Western Mass Emergency Medical Services Committee, Inc.

Meeting: Physicians Council

Date: January 10, 2002

Place: East Wing 2 Conference Room, CDH, Northampton

Presiding: Dr. Dinneen, Chairperson

Called to Order: 9:00 am

Adjourned: 10:00 am

Attendance:

Present – Dr. Conway, Dr. Dinneen, Dr. Durkin, Dr. Fay, Dr. Mausel, Ms. Maxwell PA-C, Dr. Noonan and Dr. Sutton

Present by Proxy –

Excused –

Absent – Dr. Emhoff, Dr. Gabor, Dr. Gutterman, Dr. Hayden, Dr. Sabatelli

Guests – C. Blake Gilmore, Dawn Josefski, Linda Moriarty, Matt Russo and David Zamojski

Minutes: A motion was made to accept minutes as written. This was seconded and approved unanimously.

Old Business

Diversion Report:

Discussion –

Hospitals are going on diversion with more frequency. Dr. Mausel reported that when hospitals in Region 2 go on diversion Wing Hospital is not notified and this adversely affects them. There will be a Region 1 diversion meeting on January 17, at 9 am at the AMR office in Springfield. Ms. Josefski will email out a notice to all members for which the office has an email address.

Action – Ms. Josefski to email diversion meeting notice.

Follow up on Infusion Pumps:

Discussion –

Dr. Dinneen spoke with Dr. Mike Erdos (OEMS Medical Director) and he has indicated that he will write a letter to allow the use of infusion pumps on emergency calls by those paramedic providers who have been trained through an ALS Interfacility Transfer Course.

Action – Dr. Dinneen update the council when she receives the letter.

Medical Services:

Discussion-

Dr. Dinneen reported that there was a lengthy discussion surrounding Lactated Ringers as a required solution on all ALS ambulances. After a long discussion the State Medical Services Committee voted to remove LR as a required solution and instead allow it as a Regional Option.

Action – Region One will wait for the official notice from OEMS and then this committee will decide whether or not to have it as an optional solution for burn victims.

New Business

Deerfield Rescue Ambulance P/B Waiver Initial Request:

Discussion-

Mr. Zamojski presented the P/B waiver application and together with Mr. Gilmore and Mr. Russo answered questions from the council. Deerfield is in the process of applying for an upgrade to the paramedic level and is requesting that a P/B waiver be issued coterminous with their initial Paramedic license. Currently Deerfield has paid staff on from 7-3, on-call staff from 3-11 (with good responses) and 11-7 (this is their weakest response time period). Their long-range plan is to be able to provide paid staff on the different shifts to guarantee paramedic level response 24/7.

Motion was made to recommend approval of Deerfield Rescue Ambulance P/B waiver contingent upon receiving a paramedic license from OEMS. Motion passed unanimously.

Action- Dr. Dinneen to bring forward the recommendation to Regional Council.

Easthampton Fire Dept. Ambulance P/B Waiver Renewal Request:

Discussion-

The council reviewed the waiver renewal request. Easthampton Fire has increased the number of paramedics on their department and is continuing to do so as attrition and training allow. Unfortunately Easthampton is a smaller department and does not have a lot of turn over in personnel. Their department policy is to hire paramedics for any open slots but they are only anticipating one retirement this year. Easthampton has also requested additional funding from the town for additional paramedic slots but has been denied. According to Dr. Conway, they do have an excellent QA program and as their medical director he has no problem with the quality of care they provide. Motion was made to recommend approval of the Easthampton Fire Dept. Ambulance P/B renewal waiver. Motion passed unanimously.

Action- Dr. Dinneen to bring forward the recommendation to Regional Council.

P/B Waivers:

Discussion –

There was a discussion among those present about the new regulation requiring ALS to be provided 24/7 within 3 years from initial application and /or 2-28-2001. The regulation states that ALS will be provided either by the service or through backup agreements with services able to provide the same or higher level of service. There is also the new Administrative Requirement P/B Waiver effective 11-01-2001 which defines the conditions for review and approval of these waivers. This A/R spells out all the substantiating documentation a service needs to provide the Region and OEMS for initial and renewal P/B waiver requests. Dr. Sutton posed the question: what will the state do in three years when many of the services in our region will not be in compliance with the ALS Paramedic/Paramedic 24/7 requirement? No one has heard any official comments from OEMS.

Action- None

Memorandum of Agreement (MOA) for Aspirin:

Discussion-

A copy of a proposed template for an agreement was shared with the council members. OEMS is requiring ambulance services with Basic or Intermediate EMTs who will be administering aspirin to have a signed MOA with their medical control director and affiliate hospital. Just as a reminder, all EMT Basic and Intermediates who respond with an ambulance service must be trained and an MOA in place by March 1, 2002 to be in compliance with the Statewide Pre-Hospital Treatment Protocols.

Action – Distribute Memorandum of Agreement for Aspirin template to all medical directors.

Region Medication List:

Discussion –

There was a discussion regarding the Region One medication list, especially surrounding the Terbutaline and Amiodarone. There was a clarification that when the region approves a medication from the optional medications list then ALL paramedic ambulances in Region One need to stock that medication. Dr. Durkin reported that the state might be making the optional medication list even smaller; if most of the regions all use a particular medication then it should be put on the required list. In terms of Amiodarone needing to be mixed in glass bottles of D10, Dr. Durkin will speak with the pharmacist at BSMC and explain that for pre-hospital use the medics will be mixing in NS as per the state protocols and manufacturer. Dr. Sutton has heard that States out West are completely ignoring the AHA recommendation for Amiodarone.

Action – Dr. Durkin to speak with AMR and BSMC pharmacy

FYI:

Dr. Conway shared with the committee that there is a patient in the community who has a central line of Flo-lan (a pulmonary vasodilator). This IV medication must be run as a continuous infusion 24/7, if it is stopped for longer than 20 minutes the patient will get severe rebound hypertension which could cause a stoke or death. This will be seen primarily in patients awaiting a lung transplant. If paramedics because the central line is blocked Dr. Conway has set up a policy with the specific ambulance service that they will start a peripheral line and switch the tubing over due to the expedient nature of the situation and transport time. Dr. Conway just wanted to inform this committee in case they hear of any more cases they would know what to expect.

FYI:

Dr. Sutton shared an article from the Boston Globe concerning diversion.

FYI:

Dr. Sutton was interested in how other hospitals deal with the ambulance restocking issues. Dr. Conway shared with him how CDH has charge sheets made up for the ambulance patients and the EMTs fill out the sheets when they use items gotten from CDH stock. It was clarified that ambulance charge for services (ie: IV) but the hospital charges for specific equipment.

FYI:

Dr. Conway shared with the committee that CDH has a computer generated run form developed by the CDH computer staff. If anyone is interested call him and he will get you in touch with the staff.

Next Meeting:

The next meeting will be held on February 14, 2002 at 9:00 am. This meeting will be held in East Wing 2 Conference Room.

Adjourn: A motion was made to adjourn at 10:00 am. This motion was seconded and approved unanimously.

Dawn Josefski, Recorder