PUBLIC-SAFETY COMMUNICATIONS GOVERNING BOARD

Monday, April 30, 2007          

Room 3220 -Administrative Center

10:00 a.m.

CALL TO ORDER:

Chief Randy Williams called the meeting to order at 10:00

APPROVAL OF MINUTES:

Motion by O’Malley/Burke to approve meeting minutes from February 12, 2007.   Carried.

ECHO COMMUNICATIONS – Chief Don Dominick  

Chief Dominick accredited the advantages of ECHO Communications and relayed that Firefighters commented on their clearer understanding of what the first units on the scene see and how beneficial it is.   Jay Loeffler added that Public Safety Communications is utilizing Echo Communications particularly in the EMS and Fire call.  

PUBLIC SAFETY COMMUNICATIONS ADMINISTRATOR’S REPORT – Jay Loeffler

Jay included a hand out of the statistics for the first quarter and pointed out statistic changes. 

The new microwave system is basically in and functioning at this point with only a couple minor glitches which are being worked out.  There has been a small delay from the original plan but everything should be up and running within the next few weeks.

The Mapping Software is in the process of being installed, which hinges on the mapping. It was last reported the Turn Up, or acceptance of the wireless software and getting the entire system up to speed was going to happen in April but is being pushed back to May.  Once the mapping is installed the wireless providers do their testing and verification of the system.  Expectantly within the next month phase two of the Wireless E-9-1-1 information will be available.  The dispatchers will be training this week on the new mapping software.   

We have accepted our first payment of the E-9-1-1 Wireless Grant and should be getting the second payment shortly.  Reimbursement will be collected through the end of 2008 and there will be eight more payments forthcoming. 

Staffing Update - Ken Damaschke has been promoted to Supervisor and will be Supervising 2^nd and 3^rd shifts and our newest Telecommunicator will start training in May.  Contrast to other dispatch centers our staffing position is very good, which is extremely beneficial for the department. 

Training Update – A Hazardous Material expert from the State of Wisconsin Emergency Management gave 2 ½ hours of training for everyone on the staff.  There has been APCO and NENA training throughout the state involving MABAS (Mutual Aid Box Alarm System), technological updates and information on training programs and of the 40 attendees, 10 were from La Crosse.  Jay pointed out he has a strong commitment to training and will continue to take advantage of what is available.

Jay also updated recent and current events including the Wisconsin VisionAir user group meeting in La Crosse, National Telecommunicators Week and in conjunction La Crosse hosted the Telecommunicator of the year award presentation.  La Crosse has also been awarded the 2009 North Central Regional Conference involving 500 communication officials.  

EMERGENCY MANAGER’S REPORT – Hand out - Keith Butler  

Keith gave and overview of the EPCRA and Emergency Management Performance Grants which were detailed in the handout.  Approximately 30% to 40% of the overall budget comes from these two main programs.  Keith oversees the all volunteer County Mass Casualty Team, the Community Emergency Response Team and provides guidance and grant management for the West Central Wisconsin Citizen Corps Council and CERT courses. 

Keith is also supervising the Workforce Development/AmeriCorps project which provide disaster preparedness information to special needs/vulnerable populations.

A project related to the Citizen Corp/AmeriCorps project is the Hazardous Materials Performance Grant program which is to determine how those facilities providing care for special needs for vulnerable populations are receiving warnings for hazardous material events. 

Keith highlighted the County Emergency Operations Center, information on the Local Amateur Radio volunteer project and the how volunteers can be used to help manage an effective response to a large scale disaster.  Keith also expressed his concerns and asked for direction in regards to the liability of these volunteers should cause damage or receive damage to a vehicle or injure someone else or become injured themselves.  

Steve O’Malley reported the Executive Committee is looking on this issue.  The 4-H volunteers are well organized and certified on their training and expectations but there is a separate work group that is being pulled together and administratively this is being worked on.

The remainder of the hand out covered various projects and activities Emergency Management is engaged in.  Exercises, contacts, development, updating, Grant projects and responses all play a part in the increased duties and responsibilities of Emergency Management.   

EMERGENCY MEDICAL DISPATCH – Mike McKee, Dispatch Center, Gunderson Lutheran – Matt Zavadsky, Tri-State Ambulance

Mike Mckee advised that he would be introducing what EMD (Emergency Medical Dispatch) is, how it works, give a short audio clip of an actual call, who is using EMD around the united states, what their offer is to the region, what they would like the board to consider and then to summarize the benefits of EMD.

