THE REGIONAL EMERGENCY MEDICAL SERVICES COUNCIL OF NEW YORK CITY, INC. Regional Emergency Medical Advisory Committee Minutes February 16, 2016 The Regional Emergency Medical Advisory Committee (REMAC) of New York City met on Tuesday, February 16, 2016 at the Offices of the Regional EMS Council of NYC, 475 Riverside Drive, Lounge, New York City. This meeting can be viewed via webcast at www.nycremsco.org. Members

Present

Absent

EMS Community Emergency Department Nikolaos Alexandrou, MD Medical Directors (3)

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Allen Cherson, DO Christopher Graziano, MD

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Eric Cohen, RN

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Mimi Langsam, RN

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Nurses (2)

Vacant Administrators (2) Kevin Munjal, MD

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FDNY EMS Commissioner or NonPhysician Designee

Medical Director (3)

Online Medical Control Physicians (2) Emergency Medical Technicians (Basic/Paramedic) (2)

Vacant Dario Gonzalez, MD

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Glenn Asaeda, MD

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Bradley Kaufman, MD

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Nathan Reisman, MD

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Doug Isaacs, MD

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Evan Suchecki, EMTP

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Christopher Swanson, EMTP

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THE REGIONAL EMERGENCY MEDICAL SERVICES COUNCIL OF NEW YORK CITY, INC. Members

Present

Absent

Greater New York Hospital Association

President or Non-Physician Designee (1)

√

Alison Burke Vacant, alt Jeffrey Rabrich, MD

Emergency Physician (1) Michael Redlener, MD, alt Ambulance Service Medical Director (1) On Line Medical Control Physicians (2)

Emergency Department Administrator (2) Emergency Medical Technicians (Basic/Paramedic) (2)

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Heidi Cordi, MD, Second Vice Chair

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Lewis Marshall, JD, MD Chair

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Josef Schenker, MD

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Michael Guttenberg, DO

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Vacant Scott Chiang, EMTP

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Dominick Battinelli, EMTP

Medical Standards Committee ALS Physician (1)

Paul Barbara, MD

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BLS Physician (1)

David Ben-Eli, MD

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Peter Wyer, MD

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Celia Quinn, MD, MPH

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Medical Society of New York Physician (1) New York City Department of Health & Mental HygieneEmergency Preparedness Program Physician (1)

THE REGIONAL EMERGENCY MEDICAL SERVICES COUNCIL OF NEW YORK CITY, INC. Members New York City Health & Hospitals Corporation Physician (1)

Present

Absent

Vacant √

Charles Martinez, MD New York City Police Department Physician (1)

Victor Politi, MD, alt

NYS Volunteer Ambulance & Rescue Association/District 4 & 18 Ambulance Service Medical Director (1)

Joseph Bove, MD, First Vice Chair

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Emergency Medical Technicians (Basic/Paramedic) (2)

Ralph Cefalo, EMT

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Martin Grillo, EMTP

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Burn Surgeon (1)

Robert J. Winchell, MD

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George Foltin, MD

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Stephen Blumberg, MD, alternate

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Pediatric Emergency Medicine Physician (1) Psychiatric Emergency Medicine Physician (1)

William Fisher, MD

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Regional EMS Council NYC Physician (1)

Robert Crupi, MD

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Arthur Cooper, MD

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Trauma Surgeon (1) Gary Marshall, MD, alternate Training & Education Committee Physician (1)

Jessica van Voorhees, MD

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THE REGIONAL EMERGENCY MEDICAL SERVICES COUNCIL OF NEW YORK CITY, INC. Members

Present

Absent

United New York Ambulance Network (UNYAN) Ambulance Service Medical Director (1)

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Victor Politi, MD Michael Vatch, EMTP √

Emergency Medical Technicians (Basic/Paramedic) (2)

Robert Ackerman, Alt Maryanne Sawyer, EMT √ vacant, alt

Non-Voting Members At Large

Yedidyah Langsam, PhD, EMTP

At Large

Vacant

Public

Christopher Sorrentino, RN

STAFF:

Nancy Benedetto, Executive Director Administration Marie Diglio, Executive Director Operations Joseph Raneri, Disaster Preparedness Coordinator

GUESTS: David Eng, NYMH Eric Golike, NYMH Matthew Melamed, NYMH Go Mahalingam, NYMH Nathan Reisman, FDNY Carolina Pereira, FDNY Jason Zimmerman, DO, InstaCare, MMC Johanna Miele, NYCEM Jack Quigley, FDNY Pamela Lai, NYPQ

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THE REGIONAL EMERGENCY MEDICAL SERVICES COUNCIL OF NEW YORK CITY, INC.

