PRESENT: Steve Bennett, Kathy Brimmer, Jim Chrabaszcz, Rick Churches, Fred Crist, Don Duvall, Patti Gressel, Bernadette Josbeno-Oakes, Rick Kimball, Ron Kintz, Jim Larson, Al Lewis, Kathy Lunney, Dr. Manganaro, Bob Rajsky, Mike Smith, Dick Sullivan, Maryann Sweely & Mary Ann Teeter
ABSENT/EXCUSED: Paul Card, Dr. Huffner, William Kennedy, J-R Miller, Mike Sprague, Teri Symonds
STAFF PRESENT: Judy Blair, Cathy Auge
GUESTS: Gary Blitz, Scott Brimmer, Shirley Churches, Jim Kintz, Tom Murphy & Dr Shepherd

CHAIRMAN RAJSKY: Let's call the meeting to order of the Southern Tier Regional Medical Services Council. Welcome to everyone this evening. Before we get started are there any guests that need introduction? I think everybody knows Cathy Auge from the STREMS office, our special projects manager.

DON DUVALL: Bob, Dr. Shepherd from Corning Hospital.

CHAIRMAN RAJSKY: Welcome Dr. Shepherd. Great. Anyone else? Seeing none, we will move the agenda.
      Correspondence. And I only have one. One of one of my favorite chores to do, reading the list of the not so fortunate folks of EMS who didn't play by the rules. So I only have one tonight. Name is Mark Galuski from Troy, New York, EMT number 108556. His EMT certification was suspended, then placed on three years probation after January of 2004 and assessed a civil penalty for that of $2,000 for breach of New York State law Part 800.15 and 16 (http://www.health.state.ny.us/nysdoh/ems/part800.htm#800.15 and http://www.health.state.ny.us/nysdoh/ems/part800.htm#800.16) .

MIKE SMITH: Bob, those would be a lot more beneficial if they told what the guy did.

CHAIRMAN RAJSKY: 15, yeah it always centers around Part 800.15 and 16.

BERNADETTE J-OAKES: Protocol. Because Dr. Huffner looked it up last time.

MIKE SMITH: It would be nice if they described the circumstances of events so people understand what it is that is causing this action to be taken.

CHAIRMAN RAJSKY: I can certainly break those out, because it usually centers around just those two. That is the only one this time. So that is good. I am hoping that's a trend in the state where we don't have ten or 15 a month like we were there for a while.
      You should have all received the minutes from the previous meeting, via e-mail. Those of you who are not on e-mail should have received paper copies of those. I would certainly entertain a motion to approve last month's meetings.

STEVE BENNETT: I make the motion.

AL LEWIS: Second.

CHAIRMAN RAJSKY: Second by Al Lewis, any discussion. Seeing none. All those in favor signify by saying aye. Opposed? Abstentions? Carried. (CARRIED, unanimous.)

CHAIRMAN RAJSKY: Great. Let's get right to committee reports. The first is STREMAC, SEMAC and State Council. Two of those, SEMAC and State Council, neither of those have met since our last meeting here.
      But STREMAC did meet and they met last Tuesday, February 10 at the STREMS office. And I guess I would like to report that it was virtually standing room only for that meeting which is always good to see that much interest in EMS. The minutes of that meeting are attached, were in your mailbox this evening. Dr. Huffner unfortunately is not here tonight but he told me what to read. So unlike him to do that but, and so within that he, within those minutes you will see in actually the Regional ALS Adult and Pediatric Protocols and the Scope of Practice and the Formulary for Medications was approved at that STREMAC meeting, and will get approved at the March meeting of this body.
      The other item that came up was the revisions to the AED policy and procedures. AED policies and procedure manual will also be presented at the March Council meeting. A few highlights, a few minor changes, probably the most significant change in that was the change from quarterly in-servicing mandated to twice a year. You can certainly do it more but the minimum standard would be twice year for that.
      The next item that came as you remember from our last meeting here, Dr. Wayne Shariff from Schuyler Hospital was elected to the STREMAC. We voted to have him join us, join the STREMAC, we vote first and STREMAC accepts him and they did that at their meeting.
      Another physician, Dr. Gary Enders from Corning Hospital comes to us tonight actually as a nomination to the STREMAC membership. He will be replacing actually Dr. Seaman on the STREMAC board. So we do have to act on that tonight. So that his application that can go to STREMAC. So I would entertain a motion.

AL LEWIS: So moved.

MARYANN SWEELY: Second.

