GETAC Summary – August 2014
Disaster
 Showed the AMBUS video developed by San Antonio Fire’s Training Department. Video available
on the TMDS.org website. It will be posted soon to the EMTF-7.org.
 Reviewed selecting new members to the Committee. 1/3 expires annually.
 ERCOT Update was cancelled until November.
 EMTF Update (Victor Wells):
o Focusing on maintaining the program financially.
o Eric Epley provided testimony to the House Homeland Security Committee Meeting in July.
o AMBUS was set up at the Capital in August for the legislators to see as well as in the Valley.
o EMTF-11 has supported the immigrant issue since it began as a local resource.
o Best practices being shared across the State to insure all teams are equal.
o Refined the notifications list serve into one. TX EMTF Notifications.
o Air Medical MOA is in process: AEL, CareFlite, AirLife, ETMC, Reach – signed.
o 4 stations across the State monitor the EMTF MSAT channel 24/7.
o TDMS is hosting a nationwide AMBUS list serve to allow all of these operators to
communicate with all other AMBUS owners. Schertz EMS has developed a GIS map
showing where all the AMBUS are located across the Nation.
o Provided update on the Sartin closing issue.
o EMTF Task Books completed and ready for use.
o EMTF activity reporting changed to allow notices to go to key partners including the State
Operations Center.
 TDMS Update (Dr. Emily Kidd)
o Reviewing the TDMS Overview Document and will be ready for final review in September.
o Training – Justice of the Peace and Elected Official training for ESF 8.
o Resource Typing – ESF 8 teams are being typed by this workgroup (i.e., RATS, CATS, etc.).
o Mass Fatality – Teamwork Team, maintenance in a University setting a possibility. Group
needs to look at LARGE mass fatality (1000s)
o Responder Safety – medical countermeasures survey going out soon. Please take if
received.
 Currently working
 Pre-deployment screening requirements (Is this the employer’s or TDMS’s
responsibility?), change the MOA to remind employers that they are responsible
to ensure the member is “fit for duty”
 Exposure protocols
 Tracking post deployment issues such as illness, mental
 Medical & mental rehab for responders
 Crisis Standards of Care Update (Dr. Emily Kidd) – First meeting was two and one half days last
week. Priorities developed by this Committee: EMS, Hospitals, Alternate Care Sites, and State &
Local Government. These priorities will become workgroups. Anyone interested in serving on the
workgroups or knows someone who should needs to contact Bruce Clements. (Please let HOTRAC
know as well.)
 RHMOC Update (Eric Epley) – All regions has one set up and all are almost operational.
 Legislative Update (Eric Epley) – Working on core funding from the Legislature. TETAF is heading
this process.
 OPEN COMMENT – hospital reimbursements following a disaster needs to be back on the agenda
for discussion (Eric Epley); guidance to help local agencies (prehospital) prepare for their own
internal disasters - COOP (Chris Alexander – San Marcus Fire)
Pediatric
 Committee Liaison Reports
 State CFRT Update – State Coordinator position is currently vacant.
 Position paper on minimizing CT Radiation (Dr. Jose Sainz) – still in process but not sure how to
word the document finally; will be placed on the February meeting; possible additional in rules
revision.
 Pediatric Facility Recognition Program (Sally Snow) – webinars on the EMS-C website; moving
forward in Texas looking at volunteer vs. required; looking at have Pediatric Coordinators in all
hospitals in Texas; no timeline at this time; came from the National Pediatrics Readiness Project;
interested in reviewing Texas specific data
 EMS-C Update (Sam Vance) - will be presenting resent survey results in February; EMS
recognition program is moving forward and will have more information in November.
 Update on Pediatric Transfer Guidelines – will be placed on November agendas for review by
other committees; reviewed the document sections; will hope to get to GETAC in February
 Update EMS Clinical Guidelines Project (Sam Vance) – guidelines are consensus unless already
established by PEGASUS: pain, seizure, shock, spinal immobilization, anaphylaxis/allergic
reaction, airway management, and asthma. PEGASUS is evidence-based protocols (previously
shared) on spinal immobilization, shock, anaphylaxis, and airway management. Mr. Shah will be
presenting the PEGASUS at the EMS Conference. Publication expected July 2015.
