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Meeting Name: AMBULANCE SERVICE BOARD Agenda status: Final
Meeting date/time: 8/5/2019 10:00 AM Minutes status: Final  
Meeting location: Room 301-B, City Hall
Published agenda: Agenda Agenda Published minutes: Minutes Minutes  
Meeting video:  
Attachments:
File #Ver.Agenda #TypeTitleActionResultTallyAction DetailsVideo
     1. Call to Order at 10:00 AM     Roll call Not available
     2. Introductions.

Minutes note: Ald. Borkowski introduced himself as the new chair, welcomed and thanked everyone for their attendance. All present: Dr. Ben Weston - New Director of EMS Wayne Jurecki - Vice President Bell Ambulance Chris Anderson - Director of Operations for Bell Ambulance Frank Gimble - Atty for Bell Ambulance Larry Knuth - Vice President of Operations Paratech Ambulance Bridget - Paratech Ambulance Brian Randall - Atty for Paratech and MedaCare Ambulance Rick Romanshek - Paratech and MedaCare Ambulance Paul Rauch - Paratech Ambulance Mark Rohlfing - Chief MFD John Schwengel - Asst Chief MFD Josh Parish - Asst. Chief MFD Jim Baker - CEO Curtis Ambulance James Gray - Interanl Audit - Comptroller's Office Tyron St. Junior - CIty Atty. Luke Knapp - Legislative Fiscal Analyst - COM
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     3. Approval of December 13, 2018 meeting mimutes.

Minutes note: Dr. Colella moved, seconded by Mr. Fleming, to approve the minutes of December 13, 2018. There were no objections.
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     4. Current Roster of Members.

Minutes note: Ald. Borkowski Currently board is composed of 8 members: Member of Public Safety and Health Committee Health Department Commissioner or designee Public Member appointed by Mayor - Mr. Fleming City's Homeland Security - Currently vacant City's Emergency Services Director - Dr. Colella Representatives of 2 hospitals of the 4 hospital systems (Wheaton/Franciscan, Aurora, Columbia/St. Mary's and Froedtert): Dr. Culvert (AURORA now ADVENT) Dr. Riepenhoff - (COLUMBIA/ ST. MARY'S now ASCENSION) designee of the Milwaukee County Medical Society's Emergency Medical Services Committee. Dr. Colella explained that the Milwaukee County Medical Society still remains, however, the Emergency Medical Service Committee has not been active now, for a number of years. Ald. Borkowski asked Dr. Colella to remain as the Representative for the Froedtert Hospital. Dr. Colella agreed. Dr. Riepenhoff suggested having a representative of each hospital be a member of the board. Dr. Colella is in favor of having the five health systems represented at this committee: Froedtert Hospital, Aurora, Ascension, Children's Hospital and Milwaukee VA Medical Center. Ald. Borkowski asked the City's Attorney for input in regards to the amending of the ordinance to reflect these changes and updates. ACA St. Junior said that the City Attorny's office in conjuntion with LRB and Health Department can discuss the changes to the ordinance and be presented at the next Ambulance Service meeting for revision and approval than, be forward to council for final approval.
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     5. Establish timelines/Update Applications.

Minutes note: Asst. Chief Schwengel said that the Ambulance Service providers recertification application deadline is in September. Ambulance Service report is presented to this board early fall (October-December) in conjunction to the approval of the recertification of providers. Ald. Borkowski asked if there is a need to revise the application. Asst. Chief Schwengel said that Fire Department meets quarterly with the providers. They can add to their agenda, a discussion to review the application and see if any changes are needed. Than, report back to the Ambulance Service Board of the findings.
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     6. Understand police background checks of applications.

Minutes note: Ald. Borkowski asked ACA, St. Junior about the police background checks of applications. St. Junior said that it may be Sgt. Raden. Atty. Gimble and Atty Randall both agree that there has been a very collaborative and cooperative working relationship among the providers and the Fire Department. The Health Department will provide a copy of the application packet to all parties for review and if needed, recommendations for changes.
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     7. Current Fire Department Statistics.

