PRESENT: Kathy Brimmer, Paul Card, Fred Crist, Don Duvall, Patti Gressel, Dr. Huffner, Bernadette Josbeno-Oakes, Bill Kennedy, Rick Kimball, Ron Kintz, Gary Blitz (for J. Larson), Al Lewis, Kathy Lunney, Dr. Manganaro, Bob Rajsky, Mike Smith, Mike Sprague, Maryann Sweely, Teri Symonds, Mary Ann Teeter
STAFF PRESENT: Judy Blair, Cathy Auge
GUESTS: Dean Chaifiele, Barbara Rice, Craig May
ABSENT/EXCUSED: S. Bennett, J. Chrabaszcz, R. Churches, JR Miller, R. Sullivan

CHAIRMAN RAJSKY: Let's call the STREMS meeting for March 2004 to order. Welcome everyone. We have a new stenographer tonight, Delores Hauber, and it's her first time with us, so we would ask if, as you speak if you would just state your name as we go that would help her out a tremendous amount.
     Announcements, any guests that need introduction today?

STEVEN BENNETT: Mr. Craig May, president of Schuyler ambulance which is one of our paramedic students observing the works of regional EMS council.

CHAIRMAN RAJSKY: Any other guests with us? I don't know either of you.

BARBARA RICE: I'm Barbara Rice. I'm from the Bath Ambulance Corps.

DEAN CHAIFIELE: I'm Dean Chaifiele. One of the board members of Bath Ambulance.

CHAIRMAN RAJSKY: Welcome. Any other guests this evening? We'll move on to correspondence and announcements. There's several correspondence. The first one is the regional council chairperson's, the most favorite thing to get is a certificate, about a certificate of need throughout the state. That is the most dreaded thing. In any event, it's a CON that comes to us from Woodhull and it pertains to a section of the Town of Rathbone that has been covered by Woodhull. They have been covering it, but technically it's not on their certificate of need. And so knowing the process of the CON, it comes to the council, we receive it and within 30 days we have to put into motion several steps. One of which is a public hearing, public comment times from each municipality around it and the health agencies within the geographic area have to be notified of this. And it can be a costly procedure. And to do that whole process, even the mailings and things, are expensive. So New York State was contacted. Actually our regional rep was contacted and gave us an opinion and then we contacted Albany and they said that we could do, instead of a full CON we could do an expansion of territory to include that chunk of Rathbone.
     So we have to, what in essence that, what that says is we have to get the clerks to agree on the specific territory and then ask the surrounding community if they agree with that. And I don't know, and I don't know, I don't have a sense, but I don't think this is going to be a contested kind of issue and if anybody knows differently, then speak up because if it is, then it truly has to be a certificate of need. Does anyone know of any agency that will contest that, the expansion of Woodhull territory into the Town of Rathbone? It's truly not an expansion. They are covering now, but it's not on the current certificate.

MS. SYMONDS: Actually we have been covering the area for several years. Addison divides it with us and Cameron takes a chunk of it as well and we just discovered it wasn't on our certificate.

DR. HUFFNER: Do those two ambulances cover, those other two ambulances cover the same territory in question.

MS. SYMONDS: No. Each corps covers just a chunk of it whoever is closer to there.

MS. AUGE: Can I ask a quick question? When you said that's all they cover, but is the entire township on their CON? Do you know if Cameron is?

MS. SYMONDS: I'm not understanding what you are asking.

MS. AUGE: I know there has been an agreement everybody covers a certain area. But on the actual state documents, does anybody else officially have that territory that you are aware of?

MS. SYMONDS: Not that I'm aware.

MR. SPRAGUE: I was going to ask that. We went through, the Town of Wheeler was done the same way. My question was because we are doing the block, the end result we ended up, all three wound up with the CON for the town. They couldn't handle the dividing lines. I remember we went through that in painstaking details. They finally said we can't handle that. Give the CON to all three. I wonder if that is going to happen with this one.

CHAIRMAN RAJSKY: It may. So if it's okay, the problem is we have 30 days from now to do it, to do it and make a recommendation back to the council and if we do the expansion of territory, that is easier. But in any event we have to let Woodhull know within 30 days and the problem is we won't meet again until May. So it's over the 30 day limit. So I guess I would suggest that we write to Woodhull telling them we don't meet in April. We will put the process in motion to do the expansion of territory and then do the final vote in May. So if that's acceptable to everyone, we will proceed that way and have the hearing.

MR. LEWIS: You need a motion to do that.

CHAIRMAN RAJSKY: Anybody feel comfortable?

MR. LEWIS: I'll make it.

CHAIRMAN RAJSKY: And a second, Mr. Kintz. Further discussion.

MR. SPRAGUE: Should we at the same time investigate Addison's and Cameron's CON status for the Town of Rathbone. If we are going to do one, should we make sure these are all.

CHAIRMAN RAJSKY: Make sure it's on any one of them and if not, make the recommendation to change it for all three.

MR. SPRAGUE: I guess my question for the other two-thirds of the Town of Rathbone, if this section is not on Woodhull's CON, maybe the other two are not on CONs either and can we take care of all of those.

CHAIRMAN RAJSKY: That would be a wonderful thing. Any further questions? All in favor say Aye. Opposed. Motion carried.
     Other correspondence will come under Systems-Steuben County EMS Association regarding the idea of EMS, re-credentialing of EMS personnel and will fall under Systems, we talked about in the Systems committee.
     Last but not least is my list of folks I have to read to you. I have the list of three or four. Here goes. These are the people that have been sanctioned throughout the state. Mark Galuski from Troy, New York. Violations of part 815 and part 816, civil penalty of $2,000 and suspended for one year, one year and three years probation. Charles Carroll from New York, New York, civil penalty of $5,000 and part 815 violation. His was only a civil penalty. No revocation. And then Joseph Santiago of Schenectady, New York. His certification was censured for part 815 and part 816 violation. And lastly David Mischler, M-I-S-C-H-L-E-R, from Amherst, New York, revoked certification for violating part 816. That concludes that correspondence.
     Approval of the last minutes from our last meeting in February, everyone should have received those via e-mail. Motion made by Ms. Sweely. Seconded by Mr. Kimball. Any discussion about the minutes? Seeing none, all those in favor signify by saying Aye. Opposed. Abstentions. Carried. Thank you.
     Committee reports. STREMAC, SEMAC and State Council. I did pass on the resolution that was passed at the last meeting, so if you could hand your stuff over so I could read it. Apparently resolution is not holding.

