board meeting agenda emergency medical services ... board agenda...state of minnesota emergency...

State of Minnesota

Emergency Medical Services Regulatory BoardBoard Meeting Agenda

September 8 2017900 AM

Arrowwood Conference Center2100 Arrowwood Drive

Lake Miltona RoomAlexandria MN

Map and Directions

1 Call to Order -- 900 am

2 Public Comment -- 905 am

The public comment portion of the Board meeting is where the public is invited to address theBoard on subjects which are not part of the meeting agenda Persons wishing to speak are asked tocomplete the participation form located at the meeting room door prior to the start of the meetingPlease limit remarks to three minutes

3 Review and Approve Board Meeting Agenda -- 925 am

4 Review and Approve Board Meeting Minutes -- 930 am

5 Board Chair Report -- 935 am

Request for Deviation from Statewide Trauma System Requirements -- ACTION ITEM

6 Executive Director Report -- 940 am

Agency UpdateEMSRB eLicensing System ReportSmall Agency Resource Team (SmART)

City of Jordan

Central EMS Region

7 Committee Reports -- 1015 am

Ambulance Standards Work Group -- Pat CoyneCRP and HPSP -- Matt SimpsonData Policy Standing Advisory Committee - Megan HartiganLegislative Ad-Hoc Work Group - Kevin MillerMedical Direction Standing Advisory Committee -- Aaron Burnett MD

8 New Board Business -- 1040 am

9 Closed Session -- 1045 am

Closed per Minn Stat sect 144E28 subd 5 and Minn Stat sect 13D05 subd 2(b) (ComplaintReview Process)

10 Re-Open Meeting -- 1055 am

11 Adjourn -- 1100 am

If you plan to attend the meeting and need accommodations for a disability please contact Melody Nagyat (651) 201- 2802 In accordance with the Minnesota Open Meeting Law and the Internal OperatingProcedures of the Emergency Medical Services Regulatory Board this agenda is posted athttpwwwemsrbstatemnus

bull 2829 University Avenue Southeast Suite 310 Minneapolis Minnesota 55414-3222

(651) 201-2800 (800) 747-2011 FAX (651) 201-2812 TTY (800) 627-3529

wwwemsrbstatemnus

The Mission of the EMSRB is to protect the publicrsquos health and safety through regulation and support of the EMS system An Equal Opportunity Employer

Meeting Minutes

Emergency Medical Services Regulatory Board Thursday July 20 2017 1000 am

Minneapolis Minnesota

Attendance Kevin Miller Vice Chair Jason Amborn Lisa Brodsky Aaron Burnett MD Lisa Consie Patrick Coyne Steve DuChien Paula Fink-Kocken MD Scott Hable Megan Hartigan Jeffrey Ho MD Michael Jordan John Pate MD Mark Schoenbaum Jill Ryan Schultz Matt Simpson Tony Spector Executive Director Melody Nagy Office Coordinator Greg Schaefer Assistant Attorney General Absent Rep Jeff Backer JB Guiton Board Chair

1 Call to Order ndash 1000 am Mr Miller called the meeting to order at 1002 am He asked for introductions from members and guests

2 Public Comment ndash 1005 am The public comment portion of the Board meeting is where the public is invited to address the Board on subjects which are not part of the meeting agenda Persons wishing to speak are asked to complete the participation form located at the meeting room door prior to the start of the meeting Please limit remarks to three minutes None

3 Review and Approve Board Meeting Agenda ndash 1010 am

Motion Mr Coyne moved to approve the agenda Dr Ho seconded Motion carried

4 Review and Approve Board Meeting Minutes ndash 1015 am

Motion Dr Pate moved approval of the minutes from the May 18 2017 Board meeting Mr Hable seconded Motion carried

5 Board Chair Report ndash 1020 am ndash Kevin Miller

Mr Miller said that Mr Guiton could not attend today due to another commitment

6 Executive Director Report ndash 1025 am ndash Tony Spector Demonstration of EMSRB License Management System Mr Spector provided background information on the processing of the contract for the new system He stated that a project manager is mission critical to this effort and MNiT said that they did not have staff available to perform this task After a meeting with the Commissioner of MNiT Teresa Friedsam was designated as the project manager and she has been very helpful Teresa is going to show you where we are and where we are going with the system Ms Friedsam said that EMSRB staff have only been working on the new system for a month Today is an opportunity to show you the progress of building the system She described the landing page and login to the system

EMSRB Board Meeting Minutes ndash July 20 2017 Page 2 of 5

Mr Spector said the privacy notice will be revised Mr Spector discussed required fields and customized fields we are going to implement in the system Collection of information on race and gender was discussed Ms Friedsam demonstrated opening and completion of an application Dr Pate asked for a launch date Mr Spector said the system will be phased-in by modules The first module is expected to be available after Labor Day This is dependent on a successful migration of the legacy data Mark King Initiative Mr Spector said the Mark King Initiative application process opened on July 5 2016 He referred to the handouts provided in the Board packet Mr Miller asked how many individuals obtained National Registry status using the Mark King Initiative during the last renewal cycle Mr Spector said he would obtain this information and report to the Board Agency Update New Employee Mr Spector said the EMSRB has a new temporary employee that we ldquostolerdquo from the Chiropractic Board He introduced Jennifer Nath (in the audience) and said she is working on the complaint review process Licensing Administration Mr Spector provided an update on the off-line system - We are caught up on data entry - We have 400 cards to issue to be caught up on issuing of cards - Staff will continue to process applications in a timely manner until the new system is

operational

Mr Spector said that in October 2016 MNiT pulled the data from our old system Mr Spector said he was recently informed that the persons who know this data were unavailable to work on the transition of this data to the new system The EMSRB is willing to pay for these individuals to assist with the transition Mr Spector said he has had several conversations with MNiT staff to try to obtain the assistance needed for this data conversion Mr Spector said he sought clarification of the information from ImageTrend on what assistance is needed MNiT created a service model contract that he just received It is suggesting to charge $9500 per hour for these staff persons time to work on the new system Mr Spector said he will have further discussions on this cost but brings this to the Board today for discussion Several Board members commented on costs associated with implementation of data conversions Motion Dr Pate moved that Mr Spector take all actions necessary to bring this contract forward in a fair and equitable fashion Ms Ryan-Schultz seconded Motion carried Community EMT Pilot Program Mr Spector said the Board approved a pilot program for Community EMT Hennepin Technical School will have a three day pilot program in early August Mr Spector asked for Board discussion of issuance of a Community EMT certification


Dr Burnett said that this is an approved education program and has met the requirements The applicants should be issued the certification Dr Burnett asked for a report in six months and a year as to the role that these persons are fulfilling Dr Ho asked about a recertification process Mr Spector said this is yet to be determined EMSC Grant Funding Mr Spector said the EMSC grant funding was cut Mr Spector said he was recently informed that this funding was restored Dr Fink-Kocken (medical director for this program) said it is funded through February 2018 The EMSRB will need to apply for future grant funding Dr Fink-Kocken said there is a survey being conducted and she asked for participation from all EMS managers This information is needed by the end of September She referred to a website for additional information Request for Deviation from Trauma Requirements Mr Spector said Cuyuna Regional Ambulance Service has requested a deviation from trauma requirements He quoted the statute associated with this request A recommendation will be provided to the Board Dr Burnett said the Trauma System Joint Powers Committee will be discussing the issue Documents are available on the trauma system advisory website Flight Nurse (RN) ndash EMT Status Mr Spector said that he has been having a discussion with Mr Fennell regarding an exemption for flight nurses to work on ground ambulances Mr Fennel described the situation He said persons can petition the Bard to allow critical care flight nurses to work on ground ambulances Mr Fennell said the nurses employed at his agency attend skills training as designed by the medical direction team He is asking for this not only for his agency but as a statewide scenario Board members discussed the qualifications of the nurses as EMTs Mr Miller asked if this can be acted on by the Board Mr Schaefer said this would need to be submitted on a case-by-case basis Staff can be designated with the authority to grant this exception Mr Miller said Mr Fennell has submitted information for a roster of nurses and seeks action on his request Mr Miller said that these are highly skilled resources Mr Miller asked that MDSAC discuss a revision of statute in the future and provide a report to the Legislative Ad-Hoc Work Group Mr Spector said the EMSRB will need applications for each individual and he would also like to review additional relevant statues Awards Mr Spector said he wanted to provide an award to Tammy Peterson for her extra efforts in providing representation for the EMSRB at a National Registry test He ask Mr Held (in the audience) to pass on the appreciation of the EMSRB and the award


