Western Mass Emergency Medical Services Committee, Inc.

Meeting: Physicians Council

Date: September 12, 2002

Place: East Wing 2 Conference Room, CDH, Northampton

Presiding: Dr. Dinneen, Chairperson

Called to Order: 9:10 am

Adjourned: 10:20 am

Attendance:

Present – Dr. Conway, Dr. Dinneen, Dr. Durkin, Dr. Fay, Dr. Hayden, Dr. Mausel, Ms. Maxwell and Dr. Sutton

Absent – Dr.Gutterman, Dr. Noonan and Dr. Sabatelli

Guests – Dawn Josefski

Conflict of Interest Statement: The chairperson opened the meeting with a conflict of interest statement. Those with conflicts on agenda items will abstain from voting.

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

Old Business

Diversion Report:

The diversion report for Region 1 Hospitals was distributed. There was a brief discussion on the increase of diversions recently. Dr. Mausel requested again that Wing be notified when contiguous hospitals in Region 2 go on diversion. There have been recent instances when Wing is suddenly hit with an influx of unexpected patients from outlying ambulance services.

Action- Ms. Josefski to bring the issue to the WMEMS office and Region 2 office.

Defib and Paramedic Optional Skills:

The memo sent out from the office was distributed. As a reminder the office will no longer be doing the oversight for EMT defib credentialing. In the memo each service was told to contact their medical director to determine what skills evaluation process that they should follow. It will be up to the individual medical directors and the services to develop appropriate mechanisms to ensure proper training of individuals and QA of defib utilization. The office is recommending that evaluations (semi-annual for defib and yearly for paramedic chest decompression and Intraosseous infusion) continue but that the services maintain the paperwork instead of the regional office.

Needle Cricothyroidotomy is a skill that the office will continue to credential. Therefore annual evaluations will need to be completed and submitted to the office.

The office will continue to maintain records and issue authorization cards for defib to all first responders (fire and police) until those regulations are changed.

Action: None

Valium:

A copy of the memo from OEMS was distributed. The pharmacies in our region are able to continue to supply ambulance services. Some still have 5 and 10 mg vials available but others are now in ‘Carbuject’ 10 mg. pre-loaded syringes, in packs of 5. A discussion followed about the possibility of versed use for seizures and Dr. Durkin and Dr. Conway will research the issue and perhaps request a protocol change.

Action: Dr. Durkin and Dr. Conway to report back to the committee in October

New Business

Village Ambulance P/B Waiver Renewal Request:

Copies of the P/B renewal packet were sent around for review. Village has increased their paramedic staff by 2 and they currently have 2 more in school. Motion was made to recommend approval of the Village Ambulance P/B waiver renewal. Motion passed with one abstention-Ms. Maxwell.

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

Granby Fire P/B Waiver Renewal Request:

Copies of the P/B renewal packet were sent around for review. Granby has increased their paramedic staff from1 to 2 full time medics as well as 4 per diem. Motion was made to recommend approval of the Granby Fire P/B waiver renewal. Motion passed with one abstention-Dr. Conway.

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

Amherst Fire P/I Waiver Renewal Request:

Copies of the P/I renewal packet were sent around for review. Amherst has 22 paramedics on staff and they currently have two members enrolled in paramedic school. They are now able to staff 3 and sometimes 4 paramedic level ambulances. Motion was made to recommend approval of Wilbraham Fire P/B waiver renewal. Motion passed with one abstention-Dr. Conway.

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

Needle Availability:

Mr. Harrington, from Berkshire Medical Center, has asked for guidance from this committee in regards to needle availability for Chest Decompression and Needle Cricothyroidotomy. Most hospitals are now going to the mandated “needleless systems”. Discussion ensued and the consensus of the committee was to change the procedure for chest decompression, eliminating the need for a syringe to aspirate air. Then the current needles will work. In regards to Needle Cricothyroidotomy, there is already a commercially available device that the region has accepted: Quick Trach. We have already done training and have the outline, device, PowerPoint presentation and skill sheet available. Some services are already using this device (or one similar): Amherst Fire, West Springfield Fire, BHS and AMR just to name a few.

Action-The office to change the chest decompression skill sheet.

FYI:

Two draft documents from the State Medical Services were distributed:

1) Affiliation Agreement Template: There was discussion about the wording of several sections, it is unclear the delineation between hospital medical director and service medical director. This template appears to be geared toward ALS providers and does not address the P/B waiver aspect. It was also suggested that the date line read: This agreement to run concurrent with ambulance service licensure.

2) Critical Care Transport draft regulation: The main questions raised after review of the document was, how will this affect current ALS Interfacility transports?

BSMC Neurosurgical Coverage:

Baystate Medical Center has sent out letters to the area hospitals notifying them of days when they have no neurosurgical coverage. According to Dr. Durkin this has become an issue due to unexpected staffing issues (they lost 2 surgeons). The hospital has set up an agreement with Hartford Hospital so that they can send neurosurgical patients to them the days BSMC has no coverage. It was suggested that helicopter services also be notified.

Medical Control Signatures:

Ms. Maxwell reported there seems to be some confusion about the necessity of medical control signatures on run reports in some hospitals in the Berkshires. Dr. Conway responded that it is required that the doctors sign the run reports anytime there is a standing order procedure done on a patient, for example; aspirin administered by a basic EMT, an IV started by an intermediate or any of the ALS procedures or medications by paramedics. There is a section in the Regional Policy and Procedures that addresses this issue.

Next Meeting:

The next meeting will be held on October 10, 2002 at 9:00 am. This meeting will be held in the South Deerfield Fire Station on Rt 5 &10 (just past Yankee Candle).

Adjourn: A motion was made to adjourn at 10:20 am. This motion was seconded and approved unanimously.

Dawn Josefski, Recorder