PRESENT: Steve Bennett, Gary Blitz, Paul Card, Fred Crist, Don Duvall, Patti Gressel, Dr. Huffner, Bernadette Josbeno-Oakes, William Kennedy, Rick Kimball, Jim Kintz (for Ron Kintz), Kathy Lunney, Dr. Manganaro, Bob Rajsky, Dick Sullivan, Maryann Sweely, Teri Symonds & Mary Ann Teeter
ABSENT/EXCUSED: K. Brimmer, J. Chrabaszcz, R. Churches, A. Lewis, J-R Miller, M. Smith, M. Sprague
STAFF PRESENT: Judy Blair, Linda Johnson
GUESTS: Walt Ersly, Kelly Voorheis, Debby Potter, Dave Schlicher, Mike Cornish, Vicky Cornish, Caitlin Parsons, Kristi Bartlett, Vedad Busuladzic, Christina Hanshaw, Christopher Saxton, Bryan Gammill, Carol Sullivan, Michael Roy, Tim Shady, Zachary Jones, Ryan Frisbie & Ben Kahabka

CHAIR RAJSKY: Let's call the August meeting of the STREMS Council to order, feels like August. We don't meet in the summer but certainly feels like summer out there. It's nice to be inside actually.
     We will call this meeting to order. Any introduction of guests? We have several guests, we have many folks who waited until the last Council meeting for the paramedic program, one of the requirements for paramedic students is they have to attend one Council meeting, welcome paramedic students. Also with us tonight we have several guests actually in the room. Carol Sullivan is with us. We have Linda Yonkin with us. Great. And any other guests that people would like to introduce? That's right. We have Walt Ersly, he is the new guy on the block. We are going to try to break him in. And we have News 36 in the back too so welcome to you. Great.
     We're going to suspend our normal agenda and do some awards upfront. Everyone realizing that National EMS Week is next week, and we sent out the nominations for the state awards. But one of our special awards in this region has been the Walter Ersly Award. And that's given in Walt's name, it can be done on an annual basis, the last time actually it was given was 1999, so we have had a few years where there has been a gap in giving it. And the emphasis behind it, the Walt Ersly Award was developed for people in the EMS who have been there a long time, and just not a long time, but have been dedicated to EMS. And the six qualifications to receiving the award are longevity, lifelong learning dedication, dedication to EMS, caring for patients and co-workers, teaching to pass the word about EMS on and then exceptional going above and beyond. So that's the criteria that was set out. And certainly Walter's experience in EMS just finishing his 64 year as an active EMS person, still providing EMS as an emergency medical technician with Town and Country Fire Department here in Horseheads. Still teaches, active CPR instructor. And certainly a mentor to many students over the years. And has been the practical skills exam coordinator for all of the Arnot Ogden Medical Center courses for many many years. And with that also has developed with the adoption of New York State and the National Registry of EMTs, the format they use for conducting practical skills is based on Walt's program. So that's -- (APPLAUSE)

CHAIR RAJSKY: So then we look for people that can fill those shoes behind Walt. And so that's where we are tonight. And we actually have two people that are going to receive the Walt Ersly Award. So I would ask actually if Maryann Sweely, could kind of come up and Linda, if you would come forward too.

MARYANN SWEELY: I guess I am on. I think just the name Larry Yonkin resonates quality, resonates total quality, dedication to all of his students. I have written a little note here about Larry.
     Mr. Larry, Lawrence "Larry" Yonkin was actively involved in both service and education for many decades before his untimely death in 2003. I have had the tremendous opportunity of working with Larry in the educational arena of EMS for the past 20 years. I think I spent more time with Larry than his wife Linda did.

LINDA YONKIN: Probably.

MARYANN SWEELY: Larry expended his time, his tolerance and intellect for the improvement of the EMS system. He was extremely active with the Forest View/Gang Mills Fire Department, having most recently served as chief. He continually found time to teach his colleagues the tools and information of the trade. He was respected by everyone he touched, his students, his colleagues, his friends, for not only his passion for EMS but for his total quality and dedicated efforts in improving all aspects of the EMS services. Our EMS system has lost a truly exceptional leader with the passing of our friend and our colleague Larry Yonkin. So it's with extreme pleasure that we present this award posthumously to his wife Linda.

CHAIR RAJSKY: The inscription on the plaque reads the Walter Ersly Award for Total Excellence in EMS, Larry Yonkin, 2003. (APPLAUSE)

LINDA YONKIN: I think anybody who knew Larry knew of his dedication. He was committed to instructing, he loved EMS, he loved the fire service. He was sometimes a hair shirt to the members of the Council, but that's okay, because he was doing what he did well, making sure that it was done right. Thank you, for him. (APPLAUSE)

CHAIR RAJSKY: The actual award, Walter Ersly, for Walter Ersly EMS, plaque itself is in the STREMS office and hangs as you walk in to that office. The second recipient tonight is going to be presented by Richard Kimball. Dick Sullivan, if you would like to come up.

DICK SULLIVAN: I was afraid of that.

