Microsoft word - 02-19-10 minutes final.doc

Mr. Glenn Waters Dr. Stephen Haire MEMBERS ABSENT Chief J.P. Medani, Clearwater Fire Dept. Chief Bob Markford, Palm Harbor Fire Dept. Mr. Richard Satcher called the meeting to order at 10:10 a.m. There was a quorum. After review of the October 15, 2009 Medical Control Board minutes, Mr. Richard Satcher called for approval. Dr. Bellini moved to approve and Dr.Stephen Haire seconded. The minutes were approved unanimously. 3. OLD BUSINESS a) 12-lead Transmission Update Craig Hare explained that after strenuous efforts by the ambulance company the conclusion was that we would never see greater than a 75% success rate of 12-lead transmissions with the current transmission technology. Therefore, the decision was made to use EMS grant funds of approximately $50,000 to purchase Velocitor modems. These are cellular modems that will fit in the pouch of the cardiac monitors and will be able to transmit from the patient’s side rather than having to wait until the patient is loaded in the ambulance. Otherwise, there should be little to no change in what EMS crews need to do. The modems have proven to be 100% successful in testing and should arrive in the warehouse February 27th. Vicki Glenn reported that Sunstar has done additional training for the last three months regarding necessary demographic information to be entered prior to 12 lead transmission and included in verbal patient reports. b) Patient Care Record (PCR) Summary Update Plans had been made to move ahead on the PCRs for Fire Rescue but due to County budget cuts the operating costs would be too high after year one of the grant. In year two there would not be funding for the technical support, costs for wireless networking and repair and replacement costs. For this reason the project has been deferred. The County has spoken to the Fire Chiefs about alternate uses for the grant funds that had been designated for electronic PCRs, and they set as high priorities replacing cardiac monitor defibrillators and obtaining emergency driver vehicle simulators for the Fire Academy. Mr. Satcher stated that hospitals are mandated by 2014 to have electronic patient care records and asked if that applies to EMS also. Craig Hare stated that he is unsure if this applies to first responders but that at this time Sunstar is entering all the interventions done by them on the electronic report. Dr. Romig adds it may only apply to the ambulance company and not the first responder. Mr. Hare will follow up with the County Attorneys regarding this question. Craig Hare addressed the request that had been made to improve the printed EPCR report for easier use by ED staff. The printed report has been resorted with an improved format and a sample was provided to the Board in the administrative packet. A major upgrade to the software will be made in the April/May time period. At that time we may be able to improve our data set and improve compliance with the national data set and add closed call rules to insure all information is gathered prior to closing the call. 4. MOM Changes and Protocol Discussion a) Protocol 5.34 Nausea/Vomiting Update Discussion and Approval Dr. Romig reports that Ondansetron has been monitored and found to be very safe. She thinks it is reasonable to allow the drug to be moved to Level 1, meaning no consult is required. There have been few requests for use in obstetric and pediatric patients so will be keeping those patients at Level 2. Patients who have already received analgesics or sedation or may receive them will also be kept at Level 2. Patients in spinal motion restriction will be level 1 if vomiting to prevent spinal motion and protect the airway. If nauseated but not vomiting the patient would be level 2. Dr. Romig stated the protocol would take effect April Minutes/Medical Control Board
February 19, 2010
1. Mr. Satcher called for a motion. Dr. Pell motioned and Dr. Upadhyay seconded. It passed unanimously. b) Protocol 5.12 CHF: Removal of Lasix Discussion and Approval Dr. Romig stated that Lasix has been used rarely in the last year. We would save several thousand dollars by removing it from the formulary. Dr. Romig reported that research shows that Lasix is seldom indicated in the field any longer and that cost vs. benefit ratios are no longer favorable for continuing to stock the drug. Dr. Bellini moved to approve the protocol and formulary change; Dr. Haire seconded, and the motion carried unanimously. Dr. Romig also reported we are going to a disposable CPAP device which will save $20 to $30 per device. The Flow Safe device also has a manometer, which the current CPAP device does not. This allows us to record the actual pressure being delivered and might allow us to increase indications for CPAP treatment. EMS personnel are required to report when CPAP is used but are not required to obtain permission if the patient meets all of the indications in the protocol. Craig Hare directed the Board’s attention to the administrative packet. In the upcoming budget cycle we will have to deal with the expected 12% decline in property values which will create a 60 million dollar deficit for all of County government. In the next fiscal year there will be a 20 million dollar deficit. There are agreements in place for ambulance service, medical direction, and continuing medical education. Mr. Hare reported 2.6 million dollars in adjustments were made to first responders last year so there is not much that can be done there. The County has presented some scenarios about adjusting ambulance fees, the use of reserves and a small tax increase to continue to operate the system. There will be public budget meetings and an online meeting with a blog. b) Florida EMS Advisory Council Openings for Hospital Administrator and Physician Mr. Hare announced that the State of Florida EMS Advisory Council has vacancies for the positions of layperson, physician, EMT from a Fire Service and a hospital administrator. The Council meets for three days in January, July and October and utilizes interim conference calls. Council members are reimbursed by the State for travel expenses and per diem. Advisory Council appointments are made by the State Surgeon General. Mr. Hare advised that he would be happy to assist with any nominations that MCB members may wish to make. Dr. Romig advised that her experience from having served on the Advisory Council for eight years and as Council Chair has been that the position can require a significant time commitment. c) EMS/Hospital Transfer of Care Workshop Minutes/Medical Control Board
