STATE OF CALIFORNIA COMMISSION ON EMERGENCY MEDICAL SERVICES December 4, 2019 09:00 A.M. – 11:30 A.M. (Meeting may end early at the completion of all agenda items) Marines’ Memorial Club and Hotel 609 Sutter Street San Francisco, CA 94102 (415) 673-6672 1. Call to Order and Pledge of Allegiance 2. Review and Approval of September 18, 2019 Minutes 3. Director’s Report A. EMSA Program Updates DMS Personnel Systems B. Legislative Report 4. Consent Calendar A. Administrative and Personnel Report B. Legal Report C. Enforcement Report D. EMS Plan and Critical Care Plans Update Regular Calendar 5. EMS Administration A. Approval of Paramedic Regulation Revisions 6. EMS Personnel A. Community Paramedicine Pilot Project Status 7. Disaster Medical Services Division A. Ambulance Strike Team Program Update 8. Open Nominations for Election of Officers (March 2020 – March 2021) 9. Approval of 2021 Meeting Dates 10. Items for Next Agenda 11. Public Comment 12. Adjournment A full agenda packet will not be provided at the meeting; however, you can print a full packet, including the agenda from the Department’s website at www.emsa.ca.gov. This event will be held in an accessible facility. Individuals with disabilities requiring auxiliary aids or services to ensure accessibility such as language interpreting, assisted listening device, materials in alternate formats or other accommodation, should contact Sandi Baker at (916) 431-3701, no less than 7 days prior to the meeting. STATE OF CALIFORNIA COMMISSION ON EMS Wednesday, September 18, 2019 Holiday Inn Bayside San Diego 4875 North Harbor Drive San Diego, CA 92106 MINUTES COMMISSIONERS PRESENT: Steve Barrow, Dan Burch, Sean Burrows, James Dunford, M.D., Nancy Gordon, Mark Hartwig, Ken Miller, M.D., Ph.D., Carole Snyder, Brent Stangeland, Jim Suver, Atilla Uner, M.D., Todd Valeri COMMISSIONERS ABSENT: Thomas Giandomenico, James Hinsdale, M.D., Daniel Margulies, M.D., Karen Relucio, M.D., Jane Smith EMS AUTHORITY STAFF PRESENT: David Duncan, M.D., Daniel R. Smiley, Craig Johnson, Jennifer Lim, Lou Meyer, Sean Trask, Sandra Baker AUDIENCE PRESENT (partial list): BJ Bartleson, California Hospital Association Todd, Klingensmith, California Paramedic Foundation Kristi Koenig, MD, County of San Diego EMS Dave Magnino, Sacramento County EMS Agency Kristin Thompson, Newport Beach Fire Department 1. CALL TO ORDER AND PLEDGE OF ALLEGIANCE Chair James Dunford, M.D., called the meeting to order at 10:02 a.m. Twelve Commissioners were present. Commissioner Stangeland led the Pledge of Allegiance. Chair Dunford welcomed new appointed EMSA Medical Director David Duncan, M.D. Dr. Duncan introduced himself. 2. REVIEW AND APPROVAL OF JUNE 19, 2019, MINUTES Commissioner Barrow referred to his comment on page 8 and asked to change “registries do not work until they are mandated” to “registries cannot be fully populated until they are mandated.” Action: Commissioner Uner made a motion, seconded by Commissioner Snyder, that: The Commission approves the June 19, 2019, Meeting Minutes as revised. Motion carried 12 yes, 0 no, and 0 abstain, per roll call vote as follows: Previous Agenda Next 1 The following Commissioners voted “Yes”: Commissioners Barrow, Burrows, Gordon, Hartwig, Miller, Snyder, Stangeland, Suver, Uner, and Valeri, Vice Chair Burch, and Chair Dunford. 3. DIRECTOR’S REPORT Daniel R. Smiley, EMSA Chief Deputy Director, presented the Director’s Report. A. EMSA Program Updates • Objectives to work towards, based on the priorities of the Governor and the Secretary of the California Health and Human Services Agency (CHHS), are the following: o To ensure that EMS is connected to local health departments that are working to manage vulnerable populations. o To have relevant, timely data and information to support emerging issues. o To distribute funding to help build infrastructure to the Health Information Exchange to allow EMS and hospitals to securely exchange electronic patient health care information. This is critical to drive better clinical decisions, improve transitions of care, and ultimately improve outcome data. o To support the gradual shift in culture of EMS for improved education and professional development at the clinical, educational, and managerial levels. • The Paramedic Regulations are included in today’s agenda as an information item only. o EMSA recognized the need to provide clarity concerning confusing terminology and differing interpretations on alternate destination in the pre- hospital care setting. o The Community Paramedicine Pilot Project Program has been studying the effectiveness of community paramedicine and alternate destinations for mental health and sobering center patients. o The Paramedic Regulations are expected to be presented at the December Commission