 State of Texas Emergency Assistance Registry (STEAR) Update (Bonnie Hartstein) – information
provided by DeDe Powell – TDEM and Sharon Nalls – Houston OEM; will discuss again in
November to discuss how to utilize and get more pediatrics included; Sally Know will present
SNAPS best practice used in Ft Worth for similar information but focused on pediatrics.
o As of 8/11/14 there are 25,118 registrations
 Speaks English
20,164
 Speaks Spanish
4,583
 Speaks other language
371
 Uses sign language 414
 Visually impaired
1,417
 Has a communication barrier
3,323
 Minor
1,130
 Has a care giver
13,193
 Caregiver evacs with registrant
8,273
 Has service animal 742
 Has pets
5,664
 Needs transportation assistance 15,462
 Needs moving assistance 12,682
 Needs assistance to get to evac point
6,161
 Has functional needs
15,202
 Requires medical treatment from doctor/nurse 5,496
 Needs assistance for daily living activities
12,592
 Has provider for daily needs
7,213
 Weighs more than 350 lbs. 448
 Needs gurney/bed for transportation
4,140
 Requires O2 3,124
 Needs power for life-sustaining device
3,107
 Requires wheelchair
7,174
 Has motorized wheelchair 2,021
 Dr. Macias will continue to keep this committee updated on the quality performance metrics for
the improvement of the care of children in emergent and urgent care settings, including the use of
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system performance improvement metrics linked to pediatrics and the integration of EMS-C
performance measures.
GETAC Strategic Plan (Dr. Charles Macias) – reviewed GETACs timeline and inclusion for
completing a new one. Plans to hold a workday meeting in November/December.
Injury Prevention
 Children’s Hospital Association of Texas Child Injury Report (Bryan Sperry) - Prevalence of
unintentional accidents (12,000)- MVC highest; under 1 year of age & 15-19 years old injuries due
to MVC & suffocation. Texas higher than Nation on child deaths. Things Texas have: Safe Riders
programs, safe sleep programs, 6 Poison Control Centers in Texas; 9 Safe Kids Coalitions in Texas;
Injury-free Coalition with two websites; Little Helmets, Little Heads (TMA); Texas Drowning
Prevention Coalition; federal funds for State injury prevention programs: Title V Block Grants &
NTSC; RECOMMENDATIONS: redevelop an Injury Prevention Center at DSHS has prior to last
sunset; state level coalition of injury prevention entities; develop best practices and evidence
based injury prevention programs; increase outside partnerships; develop guidance on fall
prevention. Report available on the CHAT website.
 Keep Them STEADI (Stopping Elderly Accidents, Deaths, & Injury): Implementation of a Hospitalbased Fall Prevention Program (Courtney Edwards) – STEADI is a CDC fall prevention program. 1
of 3 older adults (65 years or older) fall each year. Parkland took the CDC’s “Stay Independent”
brochure and added questions to electronic medical records. Automatically added to order set of
elder adult to have a Physician Medicine & Rehab consult. Using the American Geriatrics Society
Beers assessment, to work to deprescribe/avoid specific medications. Increase Vitamin D
supplement to at least 800 IU upon discharge. Parkland developed a fall prevention brochure
different from CDC.
 Hospital-based Injury Prevention Program Components document – APPROVED and will be sent
to GETAC in November.
o Use data to drive injury prevention projects
o Partner with outside organizations
o Write a continuing education program for injury prevention coordinator
o Evidence informed injury prevention strategies
o Evaluate injury prevention programs
 GETAC Strategic Plan – used the Injury Prevention Spectrum to provide comments on each
section.
 OPEN COMMENT: Drowning report available on DSHS website. JPS Trauma Symposium on
October 24th, information will be on JPS website next week. GETAC Committees will be taking
nominations from September 2-30 to start January 1st. October workday meeting has been
cancelled.
Stroke
 CVD Council Update (Dr. Neal Rutledge) – RAC data collection and the Rider 97 data collections.
 Lone Star Stroke Consortium – Telemedicine in stroke care (part of Rider 97).
