www.courtreportingny.com
[email protected] - (845) 634-4200 Rockland & Orange Reporting
--------------------------------------------------x
HUDSON VALLEY REGIONAL EMERGENCY
MEDICAL ADVISORY COMMITTEE
--------------------------------------------------x
MINUTES OF MEETING, held at the offices
of Hudson Valley Regional EMS, 33 Airport Center
Drive, New Windsor, New York, on Monday, January 4,
2016, at 9:30 a.m.
Yvette Arnold,
Court Reporter
ROCKLAND & ORANGE REPORTING
2 Congers Road
New City, New York 10956
(845) 634-4200
www.courtreportingny.com
[email protected] - (845) 634-4200 Rockland & Orange Reporting
2
1 A P P E A R A N C E S :
2 DR. PAMELA MURPHY,
3 Committee Chair
4 DR. DAVID STUHLMILLER, Helicopter Subcommittee Chair
5 WILLIAM HUGHES, EMT
6 HVREMSCO Executive Director
7 KAREN DELAUNAY, OFFICE MANAGER
8 JEFFREY CRUTCHER,
9 QI Coordinator
10
11 GOOD SAMARITAN HOSPITAL
12 DR. DENNIS MAO, Director
13HEALTH ALLIANCE OF THE HUDSON VALLEY
14 DR. GUTMAN,
15 Physician Representative
16 ORANGE REGIONAL MEDICAL CENTER
17 DR. PAMELA MURPHY, Physician Representative
18PUTNAM HOSPITAL CENTER
19 DR. BUTTERFASS,
20 Director
21 MID HUDSON REGIONAL HOSPITAL OF WMC
22 DR. MARK PAPISH, Director
23VASSAR BROTHERS MEDICAL CENTER
24 DR. ARSHAD,
25 Physician Representative
www.courtreportingny.com
[email protected] - (845) 634-4200 Rockland & Orange Reporting
3
1 A P P E A R A N C E S :
2
3 MIKE BENENATI ISRAEL KNOBLOCH
4 ANDY LAMARCA MIKE MURPHY
5 RICHARD PARRISH ERNIE STONICK
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
www.courtreportingny.com
[email protected] - (845) 634-4200 Rockland & Orange Reporting
4
1 Proceedings
2 DR. MURPHY: We will bring the meeting
3 to order. Sorry, I'm running a little
4 late -- I was chatting too much. So thank
5 you all for coming.
6 I know the minutes went out from our
7 last meeting from November 2nd. Hopefully
8 everybody got a chance to review them. I do
9 have enough people right now to make a
10 quorum.
11 So I would like to make a motion to
12 accept the minutes with any corrections,
13 deletions, or addition anyone has? Anything
14 anybody has comment or anything on the
15 minutes?
16 DR. MAO: Motion to accept.
17 DR. MURPHY: Thank you, Dennis. And
18 second?
19 DR. PAPISH: Second.
20 DR. MURPHY: Thanks, Mark.
21 So this morning just a couple of kind of
22 detail items, you know. As you know we had
23 put forward with the help of many people --
24 Dr. Arshad, thank you so much -- and the New
25 York State Department of Health and the great
www.courtreportingny.com
[email protected] - (845) 634-4200 Rockland & Orange Reporting
5
1 Proceedings
2 TAG committee that was chaired by Dr. Bart,
3 the whole process of long boards and spinal
4 immobilization versus cervical spine
5 protection and the whole process behind it.
6 So the Department of Health finally put out
7 letters to all the hospitals so that the
8 information was disseminated also to that
9 side of the fence, from Dr. Zucker, the
10 commissioner, directly. It did include an
11 algorithm for suspected spinal injuries and
12 such and I'll pass it around so everybody can
13 look at it. And that's what went out so
14 you'll know what is behind the scenes they
15 developed and received in the hospitals.
16 The last meeting we had here I had given
17 out everyone the -- or September -- to
18 everyone was available Dr. Bart's video on
19 his educational program for the new spinal
20 immobilization process and then Mike sent out
21 the link via e-mail so hopefully everybody
22 got it. And if you need it, please just let
23 me know and we can give it to you also. It's
24 a great program and if you want to use it and
25 even bring to department meetings I think is
www.courtreportingny.com
[email protected] - (845) 634-4200 Rockland & Orange Reporting
6
1 Proceedings
2 an important thing so everyone knows exactly
3 what is happening out there and how the whole
4 process came down. Dr. Bart was the SEMAC
5 representative who chaired the TAG that did
6 all the information behind it.
7 MR. LAMARCA: We do have the link put on
8 our website --
9 MR. CRUTCHER: We can put it up there.
10 DR. MURPHY: Hey, Mike? Put it on the
11 website will you -- no.
12 So that came down from the State so
13 everybody can see it, it will be coming
14 around.
