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Mission: Lifeline Wyoming Stakeholder Committee Meeting July 11, 2013
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Teleconference / Webinar Conference Call Number 877-686-1381, Participant Pass Code 2997862852#
www.heart.org/mlwyoming [email protected]
Co-Chairs: Dr. Michael Eisenhauer, Casper Dr. Muhammad Kahn, Cheyenne
Dr. Daniela Gerard, Gillette Dr. Chris Krell, Kemmerer Staff Liaison: Scott Nelson and Ben Leonard
1. 11:05 am Welcome Michael Eisenhauer Exhibit 1A April 4th MLWY Meeting Minutes
Exhibit 1B MLWY Stakeholder Roster Exhibit 1C MLWY Voting Proxy Form Exhibit 1D AHA Ethics Policy Exhibit 1E AHA Conflict of Interest Policy Background: Review roster and update as needed. Action:
Welcome all
Review and approve minutes from previous meeting
Review and update the draft Committee roster
Review and updates regarding MLWY Initiative
2. 11:10 am Challenge Fund Raising Abbey Dobler Exhibit 2A
Action: Information Only
3. 11:20 am Participation Updates Diana Ramirez Derek Smith
Exhibit 3A Eligible EMS Participants Exhibit 3B Eligible Hospital Participants Exhibit 3C Participation Map (To Be Presented) Background:
The current status of participating hospitals and agencies and their business document status. Action:
Review Exhibit 3A, Exhibit 3B, and Exhibit 3C
Mission: Lifeline Wyoming Stakeholder Committee Meeting July 11, 2013
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4. 11:30 am Wyoming DOH Office of EMS Updates Andy Gienapp Exhibit 4A EMS Request Approval Letter
Background: The Wyoming Department of Health, Office of EMS is to discuss or present updates related to Emergency Medical Services and healthcare. Information Only
5. 11:45 am Networking Lunch Daniela Gerard Buffett available please have lunch and will reconvene in this room at
12:15 6. 12:20 pm Equipment Advisory Council Scott Murphey Co-Chairs: Scott Murphey (EMS) and Tom Richards (Hospital)
Exhibit 6A EAC Goals and Responsibilities Exhibit 6B EAC Purchase Process Overview Exhibit 6C Equipment Grant Agreement – information only, (To Be Presented) Exhibit 6D Cycle 1 Funding Process – (To Be Presented) Background: Goals of the EAC include assessment and distribution of the equipment necessary to ensure a statewide AMI/SCA system is adequately addressed. Information Only
7. 12:35 pm Conference Planning and Education Cindy Osborne Lori Terwilliger
Co-Chairs: Cindy Osborne (EMS) and Lori Terwilliger (Hospital) Exhibit 7A CPE Goals and Responsibilities Exhibit 7B CPE Educational Assessment (To Be Presented) Background: Goals of the CPE include assessment of the educational needs of each discipline and the development, planning, and implementation of the educational curriculum and statewide educational conferences. Action:
Review to amend and/or approve Exhibit 7B
Mission: Lifeline Wyoming Stakeholder Committee Meeting July 11, 2013
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8. 1:05 pm Protocols and Quality Improvement Russ Christiansen Co-Chairs: Russ Christiansen (EMS) and Colleen Rodgers (Hospital)
Exhibit 8A PQI Goals and Responsibilities Exhibit 8B BLS Protocol (To Be Presented) Exhibit 8C MLWY Preliminary Data Overview (To Be Presented) Background: Goals of the PQI is to collect EMS and Hospital STEMI/N-STEMI and Sudden Cardiac Arrest data and identify opportunities for improvement. Action:
Sharing final BLS Protocol Exhibit 8B
Open discussion on Exhibit 8C
9. 1:45 pm Review Meeting Dates and Select Next Meeting Location Daniela Gerard
Action:
Committee members to ensure upcoming meetings are on their schedule - and accept calendar notices sent from AHA staff by email
Quarterly in 2013 and 2014 - 1st Thursday of every third month
Original Dates Proposed New Date
October 3, 2013 November 7, 2013
January 2,2014 January 30, 2014
April 3, 2014 April 24, 2014
July 10, 2014 July 24, 2014
October 2,2014 October 23, 2014
January 8, 2015 January 22, 2015
April 23, 2015 (last meeting of initiative)
10. 2:00 pm Review of Action Steps Michael Eisenhauer Information only
11. 2:05 pm Updates AHA Staff Background:
Staff and MLWY Stakeholders will provide updates and to announce local meetings and conferences
Information only o Statewide AHA happenings: o http://mlnetwork.heart.org/groups/home/1086 o www.yourthecure.com
Standardized messaging of our Mission
Public Awareness
12. 2:15 pm Adjourn
Mission: Lifeline Wyoming Stakeholder Committee Meeting April 4, 2013
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Teleconference / Webinar Conference Call Number 877-686-1381, Participant Pass Code 2997862852#
www.heart.org/mlwyoming [email protected]
Co-Chairs: Dr. Michael Eisenhauer, Casper Dr. Muhammad Kahn, Cheyenne
Dr. Daniela Gerard, Gillette Dr. Chris Krell, Kemmerer Staff Liaison: Scott Nelson and Ben Leonard
Organizations Attendees
???? Karen Dezon??
Ambulance Service - Powell Hospital ED Nathaniae Reib
American Heart Association Julie Blakie
American Heart Association Loni Denne (teleconference)
American Heart Association Kathy Hill
American Heart Association Ben Leonard
American Heart Association Scott Nelson
American Heart Association Diana Ramirez
American Heart Association Suzanne Salazar
American Heart Association Wendy Segrest
American Medical Response Cindy Osborne
Billings Clinic Susan Amundsen
Billings Clinic Diana Parker
Campbell County EMS Gregg Mentzel
Campbell County EMS - Campbell County Memorial Hospital
Daniela Gerard
Campbell County Memorial Hospital Lorna Thomas (proxy for Deb Tonn)
Carbon Co. EMS Candace Hofmann
Centennial Valley Ambulance Andrea Kern
Cheyenne Regional Medical Center Charlie Retz
Cheyenne Regional Medical Center Melissa Tschimperle
City of Torrington EMS Christy Gutierrez
City of Torrington EMS Darin Yates
Community Hospital Peggy Jolovich (teleconference)
Dayton Rescue Unit Marc Ketcham (proxy for Jonathan Miles)
Eastern Idaho Regional Medical Center Scott Lambertsen (teleconference)
Eastern Wyoming Ambulance Service, Inc Wade Wells (teleconference)
Evanston Regional Hospital Darin Lenford??
