Finger Lakes Regional EMS Council: News

FLCC GENEVA CAMPUS INAUGURAL BLOOD DRIVE

FRIDAY, MARCH 28, 2008

12:00 PM - 5:00 PM

63 PULTENEY STREET - GYMNASIUM

PLEASE CALL DONNA SPINK AT (315) 789-0108 TO SCHEDULE YOUR LIFE SAVING APPOINTMENT.

IF YOU DONATED ON OR BEFORE FEBRUARY 1, YOU WILL BE ELIGIBLE TO DONATE.

TO:                All Agencies and Providers
FROM:         Robert Stueber BS EMT-P Program Agency Coordinator
RE:                Preceptor Workshop
DATE:           December 3, 2007

Due to circumstances beyond the control of the office the Preceptor Workshop scheduled for December 6, 2007 has been cancelled.

The class has been rescheduled for December 18, 2007 at the same location(Newark Arcadia Ambulance) at the same time(6:30pm).

There are still spaces available and if you are interested in attending this course contact the council office at:

1-800-357-3672 or 315-789-0108.

TO:                 All Agencies and Providers
FROM:           Finger Lakes Regional EMS Council REMAC
DATE:            October 5, 2007

REMAC ADVISORY

In an effort to provide the highest quality care to the patients of the Finger Lakes Region, nalbuphine also known as Nubian® will be removed from the FLREMS analgesia protocol effective January 1, 2009. Agencies currently utilizing this drug as well as those considering implementation of the pain management/analgesia protocol should begin the process of applying for a narcotics license as soon as possible in order to meet the deadline noted above.

Also, in the best interest of our patients any patient who needs analgesia should have an ALS intercept from a ground or air agency that can administer morphine sulfate or fentanyl for pain management since patients are treated with nalbuphine are resistant to further treatment with narcotics for their pain and their management becomes much more complicated.

TO: All Agencies and Providers
FROM: Finger Lakes Regional EMS Council REMAC

DATE: October 5, 2007

REMAC ADVISORY

Any agency in the Finger Lakes EMS Region that has members who perform Endotracheal Intubation must have a back up or adjunct airway device available should the airway be difficult or failed. Oropharyngeal and Nasopharyngeal airways are NOT sufficient as adjunct airways. Supraglottic airways are the preferred adjunct airways.

It is also mandatory that some form of End Tidal CO2 detection be utilized in intubated patients. While colorimetric devices are acceptable currently, all agencies should be striving towards continuous waveform capnography which is currently the “gold standard” for detection of esophageal intubation and for documenting endotracheal intubation. All agencies are urged to pursue this goal as soon as possible.

TO: All Agencies and Providers
FROM: Finger Lakes Regional EMS Council REMAC

REMAC ADVISORY

It is of utmost importance that ALL EMS Personnel maintain professional conduct with regards to patient privacy. Under no circumstances should any member of an EMS or FIRE agency take pictures of patients other than those used to demonstrate mechanism of injury. If pictures are taken they are to become part of the patient’s permanent record and ALL copies are to be left with the receiving hospital. Under no circumstances should EMS Personnel have copies of PCRs or parts of patient records other than those necessary as part of appropriate record keeping for the agency that they work with or for use with a sanctioned EMS class.

It should be common knowledge that possessing and or distributing such medical record materials other than as part of your agencies record keeping is a violation of HIPPA as well as professional misconduct under NYS Public Health Law Article 30, section 800. Anyone who violates this Advisory will be referred to the NYS Bureau of EMS for investigation which may lead to suspension or revocation of EMS Certification as well as possibly leaving the individual(s) and their agency(s) open to liability by patient(s) and/or family members.

Patients not only trust EMS Personnel with their lives, but also with their privacy. EMS Personnel who violate this advisory are violating patient rights and are guilty of professional misconduct.

TO:                 All Members of REMAC
FROM:           Jack Davidoff MD, REMAC Chairperson
RE:                 REMAC Meeting for July and September
DATE:           June 25, 2007

The July REMAC Meeting has been cancelled due to scheduling conflicts. Please make a note that the September REMAC meeting has been moved to September 27, 2007 due to scheduling conflicts as well.

I hope this notice provides everyone with enough advanced notice to rearrange their busy schedules in order to make the meeting which as of this date is scheduled to be webcast.