15 Also, Karen sent out to everybody on the
16 list serve the latest draft of the memorandum
17 of understanding and that was the document
18 that we have been creating to form some kind
19 of real unity of what our collaborative
20 protocols committee is all about and it is
21 going to require me to sign now. And we were
22 asking for this right from the beginning so
23 actually this is something we have been
24 talking about. Just a document that states,
25 you know, why we are doing this, how it's
www.courtreportingny.com
[email protected] - (845) 634-4200 Rockland & Orange Reporting
7
1 Proceedings
2 organized, how it's structured, the purpose,
3 responsibilities, and it definitely
4 delineates in there that we still as a REMAC
5 are responsible for what happens in our
6 region. Even though we are part of the
7 committee and we all work on the protocols
8 together there are going to be some regional
9 differences, especially if you look at some
10 of the outlying areas of some of these
11 regions we have under the Hudson Valley. So
12 the biggest thing in here -- and there is a
13 reason why I wanted everyone to read it was
14 they kind of want it to be all or none. So
15 that when you join, you join, and you don't
16 jump back and forth, back and forth. They
17 are trying to make it very solid and so when
18 we join, we are in. And to come back out we
19 have to file a petition to leave the
20 collaborative protocols committee or
21 organization. And then with that letter we
22 are going to have to have something
23 immediately to the State to say these will be
24 the protocols going forward and that's kind
25 of like the fail safe if somebody leaves the
www.courtreportingny.com
[email protected] - (845) 634-4200 Rockland & Orange Reporting
8
1 Proceedings
2 collaborative protocols group.
3 We are now up to everybody -- we are 18
4 regions now out of New York State so really
5 the only people not in it is New York City
6 right now. And they are not going to be in
7 it because we are so different, we can't all
8 be on the same page with New York City. It's
9 a different apple, we are oranges up here in
10 Orange County and such, they are apples, we
11 can't be on the same page. But all of Long
12 Island has joined and the last hold out in
13 the Upper Northern Country joined so we are
14 up to 18 regions now in that committee.
15 If anyone in the room does want to see
16 what happens you can be on the list serve.
17 You give me the e-mail address -- we do a ton
18 of stuff e-mail wise. We have everybody
19 discuss and weigh in and, you know, tell us
20 what they think about changes and things we
21 are talking about doing.
22 Mike recently has taken on the
23 responsibility of being the overseer of our
24 protocol committee and to be the real person
25 totally intact with that committee and our
www.courtreportingny.com
[email protected] - (845) 634-4200 Rockland & Orange Reporting
9
1 Proceedings
2 communication person and to keep me
3 organized. And Mike will tell you, say we
4 put out a thing and say we want to change the
5 dose of ketamine for this. You'll have a
6 pharmacist weigh in on it, you'll have
7 prehospital providers, people that are
8 executive directors of the regions, people
9 that are on all different levels and
10 certainly the medical directors and chair --
11 REMAC chairs. But it's a great discussion
12 that, you know, how we piecemeal it down,
13 dissect the problem, look at it from just its
14 verbiage, to how feasible is it? Is it
15 something that is going to work? And is it
16 academically and educationally solid is it
17 something that should be -- you know, is it
18 something we should be moving forward.
19 So I think, you know, you can anything
20 you want to add.
21 MR. BENENATI: No. I think you summed
22 it up nicely. It's a good work group.
23 DR. MURPHY: Yeah. So after the SEMAC
24 this past month in December we all sat down
25 right after the meeting and had a meeting
www.courtreportingny.com
[email protected] - (845) 634-4200 Rockland & Orange Reporting
10
1 Proceedings
2 and, gosh, now in the room there was twenty
3 of us. I'm like God, this meeting is getting
4 so big, it used to be like six of us. So
5 it's great because really you have a lot of
6 eyes looking at it and I think it's all, you
7 know, excellent stuff.
8 And I think the thing that is also
9 important for the prehospital provider, say
10 you are working over here in the REMO area,
11 or Hudson Valley area, or you know, the
12 Upstate, you have the same protocols and
13 basically everything is very much, you know,
14 familiar so that we will have good overlap of
15 coverage and I think standardization. I
16 think it never hurts to have things be we are
17 all on the same page.
18 So that was a long-winded
19 conversation -- sorry. So the MOU was just
20 so, you know, what I'm going to sign as part
21 of that work group and protocol consortium
22 and what we are doing.
23 DR. PAPISH: So the big difference, the
24 only significant thing from what I read is
25 what you are signing is essentially saying
www.courtreportingny.com
[email protected] - (845) 634-4200 Rockland & Orange Reporting
11
1 Proceedings
2 that our previous ability to sort of have
3 some variability is gone?
4 DR. MURPHY: No. You still have
5 variability because of the region, so we can
6 do different things. Like say -- what is an
7 example, guys, help me out -- we elected not
8 to do --
9 DR. PAPISH: Nitrous --
10 DR. MURPHY: Yeah, so we have nitrous
11 and so no one else does, but we have an
12 ability to do it because we had it before and
13 so we worked it in as a process that we are
14 not going to lose that entity.
15 Now, what they have done is taken the
16 materials from David and looked at it so
17 other regions might want to take and adopt
18 it. Because he has given forth now I think
19 three sets of data, the efficacy, how well
20 does it work, and the whole nine yards.
21 People are still concerned because of the
22 whole reservoir and collection and stuff --
23 DR. PAPISH: The reservoir --
24 DR. MURPHY: Yeah. You are supposed to
25 have this thing that sucks up this stuff --
www.courtreportingny.com
[email protected] - (845) 634-4200 Rockland & Orange Reporting
12
1 Proceedings
2 MR. PARRISH: An accumulator whenever
3 you use it so as you exhale it the room,
4 especially the back of the ambulance, could
5 have it and you could be sitting there as the
6 provider getting dosed with it --
7 (Everyone is speaking at once.)
