MEETING SUMMARY July 14, 2009

SCEMS Offices Hauppauge, New York 11788

NOTE: This summary is a draft summary until formally approved by the REMSCO at the September

2009 meeting.

Present: See attached attendance list.

• Chairman Stapleton welcomed all in attendance and led the Council in the Pledge of Allegiance. Mr. Stapleton then led the Council in a moment of silent for the EMS persons who haven given their lives and for the troops fighting for our freedom overseas.

• Chairman Stapleton welcomed all those present and asked that everyone, as customary, to introduce themselves for the benefit of the guests and Council members.

• Mr. Stapleton asked for a motion to approve the meeting minutes from the May 2009 meeting. Motion made, seconded and passed.

Correspondence – M. Matuza Incoming date; from whom; subject 05/28/2009: Setauket Fire Department : Invitation to 100th Anniv. Celebration and solicitation for a journal ad. Event date 8/8/2009. 05/28/2009: NYS Vol Amb and Rescue Assoc.: Pulse check Conference brochure. 05/29/2009: Cablevision: Bill for internet service to County. 06/01/2009: All American Awards : Bill for Bruce Blowers plaque. 06/05/2009: Suffolk EMS : cc on letter to NYS in regards to the upgrade of Sound Beach FD to ALS. 06/15/2009: NYS-DOH : letter of Enforcement Notification regarding Darnell Hagins residing in New York, NY. 06/18/2009: Chase Bank: May 2009 bank statement. 06/19/2009: NYS-DOH : letter of Enforcement Notification regarding Douglas Recupero residing in Great Neck, NY.. 06/24/2009: Suffolk County Vol. Firefighters Burn Center Fund : Solicitation for funds. 07/01/2009: Infrastructure Solutions : Statement of paid services. 07/09/2009: Chase Bank: June 2009 bank statement. 07/10/2009: Suffolk EMS ; cc on letter to R. Flynn, Atty. for Halesite FD in regards to TOA procedure. Outgoing date; to whom; subject 05/14/2009: A. Johnson, NYS-EMS ; Notification of the passing of a motion for Hunter EMS, Inc to become an EMS Course Sponsor. 05/15/2009: Mr. R. Pizzolo, St. Mathews Church, Dix Hills, NY, Ms. B. Lawrence, Central Islip Little League and Ms. K. Prego, Lawrence Metal Products, Bayshore , NY; information regarding PAD law and the change of EHCP. 05/29/2009: . S. Sonder, NYS-EMS ; Transmittal of Notice of intent to provide PAD for Topaz Lighting and Electric, Holtsville, Swordfish Owners Corp., Westhampton Beach, The Village of Saltaire, The Boys and Girls Club of Suffolk County, Port Jefferson, PKL Physical Therapy, Amityville, The Chai Center, Dix Hills, Commack North Little League, NY State Office of Mental Retardation and Developmental Disabilities, Commack, Selden-Centereach Youth Association, Selden, West Islip Soccer Club, West Islip Youth Lacrosse, and Allstate Ins. Co., Hauppauge. 06/22/2009: Ms. Meghan Williams, Town of Islip Parks : Confirmation of receipt of PAD change of EHCP. 07/02/2009: S. Sonder, NYS-EMS ; Transmittal of Notice of intent to provide PAD for Constantino Brumidi Lodge, Sons of Italy, Deer Park, Batpoet-Blue Point Little League, Curves, Holbrook, Camp Gan Israel, Southampton, Pine Hills Golf, Manorville, North Patchogue Fire District, Temple Isaiah, Stony Brook, St. Patrick’s Village of the Branch Soccer Club, Holy Family Regional School Athletic Sports Program, Mid-Island YJCC, Wheatley Hts., and Kings Park Soccer Club. 07/02/2009: S. Sonder, NYS-EMS ; Transmittal of Notice of intent to provide PAD for Park Shore Country Day Camp, Dix Hills and the Driftwood Day Camp, Melville. 07/02/2009: Mr. C. Konikov, Camp Gan Israel, Southampton, NY; information regarding PAD law and the change of EHCP.

