS Awards Ceremony was being immediately after the EMS Commission meeting and that would impact the afternoon EMS Specialist Group meeting as previously planned. The decision was made by the group to conduct a one-day meeting on December 4 to allow group members to attend the EMS Awards Ceremony. Giannini will handle the meeting location logistics, possibly in Millbrae to facilitate the afternoon commute to SF Airport. Giannini discussed that the EMSA was changing the September 2015 EMS Commission meeting date, possibly to Sept 2, 2015. Decision would be made at the September 17, 2014 EMS Commission meeting. Action Item: Giannini & Garrison to work on December 4 meeting logistics and meeting flyer. Page 3 of 5
8. Roundtable Garrison EPCR & Monitor RFPs in progress. Promotions & delayed FF exam impacting FF/Paramedic vacancies. EMS Bureau build-out continues. Giannini EMS policy revisions process. Challenges with EPCR vendor/technology issues. Vega Lodge Incident burn over discussion. Lessons learned. Zeller Losing a QI part time nurse, replacing with full time QI nurse. VNC possibly going away from American Heart CPR. Pulse Point program reports only 8 patients countywide did not receive bystander CPR. Reynar LFD going to new Panasonic Tablet for EPCR. USB port available, no Otter Box case necessary, card read accessory was added for reading driver s license. Hospital wait times still an issue. LFD looking to pilot the use of hemostatic dressings, waiting for approval from LEMSA. Pendergrass New CAD system being implemented. Facebook 911 calling system crashed the CAD. The same CAD vendor is being used for EPCR. Lockhart San Clemente Hospital closure, impacting the system. ORC s E-Motion EPCR system having issues. May look for another system. Gandara Continuing to work on County Ambulance RFP. Reminder that 2015 officer positions are coming up at the December 2014 meeting. Meeting adjourned at 1630. September 16, 2014 Meeting called to order at 0800. 9. FEMP Ordering through ROSS Roebuck Discussion on the 9 designators for FEMP & FEMT currently in ROSS and the problems associated with MEDLs ordering different designators in hopes of filling the request (sometimes ordering Any Paramedic ). GACCs will only fill what is listed on the order and do not have a procedure to interpret the equivalency to the FEMP position. Discussion that it will be very difficult to convince the Federal ROSS system to only accept FEMP designator. FEMP is only used in California, not nationwide. The most likely solution is to educate the MEDLs to only use FEMP/FEMT designators for arduous line assignments and to create an equivalency tool or table for the GACCS to use when filling orders for paramedic or EMT assignments. Discussion of developing a problem statement with solutions or recommendations to submit to the TF for direction and approval. Roebuck to begin drafting a problem statement & recommendations, focusing more on the MEDL issue & equivalency tool. Gandara & Garrison to follow up on MEDL list. Page 4 of 5
10. OTC Medication Discussion Continued Gandara Continued discussion on drafting an OTC Medication action plan of how the group would like to proceed with this issue. This would be a status briefing to the TF and would give the group a written plan of how the group would like to proceed. Action Item: Gandara to complete the draft & submit to the TF through Stratton. 11. Roundtable Roebuck Discussion regarding EPCR and how data is compiled and shared. EMSA focusing more on transport data than treatment data. Gandara Conference call on Wednesday September 24, 2014 @ 0700. Gandara to send out agenda & conference call numbers. Meeting adjourned at 1030. Next meeting December 4, 2014 in San Francisco, location & times TBD. Page 5 of 5