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[email protected] - (845) 634-4200 Rockland & Orange Reporting

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HUDSON VALLEY REGIONAL EMERGENCY

MEDICAL ADVISORY COMMITTEE

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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



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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

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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



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1 A P P E A R A N C E S :

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3 MIKE BENENATI ISRAEL KNOBLOCH

4 ANDY LAMARCA MIKE MURPHY

5 RICHARD PARRISH ERNIE STONICK

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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



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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



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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



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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



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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



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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



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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



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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 --



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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



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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



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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



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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



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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



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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



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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



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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.



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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 --


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



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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



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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



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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 --



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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 --



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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



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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



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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



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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



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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.



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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



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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



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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 --


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



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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



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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 --


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



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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



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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



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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



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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.



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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.



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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



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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



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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.

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6 THE FOREGOING IS CERTIFIED to be a true

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11 ___________________________ Yvette Arnold

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Documents

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