FLORIDA EMERGENCY MEDICAL SERVICES (EMS) ADVISORY COUNCIL
Meeting minutes from the meeting of:
July 12, 2017
QuarterlyMeeting – Orlando, Florida
Member Name: / Voting Status: / Attendance:Steve McCoy, EMS Section Administrator / Non-Voting / Present
Charles E. Moreland, Ed.D., Chair (Outgoing) / Voting / Present
Mac Kemp, EMS Administrator, Chair (Incoming) / Voting / Present
Darrel Donatto, EMS Administrator (Fire) / Voting / Present
Jamie Greene, EMS Educator / Voting / Present
Lew Simon, Lay Elderly / Voting / Present
Jane Bedford, Paramedic (Non-Fire) / Voting / Present
Ann Brown, Emergency Nurse / Voting / Present
Isabel Rodriguez, EMT (Non-Fire) / Voting / Present
Danita Allen, Hospital Administrator / Voting / Present
Bari Conte, Air Ambulance Operator / Voting / Present
Antonio Gandia, M.D., Physician / Voting / Present
Nicholas Namias, M.D., Physician / Voting / Present
Mark Postma, Commercial Ambulance Operator / Voting / Not Present
Kingman Schuldt, EMT (Fire) / Voting / Present
Dan Azzariti, Paramedic (Fire) / Voting / Present
Linda Liebert-Hall (Lay Person) / Voting / Present
Charles Hagan, III, Office of the Governor, Emergency Management / Non-Voting / Not Present
James Swearingin, Department of Highway Safety & Motor Vehicles / Non-Voting / Present
Vaughn Hendrix, Department of Education / Non-Voting / Not Present
Trenda McPherson, Department of Transportation / Non-Voting / Not Present
Carlton Wells, Department of Management Services / Non-Voting / Present
Joe Nelson, D.O., State EMS Medical Director / Non-Voting / Present
Julie Bacon, EMSC Liaison / Non-Voting / Present
Public Speakers:
Chief Julie Downey, Co-Chair Disaster Response Committee
Brent Williams, FirstNet
Chief Greg Rubin, FloridaNet
Brad Elias, MD, Department of Health, Domestic Security Coordinating Group
Chris Cebellero, Cebellero & Associates
Mike Hall, Nature Coast EMS
John Peterson, Sunstar Paramedics
David Summers, Co-Chair PIER Committee
Call to Order
A call to order was conducted at 9:05 a.m., the pledge of allegiance was led by Isabel Rodriguez and a roll call was taken. A total of fifteen voting members werepresent;therefore, a quorum was met. The minutes from the October 20, 2016 Advisory Council meeting minutes were approved as submitted.
EMS Section Report
Steve McCoy recognized the 2017 EMS Award recipients and thanked everyone in the EMS Section who worked hard to make the award ceremony a success. He welcomed the new council members and stated he was pleased that this was the first time in several years that there was a full council of voting members. Mr. McCoy reported that the Department has signed a state-wide cardiac cares registry, CARES, with Emory University. He advised that the state CARES coordinator is Joe Ferrara and he will be assisting to bring agencies onboard to the registry. Mr. McCoy stated that another initiative the Department is working on is the National Collaborative for Bio-Preparedness. He explained that this agreement with the University of North Carolina Chapel Hill will provide the Department a pre-hospital bio-surveillance platform. The platform was presented originally to the Data Committee and the Department will be working on its implementation over the next several months. Mr. McCoy stated that this tool would help the Department make sure the requirements of House Bill 249, which passed at the recent legislative session, are met; getting drug overdose information back to EMS agencies, law enforcement, and public health officials in 120 hours. He informed the audience that this tool would enable the Department to give data back and that they will be working to make sure everyone’s needs and concerns are addressed.
Dr. Joe Nelson asked if the tool gave feedback on things other than just bio-terrorist and bio-preparedness issues.