RICK KIMBALL: Tough act to follow. Known Dick for many years, he has been my mentor and I just wrote up a little something about him, I would like to read it if that's okay with everybody. To the STREMS Walt Ersly Award Committee:
     I would like to officially nominate Richard (Dick) Sullivan for the 2003 Walt Ersly Award. For those of us who know Walt, Dick and Walt are very similar, they are two of the same mold. Dick exemplifies all the characteristics that the award requires and has many more that are not a requirement.
     Dick began his career in EMS in April of 64 by working for Erway ambulance as an EMT. He continued to provide EMS in this capacity until 1966 when the providers and the local physicians themselves identified a need for advanced prehospital care.
     Dick was one of the first advanced EMTs in our state, in this our area if not the state. I have often listened to Dick tell the story of working a cardiac arrest with the fire chief and medical director of the Seattle Washington fire department looking on. (They were riding with Erway ambulance when they were evaluating different EMS agencies to help plan for the now famous Medic 1 program out of the Seattle fire department.) I believe Walter was your partner on that call. Dick continued to provide care to the public as an advanced EMT in 1984 when he found that he could better serve the public as a Basic EMT and on the logistical side of EMS.
     Erway's however, is not the only love of his life. The Horseheads fire department has been a direct reflection of Dick since 1966, when he joined the department. In 1971 he became assistant chief learning the trade of a leader and administrator until 1979 when he became fire chief, a position that he holds to this day.
     Dick has also served the public of this region as a member of the Regional Council, Systems Committee and Executive Committee. I look for a date when they said it was logged way down in the records and they couldn't find the date that he joined the STREMS. Dick has been and continues to be an advocate for the betterment of EMTs through education. He is insistent that the Horseheads fire department has the best training and equipment to perform prehospital care.
    There is not a class that Dick has not fully supported in one way or the other. He has always offered the Horseheads Fire Department facilities or equipment to be used to ensure that the students have the opportunity to learn on the most realistic up-to-date equipment available. Dick's longevity is the best marker for his dedication.
     But to put it in one phrase, Dick is the "go to man". There is not too many projects initiated in this region by the STREMS Council, that Dick does not play some part. I cannot think of too many meetings with the phrase "what does Dick have to say" or "what did Dick find out" is said. If Dick has one fault, it has to be his inability to say no. His commitment to ensuring that the communities of this region have the best of everything available is evident by his participation in whatever is asked of him.
     To say Dick cares about all around him is an understatement. Dick is always offering advice to those who ask, and to some who don't. On scenes of emergencies, Dick realizes that there are two groups that require his attention, first being the patient, second being the family or friends who also need attention to help calm and reassure them. Dick is a person that co-workers and friends know he is there to listen to problems or just to listen about the call you had last week. Dick's personality is that he can strike up a conversation with anyone. He knows enough about any subject to speak intelligently and make you feel at ease. Just last week I heard a comment about Dick that made me chuckle. They said Dick could talk a brick wall in to falling down. Dick is not the type of teacher you find in the classroom, he is the type that survives and thrives in the field. Dick teaches that element that cannot be taught in the classroom. Dick teaches the ability to be a great EMT.
    I remember as a new paramedic, just two weeks out of class, I was assigned to work with Dick. I am sure all of us remember that first time, alone feeling, will I do it right, when we roll out the door for the first time. I had this feeling of insecurity, but by the time I arrived at the hospital with my patient I felt confident. This wasn't because the call went right or that I knew that I did everything right, it was because Dick walked me through what needed to be done. He taught me to be an EMT first and a paramedic second. The way Dick taught me is the way I teach my students now. He left me with a lasting impression of what a good EMT is.
     To say that Dick is exceptional is an understatement. The only way to describe Dick is he is a teacher, a mentor and I am very proud to say my friend.

DICK SULLIVAN: Thank you.

CHAIR RAJSKY: So the inscription is Walter Ersly Award for Total Excellence in EMS given this day to Dick Sullivan 2003. Congratulations. (APPLAUSE).

DICK SULLIVAN: Here is my teacher right here, Walt.

WALT ERSLY: Hate to say this but I got him when he was 15 years old.

DICK SULLIVAN: And we had a lot of fun.

WALT ERSLY: Yes, we did. He was kind of a nuisance at that age.

DICK SULLIVAN: Thank you. Thank you.

CHAIR RAJSKY: OK, so, correspondence and announcements. Several correspondence, some left over from last Council meeting, a letter that I wrote to Woodhull ambulance in care of Terry Symonds. At the last Council meeting you remember that it was thought that some information, some information that we transmitted wasn't received, and it was significant issue because we're statutorily bound to provide that information. And I just wrote back we did find, attach the copies of the return receipt which were both signed, signed copies to the Woodhull ambulance CEO. And so that should close that issue. Because that is one of the things we have to do and I want to make sure that did happen.

DR. HUFFNER: I would like the record to reflect that that was actually a STREMAC generated document, it was a copy of the protocols that had to be distributed according to the State Emergency Medical Advisory Committee's process for regional protocol approval. In fact those, all those documents are sent return receipt requested. That the record should reflect that in fact we were compliant in that protocol dissemination, that's what the document was.