CHAIRMAN RAJSKY: Al Lewis motion, second by Maryann. Dr. Enders I understand has been a long-standing ER physician at Corning, as long as I have been in EMS here. And he has participated on many committees in the past. So we are looking forward to having him with us.
      Any other discussion about the motion on the floor? Seeing none, all those in favor signify by saying aye. Opposed? Abstentions? Carried. (CARRIED, unanimous.)

CHAIRMAN RAJSKY: The last item in the packet actually is at the end of the minutes from STREMAC is the listing of the STREMAC's list of upcoming meetings. And those meetings are always open to anyone who would like to participate. That's the report from Dr. Huffner. Again the minutes from that meeting are attached.

AL LEWIS: I make a motion that you give that report every month so the meetings will be shorter.

MARYANNE SWEELY: Second.

CHAIRMAN RAJSKY: Dr. Huffner will enjoy reading that. Thank you, Mr. Lewis.
      Quality Improvement, Bernadette.

BERNADETTE J-OAKES: The Regional Quality Improvement committee met Tuesday the 10th after the lengthy STREMAC meeting at the STREMS office.
      Reports from the fourth quarter 2003 were presented. All areas of reporting for cardiac arrest, multiple traumas, peds less than six years old and GCS less than 15 were above the national standard of 80% with the exception of ALS for GCS less than 15. The average for this was 79.95 for the year. The committee plans to closely monitor this, and if the trend is identified possible interventions will be scored to improve in this area.
      Attendance was reviewed for the eligibility for the annual QIPP award. The awards will be presented at the March Council meeting. Eligible departments will be notified after the verification of attendance has been completed with the area coordinators. Please note that many departments could not meet for the last month due to bad weather. These absences will not be counted against any department.
      Plans have been made to incorporate First Responder QA in to next quarter's reports and as a permanent part of the QI plan in the future. Agencies will be receiving a letter explaining this in the near future.
      Quality Improvement manual will be changed to reflect the addition of the First Responder QA as well as the Emergency Medical Dispatch. No other changes were recommended for the manual at this time.
     You all have a copy of the QI committee 2004 goals.
      The QI committee noted the completion of the Pediatric Assessment training program now available on the website. If you have not reviewed it and taken the post test, you are encouraged to do so.
      I would like to also thank training committee for their help in making that happen, as well as Cathy Auge and Patti Gressel who did most of the work for it. It's a very good program and I encourage if you have not looked at it, check it out on the website. Your agency should have received the information also along with the CD. The office really would like to know how many people at least review the data as well as to receive you know the post test that's available after you look through the course.
      Our next meeting will be May 11, 2004. That completes my report.

CHAIRMAN RAJSKY: Thank you. Questions for Bernadette in Quality Improvement?

BERNADETTE J-OAKES: Does anybody have any questions on the goals? They are on the little vanilla colored paper.

CHAIRMAN RAJSKY: Seeing none, we will move on to Public Relations committee. Mary Ann?

MARY ANN TEETER: The Public Relations committee also met February 10th after the QI committee. So it was a marathon meeting day. There are two items I just want to bring to everyone's attention.
      The first one is the annual conference this year is going to be October 16, up at Corning Community College. We're putting those brochures and flyers together now. The other, and actually today I locked in our keynote speaker, it's actually Dr. Lentz, Christopher Lentz from Strong Memorial Hospital burn unit and he is going to do a presentation on burns and burn care.
      The second item is the awards. The committee has decided to focus on presenting at the May meeting the award of the -- actually the very distinguished Walt Ersly award and we're asking for anyone who feels that they meet that qualification to nominate -- not themselves but if they feel there is someone else that meets those qualifications to please send that nomination in, and that information will be on the website as well. And we have a deadline for that of April 15, because it will be presented at the May meeting, prior to EMS week.
      And then the last item is the next PR meeting for those who are members is March 2 at 3:00 at STREMS.
      Last but not least, I am glad Patti mentioned that. One of the things that came out of the discussion regards to providing educational opportunities for all of our members, we thought it would be great to offer displays, educational displays in addition to the conference that people could actually peruse or use as research. And we're asking all the committees of the Council to create a display of information, we will give you all the details because they want them pretty standardized and share what your committee has accomplished with the members. This will be put in the vendor area. So when people are meeting with the vendors, they also can look at those displays as well. And it's like I said more details will be coming out to the committees, but we wanted to give you the heads up now.

CHAIRMAN RAJSKY: Great. Thank you. The date for the conference, did you say that?

MARY ANN TEETER: October 16.

CHAIRMAN RAJSKY: And that's actually housed at Corning Community College.

MARY ANN TEETER: Corning Community College, the date had changed. That was the difference, location had not.

CHAIRMAN RAJSKY: Questions for Mary Ann in Public Relations? Seeing none, we will move on.
      Systems committee, they did not meet on the Tuesday.