Mr. McCoy agreed that this tool is not just for overdoses and the other standard bio-preparedness scenarios. He reported that they are working on putting performance compass measures in the system so people can see they compare. He stated the goal is to work with the committees and make sure it fits our needs and what we want to do in the State of Florida. He reported that the large rule reduction package the council has been working on over the last three years was split into two phases. This council voted on phase one of the rule package at the April 2017 council meeting and a notice of proposed rules was released on June 29th stating this is the actual language of the rules. Once the waiting period closes, the package the Department will file for adoption with the Department of State and it will go in front of the Joint Administrative Procedures Committee. Mr. McCoy advised the Notice of Rule Development was filed on the second phase of the rule package a month ago. He stated that this rule package is more specific towards EMS agencies and that the rules include a section that references the General Services Administration (GSA) and how ambulances must meet the most recent recommendations. He reported that the matter of how EMS agencies will be able to meet the requirements of the notices coming from the GSA has been discussed for several years. In this rule package, there are ambulance specifications that are as comprehensive as that the of the Federal Ambulance Specification KKK-A-1822. Mr. McCoy stated that during this council meeting he has been speaking with different groups and committees for some guidance on doing a last-minute audit to the rule packet to include a cache Ground Vehicle Standard (GVS) standard and the National Fire Protection Association (NFPA) 1970 standard. He further communicated that the department has changed its standards on issuing Advanced Life Support (ALS) and Basic Life Support (BLS) permits and the new standard will allow an EMS agency who cannot meet the requirements to respond as an ALS unit will be able to respond as a BLS unit instead of no response at all.
Medical Director’s Report
Dr. Joe Nelson reported that the Federal statute, House Resolution Protective Patient Access to Emergency Medication Act H.R. 304, that relates to EMS was passed by the U.S. House in the January 2017. He stated that is has now been sent to the Senate, assigned to Senate Bill 916 and assigned to the U.S. Senate Legislative calendar. Dr. Nelson advised that it is anticipated that there will be a vote on this bill by the end of the federal legislative session however, it has not been taken up yet, due to other higher priority work that Congress is doing. He informed the audience that this law specifically addresses how the Drug Enforcement Agency (DEA) will create rules for EMS agencies on the handling of medications and controlled substances. Dr. Nelson further explained that the bill deals with DEA licenses; and defines the responsibilities of the medical director and the EMS agency. The medical directors are in support of the bill and hope that it passes during this session. He stated that medical directors would also like to voice their support of the state’s participation in the CARES registry. Dr. Nelson reported that the Federal Drug Administration (FDA) has extended the expiration dates on four emergency medications; Sodium Bicarbonate, 50 percent Dextrose, Epinephrine, and Atropine. He confirmed with Mr. McCoy that we are currently waiting on the Florida Department of Business and Professional Regulation (DBPR) to approve this extension for use by Florida EMS agencies. The medical directors are in support of the extension for a period of six months and feel there will be no negative clinical impact from the extension. Dr. Nelson advised that the medical directors discussed the new federal recommendations for personal protective equipment for first responders when dealing with Carfentanil and other potent opioids. He stated that the recommendation says that in most cases standard personal protective equipment will suffice when dealing with these substances however, in certain circumstances additional respiratory protection may be needed. Dr. Nelson reported that Doctor Paul Pepe, gave an update to the medical directors on the latest cutting-edge cardiopulmonary resuscitation (CPR) techniques that are being researched, which includes the idea of putting the patient's head in an upright position of about 30 degrees and how this shows an improvement of blood flow to the brain during CPR. He informed the audience that this has only been done in a laboratory study at this point but that the results are very dramatic. Dr. Nelson announced that if these techniques turn out to be more affective, then the EMS community and others will be looking at significant changes in the way they perform CPR. He advised that Dr. Ken Scheppke, gave an overview of the research presentation from the Gathering of Eagles meeting in Dallas, Texas and presented information on an innovative treatment program that Palm Beach County Fire Rescue and others have undertaken for drug overdose patients. This program includes the use of community paramedics to begin long-term treatment of drug overdose patients once they have had the emergency resolved in an emergency department, using a medication called Suboxone. Dr. Nelson reported that this treatment program is still in the beta testing stage, but the results have been impressive. To clarify the success rate, he advised that in the standard drug treatment program for narcotic overdose there is about a 5 to 10 percent success rate for a long-term success in keeping the addict from going back to narcotic abuse. For the 50 patients in the program in Palm Beach County for the past year, they have had a 78 percent success rate in preventing addicts from going back to using narcotics.
Trauma Director’s Report
Dr. Nicholas Namias reported that the designation and apportionment of trauma centers remains an issue in Florida, with multiple systems remaining in litigation. But in the meanwhile, EMS has more trauma center destinations to go to than ever, which may be a good thing or bad thing, depending on where you are. He stated the Committee on Trauma met and that Florida trauma centers now have a state-wide basic trauma quality proof of program collaborative. Dr. Namias advised that the committee is working with the National Committee on Trauma to develop the program into a more sophisticated tool than they have now and as opportunities present themselves he will present them to the Advisory Council to see where EMS can help improve outcomes for trauma patients.
Committee Member Reports
Dr. Moreland opened the floor for council committee member reports.
Jamie Greene reported that at the EMS Educators' meeting it was announced that, after several years of discussion, a scholarship program for EMT and paramedic students will be rolled out over the next month or two.