EMD is a coordinative method of processing emergency medical system (EMS) responses, assuring the safety of the caller, responder and the general public.  It is a method to assign response determinacy, whether is it an emergency, non-emergency call or a call just for transport.  And it provides post-dispatch and pre-arrival instructions to the caller so they can tell them how to help manage the medical crisis or injury prior to EMS arriving.  Internationally developed protocols being used will be examined and reviewed and approved locally by Medical Director Dr. Eric Voter. 

The EMD dispatchers are trained and certified to quickly and accurately determine what the patient’s condition is, assign proper response configurations and provide instructions to the callers. This is done prior to EMS arriving and the dispatcher becomes the first, First Responders. They assist the caller and try to manage the crisis as the EMS is responding. 

The EMD starts out by asking simple questions at the beginning to determine the location and problem.  Once the problem is determined they assign a protocol.   There’s a total of 33 protocols which each tells the dispatcher what to ask to closely get at the problem and assist the caller.  They also look at any hazards that might be at the scene and report to the responders who are arriving at the scene. 

An actual call was played and the EMD program screens used by dispatchers were displayed.  EMD thoroughly asked the pertinent questions and assisted the dispatcher in talking the caller through CPR until help arrived. 

There are currently 8,000 PSAPS (Public Service Answering Points) in the US currently using EMD and there are 2,270 using the Priority Dispatch program.  Another 2,500 are using other products.  This is a collaborate effort between Gunderson Lutheran and Tri-State Ambulance.  This service is being offered to all 9-1-1- Centers in Tri-State Ambulance’s primary service area free of charge.  Gunderson Lutheran and Tri-State Ambulance feel this it is such an important piece of the EMS system, Gunderson will pay for the personnel cost. Tri-State Ambulance has already purchased the software and training, and will be supplying the maintenance costs as well.  

Mr. McKee established what is being requested from the Board:

1.  Requesting permission to have the 9-1-1 calls transferred to the EMD center.

2.  Authorize the implementation of a task force to come together and agree on protocol.

3.  Set a time on implementation.

Matt Zavadsky was then open for questions. 

Chief Kondracki questioned the zero response time, as the best he has seen is about three minutes.  Also, Chief Kondracki wanted to know who is determining the red light and/or silent run responses to the location and is there any information given regarding past history of the location.  

Mr. Zavadsky said there would be premise history from the 9-1-1 Center given.  They are recommending a task force be made up of law enforcement, fire-fighting and emergency medical personnel to determine protocol.  In the protocol there is an entire assault or violence section which asks specific questions to assure their safety while they are waiting for law enforcement to arrive.  If a call came into the center right now for a nose bleed, how do they determine if it is an assault?  They do not make that determination.

Chief Kondracki pointed out getting all this information lengthens the zero-response time.

Mr. Zavadsky explained the zero-response time is an acronym which is used.  With EMD, the call-taker is now the responder so maybe the zero-response time is 15 or 30 seconds.  This is less than it would take to get patient-side once the call is processed and then dispatched. 

Chief Kondracki also questioned how the statistics were developed in stating that thousands of lives have been saved.

Mr. Zavadsky responded that the cases have been documented from quality assurance through Medical Priority since the program has been developed over the last 20 years.  These are actually people whose lives were saved who had a spontaneous return of circulation and arrived at the hospital. 

Chief Cleveland questioned the differentiation of the success rate between having a pulse on arrival at the hospital and having the patient survive.  

Mr. Zavadsky concurred it is not determined the person lived and was released from the hospital, but did arrive with a heartbeat, which is the same way the figures are currently configured.   

Chief Alo questioned the benefit of residents of Bangor and Rockland, who use Sparta Ambulance, if this is a partnership between Gunderson Lutheran and Tri-State. 

Mr. Zavadsky pointed out Sparta Ambulance would still be dispatched.  There have been  discussions with them and they would like to be involved in this process as well. 

Chief Dominick questioned the liability if an agency decided to use a light and sirens response. If there has been an advisory not use a lights and sirens response from the EMD protocol he feels it would become a liability to the municipality because they were warned.   

Mr. Zavadsky said the cases that have been brought against agencies for accidents enroute to a call are looked at post-event.  In the 13,500 emergency medical vehicle crashes that occur every year they look at them as, should you have been responding to that call lights and siren and  would a reasonable person think it is reasonable to respond to a twisted ankle lights and siren. This is based on some good interrogation of the caller and national statistics that have been developed.  Each agency, city or county will decide whether or not they want to continue to respond lights and sirens as they are today or take that recommendation of whatever the statistic is if these are not life threatening. 