Fremont County Ambulance Lauri Wempen
Guardian Flight Keith Finch (teleconference)
Guernsey Volunteer Ambulance Service Sharon Holloway
Hulett EMS Keith Noback
Ivinson Memorial Hospital Sandy Knapton
Mission: Lifeline Wyoming Stakeholder Committee Meeting April 4, 2013
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Jackson Hole Fire EMS Wendy Blair (proxy for Mike Moyer)
Laramie Fire Department EMS Jim Hoflund
Marbleton-Big Piney Clinic - Sublette County Rural Health Care District
Vicky Marshall (teleconference)
Marbleton-Big Piney Clinic - Sublette County Rural Health Care District
Ron Gatti (proxy for Vicky Marshall)
Medical Center of the Rockies Jerre Johnson (teleconference)
Medical Center of the Rockies Kristi Ramsey (teleconference)
Memorial Hospital of Carbon County Wendy Thorvaldson
Memorial Hospital of Converse County Robynn Scheehle (teleconference)
Memorial Hospital of Converse County Toni Harms (proxy for Robynn Scheehle)
Memorial Hospital of Converse County EMS Carlos Mesa
Memorial Hospital of Sweetwater County Phil Reints
Mills FD EMS Jake Bigelow
Moorcroft EMS Dorothy Baron
Moorcroft EMS Sheila Hansen
Moorcroft EMS Keith Noback
Natrona County Fire Protection District Richard Ratcliff
Newcastle Ambulance Service Roger Hespe
Niobrara Health & Life Thomas Hoskins (proxy for Amber Keller)
North Big Horn Hospital Janet Ward (teleconference)
North Big Horn Hospital June Minchow (proxy for Janet Ward)
North Big Horn Hospital Ambulance Service June Minchow (proxy for Scott Murphey)
OEMS Trauma Prog Kelli Perrotti
Osage Volunteer FD EMS Keith Noback
Pinedale Clinic - Sublette County Rural Health District
Vicky Marshall (teleconference)
Pinedale Clinic - Sublette County Rural Health District
Ron Gatti (proxy for Vicky Marshall)
Platte County Memorial Hospital Khery Otero
Powell Valley Healthcare June Minchow
Powell Valley Healthcare - EMS Scott Bagnell
Rocky Mountain Ambulance Service LLC Rick Ballard
Salt Creek Emergency Services Jaime Jones
Sheridan Area Rural Fire Department Marc Ketcham
Sheridan Fire Rescue Rick Ballard (proxy for Terry Lenhart)
Sheridan Memorial Hospital Jennifer Rasp-Vaughn (teleconference)
Sheridan Memorial Hospital Big Horn Heart Center
Sharon Krueger (proxy for Jennifer Rasp-Vaughn)
South Lincoln County EMS G. Christopher Krell
St. John's Medical Center Wendy Blair (proxy for AJ Wheeler)
St. Vincent Healthcare Theresa Ketterling
Star Valley Medical Center Mike Kentner (teleconference)
Mission: Lifeline Wyoming Stakeholder Committee Meeting April 4, 2013
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Star Valley Medical Center Ron Gatti (proxy for Mike Kentner)
Sublette County EMS Ron Gatti (proxy for Kenna Tanner)
Sublette County EMS Gretchen Schmid
Sundance EMS Keith Noback
Sundance EMS (Crook County Medical Services District)
Ken Maston
Sweetwater Medics LLC Ron Gatti
Town of Burns EMS Erica Maddison
Town of Pine Haven Ambulance Service Keith Noback
Town of Pine Haven Ambulance Service Tom Schanefelt
University of Colorado Hospital Kim Marshall
University of Texas Health Science Center James Langabeer
University of Utah Hospital and Clinics Dawn Young
University of Wyoming Derek Smith
Upton Fire Department Roger Hespe (proxy for James Sindlinger)
Veterans Affairs in Cheyenne Jerry Zang
Washakie County EMS Mike Bryant
Washakie Medical Center Jane Pomeroy (teleconference)
Weston County Health Services Piper Orsborn (teleconference)
Weston County Health Services Roger Hespe (proxy for Piper Orsborn)
Wyoming Cardiopulmonary Services, P.C. Michael Eisenhauer
Wyoming Departmet of Health Office of EMS Andy Gienapp (teleconference)
Wyoming Medical Center Deb Giles (proxy for Julie Cann Taylor)
Yoder Ambulance Becky Halfhill
1. 11:05 am Welcome Dani Gerard Exhibit 1A Jan 30 MLWY Meeting Minutes
Exhibit 1B MLWY Stakeholder Roster Exhibit 1C MLWY Voting Proxy Form Exhibit 1D AHA Ethics Policy Exhibit 1E AHA Conflict of Interest Policy Background: Review roster and update as needed. Action:
Review minutes from previous meeting
Review and update the draft Committee roster Minutes:
Reviewed minutes from January 30, 2013, approved as is
Please make sure to send your organization’s voting member if one does not appear for your organization on the Stakeholder Roster
o Please make sure to inform those agencies within your region
Mission: Lifeline Wyoming Stakeholder Committee Meeting April 4, 2013
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that do not show a voting member about the Mission: Lifeline Wyoming initiative
Scott Nelson introduced as Hospital Director for the Mission: Lifeline Wyoming initiative
Proxy form was introduced as an alternative for voting members that are not able to attend in person to any of the Stakeholder meetings and to meet the participation requirement of the MOU, those forms must be sent with proxy to the meeting and collected at the meeting by AHA staff
o Furthermore it is not intended to be used as an alternative when an EMS agency is requesting for mileage reimbursement if a proxy was sent in your stead from another agency (i.e. Voting member from Albin Rescue is proxy to voting member from American Medical Response, mileage reimbursement will only be given to Albin Rescue), however if proxy is from same agency mileage reimbursement is allowed (i.e. Voting member from Albin Rescue sends proxy from Albin Rescue, mileage reimbursement is given to Albin Rescue)
2. 11:10 am Participation Updates Muhammad Khan Exhibit 2A Eligible EMS Participants
Exhibit 2B Eligible Hospital Participants Exhibit 2C Mission Lifeline Registration Process Background: The current status of participating hospitals and agencies. We will also talk about ML Registration forms Action:
Review Exhibit 2A and Exhibit 2B
Review required documents for Mission Lifeline Registration Minutes:
Reviewed exhibits 2A & 2B asked for help from Stakeholder to reach out to their organizations or organizations in their region to inform them of missing forms (i.e. MOU)
Reviewed exhibit 2C for those new to the process o The Mission: Lifeline forms are only for PCI hospitals to complete
3. 11:20 am MLWY Business Document Review Michael Eisenhauer Exhibit 3A Credit Worthiness Form (aka E1 Form)
Exhibit 3B Data Payment Request Background:
Mission: Lifeline Wyoming Stakeholder Committee Meeting April 4, 2013
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To ensure all business documents are properly filled out, we will review these forms and answer any questions.
Action:
Review the Exhibits
Address any questions Minutes:
Reviewed Credit Worthiness Form (aka E1 Form) stated to group o page 2 of 5 is for AHA staff to complete o page 4 of 5 do not choose Merchant Credit Card, choose either
Direct Deposit or Check
o page 5 of 5, if W9 and mailing address will be used for both hospital and EMS make sure to use two forms (i.e. Memorial Hospital of Converse County and Memorial Hospital of Converse County EMS),
Choose “Vendor/Supplier” Not required but may choose to complete if organization
is “Governmental Entity” or “Non-Profit Entity” and if organization is a minority/woman owned business
Choose net pay option, if one is not chosen then Net 30 will be used
Reviewed Data Payment Request o EMS agencies may start using it now for mileage reimbursement,
but only if MOU and Credit Worthiness forms complete o Hospitals will start using once data is submitted, but only if MOU
and Credit Worthiness forms complete o Fax number will change and will be sent to Stakeholder
11:30 am Lunch
4. 12:15 pm Equipment Advisory Council Chris Krell
Exhibit 4A EAC Goals and Responsibilities Exhibit 4B EAC Needs Survey Results(to be presented) Exhibit 4C EAC Decision Matrix Exhibit 4D EAC Recommended Awarded Applications (to be presented) Background: The survey results are reviewed. Equipment Funding Applications were sent to hospitals and EMS agencies and are up for approval. Action:
Review EAC Survey Results
Review EAC Recommended Awarded Applications
Mission: Lifeline Wyoming Stakeholder Committee Meeting April 4, 2013
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Minutes:
Email to Stakeholder exhibit 4B
Reviewed the hospital applications this morning at subcommittee meeting and the approved funds from that meeting are as followed
Hospital Level Amount Description Approved Elected
Campbell County Memorial Hospital
ACH $23,999 LN Basic $11,999 elected to downgrade
Memorial Hospital of Sweetwater County
ACH $11,999 LN Basic $11,999
North Big Horn CAH $26,606 Heartstart Telemed
$3,496 elected to downgrade
Powell Valley Healthcare
CAH $3,496 Heartstart Telemed
$3,496
Sheridan Memorial Hospital
PCI $11,999 LN Basic $11,999
South Big Horn Critical Access
CAH $23,999 LN Basic $11,999 elected to downgrade
St. Johns Medical Center
ACH $23,999 LN Basic $11,999 elected to downgrade
Total approved by EAC Subcommittee $66,987
Motion to approve the hospitals listed and the total amount of $66,987, motion approved
o Subcommittee felt these needs should be met first and will meet again for the remaining ask at a later time
Subcommittee was not able to review the EMS applications this morning and agreed to reconvene after the Stakeholder meeting
Motion to submit a document through surveymonkey or something similar which will state the approved EMS equipment funds from the EAC subcommittee, motion approved
Q: Is the organization only allowed once to submit for equipment funds? o A: No, it may submit as many times as we have openings for
equipment funds. The only requirement is to complete an MOU and the survey need assessment.
