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350 Capitol Street, Room 425 • Charleston, West Virginia 25301 • 304-558-3956 • 304-558-8379 (fax) • dhhr.wv.gov Bill J. Crouch

Cabinet Secretary

Rahul Gupta, MD, MPH, MBA, FACP Commissioner

State Health Officer



Bureau for Public Health

Office of Emergency Medical Services



September 11, 2018

Members Present OEMS Staff Guest

Edward Hicks Sherry Rockwell Kurt Gainer

Trish Watson Vicki Hildreth Charles King Jr.

Glen Satterfield Bob Dozier R. Craig Horn

David J. Weller Danny Anderson Matthew Largent

Paul Seamann Terri O’Connor Rita White

Donna Steward Jimmy Sadler John Dearnell

Connie Hall Mike Thomas

Jeff Kady Guest Marsha Knight

Brenden Brown Dr. Jonathan Newman James V. Hill Patrick Cornell Edna Williamson

Members Absent Chris Hall Shirley Morrison

Nancy Cartmill Kevin Duckwall Joe Spray II

Jim Kranz Diana Mitchell Suzanne Sellers

Dr. Lisa Hrutkay James Taylor Cheryl Whitt

Stephen McDonald Dr. Mike Peterson Derek Hart

I. Welcome, Introductions and Roll Call

Chairman Jamie Weller called the quarterly meeting of the Emergency Medical Services Advisory Council (EMSAC) to order on September 11, 2018 at 1:03 PM at the Medical Coordination Center in Flatwoods, WV. Chairman Weller welcomed members and guests. Roll call followed.

Chairman Weller noted the absence of Melissa Raynes who is out of the area and unavailable and Dr. Michael Mills due to high intensity traffic volume stemming from Hurricane Florence evacuees. Chairman Weller also noted Dr. Jonathan Newman would be speaking on behalf of Dr. Michael Mills.

Glen Satterfield paid tribute to the victims and first responders on this 17th anniversary of the September 11 terrorist attacks.

II. Approval of June 12, 2018 Minutes

Motion made to approve the minutes of the June 12, 2018 regular statutory meeting as presented. Motion seconded. Motion carried.

III. Chairman Report

Chairman Weller stated that much of what he would be reporting will be addressed during the Old and New Business of this meeting.






Chairman Weller noted that he and Melissa Raynes will be presenting a report on EMS to legislature early next week – date and time to be announced. On September 19, 2018, there will be a follow-up meeting of the ACT Taskforce created by Dr. Gupta.

IV. EMSAC Committee Reports Special Interest

Community Paramedic Update – Paul Seamann

KCEAA and Jan Care are currently operating CP programs with quality insight to gather information. The results have been positive with hospital admissions down 60%, hospital readmissions down 80% and ED business down 50%. Doddridge County is anticipated to be on board soon. The chairman of the CP Committee estimated a $7,600 per patient savings to the healthcare system. They are still striving to get that information to Medicaid and Medicare to obtain a long-term sustainable funding source.

Critical Care Transport (CCT) Update – Paul Seamann

There was a major CCT Guidelines update rolled out effective September 1, 2018 with training being held in multiple sites across the state.

C2IFT (Class 2 Interfacility Transport) Update – Paul Seamann

The sub-committee is meeting September 18, 2018 to review Pilot ePCRs.

C3IFT (Class 3 Interfacility Transport) Update – Paul Seamann

This committee has completed 23 new protocols that have passed EMSAC and MPCC.

WV Tactical EMS Update – Paul Seamann

This committee meets monthly and is working on a standardized mission. The WV State Police is now participating. “Stop the Bleed” is an integral part of this program and is sponsored in part by the EMSC grant.

EMSC – Paul Seamann

Sherry Rockwell and Vicki Hildreth previously gave a presentation on what the Pediatric Emergency Care Coordinator (PECC) program is doing. EMSC will be the center point contact for all pediatric programs within the state.


Cost of Healthcare to EMS Agencies – Connie Hall

Ms. Hall did a presentation detailing the primary costs to WV EMS agencies for providing emergency care. These cost estimates included crew wages, equipment, disposable supplies, vehicle fuel, vehicle maintenance, insurance, workers comp, support staff, dispatchers, billing, medical records, mechanics, uniforms, PR, advertising, legal, collections etc. This study indicated that in many cases, EMS is working at a loss. Ideas for improvement such as utilization / cost feasibility studies were suggested.

