SCR 40
EMS PROFESSIONAL WORKING GROUP
MINUTES
DATE: September 8, 2011
LOCATION: 628 N. 4th Street, Baton Rouge, LA
START TIME: 1:00pm
I.
Roll Call
Members:
P/A
Name
Nancy Bourgeis
P
Donna Newchurch
P
Susan Bailey
P
Butch Browning
CC
Robert Daughdril
P
Steve Erwin
P
Eileen Mederos
P
Stephen Phillipe
P
Kassi Tyler
P
Rosanne Prats
P
Merrick Tassin
CC
Clayton Williams
CC
James Wood
A
Sub-Committee Members:
P/A
Name
Kenny Salzer
A
Alan Lambert
P
Evon Smith
P
Stakeholder Attendees:
P/A
Name
Jode Burkett
A
Michelle Perry
P
Jimmy Guidry
P
Ken Roussell
P
Lauri Scivicque
P
David Marcus
P
Mark Majors
P
Katherine Kitchen
P
II.
III.
Old Business
A.
None
Sub-Committee reports
END TIME: 3:30pm
Title
Chair
Vice-Chair
Administrative Tasks
Advisory Capacity
Advisory Capacity
Title
Advisory Capacity
Title
Representing Jode
Burkett
Representation
La ACEP
LAA
LANREMT
Fire Marshall
LANREMT
Amb. Standards EMS Task Force
LERN
BEMS
La State Firemen’s Association
Director of Emer. Prep.
La Fire Chief’s Association
DHH Under Secretary
EMS Certification Commission
Representation
Fire Department
BEMS
Office of Emer. Preparedness
Representation
DHH
DHH
State Health Officer
Region 3 DRC
Region 2 DRC
Region 9 DRC
Region 6 DRC
DHH
A.
Objective #1 – Alan Lambert
1. The models that describe the National Changes are: Agenda for the Future 1996;
EMS Education Agenda for the Future 2000; National Scope of Practice Model
2007; National Education Standards 2007; National Transition Toolkit 2011
2. 1231
a. Change certified to licensed, certification to licensure
b. Define licensure
c. Adopted National Scope of Practice designations
1. EMR, EMT, AEMT and Paramedic
d. EMS Medical Director (suggestions)
e. EMS Student (pending)
f. Added “adopt and amend the title and definition of a licensed emergency
medical technician or licensed emergency medical responder” allow this to
be done by rule versus statutory change in the future
3. 1232 Training and Certification
a. Change training to education
b. Personnel to professionals
c. Add “D” Define “EMS Student” and add generic functions a student may
perform (pending)
4. 1232.2 Certification Commission
a. Certify versus licensure changes
5. 1232.3 Commission Duties
a. Certify versus licensure
b. Changed “standards of practice” to “scope of practice”
c. Changed titles and deleted reference to DOT
6. 1232.4 Bureau Duties
a. Certify versus licensure
b. Add recommend changes in scope of practice to the Commission (pending)
possible conflict in 1232.3?
7. 1232.5-1232.11
a. Certify to licensure
b. EMS personnel to EMS professionals
c. 1232.6 grounds for disciplinary proceedings – add “intentional falsification of
any document related to certification recertification, EMS education or related
to the care of a patient”
8. 1233 Civil Immunity
a. Personnel to professionals
b. “D” add EMS student (pending)
9. 1234 Duties of EMS Personnel
a. Combined all 4 levels used generic EMS professional
b. Changed “rescue, first aid, resuscitation… to “services, treatments and
procedures consistent with national education standards adopted by the
bureau…”
c. Take out reference to students – section will be added to 1232
d. Combined the “three functions” into one paragraph
e. Changed language to: “while he is caring for a patient in a clinical setting”;
“under a protocol that has been approved by the local parish medical society
or a medical director”
f. Deleted “at the earliest possible time” (pending)
g. Changes to “H” to reflect previous changes
10. 1235 EMS Transportation
B.
a. Certify versus license changes
11. 1235.1
a. Add “EMS Student” to 1235.1 A(2) pending
12. 1232.6
a. Certify versus licensure
b. Delete this second or change title
Objective #2 – Donna Newchurch
1. Every time the word Bureau appears in the statute, we will have to go back and
revisit after the full Emergency Working Group makes a recommendation as to
location of the Bureau of EMS or whatever it “becomes.”
2. Two classes of changes
a. Items the committee feels must be addressed
b. Items the committee can “live” with the language as is but if an opportunity to
make changes is available, then changes should be made
3. Items to create and/or secure
a. A cross walk document specific to each commission, task force, committee in
RS 40 (i.e., the task force does this and is composed of these individuals; the
commission does this and is composed of these individuals; the ambulance
standards committee does this and is composed of these individuals, etc.)
