Minutes of the Board of Emergency Medical Services June 9, 2014 Meeting

Transcription

1 Minutes of the Board of Emergency Medical Services June 9, 2014 Meeting CALL TO ORDER Joel Cerny, Vice-Chairperson called the meeting of the Board of Emergency Medical Services to order at 9:00 a.m. Monday, June 9, 2014 in the Lighthouse Room, Country Inn and Suites, 5353 N 27 th Street, Lincoln, Nebraska. The meeting was duly publicized by distribution of the Notice of Meeting Agenda at least 10 days prior to the meeting and posting the agenda at the entrance of the Department of Health and Human Services at least 24 hours prior to the meeting. CHAIRPERSON ANNOUNCMENT Mr. Cerny announced that this is a public meeting and the Open Meetings Law was posted. ROLL CALL The following Board Members and Department Staff participated in the meeting: Joel Cerny Judy Henning Ann Fiala Carl Rennerfeldt Randy Boldt Mike Miller Troy Hiemer Dr. John Bonta Karen Bowlin Linda Jensen Scott Wiebe Dr. James Smith Don Harmon Darrell Klein, Department Legal Counsel Rene Tiedt, Program Manager Bill Wisell, Health Licensing Coordinator Roger Brink, Department Legal Counsel Lisa Anderson, Assistant Attorney General Dennis Scott, Investigations Duane Newland, Investigations Jeff Newman, Investigations Pat Lemke, Investigations Larry Wiehn, Investigations Timothy Hoffman, Dr. Thomas Deegan and Charles LaFollette were absent from the meeting. ADOPTION OF THE REVISED AGENDA Dr. Smith moved, seconded by Mr. Miller to approve the revised agenda as presented. Voting aye: Bowlin, Boldt, Bonta, Cerny, Fiala, Harmon, Henning, Hiemer, Jensen, Miller, Rennerfeldt, Smith and Wiebe Voting nay: None Absent: Deegan, Hoffman and LaFollette Motion APPROVAL OF MINUTES Ms. Jensen indicated that under Committee Updates, Troy Hiemer is listed as the Chairperson of the Education Committee and would this need to be corrected? Mr. Wisell indicated that Mr. Hiemer was named as Chairperson to the Services and Providers Committee. Ms. Jensen moved, seconded by Ms. Henning to approve the March 3, 2014 meeting minutes with that correction. Voting aye: Boldt, Bonta, Cerny, Fiala, Harmon, Henning, Hiemer, Jensen, Miller, Rennerfeldt, Smith, Wiebe and Bowlin Absent: Deegan, Hoffman and Harmon Motion Page 1 of 9

2 FirstNet PRESENTATION Bob Wilhelm, State and Local Implementation Grant Program Manager, Office of the Chief Information Officer for the State of Nebraska provided information on FirstNet. FirstNet will be the first high-speed wireless broadband network dedicated to public safety. It will be a single, nationwide network that makes it easier for public safety users to communicate during emergencies on the job. This will provide faster access to information and wireless coverage where emergency medical services personnel need it most. The goal is to provide public safety-grade reliability and extensive coverage so EMS can count on the network throughout the State when they are on the job. The Board appreciated the information and presentation. MyVitalz PRESENTATION Justus Decher, President, MyVitalz provided information on MyVitalz, a company which collects biometric health data from patients at home through the use of Bluetooth medical devices and a 3G cellular hub that transmits the data in near real time, to a secure cloud. Once the data reaches the MyVitalz cloud, it becomes immediately available to the entire care team through a HIPAA secure portal in a dashboard format. This will assist the care team with decision making and help improve outcomes and patient care. MyVitalz is working with Preventice which provides a BodyGuardian Remote Monitoring System for patients who require monitoring for cardiac events and can be used to obtain other health data. The system is currently interfaced with e-narsis and is completing a study with Midwest Medical Transport. The company is also targeting other emergency medical services and community paramedicine groups. The Board appreciated the demonstration and information that was provided. EMERGENCY MEDICAL SERVICES PROGRAMS Dean Cole, Program Manager, EMS Programs announced Dr. Don Rice had obtained a $150,000 appropriations from the Unicameral to buy twenty 12-k lead systems and