State Council Report May 9 th & 10 th, 2017 Staff Report As many of us know from our last meeting, Lee has been traveling across the state attending REMSCO meeting, she stated that many REMSCO s have a good idea that EMS is suffering and that YTD 17 services have already closed or consolidated. The department continues to struggle with a staffing shortage and there is no end in sight. The Vital Sign s conference will be held on October 25-29 in Rochester. The EMS memorial service will be held on May 23rd, Lee is hoping we can pack the Plaza with ambulances and providers. She is also hoping that there will be a fly over by Lifenet. Sadly, this year there will be three more names added to the memorial. The Trauma Center verification process is still underway with several new verifications, there are also several more hospitals that are awaiting visits. I have attached a copy of the Bureau s operations report Medical Standards/ SEMAC Mercy Flight Central protocol changes were brought forward to the SEMAC, the changes included sedation, surgical airway and push dose pressers. Changes were approved. SEMAC also removed SEMAC advisory 97-03 which is the hyperventilation advisory as it was felt that it was no longer needed due the training and educations standards that are currently being taught. Surprisingly the next discussion didn t get heated as I thought it might, it had to do with the State BLS protocols vs. the Collaborative BLS protocols. The answer is that we can follow both sets of policies as approved by SEMAC, Lee quoted Part 800.15a which states, comply with prehospital practice standards applicable for the geographic region of the State
in which the individual is practicing. With that being said there was a TAG created between Medical Standards and Training and Education to try to align these protocols so that there is one standard to follow. The stroke protocol had an extensive conversation, what is the window we should be using from last known well? Primary Stroke centers vs. Comprehensive Stroke Centers. Do agencies actually know what services are provided at each stroke center and could that play into the time frame? When should Medical control be contacted? This protocol was referred to the BLS Protocol TAG for work over the summer. Along with the discussion on stroke, the Coverdell Stroke Hospital Data Collection Program also gave a presentation. It shows that EMS participation in stroke care shows improves the care for strokes. The Check and in Inject demonstration program has come to an end, there were a total of 77 uses without any complications. The interesting part of this was that when the commissioner approved the program he was not able to specify the same syringe that was used in the demonstration product as to endorse one specific brand of syringe so in essence any 1cc with a 23g needle can be used, however not recommended by the SEMAC. Lee also stated that the injection could occur in the thigh or arm. There was some talk about death of nursing home patients during a transport to the hospital, do they go back to the nursing home or to the hospital? In some areas neither the hospital or nursing home are taking them leaving EMS with a dead patient in their ambulance. It was recommended that EMS and Nursing homes work on some policies until more research can be done on the issue. CCT TAG report More to come on that later in the report. Pier 11 regions have submitted award nominations, there is a conference call on 5/19/17 to discuss the nominees and to select the award recipiants. Education and Training The biggest thing to come out of this meeting is that NYS has a new testing provider, PCI. Exam results will now be available to course sponsors through a portal instead of the Box. Along with that, DOH has changed their stance on on-site scoring results, they are no longer a temporary certification and that wording has been removed from the letter. On-site scoring is now only for self-gratification to see if you passed or failed. The good news is that exam results are coming to the state faster and it only took 12 days to get the cards mailed from the time of the exam. Course sponsor renewal packages have been sent out. Instructor renewal packages will no longer be mailed to CIC s and CLI s effective 9/1/17, it will be up to the course sponsor s and individual instructors to keep track of expirations and renewals. The NAEMSE Level 1 Instructor course will be offers as a pre-conference ay Vital Signs this year. This course is the alternative to the State CIC/CLI class. Remember those new instructor exams? Exam results for CLI s range between 80-100%, CIC s are much lower but starting to trend upward.
