board meetingksbems.org/html pages/board packet.pdfchairman hornung called the board meeting to...

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Board Meeting Dr. Joel Hornung - Chair

AGENDA Friday, June 2, 2017 – 9:00 AM

Landon State Office Building 900 SW Jackson, Room 509; Topeka, Kansas

I. CALL TO ORDER

II. APPROVAL OF MINUTES – APRIL 7, 2017

III. COUNCIL / COMMITTEE REPORTS a. Planning and Operations

i. Potential Action Item 1. Adoption of K.A.R. 109-2-8.

b. Education, Examination, Training, and Certification

i. Potential Action Item 1. Entrance requirements into an Instructor-Coordinator initial

course.

c. Investigations i. Potential Action Item

1. Adoption of Fine Schedule

IV. OFFICE UPDATE a. May 9th Legislative Meeting Overview

V. PUBLIC COMMENT

a. Public comment time on the agenda is limited to no more than 5 minutes by any one speaker. If an individual wishes to comment on an agenda item after board discussion but before a vote, the individual should notify the Chair prior to the start of the meeting.

VI. ADJOURNMENT

Landon State Office Building 900 SW Jackson Street, Room 1031 Topeka, KS 66612-1228

Board of

Emergency Medical Services

phone: 785-296-7296 fax: 785-296-6212 www.ksbems.org

Dr. Joel E Hornung, Chair Joseph House, Executive Director Sam Brownback, Governor

Board Meeting Minutes

April 7, 2017

Board Members Present Dr. Greg Faimon Sen. Faust-Goudeau Dr. Joel Hornung Comm. Ricky James Director Deb Kaufman Chief Shane Pearson Director Chad Pore Director John Ralston Comm. Bob Saueressig Director Jeri Smith Rep. Susie Swanson Attorney General Staff Sarah Fertig Board Members Absent Dennis Franks Rep. Henderson Dr. Martin Sellberg

Guests Brandon Beck Kathy Dooley Kathy Coleman Charles Foat John Hultgren Dan Hudson John Cota Terry David Rosa Spainhour James Zeeb Jason White Chrissy Bartel Rob Boyd Gary Winter Ron Marshall Jeb Burress Kerry McCue Craig Isom Frank Williams

Representing KEMSA/Region V Region II Region IV JCCC Dickinson Co. EMT Univ. of KS Hospital KCKFD Reno Co. EMS Kiowa Co. EMS KCKFD MARCER Norwich EMS Region II Region I KHA Butler College Ellis Co./Region I Med-Trans Corp KAMTS & Life Team

Staff Present Joe House-Exec Dir Curt Shreckengaust-Dep Dir James Kennedy Suzette Smith Emilee Turkin James Reed Mark Willis Ed Steinlage Mark Grayson Nance Young Kim Cott Ann Stevenson Chrystine Hannon

Call to Order

Chairman Hornung called the Board Meeting to order on Friday, April 7, 2017 at 9:00 a.m. Dr. Hornung announced there are changes to the agenda for legislators with time commitments this morning. After approval of the minutes, KA.R.109-3-3 and K.A.R. 109-3-4 will be addressed. At the end of the committee meeting reports and after the office update, Director Pore will give a presentation. There will be a short executive session after the meeting. Chairman Hornung called for a motion to approve the minutes.

Director Ralston made a motion to approve the February 3, 2017 minutes. Director Kaufman seconded the motion. No discussion. No opposition noted. The motion carried.


Board of




Draft 04/07/2017

Director Pore made a motion to approve K.A.R. 109-3-3 as revised. Director Kaufman seconded the motion. The motion carried.

Roll call vote as noted:

K.A.R. 109-3-3 is approved by the Board as revised on an 11-0 vote (11Yes; 0 No; 3 Absent).

Director Pore made a motion to approve K.A.R. 109-3-4 as revised. Director Smith seconded the motion. The motion carried.

Roll call vote as noted:

K.A.R. 109-3-4 is approved by the Board as revised on an 11-0 vote (11Yes; 0 No; 3 Absent).

Dr. Hornung provided the following MAC report to the Board: • The AEMT Medication list was discussed. Dr. Hornung said it was Dr. Gallagher and Dr.

Jacobson against him most of the time. Dr. Hornung was wanting to whittle down the medication list to what would be the most beneficial and helpful. Their response was all of them are beneficial; it is whether or not we can provide all the training that is needed. Dr. Hornung said they were at a standoff. The main comment was if we are going to be using these medications, we need to figure out a better way to verify the education on the

Dr. Faimon Aye Chief Pearson Aye

Senator Faust-Goudeau Aye Director Pore Aye

Mr. Franks (Absent) Director Ralston Aye

Rep. Henderson (Absent) Comm. Saueressig

Aye

Chairman Dr. Hornung Aye Dr. Sellberg (Absent)

Comm. James Aye Director Smith Aye

Director Kaufman Aye Rep. Swanson Aye

Dr. Faimon Aye Chief Pearson Aye

Senator Faust-Goudeau Aye Director Pore Aye

Mr. Franks (Absent) Director Ralston Aye

Rep. Henderson (Absent) Comm. Saueressig

Aye

Chairman Dr. Hornung Aye Sr. Sellberg (Absent)

Comm. James Aye Director Smith Aye

Director Kaufman

Aye Rep. Swanson Aye

medications to a certain level of competency. They will continue to work on the list, and so far they have not made any huge changes in the AEMT list. Planning and Operations Committee

Chairman Hornung called upon Chief Pearson to give the Planning and Operations Committee report. Chief Pearson reported to the Board:

• KEMSIS Update: Director Pore reported there are over 100 agencies entering in the system and another 30 are submitting data of some sort. There have been some issues sent on to ImageTrend. On the state side, Director House and Director Pore have been receiving around 10 e-mails per week between the both of them regarding issues or requests. There are issues with how the system is set up as a whole that they continue to work on with ImageTrend.

• Mr. Reed reported they have conducted 49 service inspections using the License Management System. They have had some technical difficulties with their tablets, but these will be corrected. Mr. Reed also reported they had completed 39 program provider audits, and it’s going fairly well.

• Two variances were issued for lettering for loaner ambulances. • The equipment regulation K.A.R. 109-2-8 is in the 60 day comment period. Nothing

significant to report at this time. The public hearing is May 23rd at 9:00am in Room 509. • Mr. Reed reported the service and vehicle renewal process started at the end of February. So

far, 89 services have been licensed and 82 ground ambulance permits renewed. Currently there is same day processing.

• The Governor will be signing the EMS Week Declaration on April 28th at 9:30. • Traffic Issue Management Training will be starting soon. This is a statewide effort with

multiple agencies involved. • The regions reported their meetings coming up over the next couple of weeks.

Education, Examination, Training and Certification Committee

Chairman Hornung called upon Director Kaufman to give the EETC Committee Report. Director Kaufman reported to the Board:

• Mr. Willis reported that there was one potential variance involving an attendant who was unable to renew due to having been in an accident. However, the attendant did not respond when contacted and will be going through the reinstatement process to regain certification.

• Rob Boyd provided a BLS Examination Vendor Report to the committee. He reported that between January 1st and March 31st, 153 students were tested and 129 of them passed. There were 148 EMT students and 5 EMR students to test, of which 20 were retests. The committee thanked them for their dedication to this process.

• At the February Board meeting the EDTF was asked to discuss the question regarding the certification of the Training Officer as currently viewed by regulation in Kansas. The regulations have been changed since the inception of the Training Officer certification. Those changes have resulted in the sponsoring organization having regulatory responsibility for continuing education conducted within the organization. No regulatory responsibility remained with the TO for education provided. The Training Officer role had been changed to one responsible for completion of paperwork. It became evident that we needed to change regulation to restore a larger role to the Training Officer or do away with the certification.

• Dr. Charles Foat, EDTF Chair, reported an initial survey was distributed by the EDTF and

the results were discussed during their Feb 23rd meeting. More issues were identified and a 2nd survey went out via the board portal. This resulted in over 1,000 responses. Among those who responded, we did identify a group of respondents who did not understand the question at hand or the ramifications for voting to retain or eliminate the TO certification. Due to the number of respondents, it was possible to look at the responses as a whole and also categorized into groups based on certification level and roles. The same percentages of responses were obtained in the group as a whole and within the sub-categories. There were 60% in favor of eliminating the certification requirement. Likewise, in answering the question regarding the expected change in education quality, 70% of respondents said they would anticipate it would stay the same or improve.

• During the March 30th EDTF meeting, the second survey results were reviewed. The EDTF members took a vote and the majority voted to eliminate certification for this role. They did want it to be clear that they were supporting education and training but not the certification of the individual in the role of completing paperwork for the sponsoring organization.

• Our committee had discussion regarding the impact of this change and points learned as a result of conducting this process. Many valid comments were received and we want to address those issues as we move forward. We do want to thank the EDTF and staff for addressing this issue as quickly and thoroughly as they did, and all those who answered the survey and provided input.