CHAIR RAJSKY: Thank you, Dr. Huffner.
     Also received from Mr. Wronski, mandated child abuse reporting clarification. Throughout the state apparently that has been an issue in when does an EMT have to report, and the gist of the letter is that the only time you have to report, you are mandated to report child abuse is when you are acting in your official or professional capacity.
     A letter received, a copy to us to John Logan who is no longer there, to Greater Valley EMS, giving them their updated certificate of operating certificate. It just clarified there were some town issues. And the new certificate was issued to them.
     On the other side of the Walt Ersly Award, my favorite part of the meeting where I list the folks that New York State Department of Health has sanctioned. And we're bound to read those in to the minutes.
    Arnold Anderson from Hilton, New York, violations again Part 800.15 and Part 800.16, civil penalty of $1,000, required to take additional CME.
    Thomas Church from Astoria, New York, again violations of 800.16, 16(c) and Part (d), civil penalty of $1,000 and probation for a year.
     Reginald Mclaurin from Brooklyn, New York, civil penalty of $5,000, suspended for violations of Part 800.16, (c) and d).
     David Mischler from Amherst, New York, violations of Part 800.16(b) and had his certification revoked. Joseph Santiago from Schenectady, New York, violations of Part 800.15 and 16, he was censured.
     Charles Carroll, New York, New York, assessed a civil penalty of $5,000.
     Mark Galuski from Troy, New York, violations of Part 800.15 and 16, civil penalty of $2000, and probation for three years.
    Clint Jackson from Rochester, New York, violations of Part 800.16 and had a revocation effective March 10 of '04. Robert Church of Queens Village, New York, Part 800.16 violation, assessed civil penalty of $2000, placed on probation for five years.
     And Samuel Gonzalez from Buffalo, New York, violation of Part 800.16, civil penalty of $2000, probation for five years and suspension for one. That concludes that report. I am sorry we have to bear with that every meeting. But it's part of our responsibility.
     Approval of the minutes from the last meeting. You all should have received those via e-mail.

DON DUVALL: So moved.

MARYANN SWEELY: Second.

CHAIR RAJSKY: Further discussion? Seeing none, all those in favor signify by saying aye. Opposed. Abstentions. Carried. (CARRIED, UNANIMOUS)

CHAIR RAJSKY: Committee reports, STREMAC, SEMAC and State Council?

DR. HUFFNER: I will start with the SEMAC and State Council, they have not met since we last met so there will be no report on that. They actually meet in two weeks. The STREMAC met last May 10, and you have a copy of those meeting minutes in your packet, they are white in color. There are a few things that I would want to point out to you. First is that Dr. Enders was elected to membership on the STREMAC, after you approved his nomination at the last meeting.
     The second thing I wanted to bring up to you is a draft policy that was included in your envelopes here when you came in to the room. It's blue in color, it's entitled Optional CFR Skills. As you well know the New York State has approved a new set of CFR protocols, and they are consistent with the NHTSA national curriculum for CFRs and several of the skills which, in our region and many places across the state are being removed to, if you will, simplify the CFR course. It's been the opinion of the STREMAC that some of the things that were removed, we did not believe were necessarily in the best interest of our region. And over the course of the development of the CFR protocols, it was clear that several regulations had some concerns with some of the skills that were being removed.
     One of those that we in our region and the STREMAC had to do with removal of blood pressure as a skill that CFRs are no longer mandated to be taught. Within the new protocols and I don't believe anyone has actually received an official document, they are coming, I think they are at the printer, there will be, there are, at least makes the provision that regulations can with REMAC authority include certain skills given, assuming that the training or that the providers are adequately trained, and are done so in a fashion that does not, if you will, violate the CFR curriculum.
     What that means is that in our region, we identified several skills that we believed were valuable in terms of patient care, blood pressure being one of them. And that we would like to, we the STREMAC would like to authorize within the region, if a CFR happens to be trained to do so, and are authorized to do so by a medical director, their medical director. This does not mean that these skills are mandated, however. We cannot mandate within a CFR class that the five skills that are listed there that were approved by the STREMAC, be mandated. However providers happen to be skilled, my favorite one is blood pressure, happen to be skilled at taking a blood pressure, and their service medical director okays them and they are adequately trained to do so, in our region, CFRs are allowed to perform that skill.
     And those skills include vital signs, blood pressure, pulse and respiration. I think the onus comes from the fact that we would not want to let current CFRs, especially those that have practiced for a few years, not to be able to use the skills that they have used for many many years, it just seems sort of counter productive. So this would allow those that have been trained. And again authorized to do so by their service medical director to perform these skills. Level of consciousness which would include the GCS, the importance of serial and repeat vital signs, this may be more specific to our region, because in many areas it is not uncommon for the First Responder to be first on the scene and to be only responder on the scene for some time, until either an ambulance or higher level providers arrive. Rapid extrication and non-rapid extrication, those have all been removed. We believe if you are trained to do that, you are a CFR, medical director authorizes it, it's okay to do this in our region. Immobilization including backboard/short board and C-collar use, also skills, not to compare them to riding a bike, but once you learn to do those things, it's fairly difficult to forget how to do that. Why if you are trained and know how to do that, why shouldn't you be allowed to do it.
     I can't emphasize enough that this policy does not require the CFR courses to teach this and in fact you cannot teach these skills should you chose to within the formal hours of a CFR course. Now we know that there is always enrichment programs available, in any course that's run, and if it happens that these skills happen to be included, that would be great. That means we're making enriched CFRs, they are not required, they won't be tested on them in any formal way by the state.
     But again emphasize that again the STREMS regulations, New York State CFRs would be authorized to perform any and all of the above identified skills if appropriately trained and authorized to do so by the service medical director.
     I had asked the chairman of the Council to pass this on to the training committee for their input. Because I think it's an important enough issue that we have certainly heard at least a few issues coming from the region that the training committee would maybe have some input. Maryann.

MARYANN SWEELY: Training committee did review your document. We only have one addition requested, and that's in bullet two, where it's level of consciousness, GCS, Glasgow coma scale / AVPU. A lot of the First Responders, it was brought to our attention are using that, especially if they don't have the documents in front of them, with a Glasgow scale on it.

