EMSCC MEETING MINUTES-DRAFT  
3/17/2017  
STATE EMERGENCY MEDICAL SERVICES COORDINATION  
COMMITTEE MEETING  
Friday-March 17th, 2017  
Call to Order:  
Dr. Edwards called the meeting to order at 9:37 AM.  
Roll Call:  
Members Present: J. Boyd, J. Bullen, Richard Oziemski for K. Cummings, Dr. R.  
Dunne, Dr. K.D. Edwards, Dr. M. Fill, B. Forbush (via phone), W. Hart, Dr. B. Kincaid,  
C. Lake, S. Myers (via phone), M. Nye, D. Pratt, G. Scafidi (via phone), L. Sincock (via  
phone), E. Smith, T. Sorensen, A. Sundberg (via phone), B. Trevithick, G. Wadaga (via  
phone), K. Wilkinson, Dr. S. Wise.  
Members Absent: Sen. Casperson  
MDHHS Representatives: K. Wahl, N. Babb, S. Slee, E. Worden, T. Godde, E.  
Bergquist, J. Potchen.  
Others Present: Pete Rogers, LSTI; John Truba, Hayes Green Beach; Richard  
Oziemski, Concord EMS; Brent Siegel, Northville Township Fire Department; Dr. Noel  
Wagner, Saginaw Valley MCA; Katy Van Douselaar, Saginaw Valley MCA; David  
Miller, Star EMS; Chris Haney, Star EMS; Kim Piesik, Superior Ambulance; Kali  
Henderson, Saginaw Valley MCA; Audrey Shaver, Saginaw Valley MCA; Jim Grady,  
MMR; Dr. Robert Swor, Beaumont Health; Kolby Miller, Med Star; Damon Obiden,  
Kent County EMS; Angela Madden, MAAS; Michelle Harper, Tri County MCA; Leslie  
Hall, MiREMS; Dr. Robert Domeier, Washtenaw/Livingston MCA; Marvin Helmker,  
Lansing Community College; Elizabeth Madore, PGY4 St. Mary Mercy Hospital; Eric  
Snidersich, Saginaw Valley MCA.  
Special Guests:  
• Dr. Mashid Abir and ReKar K. Taymour.  
o Dr. Abir presented the study findings to the group and answered questions.  
The Power Point presentation will be sent to the EMSCC members and the  
subcommittees.  
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EMSCC MEETING MINUTES-DRAFT  
3/17/2017  
Approval of Agenda and Minutes:  
AGENDA: Motion to Approve: Wilkinson, Lake. Motion Carries.  
MINTUES: Motion to Approve Minutes from November 2016 meeting: Lake,  
Wilkinson. Motion Carries.  
Old Business: None  
New Business:  
• Communication from Diane Bollman.  
o Dr. Edwards read a communication received from Ms. Bollman thanking  
the EMSCC and the Bureau of EMS, Trauma and Preparedness for  
thinking of her while she is ill.  
• Change of Venue  
o Changing the venue of the EMSCC meetings was suggested at the  
Strategic Planning meeting. This group discussed. Motion to move the  
EMSCC venue to Livingston County EMS: Pratt, Kincaid. Motion  
Carries.  
Strategic Planning Report by Kathy Wahl:  
• K. Wahl presented a draft document to the group containing a summary and next  
steps from the Strategic Planning session held on 1/20/2017. It was asked for the  
group to look it over, share it with their constituents, talk to people and find out if  
this is the direction the EMS System should go. K. Wahl asked the group to bring  
thoughts on the document to the next meeting. The document will be finalized  
and progress will be reported on at every EMSCC meeting. Strategic Planning  
will be added as an agenda item going forward.  
o Discussion: B. Hart brought up the importance of follow through.  
o This document will be sent out electronically to the group.  
Emergency Preparedness Update by Dr. Edwards:  
• The new Budget Period 1-5 will start on July 1st, 2017. The State is preparing its  
application based on regional information to submit. Dr. Edwards briefly  
discussed some of the items that will go along with this.  