DON DUVALL: There was no time left. Systems committee met this evening prior to regular Council meeting. It's our first actual meeting since October. However a lot of things have been accomplished since then.
      First and foremost is the radio project that you will recall we initiated last year. Motorola engineers are in the study phase and Mr. Smith tells us that Motorola will be in town in the next couple weeks to work on further development of objectives and goals for a radio project. So that continues to move forward.
      The MCI trailers have been redistributed to their rightful locations. Steuben, Chemung and Schuyler County each now have MCI trailers available. The agreements were completed and they are back in service.
     The STAR program, we were given an update on the STAR program. And Systems looked at ways to help facilitate the use or utilization of STAR program.
      Has anyone seen the recruitment commercial that's been airing on WETM for the last couple of weeks? Bob saw it. So if Bob saw it, it must be so.

CHAIRMAN RAJSKY: I saw it once with my own eyes.

MIKE SMITH: Made you run right out and volunteer.

CHAIRMAN RAJSKY: Yeah I called the office.

DON DUVALL: We did finally get that program through to completion. We have a commercial airing on WETM. If you get the opportunity or if you happen to see it, let us know what you think. And give us your impressions on whether it's a beneficial avenue or not.
      We looked at a group purchasing plan that we actually talked about during the last year. We're going to revisit the idea of negotiating prices that agencies within our region can take advantage of to restock consumable supplies in their services. We will be working on that.
      One new PAD program, or new PAD application was accepted by us from the YWCA in Elmira. That will be forwarded to the state.
      And that was it. Any questions?

CHAIRMAN RAJSKY: Thank you, Donny.
      Under other business, I have a few things. One we have currently three vacancies on Council, one from Schuyler County and two from Steuben. And I did bring, there is five packets, five membership packets, so if you know of someone, or an agency that would like membership, please have, please take one. And have them fill that out and return it to us. That's one from Schuyler, two from Steuben.
      Dr. Huffner and I had made a commitment to try to go throughout the region and have if you will town meetings with our member agencies, to kind of discuss state of EMS, what the STREMS perspective; what STREMS perspective, what STREMS; what STREMS Incorporated is. And how we can serve them better, how they can serve their patients better.
      We had one scheduled for Hornell, which unfortunately got canceled. It was just in the timing, we had it about a month and half we sent out the notices, but for many, many organizations who don't pick their mail up on a regular basis, they missed picking it up quick enough. Then they didn't have a meeting until after the event. So we have rescheduled the Hornell visit. And it's for any agency in the three counties, and any members can come to that. It's actually a dinner. That will be at the Comfort Inn in Hornell on March 23 at 6:00 p.m. The other two were held. We held one in Bath, New York on a very snowy nasty night and had several agencies show up and had a great exchange of information, both, on both sides.
      And then a couple weeks ago we had one in, actually right here in Big Flats. And that was well attended as well. So we're making strides to try to get to as many agencies as we can.
      The last, if you called, especially in the past six months, the STREMS office, you may have gotten frustrated. Certainly at our end we have gotten very frustrated, our phone system has not been working well. And lots of reasons for it, about a year ago it got hit by lightning, certain parts, half the system was replaced. But it's new technology with old technology and it's finally the new technology has just about had it. So hopefully tomorrow we will be presenting that to the board of STREMS Incorporated for replacement. Hopefully that will pass and we can get that, the phone system in that will get you expediently to the right person at the right time. Now I know several people have called and if you don't get to the right end point you really have to hang up and start the whole process over. And I know a lot of you had that problem. So hang on, I hope we will solve that problem shortly.
      Other business to come before Council this evening? I had put on about Steuben County 911 update. Does anybody have a report? Mike Sprague is not here, but does anybody have any?

AL LEWIS: It's not done yet. I am hoping in my lifetime we have 911.

RICK CHURCHES: Bob, just for those who saw in the paper that Schuyler County hopefully has improved their 911 system, we just went to the legislature the other night and got approval to have two dispatchers 24 and 7. That may not sound like a big deal to people, but we have been working with one dispatcher for, they have, in the last year or so gotten about 60 percent, we have had two dispatchers 24 and 7. But most of the time there is only one. The one dispatcher dispatches the sheriff, fire, EMS, also does EMD, opens up the door, works the jail, takes care of county highway, all the automatic alarms coming in and so forth. And we were really getting pushed to the limit. And we have situations where they are doing EMD then they have to put that person on hold to dispatch the fire department, then go back. And hopefully we are going to eliminate those problems. And we see that as a big improvement. So hopefully we're moving ahead. We will probably have to layoff three sheriff deputies and four county highway employees to get them. But at least we will have some people in the dispatch center.

