Westchester Regional EMS Council

REGIONAL EMERGENCY MEDICAL ADVISORY COMMITTEE

“MARK I KITS”

COLLABORATIVE AGREEMENT

Between A Certified Regional ALS EMS Agency And The Agency Medical Director

For The Possession and Utilization Of “Mark I Kits”

I, ______, ______of

(Executive EMS Officer) (Title)

______, a Certified Regional ALS EMS Agency,
(Organization Name)

and I, ______, EMS Agency Medical Director, agree to

(Physician)

abide by the following terms and conditions set forth in order to procure, possess and utilize “Mark I Kits” in the Westchester Region:

1.  The Agency is a participant in an MMRS, local municipal or Westchester County Emergency Management Office (WC OEM) Weapons of Mass Destruction (WMD) Response Plan. Proof of involvement in said plan (e.g. a letter from the municipality confirming participation and a copy of the plan) is attached to this agreement.

2.  The Agency shall acquire, store, account and dispose of used auto-injectors according to the written procedures attached. Storage and security of the “Mark I Kits” shall be consistent with NYS DOH Policy No. 00-06: Re: Security of Drug Boxes and Drug Paraphernalia on EMS Response Vehicles, or any superceding policy.

3.  The Agency shall ensure that all providers designated to posses and utilize a “Mark I Kit” have completed the minimum initial training and maintain the required continuing education outlined by NYS DOH Policy No. 03-05, WREMAC Policy No. 03-01, or any superceding policies.

4.  The Agency and its trained providers shall adhere to any NYS DOH or WREMAC policies, protocols and/or advisories regarding the administration of “Mark I Kits”.

5.  Prior to the dissemination of “Mark I Kits” to its units, the Agency shall file with the Regional EMS Office a completed WREMAC application to provide “Mark I Kits”, this collaborative agreement and any required attachments.

6.  The Agency shall notify the WREMAC and the WC OEM in writing of the existence, location, and quantity of all deployed and stocked “Mark I Kits”. Such information shall be updated as requested.

7.  The Agency shall ensure that within twenty-four (24) hours the administration of a “Mark I kit” by a paramedic is verbally reported to the WREMAC and the WC OEM, if not already notified. A copy of the PCR or ACR and any requested follow-up information shall be forwarded from the Agency to the WREMAC as soon as possible.

The responsibilities of the EMS Agency Medical Director shall include, but not be limited to the following:

a.  Participation in the WREMSCO / WREMAC QI Program

b.  Monitor the quality of patient care provided by the Agency

Name EMS Agency
Chief Operating Officer / Signature / Date
Name, EMS Agency Medical Director / Signature / Date

WREMSCO/WREMAC/MARKIKIT/CA/2003/V1