DISCLAIMER: These notes are a personal interpretation of events, information, meaning, and relevance by the
author, Mike McEvoy. All attempts at humor are intentional. www.mikemcevoy.com
News from the State EMS Council (SEMSCO) – May 2016 (page 1)
1. Excuse the extreme delay in getting these May 2016 notes out. You’ll also have to endure my interpretative efforts of those who actually attended as I was elsewhere. While I’d rather have poked my eyes out, I watched the on-line videos of the meetings, gleaning what I could from the artful masterpieces. Special thanks to Carol Brandt of Mohawk Ambulance for her meticulous notes that captured behind the scenes information.
2. The 2016 EMS Memorial Service was held on May 17th at the Empire State Plaza, attended by one of the largest crowds in history. What a fitting and memorable tribute to our fallen brothers and sisters and their families and loved ones. The attendance sent a message to the many elected officials and families about the strength of the bond we all share. If you missed it, visit www.youtube.com/watch?v=vPirfcgRLCY. Sadly, FDNY reports 1,000 of their members are currently ill from exposures sustained in the 9-1-1 attack.
3. PIER reported that 9 of the 18 Regional Councils submitted nominations for the annual NYS EMS awards (pretty pathetic). Ultimately, with some gentle encouragement (i.e., bashing over the head with a shovel), 15 regions sent in nominations. Awards will be presented at the Vital Signs Conference.
4. The Bureau announced a series of conference calls led by Council Chair Steve Kroll. The theme is business and financial stability of EMS services in a rapidly changing health care system. Calls were held in June and early July and will continue. Interested parties are welcome to join in:
July 26 at 2pm: Integration of EMS into the healthcare system
August 15 at 9am: Rural EMS
September 6 at noon: Patient-centered EMS
Others to be scheduled…
Call in information is as follows: 518-549-0500 (or 844-633-8697), Code 19290245#
5. Check and Inject NY now spans all 18 Regions, 382 agencies, 2,000 kits distributed, 4,000 people trained and 11 uses as of May which is like 1 per week, dude. Google it: www.google.com/?gws_rd=ssl#q=check+and+inject+ny.
6. In what were incredibly calm Medical Standards and SEMAC meetings, the NYS Collaborative Protocols were approved. Some notes from the workgroup: some regions will print copies but the intent is to distribute an app that will allow real time updates; eMOLST is being added (“What, what, what?” you say. Go to www.compassionandsupport.org/index.php/for_professionals/molst_training_center/emolst); roll out will involve different training in each region but much of the new content will be hosted on a University of Rochester LMS (that’s learning management system); and while controversial, patellar reductions will be included. Here’s why reducing patellar dislocations is important: the collaborative pain management protocols allow some pretty decent narcotic doses for painful orthopedic injuries. While patellar dislocations hurt like a mother, yet they are easily reduced – in fact, they often reduce just with patient movement. If you load a patient with a dislocated kneecap with narcotics to make them comfy and then reduce the dislocation: uh oh! Time to get out a BVM. Better to take a more logical approach and alleviate the pain.
7. Sad news for SEMAC and the STAC (State Trauma Advisory Council): Dr. Dan Bonville, a Trauma Surgeon from Albany Med who contributed greatly to both committees as well willing shared his expertise at QI meetings and conferences throughout NY, accepted a position in Houston. Many thanks for his dedication to advancing trauma care and EMS.
News from the State EMS Council (SEMSCO) – May 2016 (page 2)
DISCLAIMER: These notes are a personal interpretation of events, information, meaning, and relevance by the
author, Mike McEvoy. All attempts at humor are intentional. www.mikemcevoy.com
8. DHSES State Preparedness Training Center in Oriskany regularly offers active shooter, tactical EMS, remote location EMS, and EVOC training. A focus group has been established to assist in the development of relevant EMS training programs. In police work, this would be a clue: EMS attendance is not so good. Here’s their web site: www.dhses.ny.gov/sptc/.
9. Some changes to protocols and SEMAC Advisories: MAST Pants (BLS Protocol – page T-5), sentence 8 is changed from using MAST to splinting an unstable pelvis by applying a pelvic stabilizer device; the Hypoperfusion Protocol under Special Considerations #2 (SC-2) deletes Section V, essentially wiping MAST pants out of NYS Protocols. The SEMAC Advisory 97-04 on use of MAST is rescinded as is the 97-03 SEMAC Advisory on Hyperventilation in Severe TBI. Advisory 02-02 on AED for Pediatric Patients is also kyboshed. For all practical purposes, MAST is no longer in use. But wait! MAST remain in EMS Education documents, for what reason, no one knows. The pair you have in your ambulance is quite likely dry rotted and if you think you’re ever gonna get them to work, you may be delusional. Okay, after that word from our sponsor - lastly, a TAG has been established to review and update the alternative formulary, that document created during the era of drug shortages, allowing services to substitute medications when the protocol meds are not available or affordable.
10. DOH reports that PCRs are not getting to hospitals. SHOCKING (not). Uh…what to say? These are important, especially to trauma centers where PCRs are part of their certification process. Not like they’re unimportant otherwise…
11. A little budget item: the Health Commissioner is looking at whether Medicaid rates actually cover the cost of EMS services for a report to the legislature. I think we can all answer that question without much reflection. However, surveys sent to all 500 ambulance services with Medicaid Provider numbers resulted in 40 returns. That’s neither good nor helpful. The Bureau is updating their contact/email list in case that had some influence on the poor return rate. If you get an inquiry, it’s not spam.
