NNFD EMS Council Meeting “Our single overriding objective –prompt, compassionate, clinically excellent care.” September 20, 2013 at 9:00am – NNFD – 1885 Veterans Park Drive Final Meeting minutes
Introductions were given. Christy is no longer with NNFD, Kim is filling in. Meeting is being recorded for her benefit only. Changes to the Agenda New Business– deletion of Letter of Support for Dr. Debbie Lopez’s selection to the EMS Children Advisory Committee and the addition of Michael Marcus’ presentation - pelvic fracture; Radio Signal Strength Test Report will be addressed in the comments and the addition of a Smart 911 update Approval of August 16, 2013 meeting minutes. Motion by Dr. Panozzo, second by Dr. Juda to approve the August 16, 2013 meeting minutes. VOTE: Unanimous Statistical data was sent out in advance of the meeting and is provided in your executive packet. EMS call volume is up as well as an increase in acute care patients. Rides to the hospital are up in volume also. We continually track rides to the hospital as part of our CON. If ALS has been started prior to EMS on scene, our personnel will ride in the vehicle to the hospital with the patient. D/C Aguilera reminded everyone about the Injury Prevention Coalition event on September 22, 2013 at PRPR from 9:00-11:00am. Other topics for the Coalition is to get back to fall prevention and putting together a strategic plan. In October, D/C Aguilera will be releasing his Chair position with the group. There was discussion about how we monitor calls. Attempts will be made to drill down by mechanism. Dr. Panozzo would like Imagetrend to reflect a more detailed report, D/C Aguilera says there is, he just didn’t pull the report at this time.
Dr. Panozzo has requested to really focus on fall prevention with the Injury Coalition. Simple falls have been turning into more serious injuries in older people. D/C Aguilera states that Bentley Village has contacted him to do an event at their facility. The plan is to get the word out to more nursing/assisted living facilities to have more events in the community. Lt. Stanfill informed the group that they have been getting a lot of public assist calls. Noted that additional injuries were occurring after the patient has fallen and unable to move. There was discussion about assisted care facilities and nursing home restrictions on moving patients after a fall. Betsy Novakovich commented that there is no such thing as a simple fall and would like to see training for caregivers for care after the fall prior to EMS arrival to help make them more comfortable. Eng. Jameyson commented that the group should attempt to get a representative from the assisted living/nursing home communities to attend the injury prevention coalition events and meetings. Chief Kopka would like to track lift assist turned into EMS transport calls. Michael Marcus brought up the point that if there is an assistance call, maybe this is a good time to evaluate the patient’s ability to live independently. Why are they falling? Conversation between the patient, family and doctors might be a good idea. Discussion occurred regarding calls for home public assist. A/C Aguilera commented that they are trying to get the word out to the various senior agencies in the area as well as the senior living communities to have the Coalition come to their organization and do a presentation. Only a few communities have taken advantage of the programs for their residents. Commissioner Hanson voiced her concern regarding some assisted living communities are overmedicating their patients. She wonders if there is any way to monitor this. She is wondering if this overmedicating is causing the falls. Michael Marcus indicated that this is where the patient’s relationship with his/her doctor is vital. If there is family in the area, they may have a conversation with the doctor and the care facility as well. D/C Aguilera stated there is really no way to monitor. D/C Aguilera states that the drug shortage is still in effect. However, in our area we haven’t been hard hit as some other areas of the country. IV fluid production could possibly be on the downfall. Dr. Augustine provided a list that has the meds that are currently unavailable. No legislative assistance available. It’s simply a production/raw material problem. Janet Vasey provided the PSA update. She states that the group is working on ordinances for voting and trying to expand efforts on community education and awareness. Expanding Smart 911, stroke education drowning prevention and start working with the Injury Prevention Coalition. Chief Kopka has volunteered to Chair. The group is going to work with Collier County to expand in the area regarding voting membership. On Wednesday, October 30th 2013, the PSA will be having a meeting to discuss the Office of the Medical Director. D/C Aguilera will be in attendance to assist them through the process. Following a letter regarding non-compliance regarding stroke protocols, Physicians Regional Pine Ridge is working on their stroke protocols. Stroke patients going to PRPR in the second quarter is up 70%, which indicates protocols are being followed.