Mr Spector said he wanted to provide an award to Ms Nagy for her hard work dedication and extra efforts in ldquokeeping the ship upright and afloatrdquo Ms Nagy accepted the award Mr Spector said staff are meeting with the staff of NovusAgenda to develop the templates for our Board agendas and minutes and will be ready to provide this in September

7 Committee Reports ndash Committee Chairs ndash 1120 am

Ambulance Standards Work Group ndash Mr Coyne Mr Coyne said the work group met and discussed data available from other agencies He said all members agreed to remain on the work group and continue discussion of topics within the scope of the work group CRP and HPSP ndash Mr Simpson Mr Simpson reported the complaint review panel continues to have full agendas at their meetings The agency investigations are continuing HPSP reports are provided in the Board packet Data Policy Standing Advisory Committee ndash Ms Hartigan Ms Hartigan said the committee has not met Mr Spector said there are questions on the transition from MNSTAR version 2 to version 3 The recommendation from staff is that DPSAC discuss an amended timeline and present that information to the Board He commented there are additional costs for maintaining multiple data bases Education Standards Post-Transition Work Group Report ndash Mr Lawler Mr Lawler referred to the handout provided in the Board packet He said the charge of the work group has been completed The next tasks require legislative actions Mr Lawler said there has been discussion of this work group becoming a standing advisory committee He said that there will always be additional topics for discussion such as LCCR and ICCR requirements Mr Miller said the status of work groups will be discussed in the future Legislative Ad-Hoc Work Group ndash Mr Miller Mr Miller said Mr Spector has received the draft document from the consultant and he and Mr Spector will need to meet to discuss the information provided and a plan of action Mr Miller said the work group will need to set a future meeting Medical Direction Standing Advisory Committee ndash Dr Burnett Dr Burnett said physicians on the committee continue to provide representation on their assigned committees Dr Burnett said recommendations will be available soon for EBOLA (highly infectious disease) transport guidelines

8 New Board Business ndash 1145 am Ms Hartigan commented on the continuing problem of drug shortages She asked if the Board should provide a communication regarding the use of medications beyond their expiration date


Mr Spector said he had a conversation with the Executive Director of the Board of Pharmacy on this topic Mr Miller said this has also been discussed a previous Board meetings He asked for a review of the minutes on this topic Mr Spector said he would continue the discussion with the Executive Director of the Board of Pharmacy Mr Miller asked for a report on this topic for the next Board meeting Mr Miller asked for a brief recess before the Board goes into closed session

9 Closed Session ndash 1200 Noon Closed per Minn Stat sect 144E28 subd 5 and Minn Stat sect 13D05 subd 2(b) (Complaint Review Process) Disciplinary actions were discussed and voted on by Board members

10 Re-Open Meeting ndash 1215 pm Mr Miller re-opened the meeting

11 Adjourn ndash 1220 pm

Motion Dr Pate moved to adjourn the meeting Mr Amborn seconded Motion carried

Meeting adjourned at 1220 pm

Next Board Meeting Friday September 8 2017

Alexandria MN

P r o t e c t i n g m a i n t a i n i n g a n d i m p r o v i n g t h e h e a l t h o f a l l M i n n e s o t a n s

August 4 2016

John Solheim CEO Cuyuna Regional Medical Center 320 East Main Street Crosby MN 56441

Dear Mr Solheim

Enclosed please find a report on your hospitalrsquos trauma program based on the trauma system re-designation site visit It identifies a few of the many strengths your hospital contributes to the statewide trauma system as well as five deficiencies and some opportunities for improvement

The State Trauma Advisory Council (STAC) Applicant Review Subcommittee has reviewed the report and the hospitalrsquos application for re-designation Based on that material the committee plans to recommend to the full STAC that Cuyuna Regional Medical Center not be recommended to the Commissioner for re-designation as a Level 3 Trauma Hospital The STAC will consider the recommendation at their next meeting on September 13

The MDH trauma system staff is a resource while you consider the next steps for your trauma program You and your trauma program staff can follow the STAC activities and the progress of the trauma system by bookmarking our website wwwhealthstatemnustraumasystem and by subscribing online to e-Trauma Updates If you have any questions or if I may assist you further please contact me at (651) 201-3841 or chrisballardstatemnus

Sincerely

Chris Ballard Trauma System Coordinator Statewide Trauma System PO Box 64882 St Paul MN 55164-0882 Cc Ron Furnival MD STAC Chairman

STATEWIDE TRAUMA SYSTEM

Cuyuna Regional Medical Center Level 3 Trauma Hospital Site Visit Report

Minnesota Department of Health Statewide Trauma System PO Box 64882 St Paul MN 55164-0882 651-201-3838 wwwhealthstatemnustraumasystem

Upon request this material will be made available in an alternative format such as large print Braille or audio recording Printed on recycled paper

T R A U M A H O S P I T A L S I T E V I S I T R E P O R T

2

Contents Overview 3

Introductory Comments 4

Deficiencies 4

Strengths of the Trauma Program 6

Opportunities for Improvement 7

Case Summaries 8

Closing Comments 8


3

Overview This report identifies the strengths and opportunities for improvement observed during the trauma system designation site visit along with any deficiencies noted by the State Trauma Advisory Council (STAC)

Deficiencies are criteria requirements of trauma system participation that were not met at the time of the site visit and must be remedied Opportunities for improvement are recommendations for improving trauma care and care processes that should be addressed and resolved but are not criteria requirements

Site Visit Team John Cumming MD

Tracy Larsen RN

Date of Site Visit May 26 2016

Date of State Trauma Advisory Council Review July 26 2016


4

Introductory Comments Cuyuna Regional Medical Center is a 25-bed critical access hospital having an average daily census of 153 patients The Minnesota Institute for Minimally Invasive Surgery (MIMIS) is housed on campus The Minnesota Center for Orthopedics and Minnesota Center for Obstetrics and Gynecology are also housed on campus

The emergency department (ED) expanded from six to 14 beds in 2016 and has an annual volume of approximately 10500 patients There are five general surgeons that provide trauma call coverage

Cuyuna Regional Medical Center (CRMC) utilizes its own ambulance service which is clearly an invaluable resource for the community There is a fleet of three ambulances and one suburban that are staffed by advanced life support personnel 24 hours per day The ambulance service has a community paramedic program that currently has five participating staff Air ambulance services are also available via North Air Care Life Link III and Sanford AirMed

The trauma medical director (TMD) is new in the role since the last site visit The hospital is also transitioning to a new trauma program manager (TPM) Unfortunately the transition period for the two key leadership roles has been to the detriment of the trauma program It was evident within ten minutes of the introductory comments that there was not a collaborative relationship between the outgoing TPM and the current TMD

As previously identified the emergency medical service (EMS) program was a real strength for the trauma center There is excellent education and training for EMS and ancillary personnel

Deficiencies All five deficiencies are associated with global problems in the trauma performance improvement process and the lack of meaningful performance improvement activities

The trauma medical director has demonstrated limited involvement in the PI process and has a limited understanding of his role as trauma medical director The completed PI worksheets documenting his secondary review over the past year indicated that he signed off on a majority of them on the same day Review should be reasonably concurrent to facilitate the PI process (eg every two weeks) For each case reviewed indicate the presence or absence of improvement opportunities and address deviations to performance measures or acceptable standards of care Maintain these records for review at the trauma system site visits

There is no evidence that the trauma medical director and trauma program manager along with other key players of the team involved in trauma care are conducting critical case reviews There has been only cursory review of trauma care over the past two years There is a PI tracking worksheet that contains some information and is signed by the trauma medical director There is no documentation of case discussion and these tracking worksheets are typically signed several months later Continuous improvement is facilitated by a trauma program staff in a timely manner that is sufficiently critical of the institutionrsquos


5

performance relentlessly seeking opportunities to improve it Critically comprehensively and concurrently review cases evaluating care based on Advanced Trauma Life Support (ATLS) Comprehensive Advanced Life Support (CALS) and Trauma Nursing Core Course (TNCC) standards Document findings from primary and secondary review on PI tracking forms