12. Training and Education (T&E) reported exam results were reporting in an average of 12 – 14 days. Through May 2016, pass rates were:
Level # tested pass rate
CFR 1.419 92.8%
EMt 3,560 89.41%
AEMT 37 79.18%
CC 54 95.1%
P 558 88.61%
An item development workshop was held May 2-3, resulting in creation of 250 new test questions for the NYS written exams. Of course, they all need to be piloted. Additionally, the 4 hour course needed for CICs who qualify for certification taking the NAEMSE class (as opposed to the NYS CIC Course) can now be done on-line through the Moodle portal at www.vitalsignsconference.com. The first set of instructor (CLI & CIC) exams were administered May 19th. No word yet on pass rates.
13. An amendment is in the works to Policy Statement 13-06 to require active riding status when renewing any CIC certification expired for more than 2 years. Apparently, under a recent change allowing CICs to recertify even if they are not actively riding, a CIC expired for 18 years was able to recert. Go figure; there’s always a loophole to close.
News from the State EMS Council (SEMSCO) – May 2016 (page 3)
14. For those inquiring minds fascinated with specialty course funding, the Bureau has modified reimbursement for CIU (Certified Instructor Update) courses to reimburse at a rate of $15 per student versus the previous flat fee per class. Specialty course sponsors can also now charge additional tuition for any classes, if they wish to do so.
15. Got out your barf bags. CC is under review again. This time, a TAG has been appointed to compare AEMT to CC curriculum and protocols. Rich Beebe, who worked extensively on implementation of the EMS Educational Standards for AEMT told Med Standards that AEMT with some additions should be considered as a potential replacement for CC in some areas of NYS. There is also strong interest in programs that would transition CCs to Paramedic, a successful program recently concluded downstate. Of course, there are also folks who intend to fight to the end to keep the CC level intact despite it having no national equivalent. The whole thing oughta be interesting…
16. So, the National Registry is in the process of rolling out new psychomotor testing which raises the question of what NYS should do if the NREMT practical exams change. Our PSE (Practical Skills Exam, for you young folk) sheets mirror the NREMT forms. Short answer: T&E is keeping a watchful eye on the rollout. Stay tuned…
17. Finance reports that templates have gone out to Regional Councils and Program Agencies soliciting budget requests for 2017/18. Like it really makes any difference; budgets have not changed since the 1980’s (when hippies were fashionable).
18. Systems Committee voted, and SEMSCO approved a decision to reverse the Wyoming Erie Regional EMS Council’s determination denying an application by Mercy EMS to expand their operating territory to include the Town of Concord and Village of Springville in Erie County.
19. Legislative motioned and SEMSCO approved opposing any changes in NY Helmet laws.
Assembly bill 3241 www.nysenate.gov/legislation/bills/2015/a3241/amendment/original would make any motorcycle operator aged 21 or older exempt from wearing a helmet. Thus far, 30 states have repealed their helmet laws. They don’t call them donor cycles for nothin’.
20. A little update on community paramedicine: since the vociferous objections raised last legislative session by the home care industry, there is an effort underway this year to approve legislation to build a Community and Hospital Home Care Collaboration Program, designed to step outside existing laws and regulations to evaluate novel ways of addressing gaps in care. Should this legislation pass, EMS may have a window into Community Paramedicine or Mobile Integrated Health or whatever you want to call it.
21. Policy Statement 00-13 on Red Lights and Siren use is 16 years old and 7 pages long. It’s due for a revision. The Safety Committee is all over it…Code 3.
22. The psychic hotline knew you were calling…and, “presto!” – 2016 ERGs (Emergency Response Guidebooks) are out. These lovable little orange HazMat guides are distributed by your County Fire Coordinator. You could get yourself a digital copy on-line OR (say it isn’t so) download it as an app for your phone: http://phmsa.dot.gov/hazmat/outreach-training/erg.
23. If you know anyone interested in the EMSC (that’s Emergency Medicine for Children in baby speak) Committee at DOH, there are multiple openings: look at the committee membership list at www.health.ny.gov/professionals/ems/emsc/index.htm.
24. NYS DOH launched a new TBI (Traumatic Brain Injury) site with some pretty kewl resources: www.health.ny.gov/prevention/injury_prevention/traumatic_brain_injury/.
News from the State EMS Council (SEMSCO) – May 2016 (page 4)
DISCLAIMER: These notes are a personal interpretation of events, information, meaning, and relevance by the
author, Mike McEvoy. All attempts at humor are intentional. www.mikemcevoy.com
25. EMS conferences of interest include Pulse Check which is moving this year from Suffern back to Albany, September 29 – October 1 www.nysvara.org and Vital Signs in Syracuse, Oct 13 – 16 www.vitalsignsconference.com. Registration for both is currently open.