Dr. Panozzo gave the PSA Medical Director Sub-committee update regarding the adult and children traumatic brain injury study. Sepsis protocol will be going through. They also addressed the sepsis protocol. They will be going through the drug equivalent list to create a standardized list. Becky Novakovich expressed an interest in assisting with M.A.C. In addition, the Easy I.O. Protocol has been finalized. Dr. Lopez informed the group that using the humorous as an absolute last resort in pediatric and adult which has been reflected in the protocol. There was discussion on the standardized substitution drug list, which should be distributed in the near future. D/C Aguilera spoke about Smart 911. Continue to support the program and start promoting the program. With season coming, it’s important to get the word out. Chief Kopka indicated that NCH North Naples is now a Primary Stroke facility. County EMS Grant list was discussed. D/C Aguilera would like to take the list to the County Commissioners and make a formal request for a grant. He has asked for input regarding the grants content. Motion was made by Lt. Stanfill to submit a grant request to the Board of County Commissioners for EMS Training equipment and additional items as indicated in submitted e- mails. Second made by Dr. Juda. Vote: Unanimous D/C Aguilera is working on a letter to draft a presentation from the District’s perspective for the Development of Collier County Office of Medical Director. Janet Vasey informed Chief that a hard copy of the letter has to be presented to the PSA seven days prior to submission to the County. He has asked for the groups input as to the content of the letter. Dr. Lopez has been accepted to the EMS Children Advisory Committee and will be representing our area. In future meetings, Dr. Lopez will be providing updates to the group. New Business: Dan Summers advised us we should submit our COPCN early to make sure the item gets on the agenda. Motion to support our COPCN application by Commissioner Hanson, second by Eric Watson. Vote: Unanimous NNFD’s EMT’s and Paramedics are currently going through the credentialing process. In addition to the written test, they have an interview with Dr. Panozzo. Chief Stolts gave the group an update regarding Station 48. He spoke about staffing, construction process and the chosen contractor. Janet Vasey questioned how the station was going to be funded. Chief Stolts explained there are a couple of options the Board is deciding on. D/C Aguilera told the group that North Naples Fire-City of Naples are forming a Joint Cooperation Committee to see if the two municipalities can work together to share expense and equipment. Our Board will be discussing the topic and choosing member to be involved in the group.
Regarding the Single-System Pain Control Protocol to include Toradol. Mike Marcus isn’t sure how far the use for pain control has progressed in the approval process. It was mentioned that Toradol is used in pain management, and it’s not a controlled substance. Dr. Panozzo brought up the point that it would be nice to have a non-narcotic drug on hand immediately for pain relief, but not until some results from further discussion have been finalized. Mike Marcus advised to remember Toradol isn’t to be used if there is bleeding or heart issues occurring. Dr. Panozzo feels that Toradol isn’t to be used until a diagnosis has been determined. He also discussed the use of Dilaudid with older patients. Dr. Juda mentioned that Toradol does affect the platelets and the heart making it not the best solution on scene. It was decided that this discussion regarding Toradol be tabled until further discussion. It was decided that proper dosing for Toradol and other drugs be added to the next meeting’s agenda. Dr. Panozzo is going to provide a national dosing chart to the group. Further discussion regarding pain management storage on the trucks took place. Captain Maguire and Lt. Becker developed a presentation about a new drug that is being made. It’s being called DIME and there have been 6 known cases in Collier County. DIME is similar to a combination of LSD and cocaine. Dr. Panozzo informed the group that one of the many problems in dealing with these cases is sedation. Dr. Juda mentions that restraints aren’t working. When the patient is restrained, they attempt to break free and in the process, are breaking their arms and legs. D/C Aguilera recommends using the excited delirium protocol when responding to calls like this. There was discussion on which combination of drugs to use during the course of treatment. D/C Aguilera brought up the point of whether or not the trucks have strong enough drugs to treat effectively on scene. It was decided to bring back the excited delirium protocol, proper pain control, the use of Fentanyl as a choice for a drug to keep on hand as an agenda item in the future and also to get the message out to the hospitals to start monitoring cases like these for further education on how to treat most effectively. Florida Department of Health Grant funding is available for replacement of Level C hazmat suits so if the departments need to replace, applications need to be submitted. DuoDote kits might be expiring. Please check the expiration dates. Ch. Kopka will meet with D/C Aguilera to check kits that were supplied by the county. It was noted that there is no more Federal or State funding to replace these kits. If the kits have expired, it would be the responsibility of the District or County who has them to replace. Mike Marcus brought to the group information regarding how to treat pelvic fracture appropriately. He recommends slinging patients with a pelvic binder if there is a possibility of an injury whether it be visual or not. High kinetic type of injuries i.e.: car accidents and motorcycle accident would benefit from the use of a sling. It would ‘buy time’ on scene until the patient could be transported. He did indicate that whether or not an injury is visible, placing a sling on the patient would not cause any harm. A sling can be as simple as a bed sheet or as inexpensive as a $9-12 device. He reminds everyone that the proper placement is low on the pelvis, not around the abdomen. He provided a power point presentation for anyone interested in viewing after the meeting. It was recommended to bring the topic to the Medical Director meeting to schedule proper training for the use of the device.