END OF CORRESPONDENCE

REMSCO MEETING SUMMARY 2 July 14, 2009 Officer’s Reports Chairperson- E. Stapleton

• Mr. Stapleton reported that the working group for the Reconfiguration of the EMS Division is now done with their research and interviews. Mr. Stapleton stated that the working group has had several meetings and conducted several fact finding interviews with subject matter experts on the issue. Mr. Stapleton then presented an informational powerpoint presentation on what was done by the working group and what will be done to make the project complete. The following is a synopsis of the presentation given during the meeting:

o The working group was made up of the leadership of both the REMSCO and REMAC with two exceptions, Tom Lateulere and Bob Delagi whom had recused themselves from the working group stating a conflict of interest..

o The invited experts for interview were as follows; SC Health Commissioner, SC FRES Commissioner, SC FRES Deputy Commissioner, NYS EMS Medical Director, SC EMS Acting Medical Director, SC EMS Acting Director, SC EMS Chief of Training and Education, SC FRES Commission Chairperson, Past SC EMS Medical Director, Past SC REMSCO Chairperson, SC Ambulance Chiefs President, SC Fire Chiefs President, NYC EMS and FDNY EMS Deputy Chief and A Fire District Manager.

o Mr. Stapleton reported that the individuals interviewed had many credentials which make them a very knowledgeable and diversified resource for data and information.

o When the working group first met, the following principals were set for the group to use to help with all the dimensions of the EMS and assist the group with their decision making process; Serve the best interest of the patients in the Suffolk EMS system by promoting the highest quality medical care; assure continued respect and support for the volunteer providers; encourage collegial and productive relationships between the office of EMS and the many Leadership Groups in the Suffolk County EMS System including REMSCO and REMAC; Ensure that appropriate funding and resources are dedicated to the mission of EMS; assure a strong commitment to evidence based medicine in the administration of the Suffolk County EMS system; encourage fair representation of the interests of EMS agencies based in both the Fire Departments and the Volunteer Ambulance Corps.; ensure that both REMAC and the System Medical Director retain their responsibility and authority for overall medical directors and medical decision making; promote optimal response times for ambulance and other EMS response vehicles.

o Transparency was very important to the group and every interview was taped during this process. The key content areas discussed were: perceived advantages and disadvantages of the move; authority of EMS leadership; authority of medical direction; EMS representation in the Fire Service; CQI data collection; provider remediation; operations; reporting relationships; opinion of experts on the best configuration of EMS in Suffolk County.

o The process overview was as follows:40 minute taped interviews (completed) , prepare written report (The written report will go back to working group once Mr. Boyd and Mr. Stapleton draw the conclusions from the interview tapes) and discussion of the report at the September 2009 Council meeting and finally, vote of the Council at the November 2009 meeting .

• Mr. Stapleton stated that the written report will be distributed to the Council members prior to the September 2009 meeting so the discussion can be facilitated appropriately. The written report is not the final decision of the Council until reviewed at the September meeting and voted on at the November meeting as previously stated.

• Mr. Stapleton stated that he would complete his report under the Executive committee report. Vice-Chairperson- E. Boyd

• Mr. Boyd thanked Mr. Stapleton for his tireless effort and meticulous attention to detail in organizing the process and interview programs.

REMSCO MEETING SUMMARY 3 July 14, 2009 Treasurer’s Report – G. Cassara

• Mr. Cassara was excused from the meeting due to a prior commitment. No report available.

Staff/Regional EMS System Report – T. Lateulere for R. Delagi

• Mr. Lateulere distributed the EMS Division staff report and discussed salient points. (attachment #1). • Mr. Boyd asked if the CLIA applications that were sent to the state by the individual agencies incomplete, were

going to affect the agencies abilities to perform BGL testing or would the county be correcting the issues. Mr. Lateulere stated that thanks to Mr. Delagi and the restructuring of the CLIA certifications, there is no loss of service in this interim period while the paperwork is being restructured. Going forward, this will relieve the burden of the agencies doing their own individual recertifications in favor of the county doing a single recertification on behalf of the entire system.

Committee Reports

Response Committee – T. Cronogue

• There is currently a Department on the north shore that has expressed interest in hosting the next meeting if the dates are convenient to the departments’ schedule. The next meeting of the Response Committee will be posted on the REMSCO website.

• The 7TH District is sponsoring an EMT/Youth Squad competition at the Deer Park FD training facility on July 25th, 2009.

• The SCEMSIA will be meeting on Friday July 31st, 2009 @ 7:30 PM at the SC FRES Academy. All instructors are welcome to attend.

• Lastly, Mr. Cronogue is working on another system- wide provider evaluation form to be distributed in the latter part of 2009.

REMAC – Dr. Tarsia for Dr. Winslow

• Dr. Tarsia stated that at the last REMAC meeting, topics of discussion was the issue of medication facilitated intubations and the Police behavioral emergencies situation and the committee chaired by Dr. Coyne to help develop a treatment and transport protocol for the system. There were discussions but no decisions rendered in regards to the discussions.