Minutes note: Asst Chief Schwengel presented the provider report from September 2018- August 2019. First page presented the number of calls that each provider received. This information is compiled from the Internal Accountability Management report (AIM) and the private providers monthly report. Second page deals with response time and standards. All providers are meeting the response standards within the allotted time. There are few that are below, but the vast majority of these are BLS transports. These are non-urgent calls that need transport to the hospital. A medical provider is on the scene. Last page showed the turn-back. This is where the biggest challenge comes into play. We've identified a couple of providers that are struggling to meet the response standards. However, we are confident that all providers are actively engaging in strategies to try to reduce these; one of the issues being is that the number of EMT's in the system in Wisconsin is low. In conversation with the Department of Health Services in Madison, they indicated that although there are a lot of EMTs registered in the system, the vast majority do not work in pre hospital care; a lot of them are medical students, dental students that do not continue on to work in the pre hospital care area. Asst. Chief Parish said that it takes a long time to build an EMT; training can go between 6-12 months. Testing is at a very robust level where strong science background where medical terminology is needed, anatomy and physiology, 5 hours of curriculum not including any pre-requisites. There are state and federal certifications involved. Fire Department has established strong relationships with local universities who would have candidates that would already be interested in the medicine field and would have some of those pre-requisites in place. There are six schools in metro Milwaukee that have nursing programs, although not necessarily the EMT required courses in their curriculum. In looking at some opportunities for individuals who are interested in medicine and to get them to access patients quicker than it would be going through with the traditional program, the Fire Department is working to develop collaboration with Marquette, UWM Milwaukee, to see what existing students would be eligible and looking at the providers to develop partnerships. Recruits have to be 18 years of age to be eligible to take the National Registry Exam and become license in the State of Wisconsin. Asst. Chief Parish said that there is not an average age to enter the program the requirement lays more as if the individual meets the qualification required vs the age. Dr. Colella said that there are other factors affecting this lack; the economics of working as an EMT is challenging and a dangerous environment. He said that we have to think of other ways to entice others to work in this area. in working with the Fire Department for the last seven years, as the Medical Director, Dr. Colella said that he commends their exceptional diligence in everybody's parts; In looking at the turn-back numbers for Medicare and Paratech (9 -10%) and the percentage of calls. they are covering about 50% of the demand of the City. Their turn-back rates are high in comparison to the other providers. When not able to provide service it puts pressure on the other providers. From a board member's perspective it requires a bit more of attention and focused. Are they resources that we can provide to reduce the high percentage of turn-back? Mr. Romanshek said that although in agreement with all topics being expressed, he would ask for ways to promote EMTs recruitment. Regarding the numbers of turn-back, MedaCare was having the same problem covering their area, before it was bought by Paratech. There was staffing issues. From time to time there was an epic flow of resources. We are looking for ways where everybody can partner with. Another issue that can improve is other levels of intervention through our lobbyist with the State and Federal legislators to revisit the rates for these services. Dr. Colella said that CMS is putting out a Request For Proposal to allow ambulance services to look at alternate destinations for conveyance, instead of going to hospital vs Urgent Care Center or primary care doctor. The Office of Legal Counsel in Wisconsin says that no system in the state would be eligible to participate in this because Wisconsin statutes states conveyance ONLY to a hospital for reimbursement. An EMT salary, generally starts at $40,000 annually based on a 48 hour/week shift, said Mr. Romanshek. Ald. Borkowski encouraged reaching out to foundations, corporations and stakeholder of the community to fund some of the financial gap for EMT jobs can be higher paid, helping to reduce the turn-back numbers. Mr. Baker said there are two big problems they are faced with: there is a massive EMT shortage in Wisconsin. As the system has progressed, requirements have increased; the State has not raised reimbursements. It has been over 10 years that we have the same rates for Title 19 and Badger Care. Cost for ambulance has more than doubled. Dr. Colella complimented the MFD in their innovative effort in trying to reduce some of the volume by using alternate response vehicles (ARV). Even though staffing is an issue, if there is a way to direct some resources towards 9-1-1 call taking process that would be a manageable process to support the Fire Department. Asst Chief Schwengel said that MFD has two alternate response vehicles currently in their fleet that are staffed and assigned to an engine company. There is one on the North side and one on the South side. If an EMS comes in, the crew from the fire apparatus jumps on the ARV and goes to the medical response call. MFD is exploring the possibility of repurposing those ARVs to be staffed with a paramedic and an EMT to be able to take some of the lower acuity calls or calls that are typically treat/release or a treat/ no-transport. Asst Chief Schwengel said that they are looking into other ways to being creative with their available resources. Dr. Colella is very pleased with the department in their efforts to maximizing their available resources.
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     8. Comments.