Note: AHA does not endorse any one vendor, all vendors are created equal, it’s whatever the organization’s needs are that matter
Mission: Lifeline Wyoming Stakeholder Committee Meeting April 4, 2013
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5. 1:00 pm Protocols and Quality Improvement Dani Gerard Exhibit 5A PQI Goals and Responsibilities
Exhibit 5B Sample ML System Reports Exhibit 5C Non-PCI Hospital Data Entry Tool (to be presented) Exhibit 5D BLS 12 Lead protocol (to be presented) Background: The PQI Survey results are reviewed. Action:
Information only Minutes:
Reviewed exhibit 5D, this document is to be used as a review tool not a teaching tool, Wyoming Department of Health Office of EMS will need to review the document to ensure it meets requirements, add “Adult” to title “BLS Protocol for acquiring 12-Lead ECG’s”, once reviewed by Dept of Health and title changed will bring forth to the PQI subcommittee for vote
Reviewed exhibit 5B, report system for PCI and Border PCI hospitals
Reviewed exhibit 5C, report system mandatory for ACH however it is not mandatory but encouraged for CAH, abstractors are asked to sign up or submit information to receive a secure login to this report system
o We are working with Wyoming Department of Health Office of EMS to try and use WATRS for EMS reporting, however at this time we ask that EMS drop off patient information (i.e. run sheets) at the hospital for reporting purposes
6. 1:15 pm Conference Planning and Education Muhammad Khan Exhibit 6A CPE Goals and Responsibilities
Background: Provide updates only. Action:
Information only Minutes:
At this time CPE is on hold until protocols are approved and equipment disbursed
o Once this is complete CPE will be working on creating educational materials for the protocols and training sessions for equipment
Also in the works is developing the first conference in 2014
Mission: Lifeline Wyoming Stakeholder Committee Meeting April 4, 2013
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7. 1:30 Review Meeting Dates and Select Next Meeting Location Chris Krell Action:
Committee members to ensure upcoming meetings are on their schedule - and accept calendar notices sent from AHA staff by email
Quarterly in 2013 and 2014 - 1st Thursday of every third month o July 11, 2013 (Location TBA).
Note: the 2nd Thursday to avoid the 4th of July o October 3, 2013 (Location TBA) o January 2,2014 (Location TBA) o April 3, 2014 (Location TBA) o July 10, 2014 (Location TBA)
Note: the 2nd Thursday to avoid the 4th of July o October 2,2014 (Location TBA) o January 8, 2015 (Location TBA)
Note: the 2nd Thursday to avoid New Year’s Day. Minutes:
Format is working, Subcommittee meetings in the morning and Stakeholder meetings in the afternoon
Motion to hold next meeting in Riverton, motion approved o Will check if facility works for the meetings, attendance is
up/down/same
8. 1:35 Review of Action Steps Michael Eisenhauer Information only
Minutes:
Sign in sheets will always track attendance, this will be used for mileage reimbursement for EMS agencies and meeting participation requirements for all
EAC Subcommittee will continue their meeting this afternoon
All subcommittees are open to anyone who would like to participate, only those that have signed up to participate will receive notifications about the meetings and information about the subcommittee
Abstractor training changed to room 138
Make sure to complete MOUs
Voting members keep an eye out for survey regarding the EMS equipment funding will need your vote
PQI will submit documents to State authorities for approval and working on the next protocol sets
AHA staff ready to help regarding data entry o Recommended to have only one person entering data, not a
committee
CPE working on conference 2014 think about audience, time, location
Mission: Lifeline Wyoming Stakeholder Committee Meeting April 4, 2013
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9. 1:45 Adjourn Michael Eisenhauer Information only
o Statewide AHA happenings: Senate file 147, passed our legislation
Summary of bill - Requires the Department of Health to recognized the work being done in WY
We will be looking at data next Stakeholder meeting, Ben Leonard and Scott Nelson will be working with you all in the near future to start entering data Adjourned 2:00 pm
AHA MLWY Inititative Stakeholders Voting Member Roster July 2013
Albin Rescue Carrie Deselms
Alpine Fire Department Jeremy Larsen
American Medical Response Cindy Osborne
Atwood’s Family Ambulance Del Atwood, Jr.
Big Horn Fire Dist #4 Ambulance
Bighorn Airways Inc
Billings Clinic Diana Parker
Bozeman Deaconess Hospital
Buffalo-Johnson Co. EMS
Burgess Junction Rescue
Campbell County EMS Gregg Mentzel
Campbell County Memorial Hospital Deb Tonn
Carbon County EMS Candice Hofmann
Castle Rock Ambulance Service
Centennial Valley Ambulance Andrea Kern
Cheyenne Fire & Rescue
Cheyenne Regional Medical Center Melissa Tschimperle
Chugwater Ambulance
City of Casper Fire - Casper Fire Department
City of Torrington EMS Darin Yates
Classic Lifeguard April Larsen
Crook County Medical Services District
Dayton Rescue Unit Jonathan Miles
AHA MLWY Inititative Stakeholders Voting Member Roster July 2013
Eastern Idaho Regional Medical Center
Eastern Wyoming Ambulance Service, Inc Wade Wells
Eden Valley Ambulance Service
Evanston Regional Hospital Angie Foster
Evansville Emergency Service Matt Gacke
Fort Laramie FD EMS
Fremont County Ambulance Lauri Wempen
Glendo Volunteer Ambulance Elizabeth VanBuskirk
Greybull EMS
Guardian Flight Keith Finch
Guernsey Volunteer Ambulance Service Sharon Holloway
Hawk Springs FD EMS Lou Hubbs
Hot Springs County Memorial Hospital
Hulett EMS Keith Noback
Ivinson Memorial Hospital Sandy Knapton
Jackson Hole Fire EMS Mike Moyer
Johnson County EMS
Johnson County Healthcare Center
LaGrange Rescue Unit
Lander Regional Hospital Brad Langdorf
Laramie Fire Department EMS Jim Hoflund
Lingle Volunteer FD
Little Snake River EMS
AHA MLWY Inititative Stakeholders Voting Member Roster July 2013
Lusk Ambulance Service Amber Keller
Marbleton-Big Piney Clinic Vicky Marshall
Medcor, Inc. dba Medcor at Yellowstone
Medical Center of the Rockies Brad Oldemeyer
Memorial Hospital of Carbon County Christine Midget
Memorial Hospital of Converse County Robynn Scheehle
Memorial Hospital of Converse County EMS Carlos Mesa
Memorial Hospital of Sweetwater County Phil Reints
Mills FD EMS Jake Bigelow
Moorcroft Volunteer Ambulance Service Keith Noback
Mortimore’s Ambulance Service Mark Mortimore
Natrond County Fire Protection District
Newcastle Ambulance Service Roger Hespe
Niobrara Health & Life Center Cindy Treffer
North Big Horn Hospital Janet Ward
North Big Horn Hospital Ambulance Service Scott Murphey
Osage Volunteer FD EMS Keith Noback
Pinedale Clinic - Sublette County Rural Health District
Vicky Marshall
Platte County Memorial Hospital Khery Otero
Powell Valley Healthcare June Minchow
Powell Valley Healthcare - EMS Scott Bagnell
Rapid City Regional Hospital Julie Poppe
Riverton Memorial Hospital Beth Metcalf
AHA MLWY Inititative Stakeholders Voting Member Roster July 2013
Rock Springs Fire Dept.
Rocky Mountain Ambtac
Rocky Mountain Ambulance Service LLC Rick Ballard
Salt Creek Emergency Services
Sheridan Area Rural Fire Department Marc Ketcham
Sheridan Fire Rescue Terry Lenhart
Sheridan Memorial Hospital Jennifer Rasp-Vaughn
South Big Horn Hospital
South Central WY EMS
South Lincoln County EMS Jessie Kramer
South Lincoln Medical Center Eric Boley
St. John's Medical Center AJ Wheeler
St. Mark's Hospital Pawan Sharma
St. Vincent Healthcare Theresa Ketterling
Star Valley Medical Center Mike Kentner
Star Valley Medical Center EMS Mike Fleming
Sublette County EMS Kenna Tanner
Sublette County Rural Health District Vicky Marshall
Sundance EMS Ken Maston
Sweetwater Medics LLC Ron Gatti
Ten Sleep Ambulance
Thayne Ambulance Service
Torrington Community Hospital Sommer Schilreff
AHA MLWY Inititative Stakeholders Voting Member Roster July 2013
Town of Burns EMS Erica Maddison
Town of Pine Bluffs EMS
Town of Pine Haven Ambulance Service Keith Noback
Uinta County EMS
University of Utah Hospital and Clinics Dawn Young
Upton Fire Department James Sindlinger
Veterans Affairs in Cheyenne Jerry Zang
Veterans Affairs in Sheridan
Wamsutter EMS
Washakie County EMS
Washakie Medical Center Jane Pomeroy
West Park Hospital EMS Larry Jones
Weston County Health Services Piper Orsborn
Wyoming Life Flight
Wyoming Medical Center Julie Cann Taylor
Wyoming Medical Center EMS Mark Meyer
Yellowstone National Park Daniel "Boone" Vandzura
Yoder Ambulance Becky Halfhill
AHA Mission Lifeline Wyoming Initiative Proxy Voting Form
Eligibility Proxy voting must follow these rules:
1. If you wish to vote by proxy, you must use this official form (a proxy form may be a copyor facsimile of the official proxy form, but must have an original ink signature in order to be official). The proxy form must be dated and signed to be valid.