 DSHS Rider 97 Project Update - American College of Cardiology, Duke Clinical Research Institute,
and Outcome Sciences contracts have been executed. RACs having monthly calls. Reached out to
hospitals for cardiac data. Hospital stroke packets will go out this Friday. Cardiac data will be
sent back out to RACs and GETAC Council and Committees sometime in September.
 ‘Get With the Guidelines’ Participation for State Stroke Designation – Stroke Committee wanted to
recommend the use of ‘Get With the Guidelines’ as the preferred database. After a lot of
discussion, the Committee will look at developing data point recommendations instead of a
specific registry.
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Brian Attack Coalition (BAC) Standards for Stroke Ready Hospitals for Support Stroke Centers
Surveys – BAC representative notes that these standards are couched as part a stroke system of
care. TETAF (Brenda Putz) requests that a gap analysis between TETAF surveys and BAC
Standards. Joint Commission is working on Stroke Ready (Level III) certification in early 2015 as
well as others. APPROVED to GETAC Council in November.
EMS Stroke CE Recommendation of 4 hours – APPROVED to GETAC Council on Friday.
Transport Plan Bypass Workgroup (Dr. Craven) – Dr. Craven will be review the RAC plans and the
Committee with provides recommendations to RACs specifically on Primary vs. Comprehensive.
GETAC Trauma Registry Workgroup Update – Stroke Committee Representative has not been
invited.
Stroke Intervention – Past, Present, & Future Update (Dr. Kirk Conrad) – CDC says 1/3 of strokes
are preventable. 4th leading cause of death. Early invention has more significant improved
outcome and decrease in mortality. ADAPT (A Direct Aspiration first Pass Technique) is the most
current standard of care.
Air Medical
 Air Medical/TAAMS to be represented at EMTF - tabled
 Report on Recognition of EMS Personnel Licensure CompAct (REPLICA) (Joe Smeeder)– Home
States have to have the ability to investigate complaints, notify National Registry, and ????. Agree
to share adverse event reports to the Commission and the State Legislature has to adopt (pass
law) to participate. To go to Remote State, must be 18 years old and operate under their normal
Medical Director. This CompAct does not affect EMAC. Expects this CompAct to help with distance
learning. Joe will be attending next National EMS Director meeting in October.
 Trauma Registry Workgroup Update (Traci Fox) – Working on reports but some concern on EMS
proprietary information such as number of calls.
 Rule Revisions 157 – nothing to discuss, just a placeholder.
 Daylong series of air medical CEs on the Monday of Texas EMS Conference. Possibility of
scholarships.
 OPEN COMMENTS: Air Medical Golf Tournament at EMS Conference at Top Gulf since so well
received last year. As a reminder, funds go to families to attend the Hall of Honor at EMS
Conference.
Education
 Advance EMT vs. EMT-I: removing from agenda.
 Alternate Training Required for EMT-I (I-85 & I-99) transition to Advanced EMT: If EMT-I (I-85)
must retake everything to be Advanced EMT. If EMT-I (I-99) must maintain National Registry and
CE in order to become an Advanced EMT. Joe Smeeder stated that DSHS would not open the law
but try to update rules. Texas EMT-I is actually an Advanced EMT w/ airway skills. Dudley Wait
asked about entertaining a different nomenclature to call all EMS to Paramedics = Primary
Paramedic (EMT-B), Intermediate (EMT-I), Paramedic (EMT-P), Advanced (CC Paramedic).
 Community Health Curriculum for Advanced Practice Paramedic/Advanced Community
Paramedic (Jodie Harbet): Stated it will take 3-5 years to put into place. Want to ensure flexibility
in this process; additions such as epi, patho/phys, home health, pharmacology, and more. 16
current curriculums across the State of Texas. This Committee wants to have these 16 agencies to
come to workgroup to assist with development. There is currently a draft document that will be
placed in the online EMS Magazine with a permanent link. Working title “Education for the
Community Health Paramedic” and “Mobile Community Healthcare of the Community Health
Paramedic”.
 Texas Trauma/EMS Strategic Plan – Committee reviewed proposed changes. (HOTRAC has a draft
document with notes if interested.) APPROVED and forwarded to GETAC Council.
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EMS
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OPEN COMMENTS:
o Panhandle RAC has requested that an Education Work Day meeting be held in the Panhandle.
o Update on the online Medical Directors Course. It will be available 9/1/2014 free for one year.