DR. HUFFNER: I will certainly take that back to the STREMAC. I don't think there is going to be any problem with adding that to the document. Does anybody have any questions about the principle, about why this is being generated? I am not sure that this will necessarily be warmly received outside of our region. I think there is enough CFRs in our region that have voiced at least some concern about.

DICK SULLIVAN: What's the State's reason for taking it out?

DR. HUFFNER: Again trying to be consistent with the national curriculum. And a belief that the CFRs skills need to be simplified. I'm not intimately aware of the specifics of the curriculum, but it's pretty simple now. I didn't realize that that much stuff had to be taken out. But it did, if it were to be remain within the, I think it's 44 hours, right, Maryann? There are a few other things that have been put in there that were, are mandated. So they had to take some things out. And again to remain consistent with the national curriculum, National Highway Traffic Safety Organization.

DON DUVALL: As I recall our First Responder program in New York State a number of years ago was beefed up or expanded prior to a requirement that an EMT be on every run. And I remember reading that the expectation was when 2000 rolled around and EMTs were required on transporting ambulance, some of the pressure to reduce the scope of the First Responder program actually came from First Responder agency lobbies, fire fighter groups, First Responder groups, in an effort to reduce the training hours to, what was more consistent with the role of the typical First Responder. Remember that a lot of our First Responders maintain seniority and enjoy that seniority between First Responder and EMT and with the embellishment and the expectation that they would ride ambulances.

MARYANN SWEELY: I have not heard that in this area. Don, but rather we need to do this. I have heard this from Corning Incorporated where we do all the security classes, they have their teams that they go out and they need to be able to take baseline vitals, I heard this from the department of recreation in the city of Corning, they need to be able to take baseline vitals. These people are starting to migrate towards the American Red Cross courses, rather than the New York State certified CFR courses. So there is a need, especially in our Steuben County area and it has been addressed, a need for, especially the vital signs. So I welcome this.

DR. HUFFNER: From a medical perspective, to remove vital signs, that's a simple set of data points to have that historical perspective of the patient over time. It befuddles me, and that was my major, I certainly was viewed as not being very cooperative when I brought that up to the state. I mean it's invaluable to know what the patient's vital signs was 45 minutes ago into a run or an hour ago when they are in the emergency department. It's very important. So I will make a motion that we approve the, that the Council approve the policy as amended with the addition of AVPU, with the understanding that the STREMAC will have to actually agree to that. I can't imagine them not. But we will take it back at the next STREMAC meeting before we promulgate it and make sure they agree with that. And then we will make it a regional policy.

MARYANN SWEELY: I would second it.

DR. HUFFNER: The only reason this comes out as the Southern Tier Emergency's Medical Advisory policies is that my understanding the CFR protocol requires REMAC to authorize these additional skills.

CHAIR RAJSKY: Okay. Motion on the floor, and it was seconded. Great, further discussion?

DON DUVALL: I guess the question in my mind after I had a chance to read it, read the policy, I don't necessarily disagree with the policy. My question is if it's extra training is not mandatory, aren't we creating or increasing the possibility that we are going to create two different levels of CFRs and if so how are we going to differentiate those who are trained and those who are not?

CHAIR RAJSKY: I would agree with that.

DICK SULLIVAN: Wouldn't that be an option, not required.

DR. HUFFNER: You are absolutely correct, Donny. And it's, there is no easy resolution to that. I mean I have been one of the huge advocates, I think a lot of people around the room know that I am not a big advocate for the merit badges down the sleeves of a provider. Thought was that enabling a provider to do these things if they are trained to do so, would mean that the service medical director takes on a certain amount of responsibility in knowing whether or not the providers in his service are capable and competent. Now CFR that's been a CFR for, we have lots of people with lots of longevity, to say that they can't take a blood pressure any more and they have been doing it for 20 years is ludicrous.
     The real question comes is with the newbie as, what do you do with the 93 newbies. This really was generated more to established CFRs and those that are skilled. What are we going to do with these new, if you will, new kids on the block. Well it's going to be up to the individual service medical directors to make that decision. And then incorporate those skills, those that are skilled, whatever skills they have in to the, if you will the treatment team. Do we want to have a CFR badge that says you can do blood pressures, pulse but not respiration, that you can do rapid extrication, but not C-collar and backboard use. Well if you are not trained to do so, I would suggest that would probably be the best way to do that.
     And long-term, maybe we would have the ability, some day, with a credentialing program to identify exactly who has what skills and how they are competent in that. But at this juncture to enable and I don't know what the numbers, but there is a good number of CFRs that are well trained, that have been doing this for many years. To me it's like poking out your eyes, I mean they have the skills to do that, why would you not want them to do that. You are absolutely correct in that it does create a sort of muddy water if you will for the new guys and we're dumping it on the service medical directors to tease it out.

DON DUVALL: But the problem is, with the defibrillators and epi-pens, those things were set up with an agency elected to participate then every provider was required to do the training and stuff. With this expanded scope, if you will, I mean it's quite possible that the crew I get today may be two people trained under the new program, who don't have any of these skills. How are you going to guarantee that, the level of care?

DR. HUFFNER: I am not.

DON DUVALL: Make sure that the right people are in place at the right times.

CHAIR RAJSKY: I think the biggest piece there is the educational piece, that new First Responders need to realize that their colleague First Responders who may have those skills, the teaching has to be that they can't go above their level, their scope of practice; and so if their service medical director decide that once they are certified they can go on for this continuing education module, that's okay. But they have to realize that. And so the educators have to be real careful about making sure that issue is well presented.

