Region I Emergency Medical Services Council Meeting Sheridan County EMS, Hoxie, Kansas August 15, 2011 David Stithem, Region Chair, called the August 15, 2012 meeting of the Region I EMS Council to order at 19:00. Alex Riggs and Roy Litfin were welcomed. Aden Schillig is present with proxy for Jane Wyatt. The minutes of the June 13, 2011 meeting were presented as posted on the web site and emailed. Karen Hooker moved for approval. Scott Reese provided motion second. Motion passed. The financial report was presented. Kerry McCue moved for approval of the financial report as written. Karen Hooker provided motion second. Motion passed. Old Business: The 4-800 MHz hand held radios have arrived. The letter went out to services to attempt to reach those had not previously received a radio. One service applied that had not previously applied. The other replies were from those who had already applied. Aden Schillig moved one radio be located in Sherman County (the county who had previously not received one), and the other three are drawn from the remaining 4 applications. Joe Hickert provided motion second. Motion passed. The Homeland Security 800 MHz mobile radios are here to assist those services who still need ambulance radios. Please complete the transfer of agreements with required signatures. We need to complete a survey to see how many ambulances in the Region are still without mobile radios. New Business: Educator's Workshop - The fall Educator Workshop was discussed. David Stithem has discussed the workshop with several educators in the state. A variety of locations are available. Scott Reese and Jayne Holle will serve on a committee to set up the workshop. Letitia Keenan moved the Council give the committee permission to make workshop decisions. Brandon Payne provided motion second. Motion passed. Committee/Task Force Reports: ACT/NW KS Trauma Council: Kerry McCue reported his KEMSA appointment to the ACT was complete and he did not seek reappointment. The ACT minutes are available at http://www.kstrauma.org/advisory_council.htm. The NW Trauma Council has not met since our last Region meeting. The Council will next meet September 12, 2012. Northwest Kansas Homeland Security Council: Deb Kaufman reported the Council met Monday. The counties continue to work on the EOP Enhancements project. The ADA aspects of the plan have changed. EF-m will continue to work with the counties. Communications: J.L. Ellis reported the medical facilities in the region used NW 13 and NW14 for a radio test and 100 percent responded. He also gave the result of the PSAP 1
test in Northwest Kansas by county. Training is being held on radio equipment. Many of the school systems are looking to move to the 800 system and the benefits of the school districts using the 800 system was discussed. Radio training is still available and J.L. has field operation guides for the counties. Transfer agreements have to be signed before radios are issued to counties. She listed the counties that still need transfer agreements signed. IMT: Bob McLemore said all purchased laptops have been distributed. There will be position specific IMT trainings in the Kansas City area. There will be an IMT working group meeting on Wednesday and they will be discussing the Easy IAP for Kansas IMTs, this could be a possible expense to purchase the program. State mileage reimbursement rate has changed. It is 55 cents per mile for private vehicle and meals costs will be $11 for breakfast, $12 for lunch and $23 for dinner, for instate training. FY 12 robot project: prices for the robots has risen significantly. With the funds that were allotted to the project, the region will only be able to purchase two robots, instead of three and add a wheelie rod and case kit for each one and put them in Russell and Colby or Oakley if Colby declines. Homeland Security Funding Formula: the RCCC has formed two committees, a funding formula committee and a strategic plan committee. The funding formula committee has met several times to discuss how the funding will be divided among the regions in Kansas. The regional leadership groups will meet to make recommendations. Homeland Security Strategic Plan: The group discussed the challenges of the region councils, long-term viability, how to sustain the councils if funding is depleted and how to sustain current projects. They also discussed the purpose of the councils, identified goals, legitimacy and the authority of the councils. They recommended the adoption of the purpose statement, formally adoption of goals and objectives, advocacy, self-sustainment and coordination between regions. The region council discussed their purpose statement, and formalization of the council (disagreed). Tami Wood provided copies of the Community and Regional Hospital Work Plans. Hospitals must participate in ESF 8 in their counties. The hospitals will be doing a Regional Exercise in April. Healthcare Coalitions were discussed. Minutes are available at http://www.kansastag.gov/kshls.asp?pageid=255 EDTF - David Stithem and Scott Reese reported on the EDTF meetings. They continue to discuss reciprocity for those coming into the state. This continues to be a difficult topic: to provide a method that is not overly restrictive to those wishing certification when coming into Kansas with EMS credentials, but yet does not lower the standards or conflict with requirements in Kansas. Trauma Scholarship: Last meeting we had decided to split the scholarship awards into three sections. The first section resulted in award to 4 individuals. There were six applicants and 2 were not region affiliated. The second application deadline is August 31. We have 5 applications received to date. The application is on the Region I EMS website. If you are having difficulty with the website, and are using Windows 7, add the site to the safe list and the pages will open. The security is an addition to Windows 7. Letitia Keenan indicated Oakley will be hosting a class the first of October. 2
