GETAC Executive Summary
February 2015
Disaster
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TDMS Report - tabled
EMTF Report - introduced Joe Palfini as the interim SCO EMTF Coordinator; Victor Wells was promoted to the
STRAC IT Manager
AMBUS Workgroup Update - working on NICU transport guidelines; pushing the DPS Driver Course;
Ops - reviewed the 2015 goals; each region have 2 Type III teams; matrix of outcomes;
Air Medical - most of the services have signed the MOA but the fixed wing providers still owe some information
Update on EMTF trainings (information may be found at www.emtf-7.org
Infectious Disease Response Team (IDRU) - "high consequence infectious disease”; still a concept at this point;
CDC is looking for a national contract for movement of infectious disease; only UTMB can take these patients
but only up to 2 adults; will request a “task force” to work on this issue through the EMTF system; Chief Kidd is
going to push hard for RACs to be at every DDC across the State; need agreements on what information should
be shared in these types of information;
Ebola/Infectious Disease Response Summary - tabled
Discussion of RHMOC’s - tabled
Legislative Update - working on a rider for direct funding to EMTF; SB538 for quarantine changes; Darrel Pile
reported that DSHS GR may be used to keep Tobacco contracts whole; 50 cents per Texan for RACs
May GETAC get moved to TDEM in San Antonio - MOTION APPROVED
Stroke (no quorum)
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The use of the Brian Attack Coalition standards was approved and will be used for Level III Stroke Ready
designation.
Rider 97 Report - Data from 22 hospitals; Oct 2008 to June 2014 from Mission Lifeline; 67.3% ischemic; 30,096
strokes, average age 67.9; 51.3% female; 34% transported POV; 42.4% tPA within 60 minutes of arrival at
hospital; 93.4% of eligible stroke patients received tPA within 3 hours of last known well
CVD Council is championing Rider 73
Stroke Education Workgroup - meeting with EMS and Medical Directors and will report back to Stroke in May;
regarding stroke specific CEs
Transport Bypass Workgroup report (Dr. George Cravens) - need to get large vessel occlusion to Comprehensive
vs Primary (endo vs. tPA only) in the appropriate timing; not sure that all stroke transport plan
MR CLEAN (Multicenter Randomized Clinical trial of Endovascular treatment for Acute Ischemic stroke in the
Netherlands) by Dr. Paul Hansen (HCA - North Central Texas) - length of clot directly relates to the success rate
of tPA; last week 4 separate trials were published which came down heavily on the use of tPA; 1 out of 3 were
independent (mRS greater than or equal to 2) with endo+tPA, just tPA is 1 out of 5, within 6 hours of onset;
add endo not replace tPA; SWIFT PRIM trial - 50% better with both versus just tPA; ESCAPE trial to improve
time to treat - imaging to groin less than 60 minutes & imaging to reperfusion less than 90 minutes; EXTEND IA
trial if selected correctly then patients will do better with both
Recommendation for standalone EDs get special circumstances for stroke designation - I noted that this may
cause a problem with rural hospitals
Recommendation for the adding uptime requirements to stroke center designation
General public comments - Wendy Segrest (AHA) commented on the current rider and doesn’t line up with
strategies and wants more money; April 29-May 1 for Stroke Coordinators in Houston (same as Denver)
Injury Prevention
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CFRT Update - Drowning Prevention workgroup has been meeting and expect to have funding to disburse
March 30-31 Injury Conference??