8 MR. BENENATI: One of the things they
9 are going to do is pullout the policy and
10 procedural portions and give them to the
11 regions for control. So it's going to be --
12 there is going to be greater emphasis on the
13 medical procedures and then we'll be able to
14 do the administrative things the way we want
15 to them. There is talk there will be a guide
16 so if you don't want to rewrite your own you
17 take these and put your name here kind of a
18 deal.
19 DR. MURPHY: I thought of another one,
20 MFI. What they had done in another regions,
21 you know, they had two providers that were
22 MFI certified. We are doing it one
23 certification and one is educated because we
24 just couldn't afford with the resources, you
25 have to look at what you have. So other
www.courtreportingny.com
[email protected] - (845) 634-4200 Rockland & Orange Reporting
13
1 Proceedings
2 regions have that luxury, we did not. So
3 there is little things, so they do allow --
4 and you don't have to like -- there was
5 another one.
6 Oh, with the interfacility transports,
7 we are definitely going to back that out.
8 You know, we had talked about it in the very
9 beginning. We have never overseen that
10 because it's really not under our purview and
11 never dictated protocols for that. And they
12 had one in there and we are like, Mike, this
13 is a very iffy subject. It's really there
14 just as an oversight, but it's not going to
15 be giving any protocols because you have to
16 allow the service director or whoever doing
17 the interfacility transports to have their
18 ownership of what they do and what they don't
19 do. So we are still here as a protection for
20 the prehospital guys, if anybody has a
21 question, desire, or needs to talk to
22 somebody they call medical control and get
23 help and assistance. We are there to support
24 everyone and backup.
25 But the only thing that is really
www.courtreportingny.com
[email protected] - (845) 634-4200 Rockland & Orange Reporting
14
1 Proceedings
2 structured in there, that is really set in
3 stone is you are in, you are in. No one foot
4 in, one foot out. That's what I wanted
5 everybody to understand I was going to sign
6 off on.
7 But I think in the long run it made it
8 so much nicer, the whole process of getting
9 protocols approved through SEMAC, if you guys
10 have been here long enough, have been
11 torture. So now that as we come as this
12 consortium it's so much easier and it's a
13 really facilitated process that -- and I
14 think it's easier for the State too, they are
15 on the other side of it also. So that's what
16 the two --
17 DR. ARSHAD: If I may piggy back on
18 that? One of the interesting things that
19 came out of the collaborative conversation
20 was just an in depth conversation with the
21 different regions on nuances, or the way
22 certain folks are making application, or even
23 some data and some experience. So, for
24 example, one of the things we spoke about was
25 C-PAP at the BLS level because it's obviously
www.courtreportingny.com
[email protected] - (845) 634-4200 Rockland & Orange Reporting
15
1 Proceedings
2 something that has been approved at the State
3 level. And the question was how variable is
4 the penetration? How many folks are seeing
5 this? How many are doing this? And we had
6 an impromptu brain-storming conversation and
7 how we might help advocate for the increased
8 use of certain interventions. It was just a
9 great information, a lot of fun folks around
10 the table.
11 DR. MURPHY: I think the other important
12 part of that is having it available for
13 people that can do it, manage it, that have
14 the medical director behind it and the
15 equipment behind it and not making it
16 mandated that we bankrupt one agency.
17 So the way these things always have
18 gone, you start with a process, start with
19 the issue and then, you know, see if it
20 works. See how well it does and see what the
21 penetration is -- that's a good way to
22 verbalize it. And then eventually it's
23 probably going to be state of the art at some
24 point, but right now we are putting our toes
25 in the water, just like electric EKG and
www.courtreportingny.com
[email protected] - (845) 634-4200 Rockland & Orange Reporting
16
1 Proceedings
2 making sure everybody is on board and can
3 transmit. So, yeah, that's the whole thing.
4 Arshad had come to the last meeting with
5 me and I thought that was great. I think
6 anybody that wants to be involved in those
7 issues, definitely, you know, all eyes and
8 ears, it's all good stuff.
9 So those are the old business issues.
10 I'm doing a lot of talking. Anybody
11 with concerns or questions, or I can keep
12 going on?
13 Service upgrade, we have none at this
14 point.
15 The next thing on the agenda is
16 evaluation subcommittee. Dr. Brooks has
17 stepped down from that position, which she
18 held for quite a while, years and years and
19 years. So I need to have someone who would
20 be interested in chairing the evaluation
21 subcommittee.
22 Now, what is that? That's a
23 subcommittee of our REMAC that meets as
24 needed. It happens -- generally we will meet
25 at least before this meeting if there is an
www.courtreportingny.com
[email protected] - (845) 634-4200 Rockland & Orange Reporting
17
1 Proceedings
2 issue. And we do a lot electronically,
3 again. But what it is dictated as, any
4 issues that get forwarded to this office, to
5 myself, or to the medical director
6 individually, the evaluation committee sits
7 down and reviews. Now, not all subjects are
8 brought forward because there is some things
9 that need to be handled at the agency level.
10 So we bring it back to the medical director
11 and say, this was brought forward, let us
12 know what the update is and what you think.
13 But there are other issues that might be more
14 ubiquitous and more outstanding, so something
15 the State brings to us, then the evaluation
16 committee has to look at it. It's matter of
17 researching the data, everything from the
18 PCR, or provider, or whatever the instance
19 maybe, just like in the QA process, it's the
20 same issue, then we make recommendations.