26. Those of you familiar with Pulse Check know that my partner in crime Rich Beebe, who helped me coordinate the annual event for the past 7 years, died very tragically on June 5th, 2016 from injuries sustained in a motorcycle crash: www.legacy.com/obituaries/timesunion-albany/obituary.aspx?pid=180265144 Rich was a consummate EMS professional, well known across New York State for his work as a paramedic author, CIC and mentor to many. His long standing involvement with the SEMSCO Training and Education Committee, his dedication to state and regional curriculum and protocol development and continued revision, as well as his work nationally on the boards of directors of NAEMSE (National Association of EMS Educators) and CECBEMS (recently renamed to CAPCE or the Commission on Accreditation for Pre-hospital Continuing Education) helped touch every single one of us. Rich was an icon, larger than life, an in-your-face instructor who did everything in his power to make EMS providers the best they could be. Most importantly, he was a great friend not only to me, but to many. His death leaves a large hole in EMS both nationally and across New York State that all of us will need to fill. In his memory, I will be asking the PIER Committee to consider renaming the EMS Educator of Excellence annual award in his honor. In my mind, there could be no greater recognition of everything Rich did locally, regionally, statewide, and nationally to advance EMS education. A FB Memorial www.facebook.com/Remembering-Richard-Beebe-1729366273988819/ includes (scroll down) Alex Downey’s Last Call Tribute video. Godspeed to our brother.
27. SEMSCO will next meet on September 13-14 and again January 10-11 in 2017. The meetings will remain at the Hilton Garden Inn in Troy.
These notes respectfully prepared by Mike McEvoy who previously represented the NYS Association of Fire Chiefs on SEMSCO before (finally) being replaced by Mike Murphy. Contact Mike at McEvoyMike@aol.com or visit www.mikemcevoy.com. If you want a personal copy of these “unofficial” SEMSCO minutes delivered directly to your email account, go to http://eepurl.com/iaXHY to put yourself on the list (or adjust your delivery settings) or go to the Saratoga County EMS Council NYS EMS News page at www.saratogaems.org/NYS_EMS_Council.htm. There, you’ll find a link to the list server dedicated exclusively to circulating these notes and all the past copies of NYS EMS News parked at the bottom of the page. Feel free to download any notes you missed. Tell your friends. The more, the merrier.
News
from the State EMS Council (SEMSCO) – March 2016 (page 1)
1. Medical Standards and SEMAC
approved protocol revisions from NYS and Suffolk. Glucagon garnered some discussion and debate.
The medication has seen some critical shortages, skyrocketing costs and is more
likely to expire than be administered to a patient. While no definitive conclusion was reached,
glucagon may be headed for extinction in NY ALS protocols. Speaking of extinction, two long outdated SEMAC
advisories: 97-01 on hemophilia and 97-02 recommending biphasic AEDs, got the
boot. SEMAC Advisories are compiled at
the bottom of the Bureau of EMS Policy Statements page (www.health.ny.gov/professionals/ems/policy/policy.htm) and on the protocols and
advisories page at www.health.ny.gov/professionals/ems/semac_advisories.htm.
2. On the subject of protocols,
participation in the NY Collaborative Protocol set continues to grow, covering
more than half of NY Regions. SEMAC
encourages any region not currently participating to do a little “side-by-side”
comparison of theirs to the Collaborative set (pick a region, like REMO www.remo-ems.com/emergency-medical-services/protocols and have a look-see). Fortune tellers across NY see the possibility
of a statewide ALS protocol set somewhere in their crystal balls.
3. Applause, applause to the
Bureau for publishing a fully updated version of the BLS protocols on their web
site! Yes, you heard that right; no
longer do you need to download and assemble a myriad of revisions to have an up
to date BLS Protocol set. Instead, hop
over to www.health.ny.gov/professionals/ems/protocol.htm,
download version 16.02
and amaze your friends with your awesomeness.
4. No Med Standards meeting
would be complete without a little spat and true to form, there was a good one
having to do with tourniquets. You may
recall the hemorrhage control protocol, first approved in May 2015 but not
really approved because it never was voted on, finally approved for real with a
December 2015 vote? Now, it seems that
the, “high and tight” versus “3 inches above the wound” ignited debate, and one
that seemed might never end. Final
resolution revised the T-2 Bleeding and Hemorrhage flow chart to recommend placing
tourniquets 3” above the wound UNLESS the scene is unstable or it is not
possible to fully assess the extremity in which case, high and tight
application is acceptable. Look for that
revision soon. Oh, and that version
16.02 BLS protocol set was up to date until a few minutes ago…
5. Speaking of forgetting to
vote, it appears the motion allowing BLS acquisition of 12-lead ECGs discussed
ad nauseum last December was never voted on.
Problem solved: SEMAC and SEMSCO motioned, voted and approved it. If you’re feeling a little twinge of chest
pain, you’re safe now.
6. In the category of weird
requests, SEMAC was asked to approve a medical device called the LifeVac (www.lifevac.net) which is some sort of anti-choking device that can protect you and
your family, no prescription required.
Purportedly, this device was being touted as equivalent to portable
suction. Long story short, SEMAC does
not approve medical devices. Clearly, it
is not equivalent to any DOH required suction.
Just sayin’
7. The “Check & Inject NY” demonstration
project suffered a little setback when the Bureau advised participants that the
program does not absolve services from having to carry epinephrine auto
injectors as described in Policy Statement 10-01. There may or may not be many teeth to this as
auto injectors were never actually added to the State Emergency Medical
Services Code Required Equipment List (Part 800.24), a caveat needed to actually
enforce Policy Statement 10-01.