Chief Kondracki said one thing we do know is policing in America is a community response and certain communities feel having a uniformed squad come to every assignment is in fact the highest level of police service available.  His concerns are that we are putting the police and fire chiefs in a position of deciding if they want to ignore these standards and are they willing to suffer the consequences as far as liabilities are concerned.  He also said he cannot get past the zero response time while building in another step.

Mr. Zavadsky said in our system it takes six-to-eight minutes from the time someone gets a phone answered at the 9-1-1 center to the time someone is patient side and able to do CPR.  Irreversible brain damage occurs four-to-six minutes after the heart stops beating.  If we can get the caller on the scene to start administering CPR or do the Heimlich before that time is up we have dramatically enhanced the response time to that patient.    

And to address the questions about liability issues, this could be up to the task force to decide.    If you want every officer dispatched to a first responder call to go in an emergency mode, the system will be set to do so.  This will be set up by the agency with the recommendation of the system but liabilities are no different than they are now.

Chief Cleveland questioned liability of open records issues and access going to a private entity and transferring to another party.  From an efficiency standpoint he believes in EMD and the County should be doing it.   It should be a single point of contact which we should be doing it at our dispatch center rather than transferring or sending calls off to a different agency. 

Mr. Zavadsky said they are offering an overall enhancement of the system to give pre-arrival and post dispatch instructions at no cost to the taxpayers.

Steve O’Malley advised if everyone is in agreement that EMD is a valuable direction and we should ask Jay and our staff look into the costs of training and staffing to provide those kinds of service.

Mayor Johnsrud questioned the financial benefit to Tri-State or Gunderson Lutheran by providing this service to the county.  

Both Mr. Zavadsky and Mr. McKee said there is no benefit to either Gunderson Lutheran or Tri-State other than to provide a value added service to the community.  Mr. Zavadsky said they will be able to use this system to respond to fewer calls on an emergency basis, however from a contract compliance standpoint it will make their job harder. 

Dr. Voter added that as a medical director for Tri-State ambulance or the Fire Departments in this are this is huge.

Mayor Johnsrud said he is leery of that response because they are statically deploying ambulances throughout the coulee region in order to meet the contract of providing Ambulance service and this EMD is going to be prioritizing the service so the savings may be that you’re not going to have to statically deploy ambulances because of the response.  The response currently is that you have to go to every response within 8 minutes and 59 seconds per the contract and in order to do that you are statically deploying ambulances around the county.

Mr. Zavadsky said from a contract compliance standpoint that makes their job harder.  Right now when they respond to 731 emergency calls in the county almost everyone is dispatched emergency.  Which means the denominator used for calculating response time is huge so all the alcohol related or twisted ankles are being responded to lights and sirens in three-to-four minutes and under this scenario those calls being responded to in under nine minutes are not going to be there anymore which is going to actually make their job harder. 

Mayor Johnsrud said that Tri-State is relying on First Responders throughout the county to provide BLS (Basic Life Support) care while TSA is responding to that call.  So with prioritizing the calls, there will be First Responders at the scene longer.  Doesn’t that increase the cost to overall communities which are providing BLS care?

Mr. Zavadsky responded that according to statistics for the first quarter of 2007 the time difference between an emergency response area-wide is a four-minute difference between responding lights and sirens versus in a non-emergency mode.  Once the ambulance arrives the fire department is available to respond to another call. 

Mayor Johnsrud said when two fire rescue units within the city of La Crosse are both out on calls waiting for an ambulance there are certainly back-up units available, but that is taking resources away from the municipality to deal with that situation.  There is a cost to have those responders on standby and trained in order to get out to multiple calls at the same time.  Now I may have staff on the scene for 20-to-30 minutes and it lengthens out to 40-to-60 minutes because Tri-State is in a different location.  Another concern: is there any communication or cooperation between the two health care providers within the community? 

Franciscan Skemp has appointed an associate medical director to work with them on this project.  At this point they do not offer a dispatch service of any kind so they have not been invited to the table of EMD.

Joe Kruse with Franciscan Skemp said the prospective of EMD has been discussed and it would be a positive for the citizens of the region, puts the needs of the patients first and they are very supportive of it.  They do have concerns of clarity around liability and involvement of other providers in the EMS service. The task force sounds like a very good idea and if this goes forward they want to be involved in the task force and have the role in defining how this system is going to be reviewed.  From a self-serving standpoint, Franciscan Skemp is worried about some issues in terms of disposition of patients.  There are no complaints on how it is working now, but there is a worry about going forward that it would influence or change the way patients are dispatched to either of the medical centers in La Crosse.  Finally one other concern to be raise is if there would a new ambulance service entering into one of the markets in the future, how would that be handled, and would there be a level-playing field? 