21 Probably the biggest ones that come along is
22 if protocols are violated, or not followed
23 or -- I don't know. We had a couple in the
24 history of this place of like people bringing
25 things out of their car and doing things to
www.courtreportingny.com
[email protected] - (845) 634-4200 Rockland & Orange Reporting
18
1 Proceedings
2 people, those things came across our desk, or
3 a real protocol violation where someone was
4 not taken to appropriate setting, or delay in
5 care, or really truly just not following
6 protocol. So that committee now is open.
7 As I had mentioned the last time that we
8 needed to fill the medical director. I do
9 need to fill that committee chair position.
10 I don't know what peoples' availability is,
11 it's not a lot of -- it's not time-consuming,
12 but it is -- it would have to be somebody
13 that really wants to be involved in really
14 looking at the protocols, really
15 understanding the process behind it and
16 wanting to, you know, work hand-in-hand with
17 EMS providers because it's a much more
18 provider responsive process. And we have
19 brought in providers, we have interviewed
20 them, we have gone and had the medical
21 director involved when it's really serious
22 issues.
23 But just food for thought, anybody
24 interested? And I have some ideas that I'll
25 approach people about. So something to think
www.courtreportingny.com
[email protected] - (845) 634-4200 Rockland & Orange Reporting
19
1 Proceedings
2 about.
3 Helicopter committee. Dr. Stuhlmiller?
4 DR. STUHLMILLER: Actually no business
5 brought to the committee so I am happy to
6 report I have no report.
7 DR. MURPHY: Excellent. Nice. Jeff?
8 QI?
9 MR. CRUTCHER: Cardiac arrest study is
10 progressing well. By mid month we will have
11 a full year's worth of electronic data to
12 look at and four months worth of paper PCRs
13 to review.
14 IN Narcan has been relatively active
15 2015 we had 44 reversals by BLS agencies --
16 DR. MURPHY: Forty-four?
17 MR. CRUTCHER: Forty-four.
18 And we distributed a total of 633 doses
19 to agencies that come on board. Also working
20 relatively closely with the Health
21 Departments in Dutchess County and Sullivan
22 County collecting and correlating data.
23 DR. MURPHY: Okay. I had -- I was
24 reviewing -- I forget which journal -- and
25 they were talking about nebulizing Narcan.
www.courtreportingny.com
[email protected] - (845) 634-4200 Rockland & Orange Reporting
20
1 Proceedings
2 Did you guys ever nebulize Narcan? Two
3 milligrams with three cc's of saline and
4 nebulize it --
5 DR. ARSHAD: I wrote a paper, it was in
6 PEC 2012, there are multiple routes for
7 Narcan administration --
8 DR. MURPHY: Is it as effective?
9 DR. ARSHAD: It's not less effective. I
10 had to think about that --
11 (Everyone is speaking at once.)
12 DR. MURPHY: Yeah, because that was the
13 one question I had after reading the paper --
14 it wasn't your paper because I would have
15 recognized your name --
16 DR. ARSHAD: I think the reason we had
17 been more in favor, or let's just give it a
18 shot, is we had all feared this violent
19 reversal where somebody will wake up and
20 punch you in the face and things along those
21 lines. Whereas if they have some respiratory
22 rate that doesn't require critical
23 intervention and you put a nebulizer, they
24 will self-titrate. So they will wake up
25 enough so the respiratory rate rises and they
www.courtreportingny.com
[email protected] - (845) 634-4200 Rockland & Orange Reporting
21
1 Proceedings
2 will knock it off and probably be okay in the
3 next 45 to 60 minutes.
4 DR. MURPHY: Is that in lieu of
5 atomization?
6 DR. ARSHAD: Yes. The data analyzed was
7 before at atomization --
8 DR. MURPHY: Yeah, that's what I
9 gathered. I thought it was interesting.
10 Thanks, Jeff, that's a lot of reversals in a
11 short period of time.
12 DR. GUTMAN: We had six last night
13 coming from one crew from --
14 (The speaker cannot be heard.)
15 DR. GUTMAN: -- Mobile Life that brought
16 in three within three hours. It was
17 apparently just a party night --
18 DR. ARSHAD: From the same party?
19 DR. MURPHY: What was the pickup
20 location?
21 DR. GUTMAN: Apparently Kingston was the
22 place to be last night. We were very
23 excited, it was some sort of record for
24 them --
25 DR. MURPHY: It's pretty wild. I've had
www.courtreportingny.com
[email protected] - (845) 634-4200 Rockland & Orange Reporting
22
1 Proceedings
2 parents come to me because they bring in the
3 kids and the parent eventually shows up
4 talking about the whole thing of getting on
5 the program of having it in their home. You
6 go --
7 DR. GUTMAN: Yes, the Lazarus kits.
8 They came in dead, we gave them a Lazarus
9 kit, it has that on it. Trying to explain
10 the historical background of that to someone
11 who just overdosed on heroin is fun.
12 DR. MURPHY: You didn't give an exam
13 afterwards --
14 DR. ARSHAD: What we are seeing in a lot
15 of the nationwide data with reversals is
16 repeat overdose or reversals are on the
17 uprise to repeat offenders.