DR. HUFFNER: This doesn't again mandate that CFRs have to be taught this. And in fact an educator may chose not to include any of these, I don't want to say extra skills, but any of these other skills. And in fact they can't include them in the 44 hours of course work. That would be against the rules. This, and you are right, Donny, it creates a bit of quandary with the new guys. But it does enable those CFRs that are already in the system, that have been there and are already trained to use the skills that they are familiar with. It does create a problem, I am not denying that it doesn't create a problem. But we, the REMAC level decided that there was enough value to be gained from enabling those that are trained to do this to allow them to continue to do that with the understanding that the new guys coming up may or may not chose to gain those skills. And be, and could be authorized to perform those skills by their service medical director within that service. We don't have any other ability at this time to provide any other type of, I hate to use the c-word, but credentialing of those skills and it does create a problem, I agree.

CHAIR RAJSKY: Further discussion? Seeing none, I will call for a vote. All those in favor -- let's recap what the motion is. Motion is to approve the, the blue document with the addition of AVPU in the second bullet point. All right. All those in favor signify by saying aye. Opposed? Two opposed. Abstentions? Carried. (MOTION CARRIED)

DR. HUFFNER: Thank you. The only other item from the STREMAC minutes that I wanted to bring up was the consideration of Dr. William Shepherd's membership on the STREMAC, as you know consistent with Article 30, any membership change to the STREMAC nomination have to come from the Council and those nominations are then passed on to the STREMAC for consideration of election. Dr. Shepherd is working in the Corning Emergency Department and has been to at least a couple of REMACs and has shown great interest and willingness to participate. I would certainly make the nomination, I would make the motion that we nominate Dr. Shepherd for member on the STREMAC.

CHAIR RAJSKY: Motion made.

DON DUVALL: Second.

CHAIR RAJSKY: Second great. Discussion? Seeing none, all those in favor signify by saying aye. Opposed. Abstentions. Carried. (CARRIED, UNANIMOUS)

DR. HUFFNER: That's the end of my report unless anyone has any specific questions about the minutes or anything else?

CHAIR RAJSKY: Great, thank you. Training committee, Maryann?

MARYANN SWEELY: Training met this evening, minutes of the March 11 meeting were approved with no correction. We did review, we had two courses to review, an EMT and an EMT refresher taught by Tina Goodwin, sponsored by Corning Hospital. The grades for the refresher were at or above state level, where the original were not. This was a tough group, that's all I can say. I sat in on that class many times and this was a class started by Larry Yonkin and we lost Larry. And Tina was gracious enough to come in and come in to a very difficult situation and take over. In any event we had three failures out of the group of 20 in the original group, 100 percent pass rate in the refresher group. The evaluations were terrific. There were no problems there. Everyone seemed to like the course, they just didn't apply themselves.
     Course sponsorship renewal, we had one and that was Corning Hospital. That was for the basic level EMT and First Responder. The document was reviewed by training committee and approved. This was a short course renewal form this year that Corning had to do. It has already been approved by state and has now this evening been approved by training committee.
     I would ask that it be accepted and passed by the Council, unless you have any questions for me. The only changes I might add were that to equipment, updating my CLIs and CICs expiration dates; and I had to make some page changes with the new student manuals that came out for reference material. That was my changes this time around.

CHAIR RAJSKY: Great. So motion on the floor.

MARYANN SWEELY: I would ask for a second.

BERNADETTE J-OAKES: Second.

CHAIR RAJSKY: Great. Discussions regarding Corning Hospital's renewal? Any discussion? Seeing none, all those in favor signify by saying aye. Opposed. Abstentions. Carried. (CARRIED, UNANIMOUS)

MARYANN SWEELY: The next thing on our agenda were ideas for the annual conference in October. We brought some pictures in, we have a lot of handouts that we would like to use with approval of the PR chairperson. So we are still collecting information and data for your display, for our display, and we will be passing that information on to the PR chair.
     We also discussed the letter presented by New York State Department of Health which Bob has already alluded to, the mandated child abuse, we brought that up in training committee.
     We also talked about the pediatric assessment test. I am hoping that everybody in the room has taken that, that was on the STREMS Internet. It was an opportunity for you to rehearse your pediatric assessment skills. We had 272 review this assessment tool, 159 completed the test. A survey is going to be sent out to the 159 people that participated and completed the test on this, asking your input. Was it a fair test, was it too long. Do you have any suggestions for other ideas for future CEUs. It was a good way to and an easy way to get CEUs and update as well.
     Other business, we have already discussed the optional CFR skills that Dr. Huffner discussed, and we pass that with the addition of the AVPU on bullet two. Courses, EMS courses, the only proposed one come up with will taught by Mr. Insogna and that's at the MT Pictures Display. That will start the 27th of May. The rest are either current or being completed. We would ask any of the sponsors get their list of courses in to the STREMS headquarters by the first week in July, so that we can get the publicity around to all of our fire company and ambulance squads.
     We did approve a CLI, Mr. William Jewett, his name was brought to us by Mr. Rajsky. Mr. Jewett has completed his CLI forms as well as complete course and training committee did pass him as far as a certified CLI. I would ask for a motion to from Council to accept Mr. Jewett as a new CLI.

STEVE BENNETT: I would make a motion.

DICK SULLIVAN: Second.