that there are twelve units have been given to providers and training is being implemented to allow for information to be transmitted to cath labs, emergency departments and hospitals. Mission Lifeline is having a meeting with EMS Program staff later this week to prepare for an organizational meeting in July to kickoff Mission Lifeline. The strategic planning meeting that was discussed at the March EMS Board meeting has been cancelled. However, EMS Programs is researching an information meeting or EMS day with NEMSIS and the public within the next year. There will be a community paramedicine information summit September 19, 2014 at the Grand Island Library which will be open to the public. Information will be shared when all details are finalized. The ImageTrend contract has been signed for the next five years with the opportunity of extension. Mr. Cole wanted to recognize Dr. Don Rice, Doug Fuller and Sue Medinger for getting this accomplished. Training for and implementation of ImageTrends Version 3 Software will begin in August Accurate and quality data collection is important to ensure proper care is being provided to patients. Ambulance safety is another issue in which the sharing of ambulance accident information and how this is documented. There could be a national trend to require the documenting of these incidents. EMS Programs staff is currently working on the development of the data dictionary for the latest version e-narsis. Mr. Cole again expressed the concern over interfacility transfer service issues in rural areas and urged the Board to consider this issue when working on rules and regulations. Another issue is communication issues with dispatch centers and having adequate staff. The Department and EMS Programs are also reviewing the possibility of charging a fee for licensure for both providers and services that provide out-of-hospital emergency care in Nebraska. Page 2 of 9

3 Brian Monaghan, State Education and Training Coordinator reported that Ms. Tiedt and he would be attending a meeting in Chicago, IL regarding an EMS Licensure Compact. An update will be provided at the next EMS Board meeting. COMMITTEE UPDATES Mr. Boldt, Chairperson, Legislation and Regulations committee, provided the 2014 Legislative Issues Report which indicated that the second session of the 103 rd Nebraska Legislature adjourned on April 17, 2014 and two bills, LB76e Health Care Transparency Act and LB719 Administrative Procedure Act/New Rules and Regulations have a direct impact on the Nebraska Board of Emergency Medical Services. There are also four proposed interim studies: LR575, LR576, LR587 and LR596 which could have an effect on future Board decisions. Ann Fiala, Chairperson, Scope of Practices committee indicated that the committee would provide information on the scope of practice questions that were listed on the revised agenda for today s meeting. The Education, Services and Providers committees; and Trauma Board, Nebraska Nurses Association liaisons had nothing to report at this time. Debbie Kuhn, EMS Programs Specialist provided the report for Dr. Thomas Deegan, Liaison for the Emergency Medical Services for Children the following: The 2013 Ambulance Survey was now complete and would like to thank all those that participated; Direct Relief will look at donating EPI-Pens to services on a one time deal. EMSC will be working with services for training classes that will need to be completed to administer the EPI-Pens safely; The first telehealth presentation for pediatrics had 49 hospitals and approximately 125 participants. The next presentation will be June 24, Debbie Von Seggren, President of Nebraska Emergency Medical Services Association (NEMSA) informed the Board that the next NEMSA meeting will be July 9, 2014 in Kearney, NE and the spring conference date and place have not been determined. Joel Cerny, Nebraska State Volunteer Firefighters Association (NSVFA) District 4 Director reported the completion of their firefighters school in Grand Island. There were also two EMS courses offered during the weekend. Mr. Cerny felt there was good turnout for the classes and the training. The NSVFA has funds available from a grant that will benefit recruitment and retention and can be used for funding of higher education for family members of firefighters. Mr. Monaghan, State of Nebraska Training Agency Association Liaison reported that they are currently working on solidifying the group. Dr. John Bonta, Mission Lifeline Liaison reported there will be a meeting July 9, 2014 in Grand Island. Page 3 of 9