2. The designated proxy holder must be a designated voting member of AHA MissionLifeline Wyoming Stakeholder Committee in good standing.
3. Please do not send this form to the AHA office. The proxy holder must present the proxyform for certification during meeting check-in. The proxy may be exercised only by the person named.
4. If you cannot attend the committee meeting, it is your obligation and privilege to vote byproxy.
Proxy Vote
I hereby appoint (proxy name)______________________________________________, my proxy,
to represent me at the (date) ________________________________ AHA Mission Lifeline
Wyoming Stakeholder Committee Meeting, and to act in my stead, authorizing this person fully
to vote and do all things that I could or might do to the same extent if personally present. I also
authorize this person to do every act whatsoever necessary or proper to be done in or upon all
matters that may lawfully come before said meeting or any adjournment thereof. Further, I
hereby revoke any proxy or proxies previously given by me to any person or persons.
Name:________________________________________________ Date:_____________________ (Please print name legibly).
Signature:_____________________________________________
Organization:__________________________________________
Please fax to: 1-877-247-5211 or email to [email protected]
10/28/2009
AMERICAN HEART ASSOCIATION ETHICS POLICY
The purpose for this Ethics Policy is to support a culture of openness, trust, and integrity in all American Heart Association management and business practices. A well-understood ethics policy requires the participation and support of every AHA employee and volunteer. At the American Heart Association we are dedicated to working with our employees, volunteers, partners, vendors and customers to reduce disability and death from cardiovascular disease and stroke. We are committed to conducting all of the AHA’s affairs and activities with the highest standards of ethical conduct. Our AHA Code of Conduct, outlined in our Human Resource Policy Manual, provides guidance for decisions and actions during our daily work. We are committed to the responsible use of AHA assets, to provide accurate, complete and objective information, to respect the confidentiality of financial and other information, to act in good faith and exercise due care in all we do, to comply with all rules and regulations and to proactively promote ethical behavior. The American Heart Association’s Code of Ethics is built on AHA values. As such, we acknowledge our individual responsibility to ensure our collective success by practicing and promoting the following values: Integrity, Inclusiveness, Dedication, Excellence, Sensitivity, and Vision. These values reflect a shared view of how we want to operate and be seen by others. Code of Ethics The summary code of ethics includes the following provisions:
• American Heart Association employees and volunteers must: o Proactively promote ethical behavior as a responsible partner among peers in the
work environment. o Deal fairly with AHA Customers, suppliers, competitors, volunteers, and employees. o Provide constituents with information that is accurate, completely objective, relevant,
timely, and understandable. o Comply with applicable government laws, rules and regulations. o Maintain the confidentiality of information entrusted to them by the AHA or its
Customers except when authorized or otherwise legally obligated to disclose. o Accept responsibility for preventing, detecting, and reporting all manner of fraud. o Be honest and ethical in their conduct, including ethical handling of actual or
apparent conflicts of interest between personal and professional relationships. o Protect and ensure the proper use of company assets. o Prohibit improper or fraudulent influence over the External Auditor.
A link to a copy of the entire American Heart Association Ethics Policy may be found at the bottom of the homepage at www.americanheart.org and the AHA Intranet. Reporting Ethics Violations If you have questions or concerns about compliance with the subjects described in this policy, or are unsure about what is the “right thing” to do, we strongly encourage you to first talk with your supervisor, another AHA leader or the leader in the Human Resource department. If you are uncomfortable talking to any of these individuals for any reason, call the AHA ethics hotline at (866) 293-2427 to report your concerns. You may also log on to: www.ethicspoint.com. Your calls to the toll free hotline or contact through the Internet site are facilitated by a third party, Ethics Point, Inc. Reporting of ethics violations will be treated as confidential information and can be communicated anonymously.
AMERICAN HEART ASSOCIATION
CONFLICT OF INTEREST POLICY
THE AMERICAN HEART ASSOCIATION, ITS AFFILIATES AND COMPONENTS, AND ALL OFFICERS, DIRECTORS, DELEGATES, COUNCIL AND COMMITTEE MEMBERS SCRUPULOUSLY SHALL AVOID ANY CONFLICT BETWEEN THEIR OWN RESPECTIVE PERSONAL, PROFESSIONAL OR BUSINESS INTERESTS AND THE INTERESTS OF THE ASSOCIATION, IN ANY AND ALL ACTIONS TAKEN BY THEM ON BEHALF OF THE ASSOCIATION IN THEIR RESPECTIVE CAPACITIES.
In the event that any Officer, Director, Delegate, Council or Committee member of the Association shall have any direct or indirect interest in, or relationship with, any individual or organization which proposes to enter into any transaction with the Association, including but not limited to transactions involving:
a. the sale, purchase, lease or rental of any property or other asset;
b. employment, or rendition of services, personal or otherwise;
c. the award of any grant, contract, or subcontract;
d. the investment or deposit of any funds of the Association;
such person shall give notice of such interest or relationship and shall thereafter refrain from discussing or voting on the particular transaction in which he has an interest, or otherwise attempting to exert any influence on the Association, or its components to affect a decision to participate or not participate in such transaction.
(Approved by AHA Board of Directors and Delegate Assembly, June 1986)
AMERICAN HEART ASSOCIATION Record of Abstention with Conflict of Interest Policy
As a member of the AHA or Affiliate Delegate Business Session, Board of Directors, Committee, Council, Task Force or Group, the following is a record of my disclosure of a direct or indirect conflict of interest and abstention from discussion and voting on the matter at this meeting. CONFLICT:__________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________ ________________________________________ ___________________________________ (Name of board, council, committee or group) (Signature) ________________________________________ ___________________________________ (Date) (Print Name)
[Original to be filed with minutes of the meeting.]
Mission: Lifeline Wyoming Meeting the Helmsley Charitable Trust Fundraising Challenge
Introduction Abbey Dobler Development Specialist 307-631-2490 [email protected]
The Challenge The Helmsley Charitable Trust has challenged the American Heart Association to raise at least $200,000 from Foundations, Corporations, and Individuals for Mission: Lifeline Wyoming. This accounts for less than 4% of the overall budget. To date, $21,000 has been donated with $179,000 to be raised.
The Need Facility: $15,000 will help to cover the cost of Mission: Lifeline Educational Conferences AED’s: $66,190 will help to cover the placement of an estimated 31 AED’s based on the AED assessment and recommendations by the Equipment Advisory Council (EAC) and approval by the Wyoming Stakeholder Committee Training Materials: $33,810 for training is key to the success of Mission: Lifeline by providing health care professionals the opportunity to master protocols, equipment, treatment, and data collection Statewide Public Awareness Campaign: $85,000 to educate the public on the effectiveness of calling 9-1-1 when experiencing the symptoms of a heart attack
Every donor will be recognized and acknowledged for their support of this life-saving initiative.