• There will be an upgraded and revised PAPR/PPE requirement. There will be  
more discussion on the April statewide call.  
• The burn surge training module for EMS rough draft has been completed.  
Michigan has trained close to 800 people on hands burn surge training.  
• There will be a MI-TESA workshop on March 21st, 2017, followed by a short  
exercise. On March 22nd, the annual State SNS exercise will be conducted.  
• The Special Pathogen Response Network has been working on protocols and are  
close to having finalized protocols to submit to the Quality Assurance Task Force.  
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EMSCC MEETING MINUTES-DRAFT  
3/17/2017  
EMS Systems Report by Kathy Wahl:  
• K. Wahl introduced Emily Bergquist, who is the new EMS MCA Coordinator.  
• The NHTSA assessment will be March 27th through March 31st. A comprehensive  
electronic briefing book has been prepared. All of the speakers have been lined  
up. The agenda is tight and space is limited, as there are only 30 chairs available.  
• The composition of the EMSCC is being looked at because the system has grown,  
evolved and is dynamic. This can be changed through an executive order from  
the Governor. K. Wahl asked the group for suggestions.  
o Discussion: Suggestions offered included the state 911 director, the Office  
of Highway Safety Planning, Emergency Management, Extended Care  
Facilities, Law Enforcement and rural representation (MiREMS, Michigan  
Center for Rural Health). Reducing the “county less than” clauses was  
discussed. K. Wahl also mentioned the Michigan Pharmacy Association  
and Emergency Nurses. In addition a legal representative, such as from  
the AG’s office, and a representative from MDHHS policy and planning,  
were discussed as ex-officio additions. K. Wahl will put together a  
document with the suggested additions for the group’s review. This  
discussion will be added to the next agenda under “Old Business”.  
• The MEDCOM plan is being looked at. Matthew Godde has been assigned this  
task, and will be pulling a group together in the summer to review this. K. Wahl  
went over some changes that have already been considered.  
• The Michigan Center for Rural Health has a new quality improvement project for  
rural hospital MCAs. More information will be available in the future.  
• The Recruitment and Retention committee will be co-chaired by the Michigan  
Center for Rural Health, MiREMS and MAAS.  
• K. Wahl asked that the subcommittees start to meet and review the rules that  
relate to each one. E. Worden will hold an in-service workshop on the rules  
revision process for the subcommittees.  
• The MI-MEDIC cards are being mailed out and the ACR shipping is complete.  
Trauma Systems Report by Eileen Worden:  
• There are 8 requests for instate site reviews, 5 for level 4 and 3 for level 3. There  
are also 7 ACS reviews.  
• There are 178,699 incidents in the registry.  
• The regional trauma networks are engaged in writing their next round of  
applications. These are required every three years. Continuum of care is being  
addressed.  
• The Registrar Epidemiologist position is in the process of being filled.  
• The recommendations from the 2007 NHTSA assessment have either been met or  
are ongoing.  
• The rule changes are still working through the process.  
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EMSCC MEETING MINUTES-DRAFT  
3/17/2017  
Committee Reports:  
A: Quality Assurance by Dr. Edwards:  
• The protocol review continues to be worked on.  
• The QATF had an appeal hearing, as the advisory body to the EMSCC in such  
matters, regarding STAT EMS Dispatch Issue with Saginaw Valley MCA  
(SVMCA). Dr. Edwards read the following summary to the group:  
The Issue:  
Were the actions or decisions of SVMCA in accordance with their protocols and state law as  
it relates to their review of the 10 patient care related allegations contained in complaint  
number 032-16?  
Summary:  
On February 3, 2017, an appeal hearing was held by the Quality Assurance Task Force  
(QATF) in response to a request by STAT EMS under the Open Meetings Act. Notice was  
given to all parties on January 19, 2017 via email and certified mail. The notice requested that  
the parties provide a joint statement of proposed issues to be resolved, a short statement  
outlining their respective positions, and written material supporting their respective positions  
by January 30, 2017. A separate request was received by Mobile Medical Response (MMR) to  
participate in the hearing. While they were not allowed to participate in the hearing, they  
were, however, allowed to submit relevant information and attend the hearing. All three  
entities submitted documents for review prior to the hearing. STAT EMS and Saginaw Valley  
MCA were both allotted 15 minutes in which to provide testimony on their behalf.  