There have only been two multidisciplinary committee meetings in two years where cases were reviewed There is no evidence that providers attended 50 percent of the meetings as required by the trauma system criteria Schedule regular multidisciplinary trauma meetings where critical case reviews can be conducted by all providers involved in trauma care These scheduled meetings should be co-chaired by the trauma medical director(s) and the trauma program manager The agenda for these meetings should include cases that have been reviewed previously by the TMD and TPM Consider scheduling the multidisciplinary meetings to occur in conjunction with other widely-attended meetings or at another time when the agenda can be accommodated Since the trauma case volume would likely support quarterly meetings increase the frequency and regularity of the meetings to ensure that issues are addressed in a timely fashion Ensure all ED providers general surgeons and advance practice providers participate in the case review meetings and meet attendance requirements of the state trauma system

While some components of a trauma PI process exist there is essentially no functional PI process Performance improvement activities exist only as identified in the primary review by the TPM There is a process for identifying trauma patients and issue identification occurs but these data are not carried forward for adequate discussion action planning and issue resolution The TMD apparently lacks understanding of the PI process and the need for a collaborative multidisciplinary team to effect change Some limited secondary review appears to take place but it does not appear to translate into effective or meaningful performance improvement initiatives There was no documentation of any substantive discussion with all providers involved in the care of trauma patients (ie ED providers and surgeons) or a multidisciplinary team Build a comprehensive and effective trauma performance improvement process that includes case review by the ED providers and general surgeons The trauma program manager should provide the initial review scrutinizing whether the standards of care were met She should then identify certain cases for review by the medical director Typically this is any case in which care or decision-making is questioned or unacceptable deviations from the established performance standards are identified Additionally there should be criteria that prompts an automatic medical director review such as trauma deaths admits and TTAs After the trauma medical director provides the second level of review the two together determine if a performance improvement initiative should be pursued and if there is value in discussing the identified learning opportunities in one or more committees (tertiary review) All levels of review must be documented Consider having the TMD and the TPM attend Trauma Program 101 offered by the statewide trauma system to gain a basic understanding of trauma program administration and performance improvement

There is little to no evidence that the surgeons participate in the trauma program or the care of trauma patients General surgeons should assume a leadership role in the level 3 trauma hospital and provide clinical oversight of trauma care via the performance improvement process They should aspire to meet the needs of trauma patients in the community and region by accepting the responsibility of caring for trauma patients


6

admitted to the facility Ensure that the general surgeons assume a leadership role in the trauma program and in the care of trauma patients

Strengths of the Trauma Program The EMS program at Cuyuna Regional Medical Center is outstanding A fleet of three

ambulances and one suburban are staffed with an ALS crew of one paramedic and one EMT 247 There are five staff participating in the community paramedic program at CRMC

The paramedics participate in the care of the emergency department patients They may assist with advanced airway management and cardiac monitoring and are members of the Level-One Acute MI Response Team

The staff are well trained Ninety percent of the ED nurses and 81 percent of intensive care unit nurses have either Trauma Nursing Core Course (TNCC) or Comprehensive Advanced Life Support (CALS) certification The hospital requires new hires to be certified in TNCC or CALS within one year of their hire date

The new ED trauma rooms are spacious Once the organization completes the move-in process all the essential equipment used during a trauma resuscitation (adult and pediatric) will be in close proximity to the patient

The outgoing trauma program manager Violet Mussell has been active in the Central Minnesota Regional Trauma Advisory Committee

The hospital has committed to hiring only board certified emergency medicine physicians to staff the ED

Dr Allegra the trauma medical director is also the medical director for CRMC EMS

The hospital undertook a performance improvement (PI) project that resulted in new trauma team activation criteria that aligns with new statewide guidelines The activation criteria has been placed on the badge cards of all ED and EMS staff

Documentation of the care rendered was thorough

The lab department was well prepared for the site visit Staff were able to produce documentation of their emergency release process as well as their massive transfusion policy

The Orthopedic service is very active and admits many patients This resource allows individuals to stay within their own community


7

Opportunities for Improvement The trauma program manager has only 15 percent of an FTE dedicated to the trauma

program which is insufficient The trauma program performance improvement process is ineffective and will require additional resources to achieve an acceptable level Monitor the needs of the trauma program closely and increase the amount of time the trauma program manager is allotted as necessary to complete the system-required activities

The trauma program manager is responsible for entering cases into the trauma registry which represents a considerable drain on her time It is unreasonable to expect the program to have an effective PI process considering the responsibilities the TPM is charged with in light of the current FTE allocation Since her expertise are clinical in nature consider enlisting the help of others (such as staff nurses or paramedics) for data entry freeing up the program managerrsquos time to review cases and pursue performance improvement initiatives which is more in concert with her education and experience

Case review revealed a number of cases in which radiology reports from the tele-radiology provider exceeded 30 minutes Such delays can result in treatment and transfer delays but the trauma program does not track the tele-radiology providerrsquos turn-around Radiology read times should be tracked to ensure that results are communicated in a timely manner Consider adding a PI filter such as ldquoSTAT CT report received gt15 minutes routine CT report received gt30 minutesrdquo Critically review all cases that fall out of the standard with the goal of identifying factors that contribute to long CT read times and remedying them

The hospitalrsquos typical practice is to admit trauma patients to the hospitalist service with consultation of a specialty service (ie surgical services) when indicated Since hospitalists are not typically trained in trauma management consider offering trauma education for these primary care providers aimed at averting missed or delayed recognition of injuries The surgeons could provide such education in concert with the case review meetings Monitor the co-management of trauma patients carefully through the performance improvement process

The trauma program uses the filter ED length of stay for code green transfers But there is no specific time threshold for this filter which will prevent the trauma program from measuring its performance An unwritten goal of transferring patients within 120 minutes was mentioned but two hours is a long time for trauma patients to remain at a sending facility before being transferred to definitive care Trauma patients have the occasional tendency to harbor life-threatening occult injuries and can deteriorate after at first appearing stable Monitor trauma patients length of stay in the emergency department with a PI filter such as length of stay gt60 minutes which can be objectively measured then critically review all cases that fall out of that standard with the goal of identifying factors that contribute to long stays and remedying them Such a conservative filter will no doubt result in the filter falling out on many lower-acuity cases But these cases can be critically reviewed and then adjudicated as an acceptable deviation from the standard

There is a need to better define the trauma patient in order to identify those cases for analysis through the performance improvement process Broaden the trauma programrsquos scope of review to include at a minimum all trauma deaths admits transfers and trauma team activations


8

There is no emergency airway equipment in the CT scanner room Patients leaving the emergency department are at increased risk for airway complications as their distance from the emergency department resources increases Equip the CT scanner room with basic airway resuscitation equipment for all ages that is immediately accessible such as adult and pediatric bag-valve-masks and oral airways along with oxygen and suction

There appears to be limited formal interaction between the TPM and the TMD In order for the trauma performance improvement process to be effective ensure that the trauma program leaders interact regularly and collegially collaborate on PI initiatives

Case Summaries Case Summaries Redacted

Closing Comments Previous site visits identified insufficient surgeon involvement in clinical care and PI activities This continues to be a problem

The PI process is ineffective The program has had two marginal PI meetings in the past two years and none within the last year The friction between the TPM and TMD appears to be hindering the performance improvement process The TMD could benefit from better understanding trauma performance improvement and the multidisciplinary approach to programmatic PI

Substantial changes to the trauma program at CRMC are necessary for the hospital to meet the essential criteria of the statewide trauma system It is important that the hospital commit to and maintain the trauma system resource requirements in order to provide optimal trauma services the community and region

September 8 2016

Ron Fumival MD

CRMC CUYUNA REG IONAL

MEDICAL CENTER Dedicated to You Every Day

State Trauma Advisory Council PO Box 64882 St Paul MN 55164-0882

Dear STAC members

The General Surgeons Orthopaedic Surgeons Emergency Physicians and Administration of Cuyuna Regional Medical Center have received the report submitted for review by the STAC We have met together and agreed that you should receive our response before reaching a decision regarding our trauma center We all strongly feel that our Trauma Program is on the cutting edge of advanced Rural Trauma Care The recent report received from the ST AC subcommittee does not represent the state of our Trauma Services In fact the report does identify opportunities for improvement many of which have already been addressed Substantial expansion building projects and the re-organization of our Emergency Department Hospitalist Program Orthopaedic Services and Committee structures have resulted in transient delays which have already been ameliorated particularly as it relates to required meetings and the paperwork associated with PI processes