• We need to emphasize that eliminating the Training Officer certification would not take away the ability or limit services from offering training through a current long term program provider. An I/C would not be required as the program manager in those organizations.

• Following that discussion we heard a motion to no longer regulate or offer certification for the Training Officer level and we bring that forward as a motion to the full board.

Director Kaufman made a motion to move forward to eliminate the TO certification. Director Ralston seconded the motion. After a brief discussion and no opposition noted, the motion carried.

• Mr. Willis will start the revision of the 18 initial regulations that have been identified and we will probably run into a few more. We will also have statute clean up at some point in the definitions in 65-6112 and 65-6129c.

• We received a document from Colorado showing training administration course material used in their EMS Administrator Orientation Course. The staff, EDTF, and two colleges have offered to research resources that will be made available to assist with continuing education. The professional organizations and Regions will be asked as well.

• It was also suggested that we have a Frequently Asked Questions memo assembled on the questions we have fielded.

• We had discussion on the role of the program manager because of the upcoming changes needed in K.A.R. 109-5-3. Because that role reports to the sponsoring organization that has regulatory responsibility, the role will have no specific requirements.

• There are five regulations up for revocation that have been approved by the Department of Administration and will move forward through the regulatory approval process.

• Mr. Willis informed the committee that Wisconsin has given the Kansas Board of EMS permission to provide their training programs, presentations and model protocols for Naloxone to services and providers as a resource. Included is a BLS program and first responder program. This will be posted on the website as a resource. Local protocol with

specific medical direction will have to be referenced when presenting the programs. We also need to update the education guidelines for EMR and EMT to include the addition of Naloxone in medication list and the administration routes for this medication.

• In his Education Manager’s Report, Mr. Willis reported he continues to be impressed with staff working together to meet the challenges of processing education documents and responding to the EMS community with education support. He provided the committee with a written document highlighting recent activity of Board Staff. There have been 85 initial course requests for 2017. Between February 5th and April 3rd, there were 194 candidate written examination results processed.

• We viewed the 2016 State Annual Report from the National Registry of Emergency Medical Technicians. Mr. Willis briefly shared his experience from attending the 2017 NASEMSO Conference and enlightening presentations he observed. One of the presentations particularly stood out as a result of recent discussion of our pass/fail rate on the National Registry Exam at each level. It is a National problem, not just a Kansas problem, that pass rates are not as high as we would like them to be.

• Mr. Willis attended a presentation by David Page, Director of Prehospital Care Research Forum at UCLA, titled “Recipe for 100% Pass Rates on National Registry EMT First Attempt”. To mention a few of the highlights, he stressed preparing students to take a computer adaptive exam scenario to use in the classroom as a didactic event (replacing PowerPoint, reading the PowerPoints and lecturing), use of evidence based medicine and sample protocols as presented in the NASEMSO National Model EMS clinical guidelines, and utilizing progressive levels of questions designed with increase in difficulty to promote critical thinking in the class room. More ambulance clinical time is also important and time spent shows a direct correlation to passing the exam. Thank you to Mr. Willis for sharing the information. We appreciate the time he takes to identify issues with our current system and identification of resources to make available to the educators.

• Following the Education Manager’s report, there was discussion on the AEMT courses offered in the State of Kansas as a follow up to the morning MAC meeting. Each level of certification is enhanced in Kansas over what is presented nationally as a minimum guideline. Dr. Sellberg shared the AEMT level is vitally important to our state. As we enhance the certification levels, we also have that responsibility to monitor and work to ensure the education is also adequate. Director Pore reported we are reviewing data on AEMT classes and will continue to do so as we monitor education for the Kansas certification levels.

Executive Committee

Chairman Hornung presented the Executive Committee report to the Board:

• There is nothing really new on the federal side. • Director House reported on the current Kansas Legislation. House Bill 2076-The Seat Belt

Safety Fund is sitting on the calendar on the Senate side. House Bill 2044-Medicaid Expansion was vetoed by the governor but still has possibilities to be resurrected. House Bill 2137-The County Commissioner/City Council Volunteer EMS/Fire ability to participate was sent to the governor for signature on April 5th. House Bill 2217-Access to Naloxone was sent to the governor for signature on April 4th. The EMS REPLICA Multi-State Compact is set to gain its 10th state (Georgia) and go into effect July 1st.

• The Naloxone regulatory revision has already been voted on by the Board.

• Kansas Revolving Assistance Fund- The KRAF Grant submission process had 58 requests

for $1,082,796.48. The committee approved funding of around $380,000. • Director Pore commented the committee did really good and he feels very confident with the

recommendations. Dr. Hornung brought the committee’s recommendation as a motion to approve the funding for the KRAF Grant. Director Pore seconded the motion. No discussion. No opposition noted. The motion carried.

• There was a brief discussion on the examination contract renewal for the BLS examination contract. This is an extension of the current contract.

Dr. Hornung said the committee would recommend renewal of the contract for approval as a motion. Director Ralston seconded the motion. No discussion. No opposition noted. The motion carried.

• Dr. Hornung stated we have our first distributor approval for DNR identifiers. This was provided by StickyJ Medical ID. According to staff, the company did meet the qualifications for distributor as listed in the guidelines. The staff recommended this application be approved.

Dr. Hornung stated the committee would recommend approval of this distributor as a motion. Director Ralston seconded the motion. No discussion. No opposition noted. The motion carried.

• Dr. Hornung said we have an audit policy that the staff has put together for a consistent plan for auditing each education service. The committee approved the plan and recommended using the policy.

Dr. Hornung stated the committee would recommend approval of this policy as a motion. Director Pore seconded the motion. No discussion. No opposition noted. The motion carried.

Investigations Committee

Chairman Hornung called on Director Pore to give the Investigations Committee report. Director Pore reported to the Board:

• The committee heard 11 consent cases and they agreed with Board staff recommendations. Most of those were related to applications. People who had taken an EMT class had checked that they had legal issues. Some of these were old felonies such as DUI’s. The committee agreed with Board staff recommendations. This included one applicant who was not allowed to reinstate due to current legal issues.

• The committee actually talked about and took other action on the following four cases: 1) A case which was held over from last time was a paramedic who practiced outside

their protocol without any medical control. More information was requested and the committee accepted local action and closed the case.

2) An emergency order of suspension was put in for an attendant who was arrested for some person crimes. The District Attorney’s office has dismissed any felony charges, but there are still some legal issues. The emergency order of suspension was lifted to

allow the person to continue to work until the legal case has concluded. The case will be evaluated at a later date.

3) A service that had been having issues for a while received a letter requesting they appear before the committee to show cause on why they should not have to surrender their permit. Since the last meeting, the service has surrendered their permit. The case was closed.

4) A service changed Medical Directors and they both signed the forms, but forgot to send in the forms. They were found 4 months later under a stack on his desk. The forms were sent in and he filed a self-report. The committee logged that there was a violation, but since there was no ill intent no action was taken.

• The committee discussed a case afterwards. A person had just been arrested for some other person crimes. The crimes were three years old and he was never arrested. A new District Attorney reviewed the case and decided there was enough to arrest him and file charges. A summary proceeding order was issued for a temporary suspension until the legal case is finished.

New Business

• Trooper Troy Setzkorn from the Kansas Highway Patrol Tactical Team presented a report to the Board. Dr. Allen is the director of the team. Special Troopers Julie Dorneker and Luka Henderson were also present. The mission of the special response team is to provide the Kansas Highway Patrol and municipalities, sheriff offices, rural agencies, and other entities with a highly trained, well-equipped team to assist in the completion of any critical incident quickly, safely and without collateral damage. A tactical medical position will be added to the special response team. Since current EMS systems cannot provide care in hot zones, the tactical team will provide advanced care in the hot zones of the special operation until the area has been cleared for EMS to enter or to extract them out to where EMS will be staged. Our special operations include high risk warrant service, barricaded subjects, hostage rescue, fugitive tracking, clandestine labs, civil disorder riot, marijuana eradication surveillance, VIP protection, crisis negotiation, bus and aircraft assaults, WMD response and CBRNE incidents. This is the first medic program of its kind in the state of Kansas. The Tactical Team is providing troopers advanced tactics training, and then training them up to the paramedic level. Because we operate across the entire state, we will be working with many different EMS systems each having varying levels of training capabilities. We are affiliated with KU Medical Center where our medics are working regular clinical rotations in the emergency room and in the cadaver labs to maintain high proficiency in our skills. We are currently working on protocols with Dr. Allen and are in the process of acquiring the appropriate equipment and supplies. Trooper Setzkorn thanked everyone for the opportunity to introduce their program and they welcomed any expert advice from the Board. Dr. Hornung said it sounds like a great project and we might have you come back in a year or so for an update on how the process is going.

Office Update

• Director House, Deputy Director Shreckengaust and Mr. Willis attended the NASEMSO Conference the first week of March in New Orleans. There was a lot of information presented and it was a good opportunity to meet others and hear what is going on in other places.