Presentation of Parties:  
STAT EMS Presentation  
• STAT EMS, through their attorney alleged that SVMCA is not adhering to  
their protocol to ensure that STAT is dispatched as indicated on their Part  
1application for licensure.  
• STAT claims it has been prepared to respond to emergencies since 10/3/16.  
• STAT claims it has not been dispatched by the Saginaw 911secondary Public  
Safety Answering Point (PSAP) Center, even though they have medical  
control approval to be a part of the SVMCA EMS System.  
• STAT alleged that the SVMCA review of the 10 patient care cases was not  
conducted according to SVMCA protocols. STAT, however, did not  
provide any specific information to support this allegation. STAT also  
claims that the PSAP's action of not dispatching STAT to calls creates a  
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EMSCC MEETING MINUTES-DRAFT  
3/17/2017  
public health threat.  
• STAT contends that the 10 cases presented to the SVMCA for review are also  
representative of a larger issue in Saginaw County, that being the exclusion of  
STAT EMS from being dispatched by the PSAP, which is not consistent with  
SVMCA ensuring that the EMS system is coordinated in all aspects.  
SVMCA Presentation  
• The PSAP is operated by Mobile Medical Response (MMR), which has a  
contract with Saginaw County to be the secondary PSAP. The contract  
indicates that in return for being the secondary PSAP, MMR has exclusivity  
within the county.  
• The SVMCA contends that they do not have the authority to override  
the contract between Saginaw County and MMR to dispatch STAT.  
• SVMCA reported that they did review the 10 cases reported to them.  
• The SVMCA Dispatch committee reviewed the complaints by  
looking at the times on the electronic patient care records.  
• The dispatch committee is the PSRO entity that reviews any dispatch  
complaints.  
• SVMCA reported that the response times were within the time frames  
required in their protocols. They reported that there are time exceptions in  
their protocols such as weather etc.  
• SVMCA protocols do not indicate a set time for review of complaints.  
• At the time of the original complaint, SVMCA had signed a Part 1licensure  
application for STAT to provide services in Birch Run Township. The part  
1was subsequently expanded to the entire Saginaw County.  
Findings  
The QATF came to the following conclusions:  
• STAT failed to provide evidence to support its claims that the SVMCA  
did not follow their protocol for reviewing the 10 patient care related  
allegations contained in complaint number 032-16.  
Recommendations  
1. SVMCA could have communicated with the complainant STAT better. In the  
future, it is recommended that the MCA be proactive with acknowledging  
receipt of complaints and outcomes of investigations as appropriate.  
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EMSCC MEETING MINUTES-DRAFT  
3/17/2017  
2. The QATF believes it is beyond the scope of the QATF to provide a  
recommendation that SVMCA override a private contract between the secondary  
PSAP and the county.  
3. According to Act 32 of 1986 as Amended (the Emergency 9-1-1 Enabling Act)  
§484.1601,the emergency 9-1-1service committee created in section 712, upon  
request by a service supplier, county, public agency, or public service agency, shall  
provide, to the extent possible, technical assistance regarding the formulation or  
implementation, or both, of a 9-1-1- service plan and assist in resolving a dispute  
between or among a service supplier, county, public agency, or public safety agency  
regarding their respective rights and duties under this act. §484.4602 (2) ...a dispute  
between or among 1or more service suppliers, counties, public agencies, public  
service agencies, or any combination of those entities regarding their respective  
rights and duties under this act shall be heard as a contested case before the public  
service commission as provided in the administrative procedures act of 1969, 1969  
PA 306 MCL 24.201 to 24.328. The QATF believes that some of the concerns  
expressed during the hearing are .covered under Act 32 and that the involved parties  
should be referred to the Emergency 9-1-1 Service Committee as an additional  
resource to address the dispatch issues.  