Regardless, the demonstration project is proceeding and we’ll know the
results in another year or so. Stay
tuned…
8. Transcare, a major private
ambulance service in the NY Metro and Hudson Valley regions, declared bankruptcy
and abruptly closed shop in late February, causing FDNY and others to quickly
pick up the slack (https://transcare.candidatecare.jobs/). Having known about the company’s financial
woes for several months, preplans were in place and seemed to go smoothly by
all accounts. Downstream effects on
employees, families, students and course sponsors with ride time affiliation
agreements will take longer to resolve.
The closure is reminiscent of other municipalities who’ve found
themselves scrambling to provide EMS when a provider suddenly closes shop. The
Systems Committee had a lengthy discussion about service failures and closures,
noting that NYS continues to see closures of volunteer services.
9. Interestingly, despite all
the hoopla and pressure brought to bear on DOH, meeting after meeting, to roll
out regulations allowing ambulance administered blood transfusions, (see DOH
Policy Statement 15-06 at www.health.ny.gov/professionals/ems/policy/policy.htm, only one service has been
approved under the new regs which rolled out last September. Perhaps the bleeding stopped?
10. The 2016 EMS Memorial
Service will be on Tuesday, May 17th starting at 11:00am at the
Empire State Plaza. See www.health.ny.gov/professionals/ems/emsmemorial.htm. Six new Line of Duty Deaths will be added to
the Memorial this year; four are 9-11 related, reminding us of the losses we
continue to suffer from the attack on our nation. Any services interested in honoring our fallen
brothers and sisters by sending an ambulance are asked to contact Donna Johnson at 518-402-0996.
11. Training and Education (T&E)
reported a landmark year for EMS testing in 2015 with a total of 19,375 exams
given, the highest since 2011. Below are
some stats of interest:
Level
|
#
tested 2015
|
pass
rate 2015
|
pass
rate 2014
|
CFR
|
3,720
|
92.15%
|
91.87%
|
EMT
|
13,556
|
83.61%
|
82.12%
|
AEMT
|
117
|
72.13%
|
51.6%
|
CC
|
322
|
89.3%
|
89.13%
|
P
|
1,660
|
87.68%
|
88.23%
|
The total cost for exams in 2015 was $213,125. Had the testing used National Registry exams,
the cost would have been $1,385,020.
12. Instructor Exams are ready
and administration will begin in May.
Any CIC or CLI expiring during or after May 2016 will need to take the
written CLI or CIC instructor exam instead of the state written EMS exam. The CIC and CLI Exams each have 50 items and
5 additional pilot questions, all based on the NAEMSE, Foundations of Education: An EMS Approach, 2e textbook and DOH
course policies. The passing score will
be 70 and instructors will only need to pass the exam once (in their career) to
maintain their certification (in addition to the other recertification
requirements). One retest will be
permitted and remediation required after two failures. The Bureau will soon release a Moodle review
course for some of the old rusty instructors out there that need to brush up on
educational methodology. SEMSCO approved
the new exam and elimination of the required 85 passing score for
instructors. Can I get an, “Amen”? A new instructor policy statement will be out
shortly with the down and dirty details.
13. After several years (yup,
years) of trial runs and testing, a new CLI curriculum was approved. The Bureau will crunch the numbers to see if
$$ allocated to the (now defunct) prescreening could be added into
reimbursement for the CLI course.
14. In the continued “lean”
efforts at the Bureau, certification cards will soon be printed in-house. The greatest advantage will be to CME
participants who sometimes experienced delays waiting for printing of their
cards batched with monthly written exam schedules.
15. T&E wishes to remind
services that, while CPAP is mentioned in the EMT Educational Standards, it is
not covered sufficiently to prepare an EMT to use it. CPAP is a regional add-on, requiring approval
of the REMAC and initial education provided by an ALS CIC.
16. A report from the STAC
(State Trauma Advisory Committee) noted that trauma alerts from EMS to
receiving hospitals are often not timely.
Spread the word: if you want a trauma team ready, they need an earlier
heads up!
17. The Systems Committee
reminds services that a Transfer of Operating Authority (TOA) is required to be
filed when any person holding 10% or more of a service transfers their
ownership or dies. Systems also
completed a review of the TOA procedure and will be forwarding draft revisions
to Regional Councils for comment.
18. The Bureau noted that BLS-FR
(that’s First Response, in case you missed it) applications are being denied for
services not participating in local EMS systems. These include college first response teams,
industrial brigades and others not doing 9-1-1 responses. This does not prohibit them from operating
but does prevent them from using the limited training dollars which are
accessible to organizations with a DOH agency code.
19. The U.S. DOT has funded a
two year project to study fatigue in EMS workers. Several groups are collaborating on this
project and hope to produce some evidence based guidelines for EMSers. Follow the project work at www.emsfatigue.org.
20. The Federation of
Associations of Regulatory Board's (FARB) license verification site (www.imis100us2.com/FARB/LookUpALicense) now includes EMTs in all
but 12 states. Yup, you are psychic: New
York is one of the 12. You can however,
look up an EMS certification if you have access to the NYS Health Commerce
System (which you can get through your County Public Health peeps).