CHAIRMAN RAJSKY: Sounds like a vicious cycle, then the police get laid off. And.

RICK CHURCHES: I am not sure where they are going to get them from.

CHAIRMAN RAJSKY: That was a wonderful article.

RICK CHURCHES: It was good cooperation between our office and the sheriff's department. They did a good presentation, helped us to have this wireless 911 funding coming ALONG, we had to be certified siren in order to receive the fund so that helped us a lot.

CHAIRMAN RAJSKY: Mike Smith, anything on Chemung County 911?

MIKE SMITH: The only thing I got has to do with our automatic alarms we have been answering. 10 years ago we had a franchise agreement with a company to provide the alarm monitoring equipment, and the franchise is up this month. And the equipment is obsolete. Costs for replacement equipment are prohibitive. So we anticipate that the franchise is going to end. We have sent letters to all of the customers of that directly-linked alarm service and have advised them to get ahold of their alarm provider and make other arrangements now.
      So that has created some interest, the Star-Gazette was one of our automatic alarms, they got their letter and decided it was a news item. So there will probably be something in the paper. Whether or not they have quite understood the issue, I am not sure. It's always a thrill to talk to them and hope that they got the drift. But most probably people who go to someone else now will save money. Because they no longer will have to have a dedicated telephone line. So that's it there. Out there, should you hear anything, please refer them to our office and we will try to enlighten them further.

CHAIRMAN RAJSKY: Thank you.

DICK SULLIVAN: Bob, maybe as long as Cathy is here she could go over that STAR program for the other people that may not be familiar with it. I think it would be good especially with the book now out.

CHAIRMAN RAJSKY: Sure.

CATHY AUGE: If I can get these books back from the majority of the people. I have got a couple more that I can pass out so people want to take a look at them. I don't know if everybody is familiar with exactly what the STAR program is.
      STAR stands for Southern Tier Assisted Response. And the idea was to get some sort of program together where we could easily notify a large amount of people, i.e. chiefs and EMS captains and other members of all of the different agencies in our region in the case of, initially it came out with you know the bioterrorism, chemical terrorism, possible radiological stuff.
      From that it has blossomed into quite a project. Now we intend to use this to notify agencies of routine things as well as upcoming drills. The program is available to all of the county offices of emergency management. So they will be able to use it. Chemung County Public Health will be using it as well as Arnot Ogden and St. Joe's.
      What it is is, it's kind of based around an automatic dialing system where we start a data base, and can go in, record a message and send it out to pretty much anybody we want, anyone that's in our data base in a matter of about two minutes, takes about two minutes, go in, create a message and get it broadcasting.
      Currently we can call 40 numbers per hour. But we are upgrading that in the very near future hopefully to where the system can handle just about 250 calls per hour. That's going to allow us to notify quite a large number of people in a very short amount of time. The system also allows us to send out simultaneous e-mails, so to anybody who might be sitting at a computer throughout the day and have, has their e-mail pop up, all the e-mails will go out at one time. So we can send out 400 e-mails, boom, and everybody gets it.
      The book we handed out is kind of the manual for the different providers out there to understand and use the system. As I said it initially came about in response to bioterrorism. So it's really geared around possible biological attack, and the agents that are in here are different agents that are listed by the CDC as the most likely to be used against our country in the case of a terrorist attack. So red are your biological stuff, the green are the four chemical agents that are most likely to be used. And then just a quick radiation exposure fact sheet. And the nice thing about these is, I took a lot of information and broke it down in to very simple terms. I know most agencies have those chemical response books that are about this thick hanging out in their ambulance. But this is just the basics, what you need as a provider to protect yourself and to protect your patient when you arrive at the scene. The reason this book is also important, an important part of this program, is that we tried to kind of do a radio coding system where if say there is cyanide gas release in Watkins Glen, somebody doesn't get over the radio and say we got cyanide gases, gas, we got cyanide gas, and everybody over in scatter land is flocking in to see the disaster.
      So I know, I saw a few of you also looking at this flow sheet that I passed around. Sorry I don't have very much of these either, but this is just, if everybody just wants to take a look at it and then pass it along, that's just kind of how we see the system actually being used. You can see there is different alert levels, you can take a look at each of them to see what the different alert levels are considered.
      But the idea is is to be able to code something over the radio. So if we had a level 4, so you switch, you can pull up your level 4, there means that this is an unplanned incident and it's confirmed. So we have a level 4, confirmed incident. With red 1 agent. So you just turn to your red sheets, you see your agent number 1. That let's us know that we have a confirmed anthrax incident. And then attached to that will be a location code. So we have a level 4, red 1, 4821 alert. That means that there has been a confirmed anthrax incident in Watkins Glen. And that's kind of the idea of how this is supposed to be used.
      I will just mention that every agency in our region has now received two notifications on the STAR program. In order to participate in the STAR program and receive this packet as well as other information, we need to get information from the agencies. Obviously we can't notify you if you don't tell us what numbers you want to be notified by and who you want to be notified. Hopefully we would like to have a chief, an EMS officer, and then anybody else in the agency that you might want notified. But we have to have contact numbers and we have to have e-mail addresses; and we also would like to have a roster of all of the folks that are involved in your agency, so that we have some kind of idea if we called on your agency for help, we know what kind of resources you have to offer.
     If we haven't received that information back from you, we haven't put you in the data base and you haven't gotten your folder. So far only 18 agencies out of 70 in the region have opted to participate in this. And I would be very happy as well as I am sure everybody else involved if we could try to stir up some interest in this. With only 18 agencies involved, it really isn't going to do us very much on a regional level. So we really need to get everybody involved, they need to understand that it's for their own benefit. So that they can be involved in some sort of regional incident if that should happen.

