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EMS Policy Minutes 01/15/2010 m~i~~llWirn~ Fiala ..~ ~. Hiller. ' Henning ~ Coyle Coletta January 15, 2010 By:......86"......".....~t' MINUTES OF THE MEETING OF THE COLLIER COUNTY EMERGENCY MEDICAL SERVICES POLICY ADVISORY BOARD Naples, Florida, January 15, 20 I 0 LET [1' BE REMEMBERED that the Collier County Emergency Medical Services Policy Advisory Board, having conducted business herein, met on this date at 3:30 PM in REGULAR SESSION at the Neighborhood Health Clinic, 12 Goodlette Road N., Naples, Florida, with the following Members present: CHAIRMAN: Vice Chair: James Talano, M.D. (Excused) Chief Robert Metzger Chief Walter Kopka Linda Mitchell, RN Steve Shafor (Excused) ALSO PRESENT: Dr. Robert Tober, Collier County Medical Director Jeff Page, Chief, Bureau of Emergency Services Jennifer Florin, Administrative Assistant, EMS Dan Bowman, Deputy Chief, Bureau of Emergency Services MIsc. Corres. Date: U> \ 1<-\ \\ \ Item #\v"X c.\'\ ""'~ /' .---..... - -." ,~_.-_.. COLLIER COUNTY EMERGENCY MEDICAL SERVICES POLICY ADVISORY BOARD AGENDA MEETING TO BE HELD: Neighborhood Health Clinic 120 Ooodlelte Road North, 2"" floor meeting room Naples, Florida DATE: January 15, 2010 TIME: 3:30 P.M. Call to Order Pledge of AllegIance Establish Quorum Agenda AdditionsfDeletions Adoption of Agenda Minntes from Previous Meeting AdditionslDeJetionslCorrections Adoption of Minutes November 2011> Minutes Old Bnsiness Adoption of Bylaws New Business a) JEMS Back to Basics BLS care article b) JEMS Toronlo ALS/BLS model 0) JAM A IV Meds vs No IV Meds OOHCA d) SALT device and intubation Public Comment Board Member Discussion Establish Next Meeting Date Adjournment January 15, 2010 Call to Order Pledge of Allegiance Establish Qnorum The Meeting was called to order at 3:35 P.M. by Vicc Chainnan Robcrt Melzger and a quorum was eSlablished. The Pledge of Allegiance was recited. Commissioner Fred Coyle at/ended Agenda AdditionallDeletions Adoption of Agenda Linda Mitchell moved to adopt the Agenda as slIbmltted. Second by Walter Kopka. Carried /wallllllollsly, 3-0. Minutes from PrevIous Meeting AdditionslDeletionslCorrections Adoption of Minutes November 20, 2009 Walter Kopka lIIoved to approve the Minl/tes from the November 20, 2009 Meetillg as slIbmlt/ed. Second by Lillda Mitchell. Ca/'ded IIlIalllmollsly, 3-0. Old Business Adoption of Bylaws Jennifer Florin, Administrative Assistanl - Bureau of Emergency Services, confinned lhe Advisory Board members had not submitted any changes to the Bylaws since the lasl meeting. Walter Kopka moved to approve the Bylaws as sIIbmitted, Secolld by Linda Mitchell. Carried IIIumimollsly, 3-0. New Bnsiness a) JEMS - "Back to the Basics - The Lost Art of BLS Care" (article), December, 2009 Dr. Tober gave a PowerPoint presenlation and outlined lhe points contained in the article: the previous standard for emergency medical pcrsonnel was Basic Lifc Support training wilh Advanced Life Supporl-trained personnel as the exception. He stated there was a lendency to move 100 quickly to A LS-intcrvention before B LS proccdures are completed, and his goal was to shift lllc focus back to a strong foundation ofBLS training and to improve response time 10 approximately tour minutes, His concern is the deleriora\ion of ALS skills due to the incrcasing numbcr of paramedics because some paramedics do not receives an opportunity to praclice skills on a frequent basis, while BLS skills should be practiccd on a rcgular basis since BLS response should be the first on scene. 