21. Some upcoming conferences
for you to scope out include the STEP Conference in Rochester, April 7 – 9 www.stepems.org; Greater Buffalo EMS
Conference, April 15-16 www.buffaloemsconference.com; Supervisors Boot Camp (for your front-line
bosses), May 3-4 in Bennington, VT https://www.eventbrite.com/e/ems-supervisors-bootcamp-tickets-22579997380; Initial Assessment Conference in Lake Placid,
May 19 – 22 www.initialassessmentconference.com; NYS Fire Chiefs Fire 2016 in Verona, June 15
– 18 www.nysfirechiefs.com; Pulse Check in Albany,
September 29 – October 1 www.nysvara.org; Vital Signs in Syracuse, Oct 13 – 16 www.vitalsignsconference.com.
22. SEMSCO will next meet on May 24-25, then September 13-14
and again January 10-11 in 2017. The
meetings will remain at the Hilton Garden Inn in Troy.
Interesting and sometimes discouraging unofficial notes from our state leadership meetings. It helps explain why sometimes we seem so dysfunctional.
News from the State EMS Council (SEMSCO) January 2015
DISCLAIMER: These notes are a personal interpretation of events, information, meaning, and relevance by the author, Mike McEvoy. All attempts at humor are intentional.
1. Right at the top of the, "2015 Biggest Uh Oh’s" list was a message from the legal eagles at the State Division of Legal Affairs (DLA) informing SEMSCO that their May 1, 2015 deadline for ALS services to possess and administer controlled substances (CS) was out of order and needs to be done through the State Regulatory process. Interesting; and you can bet your bippy that the news spiked a bunch of blood pressures to TIA levels. Apparently, the Policy Statement (#13-07, to be exact), written by the Bureau at the behest of SEMSCO and SEMAC, imposes a, "criteria for doing business," (a CS license). Any such mandates need to be issued as NYS Regulations. So, the DLA folks will work expeditiously with the Bureau to propose said Regulation; they provided a polite bureaucratic response to questions from SEMAC on timeline ("as soon as possible"). SEMAC members noted, in between self-administered doses of nitroglycerine, that the impetus behind the DLA intervention was most likely Nassau County EMS services who have repeatedly sought exceptions to the approaching (now defunct) deadline. SEMAC reiterated their intent to assure that every ALS service carry medications to terminate a seizure and treat patients in pain, despite this setback. Members of SEMAC consider CS a standard of care. They did clarify with DLA that REMACs could remove agency medical directors in their regions who fail to assure their services carry CS. Any guesses on what happens next? The psychic hotline knows…
2. The Spinal Motion Restriction TAG, chaired by Dr. Joe Bart from Buffalo (now famous for his pronouncement that standing takedowns should be prosecuted as misdemeanors), presented their report. To summarize the 14-page document, subsequently approved by SEMAC and SEMSCO, the current Suspected Spinal Injuries (SSI) protocol should be revised to treat any patient with a SSI by application of a properly fitted cervical collar and minimizing spinal movement. Electing not to use a backboard will not constitute a deviation from the standard of care. The report and revised SSI protocol were well aligned with everything we’ve seen, read and heard of late about spinal immobilization. However, that’s where the agreement ended as there were wide variations in predicted rollout timeframes. Training and Education and the Bureau projected a January 2017 rollout; some physicians called for a Summer 2015 rollout; others just rolled their eyes. Suffice it to say, you won’t be seeing a new SSI protocol next week.
3. Suffolk County asked and received approval to undertake a study of EMTs using a single lumen double cuffed supra glottic airway (SGA) in cardiac arrest patients. Other regions are welcome to hop on the study with Suffolk. For those not savvy with generic names, we’re talking the King™ airway (www.kingsystems.com). Should be an interesting trial and yes, waveform capnography is required, even at the BLS level.
4. Exsanguinating hemorrhage not amenable to tourniquets is a distressing problem brought to light by recent active shooter events. SEMAC established a TAG charged with reviewing NYS hemorrhage control protocols to address this conundrum.
5. Proposed changes to Part 800 published in the New York State Register on September 17, 2014 received voluminous comments; substantive enough that revisions were made. These changes reviewed and approved by SEMSCO and will appear shortly in the NYS Register www.health.ny.gov/regulations/proposed_rulemaking for a 30-day comment period. Clarifications and revisions have largely eliminated concerns that generated all the hullabaloo from multiple NYS EMS services.
6. Medical Standards was once again an action packed and adventure filled meeting. A revised BLS Respiratory Distress protocol was discussed; the revisions intended to add
News from the State EMS Council (SEMSCO) – January 2015 (page 2)
DISCLAIMER: These notes are a personal interpretation of events, information, meaning, and relevance by the author, Mike McEvoy. All attempts at humor are intentional. www.mikemcevoy.com
CPAP to the BLS skill set. The question of whether asthma should be included as a CPAP indication was raised but lacking any published evidence or reported problems with asthmatics, Med Standards left it in. The NYS Formulary (list of allowable ALS meds) was reviewed, leading to a lengthy discussion on the utility of including dosing information. In the end, the formulary was updated as a drug list only with the dosing information to be maintained as a separate reference document. A revision to the NYC ESU (NYPD Emergency Services Unit) ALS protocols to allow midazolam administration on standing orders was approved. In a stroke of sheer genius, Med Standards and SEMAC approved a motion to allow any SEMAC approved protocol to be utilized by another region with appropriate notice to DOH. In other words, if the Region next door to you had the most awesome and amazing ALS protocol for crotch rocket motorcycle crashes into Stewart’s shops and your region wanted to copy it, they no longer need to submit it to SEMAC for approval. Instead, they just send a letter to DOH advising they intend to adopt and presto!