(See separate handout at the end of this document.)
o EMS.gov has the National EMS Education Agenda open for public comment until 9/5/14.
o STEMI Conference in Houston on October 15-17, 2014.
o Any education can be posted on the DSHS GETAC EMS Committee webpage, send link to
EMS/Trauma.
o Texas EMS can post the education opportunities; send to kharrell@tex-ems.com.
o Next meeting – October 10th, TBA, 9am-3pm
Strategic Plan – lots of discussion.
EMS Medical Directors
 Spinal Precautions Position Paper is on the DSHS Website. Will be adding a “Position Paper”
section to the GETAC EMS Medical Director webpage.
 State Trauma Strategic Plan – should model the HRSA Model Trauma System.
o Injury Prevention
o System Access
o Communications
o Medical Oversight
o Prehospital Triage Criteria
o Diversion Policies
o Bypass Protocols
o Trauma & Acute Care Facilities
o Emergency Preparedness
Discussion: stroke should be added because mandated? Should STEMI/Cardiac be included? Should
stakeholder input only be noted at the beginning or throughout as is currently? Not voting on medical
issues? Add requirements for inclusion in clinical registries?
Trauma (Jorie’s PowerPoint on DSHS website)
 Update on 157 Rule Revision (Jane Guerrero) – working on getting the rule ready for GETAC
comments. No dates for review at this time.
 Trauma Registry Update (Kitten ?) – Acknowledge issues with customer support lines and that has
been remedied. Director has been selected and will soon be posting the Manager position. 2013
data is not “clean”. 16–Level I; 10–Level II; 46-Level III; 177-Level IV; 329-non designated; total
578 facilities submitting to registry (121,303 total records for 2013)
 Workgroup Reports
o Trauma Registry WG – Remaining issues: NEMSIS III; vendor communication; child abuse
e-codes (?? Can hospitals share suspected cases with RACs for tracking e-codes); deadlines;
data dictionary; Registry User Guide
o Trauma Medical Director’s Best Practice WG – looking at job description, activation criteria,
PI, & geriatric trauma; Dr. Gandhi will chair unless Dr. Eastridge returns from deployment
o Advanced Practice WG (Kelly Stowell) – no update; asked for clearer direction from
Trauma Systems and Trauma Medical Directors
o RAC WG (Wanda Helgesen) – no update
o Trauma Registrars WG (Irene Lopez) – reviewed charge; continue data management course
and quarterly webinars
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o Electronic Medical Records WG (Courtney Edwards & Wendi McNabb) – plan to keep scope
broad; listing recommendations that all EMRs need to support trauma
o Pediatric Trauma Coding WG (Mary Frost & Lori Vinson) – found a single e-code that may
be used to track child abuse; expect something by next meeting
o Impact on Alcohol (Karla Hosick & Christie Reeves) – January 1, 2014 no longer allows
insurance to deny claims if patients tests positive for alcohol. Medical examiners are not
reporting alcohol on deaths but do report smoking. Education on why trauma patients
should be tested for alcohol. (tasked to Trauma Medical Directors WG)
GETAC Strategic Planning Meeting Update – Dr. Eastridge provided comments from the July 23rd
meeting to GETAC Chair. GETAC will be meeting on Friday after meeting to discuss the Strategic
Plan.
Jorie Klein reviewed trauma statistics and injury facts.
Liaison Reports
o TTCF (Courtney Edwards, President) –Education on abusive head trauma. Planning unified
approach
o ENA - 7th Edition of TNCC rolled out. Currently 10% fail rate.
o Level IV – Jorie mentioned issue with getting their data from the Texas Trauma Registry
o Level III (Dr. Lopez) – many planning to move to Level II
o Level II (Lori Boyett) – discussion about new “orange book”
o Pediatric – minimizing radiation; pedi transfer guidelines document for review of Trauma
Systems;
o Injury Prevention (Karla Hosick)– CTAA sent out summer newsletter. Course on funding
for injury prevention at the national conference. Conference is in Philadelphia in
September.