DR. HUFFNER: No. It wasn't defeated. I'm not going to allow it to take effect. Thank you, Mr. Lewis, for that show of support on that motion.

MR. LEWIS: You're entirely welcome, sir.

DR. HUFFNER: Actually STREMAC has not met since our last meeting, so I don't have a STREMAC presentation for you. But I do have news from the state EMS council which met in February, the end of the month 2004. You have a summary in your packet which again is written by Mike McEvoy which provides, if anything, a little bit of light reading. There are not significant issues that, there are no significant issues left out of the report. I would like to highlight a couple of things. One is that the new basic life support trauma protocol was approved. And it is now approved by the state and will be promulgated in the new EMS protocol. There are a few other things. The one Vital Signs Conference for 2004 will be held October 29th to the 31st in Buffalo, New York. It's nice to have it Upstate and a little bit further away for us, but still Upstate and I strongly recommend everybody's attendance. I'm not sure when mailings and stuff will start on that, but it's usually not quite this soon. I would like to report that the New York City pilot project for stroke center designation is moving forward. We don't have any hard data yet, but we will certainly be looking forward to that.
     The other item that I wanted to bring back, and it's point 17 in your summary, has to do with the State Emergency Medical Advisory Committee with the cooperation of the New York State current advisory committee. That project is to transport patients who are in need of emergent angioplasty is moving forward on the state level. Regionally you will have, you'll have in your packet, we'll talk about the first protocol in the state to determine the classifications to be set for primary cardiac angioplasty. I have been nicely asked to participate in the technical advisory group that is going to, if you will, move this forward in the state. I'll be meeting with them in a couple of weeks and I think that we will be able to see this come into fruition in the state probably in early summer I hope. I'm hoping that we can do it locally a little sooner than that if possible.
     Other details of these meetings you certainly can read. The only other thing that I did want to mention is that we did participate in a state wide intubation study. That data is not fully prepared for presentation, but it looks like the success rate is going to be somewhere between the high 70s to the high 90s in terms of success rate of initial intubation. I know that is a big number, but there is some problems with the data, but it looks like that from intubation by advanced providers it's fairly good, going fairly well in the state. There is questions about secondary tube confirmation and how often that is performed and if anything we are learning that may be an area that needs a little buffing up from both the emergency department side as well as the EMS side.
     The other thing that I do want to bring forward to you, you received in the mailing there are three sets, there are three documents that have come before the STREMAC and were approved. The first is the Pediatric Advanced Life Support Protocols. You'll recall that the STREMAC has the ability and statute to develop protocols and implement them on its own authority. It's not been the practice of the STREMAC to do any such thing like that. We make every attempt to get cooperation of the council. So I'm going to bring these three documents forward for discussion and for consideration of approval by the council. I have a few last minute corrections.
     In the Pediatric Advanced Life Support Protocol page two in the copying process, page two is left out. You should receive that in the envelope. It's the routine medical care sheet. And on page four, excuse me, no. That was the main thing in the pediatric protocols. There was a few separate typographical errors that don't change the contents, so I will make the motion that the STREMS Council approve the Pediatric Life Support Protocol.

CHAIRMAN RAJSKY: Motion on the floor. Seconded. Discussion.

MR. LEWIS: These have been out to the agencies that are involved and there has been feedback?

DR. HUFFNER: They have followed the description of the State Emergency Medical Advisory Committee for dissemination. They followed that in terms of hospitals, agencies. They have gone through, each of these documents has gone through that process, yes. And in fact a couple of the protocols went through a secondary process where they were redistributed and a second 30 day comment period was had.

MR. LEWIS: There's no opposition been received in writing from any of the protocols?

DR. HUFFNER: Absolutely there has been.

MS. SYMONDS: I did not receive these through the ambulance corps.

DR. HUFFNER: I'll check my list. We have documentation of them being sent to agencies. Who the CEOs or medical directors are from each specific agency, I don't know who that is.

MS. AUGE: That's who they got sent to, CEOs or the chief of every agency, that is who is required to get them.

MS. SYMONDS: We didn't get them.

DR. HUFFNER: I can check because I received them certified mail.

MS. SYMONDS: I didn't get them.

MS. SWEELY: Is this the document we discussed last year. When they are sent to the CEOs of the hospital, they should as well be sent to the course sponsors.

MS. SYMONDS: That's where I received them from was from St. James. I did not receive them from the ambulance corps.

DR. HUFFNER: I don't have the data base in front of me. I know that's what the direction was given.

MS. SYMONDS: It's not a problem as far as I'm concerned, but with other ILS agencies it probably is.

DR. HUFFNER: If they didn't get it, that's wrong. That needs to be fixed. We received, we received the card back on everyone we sent it to.

CHAIRMAN RAJSKY: We have to see who it was sent to.

DR. HUFFNER: I'll check and see if it's sent to the wrong person or whoever. We need to do it differently. Everybody we sent, there is nobody that didn't receive it. That's why we sent it certified mail. Who it goes to if there is a change of guard, that kind of stuff, that is something we can't fix. We have to go with what we have.

CHAIRMAN RAJSKY: Great. Other discussions? None. All in favor signify by saying I. Opposed, none. Abstentions, none. Carried.