CHAIR RAJSKY: Great. I think everybody knows Bill. If you know Bill then you know Vanessa. Any more discussion regarding Bill? Seeing none, all those in favor signify by saying aye. Opposed. Abstentions. Carried. (CARRIED, UNANIMOUS)

MARYANN SWEELY: Our next meeting is June 10, 2004.

CHAIR RAJSKY: Next Regional Quality Improvement. Bernadette Oakes.

BERNADETTE J-OAKES: The Regional Quality Improvement committee met Tuesday May 11 at the STREMS office. The reports from first quarter of 2004 were presented and accepted. There were some concerns with pediatric compliance still showed an area that dropped off, although there was better documentation. It was agreed that we will continue to track this and hope that the pediatric assessment course that was offered on-line will continue to help foster some improvement there. Other issues noted during the reports were concern that BLS services were not calling for ALS support when appropriate. We're going to continue to watch this. And see if anything further needs to be done with it in the next quarter.
     There were, continues to be attendance issue with some of the same agencies and we do notify them. We just want to remind everybody here that in the area coordinators, that to be eligible for the QIPP award annually the attendance must be 75 percent or better.
     Maryann reported on the pediatric education tool. Again just to repeat those numbers, that 159 people have completed taking the course and the testing, and 272 have viewed the program itself. It was suggested that even though the deadline has passed for when they originally, we wanted those tests back, that we extend that, and create a tool an evaluation tool so that we know if this was valuable or what we could do in the future, you know to create other programs, what was helpful, what was not. And Judy Blair took responsibility for getting that evaluation tool out to everyone.
     A letter did go out to all first response units advising them that we will be reviewing their PCRs for the months of May, June and July. Just to give them a month's notice that that is coming. A letter also went out to all the area coordinators regarding the data collection, so that it becomes more consistent. There were some discrepancies that we need to be able to clarify so that data will all be consistent.
     A good point of the meeting, Dr. Huffner reported that the STREMS Council had received accolades from the Department of Health for the pediatric review by, they had indicated that this is how the system should work, identify a problem, educate and review. So he was quite proud of that at the State Council that we were given those comments. Dr. Huffner also announced at our meeting that the protocol revision will go in to effect on July 15, 2004. And all agencies, all ALS agencies, I am sorry, and hospitals should be able to send or receive 12 lead EKGs, and then there will be 100 percent review of all these cases from the 911 call to the hospital discharge.
     And another note, AED training was changed from four times a year to just two. And it is at this point in time undecided who will continue doing that training. Our next meeting will be August 10. Thanks.

CHAIR RAJSKY: Thank you. Questions for Bernadette? Seeing none, we will move on to public relations, Mary Ann Teeter?

MARY ANN TEETER: The public relations committee met April 27. We actually did a couple of items, you saw the presentation tonight, that was one of our more honored agenda items. The other item that we went over, just to refresh everyone's memory is that we're going to be doing the EMS conference this year, October 16 up at Corning Community College and give you some highlights, it's pretty much what, it's all firmed up, but to give some ideas of who is going to be presenting and the topics that will be covered, is that we're going to have Dr. Lentz, Christopher Lentz from Strong Memorial go over management of burns, thermal injuries. Daniel West and Dr. Huffner are going to do something on meth lab presentations. Bob Faugh is going to do a presentation on emergency driving. Lee Burns from the state is going to cover documentation. Adam Oplinger from Mercy Flight is going to talk about the, actually the care of patients in helicopters. Dave Knowles, some of you may have attended one of his presentations in the past, going to do something on creepy crawlers, that's all I can say about that. Dr. Robinson is going to do respiratory topics. Cathy Auge is going to go over the STAR program, responding to terrorism. And Bob Rajsky is going to do some EMS education recert.
    The other thing I am actually so glad Maryann had mentioned this earlier, we asked that all the committee chairs please put their committee presentations together for the PR committee that we will have displayed at the conference. And a letter was sent out on March 8 to everyone and we would like that information to us at STREMS by June 30. I think that was pretty much all that we really covered at that particular meeting.
     And I see in my packet that I have some Gold Stars of Life, since our last meeting we have four altogether here and that we will select a person from the bag. I will read it now. Nominees Maryann Sweely and Kathy Lunney from the Tri-County CISM, this was from the Forest View/Gang Mills fire department. It's "Maryann Sweely and Kathy Lunney assisted us during a very difficult time when our corps experienced the death of a fellow firefighter and friend this past year. Their Critical Stress assistance helped our entire corps discuss, feel and get through a tremendously difficult period. Thank you for being there for all of us when we needed you." The next two are Tom Allen and Joe Morey from Greater Valley, this was nominated by Pam Mott, it said: "For making difficult decisions quickly and efficiently on the scene of a home delivery on April 19. Tom had several difficult choices to make rapidly and thanks to his training and years of experience, he weighed all his options and made those choices in a stressful situation. Thanks to his quick decision making and with Joe's help, both mother and baby are doing fine." So we would like to congratulate our Gold Stars. And actually Teri you are sitting next to me, why don't you pick out.

MARY ANN TEETER: And the recipient is Tom Allen. We will make sure Tom gets this. Our next meeting is schedule for June 8 at the STREMS office.

DR. HUFFNER: Mary Ann, I have one question for you. When we have our annual conference, it's not annual any more, when we have a conference, do we have any Council presentation like bulletin board to identify all the members, who they chair and where they come from.