OPEN COMMENT: Jorie - National Trauma Conference in San Antonio. Dr. Gandhi - RACs should
be standardizing care (“orange book” guidelines) across the Region and apply to all trauma
centers and prehospital providers. Lori Boyett – timely follow up on burn patients and
communication. Level III & IV feedback from Level I & II Centers.
Educational needs: TOPICS, Disaster Management, Data Management, AAAM, ABLS, T-CAR, P-CAR
Funding issues: 3588 changes; RACs need more funding “Capital of Texas” model
Cardiac
 What have we done and where are we going? – Dr. Smalling reviewed the history of the Cardiac
Committee.
o Rule Revision Update (Jane Guerrero) – as part of the first bullet – Unknown timeline for rule
revision. Plan to provide to GETAC and Committees then public comment then Healthcare
Council then comments, etc.
o National Registry is still not a requirement in Texas as far as cardiac CE requirements.
o Common Themes
 Data on regional STEMI care and outcomes is important but not all STEMI Systems or
RACs have a robust data collection and reporting.
 Pre-hospital Data remains elusive.
 Very few STEMI patients receive reperfusion therapy within 120 minutes from onset of
symptoms.
 Pre-hospital ECGs improve STEMI outcomes.
 Transfer from non-PCI hospitals to PCI Center take much too long (particularly in rural
areas).
 In hospital mortality in STEMI patients across the Nation remains unacceptably high
(10%-20%).
o Legislature
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 Need to provide a framework for STEMI Referral Center and STEMI PCI Center
a. Designation, re-designation, and de-designation
b. Q/A & Q/I standards
 Need to establish and maintain a Statewide STEMI Registry.
a. Database that is compatible….
 Need to provide mechanisms for standardization and potential funding of STEMI Care
in EMS Units.
a. 12-lead ECG machines with capability of transmission to STEMI referral or receiving
centers should be required/provided for all paramedic EMS units.
b. Capability of stocking and administering advanced pharmacologic agents for STEMI
Care including fibrinolytics and anti-platelets….
o Rule Making Needs (need to get Dr. Smalling’s PowerPoint)
AHA Mission: Lifeline Update (STEMI Coordinator at Seton Austin) – 154 PCI capable 87%
participation. Potentially a statewide report in October. Reviewed 1st quarter 2014 and CATRAC
blinded data.
CVD Council/Rider 97 Update - American College of Cardiology, Duke Clinical Research Institute,
and Outcome Sciences contracts have been executed. RACs having monthly calls. Mailed on July
23 to hospitals for cardiac data. Received contracts returned from Austin, San Antonio, and
Houston. Cardiac data will be sent back out to RACs and GETAC Council and Committees
sometime in September.
RAC STEMI Survey (Kiran Bhurtyl) – 60% share all data; 1/3 have EMS data; 77% have admin;
60% for data; 1/3 of EMS have 12 lead; 68% have Regional Plan; 60% STEMI PI
OPEN COMMENT: SETRAC provided their non-PCI survey.
RAC Chairs
 No speaking from audience until public comment.
 Required RAC Chairs’ attendance in May and November.
 21 of 22 EMS/RAC & County contracts were funded as of today.
 Tobacco should be out soon.
 LPG RFP is currently open.
 EEFs – 10 funded so far. $500,000 left and working on an additional 2 that were declined earlier
this year.
 Rule update – General stakeholder meeting prior to November. Will review at November GETAC.
Hopefully, HHSC Council agenda in February if all goes perfect. Effective September 2015.
 Sunset Update
 Provided legislative cards with information on how to login to stay current during legislative
session (see handout attached).
 Update on the online Medical Directors Course (see attached handout). Chapter 8 is only on Texas
laws, rules, and requirements. Good course for Administrator of Record.
 Senate Bill 8 rules are in place as of earlier this month. In Rules 773 and 157. New applications
are updated online.
 Enter data beginning January 1, 2015 will no longer accept EMS Affidavits for the EMS/County.
DSHS will handle the notification of this process themselves. Rule 103.5 – submit runs within 90
days.
 Neonatal/Perinatal Designations – RACs are not part of this legislation, as we know it. They are
supposed to develop their own “regions” for system development.
 Senate Bill 1191 - SANE
 EMS-C Update (Sam Vance & Dr. Remmick) – Pediatric Facility Recognition/Designation
(voluntary or involuntary) as part of the Pediatric Readiness Project to draw attention at
resources for pediatric patients. 60% hospitals in Texas responded with an average score of 77.