4. Further, it is recommended that the 911Services Committee be added to the  
EMSCC to facilitate an understanding of EMS issues as they relate to dispatch  
and the requirements for a complex and effective EMS system.  
• Motion to support the Quality Assurance Task Force’s recommendation  
and findings to the EMSCC. Wilkinson, Kincaid. Motion Carries  
(Trevithick abstained).  
• K. Wahl read the following statement regarding this matter to the group:  
Division of EMS and Trauma Additional Recommendations Regarding STAT  
EMS v Saginaw County Medical Control Authority:  
While I can appreciate the findings and recommendations of the QATF  
subcommittee, I would like to make a statement on behalf of the DHHS EMS and  
Trauma Division. In its appeal, STAT raised concerns regarding patient care due  
to delays in response times related to the dispatch policies in Saginaw County. We  
believe it is important to address on the potential public health and safety issues  
that are raised with any alleged delays in response times. Even if STAT did not  
meet its burden, it is unclear what, if anything, SVMCA did, or is doing, to address  
these issues.  
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EMSCC MEETING MINUTES-DRAFT  
3/17/2017  
According to Policy E, Emergency Medical Services Dispatching, which was  
approved by the State 9-1-1 Committee 9/21/10, it appears that Saginaw Valley  
MCA has the authority to require the Saginaw County Emergency Medical  
Dispatch service to dispatch the, “appropriate available public safety service unit  
located closest to the request for public safety service”.1 Policy E also states,  
“Dispatching decisions of a PSAP policy-setting body need to be consistent with  
the local EMS System and with local medical control protocols.”  
According to PA 368 of 1978 as amended §20919 (1), “A medical control  
authority shall establish written protocols for the practice of life support  
agencies and licensed emergency medical services personnel within its  
region. The medical control authority shall develop and adopt the protocols  
required under this section in accordance with procedures established by  
the department and shall include all of the following: …(b) Medical  
protocols to ensure the appropriate dispatching of a life support agency  
based upon medical need and the capability of the emergency medical  
services system.”  
The Saginaw Valley Medical Control Authority System Protocol 6-29 Life  
Support Agency Standards 2. indicates that LSAs authorized to operate  
within the SVMCA will have defined geographic service areas and that the  
SVMCA “shall have the final authority of whether an agreement is valid.”  
The geographic response area shall be explicitly declared on the LSA  
Agency application with the Department. Section 6 Dispatch and  
Communications b. “All dispatch protocols will be reviewed and approved  
by the Medical Director and the SVMCA. 13. New/Upgrade Services  
states, “a. Only services approved to function in the SVMCA shall operate.  
Approval to operate is based on State of MI legislation, MDCH rules, and  
SVMCA protocols. The SVMCA Board of Directors shall have the final  
authority in approving or denying application.  
Policy E describes what should be done if there is a conflict or dispute in  
EMS dispatching policies.  
1. Determine that the EMS agency is appropriately licensed to provide services in  
the area in question (that information is included in their EMS agency license  
Geographic Service Area).  
2. Consult with the local Medical Control Authority and/or the medical director  
about their existing policies. They are responsible for the overall EMS System  
1 State 9-1-1 Committee. (2010). Policy E: emergency medical services dispatching  
http://www.michigan.gov/documents/msp/Policy_E_528937_7.pdfg  
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EMSCC MEETING MINUTES-DRAFT  
3/17/2017  
and can give you advice on the development of your policy. Ask for their advice  
in writing, including protocols which have been approved.  
3. Review the contents of your approved County 9-1-1 Service Plan, as it may  
give you direction on which agency should be dispatched to a particular  
Emergency Service Zone.  
4. Consult with county and/or local municipal leaders, depending on which  
agency arranges for EMS coverage. If the EMS agencies involved are  
appropriately licensed and Medical Control has no policy, local government can  
give you advice on the development of your dispatching policy.  