How You Can Help
Recommend corporations, foundations, or individuals who may be interested in
contributing to the fundraising challenge
Introduce fundraising staff to local foundations, corporations, or individuals
Serve as a guest speaker to local Rotary Clubs, Kiwanis clubs, or similar community
organizations to share information about Mission: Lifeline
Institution Received MOU Received E1 Forms
Albin Rescue 2/2/2013 2/8/2013
Alpine Fire Department 11/28/2012 5/7/2013
American Medical Response 11/13/2012 4/8/2013
Atwood’s Family Ambulance 12/20/2012 5/7/2013
Campbell County EMS 11/27/2012 11/28/2012
Carbon County EMS 2/26/2013 6/12/2013
Centennial Valley Ambulance 11/28/2012 4/22/2013
City of Torrington EMS 11/8/2012 4/4/2013
Dayton Rescue Unit 2/20/2013 5/14/2013
Eastern Wyoming Ambulance Service, Inc 2/26/2013 4/9/2013
Eden Valley Ambulance Service 11/30/2012 4/10/2013
Evansville Emergency Service 10/29/2012 4/11/2013
Fremont County Ambulance 12/12/2012 12/12/2012
Guardian Flight 2/28/2013 Declined Payment
Guernsey Volunteer Ambulance Service 12/17/2012 4/15/2013
Jackson Hole Fire EMS 11/7/2012 11/8/2012
Laramie Fire Department EMS 1/5/2013 6/21/2013
Memorial Hospital of Converse County EMS 11/15/2012 4/8/2013
Mills FD EMS 3/13/2013 4/11/2013
Moorcroft Volunteer Ambulance Service 11/15/2012 4/30/2013
Mortimore’s Ambulance Service 2/25/2013 6/20/2013
Newcastle Ambulance Service 2/12/2013 4/4/2013
North Big Horn Hospital Ambulance Service 12/20/2012 12/20/2012
Rocky Mountain Ambulance Service LLC 12/17/2012 12/17/2012
Salt Creek Emergency Services 2/19/2013 7/1/2013
Sheridan Fire Rescue 12/17/2012 12/17/2012
South Lincoln County EMS 3/29/2013 4/17/2013
Star Valley Medical Center EMS 2/4/2013 4/29/2013
Sundance EMS 11/15/2012 4/30/2013
Sweetwater Medics LLC 11/15/2012 4/4/2013
Town of Burns EMS 11/13/2012 6/21/2013
Town of Pine Bluffs EMS 11/28/2012 11/28/2012
Town of Pine Haven Ambulance Service 11/15/2012 5/7/2013
Upton Fire Department 2/8/2013 2/8/2013
Wyoming Medical Center EMS 2/2/2013 4/4/2013
Yoder Ambulance 1/16/2013 4/25/2013
Washakie County EMS NEED 4/4/2013
Castle Rock Ambulance Service 12/7/2012 NEED
Classic Lifeguard 2/27/2013 NEED
Glendo Volunteer Ambulance 2/20/2013 NEED
Hawk Springs FD EMS 4/23/2013 NEED
Hulett EMS 11/15/2012 NEED
Lusk Ambulance Service 11/20/2012 NEED
MLWY EMS Eligible to Receive Payment
MLWY EMS Need E1 Forms
MLWY EMS Need MOU
Institution Received MOU Received E1 Forms
Natrond County Fire Protection District 4/3/2013 NEED
Osage Volunteer FD EMS 3/4/2013 NEED
Powell Valley Healthcare ‐ EMS 12/17/2012 NEED
Sheridan Area Rural Fire Department 12/17/2012 NEED
Sublette County EMS 11/19/2012 NEED
Thayne Ambulance Service 11/28/2012 NEED
Uinta County EMS 2/26/2013 NEED
Yellowstone National Park 2/14/2013 NEED
Big Horn Fire Dist #4 Ambulance NEED NEED
Bighorn Airways Inc NEED NEED
Buffalo‐Johnson Co. EMS NEED NEED
Burgess Junction Rescue NEED NEED
Cheyenne Fire & Rescue NEED NEED
Chugwater Ambulance NEED NEED
City of Casper Fire ‐ Casper Fire Department NEED NEED
Fort Laramie FD EMS NEED NEED
Greybull EMS NEED NEED
Johnson County EMS NEED NEED
LaGrange Rescue Unit NEED NEED
Lingle Volunteer FD NEED NEED
Little Snake River EMS NEED NEED
Rock Springs Fire Dept. NEED NEED
Rocky Mountain Ambtac NEED NEED
South Central WY EMS NEED NEED
Ten Sleep Ambulance NEED NEED
Wamsutter EMS NEED NEED
Wyoming Life Flight NEED NEED
MLWY EMS Need All Forms
Institution Hospital Type Received MOU E1 Form HR Form DRC Form SDRC Form
Cheyenne Regional Medical Center PCI WY 2/7/2013 3/25/2013 2/7/2013 2/7/2013 2/7/2013
Wyoming Medical Center PCI WY 12/19/2012 4/4/2013 12/19/2012 12/19/2012 12/19/2012
Billings Clinic PCI Border 1/11/2013 4/22/2013 1/11/2013 2/17/2013 2/17/2013
Eastern Idaho Regional Medical Center PCI Border 12/5/2012 7/2/2013 5/21/2013 5/21/2013 5/21/2013
Medical Center of the Rockies PCI Border 12/17/2012 4/25/2013 1/3/2011 12/17/2012 12/17/2012
Rapid City Regional Hospital PCI Border 2/4/2013 5/13/2013 9/26/2012 11/5/2012 2/7/2013
St. Mark's Hospital PCI Border 11/13/2012 6/11/2013 11/28/2012 12/11/2012 12/7/2012
St. Vincent Healthcare PCI Border 2/20/2013 4/8/2013 1/26/2007 4/16/2013 4/16/2013
University of Utah Hospital and Clinics PCI Border 3/25/2013 4/16/2013 12/12/2012 12/12/2012 12/12/2012
Bozeman Deaconess Hospital PCI Border NEED NEED 4/4/2012 NEED NEED
Campbell County Memorial Hospital Acute 11/27/2012 11/28/2012 Not Req'd Not Req'd Not Req'd
Evanston Regional Hospital Acute 12/26/2012 4/10/2013 Not Req'd Not Req'd Not Req'd
Ivinson Memorial Hospital Acute 12/1/2012 4/11/2013 12/18/2012 Not Req'd Not Req'd
Memorial Hospital of Sweetwater County Acute 2/6/2012 5/7/2013 Not Req'd Not Req'd Not Req'd
Sheridan Memorial Hospital Acute 11/7/2012 5/3/2013 11/7/2012 11/7/2012 Not Req'd
St. John's Medical Center Acute 12/4/2012 3/29/2013 Not Req'd Not Req'd Not Req'd
Lander Regional Hospital Acute 11/15/2012 NEED Not Req'd Not Req'd Not Req'd
Riverton Memorial Hospital Acute 2/22/2013 NEED Not Req'd Not Req'd Not Req'd
Crook County Medical Services District CAH 12/12/2012 4/30/2013 Not Req'd Not Req'd Not Req'd
Medcor, Inc. dba Medcor at Yellowstone CAH 1/19/2013 4/22/2013 Not Req'd Not Req'd Not Req'd
Memorial Hospital of Carbon County CAH 2/26/2013 6/11/2013 Not Req'd Not Req'd Not Req'd
Memorial Hospital of Converse County CAH 11/15/2012 4/8/2013 Not Req'd Not Req'd Not Req'd
North Big Horn Hospital CAH 12/20/2012 12/20/2012 Not Req'd Not Req'd Not Req'd
Platte County Memorial Hospital CAH 5/28/2013 5/28/2013 Not Req'd Not Req'd Not Req'd
Powell Valley Healthcare CAH 12/17/2012 6/20/2013 Not Req'd Not Req'd Not Req'd
South Big Horn Hospital CAH 12/10/2012 5/13/2013 Not Req'd Not Req'd Not Req'd
South Lincoln Medical Center CAH 3/29/2013 4/17/2013 Not Req'd Not Req'd Not Req'd
Star Valley Medical Center CAH 11/6/2012 4/29/2013 Not Req'd Not Req'd Not Req'd
MLWY PCI WY Eligible to Receive Payment
MLWY Border PCI Eligible to Receive Payment
MLWY PCI Border Need Forms
MLWY Acute Eligible to Receive Payment
MLWY Acute Need E1 Forms
MLWY CAH Eligible to Receive Payment
Institution Hospital Type Received MOU E1 Form HR Form DRC Form SDRC Form
Weston County Health Services CAH 12/19/2012 2/11/2013 Not Req'd Not Req'd Not Req'd
Hot Springs County Memorial Hospital CAH 2/13/2013 NEED Not Req'd Not Req'd Not Req'd
Marbleton‐Big Piney Clinic CAH 12/6/2012 NEED Not Req'd Not Req'd Not Req'd
Niobrara Health & Life Center CAH 11/20/2012 NEED Not Req'd Not Req'd Not Req'd
Pinedale Clinic ‐ Sublette County Rural Health D CAH 12/6/2012 NEED Not Req'd Not Req'd Not Req'd
Sublette County Rural Health District CAH 12/18/2012 NEED Not Req'd Not Req'd Not Req'd
Washakie Medical Center CAH 4/8/2013 NEED Not Req'd Not Req'd Not Req'd
West Park Hospital EMS CAH 12/7/2012 NEED Not Req'd Not Req'd Not Req'd
Johnson County Healthcare Center CAH NEED NEED Not Req'd Not Req'd Not Req'd
Torrington Community Hospital CAH NEED NEED Not Req'd Not Req'd Not Req'd
Veterans Affairs in Cheyenne VA NEED NEED Not Req'd Not Req'd Not Req'd
Veterans Affairs in Sheridan VA NEED NEED Not Req'd Not Req'd Not Req'd
MLWY CAH Need E1 Forms
MLWY CAH Need Forms
MLWY VA Need Forms
Wyoming Board of Medicine Serving the public and practitioners since 1905 130 Hobbs Avenue, Suite A • Cheyenne, WY 82002 Phone: 307-778-7053 • Fax: 307-778-2069 • Toll free within Wyoming: 800-438-5784 Email: [email protected] • Website: http://wyomedboard.state.wy.us
May 8, 2013 Via E-mail ([email protected]) Andy Gienapp, MS, NREMTP Administrator Office of Emergency Medical Services 6101 Yellowstone Rd., Suite 400 Cheyenne, WY 82002 RE: EMS 2013-21 – Requests for Action Dear Andy: At its meeting on April 12-13, 2013, the Wyoming Board of Medicine considered the requests for approval posed to it by your agency in your letter dated April 11, 2013. I am pleased to report the Board took the following actions: Item #1: Lead ECGs and aspirin The Board approved the permanent inclusion of the following in the scope of practice of EMT Basic:
1. Use of 12-lead electrocardiograph (ECG) machines, and the transmission of the information from ECG testing to receiving hospitals. EMT Basics may not provide interpretation and/or subsequent interventions based upon the presenting rhythm; however, they may provide other interventions that are authorized and appropriate based upon the chief complaint, and physical assessment, of the patient.