• There were also new individuals voted to the REMAC representing some of the hospitals. • Dr. Coyne discussed the subcommittee work regarding the behavioral emergencies protocol as follows; in

February of 2009, the topic of transporting behavioral emergencies by the Police department began being discussed as an issue in the system. The Police department transports approximately 3000 victims involuntarily per year to the UHSB CPEP facility. The major concern of the Police department is that EMS system is notified in the early stages of the instance to assist with the evaluation of the victim and possibly facilitate the transport should other illness or injuries arise prior to the Police department transport for purely psychological reasons. The subcommittee is comprised of Physicians, Police officers, EMS personnel, Mental Health professionals and law professionals, which proves that the subcommittee is well represented. To date there have been four meetings that have transpired with the topics of how the victims are to be transported, the continuity of care and the use of passive restraints. Additionally, the discussions of more in depth training for both the Police officer and the Pre-hospital care provider and what other systems are doing in these regards. The next meeting is scheduled for August 2009 at Southside Hospital.

REMSCO MEETING SUMMARY 4 July 14, 2009 REMAC – Dr. Tarsia for Dr. Winslow (continued)

• Mr. Lateulere added that the NYS BLS protocol regarding Psychological emergency transports and the use of soft restraints is mentioned along with regionally approved devices, which aren’t identified. This is why these discussions at the subcommittee level are so engrossed in the topic. The subcommittee is interested in including the hospitals in the restraint device selection and hoping that they will agree to work with the subcommittee in regards to the protocol and the restraint equipment so we can be on the same page and assure that patient transfer is a smooth exchange process.

• Mr. Blower asked if the eastern and independent village and town Police departments along with the Sheriffs Departments are also involved. Dr. Coyne stated that he will be presenting the subcommittee’s discussions and work items at the Police Chiefs meeting when able in the hopes of the independents coming onboard with the program and policies.

COMMUNICATIONS – T. Lateulere

• The website is up and running well with no issues to report. • Dr. Chaudhry, SC Health Commissioner, has given the EMS Division permission to disseminate any information

regarding the H1N1 notifications. We will be posting the notifications on the website. • We are planning to do the next massive protocol update classes on the website. Notification will be announced

hopefully within the next few months. • Mr. Blower reported that in a Newsday article in today’s publication that the flu outbreak of 1918 was in fact

related to swine flu and was possibly transmitted through the pigs. Pigs have the ability to receive the flu bug from other animals and humans and within their system, the bug changes and is then transmitted to humans. The CDC is currently changing their thought process and thinking of watching the pig population to prevent a larger or more severe outbreak this year.

• Mr. Searing added that regionally, Emergency Management offices, Health Departments and EMS Agencies from Nassau, Suffolk, New York City and Westchester Counties are working together to plan for the Flu season that will be starting in the fall. The region is currently gearing up for the upcoming season in hopes of being better prepared.

PIO – E. Komosinski

• Ms. Komosinski reported that at the REMSCO had purchased 80 tickets for a Ducks Baseball game to honor this years longevity awards recipients. Unfortunately, only 30 recipients attended the game and several agencies had responded in the affirmative but did not show. Ms. Komosinski contacted those agencies that did not show and offered them tickets to use for another game during the season which they could exchange in an exchange program supported by the Ducks. Still only 1 agency replied to Ms. Komosinki’s correspondence. If there were any members of the council or other agencies wishing to attend a game, Ms. Komosinski has the 40 remaining tickets, and should be contacted to express their interest.

• Mr. Stapleton replied that we thought this was a good idea at the time, but since its failure, we have to now transition to a different type of event to honor the longevity recipients. Ms. Komosinski suggested that the Council come up with some ideas for next year and bring them up at the September 2009 meeting.

REMSCO MEETING SUMMARY 5 July 14, 2009

PIO – E. Komosinski (continued)

• Ms. Komosinski reported that the Regional Awards Committee met on July 1st, 2009 and reviewed the 20 applications received with the following results to be sent to New York State:

The Suffolk Regional Emergency Medical Services Council is pleased to announce the winners of the 2008 Suffolk REMSCO Awards

Basic Life Support Provider of the Year: Heather Fairman - Deer Park FD Honorable Mention: Kristen Ahangari - Dix Hills FD Advanced Life Support Provider of the Year: Craig Caviness - Dix Hills FD Honorable Mention: Frank Caria - Deer Park FD EMS Leadership Award: Eileen Grubert - Deer Park FD Honorable Mention: Tim Dackow-North Shore-LIJ Health Systems

Stony Brook Volunteer Ambulance Officers

EMS Communications Specialist of the Year: Jonathan Michel-Bay Shore-Brightwaters Amb. Co. EMS Agency of the Year: Bay Shore-Brightwaters Ambulance Co. Honorable Mention: Shelter Island Red Cross Ambulance

Dix Hills FD Rescue Squad Deer Park FD

Babylon Village FD Rescue Squad Holbrook FD

Hampton Bays Ambulance Co Southampton Volunteer Ambulance Co.