Based on the record before us, it is unclear how SVMCA determined that there  
were no patient care related issues in regards to the alleged delayed response  
times. Additionally in this case, Dr. Wagner signed the STAT Part 1 License  
application indicating he will provide medical direction for the geographic service  
area of Saginaw and Tuscola counties. It appears Saginaw Valley MCA could  
request the Saginaw EMS Dispatch to dispatch the, “appropriate available public  
safety service unit located closest to the request for public safety service”. This  
would include any Life Support Agency that is licensed to operate within the  
geographic service area. It is also unclear as to what efforts SVMCA undertook  
to follow the Policy E recommendations for addressing the dispatching issues that  
STAT raised.  
• K. Wahl wrapped up by stating if assistance is needed in convening a  
workgroup or implementing Policy G (dispatching), she will be happy to  
help move that forward.  
B: Ambulance Operations by Montgomery Nye:  
• The subcommittee has not met, but the NFPA 1917 standards are up for review at  
NFPA.org and the CAAS GVS 1.0 is opening up a dialogue on remount  
standards.  
• The uprising of remounts being added to fleets was brought up.  
C: Medical Control by Bruce Trevithick:  
• An MCA orientation was discussed, as well as an MCA mentoring program.  
• In follow up to the MCA conference, they have been creating topics for potential  
presentations at the next conference.  
D: Education by Kevin Wilkinson:  
• Based on the strategic planning discussions, K. Wilkinson would like to know if  
there is interest in pursuing the discussion on eliminating the practical  
requirements at the Education subcommittee. Please send feedback to K.  
Wilkinson.  
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EMSCC MEETING MINUTES-DRAFT  
3/17/2017  
• The EMS Education Summits began at Lansing Community College and was well  
received. There will be one in Petoskey on April 7th and one in Escanaba on April  
26th.  
• DOSE Training: There was a record high number of infant sleep related deaths in  
2015 and a record low in 2016. The city of Lansing is getting ready to do a huge  
campaign.  
• DOSE and Human Trafficking will be available as webinars soon.  
• The new National Registry Paramedic Practical exams began in January. The test  
is focusing on critical thinking. Those interested in becoming exam evaluators  
should contact T. Godde.  
• T. Godde recognized Dr. Swor for winning a national award for his extensive  
work in research for emergency medicine and out of hospital care.  
E: Statewide Trauma Advisory by Eileen Worden:  
• The STAC appointments were extended for one year.  
F: By-Laws by Jeff Boyd:  
• The By-Laws subcommittee will be looking at the by-laws.  
• Recommendations for committees:  
o Rural: Matt LaCrosse, Central UP and Shirley Curtis, Southern  
Michigan.  
o Legislative: Bill Hart  
. Motion to accept the recommendations: Bullen, Dunne.  
Motion carries.  
o Data: The Slate recommended for the data committee is: Jay  
Cooper, Bonnie Kincaid, Damon Obiden, Eric Snidersich, Luke  
Bowen, Kraig Dodge, Darin Inda, Mark Vroman, Lance Corey,  
Kevin Wilkinson, Angela Madden, Jessica Riley, and Greg Flynn.  
Staff would be Kevin Putman, Kathy Wahl, Sabrina Slee and the  
EMS QI Coordinator.  
. Motion to accept the recommendations: Dunne, Lake.  
• Discussion: Dr. Dunne spoke to the importance of  
having hospital data people involved.  
• Motion carries.  
G: Data Task Force: Membership finalized at this meeting.  
H: Legislative by Bruce Trevithick:  
• The legislative committee has not met, but there is a new legislative session, so  
some bills have been reintroduced some pertinent bills.  
o HB 4170, 4171, 4173, 4174 – MI-POST – These pertain to MI-POST and  
have been supported by the committee in the past.  
• HB 4269 – This bill would require an ambulance to be at any high school  
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EMSCC MEETING MINUTES-DRAFT  
3/17/2017  
football game or other event that may have an injury. This was opposed by the  
committee last time it was introduced.  
o Discussion: B. Hart suggested the language be reviewed to ensure it is  
the same in the new bills.  
I: Rural by Gary Wadaga:  
• The committee will now meet every other month.  
• The use of the i-gel® airway was accepted by the committee after much  
discussion.  
• Tuition reimbursement and loan forgiveness are being worked on by  
Representative Whiteford.  