February 19, 2010
Going into the new fiscal year on October 1, 2009, a "transfer of care" definition was included in the Ambulance Service Agreement. The monetary value of hospital bed delays was removed from the "base services payment" and created a budget reduction of $400,000 for the Ambulance Contractor. The agreement only compensates the Ambulance Contractor when a hospital bed delay is greater than 20 minutes. The new system goal needs to be 100% of patients being placed within 20 minutes to attain cost savings. Until now, the EMS System goal has been to place 90% of the patients in a bed, stretcher or wheelchair within 20 minutes and 100% of the patients within 30 minutes. Hospitals and EMS have worked together and most Hospitals regularly attain the goal and there has been a reduction in hospital closures. EMS has made an effort to listen to hospitals on what we need to do in the EMS System. In 2006, there was a $1.7 million upgrade to the hospital communication system. Sunstar has been attempting to give more lead time in notifying hospitals via radio. In 2007, EMS upgraded to electronic medical records system. A 12-lead EKG transmission has been paid for with a Morton Plant-Mease grant. Hospitals have made a number of improvements as well. For example, Morton Plant Mease established a six sigma quality team to address quicker patient flow. By removing hospital bed delays from the Ambulance Contractor's base services, County EMS system is able to quantify the issue in terms of frequency and cost. This increased scrutiny will ensure County EMS works with the Medical Control Board, the EMS Advisory Council, and our Hospital partners to reduce the expense. Mr. Hare has briefed the Board of County Commissioners that in the future EMS may charge hospitals for supplemental services when on stand-by. It is an option for the County to consider given the budget situation. The Transfer of Care Workshop met to identify the next round of improvements. Mr. Hare directed the Board’s attention to an administrative packet that highlights ideas put forth at the December 14, 2009 workshop. Mentioned were efforts by Jeff Barnard and IT of the Medical Director’s Office to improve web-based tools and determining what can be done to reduce bed delay. Other issues that need to be addressed are partnering with Public Health, appropriate placement of Baker Act patients, and precise tracking of the time it takes to transfer care from EMS to Hospital staff. Mr. Satcher suggests we get input from the participants and to let the group continue to work as a sub-committee. It was decided that results from the workshops should be sent to the Hospital Administrators. An EMS study is under way and we should have preliminary results by mid-May. Hospital and ED staff, EMS agency personnel and Medical Control Board members may be contacted by Mic Gunderson, the study investigator, for information. Mr. Hare pointed out the results of the previous OPAGGA study in the packet provided. e) Approval of the Philips MRX Monitor Defibrillators Minutes/Medical Control Board
February 19, 2010
Mr. Hare stated that on February 2, 2010 the Board of County Commissioners approved an agreement with Philips Electronics for purchase of Philips MRX monitor defibrillators. Because of the necessity for the equipment purchases to be phased in, the recommendation was also to continue use of the biphasic Physio Control Lifepak 12’s currently in service with Sunstar for the scheduled remaining 3 to 5 years as well as to discontinue use of monophasic Lifepak 12s and all Lifepak 10’s. The Philips agreement has a 3 year term agreement 2 one year extensions. Philips give a guaranteed price and a 45% discount on hardware and monitors, which is a $8000 savings per machine over competing bids. Philips also includes a 32% discount on diposable supplies and a trade in value of $4500 on the Lifepak 12’s and a one for one exchange on current, recently purchased Lifepak 15’s. This will all result in a direct EMS savings of $420,000. The agreement also includes a savings of $50,000 per year for a lower cost maintenance plan. All Philips monitors will have identical specifications, including a Q CPR feature that monitors and provides feedback to rescuers to assure that quality CPR is being delivered. Mr. Satcher asked if the County Commission had already approved purchase of the Philips defibrillators and Mr. Hare answered that that was correct; the requested action by the Medical Control Board is for ratification purposes and to provide further support for the device as county authorized clinical equipment. In order for this to be clinically approved it must be approved by the Medical Control Board. County Attorney Bob Swain affirmed that the County Commission, sitting as the EMS Authority, does have the right to approve such contracts. Setting of specifications and protocols for use are the purview of the Medical Director and the Medical Control Board. In response to an observation that there is an existing FDA investigation regarding a possible concern that 200 Joule defibrillators such as the Philips MRX may result in some patients not receiving adequate treatment, Dr. Romig stated that the investigation is in preliminary stages with a small number of case reports and that there has been no recall at any level of the Philips MRX. She stated that she asked that the contract negotiation include provisions for Philips to address any concerns that may arise. Mr. Hare affirmed that this had been included. Mr. Waters moved for approval of the Philips MRX as a County authorized clinical device; Dr. Haire seconded and the motion passed unanimously. 6. Open Forum 7. NEXT MEETING May 20, 2010 at 10:00 a.m. 8. The meeting was adjourned at 11:48 a.m. Minutes/Medical Control Board
February 19, 2010


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