Physician of Excellence: Carl Goodman, D.O.

Honorable Mention: Augustus Manita, MD

• The notification letters to the recipients and nominating individuals will be mailed on July 15th, 2009. • The past seven years, the Agency of the Year has been sponsoring the Awards dinner. Ms. Komsinski will be

contacting Bayshore Ambulance to see if they will be doing the same. In the meantime, a motion to provide up to $2500.00 for the Awards ceremony was passed unanimously.

Disaster Planning – R. Delagi

• No report

Education & Training - J. Gardiner

• Mr. Gardiner stated that there was no report and no recent committee meeting. There will be a tele-conference meeting of the committee in August and e-mails will be sent out with the information in approximately one week.

Legislative – J. McCormack

• No report

REMSCO MEETING SUMMARY 6 July 14, 2009 Budget – G. Cassara

• No report

Resource Needs – B. Blower

• No Report • In regards to a personal issue, Mr. Blower thanked the Council for the plaque received at his retirement dinner and

Mr. Gardiner for his wonderful speech and presentation. • Mr. Blower spoke briefly about a document that was distributed in regards to the handling of patients with Autism

or Autism like disorders by First Responders. The document is good information and an easy read. it is available on the website for the New York State office of Mental Retardation and Developmental Disabilities.

• Mr. Blower also stated the Mr. Carriagan has given him a notification of a House Resolution number 96 presently on the table for vote regarding the grant of funds for Responders regarding the training in dealing with Autism Syndrome patients. Mr. Blower suggested that all departments contact their representatives to the house to show support for the resolution.

• Mr. Boyd asked the status of the Amagansett FD application for territory expansion. Mr. Blower stated that there was no movement to date on the application.

Nominations Committee- H. Rosenblum

• No report or activity Executive Committee – E. Stapleton

• The Executive Committee report was given under the Chairman’s report. NYS EMS Council Delegate – T. Lateulere for R. Delagi

• Mr. Lateulere discussed salient points of the distributed report. (attachment #2) • Mr. Lateulere suggested that all members read the distributed report and bring it back to their respective

constituencies. If there any questions regarding the report, please contact Mr. Delagi upon his return. • Ms. McCormack asked if the REMSCO or REMAC was responsible for the governing of the hospital diversion

policy. Mr. Lateulere stated that it actually was a policy co-created by the EMS division and Suffolk County FRES modeled after a NYS template. It is closely monitored by both agencies for compliance and resolution to the request.

Old Business

• None offered

REMSCO MEETING SUMMARY 7 July 14, 2009 New Business

• Mr. Ryan asked if the REMSCO monitors the PAD organizations once approved for the program and the AEDs are placed. Ms. Komosinski stated that it is not the council’s responsibility and the onus falls on the agency supplying the service. The council and the EMS division monitor correspondence only but does not have the manpower nor does it have the jurisdiction to advise of mandates or actions for compliance issues.

• After a brief discussion regarding PAD issues and policy compliance, Mr. Stapleton charged the Education Committee research the PAD issues and create a public service notification policy for these agencies as a reminder to all participants.

• Mr. Franz notified the Council of the NYS Ambulance and Rescue Associations Education and trade show on October 1st, 2009. the flyers are on the back table for distribution.

• Mr. Gardiner notified the Council that the Police Cope43 unit had another save since the last meeting and there also was a save in the Amityville area through the efforts of a First Responder and Police Unit.

• Mr. Stapleton mentioned that he and Mr. Gardiner were possibly putting together a fund raiser for the Council in the form of a Golf outing. This planning and proposal will begin after the first of the year.

Meeting adjourned at 8:15M

Next meeting of the Suffolk Regional EMS Council will be on

Tuesday September 8, 2009, 7:00 PM Suffolk County EMS Offices

Hauppauge, NY 11788 Prepared for the Suffolk Regional EMS Council by Martin Matuza, Recording Secretary.