7. Training and Educations had a fact filled meeting. The Bureau announced a "makeover" in the Regional Faculty program. There are 200 current and 117 active RF with 43 active program coordinators. The Bureau hopes to allocate 2 RF to each County and 2 Program Coordinators to each specialty course sponsor. Likely, current RF will be asked to reapply. With the in-house processing of exam scores and cards, results have been consistently out in less than 4 weeks, ranging from 18 – 28 days from exam date. The Bureau is considering a digital certification card system. The instructor fast track program using the NAEMSE course continues to be successful. Of 176 who completed the NAEMSE class, 73 are now CICs, 53 are in their CLI internship phase and 45 are in their CIC internship. 124 of these candidates were not CLIs prior to entering the fast-track program; 52 were CLIs. 2014 saw 23,727 students enroll in EMT and CFR classes (16,026 eligible for funding); 15,725 made it to the Practical Skills Exam (PSE); 270 failed and 14,275 passed the written exam. 3,816 enrolled in AEMT, CC and Paramedic courses (3,301 eligible for funding); 1,649 made it to their PSE; 9 failed and 1,666 passed the written exam. Here’s a breakdown by level of the numbers tested and 2014 pass rates:
| Level | Number Tested | Pass Rate |
| CFR | 4,051 | 91.87% |
| EMT | 12,389 | 82.12% |
| AEMT | 162 | 51.60% |
| CC | 317 | 89.13% |
| P | 1,693 | 88.23% |
News from the State EMS Council (SEMSCO) September 2014
DISCLAIMER: These notes are a personal interpretation of events, information, meaning, and relevance by the author, Mike McEvoy. All attempts at humor are intentional.
1. By all accounts, the hot
story of 2014 has turned cold. A mere
week after the SEMSCO and SEMAC meetings, the Bureau updated their EMS testing
web page, removing the ominous “tentative” markings parked in front of each
future exam date. The panic over whether
the Office of the State Comptroller (OSC) would award a new testing contract is
over. Phew! www.health.ny.gov/professionals/ems/certification/test.htm
lists the exam dates. The new
contractor, Pro Exam (www.proexam.org) is
the same Professional Examination Service (PES) that previously held the
written exam contract.
2. Medical Standards never
fails to disappoint those seeking excitement.
The REMO ALS Collaborative Protocols were approved following a bit of,
“tit for tat” regarding dosing by micrograms per minute versus micrograms per
kilogram per minute. The protocols take
effect January 1, 2015 but not for the ‘collaborator’ regions unless each notifies
SEMAC that they endorse the REMO revisions.
The banter rapidly escalated into
a discourse over AEMT scope of practice and endotracheal intubation. While not included in the National EMS
Educational Standards, ET was included in the NY AEMT curriculum, apparently a
holdover from the EMT-Intermediate level of care. This revelation both surprised and perplexed those
at the meeting. Several regions have not
included intubation in their AEMT protocols; the Bureau maintains that material
in a curriculum must be taught and tested, regardless of regional authorizations
of practice.
3. The Finger Lakes gang
presented results of their BLS CPAP Demonstration Project which included three
other regions (Suffolk, Adirondack-Appalachian and Mountain Lakes). CPAP administrations during the roughly 2
year trial were quite low (15 patients) but the sponsors argued their findings
suggest EMTs can safely deliver CPAP. In
response, Med Standards and SEMAC approved CPAP for use at the EMT and AEMT
level. Hold your PEEP, however; this
first needs approval by the Health Commissioner.
4. On the subject of changes,
the Bureau requested that any region discontinuing post-cardiac arrest
therapeutic hypothermia kindly notify SEMAC of such. Currently, some Regions continue to cool
post-ROSC; most not. In the same vein,
when regions approve upgrades or downgrades in EMS agency levels of service, the
Bureau should be advised. Psychics, they
are not.
5. A lengthy discussion followed
a presentation by the Spinal Immobilization TAG (charged with revising spinal
immobilization and related protocols).
The TAG found current NYS protocols conflict significantly with best
practices and best available evidence.
They cited the National Association of EMS Physicians (NAEMSP) and
American College of Surgeons Committee on Trauma (ACS-COT) position paper on
spinal precautions and long backboards released nearly two years ago www.naemsp.org/Documents/Position%20Papers/POSITION%20EMS%20Spinal%20Precautions%20and%20the%20Use%20of%20the%20Long%20Backboard.pdf
noting that cervical immobilization does not imply need for complete spinal
immobilization; that a backboard is not an appropriate immobilization device;
that requiring any collared patient to be secured to a long backboard (LBB) deviates
from the current standard of care; and extensive overhauls are needed in the
NYS Protocols. One member of the TAG stated
that he personally would love to see standing takedown made a misdemeanor
criminal offense in NYS. Based on the
report, it appears a TAG will be appointed to review the original TAG and
report back at a future meeting. Yup,
you read that correctly.
6. The Nassau County Executive
wrote SEMAC asking them to amend DOH Policy Statement 13-07 to allow services
to meet the requirement for controlled substances by contracting with neighboring
agencies. The May 1, 2015 deadline for
ALS services to possess and administer controlled substances (CS) per their
regional protocols (see www.health.ny.gov/professionals/ems/policy/policy.htm)
is rapidly approaching. The Nassau
County request to amend the policy was not endorsed by SEMAC or SEMSCO.