• Director House gave a slide show presenting the statistics that came out of KEMSIS and

License Management System (LMS). Using the dashboard in LMS we can instantly pull up data such as the number of attendants and when they expire. The majority of the information presented was from January 1, 2016 thru December 31, 2016.

• Service Directors were informed that some of the usual information requested on their service renewals was removed because it is now available in the system.

• We project there will be about 400,000 calls across the state this year. Using KEMSIS information we are receiving data on about 50% of the calls. We have some extremely high volume services not reporting. Vendor issues are the biggest problem right now on trying to get those services reporting.

• When looking at inter-facility transfers, he reported that you can look at where the patient was picked up and where the destination was to determine what type of call it was. About 2,000 calls were reported as 911, but were pickups from a hospital with a drop off of a hospital. So from that we know we have some education to do to say that is not a 911 response. Director Pore stated that the billing world is driving this reporting, because if the transfer is to occur right now, it is considered an emergency. He emphasized that education is needed so it is reported in KEMSIS as a transfer, but can still bill as an emergency.

• We started collecting data in KEMSIS in 2008 for a partial year with 19,000 runs. Currently we are bringing in about 50,000 runs per quarter. Last year we were at our high with 193,000 events. In 2016 we broke the one million record mark. Director Pore reported that getting some of the larger services on will really boost the numbers and services such as Sedgwick County intent to upload data back through 2008 when they are linked.

• A review of the run data shows 52% of calls are for females and the most frequently seen age group is 55-64. In the top ten pediatric impressions traumatic injury was 76.7% of the calls. In the top ten adult impressions traumatic injury was 60.6% of the calls. In the older adults (65 and over) traumatic injury was 62.9% of the calls. In clinical care we looked at a 12 lead being used for cardiac chest pain in patients 35 years and older and found it was documented as 33.6% of the time. While this percent is low, it does not take into account if it was written into a narrative. It does identify an opportunity for us to provide education on how to report usage to get more accurate data. Aspirin administration was reviewed under the same scenario and found it was reported in 35% of those calls.

• In 2017, Director House hopes to get 100% Kansas hospital participation, 90% of all calls submitted into KEMSIS, and 25% of the hospitals providing outcome data at least for the trauma patients through the hospital hub.

• The collected data suggests that we need to continue to work with our services on defining how to enter some of these runs.

• Director House said they will be looking at providing education to the Service Directors and IT staff to generate their own reports so they will have the ability to call out the anomalies. It is a whole lot easier for the services to draw out that data and address it locally than for a state report to be issued and they have to scramble to make corrections. Staff will provide education on how services can get this data.

• Director House asked the Board to let him know what other information they think we should be trending.

• Director Smith asked if the hospitals will have access to data on the hospital hub. Director House replied we have been working with ImageTrend to make this work.

• Dr. Hornung asked if a service can call the Board to obtain information on how they are

doing. Director House responded they just need to write a report and we can help them write it.

Director Pore discussed a project that Butler County has been working on for about 2 ½ years to improve safety including the redesign of ambulances. Part of the process has been working with Ronald Rolfsen from Oslo Norway. Director Pore said they are currently using a Sprinter as a 911 ambulance. One of the biggest issues is the crew are not always sitting down and staying belted in. Their internal policy was changed to not allowing manual CPR to be given during transport. The ambulance will have to pull over to the side of the road if manual CPR is to be administered. Director Pore said they are building two ambulances: a medium height Ford Transit and a low top Sprinter. A device next to the steering wheel with controls is a new safety feature. The cockpit area will have forward facing seats with cabinetry built around the seats. Everything the technician will need when they sit down facing forward in the ambulance will be within reach so they should not have a reason to unlock their seat belt and stand up. They are going to try the low top ambulance because the high top makes it easier for attendants to stand up. The low top will force them to sit and that’s where you want them. All of the controls will be in the cockpit area. The monitor will be on the opposite side within reach. The attendant will not have a reason to get up so they will have to stay engaged with the patient. They will have a full cabinet in the back to store equipment. A simulation made up of foam board had been made to determine the correct space requirements. Adjustments will be made if necessary. This will be the first low top Sprinter ambulance built in the United States. The cost of the low top Sprinter ambulance with powerload system is $135,000 to $140,000. The cost of the Transit with the powerload and medium height roof is $130,000. The Sprinter is 62 inches from floor to ceiling and the Transit is 68 inches from floor to ceiling.

Dr. Horning stated: “I move that we recess into executive session for a period of 15 minutes to discuss non-elected personnel in order to protect the privacy of those involved and that Sarah Fertig join the session. The open session will resume in the same place at 10:45.” Motion was seconded and carried. The Board recessed. The Board reconvened. Director Pore moved for the chairman to begin the evaluation and compensation review process with the Executive Director. Director Smith seconded the motion. No discussion. The motion carried. Dr. Hornung adjourned the meeting at 10:50 am.

109-2-8. Standards for ground ambulances and equipment. (a) Each ground

ambulance shall meet the vehicle and equipment standards that are applicable to that

type of ambulance.

(b) Each ground ambulance shall have the ambulance license prominently

displayed in the patient compartment.

(c) The patient compartment size shall meet or exceed the following

specifications:

(1) Headroom: 60 inches; and

(2) length: 116 inches.

(d) Each ambulance shall have a heating and cooling system that is controlled

separately for the patient and the driver compartments. The air conditioners for each

compartment shall have separate evaporators.

(e) Each ambulance shall have separate ventilation systems for the driver and

patient compartments. These systems shall be separately controlled within each

compartment. Fresh air intakes shall be located in the most practical, contaminant-free

air space on the ambulance. The patient compartment shall be ventilated through the

heating and cooling systems.

(f) The patient compartment in each ambulance shall have adequate lighting so

that patient care can be given and the patient’s status monitored without the need for

portable or hand-held lighting. A reduced lighting level shall also be provided. A patient

compartment light and step-well light shall be automatically activated by opening the

entrance doors. Interior light fixtures shall be recessed and shall not protrude more than

1 1/2 inches.

K.A.R. 109-2-8 Page 2

(g) Each ambulance shall have an electrical system to meet maximum demand

of the electrical specifications of the vehicle. All conversion equipment shall have

individual fusing that is separate from the chassis fuse system.

(h) Each ground ambulance shall have lights and sirens as required by K.S.A. 8-

1720 and K.S.A. 8-1738, and amendments thereto.

(i) Each ground ambulance shall have an exterior patient loading light over the

rear door, which shall be activated both manually by an inside switch and automatically

when the door is opened.

(j) The operator shall mark each ground ambulance licensed by the board as

follows:

(1) The name of the ambulance service shall be in block letters, not less than

four inches in height, and in a color that contrasts with the background color. The

service name shall be located on both sides of the ambulance and shall be placed in

such a manner that it is readily identifiable to other motor vehicle operators.

(2) Any operator may use a decal or logo that identifies the ambulance service in

place of lettering. The decal or logo shall be at least 10 inches in height and shall be in

a color that contrasts with the background color. The decal or logo shall be located on

both sides of the ambulance and shall be placed in such a manner that the decal or logo

is readily identifiable to other motor vehicle operators.

K.A.R. 109-2-8 Page 3

(3) Each ground ambulance initially licensed by the board before January 1,

1995 that is identified either by letters or a logo on both sides of the ground ambulance

shall be exempt from the minimum size requirements in paragraphs (1) and (2) of this

subsection.

(k) Each ground ambulance shall have a communications system that is readily

accessible to both the attendant and the driver and is in compliance with K.A.R. 109-2-

5(a).

(l) An operator shall equip each ground ambulance as follows:

(1) At least two annually inspected ABC fire extinguishers or comparable fire

extinguishers with at least five pounds of dry chemical, which shall be secured. One fire

extinguisher shall be easily accessible by the driver, and the other shall be easily

accessible by the attendant;

(2) either two portable, functional flashlights or one flashlight and one spotlight;

(3) one four-wheeled or six-wheeled, all-purpose, multilevel cot with an elevating

head and at least two safety straps with locking mechanisms;

(4) one urinal;

(5) one bedpan;

(6) one emesis basin or convenience bag;

(7) one complete change of linen;

(8) two blankets;

K.A.R. 109-2-8 Page 4

(9) one waterproof cot cover;

(10) one pillow; and

(11) a no-smoking sign posted in the patient compartment and the driver

compartment; and

(12) mass-casualty triage tags.

(m) The operator shall equip each ground ambulance with the following internal

medical systems:

(1) An oxygen system with at least two outlets located within the patient

compartment and at least 2,000 liters of storage capacity, with a minimum oxygen level

of 200 psi. The cylinder shall be in a compartment that is vented to the outside. The

pressure gauge and regulator control valve shall be readily accessible to the attendant

from inside the patient compartment; and

(2) a functioning, on-board, electrically powered suction aspirator system with a

vacuum of at least 300 millimeters of mercury at the catheter tip. The unit shall be easily

accessible with large-bore, nonkinking suction tubing and a large-bore,

semirigid, nonmetalic nonmetallic oropharyngeal suction tip.