DR. HUFFNER: The second document actually is the Adult Advanced Life Support Protocols. They come to you with several changes. Acute myocardial infarction protocol that determines the location of patients, that sends the patients with ST elevation, MIs to an angioplasty center. A great deal of discussion, that document which is page, yeah, which is page six created the bulk of the time, energy and focus of the STREMAC. You certainly should be familiar with that because it's been distributed on two separate occasions through the same principle of mailing. It has been approved. Like I said it's probably the first one in the state that will accomplish this in the pre-hospital setting. It does meet the needs of rural and suburban. I don't think we should use the term urban in our region. Certainly rural and suburban issues were addressed. My hope is our region will be considered possibly one of the pilots to participate in, we can lend the flavor of any problems that might develop from that type of flavor of using both in urban, excuse me, rural and suburban settings. I make a motion that we approve that document as well.

MR. KINTZ: I guess I'll second.

CHAIRMAN RAJSKY: Discussion about the ALS Adult Protocols.

DR. HUFFNER: And for the record those protocols did also follow those same SEMAC described respiratory regional approval more than once.

MR. LEWIS: There was no letters in opposition to any of these?

DR. HUFFNER: Oh, my, yes, sir. Both of them.

MR. LEWIS: Have both the issues been resolved?

DR. HUFFNER: Certainly from STREMAC, the majority of STREMAC I should say.

CHAIRMAN RAJSKY: Other discussions? None. All those in favor signify by saying Aye. Maybe by hand. All in favor signify by saying Aye. Opposed, one opposed. Abstentions, none. Great. Carried.

DR. HUFFNER: The last is the formulary which is the document required by the state. There are certain typographical errors. Again my fault. I'm the primary writer on this. I rely on some very astute people to second guess me and they second guess me and I will make those corrections. The first is on page, the first page table of contents in the formulary, Diazepam is not a drug that is now able to be given, considered for endotracheal use, administration, endotracheally administration. That carries over to page 10 for the actual drug discussion.
     The only other typographical error that was left was on page 16 under contradictions for the group I-P-R-A-T-R-O-P-I-U-M after the contraindications. After the word ipratropium you should add coma, atropine or lecithin.

MS. SWEELY: Psychornotor is supposed to be psychomotor.

DR. HUFFNER: That is correct. What page?

MS. SWEELY: Page 10 under drug interactions.

DR. HUFFNER: Yep. Thank you. This document really is a reference document that is required by the state now. We certainly have to extend a lot of appreciation to those people that did the bulk of work on it. It represents not the final word, but rather a reference document that can be used by the regional providers for educational purposes certainly.

MS. SWEELY: Are you looking for more changes? Page 12, adverse reactions, dose related. I think tachydysrhythmias is spelled wrong.

DR. HUFFNER: It is. Thank you. I'm pretty sure Mrs. Sweely did get a copy of these at least on one occasion.

MS. SWEELY: I did, yes, I did.

DR. HUFFNER: It would be nice if she made those comments before. I'll make the motion we approve the regional formulary.

CHAIRMAN RAJSKY: Motion on the floor.

MS. SYMONDS: Second.

CHAIRMAN RAJSKY: Discussion, none. All those in favor signify by saying Aye. All opposed, none. Abstentions, none. Carried.

DR. HUFFNER: The last document I bring forward to you is scope of practice. That document identifies the skills and procedures permitted at last level of certification with the Southern Tier Regional Emergency Medical Services System. That is the first time we teased it out, that we made a second, a separate document and the STREMAC's opinion is that it will make subsequent revisions much, much easier if it's a separate document as opposed to being integrated into one set of protocols. We had problems before in that they, the actual scope was found in the adult ALS protocols and scope for the restrictions. Now it's a separate document all by itself. I'll make the motion that that document be approved.

CHAIRMAN RAJSKY: Motion is made.

MS. SWEELY: Second.

CHAIRMAN RAJSKY: Second, great. Discussion.

MR. KENNEDY: I have a question. Maybe I'm looking at it wrong. It says permitted each level of certification within Southern Tier Region's EMS and it's left off.

DR. HUFFNER: It's left off on purpose. We didn't define the scope. At the time we did that we had not addressed those many terms of what their skills are and we just got CFR protocols completed that would hopefully be in the next integration of that document.

CHAIRMAN RAJSKY: Thank you. Other comments? None. All those in favor signify by saying Aye. All opposed, none. Abstentions, none. It is carried.

DR. HUFFNER: I should have pointed out, although they are all approved, I should have pointed out the last page on the document is called the declarations page. Also STREMAC decided to adopt this to make it easier for us and providers to realize when was the last time a protocol or a scope or whatever was altered, changed, revised. So that from now on all of the protocols will have that declarations page and obviously we are starting with these brand new documents, so this is the start date. Whenever anyone questions the documents, on the front of the page it will have a printed date. That means the date that the actual document was printed.
     o you may have a printing date of February 9th, 2004. And when in 2007 you may want to think to yourself gee, maybe I should get a little newer printing of this. It may in fact be the same document. By the way you'll know it is by looking at the declarations page. If you know there has been a change to the anaphylaxis protocol in 2006, it should be on the declarations page and should be consistent with your printing date. Essentially that keeps us sort of, if you will, consistent in making sure that, in the past this has been a problem. The protocols that have been approved are in the correct version of what is printed out. This allows us to print out whenever we want a document, whenever you want a copy of it, it can be printed out. We don't have to necessarily worry about whether or not you have all the right protocols because it should be in there, you should be able to check it by looking at the declarations page. That is sort of consistent with the way the state is approaching their documents of this nature trying to keep them organized.
     The last document that I have to come forward to you is this bright orange, not orange, lime green AED policies and procedures. This document was approved at the STREMAC at its February meeting and there were significant changes made. First and foremost the Appendix A, which had been followed in the region now and was sort of a freestanding document, has been brought into the document as part and parcel of it. So that you can see page six there is included obviously an Appendix A. The significant changes to Appendix A that the STREMAC made was that the requirements for AED certification, i.e. the testing, is going to change from quarterly to semiannually. And that, and if you want to read with me, you can see that under three, personnel must attend semiannual in-services, a person missing two consecutive, and that was changed also to quarterly semiannual, in-services will not be allowed to use the AED without meeting with a physician, medical director or designee to have their skills verified. This changes the frequency with which we require our AED providers to go through that process of certification in-service. They didn't just pull this out of a hat. There is clearly literature to support this action and we believe that going to the semiannual in-services will decrease the amount of time required for providers to maintain their skills. Mr. Crist.