Open Discussion: D/C Aguilera asked Betsy Novakovich to provide the group with an update on the Stroke program for NCH for the next meeting. Letter was written to the Collier County commissioner Chair. It may have been misinterpreted. D/C would like to invite the Communications Director from Collier County to discuss the communications plans. It may have been interpreted that the Council is OK with them putting money into fixing the existing program when in fact it needs to be replaced. Would like to hear what type of hybrid systems there are. Also addressed the need to work with Bonita Springs in Lee County to share resources. Chuck Bacon told the group about a fire Chief app. Lee County Lee Flight and Collier County Air Flight will be here October 8-9-10, 2013 landing in the soccer fields at Veterans Community Park and conducting training from 10:00am-12:00pm Chief Anderson told the group how they are spending their impact fees in the budget on new trucks, possible new Station 32 in Ava Maria. Training was completed on hazmat and confined space rescue. Commented that to replace the radio system would be very expensive. Cpt. Arigo informed the group how the County is moving forward with communication upgrade. The CAD should be updated within 12 months once the contract is signed with Motorola. Collier County is going to be a test site thereby reducing the price slightly. Chief Stolts commented on how poorly the radio signal is in North Naples. He informed the group that we are working with John Daly to find the most cost effective way to replace the system. Chief Kopka noted that in reference to the Med flight training that is upcoming, new LZ coordinates and map updates are available. Chief Dewitt questioned if the County was planning on putting EMS at Station 48. The decision on that has not been made. It was mentioned that the County was planning on building a station to house EMS to service that Livingston corridor; however, there is no formal plans. Ron Myers commented that we should consider forming a committee to discuss the best practices for Medical Director. Todd Gibson provided information regarding the Collier County Campus of Physicians Regional moving forward as a primary stroke center. They are also moving forward with plans to make the hospital a bariatric surgery center. He also noted that emergency care patients are still showing up in private vehicles and not being transported by EMS. He is stressing the group to continue to get the word out about injury prevention and raise awareness about the 911 system.
Dr. Lopez noted that Collier County has experienced a large amount of pediatric drowning. On Oct 9th there will be a CMA at the Immokalee Road location of NCH in the Brookdale Center from 6-7:30 pm called Pediatric Drowning. There will be flyers distributed. Betsy Novakovich reiterated the fact that critical people are driving themselves to the hospital of calling EMS. She wanted everyone to be aware that the ER will begin it’s renovation in March. She listed some of the details in the project: pushing back helicopter pad landing, going from 29 beds to 54 beds, expanding the pediatric emergency department. She will provide details throughout the year and a half process. Eric Watson noted that with regard to the injury prevention coalition campaign on falls. He is urging the PSA to spread the word about how to properly get up from a sleeping position. On September 24 they will go before the Collier County Commissioners regarding their COPCN. Michael Marcus talked about the mass casualty case that was brought in to the hospital on Saturday, September 14. They now have a mass surge plan put in place that worked well and they did not have to ship to other facilities. He has recommended the same for the other hospitals in the area. Dr. Panozzo has asked for a copy of the procedure plan. Dr. Panozzo reminded everyone to work all patients aggressively on the way to the hospital during transportation. It’s vital that everything is done in transit to help the ER staff when they arrive. Next meeting is scheduled for October 18th, 2013. Meeting was called at 11:00.
Curriculum Vitae David E. Ross, M.D. Narrative summary Dr. Ross is the director of the Virginia Institute of Neuropsychiatry and clinical assistant professor at Virginia Commonwealth University (VCU). He completed medical school and residency in psychiatry at VCU. After that, he finished a fel owship in neuropsychiatry at the Maryland Psychiatric Research Center, University of Mar
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