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HomeMy WebLinkAboutMinutes 03-19-2008 EMERGENCY MEDICAL SERVICES COUNCIL March 19, 2008 MINUTES The meeting of the Emergency Medical Services Council was called to order by elected Chairperson Glenn Raines at 4.00 p.m. on March 19, 2008 at the County Administration Building, IT Conference Room. Members Present: Glenn Raines, Jane Rowley, John Bolduc, Tami Speed for Jim Kruger Members Absent: Eddie Whitfield, Mike Monahan, Brenda Dupree Also Present: Jack Southard, Public Safety Director; Carlos Duran, St. Lucie County Fire District; Heather Lueke, St. Lucie County Attorney's Office; John Salvesen, All County Ambulance; Eddie Szymczyk, All County Ambulance; John Seeland, Coastal Care; Rogelio Gonzales, Community Transit; Michael Fulton, American Medical Response; Ray Williams, A Quality Care; Bob Barakos, We Care of the Treasure Coast; Beth Ryder, St. Lucie County Community Services; Melodie Colon, American Jets Aviation; Jim Hochin, American Jets Aviation. MINUTES John Bolduc made a motion to approve the minutes of the last meeting, November 7, 2007. This was seconded by Jane Rowley. The motion was carried. NEW BUSINESS Jane Rowley made a motion to approve Coastal Care Advanced Life Support renewal application. This was seconded by John Bolduc. The motion was carried. John Bolduc made a motion to approve We Care of the Treasure Coast, Inc. renewal application. This was seconded by Tami Speed. The motion was carried. John Bolduc made a motion to approve American Jets, Inc. renewal application. This was seconded by Jane Rowley. The motion was carried. Emergency Medical Services Council March 19, 2008 Page 2 Jane Rowley made a motion to approve A Quality Care Transportation renewal application. This was seconded by John Bolduc. The motion was carried. Jane Rowley made a motion to approve American Medical Response renewal application. This was seconded by John Bolduc. The motion was carried. OLD BUSINESS A copy of the new draft Ordinance was handed out. Jack Southard stated there had been a couple of changes made to the draft ordinance since the last meeting. Glen Raines questioned how to differentiate between a non-emergency call and an emergency call, especially, if you get a call from a nursing home, where they are just looking for transportation to the hospital or doctor's office and then something goes wrong. He asked if there was a protocol for this type of situation. Carlos Duran stated this is defined by the State. He stated it is a simple definition. He said non-emergency means those with no emergency, life threaten care and emergency is life threaten. He stated the definition is being used loosely, as to what the CON process is and has been. He said emergency and non-emergency is not a key issue for the Fire District. He said it is the pre-hospital and inter-facility that is an issue. He stated the Fire District has been in service since the mid 1970's and the Ordinance from 1996 shows, for Class A, the St Lucie County Fire District, is the (BLS) Basic Life Support and (ALS) Advance Life Support provider, which is just like everybody else. He stated the difference in the Classes is that, Class A (Fire District) does the pre-hospital transportation and the other services provide inter-facility transportation. He said that inter-facility transportation has been taken to the extreme, to the point where ALS emergency patients are being taken to the emergency room. He stated the Fire District has a service which consists of 15 stations, soon to be 17, with 497 employees, to provide pre-hospital transportation, which includes all patients that need to be transported to emergency rooms. He said it has been like that since the Ordinance has been set in place. He stated the intent with the inter-facility transport, was for inter- hospital transport, which means hospital back to the facilities. He said it has now been reversed, to where all services are transporting to emergency rooms, emergent and non-emergent patient. He said for the sake of the patient's care and the safety of the public, we need to look at what the language says "pre-hospital and inter-facility" and what the intent is, to make it clear so, that we're not crossing each others services and creating a situation for the public. Emergency Medical Services Council March 19, 2008 Page 3 Glen Raines stated he had an experience a couple of months ago, where he was in the emergency room with someone not feeling well, but they quickly worsened and escalated very quickly. He questioned if there was a protocol for something where as in the middle of a transport, and a patient turns for worse, what happens. Carlos Duran stated there is no way to monitor that kind of situation. He said it can be said, any patient which is picked up has deteriorated and that is what made the transport change to an ALS transport. He said nobody is there in the beginning to do an initial assessment, to say that something has changed, except for the person transporting. He