Dr. Lewis Marshall, Chair, called the meeting to order. For the purposes of web casting, a roll call was performed. A quorum was present. The Minutes of the January 12, 2016 REMAC Meeting were unanimously approved. Voting Requirements. A quorum is based on the number of voting seats – whether they are filled or vacant. Currently, REMAC has 28 voting seats, so when voting, a majority of members must vote in the affirmative to pass any motion. That means, 15 votes in the affirmative are needed to pass any motion.

CORRESPONDENCE REPORT The Offices of the Council received the following correspondence:  Membership: •

The following members requested to be excused: Allen Cherson, Maryanne Sawyer, Madeline Fong, Jeffrey Rabrich, Joseph Bove, Chris Sorrentino, Robert Winchell, Martin Grillo.

•

GNYHA made the following appointments for approval: Scott Chiang will replace Shaw Bowe as rep to REMAC. (Unanimously approved).

•

Nominations and CVs for the following were received: -

Paul Barbara, MD, nominated for Vice Chair of Medical Standards by Michael Guttenberg, MD.

-

Josef Schenker, MD nominated for Chair of REMAC by Joseph Bove, MD.

-

Jessica van Voorhees nominated for Chair of Medical Standards by Joseph Bove, MD. •

The following volunteered for the Nominating Committee: Arthur Cooper, MD. Three more members are needed.

 From NYS DOH: •

Prehospital Bleeding/External Hemorrhage Control flow chart. Includes use of hemostatic dressing and junctional tourniquet

THE REGIONAL EMERGENCY MEDICAL SERVICES COUNCIL OF NEW YORK CITY, INC.  Public Notice from New York State Department of Health, Bureau of EMS, Operations Unit, to be read into the REMAC Minutes of the following enforcement actions: Provider / Agency Name

EMT / Agenc y#

Penalty

Violation of

County of Residenc e

None  FDNY EMS: •

PCR inventory and non-compliance reports.

 Epi-Pen Auto Injector Applications received from: •

None

 NYS DOH BLS Protocol Update •

None

 Other: The Office of the Council sent the following correspondence:  Agendas, Minutes and associated attachments for the meeting.  Request for nominations for officers of Medical Standards and REMAC.  REMAC Advisories distributed: •

2016-01 REMAC Advisory Termination of Prehospital Hypothermia

SUBCOMMITTEE REPORTS Medical Standards Committee (Bradley Kaufman, MD, Chair, Josef Schenker, Vice-Chair) Dr. Josef Schenker reported the following. 1. AHA ECCC Guideline changes relevant to EMS: a. Recommending compression only CPR. This cannot apply to pediatric protocols since typical pediatric arrest is respiratory based. Added second epi dose (which we already have in our protocol # 403). b. Eliminate vasopressin (503 A Ventricular Fibrillation/Pulseless Ventricular Tachycardia and 503 B Pulseless Electrical Activity (PEA)/Asystole). c. Global change: Respiratory rate for adults and children has changed to 10/minute.

THE REGIONAL EMERGENCY MEDICAL SERVICES COUNCIL OF NEW YORK CITY, INC.

MOTION #1 The following comes in the form of a seconded motion from the Medical Standards Committee: Follow AHA Guideline recommendations and (1) eliminate Vasopressin from ALS Protocols 503A and 503B, and implement recommended global respiratory rate change to 10/minute. A roll call vote was conducted, as follows: 17 in favor, 1 abstain, 0 opposed. The motion carried It was affirmed that the NYS DOH has already approved AHA recommendations. Once implemented REMAC will notify NYSDOH. 2. CPAP: Change the term CPAP to a more generic term that would include Bi-PAP was discussed. Arthur Cooper stated that use of Bi-PAP required additional training. There need to be training guidelines developed. Also discussed was making CPAP on ALS units mandatory as of 2017. It was reported that FDNY will be providing CPAP in the near future. MOTION #2 The following comes in the form of a seconded motion from the Medical Standards Committee: Change the term ‘CPAP’ to the more generic inclusive term, ‘Non Invasive Positive Pressure Ventilation (NIPPV). A roll call vote was conducted, as follows: 12 in favor, 6 abstain, 0 opposed. The motion failed

MOTION #3 The following comes in the form of a seconded motion from the Medical Standards Committee: Change CPAP from, ‘if available’ to mandatory. Effective 2017. A roll call vote was conducted, as follows: 15 in favor, 2 abstain, 1 opposed. The motion failed 3. Stroke Transports: The transport of patients with Large Vessel Occlusion (LVO) to Interventional Stroke Centers (this is a Joint Commission designation, not a State designation) was discussed. A Stroke (LVO) TAG was formed. Michael Redlener will be the Chair; other members include Jessica vanVoorhees, Kevin Munjal, Michael Guttenberg, and David Ben-Eli.