2. Oral administration (p.o.) of aspirin in the presence of a patient’s complaint of chest pain or presumptive myocardial infarction.
3. Epinephrine auto-injectors
a. Obtaining and stocking epinephrine auto-injectors under the authority of the respective service’s Physician Medical Director; and,
Matthew H. Mead Governor
Andy Gienapp, MS, NREMTP May 8, 2013 Page 2 of 2
b. Administering epinephrine via auto-injector to adult and pediatric patients exhibiting signs and symptoms of anaphylaxis.
Although the Board did not place any limitations on the use of epinephrine auto-injectors, you are encouraged to monitor the implementation of this portion of the scope of practice. If at any time you believe limitations, protocols or guidelines are appropriate, please bring your concerns to the attention of the Board for possible further action.
Item #2: Changes in Level of Service
The Board reviewed two requests for changes in level of service:
1. Upgrading of Fremont County EMS from Intermediate level service to Paramedic level service. The Board approved this request.
2. Authorization for the Mills Fire Department (MFD) to utilize paramedics on an intermittent basis. The Board was concerned that MFD reportedly has not completed the transition process outlined in the Scope of Practice approved by the Board in 2011. Rather than approve the use of paramedics on an intermittent basis while the implementation by MFD of the 2011 Scope of Practice changes is still in process, the Board prefers to revisit the request at its meeting in August 2013. If by that time MFD has submitted and received approval for the clinical protocols, and has completed the specified transition process, the Board will gladly revisit the matter. Therefore, the Board deferred action on this request.
I hope the Board’s decisions are helpful to you and address your requests and concerns. The Board’s next regularly-scheduled meeting is set for August 1-3, 2013, in Cheyenne, and as always you are welcome to present – either in person or via letter – requests for review and approval to the Board for consideration at that meeting. In the meantime, if you have any questions or we can be of any assistance to you, please do not hesitate to let me know.
Best regards,
Kevin D. Bohnenblust Executive Director
Cc: Board of Medicine Members Jessica Frint, Assistant Attorney General – Board Counsel
Mission: Lifeline Wyoming Equipment Advisory Subcommittee October 29, 2012
1 | P a g e
Equipment Advisory Goals and Responsibilities Goal of this subcommittee is to review EMS and hospital resource gaps and develop a plan to allocate grant funding.
Identify equipment requirements for successful transmission of 12-lead ECG for all EMS Agencies.
Identify requirements for hospitals to obtain transmission of 12-lead ECG from EMS Agencies.
Identify additional equipment and training requirements and address.
Mission: Lifeline Wyoming Equipment Purchase Process Overview (Revised 06.27.2013)
Page 1 of 1
The April 4th Equipment Advisory Council (EAC) and Wyoming Stakeholder Committee (WSC) reviewed the first cycle of equipment grant applications and voted on the proposed funding allocation. This document lists the officially approved equipment to be funded and a description of the purchasing process. Changes to an approved list cannot be made without including the WSC. Each EMS agency and hospital will purchase the equipment and AHA will reimburse the agency or hospital for the purchase. Funding will only be issued for the equipment and amount that was officially approved by the EAC subcommittee and WSC Voting Representatives. An Equipment Grant Agreement will be sent to awarded EMS agencies and Hospitals. EMS agencies and hospitals are to order their approved equipment or software. Upon successful order of the equipment the vendors will create a “proforma” invoice. EMS agencies and Hospitals will send a copy of the proforma invoice along with the completed the Equipment Grant Agreement to: [email protected]. Alternatively, you can fax the documents to Diana’s attention at 1-877-247-5211. Once AHA has these documents, the payment process will begin. EMS agencies and hospitals should plan on receiving payment within 30 days of submission. A Credit Worthiness form must be completed and on file with AHA before payment will be issued. If you have any questions, please don’t hesitate to contact us. Ben Leonard, NREMT-P EMS Director, Mission: Lifeline Wyoming Quality Improvement Initiatives SouthWest Affiliate [email protected] O) 877-610-3990 C) 307-333-3641 F) 877-247-5211
Scott Nelson, B.S., NREMT-P Hospital Director Mission: Lifeline Wyoming Quality Improvement Initiatives SouthWest Affiliate [email protected] O) 307.222.8416 C) 303.883.6829 F) 866.703.1718
Mission: Lifeline Wyoming Equipment Grant Agreement
American Heart Association, Inc. – the Dallas office of the Southwest Affiliate (“AHA”), 8200
Brookriver, Suite N 100 Dallas, TX, hereby awards a grant to _________________________
(“COMPANY”), at the street address ____________________________, subject to the following terms
and conditions:
1. The grant funding this equipment is for the period from June 1, 2012 through June 30,
2015. Upon receipt by AHA of this signed Grant Agreement, COMPANY may arrange
to purchase approved equipment or software for delivery within 30 days and payment with a 60
day payment arrangement in accordance with the Equipment Grant Agreement provided by
AHA. Upon successful delivery and installation of the equipment and receipt of the final invoice,
COMPANY must deliver to AHA the signed Equipment Grant Agreement, a copy of their
original application for EMS & Hospital Equipment Funding AHA agrees it will pay
COMPANY the amount for the approved equipment ordered within thirty (30) days of
receipt (see Attachment A for dollar amount). 2. COMPANY is legally incorporated in WY, SD, MT, ID, UT,CO (please circle one) , is a
corporation in good standing with their respective State and the AHA Mission: Lifeline Wyoming
initiative at the time of this grant Agreement, and agrees it will maintain this status throughout the
term of this Agreement. If COMPANY is a non-profit organization, COMPANY confirms
further it is not a Type III supporting organization within the meaning of IRC Section
4943(f)(5)(A).
3. COMPANY will use grant funds only for activities that are consistent with its grant application
submitted to the AHA and as outlined in Attachment A. COMPANY will not use the grant funds
for political support or to carry on lobbying efforts of propaganda, or to otherwise attempt to
influence any legislation, within the meaning of IRC Section 4945 and the Treasury Regulations
thereunder. Further, COMPANY will not use grant funds to engage in, support or promote
violence, terrorist activity or related training of any kind.
4. No substantial variances, including the timing of expenditures, will be made from the grant
application without the AHA’s prior written approval.
5. COMPANY will inform the AHA immediately, in writing, of (i) any change in or challenge to its
corporate status, adverse change in its standing with their regulating state or if it becomes a Type
III supporting organization, (ii) any change in its organizational leadership or key personnel, or
(iii) any material change or adverse development relative to its financial condition, operations,
activities or affairs. No payment hereunder shall be required to be made at any time after
COMPANY ceases to be a legal corporate entity, has an adverse change in its standing with the
State of Texas or if it becomes a Type III Supporting Organization.
6. COMPANY will have full control of the disposition of the grant and accepts responsibility for
complying with this Agreement’s terms and conditions. This grant is earmarked for COMPANY
and may not be transferred to any other entity or person, except as may be specified in
Attachment A. COMPANY will maintain a separate accounting of the use of grant funds to
enable confirmation of its proper expenditure of the grant funds.
7. COMPANY will submit an annual report using the template provided by AHA and outlining its
progress towards the plans detailed in the grant application and a summary of how the grant funds
have been expended. These reports are due 60 days after the end of each calendar year starting
with the year ended December 31, 2013.