• Recruitment and retention: The committee will meet after the EMSCC meetings  
in person going forward.  
• The Michigan Center for Rural continues to do webinars.  
• Service sustainability: Michigan Center for Rural Health has helped develop a  
survey for determining attributes of a successful rural ambulance service. This  
will give an idea of where things are lacking and what needs to be done to be  
successful.  
• The committee would like to get their name out so they become the go to people  
for rural EMS providers. It was suggested they get an email list from the  
Department.  
• A white page listing the struggles of rural EMS is being developed.  
J: Pediatric Emergency Report: Nothing to report.  
Membership Round Table Report:  
• K. Wilkinson asked that those who plan to have meetings before or after the  
EMSCC at the new venue to contact him to make arrangements.  
• J. Boyd reminded everyone of the Michigan EMS Expo on Mackinac Island  
May 4th-6th.  
Public Comment:  
• Derek Wilczynski, representing STAT EMS.  
o Gave a copy of what was submitted to the QATF by STAT EMS for  
the special hearing for the record.  
o Expressed concern that the recommendation doesn’t address the issue  
of whether or not Saginaw Valley MCA is providing appropriate  
oversight with regard to dispatch issues. The ten complaints outlined  
in the brief submitted were to provide evidence to the dispatch issue as  
it exists. The QATF addressed whether those 10 issues were handled  
properly by SVMCA, but that wasn’t the issue. The issues submitted  
to the Task Force were:  
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EMSCC MEETING MINUTES-DRAFT  
3/17/2017  
. Is the SVMCA required to ensure the appropriate dispatching  
of the LSA based upon the medical need and capability of the  
EMS system as mandated by statute?  
. Is the SVMCA obligated, under its dispatching and  
communications protocol 6-29, to ensure the appropriate  
dispatching of LSA in the SVMCA’s geographic service area?  
. Pursuant to the Saginaw emergency 911 contract between the  
county and MMR (as the dispatching entity), is MMR as the  
MEDCOM provider required to dispatch the closest  
appropriate ambulance?  
. Is the SVMCA required to coordinate all dispatch  
communication activities with the MCA pursuant to the  
communications reciprocity agreement between SVR and the  
911 authority?  
. Is the SVMCA required, pursuant to the communications  
reciprocity agreement, to approve “all EMD protocols and  
determine EMD standards and EMS service protocols and all  
secondary PSAP EMD call answering dispatch protocol”?  
o The QATF’s decision was not released before the meeting today.  
None of the above listed issues were covered in the decision and an  
entirely different issue was addressed. Mr. Wilczynski stated there is a  
fundamental misunderstanding of premise versus evidence to support  
the premise. The premise wasn’t that SVMCA misapplied or didn’t  
follow their protocols correctly with regard to those 10 complaints, but  
rather the dispatching was inappropriate and the 10 complaints were  
presented as evidence of that. Mr. Wilczynski stated the issue is that  
he represents a company that is licensed by the State of Michigan.  
Medical Control oversight is mandatory and has to be provided. His  
client now has Medical Control oversight, which took over 3 years in  
ligation to get to that point. Now the client is not getting dispatched,  
even though it meets all state requirements and has Medical Control  
oversight.  
o In addressing the decision, Mr. Wilczynski asked that the EMSCC  
reconsider the issue with respect to the issues that were actually were  
presented with SVMCA protocol 6-29. Mr. Wilczynski asked what  
the procedures are for taking this up with the 911 committee.  
o In response, K. Wahl stated she would contact the 911 person and has  
already been in contact with them regarding this issue.  
• Leslie Hall, MiREMS.  
o Ms. Hall spoke about the Recruitment and Retention committee. They  
will be meeting every other month, following the EMSCC meetings.  
They will be meeting after this meeting at the BETP.  
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EMSCC MEETING MINUTES-DRAFT  
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Next Meeting: Friday, May 19th, 2017 at Livingston County EMS.  
Adjournment: Motion to adjourn: Kincaid, Wilkinson. Motion carries.  
•
Meeting adjourned at 12:02 PM.  
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