18 DR. MURPHY: That's crazy --
19 DR. ARSHAD: There is this counter
20 productive thought process everyone has it,
21 employees, 9-1-1, CFR, my family has it, so
22 is there is a comfort for more boldness,
23 which is unfortunate.
24 DR. MURPHY: I think we just have to
25 make it more expensive, it's because it's so
www.courtreportingny.com
[email protected] - (845) 634-4200 Rockland & Orange Reporting
23
1 Proceedings
2 cheap.
3 MR. LAMARCA: Drug companies will take
4 care of that --
5 DR. MURPHY: Mike?
6 MR. MURPHY: We did law enforcement
7 program from Rockland so we had 27 last
8 year --
9 DR. MURPHY: So that's police, first on
10 the scene --
11 MR. MURPHY: First on the scene prior to
12 arrival of EMS. And also what we did a few
13 months ago is incorporated any Narcan
14 reversals -- we referred the person to the
15 behavioral health response team.
16 DR. MURPHY: The mobile crisis team --
17 MR. MURPHY: Right. And they reach out
18 and make contact and see if they can guide
19 them in any direction so we don't have the
20 repeats.
21 DR. MURPHY: Yeah.
22 MR. MURPHY: It's brand new so I don't
23 have any follow-up, but that is something
24 that we started to do because we do realize,
25 you know, it's not one and done so --
www.courtreportingny.com
[email protected] - (845) 634-4200 Rockland & Orange Reporting
24
1 Proceedings
2 DR. MURPHY: I know, that's what the
3 unfortunate part is --
4 MR. MURPHY: -- trying to get the
5 behavioral folks to talk to them and see what
6 the issues are and refer them to the
7 follow-up in the county where --
8 DR. MURPHY: Yeah, it's pretty wild.
9 Thank you.
10 So SEMAC we met on December 8th. One of
11 the things I'll pass around, which some of
12 you may have seen, is the pediatric minimum
13 care standards the State put out now in the
14 booklet format for people to try to have
15 everyone on the same page in terms of
16 upgrading our pediatric treatment at each one
17 of the centers. There is a huge force of
18 people doing this pediatric material and I'm
19 forgetting their name -- Andy, do you
20 remember who the woman is? I can't remember
21 right now.
22 MR. LAMARCA: I don't remember --
23 DR. MURPHY: That's the physician --
24 there is a woman at SEMAC --
25 MR. LAMARCA: Martha --
www.courtreportingny.com
[email protected] - (845) 634-4200 Rockland & Orange Reporting
25
1 Proceedings
2 (The speaker cannot be heard.)
3 DR. MURPHY: There you go -- thank you.
4 It's a great amount of information, you can
5 get copies of it, there is a contact there.
6 They gave it to each one of us and wanted us
7 to make sure we disseminated it down so
8 everybody has that ability to access that
9 information.
10 From standards committee -- the
11 standards committee that was put through to
12 SEMAC, we went over a bunch of projects that
13 were out there. Suffolk EMT is still doing a
14 twelve lead project. It's a process where
15 it's not mandated, but available such that a
16 BLS crew, EMT crew, can get involved in
17 acquiring twelve lead EKGs and transmitting
18 them -- not to read or evaluate, but if
19 available -- if the equipment is available,
20 if the teaching is available, and if the
21 medical director is available and wants to do
22 it it's under an educational module. Mr.
23 Deloge, (phonetic), brought up it's not a
24 scope of practice change, but it's being put
25 on as a demonstration project -- or it
www.courtreportingny.com
[email protected] - (845) 634-4200 Rockland & Orange Reporting
26
1 Proceedings
2 doesn't have to be demonstration project
3 because it's not a scope of practice change.
4 But it -- he'll get us information back about
5 how successful it was, did it make an impact,
6 and is it a process of treatment and does it
7 expedite care?
8 The Epi-pen program is still going on as
9 a pilot project under Dr. Dailey, that we
10 talked about a long time ago. It came in the
11 nidus of that was because of how expensive
12 Epi-pens became once we started making it a
13 BLS entity. So they made their own kit and
14 he'll get back to us under that project to
15 see how well it's working, is it something
16 that will be effective, and it's like a tenth
17 of the cost of what an Epi-pen normally is.
18 MR. HUGHES: We do have five agencies in
19 our region that are participating in the
20 Epi-pen.
21 DR. MURPHY: One of the -- a big
22 conversation and it's kind of -- it's this
23 program that's coming around, is the
24 discussion of transportation of a pediatric
25 patient and the standard of care and you'll
www.courtreportingny.com
[email protected] - (845) 634-4200 Rockland & Orange Reporting
27
1 Proceedings
2 see in this pamphlet here that it's still a
3 standard of care that they expect that the
4 transport of a pediatric patient is in a
5 device; i.e., car seat, or car restraint
6 seat, some kind of device, not on the
7 parents' lap anymore. And that whole
8 decision of, the kid will be a projectile
9 missile if something happens with a car
10 accident. So they are trying to say if we
11 can definitely make that a standardization
12 that pediatric patients get transported in
13 some kind of device.
14 We removed hypothermia from all the
15 protocols -- as we expected.
16 We talked about the YouTube video -- Joe
17 Bart's educational thing is a YouTube video
18 we talked about for the spinal
19 immobilization. And, again, we can get you
20 the link if you want it.