As a facility we have invested heavily in our Trauma Care by developing a new model for the Emergency Department In addition to substantial changes in personnel and a dramatic physical expansion of the Emergency Department we have in the past year spearheaded a highly evolved and quality based integrated rural trauma system As of late 2015 we are the only rural lower volume out-state ED staffed 247 with Emergency Physicians with American Board of Emergency Medicine training and certification The remarkable care that our ED Physicians provide is driving all cause metrics Notably our ED volumes have grown 19 in the past year Despite facing the challenge of increasing volumes our enhanced patient flow strategies have decreased our Door to Doctor time previously over 60 minutes down to an average of 9 minutes Our Time in Department for discharged patients previously averaging 260 minutes is now averaging 100 minutes The number of patients who leave without being seen was 3 5 patients per month in the second quarter of 2015 and was 1 patient per month during the same peak season interval this year These and other metrics are

ON THE MEDICAL CAMPUS IN CROSBY

320 EAST MAIN STREET - CROSBY MN 56441 - PHONE (218) 546-7000

w wcu~middotunamcdorg

industry-leading figures which comes in large part from the insights and mentorship of the Hennepin County ED which includes five HCMC ED Faculty Physicians actively working in our ED providing insight on current best practices With this remarkable world class Emergency Medicine mentorship we have been able to grow and foster a rural ED that last fall received national recognition from the National President of the American College of Emergency Physicians Our ED Director was invited to the East Coast to speak at the President of National ACEPs Residency Training Program regarding rural Emergency Medicine last fall The demands of our Emergency Physicians training and backgrounds have necessitated that we make significant equipment investments in our trauma care for our ED to include a latest generation cardiac ultrasound fiber optic intubating scopes a dedicated trauma bay an updated airway cart Stryker Mini C-arm as well as nearly tripling the size of our ED square footage and capacity All of our investments have occurred since the summer of 2015 and these investments have direct benefits on all cause quality and care for Trauma patients presenting to our ED The patients in our ED are taking note as evidenced by our truly remarkable outlier ED Press Ganey Scores which have month to month variability between the 96th and 99th percentiles

Our Surgery Services have always been robust but have grown significantly even since the May STAC review We have four General Surgeons who all trained in urban centers as trauma surgeons We are a teaching center with Minnesota s most established Post-Graduate General Surgery Fellowship in Minimally Invasive Surgery Bariatric Surgery and Flexible Endoscopy The Fellow participates in the Trauma Program along with the four faculty general surgeons all of whom have a background of residency trauma training at Level I Trauma Centers (three at HCMC) 95 years of combined rural trauma experience and have either helped to initiate rural trauma care for Minnesota or served on the STAC We are an accredited Level I Bariatric Center and have recently started a GERD Center Our Orthopaedic Services now include three specialists and three are fellowship trained Lower Extremity Adult Reconstruction (Total Joint) Hand and Sports Medicine

Our skilled general and orthopaedic surgeons coupled with our board-certified ED physicians in a well-equipped center with a longstanding pedigree of excellent team-based trauma care provide rapid and high quality care for the trauma patients in our region

The pathways and algorithms may be novel due to capabilities not usually available to a rural lower volume center and therefore our trauma center may not align with expectations for trauma care as conceived by the American College of Surgeons for rural facilities It is all too apparent that the recent report does not represent the care we provide nor adequately reflect who we are and the

commitment we have toward excellence in trauma care If there is further guidance or improvements the ST AC feels are necessary we are keen to integrate these concepts That said at present we are disappointed with the lack of partnership and collaboration implied by the recent report

We the undersigned are eager to give the STAC the opportunity to revisit our facility and are confident that a concerted review would come to quite different conclusions

Alternatively we the undersigned representative of Cuyuna Regional Medical Center are content to resign our designation while continuing to advance rural trauma care for our region

Respectfully

Paul Severson MD F ACS Howard McCollister MD F ACS Timothy LeMieur MD FACS Shawn Roberts MD F ACS Martin Perez MD Fellow

Paul C Allegra MD Director of Emergency Services HCMC Emergency Medicine Residency Class of 2008

Erik Severson MD Director Minnesota Center of Orthopaedics Jon Herseth MD Sports Medicine Susan Moen MD Hand Center

Rob Westin MD CMO Kyle Bauer CEO Amy Hart COO

Cc Carol Immermann RN Vice Chair Sharon Moran MD Level 1 or 2 Trauma Surgeon Aaron Burnett MD State EMS Medical Director Colonel Matt Langer Commissioner of Public Safety John Fossum Rural Hospital Administrator Gayle Williams RN Level 3 or 4 Trauma Program Manager Daniel DeSmet EMT-P Rural EMS Attendant or Ambulance Director John Hick MD Emergency Medicine Physician Steven Lockman MD Rehabilitation Specialist Alan Johnson PA-C Rural Physician Assistant or Nurse Practitioner

Peter Cole MD Orthopedic Surgeon Robert Roach MD Level 1 or 2 Neurosurgeon Craig Henson MD Rural General Surgeon Mark Paulson Level 3 or 4 Family Medicine Emergency Physician

September 22 2016 Dr Edward Ehlinger Commissioner of Health Minnesota Department of Health PO BOX 64975 St Paul MN 55164-0975

Dear Dr Ehlinger

Cuyuna Regional Medical Center in Crosby MN has been dedicated to excellence in rural trauma care for 30 years well in advance of the inception of the Minnesota Statewide Trauma System We have long participated in Minnesota rural trauma program development including contribution to the formation of the State Trauma Advisory Council (STAC)

We the undersigned Trauma Service physicians at CRMC and representatives of CRMC Administration feel that the current requirements for Level III Trauma Designation as evaluated and implemented by the Minnesota Department of Health through the State Trauma Advisory Council do not adequately respect nor fully understand the widely varying needs and capabilities of Minnesotarsquos many rural hospitals including Cuyuna Regional Medical Center

It is therefore with regret that we hereby notify you that we resign the Level III Trauma Designation that had been previously granted to us by the Minnesota Department of Health and that we have held since the very first days of the Minnesota Statewide Trauma System

We are firm advocates of and strong believers in quality rural health care and we have been long-recognized leaders in that arena both on a state and national level We firmly believe in the critical importance of quality trauma care in rural America and our record and reputation over three decades clearly supports that assertion Please rest assured that despite our resignation of formal ACS Level III Trauma Designation we will continue to provide the same excellent trauma services and continue the same robust innovative Trauma Program development that we have always provided to our patients our community and all the citizens of the state of Minnesota

Respectfully submitted

Kyle Bauer Interim Chief Executive Officer

Paul Allegra MD FACEP Medical Director Emergency Medical Services Medical Director Trauma Program Howard McCollister MD FACS Chief of Surgery Paul Severson MD FACS Department of Surgery Tim LeMieur MD FACS Department of Surgery Shawn Roberts MD FACS Department of Surgery Erik Severson MD Department of Orthopaedic Surgery Susan Moen MD Department of Orthopaedic Surgery John Herseth MD Department of Orthopaedic Surgery Rob Westin MD Chief Medical Officer

middot

October 13 2016

Kyle Bauer Interim Chief Executive Officer Cuyuna Regional Medical Center 320 East Main Street Crosby MN 56441

Dear Mr Bauer

m Minnesota

Department of Health

Thank you for your hospitals application for designation as a Level 3 Trauma Hospital in April of this year After months of deliberation and review of your September 8 letter the State Trauma Advisory Council (STAC concluded on September 13 that Cuyuna Regional Medical Center (CRMC has ongoing global deficiencies with its performance improvement program dating back to 2007 Due to the serious and ongoing nature of the deficiencies (cited in the July 26 2016 site visit report) the STAC recommended that CRMC not be redesignated

Subsequent to that action CRMC sent a letter of resignation dated September 22 However there is no provision in statute that permits a voluntary withdraw from the system absent a formal refusal of designation Therefore according to STACs recommendation and in acknowledgement of your requested resignation I am denying your application for redesignation

Cuyuna Regional Medical Center is no longer a state-designated Level 3 Trauma Hospital