stated the past practice has been, if the provider is picking up a patient and found to have a non-stable patient, they are to call the Fire District, call 911, to come and pick up the patient instead. He stated the information should have been separated through the call itself. He said there are documented delays in the Fire District getting the information and sometimes they do get the information but, the information is from Palm Beach, so they loose the ability of 911 or Fire Dispatch being able to capture the information. He gave an example of a provider being a few blocks away from the hospital, during transportation the patient deteriorates. He said since they are a few blocks away from the hospital, go ahead and take the patient to the hospital, by the time 911 is called, there is going to be a delay. He gave another example of the provider coming to the hospital here from Okeechobee and once again the patient deteriorates. He said call 911 for the Fire District to intercept with the provider, they should not stop, but the Fire District will intercept with the provider and transfer the patient to the ambulance to transport to the hospital. He said if it's on Okeechobee Road or Orange Ave, Station 11 is right there to intercept. He stated even though they both provide ALS service, it is not the same procedure or equipment. He stated the Fire District has different equipment and services on the trucks, such as a procedure called Paralytic to be able to paralyze a patient in case they get the patient intubated and that procedure is not available to non-emergency providers. He said the Fire District does provide a level of care that every citizen in this county should receive when they need to be transported to the emergency room. Carlos Duran stated if you clarify the language of who transports to the emergency room and who does not, you can easily question the calls and do not have to look for justification. He said where as right now, it is just wide open and there is no control of the types of patients that are being transported to the emergency rooms. Jack Southard stated page 3 of the Draft Ordinance, Section 1-12.5-3 addresses the definition of non-emergency medical calls and pre-hospital calls. Glen Raines questioned if every provider had to be a Medicaid provider under the new Ordinance. Emergency Medical Services Council March 19, 2008 Page 4 Jack Southard stated the new Ordinance does require every provider be a Medicaid provider with the exception of those providers which have two or less vehicles. He stated it was agreed upon it isn't feasible for those providers who have one or two vehicles to be a Medicaid provider. Michael Fulton stated he would like to apologize to the council, he did not make the last workshop which was held. He stated he would like to address the definition of non- emergency calls. He said there is a difference between emergency and non- emergency. He said he had spoken to some of the other providers and they have stated it is AMR's fault for presenting this change. He said AMR has accepted responsibility for those actions and think as a team working together, they can collectively come up with a better resolution. He stated for example, a patient coming from a nursing home needing a PIC tube replacement, is not a 911 call. He stated a few weeks ago hospice called 911to transport a hospice patient to the emergency room. He said hospice patients are "Do Not Resuscitate" (DNR) patients. He said they do not need any life threaten services; they need emergency room service which the facility can not provide itself. He stated the By-Laws for St. Lucie County, Article 2, Section 1-B states "To develop and promote standards for the provision of emergency medical services" and is that not what we're here for. He said they should be here to make a difference and to come up with methods to improve the services and think they can all work together as a team to come up with a resolution. Glen Raines stated the committee has been looking at this Ordinance revision for years. He said this Ordinance has been tabled, time and time again, to be able to work together and come up with a resolution. Michael Fulton acknowledged and stated he liked some of the changes the previous manager of AMR had presented, like on chest pain and such. He said he could make a lot of suggestions himself. He said he has a good rapport with the nursing homes. He said he was at a nursing home and a patient was having chest pains, he told them to call 911, they said they had to call the doctor first. He said in the mean time one of his trucks came to do an in service and they ask them to check the patient. He said under the State Statue, inter-facility is a license care facility which is a nursing home. He said their level of care is the same; an EMT with AMR is the same level and an EMT with the Fire District. He said in fact AMR has employee's which work for the Fire District. He said there is no difference whether they are working for AMR or the Fire