4 SCOPE OF PRACTICE Mr. Monaghan and Doug Fuller, EMS Programs Specialists, while working on the data dictionary for e-narsis, brought the following questions: A. Is the Use of Hemostatic Agents Included in Hemorrhage Control B. What Level of Licensure Can Perform: 1. Chest Tube Maintenance, Replacement and Suctioning of a Tracheostomy Tube and Scalp Vein Cannulation 2. Intubation of an Existing Tracheostomy Stoma 3. Reduction of Dislocated Joint Only when Neuro or Vascular Compromise is Present 4. Use of the drug Metaproterenol The reason was to determine what levels of scope of practice of out-of-hospital emergency care providers these would fall under. The Use of Hemostatic Agents Included In Hemorrhage Control: Dr. Smith provided the Prehospital Trauma Life Support (PHTLS) committee of NAEMT provided the following summary: Numerous topical hemostatic products have been developed and released onto the market. Some of these products have since been discontinued, while others are widely used. Economic and medical considerations continue to make this a rapidly evolving and growing area of prehospital care. It is important for the EMS provider to remain cognizant of these products and their advantages, disadvantages, and complications as they continue to evolve. Recent data suggests direct pressure with standard gauze may be equally effective as commercially available hemostatic agents. Providers should consider this when attempting to control hemorrhage. Principles of adequate direct pressure and wound packing continue to be the cornerstone of controlling severe traumatic bleeding from penetrating extremity wounds. PHTLS Recommendation: Topical hemostatic agents may be used to control hemorrhage occurring in sites not amenable to tourniquet placement and which cannot be controlled by direct pressure alone. With the following literature for review: Article 1: Kheirabadi, B.S, et al. Determination of Efficacy of New Hemostatic Dressings in a Model of Extremity Arterial Hemorrhage in Swine. J Trauma. 67(3): , Article 2: Arnaud, et al. Comparison of 10 Hemostatic Dressings in a Groin Transection Model in Swine. J Trauma. 67(4): , Article 3: Littlejohn, et al. Comparison of Celox-A, ChitoFlex, WoundStat, and Combat Gauze Hemostatic Agents Versus Standard Gauze Dressing in Control of Hemorrhage in a Swine Model of Penetrating Trauma. Acad Emerg Med 18(4): , Article 4:Kheirabadi, Safety Evaluation of New Hemostatic Agents, Smectite Granules, and Kaolin-Coated Gauze in a Vascular Injury Wound Model in Swine The Journal of TRAUMA Injury, Infection, and Critical Care Volume 68, Number 2, February 2010 Conclusion: WS granules caused endothelial injury and significant transmural damage to the vessels that render them nonviable for primary surgical repair. The granules can enter systemic circulation and cause distal thrombosis in vital organs. More relevant in vitro and in vivo Page 4 of 9

5 Article 5: Adam Hewitt Smith, Haemostatic dressings in prehospital care Emerg Med J doi: /emermed Conclusion: There is a paucity of published clinical literature that provides an evidence base for the use of one type of haemostatic dressing over another in humans. Dr. Smith offered the opinion that he had dealt with this request recently by local police department. They are referring to agents like; Celox-A, ChitoFlex, WoundStat, HemCon, QuickClot, and other combat gauze hemostatic agents. These have been used extensively in the combat theater and by some EMS systems. The literature does not show superiority to other forms of hemorrhage control and one study does show one brand to cause harm. (Article 4) However, the rules and regulations also do not prohibit the usage of the hemostatic agents and has the following verbiage included for all levels of licensure: Control hemorrhaging including use of tourniquet; and bandaging wounds. Therefore it is the Scope