4. General consensus Items
a. The Bureau of EMS or whatever it “becomes” must retain rule promulgation
authority
b. Immunity from civil damages (RS 1231.2 or some version of thereof) must
remain
c. Language specific to educational requirements will not be discussed in depth
but rather deferred to the expertise of subgroup #1
d. Fee structure cannot be discussed or recommended until staffing structure for
the Bureau of EMS or whatever it “becomes” has been recommended by the
full working group
e. Every time the word “instructor” appears in the statute, it should be replaced
with educator
f. Every time “standards” of practice appears in the statute, it should be
replaced with “scope” of practice
g. Consider changing “personnel” to “professional” when it is specific to EMS
professionals
h. Consider changing “certified” to “licensed” in every instance
i. Staffing chart
1. Staff will be needed to support the Commission
2. Staff will be needed to complete licensure requirements/renewals
3. Staff will be necessary to support website functions (on-line renewals,
registrations, etc.)
4. Staff (lawyer?) will be necessary to perform certain functions (like
obtaining injunctions)
5. Group discussion about the adoption of statewide protocols; not a
recommendation for this but rather a recommendation to discuss this
6. Specific language recommendations
a. Section 1232.2 (Page 11)
1. The commission was created under the Foster administration and was
designed so there would be not fiscal note
2. Composition of the commission needs to be more representative of EMS;
perhaps less physicians?
C.
3. EMS owners/administrators appreciated and needed the function of the
Commission; to act as impartial “enforcer”
4. Review and make sure there are no scope of practice discrepancies with
other sections
b. Section 1232.4 (page 14): line 431
1. Strike everything after renewal as and add “an emergency medical
services professional
c. Section 1232.5 (page 15)
1. Discussion on whether or not to change the wording but recommendation
to leave as is
d. Section 1232.6 (page 16)
1. Definition of moral turpitude?
e. Section 1232.7 (page 17)
1. This language was based on the state board of nursing model
2. Section B came from DHH legal
3. No recommended changes
f. Section 1232.8 (page 19)
1. Currently DHH legal counsel performs this function. If BEMS moves out of
DHH, who will do this function?
g. Section 1232.9 (page 20)
1. #7 (line 577) is potentially impossible if we change language, etc.
2. The policy manual needs to be reviewed and changed to support changes
h. Section 1232.10 (page 21)
1. Authority to promulgate where the money goes needs to be included
2. Example: “to receive funds, development of escrow accounts, etc.”
3. Where does the money identified in line 591 currently go?
i. Section 1233 (page 23-24)
1. This language must stay
2. Add language identified by subcommittee #1
j. Section 1234 (page 25-28)
1. Add language identified by subcommittee #1
2. Revisit section H with Dr. Guidry, Dr. Davis and other physicians (page 28)
3. Revisit section I with State Medical Society to see if the committee defined
in the statute still exists (page 28)
k. Section 1234.1 (page 29)
1. Need information possibly from Steve Erwin
Objective #3 – Roseanne Pratts
1. Where could the Bureau of EMS lie? Nine possible options
a. Embedded under Office of Public Health
1. Pros
a. Wrap-around services of budget, HR, IT office space, office
equipment/tagging
b. Access to legal department for advice, staffing, and can execute
injunctions when needed
c. Access to legislative workings of the department
d. Placement of OPH fosters interface with critical industry
e. As OPH has a large budget comparative to other DHH Offices, some
budgeting can be absorbed by the entire office
2. Cons
b.
c.
d.
e.
f.