Four immediate consequences are now in effect

1 CRMC may not advertise itself as or use the terms trauma center or trauma hospital or otherwise indicate it has trauma treatment capabilities in accordance with Minnesota Statutes Section 144605 Subdivision 1

2 Ground ambulance services are not p~rmitted to transport major trauma patients to CRMC in accordance with Minnesota Statutes Section 144604 (Minnesota Statute Section 144602 defines major trauma)

3 CRMC will no longer receive trauma transfers from other designated hospitals in accordance with Minnesota Statewide Trauma System Level 3 Trauma Hospital Designation Criteria

4 CRMC must notify regional hospitals and emergency medical services providers and authorities that it is no longer a designated trauma hospital in accordance with Minnesota Statutes Section 144605 Subdivision 6 This is necessary since these organizations may need to change their transport andor transfer policies

Protecting maintaining and improving the health of all Minnesotans

r

Trauma system hospital designations assure the public and EMS providers that standardized trauma education policies and clinical quality review processes are verified and integrated into the care of seriously injured patients so that patients receive the most accountable and timely quality care Designations also recognize that both the administrative and medical leadership are committed to meeting all required designation criteria Participation in the statewide network of dedicated trauma hospitals is a valuable community asset

I encourage CRMC to consider the industry-proven patient and provider benefits of a trauma performance improvement process and to integrate this into its existing trauma care model I have instructed my staff to contact you within the week to offer any assistance you might desire should you want to reapply for trauma designation in the future

Please address any questions to Chris Ballard Trauma System Coordinator at chrisballardstatemnus or (651) 201-3841

Sincerely

Edward P Ehlinger MD MSPH Commissioner PO Box 64975 St Paul MN 55164-0975

Cc Amy Hart Chief Operations Officer Rob Westin Chief Medical Officer Caity Eggen Chief Human Resources Officer Ron Furnival MD Chair State Trauma Advisory Council State Trauma Advisory Council Members Tony Spector Executive Director Minnesota EMS Regulatory Board Tami Bong Chair Central Minnesota Regional Trauma Advisory Committee

Joint Policy Committee Recommendation of Cuyuna Regional Medical Center Ambulance Servicersquos Request to Deviate from Trauma Triage and Transportation Requirements

JPC Meeting Date August 25 2017

In Attendance Dr Aaron Burnett (EMSRB)

Pat Coyne (EMSRB) (Alternate in for Dr Ho)

John Fossum (STAC)

Dr Ron Furnival (STAC Chair)

Carol Immermann (STAC alternate)

Al Johnson (STAC)

Dr Sharon Moran (STAC)

Dr John Pate (EMSRB)

voting

Absent Dr Jeff Ho (EMSRB)

Staff Tony Spector (EMSRB)

Tim Held (MDH)

Marty Forseth (MDH)

Chris Ballard (MDH)

Recommendation Minnesota Statutes 144E101 Subd 14 permits the EMS Regulatory Board to approve an ambulance servicersquos deviation request (1) due to the availability of local or regional resources and (2) if the deviation is in the best interest of a patientrsquos health

The JPC reviewed and discussed CRMC Ambulance Services request to deviate from the Trauma Triage and Transportation Guideline and trauma system staffrsquos analysis of the request The committee found that the application fails to satisfy the statutory requirements because

The proposed destination hospital does not possess unique capabilities to treat specific traumatic injuries that are unavailable at two nearby trauma hospitals

The proposed destination hospitalrsquos resources and capabilities have been subjected to the trauma systemrsquos verification process and found to be insufficient to satisfy the requirements for a trauma hospital in Minnesota

Based on these findings the JPC recommends that the EMS Regulatory Board deny Cuyuna Regional Medical Center Ambulance Servicersquos request to deviate from the statersquos trauma triage and transportation requirements

1313131313

13 13$1313131313131313$ampampampampamp( amp

)+- 0+1233456677789779lt=gt8Alt6BAC=Dgt=4=36796EAE6BAC=Fgt3GFAHgtEFgtC9FICH93C3gtA9F7gt32FltJHEF9CKgt6C3gtEDLMNLOLMPFLFLMJFJQOPFNORLSN823ltETAC=Ugt3GUAHgtEgtC9ICH93C3gtA97gt32ltJHE9CKgtVGW2EXgt33CAY=gt3ACZBAC=798Alt[HR]RSMO_0)abc0defg)hifjabkclamdabc0d

nA7323TAC=297=gtlt4CAK=4AEgt2=oHC3C9TAC=Ugt3GUAHgtEltltJC9pGACqGrEgt92Y=sAEgtU2gtIVC33tlt4G7AHE=EgtY3A2KAltJHE9CKgtgt3A7=ltJHE2AH9=gt327IgtEgt3G9ATAC=2KI93CC94A93gtlt98VH3329AEH3gtAgt9A39G9gtTAC=gt9HCC3EG9CK=JG37AltJHE4CAKgt=C98iku0vq2gt9lt492A7972CTAC=w9ltJHEJAH=Cgt9C8[EEgt[ltJHE29323CCgt3ACGA32Cgt239gt=93AIVCA=7Gx3C3x83AxA=x3C3qCgtEy=zgt27GMN8Wgt=Kgt7[ltJHE29323CCgt3ACG793AI32JAH=CG8q2gt9lt492A7972CTAC=|9ltJHEJAH=Cgt9C8[EEgt[ltJHE29323CCgt3ACGA32Cgt239gt=93AIVCA=7Gx3C3x83AxA=x3C3qCgtEy=zgt27GMN8Wgt=Kgt7[ltJHE29323CCgt3ACG793AI32JAH=CG8

1313131313


)+-+01+23456+73+89+-54lt0=lt42)gt+37+3+ltlt06A+lt4+2+248A+345BltC8DltAElt55ltB3-1lt2403-DF8+-5430lt35++3-lt422+888lt+ltED+lt+8lt35+G+8D47+H+gtA543D+Glt42F8AAlt8+42DltB4G54+A3408+73+4+484+2++3+2ID+)169=lt7+8++84554G54+53+83-3D+84+ltE13+8lt4IJ5534JG54+8+7+8D++3lt0+48ltE=lt42B406++6ltDlt6+lt26++H34-5+K4+42L3-DB40MNOI932-+73+BJG54+D48D++3lt0B+8ltED+Glt240I1lt8ltEPlt24388+7+2G0932-+73+BJG54+IQRSMNH932-+73+BJG54++8Alt2+2ltRTN+U+8842Alt732+2MVT48Alt8IJ5534JG54++8Alt28lt4GltNS455840+4lt47+4-+I932-+73+BF845584+A83-3W450D380+4I=+B++P4IM42P+VSH932-+73+B+8Alt2+2ltMOM+U+8842Alt732+2MMX48Alt8ID+3+8Alt8+3+38458ltAIK480+4H932-+73+B+Alt+2D+47+4-++8Alt8+Elt4Ylt2+VZ53-D84283+8[+8Alt8+B48MVITM3+8I=+B++P4IM42P+VSD380+4HD+47+4-++8Alt8+3+38MTIM3+8ID+A8DltD47+lt+4G54+Alt732+-43+2lt+Elt55ltB3-4P50X332+lt832+D+Plt24L38lt0Y++HBD++4Blt4B48D473-48+3]+428--53-ltG+4D+IPlt24Y30Ylt35+G+P+_355B48D++BD+D+332+lt+242455+-+23ltltCRR3+8Elt44G54+lt+8Alt2ILltB+7+Hlt0+lt288DltB932-+73+BJG54++8Alt2+23M3+8I`abcdefgahhaiJlt23-lt6A+ltHD+)169=2lt+8lt8+4G54++8Alt8+3+842428HG33A4533+84+84G538DD+3ltBIL++A3Ylt0D48+84G538D+28+A44+842428EltD+lt0H30ltE13+4Alt538Hj2+7+5ltA+2klt33+8Hj2+7+5ltA+254C+klt33+842454+48IQD+30ltE13+4Alt538Hj2+7+5ltA+2lt33+8k42D+lt0484BDlt5+H4G54+8++2lt437+B3D3MSlXO3+845+48OSA++ltED+3+Imltj2+7+5ltA+254C+klt33+8HD+8424238MXlXO3+8Elt45+48nSA++ltED+455834-37+lt304245+48OSA++ltED+4558EltD+-ltAltElt33+8IQ45lt33+8HBD3D352+4+48ltEYD4D488+HD+8424238MlXO3+8Elt45+48nSA++ltED+455834-37+lt304245+48OSA++ltED+4558EltD+-ltAI_D+48C+2G0lt3549ltG+_D3AA8DltB40ltD+33+83D+8+7+olt0+lt4+4D47+8A534G54+8+73+H6A+lt84328+7+lD+30ltE13+4Alt538Hmlt6+553-Hplt52+q455+0H13+ltC4HD+q3554-+ltE6IJDlt0426Dlt+Bltlt2IrEDlt8+H_D3AA8E+5D+lt50ltA44G5+lt+ltPlt24B486Dlt+Bltlt2HBD3DD424AltA543ltltEHVS4D+548+88Ij6lt3388426Dlt+Bltlt2H42MnSltD+ltB8Z3D+8+7+olt0+lt4+4[4+D473-483-544G54+8+73+Hk_D3AA88432IYlt35+G+P++0plt+G+58432Plt24383U+G+48+338lt3D+3+3-ltED++lt4+442338ltD+lt++2-+8ltEGltD4G54+8+73+4+48IjD++48ltBD0B+4+455D++lt3-D38B+42+454-+W434537+8+lt4+BZAlt53+[E4353042B+5ltltC+2445ltltElt3+8H42BD35+D+04+B+55B3D343lt45842428HB+G+53+7+H-37+lt37+8+HD+04G+G++Eltlt33]+8Hkplt+G+58432IcsgtucdbavwcQlt2+EltD+30ltD47+lt+4G54+Alt732+Hlt+ltEBltD3-8Blt52D47+ltD4AA+I)3D+932-+73+BltJ5534Blt52D47+lt8G34+U+8ltD+)169=ltD4-+D+3A3408+73+4+4428+2+D+3+3lt0ltD+ltD+4-+0HltD+30lt524AA50Elt38ltB4G54+53+8+ID+Alt+88lt4AA50Elt44G54+53+8+38lt+480ltU3CHDlt-DID+30Blt52D47+ltA+A4+42+435+24AA5343ltHBD3Dlt524C+4E+BB++C8Ir+3388G3+2HD+)169=+73+B83lt+8+338ltA5++I