of Practice Committee s interpretation and recommendation that these agents fit into this verbiage and the committee feels that the Board should allow their use at the discretion of the medical director. Chest Tube Maintenance: Dr. Smith offered the opinion that only the level of licensure that can treat/manage at complication of a chest tube malfunction; needle compression or second chest tube placement, should be allowed to manage one which is the EMT-I and Paramedic levels according to Title 172 NAC A and A (Decompression of tension pneumothorax). Therefore it is the Scope of Practice Committee s interpretation and recommendation that EMT-I and Paramedic levels be allowed to transport patients requiring chest tube maintenance. Replacement of a Tracheostomy Tube: Dr. Smith offered the opinion that current rules and regulations may indicate EMT-I and Paramedics depending on the interpretation of A for EMT-I which states: Insertion and removal of advanced airway adjuncts including: Dual lumen airway; Supraglottic airway; Endotracheal tube through the oral route; and Suctioning of the visualized and non-visualized advanced airway adjuncts and A for Paramedic which states: Insertion and removal of advanced airway adjuncts including: Devices and/or methods utilizing a non-visualized insertion technique; and Devices and/or methods requiring a visualized insertion technique. Therefore it is the Scope of Practice Committee s interpretation and recommendation that EMT- Is and Paramedics could perform this procedure. Suctioning of a Tracheostomy Tube: Dr. Smith offered the opinion that current rules and regulations indicate EMTs, EMT-Is and Paramedics allow for the procedure of suctioning of an airway stoma. Therefore it is the Scope of Practice Committee s interpretation and recommendation that EMTs, EMT-Is and Paramedics can perform this procedure. Page 5 of 9

6 Scalp Vein Cannulation Dr. Smith offered the opinion that current rules and regulations indicate this is not clear and depends on the interpretation of a peripheral A for EMT-I which states Intravenous therapy including establishing peripheral intravenous access and A for Paramedic which states Intravenous therapy including establishing peripheral intravenous access and establish intravenous access through external jugular vein. Therefore it is the Scope of Practice Committee s interpretation and recommendation that a scalp vein is a peripheral vein and therefore its cannulation would be allowed by EMT-Is and Paramedics only. Reduction of Dislocated Joints Only When Neuro or Vascular Compromise is Present Dr. Smith stated that current model protocols and rules and regulations are not clear on this issue. In the 2010 Model Protocols, the process was addressed specifically and allows for this procedure. The current model protocols does not address it specifically, but under section: Trauma Care Amputations Extremity Soft Tissue Trauma states that all levels may manually stabilize a painful and/or deformed extremity. Therefore it is the Scope of Practice Committee s interpretation and recommendation that would allow for reduction of a deformed joint when neurovascular compromise is present and the 2010 Model Protocol verbiage be incorporated into the 2012 Model Protocols at the next available opportunity. Use of the drug Metaproterenol (Alupent) Dr. Smith stated that under current rules and regulations that Paramedics may, in the administration of medication based on the following: Physician Medical Director approved medications; online medical control ordered medications; physician ordered medications specific to the patient; and mid-level practitioner ordered medications specific to the patient. Further, the 2012 Model Protocols do allow for both EMT-Is and Paramedics to use bronchodilators in the respiratory distress; asthma, exacerbation of COPD and respiratory infection protocols sections. The protocols do limit the use of bronchodilators to Albuterol for the EMT and AEMT. Metaproterenol is specifically listed on page 143 of the model protocols and its formulary class sorting supports this opinion. Therefore it is the Scope of Practice Committee s interpretation and recommendation that allow the usage of