a. Most OPH costs are covered by the Preventative health Block Grant
(including EMS); hence, a federal decrease to funding to this program
will inevitably impact all program including EMS
b. Rick of being “lost” in priority while competing with all the programs
within OPH
Embedded under Health Standards Section
1. Pros
a. Same as #1
b. Regulatory nature of HSS for ambulances will provide more (perceived)
authority of BEMS regulatory authorities relative to EMS Professionals
2. Cons
a. HSS funding stream is state general funds; hence, a budget decrease of
funding to HSS will inevitably impact BEMS
b. HSS corporate culture is perceived more as a regulatory agency not
necessarily public partnering and outreach/education oriented. The
corporate Culture of BEMS is based on education and outreach with
Ambulance Services and EMS Professionals
Embedded under Leadership Level at DHH
1. Pros
a. Perception that BEMS is at the top of the food chain with direct access to
health care leadership
2. Cons
a. No state general funding at the Department level
b. Limited access to wrap-around services
Stand-Alone Quasi Public Private Entity
1. Pros
a. Greater flexibility on hiring/firing; budgeting; prioritizing
2. Cons
a. As a stand-alone entity they would have to find funding for all wrap
around services to include office space/lease, office equipment,
supplies, HR, IT, telephones, services
b. Budget would be dictated by what could be raised in fees or grants or
other mechanisms (taxes)
Embedded under Quasi Public/Private Entity of LERN
1. Pros
a. Better interface between Pre-hospital and hospital with regard to
system approach
b. With BEMS and LERN together, there may be a perceived ability to
leverage common needs and better obtain funding
2. Cons
a. Possible financial burden to LERN; there may not be enough money for
both LERN and BEMS; would need to seek additional funds
Embedded under the Office of the Fire Marshall
1. Pros
a. An indirect “pro” is that fire based services have a better ability to
access fire administration funding; grants; and local fees – which may
or may not result in the ability to obtain higher fees for certification to
support BEMS
b. Perceived to have robust ability to influence the legislature
2. Cons
a. Removal from healthcare arena; not all “fire providers” are medically
cross trained
b. Access to legal department with a background related to healthcare
and delivery of services
g. Stand-alone Office under Public Safety
1. Pros
2. Cons
h. Stand-alone Entity
1. Pros – see #4
2. Cons – see #4
i. Stand-alone Entity embedded under GOHSEP
1. Pros – see #1
2. Cons – see #1
2. What are the critical Stakeholders that BEMS interfaces with on a daily basis? On
a disaster basis?
a. Daily Basis
1. OPH Program
b. During a Disaster
1. OPH CCP
2. Fire Marshall
3. DHH/EP
3. What are the grants/funding streams that may be affected by re-locating BEMS?
a. BEMS is a recipient of the following federal funds
1. HRSA: Trauma/Stroke Program
2. HRSA: AED Grant
3. HRSA: EMS for Children
b. BEMS is a sub recipient of grant funds as they are embedded with OPH
1. Preventative block grant (federal cuts)
c. BEMS is a sub recipient of grant funds as they are embedded with DHH
1. Hospital preparedness Program Grant Funds
d. Unintended Affect
1. BEMS may risk losing grant funds for Preventative Block Grant and HPP
Grant if not embedded within OPH or DHH
4. What is the Current, Intermediate, and Future Structure of BEMS?
a. Future Structure – Based on National Model
1. Cabinet level department head
2. State EMS Director
a. Regulatory Staff Manager
1. Licensing Agents
2. Education Certification Staff
3. Inspectors
b. Operations and Technical Assistance Staff Manager
1. PIER Staff
2. Training and Education Staff
3. disaster Preparedness/Mass Casualty Care Staff
4. Specialty System of Care Managers
a. Burns
b. Cardiac
c. Trauma
d. Cardiac
e. EMSC
III.
IV.
5. Information Communications Technology Staff
6. PI Staff
3. State EMSS body (advisory)
a. Committee A – System Plan
b. Committee B – Training/Education
c. Committee C – Regulatory Oversight
d. Committee D – PIER
e. Committee E – disaster preparedness/mass casualty care
f. Other Committees
4. State EMSS Medical Director
a. State EMSS Medical Committee
2. Regional Medical Committees & Regional Support Agencies
3. Trauma Advisory Committee
a. Regional Committees
4. Other Specialty Systems of Care Committees
a. Regional Committees
5. EMSC Advisory Committee
a. Regional Committees
6. Cardiac Care Advisory Committee
a. Regional Committees
b. Current Structure
1. Cabinet level department head
2. State EMSS Director
a. Regulatory Staff Manager
1. Licensing Agents
2. Education Certification Staff
b. EMSC Advisory Committee
c. Training and Education Staff
d. CDC Funded Disaster Preparedness/Mass Casualty Care Staff
1. HPP Grant Manager – Disaster Preparedness
c. Intermediate Structure – To be determined
5. Discussion:
a. Objective #3 – Governor’s office of EMS is another suggestion to where BEMS
could be embedded.
b. Objective #2 – 1234.1 states that the person/entity responsible for a haz mat spill
and ambulance stand-by is needed, will receive a bill.
New Business
A. Tasks for next month
1. Steve Erwin – detail information clarifying Health Standards information, determine
if other states the size of Louisiana have paid staff or if they contract duties out
2. Butch Browning – detail information clarifying Fire Marshall/State Police information
3. Discuss adoption of statewide minimal protocols
Other Business
A.
October 13 – Fire Marshall’s Office, 8181 Independence Blvd., Baton Rouge, LA
70806
When entering the main entrance of the LSP Compound go to the end and take a
right at the stop sign. Take the first right and the Fire Marshall’s Office is the twostory building on the left
B.
Conference Call information
Dial in: 1-888-398-2342
Access code: 9556008