Trauma Registry - will look at data annually instead of quarterly
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Injury Prevention website
Houston - April 24 - Workgroup meeting
Air Medical
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EMS-C update from Sam Vance - recognition program is a little on hold because of cost for the decals; requested
a list of air medical equipment to be added to list
MOA & EMTF - tabled; waiting on rates from air providers; Eric Epley more concerned about legislative funding
Air Medical components to be part of disaster response - MIST, ASM, and ASTL - Eric Epley workgroup that
hasn’t met yet
Interstate EMS COMPAC agreements (REPLICA) - national movement for pre-disaster deployment of EMS; no
bill filed yet but will need it in order for Texas to move forward; first 10 states will be the Board of the COMPAC
Registry Workgroup Update - accept XML format from hospitals; NEMSIS in April-ish, looking for a 5-year
moratorium on changes in NEMSIS to allow catch-up; better communication between Registry staff and
stakeholders
Run sheet issue - tabled to next meeting
TETAF
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Division Reports
o Acute Care - met with Dr Rutledge of the CVD Council
o EMS - EMS data management course on May 7th
o Education - February 26-27 Injury Prevention Conference; ATS training on Trauma Survivor’s Network
o Prevention - TIPS course in August; statewide prevention for Just Drive campaign, report is ready from
Texas Tech but not available; ATS focus is 3D - Drugs & Drinking, Distraction, & Drowsiness
o Pediatric - child abuse e-codes from State Registry will be discussed on future calls; NICU & PICU beds
availability issue in NCTTRAC
o RAC - funding to RACs; Day at the Capital
o Trauma - burn protocols ready and asked to have the MD WG of GETAC Trauma to review before
release
TETAF Update - Day at the Capital; testifying on House Subcommittee on Article II - RACs, Trauma - asked to
come speak to Senate Finance as well; THAC; getting which Riders will be issued on our funding and closing the
Tobacco funding (RACs will be whole using GR); submitted NICU designation documentation;
Treasurer’s Report - December 2014 - $41,717.68 over budget , net income $8678.68; YTD $44,066.20, YTD
$,826.02 over budget - financials approved
Secretary’s Report - minutes approved
Strategic Planning - Board met last night; table restructure, focus on legislative initiatives; Board elections; visits
with each RAC Board to discuss priorities for TETAF; develop goals; possible bylaws revisions; potential
restructuring of Board
Open discussion - diversion issue (sending any guidelines from facility and/or regional level); ATS Chapter
established in North Texas in 1988 as part of TETAF (Articles of Inc exist)
EMS Education
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Stroke CE - will develop a workgroup to discuss recommendation for how this request may work and look like
Communicable diseases - will continue to discuss and find best practices
EMS Educator Summit 2015 - Corpus Christi - specifics topics important or needed information for Educators
specifically; DSHS will present; April 10 - 11; contact Kelley Harrell with questions
Advanced Practice Paramedic/Community Health Paramedic - 1) purpose to reduce the occurrence 2) target
audience should be high level paramedic but scope of practice is directed by Medical Director 2) need more
partners: LTAC, hospitals, clinics, DME, etc. - April 24th conference on this subject
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General Comment - promotion on the Community Paramedicine in Dallas on April 24th, need to set a bar for the
advanced practice; EMS Conference in Dallas in November; Administrator of Record (AOR) course June 3-4 in
San Antonio, August, November;
Next meeting - April 9, 1-5p in Corpus Christi with the EMS Educator Conference
EMS
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Ebola - Joe Schmider updated that the Feds are working on an Ebola AAR at that level, emphasized the correct
infectious disease protocols established (laziness); Dudley Wait updated what the Disaster Committee was
working on
Status of 157 - will be March 5 & 25
Air Medical Bypass of 9-1-1system - STRAC developed a letter to help with this issue; asked to poll the RACs if
any issues were elevated to that level
NCTTRAC pilot report - electronic report status to meet the information requirement 157.11, DSHS gave
their “blessing”
LPG update - submitted award recommendations to HHSC; done by the end of this week but up to two weeks;