NEMSIS V3 – David J. Weller

Chairman Weller stated that the private provider is the biggest hold up to the July 2018 timeframe. These entries have not completed the necessary testing in order to use NEMIS V3.

EMVO Certification/Recertification – David J. Weller

The EMVO Certification/Recertification Policy is written in legislative rule. If change is required, legislative rule would have to be changed.







Ambulance Hijacking – Connie Hall

The safety committee examined reports of ambulance hijacking across the US and discussed various ways to protect the EMS responder.

Safety on Scene/Combative Patients – Glen Satterfield

The safety committee reviewed a case study concentrating on safety on scene, combative patients and patients seeking drugs.

Policy/Procedure & Protocol – Chairman Weller Protocol Updates/Proposals

See Old and New Business


Special Presentations – Chairman Weller

Chairman Weller reported that various organizations have requested to make presentations during one or more of the subcommittee and or council meetings. The decision to allow these presentations is considered on a case by case basis ie. relevancy to EMS, time restrictions, quality etc.

Teleflex Procedural Cadaver Lab – Chairman Weller

Chairman Weller reported that the cadaver lab educational opportunity presented by Teleflex on September 10, 2018 was a great success.

V. Special Reports OEMS Report No report Medical Command No report Air Medical No report

VI. Old Business

1. West Virginia Public Service Training

A new WVPST map that included the training districts and staff contact information was distributed.

2. Protocol 4302 – Bronchospasm

Submitted for 30-day public comment 04/25/2018 – 05/24/2018

Revised/resubmitted for 2nd 30-day public comment 07/27/2018 – 08/24/2018

Ed Hicks made motion made to approve Protocol 4302 as presented. Motion seconded by Donna Steward. Motion carried. Protocol 4302 will become effective February 1, 2019.

3. Protocol 4413 – Pediatric Bronchospasm

Submitted for 30-day public comment 07/27/2018 – 08/24/2018

Trish Watson made motion made to approve Protocol 4413 as presented. Motion seconded by Brenden Brown. Motion carried. Protocol 4413 will become effective February 1, 2019.

It is noted that Dr. Jonathan Newman questioned the use of dexamethasone over previously approved medication. This is a topic that may be studied and considered in the future.






4. NREMT Policies

June 25, 2018 - EMSAC concluded the online vote to proceed with the proposed NREMT policies and to move forward with developing the implementation procedures.

July 20, 2018 – MPCC approved proposed policies.

The following NREMT Policies are subject to EMSAC vote:

Emergency Medical Responder (EMR) – Initial Certification Policy Emergency Medical Responder (EMR) – Recertification Policy Emergency Medical Technician (EMT) – Initial Certification Policy Emergency Medical Technician (EMT) – Recertification Policy Paramedic – Initial Certification Policy

Paramedic – Recertification Policy

The modular portion of the above listed policies has been previously approved by EMSAC and MPCC.

The Following notice has been added by legal:

“An EMR/EMT/Paramedic certified by WVOEMS must also be continually certified by the National Registry of Emergency Medical Technicians (NREMT) or an equivalent certifying organization approved by WVOEMS, during the duration of your WVOEMS certification. Your failure to retain an uninterrupted NREMT or equivalent certification may result in the immediate suspension of your WVOEMS certification and your right to practice in West Virginia.”

As we implement National Registry you may notice status changes in your certification in Continuum. This will be required to match certification cycles with the National Registry. The Credential Recognition & Transfer Policy will remain the same.

The Emergency Medical Vehicle Operator (EMVO) is not a National Registry level certification; therefore, the initial certification and recertification policies will remain the same.

Connie Hall made motion made to approve the entire group of NREMT Policies, the Credential Recognition & Transfer Policy and the Emergency Medical Vehicle Operator (EMVO) as presented. Motion seconded by Donna Steward. Motion carried. These policies will become effective January 1, 2019.