21 We discussed blood regs and transfusion
22 protocol, that came out. They know of one
23 agency now trying to get on board with some
24 of the local hospitals to be able to utilize
25 it because it is a difficult thing to do, but
www.courtreportingny.com
[email protected] - (845) 634-4200 Rockland & Orange Reporting
28
1 Proceedings
2 it is out there moving forward, it isn't an
3 easy process.
4 MR. LAMARCA: Just note, the one agency
5 secured an agreement with MidHudson Regional
6 and it should be done --
7 DR. MURPHY: Excellent. Good job,
8 Hudson Valley, good job Mobile Life, because
9 that's a tough thing -- but it's all good.
10 There was a message or a dissemination
11 of information from STAC. They had met right
12 before the SEMAC meeting and they just wanted
13 to reemphasis the process that we ensure that
14 people are communicating patient arrivals to
15 the ED and make sure they are calling in
16 advance to let people know what is happening,
17 what is arriving, what is coming, and what is
18 going on, the whole nine yards, just
19 reenforcing the whole communication issue of
20 patient safety and treatment.
21 The State trauma report is out on their
22 website. It's pretty impressive actually,
23 this report from STAC. They put together all
24 the trauma data and came up with the response
25 times, their survivability, there is a ton of
www.courtreportingny.com
[email protected] - (845) 634-4200 Rockland & Orange Reporting
29
1 Proceedings
2 information there and everyone can look at
3 it, it's on the website.
4 They talked about the DOH putting out
5 that letter I showed you this morning about
6 spinal immobilization. And there are
7 committees working on mobile integrated
8 health, the whole community paramedic
9 medicine situation. There is some issues
10 there with long-term care and, of course, the
11 nursing kind of -- let's say nursing --
12 MR. LAMARCA: Resistance.
13 DR. MURPHY: Nursing union resistance to
14 the whole process taking off -- but I think
15 it's going to happen in my humble opinion,
16 it's only something that needs to happen.
17 And then -- just a couple of words -- we
18 met, like I said, for the collaboration
19 committee, the protocol committee and we
20 talked about the MOU. The other thing is all
21 meetings that we have will be recorded and
22 will be placed in a drop box. So if somebody
23 wants to see them, listen to them and, you
24 know, and understand what came down at each
25 meeting, it will be available in a drop box.
www.courtreportingny.com
[email protected] - (845) 634-4200 Rockland & Orange Reporting
30
1 Proceedings
2 And the way each meeting will be -- we have
3 to be better at giving more of a lead time
4 for each meeting. We have been kind of bad
5 that we just say the meeting is going on at
6 SEMAC and then there is some phone meetings
7 or go to meetings in-between. But we have to
8 give people more lead time so they have a
9 chance to be able to get onto the call or the
10 meeting update.
11 The protocols we have decided will be,
12 you know, looked at and approved on an annual
13 update. Every two years there will be a full
14 protocol revision, meaning everything single
15 thing will be looked over, revised if needed,
16 verbiage, the way it's written, any kind of
17 tweaks, or things like that, but that will be
18 on a two year basis. And, you know, it's
19 always stuff being looked at, but a total
20 revision will be done every two years. So
21 that's the gist of SEMAC.
22 MR. LAMARCA: Dr. Dailey show and
23 tell --
24 DR. ARSHAD: -- BLS again.
25 MR. LAMARCA: -- remember they discussed
www.courtreportingny.com
[email protected] - (845) 634-4200 Rockland & Orange Reporting
31
1 Proceedings
2 that, the four milligram Narcan, the
3 inhalent?
4 DR. MURPHY: Yeah, it's just changing
5 the concentration and upping to four
6 milligrams. Actually, I don't know why I
7 didn't write that down. I talked about it.
8 Just increasing the concentration there and
9 so it's something that is still in the works.
10 But that is what is down the pike, we
11 have a few little things we are tweaking in
12 terms of medication dosages and things still,
13 the ketamine thing is still up there and
14 such. Can you think of anything else?
15 DR. PAPISH: Does the four milligrams
16 they are --
17 DR. ARSHAD: So the gist is there is a
18 new device or delivery system made by a
19 different pharmaceutical company so what Dr.
20 Dailey was advocating, in case of shortage
21 there should be some backup option available.
22 The other thing is the concentration is much
23 higher so it's delivered over a very small
24 volume, like one to two cc's, I think. It
25 was very very small and the total dose is
www.courtreportingny.com
[email protected] - (845) 634-4200 Rockland & Orange Reporting
32
1 Proceedings
2 four milligrams and administered by single
3 nostril -- correct?
4 DR. MURPHY: Yes, single --
5 DR. ARSHAD: Single rather than two. So
6 it was being put forward as a backup option
7 in case of shortage.
8 MR. MURPHY: And it's a single unit so
9 it's open container and squirt, whereas right
10 now you have to open the container, screw two
11 vials, and put the atomizer on --
12 DR. MURPHY: A one shot -- yeah --
13 MR. MURPHY: One shot deal, so we are
14 looking to incorporate that more. So in the
15 public safety law enforcement programs that's
16 why --
17 (The speaker cannot be heard.)