(n) The operator shall equip each ground ambulance with the following medical

equipment:

K.A.R. 109-2-8 Page 5

(1) A portable oxygen unit of at least 300-liter storage capacity, complete with

pressure gauge and flowmeter and with a minimum oxygen level of 200 psi. The unit

shall be readily accessible from inside the patient compartment;

(2) a functioning, portable, self-contained battery or manual suction aspirator with

a vacuum of at least 300 millimeters of mercury at the catheter tip and a transparent or

translucent collection bottle or bag. The unit shall be fitted with large-bore, nonkinking

suction tubing and a large-bore, semirigid, nonmetallic oropharyngeal suction tip, unless

the unit is self-contained; and

(3) a hand-operated, adult bag-mask ventilation unit, which shall be capable of

use with the oxygen supply;

(4) a hand-operated, pediatric bag-mask ventilation unit, which shall be capable

of use with oxygen supply;

(5) oxygen masks in adult and pediatric sizes;

(6) nasal cannulas in adult and pediatric sizes;

(7) oropharyngeal airways in adult, pediatric, and infant sizes;

(8) a blood pressure manometer with extra-large, adult, and pediatric cuffs and a

stethoscope;

(9) an obstetric kit with contents as described in the ambulance service’s medical

protocol;

K.A.R. 109-2-8 Page 6

(10) sterile burn sheets;

(11) sterile large trauma dressings;

(12) assorted sterile gauze pads;

(13) occlusive gauze pads;

(14) rolled, self-adhering bandages;

(15) adhesive tape at least one inch wide;

(16) bandage shears;

(17) one liter of sterile water, currently dated or one liter of sterile saline, currently

dated; and

(18) currently dated supplies, medications, and equipment as authorized by the

scope of practice and protocols, in accordance with the applicable list of supplies,

medications, and equipment approved by the medical director.

(o) The operator shall equip each ground ambulance with the following patient-

handling and splinting equipment:

(1) If required by protocol, a long spinal-immobilization device, complete with

accessories to immobilize a patient;

(2) a set of extremity splints including one arm and one leg splint, in adult and

pediatric sizes;

(3) a set of rigid cervical collars in assorted adult and pediatric sizes;

(4) if required by protocol, foam wedges or other devices that serve to stabilize

the head, neck, and back as one unit; and

K.A.R. 109-2-8 Page 7

(5) patient disaster tags.

(p) The operator shall equip each ground ambulance with the following blood-

borne and body fluid pathogen protection equipment in a quantity sufficient for crew

members:

(1) Surgical or medical protective gloves;

(2) protective goggles, glasses or chin-length clear face shields;

(3) filtering masks that cover the mouth and nose;

(4) nonpermeable, full-length, long-sleeve protective gowns;

(5) a leakproof, rigid container clearly marked as ‘‘Biohazard’’ for the disposal of

sharp objects; and

(6) a leakproof, closeable container for soiled linen and supplies.

(q) (p) If an operator’s medical protocols or equipment list is amended, a copy of

these changes shall be submitted to the board by the ambulance service operator within

15 days of implementation of the change. Equipment and supplies obtained on a trial

basis or for temporary use by the operator shall not be required to be reported to the

board by an operator. (Authorized by K.S.A. 2015 2016 Supp. 65-6110; implementing

K.S.A. 2015 2016 Supp. 65-6110 and K.S.A. 65-6128; effective May 1, 1985;

amended, T-88-24, July 15, 1987; amended May 1, 1988; amended July 17, 1989;

amended Aug. 16, 1993; amended Jan. 31, 1997; amended Jan. 27, 2012; amended

Feb. 13, 2015; amended April 29, 2016; amended P-___________.)

MEMORANDUM TO: Education, Examination, and Training Committee Dir. Kaufman, Chair Dir. Ralston, Vice-Chair Dir. Pore Dr. Sellberg Comm. James Dir. Smith Rep. Swanson FROM: Mark Willis, Education Manager RE: Interim guidelines for acceptance into Instructor-Coordinator Courses DATE: May 16, 2017 As discussed at the April meetings, we will need to provide interim guidance for prospective instructor-coordinator (IC) candidates given the fact the Training Officer (TO) certification has been proposed for elimination by the end of this year. As identified in 109-9-4 (a)4C, the I/C candidate must either possess a current Kansas BOE teaching certificate, or be currently certified as a training officer. Given the fact the certification is proposed for elimination, there will likely not be additional Training Officer courses conducted, as it seems counter-productive to require these courses only for the sake of meeting pre-requisites for admission into future I/C courses. Although I can’t provide a specific ratio, a good number of Training Officer course attendees enroll in the course specifically for meeting I/C admission criteria; I utilize the term “counter-productive” as the same course materials covered in the TO course are repeated in the Instructor/Coordinator training curriculum. The primary motivation for the proposed elimination of the Training Officer certification has been to allow local control in the selection and utilization of those delivering and managing EMS educational offerings and programs. The challenge now lies in ensuring future Instructor/Coordinators are qualified and motivated with coordinating and instructing initial courses of EMS instruction. Our current model appears rigorous; however, our collective results do not bear out we are effective in these selection and training processes, based on our below average results in comparison with other states’ National Registry certification examination results. I am respectfully requesting the EETC give this matter consideration and be prepared to provide guidance to BEMS staff regarding an approved process to enable qualified candidates, who are not certified as Training Officers, be accepted into Instructor-Coordinator programs. For your consideration, I have enclosed all relevant regulations pertaining to IC standards, selection, and certification. I have also attached an excerpt from the Educator Proposal submitted by the EDTF to the Board in 2011.


Board of




You will note the EDTF made recommendation that Educators “have substantive patient contacts in a field or clinical setting”, which they further define as “100+”, they have a minimum of 2 years’ experience (as opposed to one in current regulation), submit 3 professional reference letters, demonstrate competency in a skills assessment, then sit before an interview panel of which the composition and questions presented are “outlined” and “set” by the Board of EMS. Commentary/Staff Recommendation BEMS Staff recommendation is the EETC consider elimination of the requirements specified in 109-9-4 (a) & (b), and modify sections (c) & (d) to require the I/C candidate successfully pass the National Registry EMT cognitive assessment, and successfully pass all components of the Kansas EMT practical skills examination. It is our belief this method would most effectively affirm competency of the prospective instructor of initial courses of education. This recommendation is aligned with the current requirements of the regulation. The current cognitive and skills examinations are more informal, and do not utilize the validation methods and metrics as compared to the National Registry examination. Though this may be perceived as a more rigorous entry process, the recommended evaluation processes are aligned with establishing minimum competency of certified attendants in Kansas, thus it seems fair and reasonable we would have the same expectation of those providing initial courses of instruction. Desired Outcome of June EETC Meeting The EETC should give consideration to the issue, reach consensus on IC course acceptance requirements not presently defined in KAR 109-9-4, and determine whether BEMS Staff is authorized to approve IC course applicants who do not meet current regulatory requirements until KAR 109-9-4 is revised. Provided there is Board approval of these directives and standards, a timeline will need to be established to consider further regulatory revisions to uphold their desired standard. Respectfully submitted, Mark C. Willis, Education Manager Kansas Board of EMS Enc: KAR 109-9-1 KAR 109-9-4 (pending revision) KAR 109-10-1e EDTF Educator Proposal p. 15 (submitted June 2011)

109-9-4. Requirements for acceptance into an instructor-coordinator initial

course of instruction.

(a) Each applicant for initial training as an I-C shall apply to the executive

director using forms approved by the board. Only a complete application shall be

accepted. A complete application shall include the following documentation:

(1) Proof that the applicant is currently certified or licensed and the

applicant has been certified or licensed for at least two years as any of the

following:

(A) An attendant;

(B) a physician; or

(C) a professional nurse;

(2) proof that the applicant has at least one year of field experience with

an ambulance service;

(3) a letter from a certified I-C verifying the I-C's commitment to evaluate

the applicant on the competencies of the assistant teaching experience defined

in K.A.R. 109-9-1; and

(4) proof that the applicant has met the following requirements:

(A) Has current approval as a cardiopulmonary resuscitation instructor at

the professional rescuer level. This approval shall be by the American heart

association, the American red cross, or the national safety council;

(B) has instructed at least 15 hours of material; and

(C) possesses a current teaching certificate granted by the Kansas state

board of education or is currently certified as a training officer II

(b) If an applicant does not meet the requirement of paragraph (a)(4)(C),

the applicant may satisfy the requirement by establishing that the applicant

possesses both of the following:

(1) Authorization by any state or territory of the United States to be a

primary instructor of EMS initial course of instruction at or above the level of

EMT; and

(2) (A) A baccalaureate, master's, or doctorate in education conferred

by an accredited postsecondary education institution;

(B) certification as a fire service instructor by the national board on fire

service professional qualifications or the international fire service accreditation

from the national fire academy; or

(C) certification by any United States military organization verifying

successful completion of any United States military instructor trainer course that

is substantially equivalent to the United States department of transportation

national highway traffic safety administration “emergency medical services

instructor training program: national standard curriculum,'' as identified in K.A.R.