MARY ANN TEETER: Two questions, one have the hospitals responded to you?

CATHY AUGE: Actually they have not. That's kind of a newer angle. And we have kind of just gotten Arnot on board and St. Joe's on board and now we have to work on the other hospitals. But they have not received two notifications.

MARY ANN TEETER: The other thing ricin, I didn't see that in there.

CATHY AUGE: Actually we just got that update and it will be added.

MIKE SMITH: In fact we suspect that the two hospitals are going to use this to notify their disaster response person.

MARY ANN TEETER: So I hadn't seen it yet, so if the Arnot received it I haven't seen it.

CATHY AUGE: They actually haven't received this book yet. But they did just receive information on actually how to use the system. They got a demonstration on the STAR system.
      That's the other thing, just to let everybody know, I have done a couple presentations on it. I did it, we did a power point presentation where I actually activated the system remotely. The nice thing about this is it can be accessed remotely. I accessed it remotely and did a power point presentation for the bioterrorism, Chemung County Bioterrorism committee.
      I would be happy to do that again for anybody who is interested. If there is a group of you, one or two of you if you just want to come to the office, whip up a message real quick so you can see how easy the system really works. It's great technology. It's pretty easy.

CHAIRMAN RAJSKY: In the grant that Cathy talked about adding those lines to be able to do 250 messages an hour, or dial 250 messages an hour; the other part of that is it will be on battery back up, and then long-term there will be a generator as well that will come on automatically. So it will be a 24 hour/7 kind of thing. And up and running even if the power is out as long as the phone lines remain intact.

CATHY AUGE: The idea for the 24/7 deal; we really foresee the county emergency management offices and the hospitals probably using it more so than the STREMS office will. I mean these things don't usually happen between nine and five Monday through Friday. So the idea is that anybody with PC anywhere can access -- and the correct log in and pass words which I set up for the people that are able to use the system right now, they can dial in and activate the system just like they are sitting at my computer. So it's pretty slick.

RON KINTZ: Cathy, would you go over the, how the recipient answers, you know, they have the ability.

CATHY AUGE: Okay. The system has a feature built-in, it's a one touch reply feature, so at any time while we're calling 250 numbers, you can punch up a report on your announcement message. And I think it tracks five different things, it tracks no answers, it has a, it recognizes answering machines and it will wait until the message is completed and then leave a message on the answering machine. It recognizes any time the caller picks up and listens to the message and then it asks you if you have received this message in its entirety please press nine, press nine.
      And you can repeat the message if you want, there is another button you can have them repeat the message. So it tracks those who listen to the message and hit the nine key to say yes I got the message. But it also tracks those people who listen to the message but didn't press nine. So if the machine got all the way through the message and didn't press nine, it tracks those. Then it also tracks the telezappers, some people have those telezapper things, when any computer dials in it zaps the message. But this system actually overrides that. But it does track those. So at any time during the broadcast message you can punch that up, find out who you have managed to contact. See who, if there is an agency where you didn't get ahold of anybody from that particular agency, you might want to make some personal phone calls, see if you can track someone down.

RON KINTZ: Thank you.

CHAIRMAN RAJSKY: Other business to come before Council this evening? Seeing none, I will entertain a motion to adjourn.

STEVE BENNETT: Make a motion to adjourn.

JIM CHRABASZCZ: Second.

CHAIRMAN RAJSKY: All those in favor? Opposed? Carried. (CARRIED, unanimous.)

CHAIRMAN RAJSKY: Thank you.