MARY ANN TEETER: That type of information is what we want to do put together with committee activities, so anyone attending the conference could understand STREMS a little better and what everyone does.

DR. HUFFNER: Because the state spends a good deal of time, ends up being very nice, they have a picture of each member of the Council, where they come from, what their affiliation is. We might be able to do the same thing, get a picture of each person on the Council, so that you can recognize who they are. That would be nice, or where they come from, that kind of stuff.

CHAIR RAJSKY: We will cut apart all the Christmas cards over the years. Good idea. Anything else, Mary Ann?

MARY ANN TEETER: That's it. End of my report.

CHAIR RAJSKY: Thank you. Systems committee, Don Duvall?

DON DUVALL: Systems committee met this evening. Only a couple things to comment on here. A number of our members were absent this evening. Systems committee is working on a purchasing program whereby hopefully we'll be able to negotiate for prices on EMS equipment to get our agencies within the region the best deal possible for consumable supplies. Surveys have gone out to all the agencies in the region with a return date of June 1. So if your agency's received a survey, I ask that you urge them to complete it and send it back in so that we can decide if cooperative purchasing or price discount plans are a worthwhile endeavor for this region. Our hope is that we will be able to negotiate prices, and agencies will be able to take advantage of those by still doing their own ordering, their own purchasing, but by naming themselves as part of a Southern Tier regional group to get a special discount. So take a few minutes and send those in or make sure that your agencies send those back in so we can get an idea if this is worthwhile.
     We did listen to an update on the STAR program, I am sure Bob will comment on that again shortly. There were no applications for public access defibrillation or epi-pens. We did have a lengthy discussion again on the issue of credentialing. And myself and Dr. Huffner are going to sit down some time this month and work to see if we can't come up with a way to make the issue of credentialing move forward, hopefully we are proposing to bring back next month. And that was it. Any questions?

CHAIR RAJSKY: Thank you. Critical Incident Stress Management, Maryann?

MARYANN SWEELY: This activity report is from March 1, 2004 through April 30, 2004. Our team had nine debriefings and five educational offerings. So year to date we're up to 21 debriefings and six educational offerings. About 72 hours administrative time. Total team member education time this month eight hours. So we're still alive and active.

CHAIR RAJSKY: Great. Thank you. Just a quick recap of how your agency is activated?

MARYANN SWEELY: Well you can call 911, Mike Smith is well aware, has our names and phone numbers. We have brochures circulated around the community with contact numbers at Corning Hospital, St. Joseph's, Arnot Ogden and Schuyler County. You can call Steuben Fire Control, any of the fire control deputies or chiefs, they, St. James, they know how to access us. We do have members starting up in the St. James area and continuing all the way down through southside of Elmira. So we cover a large area.
     And I did want to mention I forgot we have had some change in leadership here. Mr. Harry Adler, chair of the committee has left the area, moved to Florida and Bernadette Oakes is the new chairperson of the team.

CHAIR RAJSKY: Welcome.

MARYANN SWEELY: She didn't show up at the meeting.

CHAIR RAJSKY: Great. Thank you. Other business? We did have the executive committee meeting that was held on April 29. We had some statutory things to do at that one, first being the approval of the budget template which you should have in your packet. Two sections of that, the general information talks about our region as a whole, we need, we do update that every year. And then the training plan, we ask each of the course sponsors to give us the information about how many folks at each level they certify in the past, what they expect for the future, up to really 2006. And so that is included, and then the Council budget is the last chunk of that, the Council operating budget. It's actually on page 12 of that document, the next to last page. And again our current budget which has been virtually the same for many many many years has been $25,000, each Regional Council throughout the state gets exactly the same amount. They always ask us to project what is the exact cost of doing business of the Council, and so for '05/'06, you can see that that's the actual cost of doing business. So in essence they get $40,000 worth of work from us for $25,000. They get but in fact the program agency, STREMS Incorporated makes that up, makes the difference up for that. So that's, that, every year we have to do that. We do, we're obligated to turn that in to New York State. So given that I would entertain a motion to accept that.

MARYANN SWEELY: I would make a motion to accept that.

DR. HUFFNER: Second.

CHAIR RAJSKY: Motion made and seconded. Discussion on the budget template? Seeing none, all those in favor signify by saying aye. Opposed. Abstentions. Carried. (CARRIED, UNANIMOUS)

CHAIR RAJSKY: I have to say that has gotten easier over the years. It used to be pain staking days of it. Now we got the flow, it's probably about time to change forms.

DR. HUFFNER: I will pass that on at the next finance committee.

CHAIR RAJSKY: Thank you. The budget template, also we reviewed committee membership. Each member we ask to be on at least, on and actively participate in at least one committee. And that was reviewed, we had one member that we're going to ask, relatively new member who wasn't assigned yet. So we are doing that, and that's actually J-R Miller.
     The other statutory thing that we had to do is to approve or disapprove the Woodhull expansion of territory. And again the Woodhull issue was Woodhull ambulance covers a portion of the town of Rathbone, and it wasn't for whatever reason on their operating certificate. And originally it looked like the Department of Health was going to make us do a full fledged public hearing. There was no opposition to this, it just was not on their operating certificate. Further investigation with the Health Department revealed that we could send out all the required documents to all the required agencies and folks in the area that's affected, and barring no outcry, we could approve that expansion of territory, which in fact truly is not expansion of territory, it is adding it to their certificate in which they already cover. And so at that meeting, at the Executive committee on April 29, the committee did approve that, the Woodhull expansion of territory. So I would bring that here as a motion, we will put it on the table and discuss.