109-10-1.

(c) Each applicant who meets the requirements in subsection (a) and, if

applicable, subsection (b) shall successfully complete an evaluation of

knowledge and skills as follows:

(1) A written medical knowledge examination at the EMT level The board-

approved EMT cognitive assessment; and

(2) a practical board-approved

psychomotor skills examination assessment at the EMT level.

(d) (b) An applicant meeting the requirements in subsection (a) and, if

applicable, subsection (b) may be approved by the executive director for

training accepted into an instructor-coordinator initial course of instruction based

upon the following criteria:

(1) A score of at least 80% on the written medical knowledge examination

described in paragraph (c)(1) passing score in each area of the board-approved

EMT cognitive assessment; and

(2) a passing score for each practical skill board-approved psychomotor

skills assessment station described in paragraph (c)(a)(2). (Authorized by K.S.A.

65-6110, K.S.A. 2010 Supp. 65-6111 ; implementing K.S.A. 65-6110, K.S.A.

2010 Supp. 65-6111, and K.S.A. 65-6129b; effective, T-109-1-19-89, Jan. 19,

1989; effective July 17, 1989; amended Feb. 3, 1992; amended Jan. 31, 1994;

amended Nov. 12, 1999; amended Nov. 9, 2001; amended Sept. 2, 2011;

amended P-______________.)

109-9-4. Requirements for acceptance into an instructor-coordinator initial

course of instruction.

(a) Each applicant shall successfully complete an evaluation of knowledge

and skills as follows:

(1) The board-approved EMT cognitive assessment; and

(2) a board-approved psychomotor skills assessment at the EMT level.

(b) An applicant may be accepted into an instructor-coordinator initial

course of instruction based upon the following criteria:

(1) A passing score in each area of the board-approved EMT cognitive

assessment; and

(2) a passing score for each board-approved psychomotor skills

assessment station described in paragraph (a)(2). (Authorized by K.S.A. 65-

6110, K.S.A. 2010 Supp. 65-6111 ; implementing K.S.A. 65-6110, K.S.A. 2010

Supp. 65-6111, and K.S.A. 65-6129b; effective, T-109-1-19-89, Jan. 19, 1989;

effective July 17, 1989; amended Feb. 3, 1992; amended Jan. 31, 1994;

amended Nov. 12, 1999; amended Nov. 9, 2001; amended Sept. 2, 2011;

amended P-______________.)

Executive Summary – Fine Schedule

Passage of Senate Bill 224 of the 2016 Kansas Legislative Session granted the Board the authority to issue civil fines and penalties as an additional tool within the disciplinary action “toolbox”. With the additional tools, it is imperative that the Board remain consistent in its approach to disciplinary action and a step towards maintaining that consistency is through the creation of a fine schedule. This schedule provides a framework for a consistent manner for which the fine amount for violations is determined.

There are 3 proposed fine schedules – Attendant, Operator, and Instructor-Coordinator. This is consistent with the 3 categories within our graduated sanctions. Each schedule contains a fine amount for each sanction level within our graduated sanctions (Levels 1 through 6) and then list out an amount for a 1st violation, a 2nd violation, and a 3rd violation. There is also a penalty amount listed for when aggravating factors are present. Each fine schedule reaches the maximum allowable amount at a Level 6 infraction.

The intent for this schedule is not to fine the Respondent in the case for each violation, but rather to consider the case in its entirety and base any fine on the single most significant violation.

The Board’s Investigation Committee is reviewing this schedule and has this item upon their June agenda for consideration and possible recommendation.

For your quicker reference, the following are defined within K.A.R. 109-16-1 (Graduated Sanctions).

• Sanction level 1 – the local action taken is approved and accepted by the board’s investigation committee.

• Sanction level 2 – modification of a certificate or permit by the imposition of conditions. • Sanction level 3 – limitation of a certificate or permit. • Sanction level 4 – suspension of a certificate or permit for less than 3 months. • Sanction level 5 – suspension of a certificate or permit for 3 months or more. • Sanction level 6 – revocation of a certificate or permit.

Also attached to this are K.A.R. 109-16-1 (in its entirety) and each of the 3 documents adopted by reference that list out the table of graduated sanctions.

Level First Violation Second Violation Third ViolationLevel Violation # Minimum Maximum Aggravating Total 1 $25.00 $100.00 $200.00

2 $50.00 $125.00 $225.001-3 1 $25.00 $75.00 $50.00 $25.00 - $75.00 3 $75.00 $150.00 $250.001-4 1 $25.00 $150.00 $50.00 $25.00 - $150.00 4 $150.00 $225.00 $325.001-6 1 $25.00 $500.00 $50.00 $25.00 - $500.00 5 $300.00 $375.00 $475.004-6 1 $150.00 $500.00 $50.00 $150.00 - $500.00 6 $500.00 $500.00 $500.005-6 1 $300.00 $500.00 $50.00 $300.00 - $500.00

1-6 2 $100.00 $500.00 $75.00 $100.00 - $500.003-4 2 $150.00 $225.00 $75.00 $150.00 - $225.004-5 2 $225.00 $375.00 $75.00 $225.00 - $375.004-6 2 $225.00 $500.00 $75.00 $225.00 - $500.005-6 2 $375.00 $500.00 $75.00 $375.00 - $500.00

1-6 3 $200.00 $500.00 $100.00 $200.00 - $500.003-5 3 $250.00 $475.00 $100.00 $250.00 - $475.004-5 3 $325.00 $475.00 $100.00 $325.00 - $475.005-6 3 $475.00 $500.00 $100.00 $475.00 - $500.00

Second violation fine will increase $75.00 at each level up to maximum fine.

Attendant Fine Schedule

Levels 2 and 3 the fines increases $25.00 at each level. Level four, and with a possible suspension up to 90 days, the fine doubles up to the maximum allowed. Levels five and six, with a possible suspension of not less than 90 days, the fine doubles at each level up to the maximim allowed. Maximum fine per violation is $500.00.

Third violation fine will increase $100.00 at each level up to maximum fine.

The Aggravating Factor Fine is suggested when circumstances are appropriate.


2 $350.00 $550.00 $1,050.001-3 1 $250.00 $450.00 $100.00 $250.00 - $450.00 3 $450.00 $650.00 $1,150.001-4 1 $250.00 $1,000.00 $100.00 $250.00 - $1,000.00 4 $1,000.00 $1,200.00 $1,700.001-6 1 $250.00 $2,500.00 $100.00 $250.00 - $2,500.00 5 $2,000.00 $2,200.00 $2,500.002-6 1 $350.00 $2,500.00 $100.00 $350.00 - $2,500.00 6 $2,500.00 $2,500.00 $2,500.003-6 1 $450.00 $2,500.00 $100.00 $450.00 - $2,500.004-6 1 $1,000.00 $2,500.00 $100.00 $1,000.00 - $2,500.00

1-6 2 $450.00 $2,500.00 $250.00 $450.00 - $2,500.002-4 2 $550.00 $1,200.00 $250.00 $550.00 - $1,200.003-4 2 $650.00 $1,200.00 $250.00 $650.00 - $1,200.003-5 2 $650.00 $2,200.00 $250.00 $650.00 - $2,200.003-6 2 $650.00 $2,500.00 $250.00 $650.00 - $2,500.004-5 2 $1,200.00 $2,200.00 $250.00 $1,200.00 - $2,200.004-6 2 $1,200.00 $2,500.00 $250.00 $1,200.00 - $2,500.005-6 2 $2,200.00 $2,500.00 $250.00 $2,200.00 - $2,500.00

1-6 3 $950.00 $2,500.00 $500.00 $950.00 - $2,500.003-5 3 $1,150.00 $2,500.00 $500.00 $1,150.00 - $2,500.004-5 3 $1,700.00 $2,500.00 $500.00 $1,700.00 - $2,500.004-6 3 $1,700.00 $2,500.00 $500.00 $1,700.00 - $2,500.005-6 3 $2,500.00 $2,500.00 $500.00 $2,500.00 - $2,500.00

Operator Fine Schedule

Levels 2 and 3 the fines increases $100.00 at each level. Level four, and with a possible suspension up to 90 days, the fine doubles + $100.00. Levels five and six, with a possible suspension of not less than 90 days, the fine doubles at each level up to the maximim allowed. Maximum fine per violation is $2,500.00.