Medical Directors Workshop: Participants felt the time allotted for the meeting was not long enough. Kansas used to have a model set of protocols. No one had the time to keep them up to date. There is a move right now to do that again. It was noted a statewide model refusal form would also be helpful. Oklahoma has a set of medical protocols on line that may be used as a resource. KEMSA Conference: Amanda Rohmine from Sherman County and Pat Pomeroy from Norton attended on scholarship. They will be present at the next meeting to give report. Certain presentations in particular were enjoyed. Statewide Model Protocols: Volunteers were requested to assist Darlene Whitlock on statewide protocol development. Mark King Initiative: The services present at the Council meeting were not in favor of National Registry as the only method of certification renewal. Of most concern is the number of required hours of continuing education for renewal. The volunteer services felt this requirement is unrealistic and exceeds many other healthcare certification or license renewal requirements. BEMS Update: Planning and Operations: Joe Moreland gave a KEMSIS update. NEMSIS version 3 is coming. Joe Moreland presented two letters requesting national participation. The first, from Dr. N. Clay Mann, Principal Investigator for the NEMSIS Technical Assistance Center, invited Kansas to upgrade to the NEMSIS Version 3 standard. The second was from Michael McBrady, President of ImageTrend. He asks Kansas to be one of the initial pilot systems for the Version 3 standard. The committee will wait until the next meeting to make a decision. This was not on the agenda. The Board had previously voted to provide a grace period for pediatric protocol compliance. This was to expire September 12, 2012. So far, 98 services have been inspected, leaving 71. The committee voted to extend the grace period until the end of the year. Letters are being sent out to non-transitioned attendants tomorrow. The letters were also sent to service directors. The notices are reminders regarding the transition requirement. K.A.R. 109-3-5 Update The regulation was published in the Kansas Registry on July 5, 2012 and the hearing is scheduled for September 7, 2012 at 9:00. The hearing for this regulation by the Joint Rules and Regulations committee was scheduled for July 23, 2012 at 10:45 in room 152 at the State Capitol building. The only question asked was regarding the regulation access by the public being on line and they were pleased to hear it was. Dr. Smith did have comments on the medication list. Darlene Whitlock has been employed by the Kansas Medical Society to develop model statewide protocols. She was present to give us an update on the project to date. She plans on contacting members of the original taskforce with the addition of fire and air representatives to clarify particularly the historical division between administrative / 3
operations, disaster management, and medical protocol. She is asking for volunteers and will select her committees from those volunteers. There are still more issues with the service inspection policy. Deb Kaufman requested anyone with comments to send them to Dave Cromwell. This will be back on the October agenda. Executive: The Legislative packet was presented for consideration. Steve Sutton presented staff recommendations. Dr. Allin would like to get some people together to see what the public feel should be accomplished in the next legislative session. Staff s Recommendations: o Insert language to authorize hearings for service directors o Insert language for BEMS to exercise authority to waive any EMS rules, regulations or policy in the event of a public health emergency. o Adjust definitions in 65-6112 as needed o Insert training officer in 65-6133 where it was accidently left off o Communicable disease reporting requirements o Assessment of civil penalties o Subpoena authority o Criminal history records check. Does the region have any legislative issues or legislative objectives. The committee moved to proceed with the legislative packet as presented with input from legal and the public. Sarah Fertig provided clarification on differences between the MAC and the board during discussion on a proposed issue on the medication list for the AEMT. Steve Sutton updated the committee on the strategic plan. Dr. Allin discussed KBEMS workgroup. He would like to create a strategy/action plan for the staff. Dr. Allin feels the