ATTACHMENTS TO FOLLOW

Attachment #1

EMS DIVISION STAFF REPORT – BY: Bob Delagi, Tom Lateulere & Linda Mermelstein, MD, MPH For the REMSCO & REMAC. May - June, 2009 AMBULANCE SERVICE OPERATIONS

• ePCR Update; thirty (30) day Pilot Program has been completed. Division staff held an end-users meeting with representatives of the five (5) pilot agencies to gain information about program functionality, experiences, and to gauge success of training thus far. Division received written confirmation from the NY State DOH that the data extract has been successfully transmitted and received, and that the product meets required NY State specifications. Printers and cables have been installed in all hospitals, and additional printers and cables have been approved and ordered for select hospitals on the eastern Nassau County boarder, routinely accepting patients from Suffolk County services. Multiple additional user-suggested modifications to ensure consistency with NY State and Suffolk County requirements have been made. Product has been formally accepted by Suffolk County and that information has been transmitted to ZDS. Additional training sessions have been offered to pilot agencies to address deficiencies in training progress in 4/5 agencies. Plans underway to open the system to the first round of interested ambulance services.

• Participated in multiple conference calls, provided significant technical support, developed and distributed policies, assisted in the establishment of revised dispatch protocols, provided regular situational reports, monitored biosurveillance data, and assisted in a wide variety of other issues regarding the H1N1 Swine origin Influenza A Virus (S-OIV) outbreak.

• Division staff provided a presentation at the New Chief’s seminar, sponsored by FRES and the Suffolk County Fire Academy.

• Participated in planning, development, execution and evaluation phases of a MCI/patient influx exercise with Brookhaven memorial Hospital, Patchogue FD, Patchogue Ambulance, and several mutual aid companies.

• Participated in the Long Island MacArthur Airport Tabletop Exercise. • Provided introductory, then event-specific NIMS/ICS 100 training for event organizers for the LI-2 Day Breast Cancer Walk. • Assisted with coordinating several ambulance services and field medical and rehab services for the LI-2 Day Breast Cancer

Walk. • Several staff members represented the Division of EMS at the EMS Memorial Induction Ceremony at the Empire State Plaza. • Attended countywide Terrorism Response Task Force Meeting. • Attended countywide Decontamination Strike Team Meeting and training. • Worked with FRES, PD and IT to install video conferencing equipment. • Attended Emergency Preparedness Conference in Southampton Hospital • Provided technical support and REMAC –required review, inspection and in-service training for ALS Upgrade for Sound

Beach FD. • Provided technical support and on-site resources at the Our Lady of the Island Shrine Outdoor Healing Mass. • CISM team provided twelve (12) interventions. • Met with the East Farmingdale FD to assist them in re-instituting Controlled Substances Program. • Met with representatives of the LI Harbors Bike Tour to address EMS coverage coordination across multiple districts. • Hosted SNS Strategic National Stockpile Stakeholders meeting. • Attended the Suffolk County Ambulance Chiefs Assn. meeting. • Attended the Suffolk County Traffic Safety Board.

Continued.

EMS DIVISION STAFF REPORT – BY: Bob Delagi, Tom Lateulere & Linda Mermelstein, MD, MPH For the REMSCO & REMAC. May - June, 2009 – Page 2. AMBULANCE SERVICE OPERATIONS – continued.

• Prepared the Division’s 2010 Operating Budget. • Provided staff support to the REMSCO for their May meeting. • Provided staff support to the REMAC for their May meeting. • Provided staff support to the REMSCO’s Resource Needs Committee. • Provided staff support to the REMAC’s PMI Ad Hoc Committee. • Attended a Mental Health Crisis Response Summit sponsored by the New York State Division of Criminal Justice Services

(DCJS), the Suffolk County Police Department and the Department of Health Services, Division of Community Mental Hygiene, representing the EMS perspective on the growing issues associated with patients with mental illness.

• Attended meeting of the Town of Islip / North Shore – LIJ Steering Committee. • Facilitated the lighting of the H.L. Dennison Building in blue light, to honor the work of all EMS providers and agencies

during National EMS Week. • Provided certificates of appreciation to all ambulance and first response services to acknowledge the work of all EMS

providers and agencies during National EMS Week. • Participated in a telephone conference call with the SEMAC’s medical Standards Committee regarding On-Line Medical

Control (OLMC). • Represented the region at the June Program Agency Director’s Coalition, SEMAC, SEMSCO, and associated committee

meetings. • Provided technical support to Good Samaritan Hospital, FRES and BCFA on a recent hospital diversion/ambulance re-

direction occurrence. • Provided focused technical support to the Board of Fire Commissioners, Chiefs, and EMS Officers of the Fishers Island FD. • Completed the 2010-2011 NY State Training Plan & Budget Template on behalf of the Program Agency, REMSCO and each

Course Sponsor in the region.. • Collected and process information/applications about the 2008 NY State EMS Awards Program to the EMS System. NOTE:

applications were due back to EMS Division no later than June 19, 2009. • Completed work with representatives of the Clinical Laboratories Evaluation program (CLEP), reference the countywide

Clinical Laboratories Improvement Amendment (CLIA) Permit Waiver affecting all ALS services, resulting in a new countywide multi-site licensing agreement.