VII. New Business 1. Protocol 4903

Rapid Sequence Intubation (RSI)

Rapid Sequence Intubation (RSI) Algorithm Ground Ambulance Equipment and Supply List

The addition of Rocuronium as an optional medication affects 4903 RSI, 4903 RSI Algorithm and the Ground Ambulance Equipment and Supply List.

Glen Satterfield made motion to approve Protocol 4903 as submitted; post for the thirty-day comment period and move forward to MPCC for review and consideration. Motion seconded by Connie Hall. Motion carried.

2. Continuum Rollout – Information Only

Chairman Weller reported that the problems and issues with continuum are being addressed.






3. Naloxone Training

Ed Hicks reported that the Kanawha Charleston Health Department (KCHD) holds Naloxone auto injector trainings at 12:30 pm each Wednesday. Those completing the training receive two doses of Naloxone, which were provided to the health department through grants and donations. Naloxone education and training are recommended for anyone who may be in the position to save a life with Naloxone, particularly first responders, friends and family members and those suffering from addiction.

4. Naloxone Auto-Injectors – Information Only

The following memo was distributed to all medical command administrators, agency official representatives and squad training officers on September 5, 2018:

Several EMS Agencies have received donated Naloxone Auto-Injectors containing 2 mg Naloxone per injection. If you have received this product, it is permissible for EMT-Basic providers to administer in a suspected overdose situation.

This change applies to:


o Section E. If blood glucose level is >60 mg/dl, administer Naloxone (Narcan®) 2 mg intranasal (IN) via atomizer or OPTIONAL NALOXONE 2 mg AUTO-INJECTOR .


o Section E. 2. Narcotics / Opiates:

a. Support respirations, as necessary, with a BVM and supplemental O2. Defer consideration of advanced airway management until after administration of Naloxone, if BVM ventilation is adequate.

b. Consider hypoglycemia. Perform rapid glucose determination. If glucose is <60 mg/dl or clinical signs and symptoms indicate hypoglycemia, refer to the Diabetic Emergencies Protocol 6604.

c. For a suspected narcotic overdose complicated by respiratory depression: i. Administer Naloxone (Narcan®) 2 mg intranasal (IN) via atomizer or OPTIONAL NALOXONE 2 mg AUTO-INJECTOR .

5. Officer Nominations

Ed Hicks made motion to nominate D. Jamie Weller as EMSAC Chairman. Donna Steward seconded the motion. Motion carried.

Donna Steward made motion to leave the EMSAC Vice-Chairman position open pending legislative session. Ed Hicks seconded the motion. Motion carried.

Donna Steward made motion for Terri O’Connor to continue as clerical secretary. Brenden Brown seconded the motion. Motion carried.

Officer election will be held at the next EMSAC meeting.

6. National Registry Implementation Update

Chairman Weller reported there will soon be an update to the National Registry FAQ that is posted on the EMSAC website. General discussion followed. Information will continually be posted and shared as the implementation deadline approaches.






A National Registry in service for training agencies will be held on October 22, 2018 at the Medical Coordination Center in Flatwoods. This will be an all-day event starting at 8:00 AM.

Testing sites have been an ongoing concern with the implementation of National Registry. Public Service Training will have the opportunity to become testing sites in addition to the other Pearson VUE sites.

7. AEMT EMSAC Proposal – Chairman Weller

The BPH Commissioner created the ACT Task Force to address the decision of the National Registry of Emergency Medical Technicians (NREMT) to no longer recertify individuals as a National Registry Emergency Medical Technician-Intermediate, effective 2019. This decision affects the OEMS ACT level of certification.

At the direction of the ACT Task Force, a subcommittee of EMSAC was put together to review and make recommendations on the development of the AEMT program in West Virginia to fill the void of a mid-level provider. The AEMT program in and of itself requires additional skill sets to fill the void in West Virginian in areas where paramedic population is limited.

Chairman Weller addressed specific sections of the proposal as listed below. The recommendations are as follows:

1) Candidate shall hold a current EMT certification

2) Complete an Advanced Emergency Medical Technician (AEMT) Education Program accredited by the Commission on Accreditation of Allied Health Education Programs (CAAHEP) in a manner prescribed under the Accreditation of EMS Programs (CoAEMSP).