District. He passed out a Pasco County Emergency Medical Services Inter-facility Medical Transport Feasibility Study to all committee members. Carlos Duran stated he was very surprised this subject is being brought up at this point and time. He stated the Fire District has had meetings with every agency and the County to discuss and iron out any difference or any questions/concerns and as Mike Emergency Medical Services Council March 19, 2008 Page 5 Fulton stated, AMR did not show up at the last workshop. He said Jack Southard then setup another meeting so the Fire District could meet with AMR to discuss any issues or concerns, this issue never came up. He said in fact the last thing that AMR said was that they were willing to do what it takes to follow the Ordinance and AMR was not here to step on toes. Carlos Duran stated the Fire District is not willing to give up as to what AMR is defining as non-emergency. He said the Fire District is a BLS and ALS provider, so is AMR, so is All County, and some of the other agencies, we are all the same. He said the difference is, who transports where. He reinstated the Fire District has been in St. Lucie County for 30 years and the service has never changed, the Fire District has always transported to the emergency room. He stated through the years their services have been fringed upon because the larger organizations have come in and they are taking patients they know they can't take. He said Mr. Fulton is right in saying the definition for inter-facility is a license medical facility, however that was never the intent of the Ordinance and it does say "pre-hospital" on Class A and "inter-facility" on the others. He said inter-facility was stated there because of hospital to hospital and taking patients back to nursing homes and such. American Jets Aviation questioned the Medicaid issue in the current draft Ordinance. Jack Southard stated the Medicaid issue did not apply to American Jets Aviation. Bob Barakos stated all We Care Transportation does BLS. He said if he can not do this kind of transport it will probably put him out of business. He said when the nursing homes call and ask when they can get there and they tell them one hour and it's alright, then that's not an emergency. He said there is a grey area there. Carlos Duran stated the Fire District has always been an ALS/BLS provider, they are to take the patients to the emergency rooms, the other providers take them from the hospitals back to the facilities, what has changed over the years is the providers are deciding to take ALS patients to the emergency rooms and if it's truly an emergency call then, it may be too late for that patient. John Bolduc stated from his experience as a police officer of 22 years of service, what you get when you get to a call, as to what it was dispatched as, are two different things. He stated he was very uncomfortable of going with an assessment over the phone of a patient's condition either. Tami Speed stated she works in an emergency room and Mike Fulton has said PIC Tubes are not an emergency, well PIC tubes are an emergency, they have to be put in fast otherwise the patient is looking at surgery. She said Fire District also has medical Emergency Medical Services Council March 19, 2008 Page 6 control communications with the emergency rooms. Mike Fulton stated all the providers have a set of protocols. He said all he was asking is that this Ordinance be tabled to be able to look over this again as a team. Carlos Duran stated there have been numerous meetings on this Ordinance for years and this is a clean way to go back to the way it was meant to be. He said if somebody dies in the process, he will not be able to answer why this system is failing other than put the parameters on as to who is suppose to be doing what. He stated once again, the Fire District is not willing to give up transporting all patient to the emergency room, unless the Fire Districts needs the help such as in a disaster and there is a statement put in the draft Ordinance which states "unless authorized by the St. Lucie County Fire District, and then the providers will be asked to help, if needed. Jane Rowley stated she has been in this county for over 30 years and the Fire District services are superior, their medical technology is superior and if she ever has to go to the emergency room, she wants the Fire District to transport her, not one of the providers. She said she knows from experience with her son being a chief in Palm Beach County, it is important to our citizens to have the best of care. Tami Speed said she knows when Fire District is transporting a call to the emergency room, they are in constant communications with the emergency room so the emergency room knows what kind of patient they have coming, whether it be a patient with an insect bite or chest pains. Jane Rowley made a motion to approve the new draft Ordinance. This was seconded by John Bolduc. The motion was carried. With there being no further business to discuss the meeting was adjourned.