workgroup should work on the strategic plan, and then give the board the ability to drop items. The workgroup will continue to work on the plan. Jason White provided an update on the FRA. It is moving forward. Steve Sutton would like to use returned EIG funds to support recruitment and retention. This would include flyers, ads, etc. The committee made a motion to approve. Steve Sutton presented a PowerPoint presentation on the regulation review process. The committee wants staff to be open to comments early on in the process of regulation and statutes development. Education: Carman Allen provided a transition update. There have been 2391 attendants transition so far, with approximately 5300 remaining. The most prevalent issue noted during transition audits is programs not maintaining application documents, specifically copies of the actual application for the training. All but 2 of the transition course problems have been resolved. Regulations moving forward: o 109-5-3 Continuing education approval for long-term providers. Move forward with grammar corrections. 4
o 109-10-2 Long-term accreditation of training programs. Chy Miller questioned the first paragraph, which might not allow the basic level (it excludes the BEMS processes). Moved forward with changes. o 109-5-5 Retroactive approval. Moved forward. o 109-15-2 Recognition of non-kansas credentials. Have EDTF continue to work on it. It may require a class. o 109-1-1 Definitions. Move 109-1-1a into 109-1-1. Keep moving forward. o 109-15-1 Reinstate attendant certificate after expiration. Clarification only. Move forward. o Revoke the following outdated regulations: 109-1-1a, 109-10-5, 109-11-1, 109-11-3, 109-11-4, 109-11-5, 109-11-6. One variance was processed by staff for an attendant requesting to forego a portion of the I/C course. The RFP for the state exam was approved with moulage stricken from the requirement. The educator proposal appears to be moving forward. Currently certified instructors would be grandfathered in to the new levels (by consensus - not voted on) JR Behan will ask the full board if there is any interest in the Mark King proposal. Jason Bolt spoke in favor of it. Board staff requested the suspension of the legal recognition process from 10/1 21/31 of each year to relieve some of the congestion of staff projects. No decision was made. Investigations: Graduated sanctions were discussed. Previously, the sanctions were going to be in the 109-15-1 range of regulations, but those numbers have been taken by education regulations. Joe wants to start with 109-16-1. There may be problems with the graduated sanctions until after the petition is filed against the petitioner. Board councils need to give their opinions. 2009-026 & 027 Same case. There were 3 complaints. It was tabled from May 31, 2012. They still have not received the requested documents (protocols). The protocols in the packet are from 3 years ago (at the time of the incident). The committee is waiting on proof that the trauma protocols have been reviewed. Involved a MVC with no spinal immobilization or long or short spine board. The committee will have a letter sent stating if all requested information is not received within 45 days (including the current continuing education request) the service s license will be revoked. Motion passed. 2009-031 Involved 3 complaints in one letter regarding protocol violations. An MICT was told not to respond by the service director. The MICT followed protocol. Complaint 1 was closed. Complaint 2 involved an intoxicated patient, where the attendant was said to use offensive language. The service director witnessed the incident, but did nothing. A summary order for a 3-month suspension will be issued. Complaint 3 involved not starting an IV on a patient. The director, an EMT-I declined due to BP. No violation was found. Complaint 3 was dismissed. 2009-032 An EMT reportedly verbally abused a patient and his wife at 1:00 in the morning. Staff recommendation is to drop the case. The service director sent an apology. The attendant no longer works for the service, or anywhere else. The respondent s father is the medical director. The case was closed. 5
2009-058 A self-reported staffing issue. A first responder and a nationally registered, but not Kansas certified attendant took an ambulance to the scene. An RN/EMT on scene did not ride with the ambulance. The committee recommended to send a letter regarding the violation and dismiss the case. 2012-15 An attendant pled no contest to aggravated battery, which is a felony. The case would have been for aggravated indecent liberty with a child. The attendant was placed on 24 month probation. A summary order for an indefinite suspension will be issued. 2009-079 An LTC resident stated the EMTs cut her leg during transport. There was no evidence, and the case was closed. The attendant obtained the cell phone number of an accident victim and sent a text message asking if she was okay. The patient had not been transported. The attendant received 3 months probation locally. The committee accepted local action/ closed. 