GETAC SUMMARY

August 2017

Stop the Bleeding Coalition of Texas:

  • Established Mission, Vision, and Goals
  • Newsletter is being developed to help everyone share information throughout the State. The newsletter will be handled by Cathy Glenn (). Anything that should be included should be emailed to her.
  • Establishingregistry hosted by STRAC to report all training;

TETAF:

  • All discussion was around the restructure presentation from the consultant. Anyone wishing to review the proposal and provide input please see RAC Staff.
  • Board approved to decrease RAC dues by 50% for 2018.

Disaster Committee:

  • TDMS Update (Dr. Emily Kidd) - TMORT is now officially part of the EMTF program. Looking for members to serve. RAT training to MIST and State OEM and DPS instead of public health. Family Assistance Center Workgroup chaired by BCFS. At-risk pop workgroup will be established. Reviewed goals for the coming year. Medical Evacuation Workgroup will meet at 0900 prior to TDMS. Next TDMS meeting is September 28th at the SMOC from 1100-1500.
  • EMTF Update (Sara Jensen) – Participated in the Hurricane Charlie Exercise. Approved the minimum order sets for all clinicians. IDRU is recruiting team members, setting donning & doffing protocols, training made available. Reviewed current training.
  • Hospital Preparedness/Acute Care Workgroup Update (Dr. Jason Aydelotte) – Will be looking at all hospitals and RACs. More information on this workgroup in November. Looks like DSHS have found some money to support this workgroup.
  • THA Plain Language Project (Sharon Beasley)–Facility Alert (bed capacity, EOP), Weather Alert, Security Alert (civil disturbance, abduction,), and Medical Alert. A spreadsheet is available for review. Code Blue will be remaining. Voluntary participation but please let THA know for tracking purposes.
  • Discussion about using EMResource to share Amber and Silver Alerts across the State.
  • Discussion about RACs and their strength is in the membership. RACs are not just the paid staff.
  • 2018 Priorities –each member needs to identify one issue that should be addressed.

Rapid hospital communications integrated with OEM

Disaster patient & resource tracking (EMSystem & WebEOC)/ETN

Evaluate readiness/complacency

Rural involvement in preparedness activities

Interoperable communications

Special population/STEAR

Patient evacuation

Coordination GETAC and TMAC (TDEM) groups

Ambulance IDs/barcodes

Regional funding for regional teams

Law enforcement support for active shooter

  • GETAC Council meeting is moving to 0800 on Fridays instead of 0900.
  • GETAC Committee applications will be open from August 21st to September 17th.

Pediatric:

  • GETAC Council meeting is moving to 0800 on Fridays instead of 0900.
  • GETAC Committee applications will be open from August 21st to September 17th.

Injury Prevention:

  • GETAC Council meeting is moving to 0800 on Fridays instead of 0900.
  • GETAC Committee applications will be open from August 21st to September 17th.

Stroke:

  • Establishing a Stroke Education Workgroup to discuss CE training for pediatric strokes for EMS and stroke training to include FAST for first responders, fire, and law enforcement.
  • Use of NIHSS along with anEmergent Large Vessel Occlusion (ELVO) scale and ELVOs should be taken directly to Comprehensive Center. Looking to adjust transport plans at the RACs to include severity along with time; set objective severity score tool. (DAWN study – only looked at IR not drip & ship); presentation on the LVO study at the November meeting; not just a transport issue but should be addressed by Primary Stroke Centers for POV strokes; determination of which LVO scale is the best (LAMBS, VANS)
  • RACs have had their funding completely cut for CVD data collection.
  • F.A.S.T. ER app available for free and a lot of Texas has been populated.

Air Medical: (no quorum)

  • Air Medical PI will be continue to be discussed and try to establish set criteria for fixed wing and roto-wing.
  • Removed the committee orientation training from agenda because no one was willing to handle in Alicia McDonald’s absence.
  • Updates from other committees by air medical reps.
  • Discussion on unmanned aircraft and will be bring documents to November meeting.
  • GETAC Council meeting is moving to 0800 on Fridays instead of 0900.
  • GETAC Committee applications will be open from August 21st to September 17th.