Minutes note: Dr. Colella said that Froedtert hospital has been re-accredited as Level One Trauma and Comprehensive Stroke Center. continue to provide that availability 24/7. Dr. Freiheit said that Health Dept. is undergoing a massive space and personnel reorganization. She asked if board can consider for future agenda the impact that the 2020 DNC will impact Milwaukee. Mr. Fleming said that board needs to make sure that Basic Life Support service is being consistently provided across the City. Dr. Riepenhoff said that Ascension re-organization is moving forward. Dr. Calvert commended the great job ambulance providers have done and continue to do. Asst. Chief Schwengel said moving forward to improve their services. The Community Paramedic Program with the Captain at station 31 has shown dramatic impact in reducing some of the calls out of the system; program consist of identifies some of the individuals that are struggling with managing their health care and partner them up with tools and resources they need to better managed their care. This program has shown an exponential decrease and the times they have to call 9-1-1. There is also an OPIOD outreach program that has shown great success in its month of operation. Asst Chief PArish said that MFD start having those conversation with the local academic institutions to make sure they understand the importance of those partnership with the EMS. Mr. Romanshek said that he has never had a Fire Department as responsive and cooperative as the current one. They are working on the response time for battery calls and working on a recruiting program that expand beyond the state to bring on EMTs. Mr. Baker echoed the comments about the Fire Department. The battery issue alone is about 400 requests per month. Resulting in only one transport. Part of it being a police protocol that, its being worked on. that should take off some relieve from the calls. concerned about number on turn-backs and some of the response times on turn-backs. Mr. Anderson also echoed the comments about the Fire Department and appreciates the collaboration and guidance of Dr. Colella. Dr. Weston will be succeeding Dr. colella. Originally from Milwaukee, trained between Appleton and Madison, Minneapolis and fellowship under the directionof Dr. Colella; Dr. Weston is currently overseeing the on-line medical control phisician to paramedics interaction for the last several years, medical director for City of Kenosha for last 2 years and transitioning taking over as the Director of Medical Services in about a month or so. Looking forward to continue working with the board; regarding 2020 DNC, Dr. Weston will be meeting with the DNC convention staff to discuss the Health and Wellness expectations. Possible future meetings: October 7, 2019 at 9AM December 2, 2019 at 9AM
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     9. Meeting adjourned at 11:16 Joanna Polanco Staff Assistant     Not available
     In the event that Common Council members who are not members of this committee attend this meeting, this meeting may also simultaneously constitute a meeting of the Common Council or any of the following committees: Community and Economic Development, Finance and Personnel, Judiciary and Legislation, Licenses, Public Safety and Health, Public Works, Zoning, Neighborhoods & Development, and/or Steering and Rules. Whether a simultaneous meeting is occurring depends on whether the presence of one or more of the Common Council member results in a quorum of the Common Council or any of the above committees, and, if there is a quorum of another committee, whether any agenda items listed above involve matters within that committee’s realm of authority. In the event that a simultaneous meeting is occurring, no action other than information gathering will be taken at the simultaneous meeting.     Not available
     Upon reasonable notice, efforts will be made to accommodate the needs of persons with disabilities through sign language interpreters or auxiliary aids. For additional information or to request this service, contact the City Clerk's Office ADA Coordinator at 286-2998, (FAX)286-3456, (TDD)286-2025 or by writing to the Coordinator at Room 205, City Hall, 200 E. Wells Street, Milwaukee, WI 53202.    Not available
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