3) Complete ACLS or WVOEMS approved equivalent 4) Complete ITLS, PHTLS or WVOEMS approved equivalent 5) Complete PALS, PEPP or WVOEMS approved equivalent 6) Complete an AEMT protocol In-service

7) Complete a West Virginia Pharmacology Module 8) Complete a West Virginia Cardiology Module

a. Basic Rhythm Interpretation

i. Basic 12 Lead (transmission for interpretation) ii. STEMI recognition

iii. Treatment of immediate life threatening dysrhythmias 9) Successfully complete and pass all practical skills evaluations for the

AEMT level of certification as outlined by National Registry.

10) Successfully complete and pass all cognitive examinations with a certifying score for the AEMT level determined by the National Registry of EMT's cognitive examination.

Course Breakdown:

1) EMT to AEMT didactic ± 200 Hours

a. Alphabet Courses (48 Hours) b. Pharmacology module (50 Hours) c. Cardiology module (20 Hours)

2) Clinical Component ± 125 Hours






*The program is based on competency and not hours. Hours may vary based on program design and clinical availability in particular areas of the state.

AEMT Medication List:

Acetaminophen (Tylenol®), 160mg/5mL oral suspension Albuterol, 2.5mg/3mL unit dose ampule

Albuterol/Ipratropium (Duo-Neb®), 2.5mg/0.5mg in 3mL unit dose ampule Amiodarone, 450mg total (May be substituted with Lidocaine)

Amiodarone, 150mg pre-mixed solution (May be substituted with Lidocaine) Aspirin, 81mg chewable tablets

Adenosine (Adenocard®), 18mg total Atropine, lmg pre-loaded syringe

Combivent® -OR- Duoneb® - 2.5mg Albuterol mixed with 0.5mg Ipratropium Bromide 05°W, 25g pre-loaded syringe

D25W D10W

Epinephrine, 1:10,000, 1mg pre-loaded syringe Epinephrine, 1:1000

EpiPen EpiPen Jr.

Furosemide (Lasix®), 80mg total Glucagon, 1mg

Ipratropium Bromide (Atrovent®) 500 microgram unit dose ampules

Lidocaine (Xylocaine®), 100mg pre-loaded syringe (May be substituted with Amiodarone.) Lidocaine (Xylocaine®), 1gm pre-mixed solution (May be substituted with Amiodarone.) Naloxone (Narcan®), 4mg total

Nitroglycerin, 0.4mg (1/150) tablets or spray Normal Saline (0.9%), 1,000m1

Ondansetron (Zofran®), 8mg total Ondansetron (Zofran®) 4mg ODT Oral Glucose, 15g tubes


The EMSAC AEMT proposal also included:

• West Virginia State specific requirements for EMR, EMT, AEMT and Paramedic • EMS Scope of Practice

• Educational Infrastructure

This proposal if approved by EMSAC will go back to the ACT Task Force for review and consideration. It is noted that MPCC has reviewed this proposal and agree with it as presented. In-depth discussion followed addressing various concerns ranging from the scope of practice to the proposed AEMT medication list. Dr. Jonathan Newman addressed the council regarding the mid-level educational components and the knowledge base of the AEMT provider compared to that of a paramedic. Additional discussion and commentary followed. It is noted that the MPCC unanimously agreed that AEMT providers will have no access to Narcotic medication.

Connie Hall made motion to strike recommendation No. 2. Motion was not seconded. Motion dies from lack of a second.






Motion made by Trish Watson to accept the EMSAC AEMT proposal and forward to the ACT Task Force as written. Motion seconded by Ed Hicks. Motion carried. Due to the importance of this proposal a roll call vote was taken by Chairman Weller. The motion was approved 4 to 3 as follows:

Brenden Brown Yea Connie Hall Nay

Ed Hicks Yea Jeff Kady Nay

Donna Steward Yea Paul Seamann Nay

Trish Watson Yea

VIII. Good of the Order

Due to scheduling conflicts, the MPCC meeting has been changed to October 26, 2018 from October 19, 2018. Meeting time remains the same at 9:00 AM.

Recommendation made to read Senate Bill 625.

The next EMSAC meeting will be December 11, 2018 starting at 9:00 with the subcommittee meetings.


Donna Steward made motion to adjourn. Motion seconded by Connie Hall. Motion carried.


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