7. There was a loooong
discussion at SEMAC regarding Policy Statement 12-03 requiring services leave a
copy of their PCR or equivalent information (see www.health.ny.gov/professionals/ems/policy/policy.htm)
prior to leaving the ED. Physicians
believe that many services are not complying with the policy. The Bureau is willing to take enforcement action,
but has not received complaints. You
heard it here first.
8. The Community Paramedicine
TAG presented a 17-page paper, “Achieving Mobile Integrated Health Care Through
Use of Community Paramedicine” for endorsement by SEMSCO. The document will be used to encourage
legislators to make necessary changes in Public Health Law lifting current
restrictions against EMS providers practicing in any non-emergency setting or
situation.
9. Here’s a prediction: during
November/December, you’ll get a letter from State EMS Director Lee Burns
regarding Transportation Assistance Levels (TALs). A movement is afoot to create a statewide,
standardized nomenclature to assist with evacuation and sheltering during
disasters. Stay tuned…
10. Ebola is increasingly in the
news, no kidding. The NYC REMAC issued
an Ebola Advisory in August www.nycremsco.org/images/articlesserver/2014-06%20Ebola%20REMAC%20Advisory.pdf
that was followed by rapid fire advisories from every which direction after the
fiasco in Dallas a short time ago. The
CDC also sent out a Detailed Checklist for EMS Ebola Preparedness, downloadable
from www.cdc.gov/vhf/ebola/pdf/ems-checklist-ebola-preparedness.pdf. They also set up a web site with information
for 9-1-1 caller screening and EMS service recommendations for screening,
transport, decon, etc. This site is
being updated daily by the CDC: www.cdc.gov/vhf/ebola/hcp/interim-guidance-emergency-medical-services-systems-911-public-safety-answering-points-management-patients-known-suspected-united-states.html
The World Health Organization
(WHO) maintains a site with up to date info and recommendations at www.who.int/csr/disease/ebola/en/. Bottom line for EMSers: if you have no idea
how to screen a patient for Ebola and no clue what PPE you need for an Ebola
patient, it’s time to get your head outta the sand, post haste!
11. Taking a back seat to Ebola,
but accounting for more considerably more infections in New York State, is
enterovirus D68 (EV-D68). This virus
causes respiratory illness, primarily in children, some severe enough to
require hospitalization. CDC has a web
page with EV-D68 info at www.cdc.gov/non-polio-enterovirus/hcp/EV-D68-hcp.html.
12. NYSCON is a sexy DOH web
site established to process health care facility CON (Certificate of Need)
applications (www.health.ny.gov/facilities/cons). Guess what? EMS has been roped into this
electronic platform. Discussions are in
early stages presently, but you might want to scout it out (at which point
you’ll see there’s nothing sexy about it).
13. Training and Education had a
lengthy discussion on creating a new level of CIC specifically for those who
work only in CME programs. The idea went
overhead like a lead balloon. On the
topic of CICs, another 37 people completed the fast track CIC program in
August, bringing the total to 123 who have gone through the program since it
was approved. Of those, 56 are now
CICs. Impressive.
14. TIMS is the latest new
course from the US DOT. Expect to see
Traffic Incident Management programs soon (http://ops.fhwa.dot.gov/eto_tim_pse/about/tim.htm). New York’s DOT is in on it as well: www.dot.ny.gov/divisions/operating/oom/transportation-systems/systems-optimization-section/ny-moves/tim/tim-resources.
15. Golden Hour, the vendor that successfully sued emsCharts
(www.emscharts.com) for patent
infringement has now acquired emsCharts.
Golden Hour plans to operate emsCharts as a wholly owned subsidiary and
it should be, “business as usual,” from all indications. A list of FAQs is available from emsCharts
at www.emscharts.com/pub/docs/emsCharts%20Golden%20Hour%20FAQ%20Sep%202014.pdf?utm_source=Frequently+Asked+Questions&utm_campaign=GH+FAQ&utm_medium=email.
This is a HUGE relief for
administrators who were forced to search for replacement PCR vendors. And if you’re looking for your old emsCharts
rep Joe Meath, he’s back from a stint with ESO and can again be reached at jmeath@emscharts.com.
16. On the subject of PCRs, the Bureau expects to begin
migration up to the NEMSIS version 3 dataset (http://nemsis.org/v3/index.html) by
November (that’s this November, 2014).
Take note: your PCR vendor should be gearing up to collect and send PCR
information in the NEMSIS 3 (National EMS Information System) format. If not, you’d better start asking why.
17. The Safety Committee finalized recommendations for EMS
response to active shooter and hybrid targeted violence incidents as well as
draft revisions to the DOH-4461 Reportable Incident Form. Look for both from the Bureau (great stocking
stuffers, maybe).
18. The revised NFPA 1917 Ambulance Standard (www.nfpa.org/1917) is on schedule for a December
12, 2014 release, final publication during August 2015 and implementation
beginning 2016. CAAS, the Commission on
Accreditation of Ambulance Services (www.caas.org)
organized a series of meetings to develop a consensus based ground ambulance
standard and although discouraged by key stakeholders from working outside
rather than within the NFPA process, nonetheless released their own draft
standard for public comment until December 1, 2014: www.groundvehiclestandard.org/?page_id=53. For those savvy in the federal KKK ambulance
purchasing spec, the CAAS document seems little more than a rehash of KKK. The GSA has announced plans to sunset KKK
once NFPA 1917 publishes in 2015. Be
interesting to see how this shakes out.