RAC Chairs:

  • Linda (Public GETAC Member) thanked all of the RACs thank you for everything!!!!
  • Trauma Registry Update (Dan Dao) – all JPs and Medical Examiners to report all TBI, SPI, submersion; NEMSIS Webinar for web services is almost ready; Briefs available for suicide and homicide; doing briefings in all RACs – HOTRAC is 9/12; affidavits for 2017 runs
  • TETAF Update (Dinah Welsh) – special session legislative update; preparing for the 2019 legislative session; Dr. Maddox has requested a pool of information about what RACs do, need, and want on a regular basis; reviewed the consultant report and restructure recommendations; comments are due back by 9/28; Next meeting will be Nov 19th 1730 or 0700
  • Contract Management Update (Norma Six) – Funds should be coming out; cost reimbursement contracts effective 5/1/18 – large heated discussion about this change – will establish a workgroup to discuss; will be reviewing the statement of work; draft language in late September for review and comments
  • LPG – looking at having the RACs administer it again, won’t know until January or February 2018, expect about the same, will update on at the February meeting, contract amendment
  • Designation/Rules Update (Elizabeth Stevenson)– Maternal rules to be adopted by 2018, stakeholder meeting in September; stroke & trauma rules will be putting a request to Commissioner to revise rule 157 (not EMS); several Level IV facilities are choosing not to re-designate; averaging 4 neonatal surveys per year; questions about increase in Level II status
  • EMS Update (Joe Schmider) – Jurisprudence is required effective 9/1/17 for certification/licensure; EMS Providers have to attest that employees are meeting that requirement as well; calling everyone paramedic – Paramedicine system versus EMS system; EMS Agenda 2050 is starting – hasn’t happened since 1996 – May 1, 2018 in Dallas, TX – will be put in the EMS newsletter; REPLICA is in place for 11 states and on the desk of the Governor in Delaware – October 7-8 first meeting of the COMPAC
  • All RACs need a Conflict of Interest Policy if they don’t have one.
  • John Burleson, Associate Commissioner, addressed the RAC Chairs; committed to ‘open mind’ approach.
  • RDC Update (Eric Epley) – 16 of 22 RACs currently; $25k by each of the big 3 and $50k shared by the other 13; need to know who is participating by 10/1.

Education:

  • Update on Recruitment & Retention of EMS Personnel – “Bring Sexy Back to EMS”; RC Health Services presentation; take education to the people and make it flexible; think outside the box; increased scope of practice; we seem to be straying from the original issue of paramedic education which was the original charge not CE and EMT training (Dudley Wait)
  • CE requirements–provided clarification on the Committee’s stance on matching NR CE but not only use NR; committee should have this portion of the rule ready for discussion in November
  • Jurisprudence education and exams available on the DSHS website; 40 course are open and are listed; available from $0-$50; requirement goes into effect for personnel and services 9/1/17
  • Comprehensive Clinical Management Program (CCMP) – Rule 157.39 (49 pages); discussed a lot at the July meeting; for the next meeting 1) members of committee to be surveyors, 2) discussion on education rule or provider rule, 3) survey team - two coordinators, 1 provider, 1 DSHS, & 1 medical director; will share the Harker Heights documents before the next meeting; Dudley asked to include EMS providers in this process revision
  • Mentoring program – last EMS Coordinator course was more than 30+ passed; will establish a means for new coordinators to get mentored no matter where they are in the State
  • GETAC Council meeting is moving to 0800 on Fridays instead of 0900.
  • GETAC Committee applications will be open from August 21st to September 17th.
  • Next meeting October 20that Montgomery County at 0900 – discuss CE and CCMP only

EMS:

  • Jurisprudence Exam – requirement starting 9/1/17; 3 webinars hosted by DSHS over the summer (555 attended); Jurisprudence education and exams available on the DSHS website; 40 course are open and are listed; available from $0-$50; DSHS understands the learning curve and will work with providers
  • NTSB Report – Lights & Sirens Use by EMS: Above All Do No Harm – need to reduce the use of lights & sirens; majority (70%) of fatality wrecks involved lights & sirens; report will be posted on DSHS website but is in the current DSHS EMS Newsletter; education of the political & public is a big need – non-emergency vs. lights vs. lights/siren
  • Registry Update (Dan Duo) – 50k records receive via web services; EMS agencies should have their vendor; Statewide Data Report - 3 mil EMS 67% were 9-1-1, 1.6 mil by ground, 13% were trauma 47% medical, runs peak at noon and again at 1700, most were reported as non-specified places, female are 51%, 55 & older were 46%, ethnicity was under reported; affidavits for 2017 runs; working to have these types of reports available for all RACs; Registry staff rode out with Austin-Travis County EMS to get that viewpoint
  • Legislative Update – LPG still remains but no additional funding; balance billing; No texting bill passed; HB435 gun bill for volunteer first responders; mental health workgroup for PTSD; line of duty deaths property tax exemption
  • National Update (Joe Schmider) - REPLICA is in place for 11 states and on the desk of the Governor in Delaware – October 7-8 in Dallas first meeting of the COMPAC, Joe will be the Texas rep; calling everyone paramedic – Paramedicine system versus EMS system; EMS Agenda 2050 is starting – hasn’t happened since 1996 – May 1, 2018 in Dallas, TX – will be put in the EMS newsletter;
  • EMS-C Update – not provided
  • Substance abuse and reintegration – meeting with several State groups to see how they do this issue; should EMS re-invent the wheel or piggy bank on successful programs; need funds to start the start the program; cost of treatment goes to patient;
  • Uniform IDs for EMS vehicles–tabled
  • GETAC Council meeting is moving to 0800 on Fridays instead of 0900.
  • GETAC Committee applications will be open from August 21st to September 17th.
  • Public Comment: Update from the Stop the Bleeding Coalition; EMS will be effected by the new telemedicine rules, rule (HB2697?) closed with TMB public comment, second posting should happen soon

EMS Medical Directors:

  • CARES – no update; still looking for the funding; funding is the only hold back
  • Freestanding ED position paper (Dr Jeff Jarvis) - revised version on the website, Panhandle has a protocol for use of Freestanding ED when hospital EDs go on divert
  • Substance abuse and reintegration (Dr. Robert Gebhardt) – meeting with several State groups to see how they do this issue; should EMS re-invent the wheel or piggy bank on successful programs; need funds to start the start the program; cost of treatment goes to patient;
  • DEA legislation (Dr. Craig Manifold) – hoping would be on the Federal House Consent agenda and waiting on Senate since their language is different; some have distributor licenses if more than one station or agency; drug shortages: epi; Dr. Peruse talked about the telemed issue – SB311? (see EMS)
  • Paramedic Education (Dr. Sharon Malone)–reviewed the survey results of the educational programs;
  • GETAC Burn Center Task Force Update – not provided
  • TETAF Update (Dinah Welsh) – same as other meetings; added the information about the court decision that two legislative districts were done illegally, either another special session or leave to the courts to decide unsure how this will happen
  • Registry Update (Dan Duo) – same as the other meetings; concerns that as everyone gets on board to 3.3.4 but moving to 3.4 on January 1st; 2017 run affidavits
  • EMS-C Update – not provided
  • REPLICA (Joe Schmider) -REPLICA is in place for 11 states and on the desk of the Governor in Delaware – October 7-8 in Dallas first meeting of the COMPAC, Joe will be the Texas rep
  • GETAC Council meeting is moving to 0800 on Fridays instead of 0900.
  • GETAC Committee applications will be open from August 21st to September 17th.
  • Public Comment: starting a Texas Chapter of the National EMS Medical Directors, first meeting is November 20th during EMS Conference, more information to follow

Trauma Systems:

  • Rule update (Elizabeth Stevenson) – making request to Commissioner to open the Trauma rules for revision; we will take up where we left off and not start all over again
  • Registry Update (Dan Duo) – same as the previous meetings
  • Trauma System Committee Deliverable

Priority Patients - injuries with hemorrhagic shock, TBI, SPI, active hemorrhage, multi-system injury w/ shock, and potential for secondary from bleeding

-Activation Guidelines – every RAC will establish field triage criteria to address the priority patients. Recommendation to RAC Essential Criteria

-Transfer guidelines – regional auto-accept guidelines for the priority patients; over radiation of patients especially pediatrics; reduce time from onset of injury to definitive care; attention should be directed to life-saving stabilization and not definitive diagnosis testing; early communication with the receiving trauma center

-Trauma Feedback from Higher to Lower Recommendations – within 45-60 days, developed an example and will be available on website; STRAC has a feedback portal to pull data not push out all patients – demo in November; El Paso is setting thresholds for feedback timeline

-Regional Field Triage Guidelines updated with priorities, 2017 ATLS, 2001 CDC Field Triage, 2014 ACS Resource Document

EMS as an essential service

Psychosocial support for trauma staff – survey Level I, II, III; screening & intervention for PTSD, suicide, substance abuse, partner violence