MR. CRIST: Thank you, sir.

DR. HUFFNER: And lessen some paperwork and at the same time continue with the program we think is very valuable in the region in maintaining those skills. There are a few other changes in the document that are substantive. Essentially allows for the decision of the appendix, it's on page five, see attached Appendix A, AED requirements. I believe that is the only other change.
     Given that, I'll make a motion that this draft, which has STREMAC approval, be approved with the changes that I just mentioned and with the addition of that February 5th appendix.

MS. SYMONDS: Does the same thing in here, the AED must shock the adult and the child?

DR. HUFFNER: No. That is a state requirement that is being phased in so we're silent on that.

MS. SYMONDS: I think personally.

CHAIRMAN RAJSKY: Motion made. Is it seconded?

MR. KIMBALL: Second.

CHAIRMAN RAJSKY: Discussion.

MS. SYMONDS: I think that should be included, the new agency looking at the requirements they may assume they just need to buy an adult AED, when in fact.

DR. HUFFNER: I hadn't thought about that. It's not unreasonable. It is a state policy. By a certain date, I don't know what the date is, you have to have both capabilities. It's a couple years down the road.

MR. LEWIS: It's not an unreasonable thing. I think it's the end of '05.

MS. SYMONDS: That is any new purchases of, if you're an agency and you're going to buy an AED, you want something capable of doing both.

MR. LEWIS: That makes perfect sense in what you are saying.

DR. HUFFNER: The STREMAC was very specific in terms of being very silent on, you remember the initial issue was not whether, could pediatric or adult was, the issue was which one. Should we be going out and acquiring one AED over one or the other. The concept of being capable of doing both adult and pediatric certainly is valid.

CHAIRMAN RAJSKY: Can we attach to that document as Appendix B the state policies?

MS. GRESSEL: Actually it says it would be attached to it under the table of contents Appendix A, very last sentence, New York State EMS policies attached.

DR. HUFFNER: That is one that was revised that says you have to have it. It's not 95-07. It's got a new, what I would recommend is that we change this from 95-07 to whatever the new reiteration of the 95-07. Thank you. That will be attached.

CHAIRMAN RAJSKY: Other comments? Mr. Kimball.

MR. KIMBALL: In Appendix A 304, Dr. Huffner, second line down you might want to change quarterly to semiannually.

DR. HUFFNER: I said that the second quarterly was left, was suppose to be semiannual. I corrected that myself on the minutes.

CHAIRMAN RAJSKY: Other discussions? None. All those in favor signify by saying Aye. All opposed, none. Abstentions, none. Carried.

DR. HUFFNER: I'm pretty sure that concludes my report. Sorry it was so long.

CHAIRMAN RAJSKY: Ms. Sweely, training committee.

MS. SWEELY: Training committee met this evening. We had an approval of our last minutes which were January 8th of this year. A note to the members of training committee, there will be no written notes or minutes mailed out to you. They are available on the website and all of the training members do have, do have access to that so we would ask you to access the committee meeting e-mail.
     We reviewed three course evaluations. They were all very good. We reviewed three courses for grades. Two of the courses unfortunately were below state average. One had a 50 percent failure rate. One had 25 percent failure rate. We are going to be tracking the instructor on this to make sure it's not a trend. We had no other documents to compare it to because we had not had reports handed in from these two particular instructors before. We are aware and we will track.
     The next thing on the agenda was the update of the pediatric Power Point review that we have out on the web. I had asked Judy to take a look at how many had accessed this website. Out of 1,100 active EMTs in the area, 102, which is a minimal 10 percent, have actually taken the test. Now some may have gotten onto the website, reviewed it and not bothered to take the test. But it is an absolute review. You do get credit, especially those that are in the pilot programs. It can be applied to that. So we felt it was a good tool. We also discussed working with QI to look for identifying future programs that we could possibly develop and put out there once a year. For any needs that we find directed from QI.
     Instructor recommendations we had three. The training committee approved Mr. Chip Wood from Schuyler County, a Rita Costello from Arnot Ogden and Nancy Snyder from Hammondsport. I would ask, at this point I would like to put a motion on the floor to approve Mr. Wood, Ms. Costello and Ms. Snyder as CLIs for our STREMS.

MS. TEETER: Moved.

CHAIRMAN RAJSKY: Second. Discussions. All those in favor say Aye. All opposed, none. Abstentions, none. Carried.

MS. SWEELY: We reviewed six new course schedules and we do that for completeness of the schedules to make sure that all of the material that is suppose to be covered within the EMT courses are indeed at least identified to be covered. The one that we have been focusing in on have been weapons of mass destruction. That is a relatively new mandate by state. We did find one course application out of the six that did not identify it as a-CFR refresher course-that does not identify weapons of mass destruction. We will bring it to the attention of the sponsors and they can get in touch with the instructor to make sure this will be covered.
     Another note for those of you responders here or instructors, please be sure in any of the courses, even if it's the CFR level, a complete CPR course has got to be taught. It can't be just the refresher. It has to be a complete course. That is a mandate from the state.
     We talked about ideas for our annual conference which again will be in October. This committee is putting together documents for display for the October conference. We looked at an update that came from the state January 27th. It was addressed to the corps sponsors. Most of the material or items on this letter were certainly distributed to course sponsors. There were a few things I think we needed to bring to training. One was the three year pilot recertification update. They published a new program guide for the three year pilot research program. That was the biggest change, was how the hours were broken down by category. The problem being there is an error in the new book. The hours didn't match the curriculum. When they are going to change that I don't know. Just so you are aware that we had, it has been reviewed and we are aware of that.
     CFR refresher curriculum, a new version came out for the refresher courses testing on or after September 1st, 2004 and there are new CPR protocols coming out. They are not yet available on the web. Just FYI people look for them. They will be coming.
     The only other business we had was to version 5 of the PCR forms. Apparently there is an error on that as well. It has residence listed twice instead of residence and recreation. Just FYI.
     And the last matter of business was to welcome Kathy Brimmer, the new member to the training committee, and say good-bye to Mr. Larson, who I know is not sitting over there. And hopefully we will have his replacement on training committee. That was it. Our next meeting is May 13th.