Vicki Burke commented EMD would give more rapid medical information to people who live in the outer areas of the county and is a very important part of the procedure.  The cost has to be looked at of course and the increase of early intervention and medical treatment.  As Mr. O’Malley suggested, we should also look into alternatives because we all recognize the value of the EMD.     

Chief Cleveland followed up with the point if there are higher priority calls there is potential to have two or three medical calls simultaneously and would we have enough resources available to meet those demands.  Chief Cleveland also wanted clarification of the third paragraph under “Why Emergency Medical Dispatch”. Regarding the cost of EMD being paid for from revenues generated by the user of the service.

Mr. Zavadsky said Gunderson Lutheran, Tri-State or any health care systems revenue source is billing patients.  There is a build in revenue stream and people who use their services pay for their services and what this is saying is that they have the money available, they are not a for profit organization and they can reinvest into this system to make it better.  The reinvestment into the system is already being funded by the people paying for their services.  All the money put out is from money they’ve built up already for the process in place.  They firmly believe this is the best for the community and are willing to fund that resource. 

Chief Kondracki agreed that if you can teach CPR to someone on the phone while the ambulance is on the way how anyone could argue with that.  His concern is that if this Board is being asked, as is outlined on the information sheet, to vote on allowing call transfer from the La Crosse County to Gunderson Lutheran Medical Communication Center.

Steve O’Malley conveyed, what has been presented is a proposal by EMD to be provided by Tri-State and the policy decision by this body is to decide how to deal it.  We can get more information on the cost and staffing for us to do this and evaluate the trade off.  No-one says we have to vote on this in any way and unless there is anyone who disagrees to pursue EMD we have a proposal to consider and it is up to us as a public body to decide if this is the best opportunity, is there an alternative proposal and what is the timeline.  How do we want to direct our staff in relation to analyzing this proposal further or to develop another proposal?

Chief Kondracki said he is very concerned there is going to be a reduction in service to our community by building in this extra step not to mention the liability issues raised by the Fire Chiefs.  

Chief Cleveland conveyed his concerns with the potential of conflict of interest with GL and Tri-State.  There is a potential for public steerage, not saying this would occur, but 9-1-1 centers are public answering service points not affiliated with one service or private entity and it is important that an issue such as EMS and EMD be performed by that neutral third party agency.  Again not saying this would happen but we need to look within our own jurisdictions,  how many times has this happened and have counties said this is the state of the art and what we need to do.  These are the issues the county certainly needs to take consideration of. 

Chief Williams said this has been and excellent discussion and which needs to continue.  There seems to be a discomfort level from the board to make any type of approval of what has been  proposed so unless there is new discussion regarding this matter we should get a sense from the board how to proceed.

Motion was made by Cleveland/Dominick to respectfully decline the offer from Gunderson Lutheran and Tri-States offer to transfer call taking and provide EMD services.

Steve O’Malley said he would speak against the motion and feels there is no need to accept or decline the offer and we need additional information.  Taking a position declining an offer before we have had a long discussion and evaluation of options would rush a decision and he respectfully disagrees with the motion.  Steve would like this body to meet more frequently than it does now to consider the issues that have been raised. 

Dr. Voter stated he would respectfully decline the motion and feels it would send the wrong message that we are saying no thank you.

Chief Roeck said on behalf of the other Fire Chiefs excluding the two here, they would like to learn more information.  This is the recommendation he did receive from them.

Bruce Ranis interjected that he would like to hear from our own people and would like a report form Jay Loeffler before he votes for an approval. 

Vickie Burke suggested we vote down this motion and make a motion to look at the costs and related issues. 

Motion to withdraw by Cleveland/Dominick the motion to respectfully decline the offer from Gunderson Lutheran and Tri-States offer to transfer call taking and provide EMD services.

Motion by Cleveland/Ranis to receive and place the report on file. Motion carried.

Motion by O’Malley/Burke to:

1.      Direct staff to compile all the questions and issues that were raised today.

2.      To analyze our options to do in house EMD.

3.      This body should meet within four weeks to evaluate the information.

Motion carried. 

ITEMS FOR FUTURE AGENDAS      

Emergency Medical Dispatch

NEXT MEETING DATE

The next meeting of the Public Safety Communications Governing Board is scheduled for Wednesday, May 30, 2007 at 1:00 p.m.,  Room 3220 – Administrative Center

ADJOURNMENT     Motion to adjourn by Williams/Roeck at 11:58 a.m. Motion carried.

Disclaimer:  The above minutes may be approved, amended or corrected at the next board meeting.   Patti McDonah, Recorder