1313131313


)+-0012+-2324+3501-62-740891242---lt=24-gt-13+1400gt6-+--2-244-A31gt4gt3-2BCD-gt24EFGH+355-0gt23CI--3J-EFGH+355-0gt2362J-gtgtBK3gtJgt+355-42300342-233J-0012+-2362-=34-3-LMltN93gtJ3gt00gt3K13gt21COJ-gtgt53gt-BK+355-42300342-236-0012+-4EFH4-3gt431KH+3+gt4COJ-34+3+gt4+3-9gt431K6-0012+-23+53K-3+3-4-+4gt2=2-5224-gt-2K1P8=C)gt1gt2--K2+240gt4-6-+2-H--3gtH+38100gt6-5224-gt-2K1P8=4QFH4Jgt35--3J08912+-23-348952-gt+355-23-3-LMltNC0+-3gt42-P8=gt1243-454--8-3gtH+gt2-gt2---LMltNgt1243gtK22=0012+-23CD93gt74+242324B1489P+--3P82+21gtK2C0+-3gt42-5224-gt-2K1P8=74gt+355-2324P84---Rgt+355-23-3-J811LMltNCSO-248-2=3Kgt152=0gt3+4462-gt11H24R2-343-00--3J-6T0+-3gt42CDJ+---gt0gt4--2K4Jgt355981+0gt3K2gt463KB+214-A0gt25gtH4gtK2+gt4gt+11=642-3-LMltN23-42-112-U2004CD93gt241435803J52+1Bgt0gt4312+1843gt0gt4--2KJgt35-V384-61-38=--4-24+8gtgt-1HK+-Clt2=-36WK2M211gt2-I112V1-LMR33J--30gt3K2gt44gtK2=X3gtR243-LMltNCSY38gt-112=84gt03gt1442-4384-3512A-2431-2=6J3gt1+A3J9--gt3gt624gt2==9+8481442+3gt03gt-38gt35981+4gtK2+6-gt243H+0-2-23-5981+4gtK2+-3+=6-31H01Hgt4--+gt-2+3gt03gt-5981+4gtK2+46TU200442CSZgt48591H6-Hgt-45-2-24--gtgt[82gt9H4--8--392J3gt543-H++3-4-2JH93H-4-353K2-3-2gtgtCSU2004--2-343-4512A-LMltN244gtK2=-03013gt0301744J-H-03013KK4-2-gt4-25A2=53H3-5981+4gtK2+gt-31H343+001H-35A+=2ZI938gt24CI1-38=-0gt3+44242+81-60+-3gt422-243-88481-3K+2-H312-435981+12+4CI45--gt3JJ+-62=93gt2=N11Z1242-435981+12+4+3-gt+-42-lt2=K2I5981+-30gt3K24gtK2+C] _ab_cdaebcfcbgU21-+38+2138112AJ4-gt5981+gt4034-25460+-3gt423-gt5gt=+H0gt431612A0312+BgtB=-gt46gt1430gt-3J-LM4H4-54381903-30gt3K2+gt25gt=+HCSU12A-3438gt0312+3+gt438gt4gt27408-24K5225855gt=+H52+1gt403gt+gt-2B+-23gt=24-gt-239+840312++gt5H9528--3-3528-438-CDH+J3+84352-22=-2gtH624-0-2-9gt-2=634-0gt43hZlt634-0gt43ILijUgt1H338gt0gt-gt42-4H4-56T0+-3gt42CI11X3gtZ312+3+gt4KLM-gt22=6++3gt2=-3Z312+h2JNgt--L50HCI+38+215Xgt5Hk3916324K318-gtBgtB=-gtJ3gt-+2-H64242lBgtB=-gt462+182=2541J6gt12+4LMD4CO2-236BgtB=-gt4+gtgtHmgt+62++4-30gt8=3Kgt3422-4-gt+A4CDH33-63Kgt6+gtgtH020gt2J3gt11gt=2+gt+-23CSU-2-932143-3J3gt524--no528-46np528-46--242=COA32-242-2-5l2585CCCgt3-38-423JH9gtgt2gt4698-4+38+21559gt43J38gt3LM4H4-5gt6K+2--+39--gt6Tk39142CI1-38=3+24234gt5--3gtA4306--5340gtJ31132=-5-2=433JJgt84-gt-234+38+21559gt4+3-28-32gt-2gt+35012-42--1252-30-234-HK-308gt4835981+4gtK2+CI+38013J+38+21559gt4-AU2004=gt2-24+355----0gt3+44454-39gt2==CU-gt-+38+21211--50--308gt48001H2=J3gt2-435981+12+443-H++3-gt+-2-35981+0gt3K2gtgt524-394CLMltN559gt4DL5gt=+HM2+1gtK2+4lt=81-3gtHN3gt245803JnQ559gt4--gt0032-9H-=3Kgt3gtCI0032-44gtKJ38gtGHgt-gt54C

1313131313

13 13$1313131313131313$ampampampampamp( )amp

+-01230456-2078890-0-104lt8-=68788gt=-=+8+56A=B04C068=898D8E8gt3D81+-=86gt++-gtF7--D81+5=88GA6+8gt04H-gt1I--+90Agt=88J8JE6=88788gt=-=+8K-A-L+gt2M028gt04I+gtgt8-70+9781+-=++-gt06gtK-=804N-18gt-94-D+37-=+8763++-gtO+B-P8=6Q0gt+804I+gtgt8-70+97048+0gt-J8JE6=8RRHA+=0gt04N001PA39P0-16-+-gt1D8=0OI58788gt=-=+88S83-28045=RK-A9lt0A88788gt=-=+8-0gtTDP0gt045=RK-A9Q0DD++0gt804KAP+5-48=318+Egt88I-25608gtP-AD045=RK-A9Q0DD++0gt804lt8-=618+Egt88I-==68U5+D70gt045=RK-A9J86+848788gt=-=+8I+6-801-gt04T778V-8397AP+D8DP8T-0gtAgt8==045=RK-A98D8E8gt3763++-gtK-=+2Q03gt804-+gt89-DPA-gt88+81+8=0-=W0=6I8D0+-lt8-=6Q-850==lt-P804lt8=090Agt=368+S8788gt=-=+8XC8gt+8Q0Agt=3YI8E-gtlt-=+E-gt04I0gt=+8098E+=881gtA88S83lt004I+gtgt8-70+98E+0gt-OI570E-D8788gt=-=+8Xlt8gtgt87+gtQ0Agt=3I81+-Q8gt=8YM8+gtI+804Q-gtgt0gtL-9607+=-8788gt=-=+8XT+gt-lt8-=6OI5Y58gt-=8D8DP8M-=63568-gt1+1gt0=8828Z-770+gt=D8gt=U68gt68=8D8[7+810gt-gtR9-gt1-gt8U58gt-=88788gt=-=+86-gt0=38=P88gt-770+gt=81=0J=68--gt3R