CHAIRMAN RAJSKY: Thank you. Quality Improvement.

MS. OAKES: Quality Improvement did not meet, but as a result of the meeting prior we, every year, the last three years I believe we give a quality improvement participant award to those agencies that participate in quality improvement and the regional quality improvement program and to be eligible you have to have at least 75 percent participation. So the list of those folks that will receive them this year, they already have a plaque. Everyone that has had already got the plaque. It's called the QIPP award and each year they will get another plaque. So for 2003 those agencies that participated and participated with at least 75 percent attendance and reports and all the requirements, the first one was Troupsburg Ambulance. Jasper Ambulance. Chemung County 911 Center. St. James Mercy Hospital. Cohocton Ambulance. Cameron Ambulance. Hornell Ambulance. Wayne Ambulance. Schuyler Ambulance. Hammondsport Ambulance. Addison Ambulance. Ira Davenport Hospital. Arnot Ogden Medical Center. Erway Ambulance. Schuyler Hospital. Tyrone Ambulance. Pulteney Ambulance. Bath Ambulance. Corning Hospital. St. Joseph's Hospital. Woodhull Ambulance. And I said Troupsburg. So those are the award winners this year for the quality improvement award. So we thank them for their hard work and diligence in getting the reports, not only the reports but their participation at each of the area quality improvement meetings.

CHAIRMAN RAJSKY: Must be Public Relations committee. Ms. Teeter.

MS. TEETER: My first item, it's my privilege to announce the Gold Star of Life recipients from the last meeting and the first one is Tammy Lynn Faulkner from GVEMS and Patty Gressel. It says Tammy is an excellent clinical student. She is always ready to do minor tasks or to become involved in major messes. Tammy assisted me during a challenging patient's care on 12/21/03. The situation became quite tense and threatening. She was supportive to this grateful RN and she was not bashful about supporting me in front of many aggressive and loud family members. She observes well, asks pertinent questions and is not shy about becoming deeply involved in a patient's care (no matter how dirty she might become). Thank you, Tammy, you are an excellent example of a patient advocate and supportive co-worker.
     Next recipient is Tompkins Corners Fire Department by Bud Baldwin, Erway Ambulance. On January 24, 2004 the Tompkins Corners Fire Department responded to an EMS call in the northern most part of their district and the very northern most area of Chemung County. Weather and road conditions, along with the distance to the scene, delayed the arrival of ALS to the scene. I feel Chief Michael Foster and the members who were there did an outstanding job doing CPR and BLS protocols for what must have seemed like forever until the ALS crew arrived on the scene. Although the outcome was not favorable, they need to be commended for the efforts to save this patient's life.
     Next recipient is Michael Johnson, Webbs Mills Fire Department and that was anonymous. Dedication on cardiac arrests on 2/6/04 and 2/8/04. Very helpful in actions and willing to assist and initiate the appropriate care without hesitation.
     And last is Rick Kimball, Erway Ambulance from Shannon Keeney, for going above and beyond the call of duty. Recently we had an elderly gentleman in St. Joseph's ER with a disabled wife at home. Rick made sure the wife was being cared for by a neighbor and stayed with the patient in the ER while his arm was being sutured. He returned the patient to his home so he could continue caring for his wife. The patient could have had to wait an extended amount of time to return home and care for his wife without the caring and concern shown by Rick.
     And congratulations to those four. The next item is actually the Public Relations committee meeting. The last meeting was March 2nd and here is some highlights for you. The conference as previously mentioned is scheduled for Saturday, October 16th, Corning Community College. We already sent out 23 letters to vendors to participate in this conference. We contacted the speakers and we're getting a good response from that. I think you'll all be delighted when you see the topics. We decided we needed a theme for the conference. It's called STREMS Conference: Meeting the Challenge '04. The committee, as Maryann had mentioned earlier, will be contacted by letter asking to put together information to set up displays to be set during the conference for people to look at and understand more of what we do. The last thing, most of you should have received a postcard announcing the date and mark it on your calendar.
     And the last one is the Walt Ersly award. That is on the website so anyone you feel meets the qualifications for nomination, please do so by April 15th because that award will be presented at the May meeting just a week prior to EMS week. And the last is our next meeting is scheduled for April 27th at 3:30 p.m. down at the STREMS office.

CHAIRMAN RAJSKY: Thank you.

MS. SWEELY: I have a question. Walt Ersly award, can that be done posthumously?

MS. TEETER: Can it be done posthumously to nominate someone?

CHAIRMAN RAJSKY: I don't know about the humorous thing.

MS. SWEELY: They're dead.

MS. TEETER: It doesn't say they can.

MS. SWEELY: Yeah. Okay.

CHAIRMAN RAJSKY: I don't think they, is anything we don't have.

MS. TEETER: No contradiction to that.

CHAIRMAN RAJSKY: Thanks for that. Anything else for public relations? Seeing none, Systems Committee Mr. Duvall.