STEVE BENNETT: I make a motion.

FRED CRIST: Second.

CHAIR RAJSKY: Okay. Fred is on it. Discussion? So we did receive three or four, two.

JUDY BLAIR: Two.

CHAIR RAJSKY: Two letters of support for that, and there was no opposition to that. That's my feedback. Anyone else want to add anything to that? Seeing none. I would call, unfortunately for a roll call vote, because we are statutory obligated, we have to do it via roll call. So Judy if you would.

JUDY BLAIR: I will call the names of the members in alphabetical order. As your name is called, if you are in favor of the resolution please answer yes. If you are not in favor of it, answer no. If you do not wish to vote you may answer present. If you are not ready to vote you may answer pass, and I will complete the list and come back to you. After each person votes, I will repeat your name and your vote. If you are here as an alternate for a member, when that member's name is called please answer by first stating your name and then your vote. Steve Bennett.
STEVE BENNET: Yes.
JUDY BLAIR: Kathy Brimmer? Paul Card?
PAUL CARD: Yes.
JUDY BLAIR: Jim Chrabaszcz? Rick Churches? Fred Crist?
FRED CRIST: Yes.
JUDY BLAIR: Don Duvall?
DON DUVALL: Yes.
JUDY BLAIR: Patti Gressel?
PATTI GRESSEL: Yes.
JUDY BLAIR: Dr. Huffner?
DR. HUFFNER: Yes.
JUDY BLAIR: Bill Kennedy?
BILL KENNEDY: Yes.
JUDY BLAIR: Rick Kimball?
RICK KIMBALL: Yes.
JUDY BLAIR: I am not repeating all of these but everybody is yes. Ron Kintz?
JIM KINTZ: Jim Kintz, yes.
JUDY BLAIR: Jim Larson?
GARY BLITZ: Yes.
JUDY BLAIR: Okay. Gary voting for Jim. Al Lewis? Kathy Lunney?
KATHY LUNNEY: Yes.
JUDY BLAIR: Dr. Manganaro? J-R Miller? Bernadette Josbeno-Oakes?
BERNADETTE J-OAKES: Yes.
JUDY BLAIR: Bob Rajsky?
CHAIR RAJSKY: Yes.
JUDY BLAIR: Dr. Seaman? Mike Smith? Mike Sprague? Dick Sullivan?
DICK SULLIVAN: Yes.
JUDY BLAIR: Maryann Sweely?
MARYANN SWEELY: Yes.
JUDY BLAIR: Teri Symonds?
TERI SYMONDS: Yes.
JUDY BLAIR: Mary Ann Teeter?
MARY ANN TEETER: Yes.
JUDY BLAIR: Is there anybody I missed? Got 16 yes votes.

CHAIR RAJSKY: Great. Motion for the Woodhull expansion territory be forwarded on to New York State. Great, thank you.
     The other issue was with membership. There is a recommendation to approve Gary Blitz from Elmira Fire Department to fill a vacancy left by Jim Larson's retirement. It was passed at the Executive committee unanimously. And I would entertain a motion here to --

DICK SULLIVAN: I will make a motion.

FRED CRIST: Second.

CHAIR RAJSKY: Great. Further discussion? Gary has been with us, he has been like a member, even though Jim has been here, he has been his alternate and has attended as well. Great. Any further discussion? All those in favor signify by saying aye. Opposed. Abstentions. Carried. (CARRIED,UNANIMOUS)

CHAIR RAJSKY: Welcome officially.

GARY BLITZ: Thank you.

CHAIR RAJSKY: The last item we had was the vacancies. We still have two vacancies in Steuben County and actually two in Schuyler. And I had asked anyone at that committee if they knew of anyone that was interested, would have, you know, the time and energy to do that. And actually we do one member that we will look at, executive committee next time, William Hawk from Bath ambulance. And that, we have potential of filling one, we still need two in Schuyler. Two Schuyler and potentially one from Steuben.

DON DUVALL: If I may, we do have a couple more applications, they are just not in yet.

CHAIR RAJSKY: Great, super. And we certainly have them at the office if you need an application to hand to someone, feel free to contact us. And that was the executive committee. Other business to come before Council? I think everybody realizes EMS Week is next week. So in light of that, everyone has a, one of these little, I don't know what you call these, it's so you can find your keys at night, I guess a small token from us at STREMS to everyone to recognize National EMS Week next week. Anything big planned throughout the region? I know Steuben County is doing a teaching day next week.

MARYANN SWEELY: Saturday.

CHAIR RAJSKY: Teaching days, any information about that?

DON DUVALL: May 15, Haverling High School. It's a day long seminar sponsored by Steuben County and Rural Health Network. And the exact agenda escapes me at this time. We are taking reservations, it's free of charge, lunch is provided and continuing ed credits are available for providers.

JUDY BLAIR: The schedule is on the STREMS website.

DON DUVALL: That's right. You are correct.

CHAIR RAJSKY: So if you are in need of continuing ed, good place to get, I think it's six and a half hours of con ed.

DON DUVALL: Mike said he was having steak for lunch.

CHAIR RAJSKY: Great. Anything else to come before Council tonight?

DR. HUFFNER: Move to adjourn.

STEVE BENNETT: Second.

CHAIR RAJSKY: Next meeting is June 10. We are back at Lodge on the Green. Motion to adjourn and seconded. Thank you.