meeting for approval without the alternate destination piece, which requires further discussion. • Stroke, STEMI, and EMS for Children Regulations have gone into effect since the last Commission meeting. Staff will be working with the local EMS agencies (LEMSAs) to incorporate them into EMS plans. Questions and Discussion Commissioner Uner asked how the removal of alternate destination from the Paramedic Regulations will affect current or planned alternate destination projects. Previous Agenda Next 2 Mr. Smiley stated the Office of Statewide Health Planning and Development (OSHPD) has granted a one-year extension through November of 2020. Commissioner Suver asked to include the California Hospital Association (CHA) in the alternate destination discussion. B. Legislative Report Jennifer Lim, EMSA Deputy Director, Legislative, Regulatory, and External Affairs, summarized the EMSA Legislative Report of the bills currently being tracked and analyzed by staff, which was included in the meeting packet and posted on the website. 4. CONSENT CALENDAR A. Administrative and Personnel Report B. Legal Report C. Enforcement Report Action: Vice Chair Burch made a motion, seconded by Commissioner Barrow, that: The Commission approves the Consent Calendar as presented. Motion carried 12 yes, 0 no, and 0 abstain, per roll call vote as follows: The following Commissioners voted “Yes”: Commissioners Barrow, Burrows, Gordon, Hartwig, Miller, Snyder, Stangeland, Suver, Uner, and Valeri, Vice Chair Burch, and Chair Dunford. The item was noted and filed. REGULAR CALENDAR 5. PARAMEDIC REGULATIONS REVISION Sean Trask, Division Chief, EMS Personnel Division, stated the Director’s Report updated the Commission on the Paramedic Regulations Revision. He noted that the Paramedic Regulations are in the fourth 15-day public comment period and are expected to be presented at the December Commission meeting for approval. Questions and Discussion Commissioner Uner stated the additional four hours required for tactical medicine can be a burden for private students who pay out-of-pocket or for private or public entities who send them. Commissioner Barrow respectfully disagreed. He spoke in support of the added training hours and increased fees due to the complicated work. Public Comment Kristi Koenig, M.D., EMS Medical Director, San Diego County, and former Commissioner, spoke in support of the new four-hour tactical training requirement. She asked about the anticipated timeline to re-look at adding alternate destination language Previous Agenda Next 3 into the regulations. Mr. Smiley stated a collaborative solution is expected within this next year to address both the community paramedicine and alternate destination issues. 6. EMS PERSONNEL A. Community Paramedicine Pilot Project Status Update Lou Meyer, EMSA Community Paramedicine Project Manager, summarized comments given by OSHPD in their Community Paramedicine Pilot Project extension approval letter. • No patient safety or non-compliance issues were reported during the past year. • The extension will allow EMSA to collect additional data, particularly for those community paramedicine sites that have recently become operational. o Los Angeles City Fire has two new pilot projects: behavioral health and alternate destination to a sobering center. The independent evaluator from the University of California San Francisco has filed their fifth public update to the community paramedicine program. • Findings from the evaluation indicate that California has benefited from these innovative models of health care that leverage an existing work force operating under medical control, either directly or by protocols developed by physicians experienced in EMS and emergency care. • No health professionals were displaced. The pilot projects have demonstrated that community paramedics can partner with physicians, nurses, behavioral health professionals, and social service workers to fill gaps in the health and social services safety net. • No adverse patient outcomes are attributable to the pilot projects. Mr. Meyer stated the pilot projects have answered many questions over the past five years and have added credibility to the work that the field paramedic can do to fill gaps in the health care system of care. The Pilot Project Manager and Independent Evaluator contracts expire on November 30th. The next step, now that the OSHPD approval has been secured, is to ask the California Health Care Foundation to continue the funding. Questions and Discussion Commissioner Barrow stated one of the complaints he keeps hearing is that the quality of care for patients is not good and that the data is skewed. This is what policy makers hear. He stated, if there are issues, they should be brought up so they can be corrected. Mr.