• Secured NY State DOH approval for EMT-CCs to provide CPAP therapy.

EDUCATION & TRAINING • Provided focused emergency response training for the medical staff at the Jail Medical Unit. • Reviewed and submitted ten (10) EMT-B, twenty (20) EMT-CC, and one (1) EMT-P CME packets to State DOH. • Several courses tested in June. Seventy seven of seventy nine (77/79) passed the NY State written examination. This 98%

success rate is our highest pass rate this year, and a full five (5) points above the NY State average. • Thirty one of thirty one (31/31) students passed the NY State PSE for EMT-CC certification, this included sixteen (16)

separate stations.

Continued.

EMS DIVISION STAFF REPORT – BY: Bob Delagi, Tom Lateulere & Linda Mermelstein, MD, MPH For the REMSCO & REMAC. May - June, 2009 – Page 3. EDUCATION & TRAINING – continued.

• Opened two (2) EMT-B refresher courses for fifty six (56) students. • Opened one (1) EMT-B original for forty (40) students. • Opened one (1) EMT-CC original for ten (10) students. • Opened one (1) EMT-P refresher for nine (9) students. • Provided 12-lead EKG and waveform capnography training in Sag Harbor for thirty two (32) ALS providers. • Provided Emergency Incident Rehab, RAD-57 Non-Invasive Co-Oximetry training in Hampton Bays for thirty four (34)

providers. • Provided Child Abuse/Meth Lab Awareness Training @ NFVRA • Provided EZIO Adult Intraosseous hands-on training for twenty four (24) ALS providers. • Provided Core Content WMD and geriatrics training at Yaphank FD for eighteen (18) registered providers. • Provided update training on NY State Child Abuse Mandated Reporters / Abandoned Infant Protection Act for twenty five

(25) providers in Greenport FD. • Credentialed eighteen (18) new EMT-Paramedics into the Suffolk County EMS System. • Provided PCR Documentation for Jamesport FD, reaching thirty four (34) providers. • Provided ASA Diagnostic Tool training for the EMD’s at CVAC, for fifteen (15) dispatchers. • Provided non-core Patients In Crisis training for sixteen (16) providers. • Completed four (4) remedial sessions with ALS providers (3 med errors, 1 unrecognized ETI). Currently working on an

additional six (6) cases. • Performed fifteen (15) telephone remediactions. • Working with several hospitals, EMS agencies, and five (5) patients living at home in the county with LVADs. • Developing web based training and testing for ALS protocol revisions. • Developing CPAP training for EMT-CCs.

DOMESTIC PREPAREDNESS / HOMELAND SECURITY • Attended RPC Meeting. • Provided technical assistance to the RRC in the development of an MCI exercise. • Took delivery of replacement atropine auto injectors from the NY State DOH, top replace expired countywide cache of

medication.

END OF DIVISION STAFF REPORT

Attachment #2

NY State EMS Council Delegates Report June 9-10, 2009

Albany, NY. Submitted By: Robert Delagi The NYS EMS Memorial Service was held on Wednesday, May 20th at the Empire State Plaza in Albany. Edward P. Mueller of West Islip Volunteer Fire Department, who died in the line of duty February 2, 2008, and Norman H. Haines of Laurens Fire District Emergency Squad, who died in the line of duty July 19, 2007, were inducted in a moving and well attended ceremony. Congratulations to Ms. Lee Burns, named Acting Deputy Director of the Bureau of EMS. Lee will retain her duties in the Operations Section and fill the void created by Marjorie Geiger’s promotion to another unit within the Department. In another personnel move, Mr. Dan Clayton has moved laterally from the Education & Training Section to the Operations Section. SEMSCO 2nd Vice Chair Tim Czpranski from Monroe County gave an update on their region’s alternative destination demonstration project. This project was undertaken in attempt to decrease 911 use by patients for their primary care needs, a growing problem across NY State. This project study sent a paramedic to specific low priority EMS calls and, in consultation with Medical Control, referred patients to urgent care centers or community clinics instead of hospital emergency departments. The project is complex and planners have encountered several roadblocks, including: medics that were reluctant to participate; clinics that did not want to take Medicaid patients due to lower reimbursement rates; and patients that expected to go to an ED and were not amenable to alternative destination transportation. Additional work in the region remains, and there is considerable discussion to be had on the issues of alternative destination for ambulances as hospital overcrowding continues. Regarding hospital overcrowding locally; representatives of Suffolk County EMS and FRES refined local hospital diversion policy to address uniform application of, and response to, hospital diversion requests. Among the new initiatives is EMS Division staff contact (personal site visit, or telephone) with requesting hospital to ensure that high occupancy plan and efforts to reduce ED surge are underway, that unintended consequences of shifting the burden to other hospitals are addressed; and that early notification of a hospital’s request for diversion are communicated earlier in the call (ambulance signal 2). NYSDOH BEMS is supplying replacement atropine auto-injectors pens, to replace those previously delivered and have expired. In combination with new DuoDote autoinjectors, the Division of EMS will be re-distributing to replace now outdated Mark I kits, based on existing supply. As a result of state legislation enacted about a year ago, the NY State Office of Mental Retardation and Developmental Disabilities (OMRDD) has published its document entitled Putting People First: On The Scene and Informed-First Response and Autism. The document can be found by pasting the following link into your browser. http://www.omr.state.ny.us/document/hp_brochures_firstresponse_autism.jsp Regarding EMTs as Mandated Child Abuse Reporters, there is free-of-charge on-line mandated reported training, courtesy of NYS Office of Children and Family Services. Paste http://www.ocfs.state.ny.us/main/prevention/ into your browser for complete information about abuse, maltreatment and reporting.