If there are any questions or concerns feel free to contact either Bob Stueber or myself, and have a great summer.

TO:                 All ALS Agencies and Providers
FROM:           Ray McLean, ALS Committee Chair
RE:                 ALS Committee
DATE:           May 17, 2007

This committee has the power to stream line training, protocols, and procedures throughout the region. With that stated all "Action Items" must be voted on as a body and then brought in front of the council for approval.

I strongly recommend that every advanced agency represents themselves at the ALS Committee meetings. Your voice counts, however, if you are not there we will not hear you.

As the Committee makes recommendations to the Council the Council might accept these items which in turn might affect procedures your agency abides by.

The ALS Committee will have voting power so we are asking that every agency submit a letter to Bob Stueber through the Council office on agency letterhead with recommendations for an Agency Representative to sit on the ALS Committee. We are also asking that every Agency has an alternate to sit in when applicable.

This does not mean the EMS community cannot attend. We are strongly encouraging all providers to attend and voice their concerns. This will be done in a formal format and then voted on by Committee seats. Once voted on all items will be brought in front of the council for approval.

The next meeting will take place on June 14th at the Regional Office in Geneva at 1900(7:00PM).

Please get your letters in to Mr. Stueber prior to the meeting so we may plan accordingly.

The Executive Committee has come up with the following action items for vote:

· Membership to include ILS and above agencies

· Each County shall have one representative

· Each Agency who represented shall have a vote, (Can one person have more than

one vote if he/she represents more than one agency) this will need to be discussed at

length during the next meeting.

· The Executive Committee shall not have more than one consecutive year in current

office.

· Meetings shall take place one week prior to Council Meetings.

· Adoption of Mission Statement:

            "The ALS Committee will support the development of pre-hospital advanced life
             support in the Finger Lakes region by working together with the Finger Lakes
            Regional EMS Council and the Finger Lakes Regional Medical Advisory
            Committee to facilitate the delivery of high-quality, consistent Advanced Life
            Support care throughout the region."
     ·         Proposal of Bi-Laws

I look forward to seeing all of you there.

TO:                 All Agencies and Providers
FROM:           ALS Committee
RE:                 Meeting Notice
DATE:            April 25, 2007

The ALS committee will hold their next meeting on May 10, 2007 at 7:00pm at the regional office located at the Finger Lakes Community College Geneva Extension 63 Pulteney St. , Geneva , NY

All ALS services within the region are urged to send a representative to this meeting.

TO:                 All Agencies and Providers
FROM:           Robert Stueber BS EMT-P Program Agency Coordinator
RE:                 PCRs
DATE:            April 2, 2007

All Agencies and ProvidersRobert Stueber BS EMT-P Program Agency Coordinator PCRs April 2, 2007

On May 1, 2007 the United Sates Postal Service will be raising their rates and this will directly affect the way the council and program agency distributes information and other services.

One of the biggest services affected will be the distribution of PCRs to the providers. At the present time if an organization requests PCRs and no one will be near the office to pick up the PCRs they are mailed to the agency. To this point while it has been expensive at times to do this the new postal rates will make this practice truly impossible to continue.

As an example, at the present time if an agency requests 125 PCRs and they are mailed to the agency it currently costs approximately $5.20 to mail the package. When the new postal rates take affect in May the same package will cost approximately $10.00 to mail. It is council and program agency’s understanding from conversations with the postal service that organizations should anticipate a twenty-five percent increase in their postage budget. Increases of that size are unacceptable since the agency’s budget is fixed and there is no anticipation of an increase in the near future.

All Agencies and ProvidersRobert Stueber BS EMT-P Program Agency Coordinator PCRs April 2, 2007 All Agencies and ProvidersRobert Stueber BS EMT-P Program Agency Coordinator PCRs April 2, 2007 On May 1, 2007 the United Sates Postal Service will be raising their rates and this will directly affect the way the council and program agency distributes information and other services. One of the biggest services affected will be the distribution of PCRs to the providers. At the present time if an organization requests PCRs and no one will be near the office to pick up the PCRs they are mailed to the agency. To this point while it has been expensive at times to do this the new postal rates will make this practice truly impossible to continue. As an example, at the present time if an agency requests 125 PCRs and they are mailed to the agency it currently costs approximately $5.20 to mail the package. When the new postal rates take affect in May the same package will cost approximately $10.00 to mail. It is council and program agency’s understanding from conversations with the postal service that organizations should anticipate a twenty-five percent increase in their postage budget. Increases of that size are unacceptable since the agency’s budget is fixed and there is no anticipation of an increase in the near future.