2 $75.00 $150.00 $250.001-3 1 $50.00 $100.00 $75.00 $50.00 - $100.00 3 $100.00 $175.00 $275.001-4 1 $50.00 $200.00 $75.00 $50.00 - $200.00 4 $200.00 $275.00 $375.001-5 1 $50.00 $400.00 $75.00 $50.00 - $400.00 5 $400.00 $475.00 $500.001-6 1 $50.00 $500.00 $75.00 $50.00 - $500.00 6 $500.00 $500.00 $500.002-6 1 $75.00 $500.00 $75.00 $75.00 - $500.004-6 1 $200.00 $500.00 $75.00 $200.00 - $500.00

1-6 2 $125.00 $500.00 $100.00 $125.00 - $500.002-6 2 $150.00 $500.00 $100.00 $150.00 - $500.003-4 2 $175.00 $275.00 $100.00 $175.00 - $275.004-5 2 $275.00 $475.00 $100.00 $275.00 - $475.004-6 2 $275.00 $500.00 $100.00 $275.00 - $500.005-6 2 $475.00 $500.00 $100.00 $475.00 - $500.00

1-6 3 $225.00 $500.00 $150.00 $225.00 - $500.003-5 3 $275.00 $500.00 $150.00 $275.00 - $500.003-6 3 $275.00 $500.00 $150.00 $275.00 - $500.004-5 3 $375.00 $500.00 $150.00 $375.00 - $500.005-6 3 $500.00 $500.00 $150.00 $500.00 - $500.00

IC / TO Fine Schedule

Levels 2 and 3 the fines increases $25.00 at each level. Level four, and with a possible suspension up to 90 days, the fine doubles up to the maximum allowed. Levels five and six, with a possible suspension of not less than 90 days, the fine doubles at each level up to the maximim allowed. Maximum fine per violation is $500.00.




109-16-1. Graduated sanctions.

(a) The following documents of the Kansas board of emergency medical

services, dated April 10, 2013, are hereby adopted by reference:

(1) "Graduated sanctions for attendants";

(2) "graduated sanctions for I-Cs and T.O.s"; and

(3) "graduated sanctions for operators."

(b) For purposes of applying the tables of graduated sanctions for attendants,

instructor-coordinators, training officers, and operators, the following sanction levels

shall apply:

(1) "Sanction level 1" means that the local action taken by the operator of the

ambulance service, or its designee, is approved and accepted by the board’s

investigations committee.

(2) "Sanction level 2" means the modification of a certificate or permit by the

imposition of conditions.

(3) "Sanction level 3" means the limitation of a certificate or permit.

(4) "Sanction level 4" means the suspension of a certificate or permit for less than

three months.

(5) "Sanction level 5" means the suspension of a certificate or permit for three

months or more.

(6) "Sanction level 6" means the revocation of a certificate or permit.

(c) When the investigations committee is determining the appropriate sanction

level, the following mitigating and aggravating circumstances, if applicable, shall be

taken into consideration:

K.A.R. 109-16-1 p. 2

(1) The number of violations involved in the current situation;

(2) the degree of harm inflicted or the potential harm that could have been

inflicted;

(3) any previous violations or the absence of previous violations;

(4) the degree of cooperation with the board's investigation;

(5) evidence that the violation was a minor or technical violation, or a serious or

substantive violation;

(6) evidence that the conduct was intentional, knowing, or purposeful or was

inadvertent or accidental;

(7) evidence that the conduct was the result of a dishonest, selfish, or criminal

motive;

(8) evidence that the attendant, instructor-coordinator, training officer, or operator

refused to acknowledge or was willing to acknowledge the wrongful nature of that

person’s conduct;

(9) the length of experience as an attendant, instructor-coordinator, training

officer, or operator; and

(10) evidence that any personal or emotional problems contributed to the

conduct. (Authorized by K.S.A. 2012 Supp. 65-6110, 65-6111, and 65-6129, as

amended by L. 2013, ch. 95, sec. 4; implementing K.S.A. 2012 Supp. 65-6129, as

amended by L. 2013, ch. 95, sec. 4; effective Jan. 17, 2014.)

1

Graduated Sanctions for Attendants Kansas Board of EMS April 10, 2013 Violation: attendant K.S.A. 65-6133

Number and/or severity of violation Sanction level range

(a)(1) intentional misrepresentation in obtaining or renewing certificate

1st violation 2nd violation 3rd + violation

1 to 6 or deny 1 to 6 or deny 1 to 6 or deny

(a)(2) performed activities not authorized at level of certification held (a)(2) attempted to perform activities not authorized at level of certification held (a)(3) incompetence: demonstrated lack of ability, knowledge, or fitness to perform patient care per applicable medical protocols or as defined by the authorized activities of the attendant's level of certification as defined in K.A.R. 109-1-1. (a)(3) inadequate patient care (a)(4) violated provision of act (a)(4) violated regulation (a)(4) aided and abetted in violation of provision of act (a)(4) aided and abetted in violation of regulation

1st violation: no likelihood of harm to patient 1st violation: potential harm to patient 1st violation: actual harm to patient 2nd violation: no likelihood of harm to patient 2nd violation: potential harm to patient 2nd violation: actual harm to patient 3rd + violation: no likelihood harm to patient 3rd + violation: potential harm to patient 3rd + violation: actual harm to patient

1 to 3 1 to 4 1 to 6 3 or 4 4 or 5 5 or 6 3 to 5 4 or 5 5 or 6

2

(a)(5) convicted of felony and not sufficiently rehabilitated to warrant public trust

Dependent on severity level and type of felony (person vs. non-person) and whether no likelihood, potential or actual harm to patient.

1 to 6

(a)(6) inability to perform authorized services with reasonable skill/safety due to: illness, alcoholism, excessive use of

drugs, controlled substances, or

any physical

condition, or any mental condition

1st violation 1st violation 1st violation 2nd violation 2nd violation 2nd violation 3rd + violation 3rd + violation 3rd + violation

1 to 6 1 to 6 1 to 6 1 to 6 1 to 6 1 to 6 1 to 6 1 to 6 1 to 6

(a)(7) unprofessional conduct per 109-1-1: failing to take appropriate action to safeguard patient performing acts beyond authorized activities falsifying patient's records falsifying ambulance service's records



verbally abusing patient 1st violation 2nd violation 3rd + violation

1 to 6 1 to 6 1 to 6

sexually abusing patient physically abusing patient


5 or 6 6 6

3

violating statute or regulation concerning confidentiality of medical records or patient information


4 to 6 5 or 6 6

diverting drugs belonging to patient diverting drugs belonging to agency [i.e., ambulance service]


5 or 6 6 6

diverting property belonging to patient diverting property belonging to agency [i.e., ambulance service]


4 to 6 5 or 6 6

making false or misleading statement on renewal application or any agency [EMS Board] record


1 to 6 or deny

fraudulent act related to qualification, functions or duties of an attendant dishonest act related to qualification, functions or duties of an attendant



failing to cooperate with board investigation, including failing to furnish legally requested documents or information within 30 days


4 to 6 4 to 6 5 or 6

1

Graduated Sanctions for I-Cs and T.O.s Kansas Board of EMS April 10, 2013 Violation: I-Cs and T.O.s K.S.A. 65-6133

Number and/or severity of violation Sanction level range

(a)(1) intentional misrepresentation in obtaining or renewing a certificate



(a)(2) performed activities not authorized at level of certification held (a)(2) attempted to perform activities not authorized at level of certification held (a)(3) incompetence: demonstrated lack of ability, knowledge, or fitness to perform student care per to applicable medical protocols or as defined by the authorized activities of the attendant's level of certification as defined in K.A.R. 109-1-1. (a)(3) inadequate student care (a)(4) violated any provision of this act (a)(4) violated any regulation (a)(4) aided and abetted in the violation of any provision of this act (a)(4) aided and abetted in the violation of any regulation

1st violation: no likelihood of harm to student 1st violation: potential harm to student 1st violation: actual harm to student 2nd violation: no likelihood of harm to student 2nd violation: potential harm to student 2nd violation: actual harm to student 3rd + violation: no likelihood of harm to student 3rd + violation: potential harm to student 3rd + violation: actual harm to student


2

(a)(5) convicted of a felony and not sufficiently rehabilitated to warrant the public trust

Dependent on severity level and type of felony (person vs. non-person) and whether no likelihood, potential or actual harm to student.