The NYSDOH Bureau of EMS released new Policy Statements that impact EMS providers. 09-05 Certification for Individuals with Criminal Convictions and 09-07 Security and Safety of EMS Response Vehicles. These policy statements can be found by pasting the following links into your browser. http://www.health.state.ny.us/nysdoh/ems/pdf/09-05.pdf, and http://www.health.state.ny.us/nysdoh/ems/pdf/09-07.pdf respectfully, and should be shared with your EMS providers. Continued.

Page 2. NY State EMS Council Delegates Report June 9-10, 2009

Albany, NY.

The SEMAC and SEMSCO approved a recommendation that all ambulance service vehicles carry a copy of current NY State BLS Protocols and Suffolk Regional ALS Protocols, available for reference during patient care activities. This recommendation comes as a result of increasingly complex patient presentations, protocols that are comprehensive in scope and breadth, to reduce liability and risk associated with protocol violations or improper treatment pathways, and to ensure consistent application of the standard of care. The NYSDOH BEMS will be communicating directly with agencies, this early notification will help you prepare for compliance. Vital Signs 2009 EMS Conference and Trade Show will be held October 15-18, 2009, in Rochester, NY. The multi-page conference brochure, with all relevant travel, hotel, and conference information contained therein, is available by pasting http://www.vitalsignsconference.com/vs2009brochure.pdf into your browser. SEMSCO heard an appeal, filed by multiple parties, as this occurrence fell out of the parameters for inclusion on the NY State EMS Memorial. SEMSCO passed a motion to induct Paramedic Richard Quigley, 46, onto the EMS Memorial, in acknowledgement of his death in the line of duty. He stopped at a crash scene on the Taconic State Parkway while his way home from a shift at TransCare Hudson Valley Ambulance in Wappingers Falls on January 10th, 2009. Paramedic Quigley collapsed on scene and died, leaving behind two sons, ages 18 and 13. He was also a medic for Alamo Ambulance, a Corrections Officer for the Dutchess County Sheriff’s Department, and a volunteer firefighter. Richard Quigley’s life of service will be honored permanently on the EMS Memorial during EMS week in 2010. Several new protocols were approved: Nassau County Hospital Diversion/Re-Direction Protocol; Nassau County Adult and Pediatric Nerve Agent/Organophosphate Poisoning protocols; Mercy Flight Central request to add ketamine to the State ALS formulary; and a request from the EMSC Program to add corticosteroid therapy for congenital adrenal hyperplasia (CAH) to NY State ALS Protocols. Regarding ketamine, the next step is to receive approval by the Bureau of Narcotic Enforcement for prehospital protocol development and approval. To facilitate the sharing of follow-up data as part of the CQI process, the Evaluation Committee met with the Director and Associate Director of the Division of Certification and Surveillance to ensure consistent application of the catchment area hospital – to – EMS relationship. Clear consensus was reached in that EMS providers are part of the continuum of care and that there are no HIPAA issues associated with hospitals providing patient-specific follow-up data on patients transported by EMS. Next step is to get an Article 28 facility – Article 30 collaboration as to what can be done, and what is required to be done. Discussions continue on the debate regarding who can provide On-Line Medical Control (OLMC) in NY State. Centered in the discussion is a piece of the public health law that defines OLMC as “by a physician, or under the direction of a physician.” A survey of actual practices across the state reveals that it’s not always a physician, but rather, a mid-level practitioner such as a Physician Assistant (PA) or Nurse Practitioner (NP). A motion was passed to allow 100% of Core Content training requirements for those enrolled in CME Programs be web based AND that a TAG be formed to address multiple issues contained in the pilot CME program legislation for approval and instructor/medical director oversight. This is not a done deal at this time! This is a work-in-progress that will extend well into 2010 before decisions are made.