Therefore, effective July 1, 2007 the following policy will take affect.

The program agency will keep a six-month supply of PCRs on stock for each agency based on the records of PCR submitted to the agency for the previous 6 month period. An agency may call and make arrangement to pick up their PCRs during normal business hours (Monday – Friday 8:30am – 4:30pm ). Evening pick-ups will also be possible if an agency calls the office during business hours. Also, if a group of agencies designate an individual to pick up PCRs for their organization and they have called the office the designated person may pick up the PCRs. The council and program agency will explore all available avenues, within reason, to see that the agencies within the region have PCRs and will work with the agencies to insure that PCRs are available. All reasonable requests will be handled in a timely manner.

If there are any questions feel free to the Program Agency Coordinator – Robert Stueber at: 1-800-357-3672 or via email rstueber@flremsc.org.

TO: All Agencies and Providers
FROM: Finger Lakes Regional EMS Council REMAC

REMAC ADVISORY

Thompson Hospital will have their Operating Room closed beginning at 1600hrs( 4pm ) on April 10, 2007 and will re-open at 0005hrs( 12:05am ) on April 16, 2007 .

Thompson relates that they will be able to do only C-sections and/or minor OB procedures in their OB OR and they will have another room set up for life threatening emergency surgery only. Things such as hip fractures, appendectomies and other such procedures will need to be transferred to other appropriate facilities.

This does not mean that the ER can not accept patients, but anything that would require surgery and is not life threatening will be transferred. Therefore, good judgment might save both you and your patient from having to make a second trip to another facility.

As always when in doubt contact medical control for guidance/assistance.

TO:                 All Agencies and Providers
FROM:          Robert J Stueber BS EMT-P Program Agency Coordinator
                        Jack Davidoff MD, Finger Lakes Regional EMS Council REMAC Chair
RE:                 Focused Study
DATE:            December 7, 2006

Finger Lakes Regional EMS Council’s focused study for the current year is evaluating the on scene times for BLS crews that may be performing Blood Glucose Testing. The study will look at the amount of time that is spent on scene and try to determine if on scene times are longer for BLS crews that are performing the skill now that they are trained to do so.

A preliminary set of control data was collected earlier in the year utilizing data taken directly from the PCRs that are sent to the regional office for QA/QI purposes. As part of the control group ALS services were also included since Blood Glucose Testing is a routine skill performed by the services.

The second phase of the study which will begin in January will require the cooperation of all of the services within the region and will again evaluate on scene times. The enclosed form needs to be completed for each patient contact where the patient exhibits: Altered Mental Status, Weakness, Syncope, Seizures, Unconscious/Unresponsive with vital signs. These forms should be completed for all patients with these presenting problems for the months of January, February and March and the form should accompany the PCR for the particular response when PCRs are sent to the regional office for QA/QI. Again both BLS and ALS services will need to complete the form.

Thank you in advance for your cooperation in gathering the data for this study and if there are any questions feel free to contact Bob Stueber in the program agency office for assistance or clarification.

TO: All Agencies and Providers
FROM: Finger Lakes Regional EMS Council REMAC

REMAC ADVISORY

The following policy has been adopted by the REMAC in regards to BLSFR units within the Finger Lakes Regional EMS Council’s region.

All BLSFR units will submit a Patient Care Report (PCR) each time the unit is dispatched. NYSDOH Version 5 PCRs are to be utilized for reporting, and the research copy shall be submitted to the regional office by the tenth day of the following month. Patient Care Reports will be dispersed to each service upon request to the Program Agency, and the required PCR submission forms will be provided by the program agency as well.

Part 800.15 requires all certified providers to complete a PCR for each patient treated. Additionally as part of the EMS system BLSFR must participate in the regional quality assurance program and patient documentation is the foundation of quality assurance.

The medical directors of those organizations that elect not to comply with this policy will be notified by REMAC of the compliance problem. These organizations could find their privileges to carry, administer and/or use Albuterol, Epi-pen auto injectors, and AEDs (other than those organizations in PAD programs) restricted or revoked by their medical director.