18 DR. MURPHY: Yeah, I remember now
19 because he definitely kept saying, I have no
20 financial tie to this product --
21 MR. LAMARCA: That and the two twelve
22 lead units he --
23 DR. MURPHY: Yeah, that was kind of
24 interesting. They are a little bit
25 expensive, but they are strap units that
www.courtreportingny.com
[email protected] - (845) 634-4200 Rockland & Orange Reporting
33
1 Proceedings
2 literally you put around the chest and you
3 hook it up, like you measure and put a loop
4 and hook it up. And one was a strap with
5 this little box and it delivers a twelve lead
6 EKG. And the other is box, but you have to
7 hook on the leads so you have to teach
8 somebody to hook on the leads. Again, it's
9 not rocket science, but it delivers and
10 requires a twelve lead EKG. They were pretty
11 pricey. They were not cheap. But it was two
12 things they are looking at and that is what
13 this whole Suffolk project is looking at,
14 some of these devices.
15 DR. STUHLMILLER: Do we need to vote on
16 that? You signing the MOU --
17 DR. MURPHY: I guess it's not necessary
18 since we are part of the protocol. I just
19 wanted to let people know what I'm signing
20 because I'm signing us into this since we
21 voted to be in there I guess that was -- we
22 just never had a piece of paper. And
23 actually, Mike was the first one -- was it
24 two years ago now, Mike, right? He was like,
25 but what about -- and so they really wanted
www.courtreportingny.com
[email protected] - (845) 634-4200 Rockland & Orange Reporting
34
1 Proceedings
2 some kind of operational document so -- you
3 know, some kind of document of understanding.
4 And it worked out that it's finally put
5 together and a bunch of people worked on it
6 and it came out pretty good, I thought. So I
7 wanted to make sure people understood what I
8 was signing.
9 MR. BENENATI: There was also discussion
10 with regards to the placement of tourniquets
11 --
12 (Everyone is speaking at once.)
13 MR. BENENATI: -- and ultimately the
14 protocol was slightly modified. They added
15 the word should to be high and tight, so the
16 tourniquet should be high and tight when it's
17 applied on a limb.
18 DR. MURPHY: It was more so Andrew was
19 concerned about the verbiage in that. But if
20 you look at all the documents and most of the
21 prehospital and definitely all the protocols
22 from the military it's all high and tight.
23 DR. ARSHAD: I think the mild
24 controversy there was in the ACEPT tactile
25 conversation threads there was debate whether
www.courtreportingny.com
[email protected] - (845) 634-4200 Rockland & Orange Reporting
35
1 Proceedings
2 the tourniquet should be applied proximally
3 as possible, or just proximal to the wound or
4 injury. So medical logic was if you apply it
5 as proximally as possible and are unable to
6 obtain hemostasis it gives you additional
7 wiggle room to apply a second tourniquet.
8 DR. MURPHY: It became a little hot, I
9 have to say, that conversation. I didn't
10 know tourniquets could rouse such fervor.
11 Any or comments? No?
12 We have no new applications for new
13 programs, Epi-pen, PAD, albuterol,
14 glucometry, or Narcan at this time.
15 A couple of announcements and updates.
16 We have had some requests from hospitals to
17 provide CME and such and it's great that, you
18 know, all these lectures and things are being
19 done for the providers in each area. But one
20 of the issues still in our CME and still in
21 our project of how people acquire their CME
22 hours is, we still require medical control
23 contact. Meaning that a medical control
24 physician is at the lecture, at the
25 educational experience, and there as part of
www.courtreportingny.com
[email protected] - (845) 634-4200 Rockland & Orange Reporting
36
1 Proceedings
2 that educational process. Such that they are
3 there to answer questions, to make the
4 information pertinent to what we do, make
5 sure we are staying within protocol, make
6 sure that we are providing good educational
7 material. And that contact, I think, is
8 extremely valuable. And when the medics come
9 into the ER they get a certain amount of
10 credit for discussing a case, going over EKG,
11 going over a process, having you sign off,
12 but the medical control contact hours from
13 lecture were strict on the medical control
14 physician has to be there. We had a couple
15 of recent submissions for medical control
16 contact hours that we are not going to give
17 because there was no medical control
18 physician there present or doing anything of
19 the lectures. So come on, it's just a little
20 bit of input we need to do, so I can't bend
21 that rule, that's not something we will bend.
22 MR. HUGHES: The medical control
23 physician is actually supposed to give at
24 least 50 percent --
25 DR. MURPHY: Yeah. And it's a thing
www.courtreportingny.com
[email protected] - (845) 634-4200 Rockland & Orange Reporting
37
1 Proceedings
2 where it's a whole discussion process. Even
3 if you have outside lecturers -- what we did
4 for ORMC, I had a national lecturer come in
5 and what I did was do the lecture with them
6 and just that way we make this pertinent to
7 what we have in this area and, you know,
8 talked off each other and discussed it so it
9 makes sense and the poignant parts of how we
10 utilize this information or process and make
11 it relevant. I think that control -- medical
12 control contact is very important for the
13 providers. And just every time they approach
14 you in the ER and every time they come up to
15 ask you a question or discuss a case, that's
16 all really good information, really good
17 feedback, it ties us in, it ties in what we
18 are supposed to be doing here. So I wanted
19 to reiterate that we need to make sure we
20 abide by those kind of basic issues.
21 Under kind of open forum and new
22 business, I try to bring forward materials
23 that are sent to the office. We were
24 notified by Lee Burns that the verification
25 process for Good Sam was they were unable to
www.courtreportingny.com
[email protected] - (845) 634-4200 Rockland & Orange Reporting
38
1 Proceedings
2 pursue it. So just as of this point -- this
3 letter was dated November 16, 2015, Good Sam
4 lost their designation as a local area trauma
5 center. They -- they were -- we disseminated
6 that information, but they are hoping this
7 facility will reapply for provisional trauma
8 designation and get back their status. But
9 it was a FYI move forward towards us.