Systems The systems Committee met and had a pretty uneventful meeting as there were no appeals to be dealt with, there are currently 3 appeals that are pending and with any luck the ALJ will have ruled by the September meeting. There was a reminder that policy 06-06 remains in effect and should be followed until the revisions are complete, whever that may be. There are currently still 6 ALS agencies that are not in compliance with the new controlled substance regulations, some of which are due to the agencies not renewing their license. It is a federal offense for these agencies that still may be carrying narcotics without a valid license. Regional coucils are reminded that they should be taking action against these non compliant agencies. Executive Committee No Report Finance There are 4 program agencies that have not submitted their budget template yet and the due date has passed. Currently about 30% of the bureau staff is eligible for retirement, the bureau feels that if this were to happen they would be left even more short staffed due to not being able to hire. Safety The committee has started working on the revision to 800.22, outlining the regulations for ambulance construction. The NFPA and CAAS are the primary source of the proposed changes. The committee has also continues working on policy statement 00-13 which is the emergency vehicle operations. The topic of ballistic vests was brought up and where agencies may be able to find grant money. It also appears that many agencies are just picking out vests and have no real policies in place or even what type of vest should be worn. The was also some talk about scene safety and the awareness of the EMS Providers, this discussion included things like defensive tactics for the EMS provider. Legislative 2 seconded motions for support were brought forward to SEMSCO and were passed: - A03978A-S02528 - Amend Social Services Law in relation to timely Medicaid reimbursement of transportation costs for emergency care. -A04213-S00230 - Amend the Executive Law in relation to designating the month of September as firefighter, police officer and emergency medical technician appreciation month.
Bills that are being watched: A02733A-S05588 - Community Paramedicine services. Would enable EMS personnel in collaborative programs to serve in other than emergency and transport services. After discussion a motion was made and passed to support the legislation currently being refined. A07505-S05643 - Would enable oversight by Commissioner of Transportation on hours of work by EMS personnel driving an ambulance. S4384 - Would allow RNs and LPNs to serve alongside BLS and ALS personnel on volunteer ambulances and BLSFR services without having EMS certifications. Currently noncertified personnel can be on an ambulance and serving in positions such as driver or attendant. S1315 - Concerns Municipal CONs and removal of 2 year initial temporary requirement. S2770 - Would classify EMS as an Essential Service along with police and fire. As such there would be access to Homeland Security grants. Worker s Compensation will allow stress as a compensation claim. Other SEMSCO Business EMT-CC TAG REPORT The separate 85 page attachment that covers TAG membership, statistical data, narrative information and the 4 recommendations was sent out via email to all REMSCO members earlier. Statistical data indicates: There are over 58,000 certified EMS providers in NYS. The number of EMTs, AEMTs and EMT-Ps are increasing each year. The number of EMT-CCs are decreasing and was down to 2.78% in 2016. The number of EMT-CC original and refresher courses are decreasing each year. Some regions have a higher % of and higher reliance on EMT-CCs than others. The EMT-CC course materials need to be updated and the test validated, both involving significant costs. Reciprocity and mutual aid between states are hampered by the lack of equivalent certifications in other states. In NY the EMT-CC level is not utilized in NYC. The EMT-CC program was created to assure delivery of ALS to rural and underserved areas but it is also currently used by some suburban regions. The National EMS Educational Standards suggest that the AEMT level of care exists to fulfill that same purpose and an analysis of the scope of practice of the AEMT suggests this skill set may be a suitable replacement for EMT-CC level care in some locales. During the public comment period at SEMSCO meeting there were 9 individuals that offered comments. Some had also made comments at the SEMAC meeting. These individuals included agency director, course sponsors, several instructors and Regional officials. There were several comments on how specific regions heavily rely on EMT-CCs for ALS level care. Travel time and costs for EMS personnel to acquire training is a big issue in some areas. Time frames in the recommendations were felt by some to be too short. After discussion and a defeated motion to table action on the report, the 4 recommendations in the TAG report were modified as follows: 1. Continue the CC CME refresher program. This item changed from #3 to #1 in the list of recommendations. 2. DOH no longer approve original CC courses starting after September 1, 2017. Changed to January 1, 2018 3. DOH no longer approve CC refresher or CC rapid refresher courses starting 18 months from item #1 above. Reference is now to #2 above since the initial recommendations were reordered.
4. DOH create an automatic advanced standing CC to Paramedic bridge program open to any currently on-line NYS CC *. Such a bridge program should include on-line didactic content with availability of skills and testing a local course sponsors. ** * ADD: with 3 years of continuous practice ** ADD: DOH will operate this bridge program for a minimum of 10 years from January 1, 2018. The final SEMSCO vote was 17 YES, 3 NO and 0 Abstentions The next meetings will be held on September 13 th and 14th.