Metaproterenol for EMT-Is and Paramedics only and limiting EMTs and AEMTs to the usage of Albuterol. However, after discussion with the Board and input from Department Legal, it was determined that where the drug Metaproterenol is not specifically listed in A for EMT-Is, nor is there language allowing for PMD approval to allow them to use this drug specifically, it is determined that Metaproterenol can only be used by Paramedics. EMTs, AEMTs and EMT-Is cannot use Metaproterenol. Mr. Wiebe moved, seconded by Mr. Rennerfeldt to recommend approval of the Scope of Practice Committee s interpretation and recommendations as presented with the change that limits the use of the drug Metaproterenol to Paramedics only at this time. Voting aye: Bonta, Cerny, Fiala, Harmon, Henning, Hiemer, Jensen, Miller, Rennerfeldt, Smith, Wiebe, Bowlin and Boldt. Voting nay: None Absent: Deegan, Hoffman and LaFollette Motion Page 6 of 9

7 The Board took a short break at 11:32 a.m. The Board returned from break at 11:45 a.m. Dr. Bonta left the meeting at 11:50 a.m. MISCELLANEOUS BUSINESS Ms. Tiedt indicated that at the March 3, 2014 Board meeting the discussion concerning support of a universal Do Not Resuscitate and Physician s Orders for Life Sustaining Treatment (POLST) documents had failed to produce an acceptable document. After discussion, Mr. Miller moved, seconded by Mr. Boldt to draft a letter to Senator Dan Watermeier offering Board support of LR596 and for the recommendation of the requirements that all documents have the date, the patient s name, and the physician s signature, the words out-of-hospital are included, that it be limited to one page, with the orders regarding cardiopulmonary resuscitation prominently displayed and the forms contain documentation of conversation(s) and notifications. Voting aye: Cerny, Fiala, Harmon, Henning, Hiemer, Jensen, Miller, Rennerfeldt, Smith, Wiebe, Bowlin and Boldt. Voting nay: None Absent: Bonta, Deegan, Hoffman and LaFollette Motion Ms. Tiedt had received an inquiry from the Thedford Volunteer Rescue Squad concerning the format of acceptable recordkeeping available for their employee s information and training records. After discussion the Board determined that recordkeeping could be in electronic format as long as it was accessible when requested. Ms. Tiedt indicated the Department had received an inquiry concerning the duties of a qualified physician surrogate. Mr. Brink, Department Legal Counsel, indicated that a qualified physician surrogate means a qualified, trained medical person designated by a qualified physician in writing to act as an agent for the physician in directing the actions or renewal of licensure of outof-hospital emergency care providers. A qualified, trained medical person is defined as an EMR, EMT, EMT-I, AEMT, Paramedic, LPN, RN, PA or Physician and does not act as an agent of the physician medical director above the level of his/her license. The duties that a qualified physician surrogate can be assigned are included in Medical Direction Standards which states that responsibilities of a physician medical director include but are not limited to the following and those identified in 172 NAC A, A, B, C, and , item 7. Also, the physician medical director has ultimate responsibility and liability for decisions involving the service and these cannot be assigned to the surrogate. Ms. Tiedt requested the Board s opinion on approval of cardiopulmonary resuscitation courses or organizations. Title 172 NAC Requirements for Approving Organizations Issuing a Cardiopulmonary Resuscitation Certification states that the Board will review and approve organizations. After discussion, Mr. Wiebe moved, seconded by Mr. Rennerfeldt that the Board would approve cardiopulmonary resuscitation organizations only as long as they meet the requirements listed in Voting aye: Fiala, Harmon, Henning, Hiemer, Jensen, Miller, Rennerfeldt, Smith, Wiebe, Bowlin, Boldt and Cerny. Voting nay: None Absent: Bonta, Deegan, Hoffman and LaFollette Motion The website will be updated to reflect approval of organization without reference to specific courses. Mr. Wisell provided the Board an update of the Quality Assurance Report (QAR). Currently 105 Nebraska Licensed Emergency Medical Services have submitted either their QAR or Commission on Accreditation of Medical Transport Systems (CAMTS) certificate. The Department is continuing to work with services to ensure they are in compliance with prior to the expiration of their licenses. This report is for information purposes only. Page 7 of 9