2010-006 Two 16 year old MVC patients were allowed to sign refusal of care without assessment or parent s consent. Their protocol requires 3 signatures. They did not follow protocol. It was described as tunnel vision on the part of the attendants dealing with the 3 rd patient and ignoring the first 2. The new service director just became aware of this case 3 weeks ago. He has new protocols and is reviewing patient refusals with staff. The committee accepted local action and closed the case. 2010-027 & 028 Both cases are from the same event. It involved a self-reported incident where a unrestrained MVC patient was trapped and not breathing. The complaint states an air ambulance was requested, but it was cancelled. The MICT failed to recognize the patient was not breathing and was pulseless. An IV was unsuccessfully attempted 4 times by an EMT-I. The MICT started an IO. The cardiac monitor was applied 17 minutes after arrival. Medical review felt, although patient care was not the best, the injuries gave little chance for survival. The MICT resigned, moved out of state and is no longer state certified. The EMT-I received 6-months probation and training, which has been completed. The committee will accept local action for case 028 and closed the case. Since the MICT is no longer certified, the committee felt they had no jurisdiction on case 027. The draft of the felony policy will be taken to the full board. Joe House was concerned about the back-log of cases. He does not think it is fair to the respondent and complainant. Joe Megredy wants the summary of investigations (case log). Jerry Cunningham discussed the large number of old cases. Joe House is working on getting the back-log brought up to date. Joe Megredy asked if the committee needs to have additional meetings. Full Board August 3, 2012 The previous minutes were approved. Planning committee. Extending the deadline for pediatric protocols passed. Education committee. Continue the process for the regulations as presented was approved. The RFP for the state exam was approved with the moulage removed. 6
If and when the educator proposal happens, all I/Cs and T/Os will be moved to the new certification at once. The board was asked if there is any interest to pursue the Mark King Initiative. Dr Allin wants the strategic plan workgroup to look into it. The Investigations committee would like the felony conviction policy adopted, but the other board members did not have a copy of it. Executive committee: proceed with the current legislative package for review by staff, the board and stakeholders. Using the returned EIG funds for recruitment and retention passed. The committee would like to see the regulation review process extended to the statute review process. Steve presented the RSS feed. Subscribe at the top right corner of the website. There is a public comment area for the regulation review. There is an area showing regulations status and history. This has a link at the bottom for the public comment. Deb Kaufman requested a statement this version expired on (date) on the old regulation versions. Office update. Patti Artzer is retiring. Dr Allin presented a certificate from the Board. Steve Sutton has hired her replacement. Steve Sutton wants to submit the budget with old information for this year. There were no objections. KRAF Grant. A service wants to be allowed to train in equipment purchased through the grant. BEMS will track the equipment. There will be a service director s workshop at BCCC on October 27 th 2012. It will be free to attend and stay for those attending from more than 60 miles away. Steve Sutton is putting together bylaws, which will contain everything the Board has done. Four staff and four Board members will be attending the KEMSA conference. There will be a panel discussion. Steve Sutton submitted a document on performance measures. During public comment, Mark Willis stated he would like to see national registry testing, especially practical testing, adopted. He would also like to see practical skills evaluated. Steve Sutton presented an RSS feed that can be found on the KBEMS website that can be subscribed to. This is an information push only and does not allow for comment or discussion. Kerry McCue reported the KEMSA Administrator Committee will present a leadership conference in Manhattan. It will have service director focus but is also appropriate for midlevel organization members. The date will be announced and fliers sent out. Gary Winter drew attention to the financial report. A memorial was issued in memory of Mickie Helberg's father. Deb Kaufman will contact Blue Cross Blue Shield regarding a presentation of a program prior to the next Region I meeting. Scott Reese moved to adjourn with second by Brandon Payne. Motion passed. 7
Respectfully submitted, Deb Kaufman, Secretary (These minutes are pending Council approval.) Jannelle Bowers, Cheyenne County Kerry McCue, Ellis County Ericka Gillespie, Gove County Jayne Holle, Phillips County Deb Kaufman, Sheridan County Melody Knudson, Sherman County Joe Hickert, Thomas County Jamie Elder, Wallace County Gary Winter, Region I Coordinator Karen Eskew, Decatur County Scott Reese, Ellis County Letitia Keenan, Logan County Ken Tharman, Phillips County David Stithem, Sheridan County Karen Hooker, Sherman County Brandon Payne, Trego County Kirk Rice, Wallace County 8