contract starts the beginning March 1st and end August 31st; DSHS will no longer be the Program Manager of
this grant; 2016 LPG RFP will be posted at the beginning of April
Interstate Issue - see Air Medical
EMS-C update
EMTF update - see Disaster
Registry Presentation (Dr Drucker & Dr Patel) - only 65% of 2013 EMS call type data is considered valid; 59% of
2013 EMS cause of injury data is considered valid; NEED VALID DATA; update to NEMSIS V3 may help with
some of the validity; Texas expects to be NEMSIS certified in 4-6 weeks (April at the earliest); DSHS w/ TETAF
doing EMS Data Management Course, May 1st at Crowne Plaza; Chapter Rule 103.5 requirements for reporting
to registry; all emails are cleared out daily
General Comment - DSHS updated on provider surveys 189 surveys in FY14 and 65 surveys in FY15, new
checklist because of changes in 157.11(m) - SB8, scheduled in advance, will do a FAQ in the April Texas EMS
newsletter, expect to do them once every three years, will use customer satisfaction surveys; HB1547 reworks
how EFFs will function
EMS Medical Directors
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Required Stroke CEs – Medical Directors support improving stroke outcomes by training but do not want a
specific number of stroke CE hours dictated in Rule 157. Suggested to focus on a data driven PI base for training
Medical control state to state - error on the side of the patient
Position statement on mental health and EMS - Dr Moore will chair a workgroup
Positions statement on the over use for inter facility transfers of air vs ground
Registry Update - NEMSIS V3.4 should be completed in April; trauma continuum of care is in its infancy;
C-spine Restrictions Position Statement - article will be endorsed at GETAC but sample guidelines are still
needed; noted it does cause an issue with receiving ED nurses; Joe Schmider asked about whether it should be
called “cleared” or assessment
Letters from municipalities for EMS service levels (SB8) - municipalities need to assess their individual EMS
needs prior to establishing/hiring an EMS services
Pediatric Transfer and Transport Guidelines - developed by the Pediatric Committee workgroup; add all pediatric
capable facilities by designation and TSA, change the use of POV for non-critical pediatrics
Advanced Paramedicine - tabled
Narcan administration without prescription - tabled
Recommendations on gaps between statutes effecting EMS Medical Directors - tabled
Interstate COMPAC (REPLICA) - see Air Medical
GETAC Strategic Plan - draft will be available tomorrow
Reviewed accomplishments since 2006
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General Comments - DSHS can identify all EMS Medical Director but there is no email list (TMB gets update
from DSHS); SB538 - infectious disease emergencies, Commissioner of Health responsible to manage all “ESF8”
in a declared disaster; online EMS Medical Directors course reminder
Trauma
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Review of Registry Data (get copy from Lori) - 578 hospitals; 19,033 non-designated (16%); $4.4 billion in
trauma; 3000 died in hospitals that met registry criteria; 2013 - 2.69% death rate; Falls #1 & MVC #2 for injury
and death;
Rule 157 Update - March meetings for EMS and follow with other meetings after that and prior to GETAC
GETAC Strategic Plan - tabled
Trauma Registry Workgroup Update - user guide is almost available; discussed the difference between required
versus mandatory; NEMSIS V3 is not quite ready for testing, expect certification by April ; 2014 NTDB upgraded
data dictionary the late month of January; can now receive XML from hospitals validation is not done at this
point but is a high priority; Trauma Committee requested a list of “parent” questions at next meeting; freestanding
ED are NOT required nor have the statutory ability to enter their into the registry; Texas specific elements still
needs some work but should be ready by April; data validity for hospital condition on discharge is 73% valid
Trauma Medical Director Workgroup - trauma PI templates and forms until the new taxonomy; TBI and ortho
guidelines as part of TQIP; imaging data for Telemed
Non-physician Provider Workgroup - tabled as Kelly Stowell was unable to attend
RAC Workgroup - have RAC report to Trauma Systems; update on progress of activities & accomplishments
including barriers; A-H in May, I-N in August, O-V November for the last 18 months
Trauma Registrars Workgroup - tabled due to Irene Lopez unable to attend
EMR Workgroup - a draft white paper on EMR implementation for the full care of a trauma patients has been