8. COMPANY acknowledges and agrees that any equipment provided hereunder by AHA will,
upon delivery, be owned by COMPANY, and COMPANY solely will be responsible for the
upkeep, maintenance, repairs, safety, insurance and operability of such equipment. COMPANY
also acknowledges and agrees that the AHA does not endorse, impliedly or expressly, any brand
or manufacturer of any equipment that may be provided hereunder.
Mission: Lifeline Wyoming Equipment Grant Agreement
9. COMPANY agrees to respond within 30 days of request to interim inquiries and requests for
information from the AHA regarding uses of the grant funds, compliance with the terms of the
grant and progress made towards achieving the goals of the grant.
10. COMPANY acknowledges that the AHA and its representatives have made no actual or implied
promise of funding or renewal of funding in addition to amounts provided under this Agreement.
11. It is understood that by signing this grant Agreement, COMPANY agrees that it will conduct all
activities to be funded by this grant in compliance with all applicable United States, state and
local laws, as well as in compliance with the laws of any location or jurisdiction in which
COMPANY is operating, including applicable anti-terrorist financing and asset-control laws,
statutes and executive orders.
12. COMPANY agrees to ensure that all potential recipients and participants of COMPANY’s
programs and services have access to programs and receive equitable services without regard to
race, sex, education, ethnicity, socio-economic status, religion, ability/disability, sexual
orientation, gender self-identification, age, country of origin, first language, marital status,
citizenship or immigration status.
13. If COMPANY wishes to publicize this grant, COMPANY must contact the AHA at least 2 weeks
before the desired date of the publicity for review and approval by the AHA and The Leona M
and Harry B. Helmsley Charitable Trust (“TRUST”). COMPANY shall not issue any press
releases or otherwise make any public statement referring to this grant or using the AHA, or
TRUST’S logo without the prior written consent of the AHA and TRUST. The text of all press
releases, public announcements, statements, campaign reports or materials that mention the grant
must be approved in advance in writing by the AHA and the TRUST. COMPANY shall provide
the AHA with copies of any and all final press releases, public announcements and/or
publications related to this grant. The AHA and the TRUST may make information about this
grant public at any time on their websites or in presentations or as part of their public reports or
documents.
14. COMPANY hereby agrees, to the fullest extent permitted by law, to defend, indemnify and hold
harmless the AHA, the TRUST, their officers, directors, volunteers, employees and agents from
and against all claims, liabilities, losses and expenses (including reasonable attorney’s fees),
directly or indirectly, wholly or partially arising from or in connection with any act or omission of
COMPANY, its directors, employees or agents in obtaining or accepting the grant from the AHA,
in expending or applying the proceeds of the grant from the AHA, in operating the equipment
provided hereunder, or in carrying out the project or programs funded with grant funds from the
AHA.
15. If the AHA terminates this grant for cause, or if COMPANY ceases to be a legal corporate entity,
or ceases to be in good standing in their respective state, or becomes a Type III Supporting
Organization, COMPANY shall immediately repay the full amount of grant funds that are
unspent and surrender any equipment purchased with grant funds as of the date of the termination
or date its corporate status changes. In addition to the circumstances cited above, the AHA shall
have cause to terminate the grant if the purpose of the grant has been fully completed;
COMPANY becomes unable to carry out the purposes of the grant; COMPANY uses the grant
funds for a purpose other than those set forth in this Agreement, unless the AHA has consented in
writing to such modification; or COMPANY is in breach of any term of the grant. The AHA
reserves the right to request immediate reimbursement of any grant funds used for purposes other
than those for which the grant was made or to which the AHA has consented.
16. COMPANY acknowledges and agrees to be responsible for the upkeep, maintenance, repairs,
safety, insurance and operability of such equipment not only for the term of the grant, but for as
long as COMPANY owns such equipment. The COMPANY will be required to retain records to
attest to upkeep, maintenance, repairs, safety, insurance and operability and should be readily
available upon the request of the AHA for verification.
Mission: Lifeline Wyoming Equipment Grant Agreement
For American Heart Association, Inc. – Southwest Affiliate:
Signature Name/Title Date
On behalf of COMPANY, I understand and agree to the foregoing terms and conditions of the AHA’s
grant and hereby certify my authority to execute this Agreement.
By:
Signature Name/Title/Company Date
Mission: Lifeline Wyoming Equipment Grant Agreement
Attachment A
Funding was approved by the Mission: Lifeline Wyoming Committee as follows:
Approved and
received by
COMPANY Equipment – Brief Description
Total Cost Requested (to
include applicable sales tax
and S&H charges)
COMPANY will attach the invoice detailing the equipment that was purchased and the total purchase
price paid for the AHA to reimburse.
Name of EMS Agency or Hospital Rank Equipment WSC Approved Amount ProForma Inv Amt (Taxed amount) 12 Lead Modem 12 Lead ECG Transmission Service EMS 12 Leads Cell Boosters Amount in E1 E1 Order # Freight
Albin Rescue (Y) B 2 2 ReadyLink, 2 boosters $11,898.00 11,096.60$ 598.00$ 10,498.60$ 400.00$ 11,096.60$ 796721
Alpine ems (Y) I 2 1 Zoll X series $25,000.00 25,000.00$ 25,000.00$ 25,000.00$ 796577
Atwood Ambulance (Y) I 2 4 upgrades, 4 data plans, 4 modems $32,324.00 32,143.00$ 2,997.00$ 796.00$ 28,350.00$
Campbell County Gillette (Y) P 1 5 x modem & data plans $4,991.00 4,990.80$ 3,996.00$ 994.80$ 0.00$ 4,990.80$ 796722
Carbon County Mem Hosp EMS (Y) I 2 2 LP 15, 3 booster $50,894.00 ‐$ 1,170.00$
Centennial Valley Vol Fire Dept (Y) B 2 1 Phillips MRX basic $13,494.00 13,494.00$ 3,247.00$ 10,247.00$ 13,494.00$ 796582
City of Torrington EMS (Y) I 2 2 Zoll X Series $50,000.00 52,625.00$ 2,625.00$ 50,000.00$ 52,625.00$ 796583
Dayton Rescue (Y) B 2 1 LP 15 $24,863.00 ‐$
Eastern Wyoming Ambulance (Y) P 2 2 Zoll X Series, 4 Cell Boosters $51,920.00 53,000.01$ 3,000.01$ 50,000.00$ 1,920.00$ 53,000.01$ 796588
Eden Valley Ambulance Service (Y) I 2 1 LP 15 and 1 Upgrade $31,542.00 31,265.50$ 1,398.60$ 1,194.00$ 28,672.90$ 185.00$
Evansville Fire Department (Y) I 2 2 upgrades, 2 batteries $15,656.00 14,920.45$ 9,798.75$ 5,121.70$ 14,920.45$ 796591
Fremont County Ambulance (Y) P 1 4 Zoll X Series $100,000.00 100,000.00$ 100,000.00$ 100,000.00$ 797229
Guernsey Vol Ambulance SVC (Y) I 2 2 Phillips MRX 2 batteries $45,548.00 45,548.00$ 3,247.00$ 42,301.00$ 45,548.00$ 796710
Jackson Hole Fire/EMS (Y) P 2 2 Zoll X Series, 1 ReadyLink $55,674.00 53,000.01$ 3,000.01$ 50,000.00$
Kemmer EMS (South Lincoln County EMS – Y) I 2 1 Zoll X Series, 3 boosters $26,170.00 ‐$ 1,170.00$
Laramie Fire Department (N) I 1 Modems $6,000.00 5,209.80$ 4,015.80$ 1,194.00$ 5,209.80$ 796713
Mem Hosp of Converse County (Y) P 2 4 Zoll X Series $100,000.00 100,000.00$ 100,000.00$ 100,000.00$ 796714
Moorcroft (Y) I 2 1 Phillips MRX, 1 MRX upgrade, 2 booster $35,726.00 34,391.00$ 7,016.00$ 27,375.00$ 780.00$ 34,391.00$ 796715
Mortimore Ambulance Svc. (Y) I 2 2 Phillips MRX $45,555.00 45,548.00$ 6,494.00$ 39,054.00$ 45,548.00$ 796597
Newcastle Ambulance Service (Y) I 2 2 Zoll X Series $50,000.00 52,500.00$ 2,500.00$ 50,000.00$ 52,500.00$ 796716
North Big Horn Hospital Ambul (Y) I 2 1 Phillips MRX, 1 MRX upgrade and 3 boosters $28,446.00 26,981.00$ 4,544.00$ 21,037.00$ 1,400.00$ 26,981.00$ 796717
Pine Haven (Y) I 2 1 Zoll X Series and cell Booster $25,390.00 26,500.00$ 1,500.00$ 25,000.00$ 390.00$ 26,500.00$ 796718
Powell Valley Healthcare (N) I 1 3 Phillips MRX $67,452.00 67,452.00$ 9,741.00$ 57,711.00$ Need E1 Acct #