MR. DUVALL: The Systems Committee met this evening before Council. The radio project that, that's the larger ongoing systems project. Systems committee was reported on. Mr. Smith has yet to see the Motorola representatives. The MVA trailers continue to be worked on. We have a couple equipment issues that need to be resolved. The trailers are in the respective counties and we are just resolving some minor equipment issues with those. EMO directors are working on helping to fill out the STAR questionnaire so the STAR project is more complete. We discussed the fact that the trial runs for the meeting dates seem to be successful and we were happy about that. And we are going to continue through fire advisory board and through county level meetings to gather the information we need to complete those. There were no PAD or EPI applications before the committee at this time.
     The Systems Committee is working on developing a cooperative purchasing program, if you will, that we would like to offer to EMS agencies throughout the region. We have undertaken the project and we are in the process of looking at creating buying agreements whereby agencies would be responsible to order and purchase their own equipment or supplies, but could do so under a deal orchestrated by the EMS council or deal sponsored by the EMS council. We have created a list of items and supplies that we believe would be helpful to have on a cooperative buying program and we are going to be sending out a survey within the next month to find out if agencies are interested in buying under the cooperative program. And also to see if there are items that we should add or maybe some things we should take off the preferred equipment list and two-thirds of the proposed list is coming around to you so you can see it. What's left off of this copy are basically IV fluids and drip sets, catheters and IV supplies. But you'll get the idea what we are looking at and get an idea of what we are hoping to accomplish. So you can be looking for the surveys or questions for information.
    Lastly under other business and items this evening, we received and discussed correspondence from the Steuben County Emergency Medical Services Association. And we are sending copies of that around as well.

MS. AUGE: No, I don't have copies of that.

MR. DUVALL: Bear with me. Would you like me to read this to council?

CHAIRMAN RAJSKY: You can, sure.

MR. DUVALL: I don't have copies for everyone. It was the letter that was alluded to earlier regarding credentialing. The letter is to members of Southern Tier EMS Council. Basically says that the topic of credentialing has been a major concern of this council since its return to the forefront over a year ago. The council being the Steuben organization. The Steuben County people have looked closely at the proposal from STREMS and would like to present a version of the same document with changes that we would like to see based on the needs of Steuben County members. Goes on to talk about their concerns with respect to dwindling membership and added paperwork and a perceived increased burden on providers within Steuben County. However, the Steuben County Association states that they do recognize the need for maintaining skills at an optimal level in order to deliver the utmost quality care to communities and to that end they would like to come together and work towards a credentialing package that would be acceptable to all.
     So that being done much discussion followed regarding regulations on where we should go on credentialing from here. And I expect that that discussion will be ongoing within the next couple of months to hopefully see some resolution to that.

DR. HUFFNER: I'll speak to it only because I got a copy of this letter when I was in the office today and read it with great interest. I think it represents a humble step for the Steuben County EMS Association to, while they don't embrace credentialing and give it a big kiss, they certainly make a concrete suggestion that they change the pilot recertification be made to require the inclusion of practical skills and review.
     Don, you make a big suggestion of suspicions that this is going to be discussed further. The problem with credentialing that it embraces all levels of providers or it should. I take that back. It doesn't have to. My personal philosophy, if it's good for the goose, it should be good for the gander. It's good for the physician, it should be good for the paramedic. If it's good for the paramedic, should be good for every level of the provider and assistant. Credentialing was brought up a year ago. It's more like two years ago. They have been kind. They say it's been a year. It's been a long time. In fact it's been so long I think Mr. Lewis was chairman of systems when it was initially sort of transferred over to systems.
     The STREMAC was directed by the department of health deliverable from the program agency to begin credentialing of EMS physicians that provide on-line and off-line medical control. And you recall that big document that was sent around that created so much excitement was really an expansion of a compilation of programs seen throughout the state. Many of the regions in the state have credentialing to some degree or less. It's very unclear to me how we are going to move this forward because we don't have any, if you will, lead committee leaders, if you will, to campaign this so, and I sort of backed off because of frankly the huge amount of opposition we got from the Steuben County EMS Association certainly when we went there. Certainly to me, and I'm definitely reading between the lines, but to me it says that they accept the concept of credentialing. They are very interested, if you will, in the particulars.
     And the document that was drafted was absolutely a hundred percent vague on particulars. There were no particulars and at several meetings both the Steuben County EMS Association meeting as well as Chemung County Fire Advisory Board and at least two of the three town hall meetings that we had, I specifically addressed the concept that we would convene groups of individual levels of providers who would be charged with the responsibility of coming to a consensus of what they believe, feel, hope for, have faith in as being a reasonable credentialing process for the individual layer and as I suggested it may be for CFRs that they refresh like they are required to do every three years. Whereas paramedics who have, you know, invasive skills, if they fail to perform that skill on a certain frequency, they may be required to go to a lab, a mini lab or something like that.
    I guess it really comes down to a lack of trust in the ability of that procedure, if you will, of a group coming together, coming to consensus then going forward that we are not at the Systems Committee able to move forward with what I thought was a reasonable charge of giving ourselves a deadline, giving ourselves, the Council orders of saying that we have been kicking credentialing around for years now and nothing has happened. Let's do something. Let's set ourselves a deadline and I suggested that we set a deadline that 18 months from tonight we better have credentialing of paramedics, physicians, and critical care techs up and running and initiated and accomplished. Furthermore that 36 months from now, from tonight we should have rather, until we credential all the remaining levels of providers, that be emergency medical dispatchers, certified first responders, basic and intermediate EMTs. Those of you who know me know that I'm not particularly good when it comes to panache and finesse and I came up with some whereas and theretos and made some halfhearted attempt to come up with something formal. It didn't pass well. It did get accepted, but I was the only one that, only one that voted for it.
     I wanted to stress to the Council the need for us as a region to realize we are one of the few, not the only, but there are a few. We are very progressive in many, many ways. Very progressive in terms of the things we do, the things that we embrace. But we are archaic when it comes to the concept of credentialing We don't have any, as the regional medical director I cannot tell you whether or not that EMTP in downtown Watkins Glen has the same skills as the paramedic might in the City of Hornell or in the metropolitan Southport. I don't have any ability to make any pronouncements or any judgements or any suggestion as to his competence in what he is doing.
     Now that's not to say that possessing an EMTP card in the State of New York doesn't mean anything any more than possessing a doctorate of medicine, does it say anything about your abilities to perform whatever procedures you might want to. So physicians, when they do procedures or do things in hospitals, go through that same procedure as nurses do, technicians, whether it be respiratory techs or any other personnel that performed procedures. They are, if you will, certified, credentials, whatever kind of C word you want to use, they are held up, if you will, to often times peer scrutiny.
     I don't exactly know how to sort of push the big credential ruling. My attempt of some type of a motion failed, but it speaks to, I think it's necessary for us as a Council to come to some conclusion or to some epiphany, if you will. You know what, we really need to do this. We need to do it, frankly, and we don't have to do it the way I said, but we need to do it in a collaborative matter and I don't now what group to bring together than CFRs to determine what CFR credentialing would be, basic EMT, to determine what basic EMT credentialing should be, paramedics, physicians, emergency medical dispatchers and so on.
    The bottom line we need this system, however, to insure that our providers possess the skills that they need to have, whether it be a basic EMT emergency medical dispatcher, on-line medical control dispatcher or EMT. We don't have that in this region and it's hard to, if you will, bite the bullet. My attempt at biting the bullet tonight failed. I don't know what else to do. I'm going to go back to the STREMAC and report that the concept any way of credentialing has not moved any forward. As Donnie said, maybe he suspected something will happen, but I don't know where it's going to happen, who it's going to happen by or who is going to do it.