Increase awareness in the gaps that exist in our pediatric population. Joint policy statement – 7
focus areas. EMS Recognition program for services that meet the pediatric tiers (Bronze, Silver, &
Gold). Draft proposal available for review.
GETAC
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Chair Report (Chief Vance Riley) – Acknowledged Dr. Brian Eastridge’s deployment. Dr. Bobby
Greenberg has been appointed as Vice Chair of GETAC. Council will no longer receive copies.
Received letter from Panhandle RAC regarding appointment to GETAC and Committees not having
appropriate representation on them. Committee nominations will be open September 2-30.
Explained how committee appointments are handled. Thanked the entire current serve in this
process.
Assistant Commissioner Reports
o Asst Comm Kathy Perkins
o Asst Comm John Villanacci
 Update on staffing changes. Reviewing Manager Position applications currently.
 Registry reports - 2013 summary EMS, hospital, and submersion. Reports are available
on the Injury website under “New 2013 Reports added".
 Customer Service – Registry lockouts. Users can reset their own passwords. 245 new
requests since last GETAC. Enacted a general email and toll free number because
 System Improvements – Hospitals can enter NTDB and state requirement. Holding off
until all new items are active in September before updating system to current national
standards. NEMSIS expected to be ready this fall. Working on file extracts.
 TxDOT – received a notice of award for continued Registry support. Extra for
improvements not general maintenance.
o Asst Comm Dave Gruber
 Future of the RACs: Nothing is not being taken off of the table but there is no intent at
this time for a RFP. Will be doing open stakeholder input to find the best way. Trauma
is second to none. He and Asst Comm Perkins will be meeting with RAC Leadership.
Continued to say “but” and “however”. No hidden agenda.
 Crisis Standards of Care (Bruce Clements) – The initial meeting occurred last week.
Behavioral health and ethics will be carried across all. Workgroups: EMS, Hospital,
Alternate Care Sites, and State & Local Government (Public Health). Taking
nominations for people to serve on the workgroups. General Public Comment will be
key in this process. Target is Spring 2016.
 Standard Emergency Codes Across Texas – DSHS would like to move this direction.
Council focused him to Texas Hospital Association
 Sunset – EMS/Trauma was not affected. Only seems that regulatory on EMS was noted.
Emergency preparedness was not noted.
State EMS/Trauma Report (Jane Guererro)
o Provided financial document plus a funding flow chart. Uncomp “Trauma Up” process will
start after September 1. FY14 dispersed June 30th. FY15 application will be available October
15th due 90 days later. Still shifting funds for Medicaid dollars draw down for SDA funding.
Updated on EEFs.
o RAC Contracts were delayed due to HHSC transition.
o 281 trauma centers and 20 ‘in-pursuit”. 16 Level I Trauma Centers, 3 Level IIIs are seeking
Level II
o 129 stroke centers including 11 Comprehensive Centers
o Provided staffing update
o Chapter 157 Rule update – no changes. Hopes for draft to GETAC and Committees at the
November meetings.
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o Moratorium ends August 30th. The EMS Providers application has been updated to SB8
o Update on EMS Medical Directors Course – available September 1st. An additional session
(Chapter 8) on Texas specific information. Unsure if CME is available. Will let us know. Only
free for one year.
Preparedness Coordinating Council (PCC) – Eric Epley reported they did not meet.
Committee Reports
Liaison Reports
o TETAF (Jorie Klein) – “good healthy” discussion. Very active at the Capital. Brought Senator
Zerwas to the July 23rd Strategic Planning meeting. TETAF is our Champion for Legislative
movement. One voice moving forward. Support and maintain current funding. Need
additional funding for the Emergency/Trauma Healthcare System.
o EMS-C (Sam Vance)
EMS Patient Care Reports – Lots of discussion about solutions to provide patient information
according to Rule. Face Sheets need to be left by EMS and Hospitals need to provide loop closure.
Council establishing workgroup to discuss with reps from all partners. Charged with finding a
solution and/or changing the Rule.
GETAC Strategic Plan – Council worked on the strategic plan.