completed
Pediatric Trauma Coding - child abuse e-codes; using assault vs e-codes; working with Erin from DSHS Registry;
Society of Trauma Nurses has training
Impact of Alcohol Workgroup - tabled, no update
Trauma Center designation for specialty services only - Jane Guerrero with DSHS was clear that rules designate a
facility not just a service
Partner Feedback Reports
o ACS - focus on new PI standards and orange book (it is ready for purchase); orange book starts July 1,
2015; prehospital very important piece to Level I Trauma PI
o EMS - data validation; request for registry report must be precise and takes 10 days to receive
o RAC Chairs - no update
o TTCF - Day at Capital May 10th on Trauma Education Course; May 11th meeting will be 8 hours; TIPS
on August 16th
o ENA - no update
o Pediatrics - NICU/PICU availability in NCTTRAC issue
o Level IV - no update
o Level III - not receiving timely feedback or no feedback from Level II & I
o Level II - reviewed several feedback mechanisms and will come up with a number of specific elements to
provide in feedback and define timely and how; BSW-Memorial has developed an EMS feedback form;
HOTRAC polling EMS for what feedback they want; Austin are all part of HIE
o Level I - TQIP (14 hospitals); hired a contract person; TOPIC course on Wednesday; would it be good to
have taxonomy; did a Trauma Survivors course
o Injury Prevention - hospital-based injury program; approved at November GETAC; available on website;
15 question evaluation (paper & online) planned for May, August, and May 2016 meetings
TETAF - introduced Courtney DeBower; Trauma Day at the Capital; Article II testimony this week; working with
DRP - Rep Turner all trauma funding appropriated; reviewed upcoming training
Trauma Registry Update - Hospital Data Management has one rep from each TSA; June 11-12 AAAM AIS
General Comment - Dr Gandhi want to have insurance require $250,000 as minimum; Lori Boyett to discuss
EMS run sheets; people against “special” designation
Cardiac
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AHA ACTION Update - 134 hospitals participating in Texas; 50 in CVD data collection; 3rd quarter report have
dropped (not a 3rd quarter State report due to funding from DSHS); new data fields added
STEMI CVD Collection - 44 participating in the Oct 2008-June 2104; 27,568; 59.8% POV; FMC to EKG 28%
did not get 10 min; 35% did not get EKG in 10 min in hospital; 77% by POV EKG in 10 min for 2nd qtr 2014;
FMC to PCI Nation - 80 min, TX - 41-121 min adv 76 minutes; PCI within 90 94.3% - median 60 min; 194
PCI transfer from hospital 45.5 min at transferring; fibrinolytics plus PCI
Carruth I & II Update (Wendy Segrest - AHA) - Dallas County - 15 hospitals and 24 EMS agencies; preactivation
from 5 minutes to 21 minutes saved at hospital; “Don’t Die of Doubt. Trust 9-1-1.” - 32 participating hospitals as
well as 32 EMS agencies for this campaign; materials aren’t available until Carruth II over 12/31/16
RAC Chair
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3588 - $643M to hospitals; 297 eligible actually submitted application for FY15; late April to early May
1131/911 - $603,000/$326,000 and FY15 will be disbursed in September 2015
EFFs - received 4 and 1 approved for $39,788
ECATs - 2 pending approval for start dates; left $18,298
LPGs - see EMS above - 112 applications; Roslynn is new Project Manager; beginning 3/1/15 but still ends
8/31/15; final award 10-15 days after tentative award; FY16 should be posted by first of April with start October
1st
Indra will email out the contracting document flow chart
all EMS and RAC funding not used rolls to hospitals
Alicia Babbin (budget specialist) is a friend to RACs in HHSC
Expect FY15 EMS/County & EMS/RAC are expected to start 5/1/14
No update at this point about electronic submission of reporting
Linda Reyes is retiring at the end of March
Rule 157 Update - EMS Stakeholder March 5 and 25 at ITT building then trauma pieces prior to GETAC; plan to
have a separate discussion for RAC Rule 157.122 & 157.123
Perinatal Regions - Perinatal Council against aligning with TSAs; but no additional funding for DSHS or to start
new RACs; feel like they would get lost in trauma - about 250 have to be designated by Sept 2017
Trauma Registry Update - Hospital Data Management, February 26th, 22 RAC representatives; EMS Data
Management, May 7th, RACs to designate our representative; June 11-12 AIS has 71 spots, 22 RACs and 49
Level III Trauma Coordinators (3 more Level III’s than the grant was written); will work with RACs to get them
included; communication when registry is unavailable or upgraded has been better