MR. DUVALL: With all due respect, I intended to agree with the intent of what you're trying to do, but as you stated it was a halfhearted attempt given about ten minutes worth of discussion and the request was called. And my allusion to maybe something happening in the next month or two is that given more than ten minutes with a hastily drawn up resolution, maybe there is a chance to set a deadline as you intended, but to make a wholehearted attempt to do it and do it properly rather than a halfhearted attempt that failed in committee. As I said I don't necessarily disagree with what you were looking to do, but I think the manner and how it was done and I didn't intend to say that, but I felt it needed to be said.

MR. SMITH: And if I might offer a couple of concerns. I was concerned about the lack of opportunity for discussion. We were by no means done when we had to discontinue our discussion to come to this meeting. I think it's very important that we recognize the political reality that has transpired previously in Steuben County. I was very pleased to see the letter from the Steuben Regional EMS, as Dr. Huffner said, there is now recognition on their part that this does need to happen. The issue is how we go forward with it so that they will come along as willing partners. What we have seen in the last couple of years, and, Mr. Sprague, certainly correct me if I'm getting it wrong, has been a good deal of feeling from the Steuben County contingent towards STREMS in filing ramifications of meetings with county legislators where perhaps the message is not correctly portrayed or correctly understood and we have issues here I think related to funding of STREMS by the counties and I think we have to go forward with this. I think absolutely credentialing is a good idea and I agree with the timeline concept, but I think we got to make sure that we got these providers on board because we don't need to start a war over here again and we got a peace branch being offered and we need to take that and see how we can make this work now in conjunction with that.

MR. LEWIS: Question is, was this shared with the Steuben County Legislature also that there is some interest in going further with this?

CHAIRMAN RAJSKY: It was not. It was received a couple weeks ago.

MR. LEWIS: I know there has been some issues and you had met with the Public Safety committee. I know as Mr. Smith said there has been some unrest there.

MR. SPRAGUE: I think it's been shared in the County Administrator. I'd like to tie on to what Mike said. I do look at this as an olive branch. My concern is that we reach out and embrace the olive branch, not clamp on to it and I guess that might be the view. Whether it is in fact the case or not, it might be the view on the other end of the olive branch if we were to have put this on the floor and adopted it today, without any correspondence or recognition I guess back to that association.

CHAIRMAN RAJSKY: Any further discussion about that.

MS. SWEELY: I guess I should have a question. Maybe it's ignorance. Who is this Steuben County Regional?

MR. SPRAGUE: It's an EMS association that was put together probably a year or so ago. They are still fairly, I guess it's longer than that, a year and a half now probably.

MS. SWEELY: Comprised of?

MR. SPRAGUE: Representatives of different areas of the county. EMS squads. There is a full association and then there is an advisory board that meets more regularly.

MS. SWEELY: Purpose of?

MR. SPRAGUE: Basically for providing better EMS care within the community.

MR. LEWIS: They have goals, objectives?

MR. SPRAGUE: Yeah.

MR. LEWIS: Maybe it could be shared with us.

MR. SPRAGUE: Ellen Prutsman was the chair when she applied to the council there right through. Now there are two cochairs. As you know those are pretty good shoes that Ellen was wearing. But they have been discussing a lot of these issues and, well, you've been to a couple of meetings that they have had, talked with them somewhat. I think that as a group they are maturing as far as their understanding of the operations with STREMS and the issues surrounding Article 30, Part 800, all that stuff. It's when you become an EMT you are introduced to a very small part of that, but really that has all to do with the separation of this council and with the policies and procedures that are set up, so on and so forth. They are, they have learned a lot I would say in the last two years over that, just that particular issue.

CHAIRMAN RAJSKY: Moving on to Tri-County Stress Management.

MS. SWEELY: We are just reporting January and February this year. We've had 12 debriefings, no defusing and one educational offering. Our total activity time is around 30 hours for those two months. As far as education for our team, there is about six hours involved for education for team members. That's it.