2 January 15,2010 Linda Mitchell asked if a paramedic and an EMT were both on a scene, would both administer ALS instead of BLS care. Dr. Tober replied when there is a joint team working, the efforts have been coordinated. He referenced the East and North Naples Fire Districts which hircd a largc numbcr of paramedics who have jumped to ALS skills without a coordinated BLS intervention. He cited fi"Om the JEMS article: "As more and more fire departments realize that their futures are staked on the ability to positiol/themselves as Fonlline EMS provider". pammedic 'saturatioll'ls llkely 10 comil/ue. It's therefore incumbent on those in the field to acknowledge the problems thai can result from abselll or inadequate BLS care and incorporale into their paradigm and oil-scene procedures a strong commitmem tv appreciating and implementing the prillciples under- lying the admollitioll, 'BLS comes bejore ALS. " He stated a greater effort is nceded to teach the community how to adminisler CPR until EMS arrives and suggested 10 resume broadcasling the five-minute instroction tape on the Counly's cable channel. Vice Chairman Metzger welcomed Commissioner Coyle to the Advisory Board. He also asked if other studies, in addition to the OPAL Study, were available that compared similar populalions in syslems that ran BLS versus ALS, based solely on cardiac mns. Dr. Tober stated lhe first five minules 10 ten milllltes of an emergency medical situation impacls patient livelihood and almost any patient can be stabilized by enhanced CPR. He further stated he was not aware of any article specifically suggcsting that a "saturation" of paramedics has positively affecled the heallh and wellbeing of a community. Vice Chairman Mctzger asked what was done, after reviewing the run reports from NOIth Naples and East Naplcs, to identify and corrccl the situation with the Fire Districls. Dr. Tobcr slated the deviations from established protocol werc rcvicwcd with the Departments' training officers. Vice Chairman Metzger asked if the medical response data compiled by Collier County had been kept in lhc samc fonnat for the past tcn years Chief Jeff Page slaled the format was revised, as reqnested by the Fire Chiefs, and is more inclusive. Vice Chairman Metzger lISked if dala was collected for "Signal 7 Declarations" and further asked Staff to supply the data for cardiac arrest runs lhat were worked and not worked in order to understand how the runs have evolved over tillle and how to atlribule the improvements. Chief Page will provide lhe dala at the next Advisory Board meeting. b) JEMS - "Toronto Tests New ALS/BLS Model" - August, 2009 The author stated, "." mallY others accepted the all-ALS theory that was based 0/1 :vou /lever know what could go wro/lg' 011 a call. Research /lOW shows that we don't lIeed ALS 011 all calls. In fact. only about 5% of calls lIeed ALS. " 3 January 15,2010 Dr. Tober slated similar data was reviewed to evaluate Collier County's protocols. Hc noted low blood sugar can kill quickly and is considered to be a life-threalening issue. The use of glucometers in Collier's system is considered to be a BLS skill. He suggested au EKG hook-up and LV. initiation, when prophylactic, could also be a BLS skill. Vice Chairman Metzger questioned whcther taking an ALS unit out of service for a BLS transport was the best use ofthc resourec. He askcd if the focus was to expand the BLS footprint, should belter ways to utilize ALS transport for serious incidents be explored, and find alternative methods for BLS transport. Dr. Tober statcd he was not aware lhal A LS rcsponsc was suffering. The focus is to shrink BLS response times. Discussion ensued concerning olher options such as: . Utilizing private providers for nOll-emergency transpOlis . Subsequent loss of revenue . The need to keep thc system as cost effeclive as possible . How 10 maximize resourccs. Also discussed: · compRling data to agree on a definition ofwhal constitutcs an ALS call · current revenue stream - 50% is call-generated and 50% from Ad Valorcm taxes . Operation "Zone Coverage" c) JAMA: "LV. Meds vs. No LV, Meds" - OOHCA, November, 2009 01'. Tober oullincd the article: COlltext: Intravenous access and drug administration arc included in Advanced Cardiac Life Support (ACLS) guidelines despite a lack of evidence to improve oulcomes. Obieclive: To determine whelher removing intravenous drug administration fj'om an ACLS protocol would improve survival to hospilal discharge after out-of-hospital cardiac arrest. Main Outcome Measures: The primary outcome was survival to hospital discharge. Conclusion: Compared with palienls who rcceived ACLS without intravenous drug administration following out-of-hospital cardiac arrcsl, patients wilh intravenous access and drug adminislration had