8 Mr. Wisell provided the Board an update of the Application Processing Report. The report shows by licensure level: the number of applications currently being processed by the Department; number of applications denied; number of licenses issued; number of active licenses; number of renewed licenses. This report is for information purposes only. Ms. Harrison, Ms. Lemke, Mr. Newland, Mr. Scott, Mr. Newman and Mr. Wiehn joined the meeting at 12:30 p.m. Ms. Henning moved, seconded by Mr. Miller to reaffirm the mail ballots for licensure of: Morrill County Community Hospital as an Advanced Non-Transport Service and Star Care in Crete, NE as an Advanced Transport Service. Voting aye: Harmon, Henning, Hiemer, Jensen, Miller, Rennerfeldt, Smith, Wiebe, Bowlin, Boldt, Cerny and Fiala. Voting nay: None Absent: Bonta, Deegan, Hoffman and Hiemer Motion Mr. Klein and Mr. Brink left the meeting at 12:30 p.m. CLOSED SESSION Dr. Smith moved, seconded by Mr. Boldt to go into closed session at 12:45 p.m. to hear discussions regarding confidential information and to protect the reputation of individuals. Voting aye: Henning, Hiemer, Jensen, Miller, Rennerfeldt, Smith, Wiebe, Bowlin, Boldt, Cerny, Fiala and Harmon Voting nay: None Absent: Bonta, Deegan, Hoffman and Hiemer Motion Mr. Wiebe left the meeting at 1:09 p.m. Mr. Hiemer left the meeting at 1:10 p.m. Mr. Wiebe returned to the meeting at 1:10 p.m. Ms. Harrison left the meeting at 1:15 p.m. Mr. Hiemer returned to the meeting at 1:16 p.m. Mr. Boldt left the meeting at 1:19 p.m. Mr. Boldt returned to the meeting at 1:20 p.m. Mr. Rennerfeldt left the meeting at 1:29 p.m. Mr. Rennerfeldt returned to the meeting at 1:33 p.m. Mr. Hiemer left the meeting at 1:37 p.m. Mr. Hiemer returned to the meeting at 1:40 p.m. Mr. Newland, Mr. Scott, Mr. Newman, Mr. Wiehn and Ms. Lemke left the meeting at 1:45 p.m. OPEN SESSION Ms. Fiala moved, seconded by Ms. Jensen to return to open session at 2:05 p.m. Voting aye: Hiemer, Jensen, Miller, Rennerfeldt, Smith, Wiebe, Bowlin, Boldt, Cerny, Fiala, Harmon and Henning Voting nay: None Absent: Bonta, Deegan, Hoffman and Hiemer Motion DECISIONS Mr. Wiebe moved, seconded by Mr. Rennerfeldt to offer Ryann Hauck a two year probationary license based on Ms. Hauck s misdemeanor convictions and alcohol abuse diagnosis. Voting aye: Jensen, Miller, Rennerfeldt, Smith, Wiebe, Bowlin, Boldt, Cerny, Fiala, Harmon, Henning and Hiemer Voting nay: None Absent: Bonta, Deegan, Hoffman and Hiemer Motion Mr. Wiebe moved, seconded by Mr. Rennerfeldt to approve the application for licensure for Teena Fedorchik. Voting aye: Miller, Rennerfeldt, Smith, Wiebe, Bowlin, Boldt, Cerny, Fiala, Harmon, Henning, Hiemer and Jensen Voting nay: None Absent: Bonta, Deegan, Hoffman and Hiemer Motion Page 8 of 9

9 Dr. Smith moved, seconded by Mr. Boldt to offer Jenee Blundell a five year probationary license. The basis for the probationary license is Ms. Blundell s misdemeanor convictions, alcohol dependence diagnosis and disciplinary actions against her current Nebraska Licensed Practical Nurse license. Voting aye: Rennerfeldt, Smith, Wiebe, Bowlin, Boldt, Cerny, Fiala, Harmon, Henning, Hiemer, Jensen and Miller. Voting nay: None Absent: Bonta, Deegan, Hoffman and Hiemer Motion Dr. Smith moved, seconded by Mr. Rennerfeldt to approve the applications for licensure of Kimball County Ambulance Services as an Advanced Life Support Transport Service and Shelton Volunteer Fire and Rescue as a Basic Life Support Transport Service. Voting aye: Smith, Wiebe, Bowlin, Boldt, Cerny, Fiala, Harmon, Henning, Hiemer, Jensen, Miller and Rennerfeldt. Voting nay: None Absent: Bonta, Deegan, Hoffman and Hiemer Motion ADJOURNMENT There being no further business, the meeting was adjourned at approximately 2:15 p.m. Respectfully submitted, Scott Wiebe, Secretary Written by: Bill Wisell, Health Licensing Coordinator Page 9 of 9