TO: All Agencies and Providers
FROM: Finger Lakes Regional EMS Council REMAC

REMAC ADVISORY

It has recently been brought to the attention of the REMAC that gross deviations from the Trauma Protocol are occurring. While REMAC acknowledges that not every situation is the same, gross deviations from the protocol are problematic. The Trauma Protocol was developed with the use of accepted regional, state and national standards, and refined through out the years to insure that individuals that are injured in the region receive optimal patient care in a timely and appropriate manner. Deviations from this protocol violate accepted regional and national standards, and could put patients at risk for less than positive outcome.

Therefore, it is imperative that both service administrators and field providers review Section 2.0 – Adult Trauma Protocol, and Section 3.10 – Pediatric Trauma Protocol of the 2006 edition of the regional protocols. In summary, both of these protocols outline treatment and transport condition, including transport to appropriate trauma centers and the use of flight evacuation when appropriate.

Again, all services and providers are strongly urged to review these protocols and utilize them, when indicated, for the appropriate care of patients injured in the region.

TO: All Agencies and Providers
FROM: Finger Lakes Regional EMS Council REMAC

REMAC ADVISORY

It has recently been brought to the attention of REMAC that at times the protocol related to the use of air medical utilization is either being misinterpreted or disregarded with respect to the transport of patient’s whose care might possibly benefit from the use of this service.

Section 4.2 of the 2006 edition of the Finger Lakes Regions EMS System entitled Air Medical Utilization Guidelines states:

Air medical services should be considered for the following:
        1.      Patients who meet the vital signs or injury criteria for trauma care when ground transport time is greater than 15minutes to a trauma center.
        2.      A multiple casualty incident
        3.      A remote/wilderness area, difficult terrain, or any other time when a ground ambulance is unable to access the patient in a reasonable time frame
        4.      Any unstable patient when ground transport to the nearest hospital exceeds 15 minutes.

Service administrators and field providers are strongly urged to familiarize themselves with the policy and utilize it for the timely and appropriate care of patients within the region.

TO: All Agencies and Providers
FROM: Finger Lakes Regional EMS Council REMAC

REMAC ADVISORY

It has been brought to the attention of REMAC that when a BLS ambulance service requests an ALS intercept, at times the closest available ALS unit is not being sent to provide assistance. In fact at times this service is being provide from services at greater distance with long intercept times and passing through multiple service areas where the same level of care is both closer and available. This action is problematic and needs to cease immediately.

Section 4.13 of the of the 2006 edition of the Finger Lakes Regional EMS Standards of Care titled “ALS Intercept Utilization” states that a BLS service may have an agreement with an ALS agency to provide service when needed (#2), but the policy also states that ALS care should not be delayed if a closer service, either ground or air, is able and available to respond quicker than the prearranged service.

Service administrators and providers are strongly urged to not only review this policy but adhere to it in its entirety at all times without exceptions. There has been discussion with DOH in regards to this situation, and it is the assumption of both REMAC and DOH that individuals that violate this policy are subject to administrative action by REMAC up to and including suspension of practice privileges.

TO: All Agencies and Providers
FROM: Finger Lakes Regional EMS Council REMAC

REMAC ADVISORY

At the last REMAC meeting there was discussion about the transport of psychiatric patients to the appropriate facility. Some of this discussion more specifically centered on whether certain types of patients, specifically those that are under the influence of drugs or alcohol, were being transported to the most appropriate facility.

That having been said, REMAC has developed the following guidelines which it urges all services and providers to follow when there is a request for a psychiatric transport.
        1.      If a patient has a psychiatric condition or decompensation and is not suffering from an injury, obvious medical illness, or intoxication from drugs or alcohol should be taken to the closest appropriate hospital with psychiatric services.
        2.      Psychiatric patients with substantial impairment from drugs or alcohol as manifested by decreased level of consciousness or an inability to safely ambulate independently should be taken to the closest hospital.
        3.      Any psychiatric patient with a traumatic injury should be transported to the closest hospital.
        4.      Any individual with a potential history of significant overdose should go to the closest hospital.
        5.      In unclear situations Medical Control should be contacted for a decision on the appropriate destination of the patient.

Additionally, some of the discussion at the meeting centered on the fact that law enforcement or security services are instructing crews as to where patients are to be transported, this is not only inappropriate but may at times not be in the best interest of the patient which is who we are there to serve.