10 And I think -- oh, you have handout up
11 front of all the meetings coming forward for
12 this year. Mark them in your little books.
13 And hopefully we haven't made one over a
14 holiday, we changed September so it didn't
15 hit Labor Day again. So hopefully that will
16 -- they will go off without a change.
17 Okay, open forum. Anybody want to bring
18 anything forward?
19 MR. BENENATI: Just we formalized the
20 protocol committee a little more. We will
21 meet monthly, the third Thursday every month
22 and the meetings are open. If anybody is
23 interested in attending to bring ideas forth,
24 join us. And we want to provide a monthly
25 report to this group of what is going on.
www.courtreportingny.com
[email protected] - (845) 634-4200 Rockland & Orange Reporting
39
1 Proceedings
2 There was a discussion with regards to Locums
3 not willing to sign paramedic reports, this
4 is an ongoing issue. If you could try and
5 get that brought back to the personnel in
6 your hospitals, that would be appreciated.
7 MR. PARRISH: What time?
8 MR. BENENATI: Good question --
9 MR. HUGHES: Eight-thirty.
10 MR. BENENATI: I think it was
11 eight-thirty, right?
12 MR. HUGHES: Yes.
13 MR. PARRISH: Here?
14 MR. BENENATI: Well, next door.
15 MR. HUGHES: Yes.
16 DR. MURPHY: And I think -- oh. We
17 definitely -- one of the things I brought up
18 last meeting, the replacement of medical
19 director. I know that I had -- or Dr. Papish
20 has had discussions with people and I didn't
21 know, Arshad, are you still interested or --
22 DR. ARSHAD: I'll throw my hat in the
23 ring.
24 DR. MURPHY: And the other thing you can
25 think about too is evaluation subcommittee.
www.courtreportingny.com
[email protected] - (845) 634-4200 Rockland & Orange Reporting
40
1 Proceedings
2 I thought you would be great for that just
3 because having that interaction with the
4 providers it's a much more provider
5 interaction so that was the other thing I was
6 thinking about.
7 So this morning what I would like to do
8 then is since we have a quorum is to be able
9 to make a recommendation from this body for
10 the medical director.
11 Now, I was having these guys laugh
12 because no one -- I don't think anybody in
13 the room here except for like Andy and you
14 guys, prehospital guys, remember back --
15 didn't you guys make me go out of the room
16 and they voted -- do you remember?
17 MR. LAMARCA: I don't know.
18 DR. MURPHY: It's too long ago --
19 MR. LAMARCA: Even if I did remember, I
20 would just deny it --
21 DR. MURPHY: The only thing I was
22 thinking was that Mark and Arshad, you would
23 have to leave the room and we would have a
24 discussion about making the recommendation
25 from this committee because we will vote on
www.courtreportingny.com
[email protected] - (845) 634-4200 Rockland & Orange Reporting
41
1 Proceedings
2 it. We will have an official vote, okay?
3 So I'll ask you guys to step out for
4 just a second. Off the record.
5 (Discussion held off the record.)
6 DR. MURPHY: So all those in favor?
7 ALL: Aye.
8 (Discussion held off the record.)
9 DR. MURPHY: Back on the record. I had
10 gone off record for just the discussion and I
11 just gave everybody a little bit of
12 background of everything.
13 So, Mark, we voted you to be the new
14 medical director.
15 And if you would, would you be the
16 evaluation subcommittee chair?
17 DR. ARSHAD: Of course.
18 DR. MURPHY: I think that is just great
19 -- you would be top top in terms of that.
20 The decision rested upon more so I think
21 these positions have to be from people that
22 have been here a while. And so I think this
23 will all go together and you are such a
24 valuable tool we have to have you in there.
25 And Mark has been around us -- and he used to
www.courtreportingny.com
[email protected] - (845) 634-4200 Rockland & Orange Reporting
42
1 Proceedings
2 have hair when he started with us.
3 But thank you guys and I appreciate and
4 we look forward to working with you and we
5 will make sure you are on all the list serves
6 and such.
7 Again, on behalf of the region and all
8 the providers, thank you very much, it will
9 be very helpful.
10 Any -- okay, any other info? New
11 business? Anything anybody wants to bring
12 forward -- oh, you want to talk about your
13 little card you showed me?
14 MR. HUGHES: No, not necessarily.
15 Nothing has happened yet, I was just talking
16 to you about it.
17 DR. MURPHY: Okay, anything else?
18 A motion to adjourn?
19 DR. PAPISH: Motion to adjourn.
20 DR. GUTMAN: Second.
21 DR. MURPHY: Okay, second. Thank you
22 all for coming, that was a record one hour
23 meeting.
24
25
www.courtreportingny.com
[email protected] - (845) 634-4200 Rockland & Orange Reporting
43
1
2
3
4
5
6 THE FOREGOING IS CERTIFIED to be a true
7 and correct transcription of the original
8 Stenographic minutes to the best of my ability.
9
10
11 ___________________________ Yvette Arnold
12
13
14
15
16
17
18
19
20
21
22
23
24
25