1313131313

13 13$1313131313131313$ampampampampamp( ampamp

Central Minnesota EMS Region 705 Courthouse Square St Cloud MN 56303

Phone 3206566122 Fax 3206566130

Benton Cass Crow Wing Kanabec Mille Lacs Morrison Pine Sherburne Stearns Todd Wadena Wright ______________________________________________________________________________________________________________________________________________________

August 14 2017

Tony Spector EMSRB Executive Director2829 University Ave SE Suite 310Minneapolis MN 55414-3222

Dear Mr Spector

I am writing to you on behalf of the Central Minnesota Emergency Medical Services (CMEMS) Region Joint Powers Board The CMEMS Region serves the EMS providers in Benton Cass Crow Wing Kanabec Mille Lacs Morrison Pine Sherburne Stearns Todd Wadena and Wright counties

There are 8 Emergency Medical Services (EMS) Regions that cover the State of Minnesota Each Region is designated by the Emergency Medical Services Regulatory Board (EMSRB) pursuant to the Minnesota Emergency Medical Services System Support Act (Minn Stat 144E50) The monies for these grants come from the General Fund and seatbelt citations These are the funds used to help maintain the EMS system in our region

A proposed increase to the System Support Act was included for possible inclusion to the 2017 budget bills in the house senate and in the governorrsquos budget Unfortunately additional funds for the EMS System Support Act were not included in the recently passed budget bill Our current funding has reached a critical level Without an increase this fiscal year the Board had to drastically reduce programs that directly maintain first responders This system is already stressed Aging responders and lack of new volunteers to replace them is creating difficulties in our ability to maintain this basic safety system This is concerning to us We are at a point when a citizen calls 911 there may be long delays in response

This system is in crisis We need your help The CMEMS Region Joint Powers Board requests your attendance at our September 29 2017 Board meeting The Board would like to discuss avenues of potential future funding Please contact Sue Feldewerd at 320-656-6603 to obtain additional meeting information directions and to RSVP

We look forward to working with you in partnership on this grave situation

Sincerely

Commissioner Jeffrey J Jelinski Central Minnesota EMS Region Chair

CC EMSRB Executive Director Tony Spector CMEMS Region Joint Powers Board members Governor Mark Dayton Senator Paul Utke Senator Justin Eichorn

(continued on back)

Senator Paul Gazelka Senator Carrie Rudd Senator Tony Lourey Senator Torrey Westrom Senator Michelle Fischbach

Senator Jerry Relph Senator Andrew Mathews Senator Scott Newman Senator Bruce Anderson Senator Mary Kiffmeyer Senator Michelle Benson Representative Steve Green Representative Matt Bliss Representative Sandy Layman Representative John Poston Representative Ron Kresha Representative Josh Heintzeman Representative Dale Lueck Representative Mike Sundin Representative Jason Rarick Representative Paul Anderson Representative Jeff Howe Representative Tim OrsquoDriscoll Representative Tama Theis Representative Jim Knoblach Representative Sondra Erickson Representative Jim Newberger Representative Dean Urdahl Representative Joe McDonald Representative Marion OrsquoNeill Representative Nick Zerwas Representative Eric Lucero Representative Kurt Daudt

Meeting Agenda

10 Re-Open Meeting -- 1055 am

11 Adjourn -- 1100 am

If you plan to attend the meeting and need accommodations for a disability please contact Melody Nagyat (651) 201- 2802 In accordance with the Minnesota Open Meeting Law and the Internal OperatingProcedures of the Emergency Medical Services Regulatory Board this agenda is posted athttpwwwemsrbstatemnus


(651) 201-2800 (800) 747-2011 FAX (651) 201-2812 TTY (800) 627-3529

wwwemsrbstatemnus


Meeting Minutes













EMSRB Board Meeting Minutes ndash July 20 2017 of 5


operational

















Alexandria MN


August 4 2016


Dear Mr Solheim




Sincerely







2

Contents Overview 3


Deficiencies 4



Case Summaries 8

Closing Comments 8


3




Tracy Larsen RN




4










5






6















7









8







September 8 2016

Ron Fumival MD




Dear STAC members













Respectfully








Dear Dr Ehlinger








middot

October 13 2016


Dear Mr Bauer

m Minnesota











r




Sincerely







John Fossum (STAC)



Al Johnson (STAC)



voting



Tim Held (MDH)

Marty Forseth (MDH)

Chris Ballard (MDH)






1313131313




1313131313



1313131313



1313131313



1313131313



Phone 3206566122 Fax 3206566130


August 14 2017


Dear Mr Spector






Sincerely



(continued on back)



Meeting Agenda


(651) 201-2800 (800) 747-2011 FAX (651) 201-2812 TTY (800) 627-3529

wwwemsrbstatemnus


Meeting Minutes















operational

















Alexandria MN


August 4 2016


Dear Mr Solheim




Sincerely







2

Contents Overview 3


Deficiencies 4



Case Summaries 8

Closing Comments 8


3




Tracy Larsen RN




4










5






6















7









8







September 8 2016

Ron Fumival MD




Dear STAC members













Respectfully








Dear Dr Ehlinger








middot

October 13 2016


Dear Mr Bauer

m Minnesota











r




Sincerely







John Fossum (STAC)



Al Johnson (STAC)



voting



Tim Held (MDH)

Marty Forseth (MDH)

Chris Ballard (MDH)






1313131313




1313131313



1313131313



1313131313



1313131313



Phone 3206566122 Fax 3206566130


August 14 2017


Dear Mr Spector






Sincerely



(continued on back)



Meeting Agenda



operational

















Alexandria MN


August 4 2016


Dear Mr Solheim




Sincerely







2

Contents Overview 3


Deficiencies 4



Case Summaries 8

Closing Comments 8


3




Tracy Larsen RN




4










5






6















7









8







September 8 2016

Ron Fumival MD




Dear STAC members













Respectfully








Dear Dr Ehlinger








middot

October 13 2016


Dear Mr Bauer

m Minnesota











r




Sincerely







John Fossum (STAC)



Al Johnson (STAC)



voting



Tim Held (MDH)

Marty Forseth (MDH)

Chris Ballard (MDH)






1313131313




1313131313



1313131313



1313131313



1313131313



Phone 3206566122 Fax 3206566130


August 14 2017


Dear Mr Spector






Sincerely



(continued on back)



Meeting Agenda
















Alexandria MN


August 4 2016


Dear Mr Solheim




Sincerely







2

Contents Overview 3


Deficiencies 4



Case Summaries 8

Closing Comments 8


3




Tracy Larsen RN




4










5






6















7









8







September 8 2016

Ron Fumival MD




Dear STAC members













Respectfully








Dear Dr Ehlinger








middot

October 13 2016


Dear Mr Bauer

m Minnesota











r




Sincerely







John Fossum (STAC)



Al Johnson (STAC)



voting



Tim Held (MDH)

Marty Forseth (MDH)

Chris Ballard (MDH)






1313131313




1313131313



1313131313



1313131313



1313131313



Phone 3206566122 Fax 3206566130


August 14 2017


Dear Mr Spector






Sincerely



(continued on back)



Meeting Agenda


August 4 2016


Dear Mr Solheim




Sincerely







2

Contents Overview 3


Deficiencies 4



Case Summaries 8

Closing Comments 8


3




Tracy Larsen RN




4










5






6















7









8







September 8 2016

Ron Fumival MD




Dear STAC members













Respectfully








Dear Dr Ehlinger








middot

October 13 2016


Dear Mr Bauer

m Minnesota











r




Sincerely







John Fossum (STAC)