Bari Conte advised that her term with Florida Aeromedical Association (FAMA) is over and that Diane Fojt, who was previously Vice President, will now serve as President. Chad McIntyre is the new Vice President. She also reported that they have added a new component to the FAMA board to include all aspects of service which include ground, critical care and neo-pedi. Ms. Conte stated FAMA will be provide a training in January 2018 which will insure there are personnel available with appropriate training in the area if there ever is an environmental disaster incident or accident. Once more information on the training becomes available they will get it sent to the state.
Chief Darrel Donato reported that the Florida Fire Chiefs’ Association has worked hard on the balance billing issue. He reminded the audience that most EMS services in the State of Florida are provided by a government service provider and the Fire Chief's Association has worked hard to improve funding and protect funding for EMS providers. They have prevented legislation going through that would have removed some of that funding and are still working actively on that issue. Chief Donatto stated that on the plus side, they have been able to bring in over $50 million the past few years to government agencies who have provided EMS care to the medically indigent population. He encouraged agencies that are not currently participating in the program to reach out to the Fire Chiefs’ Association to get connected with the program. Chief Donatto shared the chiefs’ support of H.R. 304 but stated they are in opposition of Senate Bill 967. He stated this Bill is intended to extend Medicare ambulance payments and increase funding at the reimbursement level. However, there is parts of that Bill that Florida Fire Chiefs Association along with the International Association of Fire Chiefs, the International Association of Firefighters, and most state Fire Chiefs' Association are opposed to which regards a move from supplier to provider for EMS agencies. Chief Donatto reported that they are working with the legislators at the federal level to replace this current Bill with a bill that provides for the ambulance payments, considers costs of reporting methodologies, but does not make the supplier to provider move.
Mac Kemp advised that the Florida Council of EMS Chiefs met and would like to make a recommendation to the council regarding current issues of drug shortages in several areas. They would like the council to consider re-initiating the drug shortage committee. Mr. Kemp notified the council he had already talked briefly with Cory Richter about this, due to Cory leading this charge last time, and that he said he would be available if needed for this task. Mr. Kemp stated that he believes it would be nice to get a report back to the council on the drug shortage issue so they can try and stay ahead of the issue and provide as much information to all the EMS systems in Florida regarding alternatives.
Dr. Moreland agreed that is an important issue and something that Mac Kemp and the new council will be able to address. He stated that Cory and the team did a great job when the issue came up a few years ago and that it would be good to get a report and clear consistent messaging out to all EMS providers throughout the State of Florida on what they can and cannot do so they do not get in trouble with any type of governmental entity.
Dr. Moreland announced that it was time for him to leave the council. He thanked everyone currently on the council, as well past members he has worked with over the years and that there were several people present who he had a lot of respect for and who were inspiring to him. Dr. Moreland stated he has grown as an individual, as a professional, as a leader within his city and throughout the state and he just wanted to thank everyone for being a part of that. He shared with the audience that he feels that leadership is important and that everyone present can grow, lead and be a good example. Dr. Moreland encouraged everyone to go back to their agencies and identify individuals who are ready to step up into a leadership role and get them working with one of the council’s committees so they can be ready to work on the council in the future. He also encouraged the current council members to make sure they make their voices heard and work as a team. Dr. Moreland passed the gavel to Mac Kemp and told him he looks forward to his continued leadership to make the Council even better. He stated that Mr. Kemp has a lot of good people ready to work and ready to get it done for the men and women who serve and protect our cities and our state every single day. Mr. Kemp thanked Doctor Moreland for his leadership, his vision and commitment to EMS through his work on the council and throughout the state. Dr. Moreland retired from the council table at this time.
Mr. Kemp stated that he would like to begin that he has been guided by two principals throughout his EMS career and that he wants to guide the council the same way. He advised the first principal pertains to if what is being done is good for patient care and wants the council to keep in mind that what they do needs to lead to better care for the citizens of and visitors to the Florida. Mr. Kemp explained the second principal, which follows very closely to the first, is that what the council does is good for EMT’s and paramedics that work in the state because they are the ones that provide the care. He believes the council should make things easier and better for them to provide the best care possible in Florida. He stated those will be the two litmus tests he is going to ask each time something comes to the council as each of these issues are very important. Mr. Kemp requested the council members to remember that they are there to represent all the EMS community not just their individual constituency groups. He stated that he wants the council to approach issues in a collaborative manner and for every council member to not only use their voices to share their opinions but to also be active listeners. Additionally, Mr. Kemp advised that he expects everyone to be respected and respectful.