higher rates of short-term survival wilh no slatistically significant improvemenl in survival to hospital dischargc. quaJily of CPR, or long-term survival. Dr. Tober stated mosl of the individuals sent home fi.om hospilal in Collier County rcceived CPR and treatment within four to five minutes from onset of the emergency call. d) S.A.L.T. Device aud Intubation 01'. Tober explained how the device is used, lhat il was developed by the Almy Corps of Engineers and had 99% success rate when used in Afghanistan. He stated it was nol necessary 10 stop CPR in order to intubale using the device, and allows for blind insertion, unlike a laryngoscope. 4 January 15, 2010 Copies ofaliicles from Emergency Physicians Monthly, dated January 12,2010, and The Washington Posl, dated December 4, 2008, were distributed to the members for review. Public Comment None Board Member Discussion . VIce Chairman Metzger questioned whether the Advisory Board was laskcd to examine any outstanding system issues relaled to Q/ A ("Quality Assurance") or concerns raised by the public in its capacity to interacl with Collier EMS. There was a discussion concerning the charge fi.om the Board of Counly Commissioncrs outlined in the Ordinance which crcated thc Advisory Buard. Reference: Section Two, "Functions, Powers and Duties," Ordinance #2009-0 I, states: "The Advisory Board shall have Ihefollowing duties: 1. To review alld advise the Board of Coullty Commissiollers of all issues cOllcerning pre-hospilal emergellcy medical services within Collier County. 2. To heal' all disputes arising out of the ALS Ellgine Interlocal Agreements betweell Collier COllllty and Ihe various Fire Districts, and make written recommendations to the Board of County Commissioners jor resolution of such disputes. 3. To 1V0rk to improve and enhallce pre-hospital emergency medical care within Collier County. 4. To review and make written recommendation to the Board ofCounlY Commissioners of all changes to established protocol and practices recommended by the Medical Director's Quality Assurance Committee. 5. To make its special knowledge and expertise GI'ai/able 10 the Board ofCmmty Commissioners upon wriflell request by the Board ofCol/my Commissioners. " Commissioner Coyle staled the intenl of lhe Board of County Commissioners was for thc Advisory Board to serve as a coordinating committee and sounding board for any changes to protocol, organizational responsibilities, or anything else conceming the administration of emergency medical services within Collier County. It is the responsibility ofthe Board of COllnly Commissioners to make final decisions concerning lhe issues examined by the Advisory Board and its rccommcndations to the BCe. He slaled the BCC is interested in the goal of improving response times and welcome a clear definition of the steps to bc taken 10 achieve the goaL New technology, such as SAL.T., is also of interest to the BCC as well as a definition of BLS skills. The Advis01Y Board is to make recomme1ldations regarding the course of action to be lake1l by the Board of Call lily Commissiollers. Chief Kopka stated lhe articles presented should help to lead the Advisory Board in a direction, such as an emphasis on improving inilial BLS lraining. 5 January 15,2010 Dr. Tober staled EMS is developing a more aggressive first aid training program for the ColIier County Sheriffs Office and leach basic CPR to bus drivcrs and cmployees ofthe County's Department of Parks and Recreation. He stated another issue is 10 examine how the Fire Departments can help distribute its vehicles for fasler BLS response times. . Linda Mitehell asked if the members were aware of any articles concerning the hand-off of care in hospitals. Next Meeting Date April 23, 20 10 from 3:30 to 5;00 PM at lhe Neighborhood Health Clinic located al 12 Goodlette Road N., Naples, Florida. ***** There being uo further business for the good of the County, the Meeting concluded by order ofthe Viee Chair at 4:45 PM. COLLIER COUNTY EMERGENCY MEDICAL SERVICES POLICY ADVISORY BOARD --rJ2- ~ ~il\1etzger, 'ee The Minutes were apnroved hy the Board/Committee Chair on as presented v7 , or as amended 9d-1 I/o . 6