19. Blood is coming, 45 days from August 13th,
2014 when proposed rules were published in the New York Register. The rules create ambulance transfusion
services, allowing paramedics to administer blood and blood products under
certain circumstances. Check https://govt.westlaw.com/nyreg/Document/Id2abcbbe1e3d11e4acf20000845b8d3e?viewType=FullText&originationContext=documenttoc&transitionType=CategoryPageItem&contextData=(sc.Default)
for the details.
20. Also published in the New York State Register on
September 17, 2014 were proposed changes to Part 800 that would make the CME
program permanent, clarify suspension and certification requirements, and clean
up Part 800 language (such as EMT-D).
These rules are planned to take effect on November 3, 2014. See https://govt.westlaw.com/nyreg/Document/I761b99c239bd11e4b6900000845b8d3e?viewType=FullText&originationContext=documenttoc&transitionType=CategoryPageItem&contextData=(sc.Default).
21. Vital Signs 2014 October 23 – 26th will be in
Rochester (www.vitalsignsconference.com). If you decide to go, you’ll have dibs on
Vital Signs polo shirts, on sale for the first time ever. EMS Today is returning to Baltimore February
25 – 28th, 2015 (www.emstoday.com).
22. Here’s a little ditty from the Systems Committee
handouts: NYS Penal Code §240.50(2) makes reporting an emergency where none
exists a Class A Misdemeanor. If you
suspect that a Medicaid enrollee is abusing emergency ambulance services, the
Medicaid Transportation Policy Unit would like to hear from you. Send the Medicaid enrollees name, Medicaid
identification number and circumstances of the perceived abuse to MedTrans@health.ny.gov or call them at
518-473-2160. The Office of the Medicaid
Inspector General’s Recipient Fraud Unit will investigate referrals made by the
Medicaid Transportation Policy Unit.
Fine print: enrollee names and identification numbers are PHI (protected
health information) and need to be forwarded in a secure format.
23. MONOC, the organization responsible for last year’s
famed Siren video, has produced a Safety Vest video. Both are available for free download at www.monoc.org.
Check ‘em out!
24. The SEMSCO nominating committee for 2015 offered a
slate of officers: Chair – Daniel Blum (Westchester REMSCO), 1st
Vice Chair – Steven Kroll (Healthcare Association of NYS) and 2nd
Vice Chair – Patty Bashaw (Mountain Lakes REMSCO). The slate was elected unanimously (following
proper parliamentary procedure, of course).
25. SEMSCO has one more meeting currently on the calendar:
January 13-14, 2015 at the Hilton Garden Inn in Troy. If you’re looking for info, you can take a
look at the meeting page: www.health.ny.gov/professionals/ems/meetings_and_events.htm.
News from the State EMS Council (SEMSCO) January 2014
DISCLAIMER: These notes are a personal interpretation of events, information, meaning, and relevance by the author, Mike McEvoy. All attempts at humor are intentional. www.mikemcevoy.com.
1. Note: This issue has been temporarily resolved through the August 2014 test date. Already widely circulated in the EMS rumor mill is word that the NYS EMS written testing contract expires April 1, 2014 and may not be reinstated in time to prevent an interruption in NYS written exams. Before you run screaming from the room in panic and incite a riot amongst your local EMSers, take note of the whole story. Yes, indeed the contract does expire April 1 and no, it does not appear that the wonderfully efficient NYS Bureaucracy will have a new contract in place prior to April 1. Several things could happen including approval of a proposal from the Bureau of EMS to allow a 5 month “no cost extension” of the current contract. This would essentially use unspent monies remaining in the current contract to extend the deal with the present testing vendor. The Office of the State Controller (OSC) might actually approve a new testing contract in time to avoid any gaps. The State Council voted to send a letter to the Health Commissioner advising that any lapse in the testing contract would create a public health emergency. You can bet your bipee that State Fire and EMS Associations will be on the blower to legislators advising them of the same. Lastly, if all else fails and there is no written exam contract after April 1, DOH would s end students who complete courses a SAPA (State Administrative Procedures Act) letter allowing them to test as soon as a new contract is in place. Students whose cards expire after the written test date originally planned for their refresher courses would have their certification extended until a test became available. DOH estimates that there are 14,000 students who need to recertify between April and September this year (2014, in case you are not A&OX3). Students in original courses and refreshers who expired prior to their courses planned test dates would have to wait to test until contract is in place. As of this writing, word on the streets is that the 5-month extension will most likely be approved. Stay tuned...this here is a hot one!
To see the rest of the notes follow this link:
New York State State EMS Council (SEMSCO) notes
Measles is a highly contagious virus that lives in the nose and throat mucus of an infected person. It can spread to others through coughing and sneezing. Also, measles virus can live for up to two hours on a surface or in an airspace where the infected person coughed or sneezed. If other people breathe the contaminated air or touch the infected surface, then touch their eyes, noses, or mouths, they can become infected. Measles is so contagious that if one person has it, 90% of the people close to that person who are not immune will also become infected.