Rehab – only submit data on TBI and SPI

Registry by TSAby trauma level by ISS score; wants age breakdown but State not sure that can get that granular with such specific requested reports but will look into

-ISS scores

-Mortality

-BP>90 on arrival

-BP>90 w/ mortality

-BP>90 transferred

-BP>90 transferred to Trauma Center w/ second transfer

-BP>90 transferred to Trauma Center w/ second transfer w/ mortality

-Identified TBI

-Identified TBI w/ mortality

-TBI transferred

-TBI transferred w/mortality

-TBI transferred to trauma center w/ second transfer

-TBI transferred to trauma center w/ second transfer w/ mortality

-Tourniquet application (unsure if even available); group will work on an E-code much like we are doing with ETOH

-SPI transferred

-SPI transferred w/mortality

-SPI transferred to trauma center w/ second transfer

-SPI transferred to trauma center w/ second transfer w/ mortality

Best Practice Guidelines for the Priority Patients – ACS, TACEP, AAST, STN, ENA, TETAF, COTs, GETAC

Need to align the State PI plan with all of these priorities

  • Data Management Task Force – all GETAC committees should have a rep and all statewide requests should be sent thru this group
  • Trauma Registrar Workgroup (Irene Lopez) – job description white paper at the November
  • Advanced Practice Provider Workgroup – assigned to Dr. Gandhi
  • Burn Center Workgroup – did not meet this GETAC, can be integrated into trauma designation rules, can use the 2 current criteria but will add more within the rule when opened for revision
  • TQIP (Lori Robb) – proposal to TETAF to cover funding and FTE; results from VTE survey were reviewed, recommendation (bundle) in November; next step geriatric survey to participants
  • Pediatric TQIP (Lori Vinson) – working with ACS on what information will be available to Pediatric Centers; will have a conf call in September and October then in person in November
  • Stop the Bleeding Coalition Update – see notes at beginning of document
  • Palliative Care – tabled to November
  • Liaison Reports
  • GETAC Council meeting is moving to 0800 on Fridays instead of 0900.
  • GETAC Committee applications will be open from August 21st to September 17th.

CARDIAC:

  • RAC STEMI/OHCA survey (Dr. Jamie McCarthy)–reviewed and made a lot of changes
  • STEMI Best Practices white paper (Dr. Jamie McCarthy)–
  • Discussion on OHCA Centers of Excellence - AHA/ACC guidelines for cath intervention
  • Surveying RACs for OSCA

# of ambulances and training level of providers in each TSA

# of EMS providers with 12-lead capability/transmission

Gap analysis to optimize STEMI prehospital care provision

  • Cardiac Care Committee Goals

Establish a public education initiative reinforcing the importance of calling 9-1-1 for patients with chest pain

Establish educational materials reinforcing the importance of fibrinolytics administration to STEMI patients prior to emergent transfer for PCI

Standardize specific cardiac data elements for each RAC to collect and report to the Cardiac Care Committee for STEMI care analysis

GETAC

  • Public Comment: Jeff Mincy – suggested moving forward with the survey process for CCMP and not to re-open the rule for review/change; Sell – Texas EMS Alliance could handle the survey process as it stands
  • TX Suicide Prevention Council is looking for a representative from GETAC group. Next meeting is August 22nd
  • Retreat – October 5-6 to review committees and appointments
  • Introduced John Burleson as the new Associate Commissioner for DSHS (Kathy Perkins position).
  • Linda Dickerson (Public Representative on GETAC Council) resigned from GETAC Council.
  • Registry Update (Dan Duo & Dr. Amanda Hall)–see other updates; Transformation effective 9/1/17 will organize to focus on function and purpose, Community Health Improvement is a new division, standalone Injury Prevention Section (Registry, CFRT, SafeRider)
  • EMS/Trauma Systems Report (Jane Guerrero) – fluctuation in Trauma Center report, losing Level IV Centersdue to funding, trend in Level III upgrading to Level II; EEF funding spent up to clear funds by 8/31; 9/1/17 EMS/Trauma Division changes Consumer Protection Division, terminology will change, Trauma System is a public health issue; staff changes – Indra Hernandez will handle travel, Colin Crocker is Council support; 2018 dates are not available yet; request to open rules to Commissioner will go out next week or so; REPLICA update
  • Committee Updates

Stroke- Transport Plan changes will posted to GETAC website for public comment to take action in November.