CHAIRMAN RAJSKY: Thank you. Under other business, I have a couple things. First is the first issue Spring '04 of the EMS Dispatch. So that's the council's newsletter and we haven't had one in a while. That is back and we are going to hope to do quarterly newsletters. So that's a nice thing it had about the pediatric update and saving the date for the conference, October 16th, as Ms. Teeter talked about.
     Also correspondence, should have talked about that earlier. Correspondence from the Fire Department of the City of New York and the letter came to the Council chair for a few agencies and I'll read the letter.
     The Fire Department of the City of New York wish to thank you for the mutual aid ambulance resources that were provided to New York City during the weeks following September 11th, 2001 attacks on the World Trade Center. As a representation of our appreciation we hope you'll accept the enclosed certificate of thanks to your agency and the staff who came to the city. Your cooperation and response made this the largest and most successful mutual aid response in history. And again our thanks for your assistance to the City of New York in our time of need. Signed John J. Clair, Assistant Commissioner of Emergency Medicine and Robert McCracken, Chief of EMS Operations.
     So those agencies receiving this, and it's actually a beautiful color page photo with one of their ambulances with the dust on it and thank you written on the back window. Those agencies receiving that award from New York City; Woodhull Ambulance, Greater Valley EMS, Erway Ambulance Service, Cohocton Volunteer Ambulance, Bath Volunteer Ambulance Service, and the City of Hornell Fire Department Ambulances. Lets make sure they will get distributed to the proper ambulance services for their help to New York City.
     Also the town meetings, we alluded to those earlier, we've had several town meetings in all three counties asking all three counties to come together talking about EMS concerns. We've had one in Bath now. One in Bath, one in Big Flats actually right here. And unfortunately the one in Hornell there is a timing issue and it was rescheduled for in Hornell, March 23rd at 6 p.m. That is a dinner meeting for any EMS provider that would like to attend and letters went out actually in all three counties again for anyone who would like to participate in that.
     And, Cathy, do you know how many we have signed up for that?

MS. AUGE: We don't have anyone signed up.

MR. KINTZ: How long ago did it go out?

MS. AUGE: It's been out for at least two or three weeks.

CHAIRMAN RAJSKY: I would say a month or more that we, in the March, that went out right after the first of the year.

MR. SPRAGUE: I've had mine about two weeks if I remember.

CHAIRMAN RAJSKY: So unfortunately we don't have anybody signed up for that so hopefully maybe we can muster up some energy for that STAR program. Cathy, would you like to report anything on STAR?

MS. AUGE: Just that everybody should have received their automated message for the reminder of the Council meeting. In passing it around in the Systems Committee I actually have a report for everybody to take a look at. We've been talking about the reports so you can see what the scoop is. I found out I have a couple of wrong numbers. I don't know if that's because we have it wrong in the data base or my bad typing skills. Could you look at your number and let me know and especially the ones under Tyrone ignore. Let me know that it's the right one. Besides that it is up and running, so it can be, can be accessed at any time should the need arise.

CHAIRMAN RAJSKY: Thank you. Steuben County 911 update. Mike, any news to report?

MR. SPRAGUE: Yeah, actually the RFPs were opened up probably about a month ago. They narrowed it down to six vendors and last week they had three of the vendors come in and do full blown demonstrations of their response for a panel to go over and the remaining three will be next week. Once that is concluded, they will select a vendor, try to turn a contract around fairly quickly and that should give us our final, pretty much final timetable as to how long it's going to take to actually set that system up. Typically CAT systems can take months to do so that will pretty much put us to a point if we wanted to turn on 911 we could and that will give us an indication about what to do about staffing and hiring personnel and etcetera. Right now it appears we are still on target for the beginning of next year.

CHAIRMAN RAJSKY: Thank you. Mike Smith from Chemung County.

MR. SMITH: We've applied for a grant from the state 911 board to upgrade our telephone equipment, so we'll be able to receive wireless 911 calls that will provide us the call back number, tower location and the longitude and latitude coordinates so we'll be able to do the Phase 1 and Phase 2 911 identification work so we'll be able to pinpoint the location of wireless calls.
     The other thing, as we've come up, as with the increasing clandestine drug laboratories in Chemung County and surrounding areas, we attend the three county zone, we asked them if their drug enforcement units are sitting on clandestine laboratories for the purpose of gathering evidence, we would like to know the locations of those facilities for publications to enter into our CAD systems should there be a call for service, a police call, EMS fire or whatever, we would have some indication there was a problem associated with that address. Whether we could just inform the responders there is a potential hazmat problem or whatever we come up with, we intend to push pretty hard on the police community for that because so far only police officers have been injured in responding to these laboratories, but certainly we have the potential for fire fighters or EMS responders to inadvertently walk into the places and be injured. We are hopeful the cops are going to go along with us on this and give us some intelligence to keep our folks safe.

CHAIRMAN RAJSKY: Bill, anything from Schuyler 911?

MR. KENNEDY: We also applied for the same grant to update our communication and wireless 911. We have been successful in the last month to get our legislators to hire enough dispatchers to cover the minimum requirements and they are in the process of hiring dispatchers now, so we have two on full time, 24 hours a day, seven days a week. We are making advancements.

MR. SPRAGUE: I might add we also applied for the same thing. Mr. Whitcomb was not bashful. Applied for the largest request. Somewhere around 500,000 or so. That should get somebody's attention.

MR. SMITH: We got all new stuff now.

MR. SPRAGUE: We haven't bought anything yet.

CHAIRMAN RAJSKY: Any more business to come before Council this evening? I would entertain a motion to adjourn. One more thing. Too late. Just so everybody will know, I talked about it at the last meeting, but currently we have an opening, one in Chemung County. We do have an application for that. Would be Gary Blitz. That looks like it will be filled. Schuyler, we have two openings for Schuyler County. We don't have any applications for that. Currently in Steuben County we have three openings and one application, so there are two openings for Steuben and two for Schuyler. If you know of people who you feel would make good representatives on this Council, please have them contact our office for the application. Any other business? None.

MS. TEETER: Motion made.

MS. BRIMMER: Second.

CHAIRMAN RAJSKY: All in favor.

(Meeting was adjourned)