1 to 6 or deny

(a)(6) inability to perform authorized services with reasonable skill and safety due to: illness, alcoholism, excessive use of

drugs, controlled substances, or

any physical

condition, or any mental condition



(a)(7) unprofessional conduct per 109-1-1:

engaging in behavior that demeans a student, including ridiculing or engaging in inhumane or discriminatory treatment verbally abusing a student physically abusing a student



3

failing to take appropriate action to safeguard a student falsifying any document relating to a student falsifying any document relating to an EMS agency violating a statute or regulation concerning the confidentiality of student records obtaining or seeking to obtain any benefit, including a sexual favor, from a student through duress, coercion, fraud, or misrepresentation, or creating an environment that subjects a student to unwelcome sexual advances, including physical touching or verbal expressions



an inability to instruct due to: alcoholism excessive use of

drugs or controlled substances

any physical condition any mental condition


1 to 6 1 to 6 1 to 6

reproducing or duplicating a state certification exam without authority


6

4

engaging in any fraudulent act related to qualifications, functions or duties of an I-C or T.O. engaging in any dishonest act related to qualifications, functions or duties of an I-C or T.O. willfully failing to adhere to the course syllabus



failing to cooperate with a board investigation, including failing to furnish legally requested documents or information within 30 days


4 to 6 4 to 6 5 or 6

1

Graduated Sanctions for Operators Kansas Board of EMS April 10, 2013 Violation pursuant to K.S.A. 65-6132

Number and severity of violation Sanction level range

(a)(1) misrepresentation in obtaining permit



(a)(1) misrepresentation in operation of ambulance service

1st violation: no likelihood of harm to patient 1st violation: potential harm to patient 1st violation: harm to patient 2nd violation: no likelihood of harm to patient 2nd violation: potential harm to patient 2nd violation: harm to patient 3rd + violation: no likelihood of harm to patient 3rd + violation: potential harm to patient 3rd + violation: harm to patient

1 to 3 1 to 4 1 to 6 2 to 4 3 to 5 5 or 6 3 to 5 4 or 5 5 or 6

(a)(2) engaged in an ambulance service not authorized in permit (a)(2) attempted to engage in ambulance service not authorized in permit (a)(2) represented as entitled to perform ambulance service not authorized in permit


1 to 3 1 to 4 1 to 6 2 to 4 3 to 5 5 or 6 3 to 5 4 or 5 5 or 6

(a)(3) incompetence: inability to provide level of services required for class of permit held as defined in K.A.R. 109-1-1.



2

(a)(3) unable to provide adequate ambulance service

1st violation: no likelihood of harm to patient 1st violation: potential harm to patient 1st violation: harm to patient 2nd violation: no likelihood of harm to patient 2nd violation: potential harm to patient 2nd violation: harm to patient 3rd + violation: no likelihood harm to patient 3rd + violation: potential harm to patient 3rd + violation: harm to patient


(a)(4) failed to keep and maintain required records


1 to 6 3 to 5 4 to 6

(a)(4)failed to make required reports


1 to 6 3 to 5 4 to 6

(a)(5) knowingly operated faulty equipment


1 to 6 3 to 6 4 to 6 3 to 6 4 to 6 6 4 to 6 5 or 6 6

(a)(5) knowingly operated unsafe equipment


1 to 6 2 to 6 3 to 6 3 to 6 4 to 6 6 4 to 6 5 to 6 6

3

(a)(6) violated any provision of act



(a)(6) violated any regulation of this act



(a)(6) aided and abetted in violation of any provision of act



NOTES: Please remember to turn off all cell phones or place them on silent mode during this meeting. If it is necessary to accept the call, please step outside of the meeting room to continue your phone call. Additionally, the use of tobacco is not permitted inside this building.

Legislative Meeting TENTATIVE AGENDA

May 9, 2017 Kansas Highway Patrol Training Academy

Salina, Kansas 9:00 AM – 4:00 PM

1. Welcome and Introductions

2. 2017 Legislative Update 1. HB 2076 – Seat belt safety fund 2. HB 2217 – Access to naloxone 3. HB 2137 – County Commissioner/City Council Volunteer ability 4. SB 186 – GEMT reimbursement 5. SB 76 – Restrictions on fees and licensing requirements 6. REPLICA – Interstate Compact for EMS Personnel Licensure 7. Recent Regulatory Changes

3. Idea Gathering –

1. The purpose of this section is to have an open discussion on ideas for improving patient outcomes, improving or maintaining EMS, and improving prehospital medicine.

4. Prioritizing and Grouping

5. Other Topics for Discussion (as time permits) 1. Fine Schedule 2. Protocol Approval Method 3. Non-transporting agencies 4. Basic Life Support Examination (EMR and EMT) 5. Requirements for entry into an instructor-coordinator initial course 6. Defining/Redefining unprofessional conduct

6. Adjournment

Lunch is on your own and will be for approx. 1 hour at a natural stoppage in the meeting. Beverages (coffee, tea, water, juice, and soda) are provided and are available in the cafeteria.


Board of




FINAL 05/17/2017

Kansas Board of EMS Legislative Meeting 9:00 am – 4:00 pm

Tuesday, May 9, 2017 Kansas Highway Patrol Training Academy

MEETING NOTES

Attendance: Terry Morrand – Fort Riley Fire Marty Coufal – Fort Riley Fire Joel Hrabe – Phillips County EMS Pete Rogers – Phillips County EMS Kerry McCue – Region 1 and Ellis County EMS Cindy Casey – Franklin County EMS Scott Harris – Anderson County EMS Dave Johnston – Sedgwick Co. EMS and Region 3 Darrel Kohls – Wichita Fire Lloyd Youel – Airport Police and Fire Don Paget – Sedgwick County Fire Janice Bernel – Windom Fire Department Todd Baldwin – Windom Fire Department Brittney Glenn – Ellinwood EMS Chris Steiner – Claflin EMS Jeri Smith – Arkansas City Fire and KBEMS Sean Hankin – Kansas Association of Fire Chiefs John Helmer – McPherson EMS Cindy Welch – CHS / McPherson Refinery Jason Green – Overland Park Fire Department Jessica Singhisen – Gray County EMS

Carman Allen – KDHE John Claxton – Bonner Springs EMS Kristyn Harding – Bonner Springs EMS Ashlye Baxter – McPherson EMS Patrick Talkingten – Lawrence-Douglas Co. Fire Med Brandon Beck – KEMSA and Region 5 Darla Talley – Rawlins County EMS Wendy Gronau – Kansas Trauma Program Jason White – Mid-America Regional Council Kent Vosburg – Junction City Fire Department Charles Foat – Johnson County Community College John Gallagher – Wichita/Sedgwick County EMSS Scott Cooper – Clearwater Emergency Services Craig Isom – Med-Trans Corp dba EagleMed Rosa Spainhour – Kiowa County EMS Shane Pearson – Salina Fire Department and KBEMS Mark Willis – Kansas Board of EMS Curt Shreckengaust – Kansas Board of EMS James Reed – Kansas Board of EMS Joe House – Kansas Board of EMS

(37 in attendance and 4 Board staff) • Welcome and Introductions

• 2017 Legislative Update

o An update was provided on Items 1 through 5 – HB 2076; HB 2217; HB 2137; SB 186; and SB 76. o It was reported that REPLICA officially received its 10th state to enact the law and the

commission will be stood up in October. o A quick review of the recent regulatory changes pertaining to Naloxone use at the EMR and EMT

level; changes pertaining to the training officer level; and changes to operational regulations.

• Idea Gathering (ordered as discussed/introduced) – asterisked items were discussed in previous years as well.

o Mandatory Reporting of Abuse **

Discussion pertained to a previous bill introduced by the Kansas Department for Aging and Disability Services (KDADS) that would have mandated EMS providers, along with some others, to report suspected abuse of the elderly and/or dependent adult. This bill ended up caught up in an unrelated discussion and the mandatory reporting was a non-contentious portion of the bill. Currently, there is confusion and inconsistency on when an EMS provider is mandated to report abuse.

o Licensure vs. Certification ** This item was brought up for consideration due to some problems being encountered by

a service for the individuals not being licensed and therefore not having an ability to practice within a facility. The question was whether there is a difference in state law between licensure and certification, liability concerns, and whether it is worth pursuing a change in naming of the process (risk vs. benefit). This topic also related to the usage of the title “Attendant” listed below.

o CPR in High Schools Discussion pertained to the thought that every high school graduate should be exposed

to learning CPR at some point during their high school education. It may not be necessary to provide CPR certification to each, but the education and verification within the school system should take place (at a minimum).

o Usage of the title “Attendant” ** Discussion pertained to the confusion caused by utilizing the word “attendant” for

multiple meanings throughout statute and regulations and to provide a consistent application of the term that would better align with a perception of being part of the healthcare delivery system and a healthcare provider. This would involve reviewing other state statutes that define healthcare providers to identify which also list EMS providers within that definition, if applicable. Discussion also pertained to alternatives to “attendant” that could better align (other states, other locales, international nomenclature, etc.). This topic also related to Licensure vs. Certification listed above.

o Board Composition ** Discussion pertained to thoughts that the Board should continue to be representative of

the industry and to potentially revisit the expectations of the role that each grouping serves on the Board.

o Term Limits for Board Members ** Brief discussion pertained to maintaining involvement and preventing stagnancy by

effectively rotating membership. o Peer Review Protection **

Discussion pertained to the ability for entities to openly discuss outcomes of patients across jurisdictional boundaries (both physical and industry) without the fear of disclosure for litigious purposes. The ability for all aspects of a call (dispatch centers, law enforcement, fire response, first response medical, ambulance, hospital, rehab hospital, home rehab, etc.) to meet and discuss a call to better the system of care and improve patient outcomes.