Continued.

Page 3. NY State EMS Council Delegates Report June 9-10, 2009

Albany, NY As a holdover from previously reported discussion, the SEMSCO Chair introduced a motion to request that the Bureau of EMS amend Part 800 to include an AED, or use language to ensure that every ambulance have capability to defibrillate patients of all ages. The issue surfaces as the regulatory environment has not maintained the same pace as technology environment and that in this era, it is inconceivable at there are ambulances that are in-service across the state that do not have the capabilities of providing defibrillation as the standard of care. Much work needs to be done, this is a work-in-progress. The Finance Committee continues its work on the 2010-2011 budget proposal. At issue is the increasing costs of goods and services in a flat budget environment over the last decade-plus, and legislation governing how EMS funding may be utilized. Issue one is the legislative mandate that states that all BLS Ed & Training must be funded wholly before any ALS Ed & Training can be funded, and issue two the legislative mandate that one-half of the dedicated EMS fund must be used for Ed & Training, and monies left over may not be applied to other EMS related costs, such as REMSCO or Program Agency reimbursement. Therefore, the Finance Committee spent additional time attempting to reallocate course funding based on data compilation and analysis from several sources, including the Bureau of EMS, the Budget Office, and each Course Sponsor in the state. A DRAFT PROPOSAL was presented for comment to both the Education & Training and the EMS Systems Committee for review and feedback on system wide implications. The most significant reimbursement issues include increasing reimbursement rates for BLS training across the board (original, refresher, and CME) at a cost of eliminating reimbursement for EMT-I original and refresher, EMT-CC original and Paramedic original courses. This is only a draft, and only in discussion stages. Comments should be made in writing to your Regional EMS Council Delegate. Most applicable to our regional commercial ambulances, several issues regarding reimbursement were addressed. The American Ambulance Association reports that any increases in Medicare reimbursement for ambulance transportation will be attached to robust quality improvement and reporting accountability. Similarly, the DOH reports that meetings with state Medicaid continue and that BLS ambulance services may NOT bill for ALS service and subsequently assign the ALS costs to a non-transporting ALS service, especially if that service does not hold a Medicaid provider number. The Safety TAG continues its work and anticipates the release of a White Paper to address multiple aspects of safe EMS operations. The paper seems to be emerging as a best practices document that will put safety in the forefront of several aspects from response to patient care to the classroom environment. The final version of the Reportable Incident Form (DOH-4461) will be out shortly. This form is designed to collect reportable information to assist in education and prevention of similar occurrences, not for punishment or enforcement. Still no changes to report regarding the use of tourniquets as a primary alternative to bleeding control. As previously reported to you, there was a recent decision by the National Registry to change their bleeding control practical skills station to go directly to application of a tourniquet when direct pressure fails to control external extremity bleeding. The SEMAC, in conjunction with the STAC will take a look at the evidence and try to draw some conclusions to standardize our performance , educational and testing objectives in NYS.

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Page 4. NY State EMS Council Delegates Report June 9-10, 2009

Albany, NY DOH representatives reported that they participated in a Stroke Conference, held in May 2009 reviewing the state of stroke care in New York. Of note, statewide, less than fifty percent (<50%) of stroke patients get to a designated stroke center. Of stroke patients eligible for clot busting drugs (tPA), only 4.5% received them at designated stroke centers, and only 2.7% receive them at non-stroke centers. Considerable review of inclusion criteria, new diagnostic equipment, and therapeutic windows are being reviewed. DOH representatives reported that they participated in a recent STAC meeting, where accomplishments of the statewide trauma system were identified. It was reported that from 2003-2006 mortality and morbidity improved each year and when risk-adjusted mortality rates are examined, NY has experienced a 20% reduction, and when compared to the CDC, we fare markedly better than many states. This includes prevention strategies, pre-hospital care and transport to appropriate hospitals, and trauma center care. The DOH reported that a letter will go out to all hospitals in NY State, encouraging their support of clinical training and asking that clinical training opportunities for EMS students in hospitals be encouraged and facilitated. The Legislative Committee is tracking about 150 bills with EMS provider or EMS/Fire system implications. The SEMSCO voted to support S3293 / A 7610 - Makes provisions relating to HIV testing, including consent for such testing, required offering for such testing, confidentiality and disclosure.

End of Report