EMS Compliance Update - feel free to invite our EMS Specialists
RAC Meeting Restructure for February and August RAC Chair Meetings - May & November are MANDATORY
for RAC Chairs - Jorie Klein: pushing PI and data, reported on the RAC tasking from Trauma Systems;
TETAF Restructuring Process Update - Jorie outlined the TETAF plan for moving forward; wanted to know if
any RAC wanted a TETAF visit from end of June to end of July
I requested a May update about sunset if any is known
Lori Boyett - asked if others are having issues with public health and ESF8; El Paso, San Antonio, Houston, and
Metroplex agreed
Dudley Wait - air medical bypass of ground/9-1-1; mainly oil field/industry
Scott Christopher - thanked Darrell Pile for his testimony
Matt Baker - asked if anyone was transporting patient via EMS to freestanding EDs; most all don’t to true
freestanding but do to satellites
Dave Reimer - asked if regions are having conversations about numbers of Level I's and II’s; Metroplex is; Dr
Wenschel chairs ACS Trauma Committee and that more Level II’s are coming and in the future RACs may be
asked to do this
GETAC
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Assistant Commissioner Kathy Perkins Report - Schwertner SB about “ Mahmood” issue with freestanding ED
SB425 Schwertner; SB219 sunset, cleanup of statutes, inconsistencies; program sunset bill has not been filed yet
and is hard to pass - permanent location for EMS, ownership/lease equipment, jurisprudence exam, enforcement
based on another governmental inspections; March13th final bill filing; sunset bill to consolidate all with HHSC
has not been filed yet; HHSC has RAC wordings; Texas EMS magazine has an article about run sheet issue;
DSHS contact list will be available on the website; EMS surveys; customer service improvement; 200 less EMS
providers due to fraud changes; down to approximately 1 new app per month - CMS/MCR moratorium has been
renewed in the Houston and surrounding counties; CMS requirements for hospital for Ebola and just issued a Q &
A document outlining EMTALA; HB15 requirements for perinatal is almost done with NICU, PAC need to have
a system/RAC, Kathy will recommend current RAC structure to the DSHS Council, formal rules will take about a
year
State OEMS/Trauma Director Jane Guerrero Report; 285 designated trauma centers, 11 in active pursuit (295
were eligible and all applied); 134 stroke designated center, 12 Comprehensive; general funding update (see RAC
Chairs); beginning stakeholder meetings for Rule revisions stakeholder process with EMS starting in March;
GETAC May 13-15 at Crowne
Assistant Commissioner Epi John Villanacci (Jana Sutherland) - contracted with TETAF for the data management
training; registry team will visit RACs as needed, if wish to have a visit contact Dr. Chris Drucker; XML is now
accepted and provides a “received” report; NEMSIS expected soon
o Trauma Registry Report (Dr. Drucker) - provided a review of history that lead to current; (50% provider
report) EMS records are increasing from 2007 1.6 million to present 2.7 million and more providers are
meeting the 90 day requirement; prehospital time median is just under 50 minutes; response time is 9
minutes median, on scene 16 minutes median, transport time is 14 minutes median; case fatality rate is
2.9% for 2013 and nationally 4.6%
Assistant Commissioner Dave Gruber Report - not in attendance
Preparedness Coordinating Council - Eddy Olivarez (Hidalgo County PHD) is new Chair, DSHS Ebola AAR
Committee Reports and ACTION Items
o Disaster Committee will meet in San Antonio in May due to TDEM Conference; requested that GETAC
consider moving to San Antonio
o ACTION - Cardiac recommendation for STEMI to be listed as a reportable disease - tabled to May asked for a position statement
o ACTION - EMS Stroke CEs - tabled for more discussion in May
o EMS asked for a joint workgroup to discuss the 9-1-1 bypass by air medial - Approved - will report back
in May
o ACTION - Sharing patients outcomes with EMS - tabled
o ACTION - Endorse position paper on transfer of Patient Care between EMS and Receiving Facilities APPROVED
o ACTION - Pediatric Transfer Guidelines - tabled
o ACTION - Freestanding ED designation - in order to make this happen, it will take a legislative changed
o Trauma Systems - Jorie Klein requested to appoint a Vice Chair. Approved and she appointed Dr. Brian
Eastridge
TETAF - explained the legislative update; noted the DRP; 50 cents per Texan for RACs; Tobacco corpus
EMS-C update - nothing to report but will have a presentation in May.
left at 11:48