Al Johnson (STAC)



voting



Tim Held (MDH)

Marty Forseth (MDH)

Chris Ballard (MDH)






1313131313




1313131313



1313131313



1313131313



1313131313



Phone 3206566122 Fax 3206566130


August 14 2017


Dear Mr Spector






Sincerely



(continued on back)



Meeting Agenda






2

Contents Overview 3


Deficiencies 4



Case Summaries 8

Closing Comments 8


3




Tracy Larsen RN




4










5






6















7









8







September 8 2016

Ron Fumival MD




Dear STAC members













Respectfully








Dear Dr Ehlinger








middot

October 13 2016


Dear Mr Bauer

m Minnesota











r




Sincerely







John Fossum (STAC)



Al Johnson (STAC)



voting



Tim Held (MDH)

Marty Forseth (MDH)

Chris Ballard (MDH)






1313131313




1313131313



1313131313



1313131313



1313131313



Phone 3206566122 Fax 3206566130


August 14 2017


Dear Mr Spector






Sincerely



(continued on back)



Meeting Agenda


3




Tracy Larsen RN




4










5






6















7









8







September 8 2016

Ron Fumival MD




Dear STAC members













Respectfully








Dear Dr Ehlinger








middot

October 13 2016


Dear Mr Bauer

m Minnesota











r




Sincerely







John Fossum (STAC)



Al Johnson (STAC)



voting



Tim Held (MDH)

Marty Forseth (MDH)

Chris Ballard (MDH)






1313131313




1313131313



1313131313



1313131313



1313131313



Phone 3206566122 Fax 3206566130


August 14 2017


Dear Mr Spector






Sincerely



(continued on back)



Meeting Agenda


4










5






6















7









8







September 8 2016

Ron Fumival MD




Dear STAC members













Respectfully








Dear Dr Ehlinger








middot

October 13 2016


Dear Mr Bauer

m Minnesota











r




Sincerely







John Fossum (STAC)



Al Johnson (STAC)



voting



Tim Held (MDH)

Marty Forseth (MDH)

Chris Ballard (MDH)






1313131313




1313131313



1313131313



1313131313



1313131313



Phone 3206566122 Fax 3206566130


August 14 2017


Dear Mr Spector






Sincerely



(continued on back)



Meeting Agenda


5






6















7









8







September 8 2016

Ron Fumival MD




Dear STAC members













Respectfully








Dear Dr Ehlinger








middot

October 13 2016


Dear Mr Bauer

m Minnesota











r




Sincerely







John Fossum (STAC)



Al Johnson (STAC)



voting



Tim Held (MDH)

Marty Forseth (MDH)

Chris Ballard (MDH)






1313131313




1313131313



1313131313



1313131313



1313131313



Phone 3206566122 Fax 3206566130


August 14 2017


Dear Mr Spector






Sincerely



(continued on back)



Meeting Agenda


6















7









8







September 8 2016

Ron Fumival MD




Dear STAC members













Respectfully








Dear Dr Ehlinger








middot

October 13 2016


Dear Mr Bauer

m Minnesota











r




Sincerely







John Fossum (STAC)



Al Johnson (STAC)



voting



Tim Held (MDH)

Marty Forseth (MDH)

Chris Ballard (MDH)






1313131313




1313131313



1313131313



1313131313



1313131313



Phone 3206566122 Fax 3206566130


August 14 2017


Dear Mr Spector






Sincerely



(continued on back)



Meeting Agenda


7









8







September 8 2016

Ron Fumival MD




Dear STAC members













Respectfully








Dear Dr Ehlinger








middot

October 13 2016


Dear Mr Bauer

m Minnesota











r




Sincerely







John Fossum (STAC)



Al Johnson (STAC)



voting



Tim Held (MDH)

Marty Forseth (MDH)

Chris Ballard (MDH)






1313131313




1313131313



1313131313



1313131313



1313131313



Phone 3206566122 Fax 3206566130


August 14 2017


Dear Mr Spector






Sincerely



(continued on back)



Meeting Agenda


8







September 8 2016

Ron Fumival MD




Dear STAC members













Respectfully








Dear Dr Ehlinger








middot

October 13 2016


Dear Mr Bauer

m Minnesota











r




Sincerely







John Fossum (STAC)



Al Johnson (STAC)



voting



Tim Held (MDH)

Marty Forseth (MDH)

Chris Ballard (MDH)






1313131313




1313131313



1313131313



1313131313



1313131313



Phone 3206566122 Fax 3206566130


August 14 2017


Dear Mr Spector






Sincerely



(continued on back)



Meeting Agenda

September 8 2016

Ron Fumival MD




Dear STAC members













Respectfully








Dear Dr Ehlinger








middot

October 13 2016


Dear Mr Bauer

m Minnesota











r




Sincerely







John Fossum (STAC)



Al Johnson (STAC)



voting



Tim Held (MDH)

Marty Forseth (MDH)

Chris Ballard (MDH)






1313131313




1313131313



1313131313



1313131313



1313131313



Phone 3206566122 Fax 3206566130


August 14 2017


Dear Mr Spector






Sincerely



(continued on back)



Meeting Agenda








Respectfully








Dear Dr Ehlinger








middot

October 13 2016


Dear Mr Bauer

m Minnesota











r




Sincerely







John Fossum (STAC)



Al Johnson (STAC)



voting



Tim Held (MDH)

Marty Forseth (MDH)

Chris Ballard (MDH)






1313131313




1313131313



1313131313



1313131313



1313131313



Phone 3206566122 Fax 3206566130


August 14 2017


Dear Mr Spector






Sincerely



(continued on back)



Meeting Agenda



Dear Dr Ehlinger








middot

October 13 2016


Dear Mr Bauer

m Minnesota











r




Sincerely







John Fossum (STAC)



Al Johnson (STAC)



voting



Tim Held (MDH)

Marty Forseth (MDH)

Chris Ballard (MDH)






1313131313




1313131313



1313131313



1313131313



1313131313



Phone 3206566122 Fax 3206566130


August 14 2017


Dear Mr Spector






Sincerely



(continued on back)



Meeting Agenda


middot

October 13 2016


Dear Mr Bauer

m Minnesota











r




Sincerely







John Fossum (STAC)



Al Johnson (STAC)



voting



Tim Held (MDH)

Marty Forseth (MDH)

Chris Ballard (MDH)






1313131313




1313131313



1313131313



1313131313



1313131313



Phone 3206566122 Fax 3206566130


August 14 2017


Dear Mr Spector






Sincerely



(continued on back)



Meeting Agenda

r




Sincerely







John Fossum (STAC)



Al Johnson (STAC)



voting



Tim Held (MDH)

Marty Forseth (MDH)

Chris Ballard (MDH)






1313131313




1313131313



1313131313



1313131313



1313131313



Phone 3206566122 Fax 3206566130


August 14 2017


Dear Mr Spector






Sincerely



(continued on back)



Meeting Agenda





John Fossum (STAC)



Al Johnson (STAC)



voting



Tim Held (MDH)

Marty Forseth (MDH)

Chris Ballard (MDH)






1313131313




1313131313



1313131313



1313131313



1313131313



Phone 3206566122 Fax 3206566130


August 14 2017


Dear Mr Spector






Sincerely



(continued on back)



Meeting Agenda

1313131313




1313131313



1313131313



1313131313



1313131313



Phone 3206566122 Fax 3206566130


August 14 2017


Dear Mr Spector






Sincerely



(continued on back)



Meeting Agenda

1313131313



1313131313



1313131313



1313131313



Phone 3206566122 Fax 3206566130


August 14 2017


Dear Mr Spector






Sincerely



(continued on back)



Meeting Agenda

1313131313



1313131313



1313131313



Phone 3206566122 Fax 3206566130


August 14 2017


Dear Mr Spector






Sincerely



(continued on back)



Meeting Agenda

1313131313



1313131313



Phone 3206566122 Fax 3206566130


August 14 2017


Dear Mr Spector






Sincerely



(continued on back)



Meeting Agenda

1313131313



Phone 3206566122 Fax 3206566130


August 14 2017


Dear Mr Spector






Sincerely



(continued on back)



Meeting Agenda


Phone 3206566122 Fax 3206566130


August 14 2017


Dear Mr Spector






Sincerely



(continued on back)



Meeting Agenda



Meeting Agenda