REGIONAL COUNCIL UPDATE Dr. Langsam reported that the Regional Emergency Medical Services Council of New York City met on January 26, 2016 at the offices of the GNYHA. A water main break at our usual location prevented holding a meeting there. Thanks to Greater NY Hospital Association for allowing us to meet at their offices. The following is a meeting summary: •

Elections were held: The following were recommended for appointment as At Large members beginning November 17, 2015: o o o o

Joseph A. DeMorato, EMT-P Rachel E. Freier, EMT Mitchell S. Powell, EMT-P Vincent Barranco, EMT-P

THE REGIONAL EMERGENCY MEDICAL SERVICES COUNCIL OF NEW YORK CITY, INC. o Mordechai Lax, EMT-P Member’s terms are for four (4) years, ending June 30, 2019. The following were recommended for appointment as Officers beginning November 17, 2015: o Yedidyah Langsam, PhD, EMT-P, Chair o Robert Crupi, MD, 1st Vice Chair o Christopher Legaz, EMT, 2nd Vice Chair o Vincent Barranco, EMT-P, Secretary o Mordechai Lax, EMT-P, Parliamentarian Officer’s terms are for two (2) years, ending June 30, 2017. •

MTA-Metro North Railroad BLS First Response Application approved.

•

Davis Training Center was approved as a BLS Course Sponsor Training Center in Queens (Rockaways).

•

Transfer of Operating Authority approved for: o New York Hospital Medical Center of Queens (7302) to New York Presbyterian/Queens

Dr. Langsam added that there was a significant challenge to the elections at this meeting. If we had not adhered to quorum rules, we could have been overturned. The next meeting of the Regional EMS Council of NYC will be held on Tuesday, March 29, 2016. JOINT REMSCO/REMAC QA COMMITTEE UPDATE (JOSEPH SCHENKER, MD, CHAIR) Dr. Schenker reported that the Joint Regional Emergency Medical Services Council/Regional Emergency Medical Advisory Committee (REMAC) Quality Improvement Committee met on February 9, 2016. The following is a summary: • Kevin Munjal gave a report on the status of the Community Paramedicine Project at Mount Sinai • The 10 question Trauma Survey has been developed and was revised. It was based on ACS and CDC trauma criteria. It will be posted on the REMSCO website soon. All participants will receive CME and be entered into a drawing for a $100 gift certificate. • Medical Director Requirements were revised. o Reviewed by QA Committee 02-09-2016: All requirements deemed appropriate and not onerous. o Medical Director Requirements will be assessed when ALS Agency recertifies. Agency will be responsible to provide all information needed. If requirements not met, ALS agency will receive a 30-day warning letter, then suspension. o Recommend this becomes effective July 1, 2016. • C&C Reported that the following are problem areas in testing: o CPAP o Smoke Inhalation o Sedation for Synchronized cardioversion o Excited Delirium • It was reported that exam questions are written by C&C members, and reviewed by C&C members. QA members questioned how is validity tested?

THE REGIONAL EMERGENCY MEDICAL SERVICES COUNCIL OF NEW YORK CITY, INC. •

QA Committee stated that it must receive actual exam questions for review, not exam outcomes. Possibility of have a test designer review exam was discussed.

REMAC discussed the Medical Director Standards. Copies were emailed to all members prior to this meeting. It was suggested that these standards be published prior to vote. Other members stated the document has been distributed multiple times, and that its contents are consistent with ABEM, etc. Everyone has had ample time to review.

MOTION #4 The following comes in the form of a seconded motion from the Joint QA Committee: Approve the Medical Director Standards, with an implementation date to begin July 1st, 2016, with a final date of July 1, 2019. A roll call vote was conducted, as follows: 15 in favor, 2 abstain, 1 opposed. The motion carried. The next meeting of the Joint REMSCO/REMAC Quality Improvement Committee will be held on Tuesday, March 8, 2016. STATE EMS COUNCIL/SEMAC UPDATE (Yedidyah Langsam, PhD) The State Emergency Medical Advisory Committee (SEMAC) will meet on March 1 & 2, 2016.

UNFINISHED BUSINESS No Unfinished Business.

NEW BUSINESS No New Business.

The meeting adjourned at 7:30pm. The next meeting of the REMAC Committee will be held on March 22, 2016.