o Inactive status ** Discussion pertained to being able to allow retirees, and others that may no longer

perform patient care activities, to retain their certification. Among other things, this

would allow those individuals to still qualify to utilize an EMS license plate, if they choose. This could provide the state with a more accurate number of EMS providers that are within a patient care role. This would involve the development and definition of active and inactive; methods of moving from one status to another; and recertification requirements/procedure for an inactive status.

o AEMT Discussion pertained to the poor pass rates that the state is currently seeing upon initial

examinations and the generalized thought that it needs to be analyzed further to determine how to better prepare these students as AEMTs. Discussion talked about the Kansas enrichments being the cause for increased failures; however, the categories that Kansas students are performing poorest in are Trauma and Operations – which neither deviates from the national standard. It was mentioned that staff is currently working to compare the Kansas standards to the National standards completely.

o Scope of practice Discussion revolved around whether the current scope of practice model should be

adjusted away from the “ceiling” thought and more towards the “floor” thought. This would require the development and management of a process to exceed the minimum, but may allow for more continuity in the minimum level of care being delivered across the state. It was thought that this may be better discussed and formed in focused meetings on the topic.

o Community Paramedicine Discussion pertained to whether legislation needed to occur to enable community

paramedicine. It still seemed to be the consensus to not move on this topic unless it became necessary to validate a method of reimbursement or otherwise became necessary to legislate.

o Medicaid Expansion ** Discussion pertained to the fact that Kansas made an attempt to expand Medicaid, but

that it did not receive enough votes to override the Governor’s veto. It is thought that Medicaid expansion may lead to more residents being insured, resulting in an increase in payment received. It was also discussed that this may be the boost to temporarily sustain those critical access hospitals on the extreme edge of closure.

It was asked if the Board had any legislative priorities or items to consider and these three items were briefly touched upon.

o Clean up of older scope references throughout statutes With the elimination of the levels of EMT-I; EMT-I/D; EMT-D; and training officer, there

are many references in statutes to these scopes that need to be removed. o Background checks **

Having adopted the interstate compact, it is known that the Board would need to pursue having new applicants complete a background check within 5 years of the Interstate Compact becoming effective. That means that legislation will need to come forward and pass prior to October 7, 2022, in order for Kansas to remain to participate in the Interstate Compact. It would still be nice to pursue the ability to have the state of Kansas unify under a single umbrella for background checks (example: a teacher that is a

part-time realtor and has a concealed carry permit would need to complete his/her 4th state background check to become an EMT); however, it is noted that this would involve multiple state agencies and a change in the way that Criminal Justice Information is handled within the State. This will not require all providers to have a background check, only once for each person as they gain their initial EMS certification in Kansas.

o Medical protocol approval / local medical director Discussion pertained to the ability for the local medical director to approve protocol in

addition to the other 3 methods of approval (hospital for which the service transports a majority of their patients, local medical society, or the medical advisory council). Additional discussion revolved around EMS personnel working under their medical director’s license, some of the other methods being able to “hold hostage” the approval of protocols for political purposes (i.e., force transport to specific facilities)

• Prioritizing and Grouping

o The thought is that whereas all items listed may require a statutory change, the Board of EMS should focus solely on those statutory areas that would pertain to the protection of public welfare through the regulation of attendants, operators, services, and educators and allow other groups/entities to focus on changes that may better align with their vision and mission. This discussion led to the following classification of the listed items:

o KSBEMS Inactive status Usage of the title “Attendant” Licensure vs. Certification AEMT – Pass Rates Scope of Practice Higher priorities were given to the AEMT topic and Scope of Practice conversation

o Other Groups Mandatory reporting of elder abuse CPR in high schools Medicaid Expansion Board composition Board Term Limits Peer Review Protection

o No change necessary at this time Community paramedicine

• Other Topics for Discussion

o Fine Schedule During the last legislative session, the Kansas Board of EMS was granted the ability to levy civil

fines as an additional tool available for disciplinary action. With that ability, it had been discussed that a schedule needed to be developed to help provide for a consistent approach to handling similar cases. Staff’s Draft attempt at a fine schedule was presented for comment.

Questions/Comments that arose were ensuring consistency in application and the handling of multiple violations.

o Protocol Approval Method Discussion pertained to whether the current 3 methods of protocol approval are meeting the

intent and whether there is an alternative method that achieves the same intent. Items brought up were the ability for the local medical director to approve protocol in addition to the other 3 methods of approval (hospital for which the service transports a majority of their patients, local medical society, or the medical advisory council). Additional discussion revolved around EMS personnel working under their medical director’s license, some of the other methods being able to “hold hostage” the approval of protocols for political purposes (i.e., force transport to specific facilities), and whether a more regional approach to protocol approval and development is necessary.

o Non-transporting Agencies The conversation and discussion was started about how to appropriately regulate the EMS

medical care being provided by EMS providers of non-transporting agencies in order for the care to be provided legally. It is to be noted that the Board’s desire is to legally allow medical care to occur by both non-transporting and transporting agencies and that communication take place prior to the incident occurring in order for the patient to receive continuous treatment down a medical community-approved route of treatment. Statute states that an EMS provider must provide care pursuant to medical protocols, must have received training to perform such care, and must be competent to perform such care. There are a significant number of non-transporting agencies in the state of Kansas (approx. 700-750). Some of these utilize a local EMS jurisdiction medical protocols, some do not. Some exceed the capabilities of their transporting agency, some do not. Discussion during this meeting revolved around how this is envisioned to happen, inspection process, what won’t be regulated, how a non-transporting agency determines protocols to use (when working with multiple transporting entities), the interaction that needs to occur between transporting and non-transporting agencies, and to what degree the Board felt it needed to be regulated.

o Basic Life Support Examination (EMR and EMT) With the current BLS Examination contract set to expire on July 1, 2018 and the Board needing

to consider how to write a new Request for Proposal, the question was asked as to whether the current examination process (rote skills) is adequate to assess the psychomotor level of a prospective candidate for certification. A 2nd question was whether the student should be expected to be able to put the psychomotor skills and the cognitive skills together prior to granting certification or if this was another’s responsibility. Topics that came up during the discussion were current examiner bias, test anxiety, and the skills examination complete failure at being a valid or reliable method of testing. A solution to allow the local program to verify psychomotor competency was introduced; however, it was pointed out that those that are currently failing at the skills examination have been signed off by the instructor as being competent to perform these rote skills. Discussion revolved around a change being needed, but uncertainty whether a new method could be developed in time to let a contract and to have no lag in examination.

o Requirements for entry into an instructor coordinator initial course

With the proposed changes in training officer, one of the items known to need to be addressed was the requirement of holding a training officer 2 (TO2) certificate in order to be considered for entry into an initial course for instructor-coordinator (IC). It was discussed that there are currently 4 requirements for an individual to be accepted into an IC initial course of instruction: 1) Proof that he or she is or has been certified for at least 2 years as an EMS provider, physician, or professional nurse; 2) Proof that he or she has at least one year of field experience with an ambulance service; 3) a letter from a certified IC verifying the commitment to evaluate the applicant on the competencies of the mentored teaching experience; and 4) Current CPR Instructor at professional rescuer level, have instructed at least 15 hours of material, and currently holds a current teaching certificate or is certified as a TO2. In addition to these 4 requirements, these individuals must successfully complete an evaluation of knowledge and skills by completing a written medical knowledge examination at the EMT level and scoring an 80% or higher and by completing a practical skills examination at the EMT level and receiving a passing score for each practical skill station. A potential solution was provided to the group that involved elimination of the 4 requirements and adjusting the evaluations to reflect the current examination process (the NREMT assessment for the EMT level and the current skills examination for the EMT). This solution would allow the organization putting on the course to determine any pre-requisites necessary to take the initial course, except that staff felt that if the expectation of the person is to teach at the EMT level, that person should prove that he or she has the cognitive knowledge expected of an entry level EMT and the ability to properly perform any skills being examined for certification (since this is the knowledge they are expected to instruct upon). This topic seemed to be generally accepted by the group with a request for actual verbiage to be provided to the chair of the EDTF.

o Defining/Redefining unprofessional conduct It was mentioned that this is being looked at to update current definitions and to create a

definition of unprofessional conduct for the operator. Current definitions of unprofessional conduct were provided and draft language that was sent to the Board’s legal staff was also provided. No further discussion took place.

• Adjournment and Thanks

Meeting organizer note: I would especially like to thank those in attendance for their openness and willingness to provide input and feedback to the Board and Board Staff. This information will prove extremely beneficial in moving forward EMS in Kansas and continuing to provide better out-of-hospital care to our patients. Great job to the attendees on their focus across a myriad of topics and thanks for a wonderful discussion!! Joe

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