ADIRONDACK-APPALACHIAN

REGIONAL EMERGENCY MEDICAL SERVICES COUNCIL

2920 State Route 30

PO Box 212

Speculator, New York 12164

Telephone (518) 548-3535 * 1-800-952-7367 - FAX Phone (518) 548-7605

e-mail:

www.aarems.org

AAREMS REMAC MEETING

Thursday, May 21, 2015

Holiday Inn, Johnstown, NY 12095

[Approved Motions are shown in bold face]

MINUTES

MEMBERS OF REMAC AND STAFF ATTENDING:

William Fisher, MD Lewis Jones, RN Philip Mulleedy

Deborah Funk-Valois, MD August Leinhart, MD Thomas Pasquarelli

Patricia Green, RN David Markowitz, MD

MEMBERS OF REMAC AND STAFF ABSENT AND EXCUSED:

Sidney Chase Thomas Isenovski, MD Joyce Mulleedy, RN

MEMBERS OF COUNCIL AND GUESTS PRESENT:

Steve Anderson Yvonne Hart, RN Michael Swartz

William Beevers Edward Hillenbrand Gary Wickes

Charles Caruso Robert Kersmanc Margaret Wilson

Donald Coy Deborah Kufs, RN Sean Wilson

Jill Dunham John MacMillan Mark Zeek

Joseph Farrell Mary Ramo

*

The meeting was called to order at 10:40 AM, by Chairman Dr. Leinhart. A voting quorum was present.

APPROVAL OF MINUTES OF THE MARCH 19, 2015 MEETING

All members had received the March 19, 2015 Minutes in a timely fashion by email. They were published on the Regional web site and copies were also available today for all wishing to review them. Motion was made by Dr. Fisher and seconded by Dr. Leinhart, as follows:

RESOLVED, that the Minutes of the March 19, 2015 meeting are approved as written.

This was adopted unanimously, with no abstentions.

NEW BUSINESS

Roxbury Requests Approval to Begin BLS Narcan Program

An application has been received from Roxbury to begin the BLS Narcan program, and includes the signature of their medical director. Motion was made by Dr. Fisher and seconded by Dr. Markowitz, as follow:

RESOLVED that the Roxbury Fire Department Ambulance Squad is approved to become part of the BLS Narcan program.

This was adopted unanimously, with no abstentions.

Meridale Requests Approval of New Agency Medical Director

Meridale has presented a written request to acquire the services of a new agency medical director – Dr. Kelly Robinson. The application was properly completed. Motion was made by Dr. Leinhart, and seconded by Dr. Markowitz, as follows:

RESOLVED, that Dr. Kelly Robinson is approved as the new agency Medical Director for the Meridale Emergency Squad.

This was adopted unanimously, with no abstentions.

Introduction and Nomination of Dr. Funk as a Member of REMAC

At this juncture, Dr. Leinhart introduced Dr. Deborah Funk-Valois, who is taking Dr. Fanion’s place at Cobleskill Regional Hospital. He offered the following Motion, which was seconded by Dr. Fisher:

RESOLVED, that Dr. Deborah Funk-Valois is appointed to the REMAC to fill a vacancy occasioned by Dr. Fanion’s transfer from Cobleskill Regional Hospital, and subject to AAREMS approval.

This was adopted unanimously, with no abstentions.

Dr. Funk-Valois spoke briefly.

Reminder about the Mandate for Transfer of Patient Care Information on Arrival at Destination Facility – Discussion

Dr. Leinhart led a lengthy discussion on the DOH requirement that essential patient care information be left at the receiving facility with the patient, and not delayed until a later time. This is important for ePCR agencies which do not have an electronic interface with the receiving facility (most of them do not have such), but also for all other transporting agencies as well, when they are not able to present the appropriate copy of the regular paper PCR. It was decided to solicit copies of information transfer documents from other agencies and regions so the REMAC could decide on an appropriate document to suggest for agency use, where the pink copy of the regular PCR was not able to be used, for whatever reason. [N.B., on June 01, such documents received to that date were sent to the REMAC for evaluation].

New MidState Regional Protocol for Patient Restraint – Discussion Requested

The new MidState regional protocol for dealing with excited delirium patients was reviewed by the REMAC physicians. It calls for administration pf Versed and Haldol on standing orders by Critical Care and Paramedic level providers, and therefore differs from the current collaborative protocols on the subject. Dr. Leinhart led a discussion on this, and Mary Ramo also spoke. It was decided that there would be no unilateral change of the collaborative protocols by this REMAC.

[N.B., Dr. Leinhart has advised that Dr. Dailey communicated with him later on this subject, and that there will be a future change in the collaborative protocols, but only as regards Versed, not Haldol]

Any Other New Business, as May Be Pertinent

BLS CPAP Issue

Charles Caruso of JAVAC was present, and spoke about a situation where a patient transported with CPAP in place had the CPAP removed in the ED, apparently prior to hospital staff having first consulted with the physician on duty. Dr. Fisher noted, and the other REMAC physicians concurred, that in an instance of this type it would be appropriate to contact the ED nurse-manager or the ED medical director, for appropriate attention, since this involves in-hospital policy.

Termination of Resuscitation

Dr. Funk-Valois spoke about termination of resuscitation in the field for patients in cardiac arrest after all applicable protocols had been followed by prehospital practitioners, and subject to medical control contact. There followed a lengthy discussion on the subject. It was pointed out that some ED physicians still require such a patient to be brought to the ED with resuscitative efforts continuing enroute, despite lengthy destination times. In addition, circumstances at the scene sometimes leave no choice but to transport the patient (e.g., the presence of distraught family members). It was decided that an educational program should be developed to assist responders in dealing with those at the scene of a cardiac arrest. Mrs. Mulleedy will be in contact with Dr. Funk-Valois on this topic.

Epi Demonstration Project

Dr. Markowitz and Mr. Zeek both spoke about a developing Epi demonstration project that was outlined on page 2 of Mr. Pasquarelli’s May 13-14, 2015 State Council report (which is being distributed with the AAREMS Minutes). It is excerpted here:

“Dr. Dailey gave a presentation on an Epi demonstration project that he would like to have approved. This would allow basic EMTs to draw up Epi in a syringe and administer that way instead of the Epi-Pen….”

It was noted that this project would be conducted in conjunction with the University of Rochester. Any agency in the state can participate. It was decided that interested agencies could contact Mr. Mulleedy who would in turn notify the REMAC physicians and Dr. Dailey.

Correspondence

The only correspondence received was to be dealt with appropriately in executive session.

Old Business

Any Old Business, as May be Pertinent

Dr. Markowitz asked about AEMT level personnel using an IO device in cases of cardiac arrest. This will be discussed again.

Executive Session

REMAC convened in executive session at 11:46 AM, for discussion of QI issues. It returned from executive session at 12:14 PM.

ADJOURNMENT

Following return from executive session, the only remaining business was a Motion for adjournment by Dr. Leinhart. Adjournment was at 12:14 PM

The next scheduled REMAC meeting will be held at the Holiday Inn in Johnstown on Thursday, September 17, 2015 at 10:30 AM, with an AAREMS meeting to follow at the same location on that date at 1:00 PM.

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AAREMS REMAC Minutes for May 21, 2015 Page 3