Rocky Mountain Ambulance SVC (Y) P 1 3 LP15 $74,588.00 76,493.60$ 4,329.80$ 2,397.60$ 597.00$ 69,169.20$ 76,493.60$ 796719
Salt Creek Emergency Services (N) B 1 1 Phillips MRX new $22,774.00 22,774.00$ 3,247.00$ 19,527.00$ 22,774.00$ 796720
Sheridan Area Rural Fire Prot Dist (N) P 1 1 LP 15 $24,863.00 ‐$
Sheridan Fire and Rescue (Y) P 1 2 LP 15 $49,725.00 ‐$
Star Valley Medical Center EMS (Y) I 1 1 Zoll X Series $25,000.00 25,000.00$ 25,000.00$ Need E1 Forms
Sublette County EMS (N) I 2 8 boosters $3,120.00 ‐$ 3,120.00$
Sundance Ambulance (Y) P 2 2 Zoll X Series $50,000.00 53,000.01$ 3,000.01$ 50,000.00$ 53,000.01$ 796799
Sweetwater Medics (Y) P 1 3 LP 15 $74,588.00 78,023.69$ 4,360.01$ 2,397.60$ 596.88$ 70,669.20$
Town of Burns EMS (N) B 2 1 LP15, 1 ReadyLink, 2 cell boosters $30,986.00 24,591.40$ 699.30$ 199.00$ 23,693.10$ 750.00$ 185.00$
Wyoming Medical Ctr EMS (Y) P 1 7 Phillips MRX upgrades $9,079.00 ‐$
Yellowstone National Park (Y) P 2 1 Phillips MRX monitor and upgrades (no temp) $44,137.00 ‐$
Yoder Ambulance (Y) B 2 1 Phillips MRX, 1 booster $22,874.00 22,484.00$ 3,247.00$ 19,237.00$ 390.00$
WSC Approved Amount‐ EMS Proforma Invoiced Total Taxable Amount 12 Lead Modem 12 Lead ECG Transmission Service EMS 12 Leads Cell Boosters
$1,330,276.00 1,098,031.87$ 24,314.84$ 68,483.65$ 6,169.68$ 997,663.70$ 11,490.00$ 764,072.27$
EMS Funding Remaining Amount $351,053.00
Amount Entered in E1 966,690.96$
WSC Approved Date
Campbell County Memorial Hospital (Y) ACH LN Basic $11,999.00 11,998.80$ 4/4/2013 11,998.80$ 796724
Hot Springs County Memorial Hospital* CAH Heartstart Telemed $3,496.00 *7/2/2013
Ivinson Memorial Hospital* ACH LN Basic $11,999.00 *7/2/2013
Medcor Clinic at Yellowstone* CAH Heartstart Telemed $3,496.00 *7/2/2013
Memorial Hospital of Carbon County* CAH LN Basic $11,999.00 *7/2/2013
Memorial Hospital of Sweetwater County (Y) ACH LN Basic $11,999.00 4/4/2013
North Big Horn (Y) CAH Heartstart Telemed $3,496.00 2,395.00$ 4/4/2013 2,395.00$ 796725
Powell Valley Healthcare (N) CAH Heartstart Telemed $3,496.00 3,496.50$ 4/4/2013 need to wait
Sheridan Memorial Hospital (Y) PCI LN Basic $11,999.00 11,998.80$ 4/4/2013
South Big Horn Critical Access (Y) CAH LN Basic $11,999.00 4/4/2013
St. Johns Medical Center (Y) ACH LN Basic $11,999.00 4/4/2013
West Park Hospital* CAH LN Basic $11,999.00 *7/2/2013
WSC Approved Amount‐Hospitals Proforma Invoiced Total
$109,976.00 29,889.10$
Hospital Funding Remaining Amount 80,086.90$
Amount Entered in E1 29,889.10$
Mission: Lifeline Wyoming Conference Planning and Education October 29, 2012 Conference Planning and Education Subcommittee Goals and Responsibilities
1. Plan the content and schedule of a regional professional education conference for 2014
2. Plan the content and schedule of a regional professional education conference for 2015
3. Format the regional professional education conference on the latest STEMI and sudden cardiac arrest treatment and system initiatives
4. Professional a. Assess AMI emergency care knowledge gaps b. Develop an education curriculum – content and structure c. Evaluate educational outcomes
5. Public
a. Identify a public awareness campaign strategy and timeline for promotion of “911” for heart attack symptoms via third party evaluation
1 | P a g e
1.
1. Name of person completing this survey
2. Please provide a working email address that you check frequently.
3. State EMT Number or Nursing License Number (if known)
4. Please choose your discipline: mlj
EMT - Basic
mlj
EMT - Intermediate
mlj
EMT - Paramedic (includes Licensed Paramedic)
mlj
Registered Nurse
mlj
Physician
mlj
Other (please specify)
5. Please provide the EMS agency, Fire Department or Hospital where you work.
6. Please select the following patients who are at high risk of Acute Coronary Syndrome (ACS) (you may choose more than one)
fec
A 52 year old semi truck driver that is severly obese with high blood pressure.
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A 33 year bar tender that smokes 2 packs of cigarettes a day.
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A 52 year old female that has a history of diabetes.
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A 45 year old firefighter with high cholesterol.
fec
A 60 year old male who swims three times a week.
7. Which of the following are, or could be, signs and symptoms of a heart attack?
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Chest Pain
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Nausea
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Shortness of breath
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Back pain
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Abdominal Pain
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All of the above
8. The 12-Lead ECG should be accomplished with minutes of initial patient contact. mlj
<15 mins
mlj
<20 mins
mlj
<10 mins
9. Describe two ways time may be reduced on STEMI Patients (EMS-reduce scene time; Hospital-reduce door to needle time or door to balloon time)
1
2 10. Which of the following time elements are important to note when treating STEMI patients? (you may choose more than one)
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Time of inital patient contact
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Time of symptom onset
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Time of ECG
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In Service Time
11. Which of the following are ABSOLUTE contraindications for a patient from receiving fibrinolytic care?
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Active bleeding or bleeding diathesis (excluding menses)
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Any prior ICH (Intra-cranial Hemorrhage)
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Allergy to Aspirin
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Significant closed-head or facial trauma within 3 months
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Severe uncontrolled high blood pressure (unresponsive to therapy)
2.
Use this image for the question below.
1. What chest lead, or "v" lead does each letter represent? (Please answer all six rows.)
B - (4th intercostal space, right of the sternum)
F - (5th intercostal space, mid-axillary line)
D - (5th intercostal space, mid-clavicular line)
Chest lead
6
6
6
C - (Between v1 and v2) 6
A - (4th intercostal space, 6 right of the sternum)
E - (5th intercostal space, 6 anterior axillary line)
Use this image for the question below. 2. Using the diagram above, which letter represents the "J-Point"?
mlj A
mlj B
mlj C
mlj D
jml E
mlj F
mlj G
mlj H
mlj
I am
not trained to interpret 12 Lead ECG's
3. Using the diagram above, which letter represents the "ST Segment"? mlj A
mlj B
mlj C
mlj D
jml E
mlj F
mlj G
mlj H
mlj
I am
not trained to interpret 12 Lead ECG's
4. Using the diagram above, which letter represents the "Q Wave"? mlj A
mlj B
mlj C
mlj D
jml E
mlj F
mlj G
mlj H
mlj
I am
not trained to interpret 12 Lead ECG's
Use the image below to answer question #5 5. The 12 lead ECG above represents a(n)" " STEMI (you can choose more than one)
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Inferior
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Septal
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Anterior
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Lateral
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I am not trained to interpret 12 Lead ECG's
Use the image below to answer question 6 6. The 12 lead ECG above represents a(n)" " STEMI (you can choose more than one)
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Inferior
fec
Septal
fec
Anterior
fec
Lateral
fec
I am not trained to interpret 12 Lead ECG's
7. Which of the following phrases is the definition of "Preload"? mlj
A - "The stretched condition of the heart muscle at the end of diastole just before contraction"
mlj
B - "The end-diastolic blood volume at the beginning of systole"
mlj
C - "The amount of blood in the heart just before systole"
mlj
D - "An inspection of the trunk of your car before you put your bags in"
mlj
E - Answers A, B, C are correct.
Mission: Lifeline Wyoming Protocols and Quality Improvement Subcommittee October 29, 2012 Protocols and Quality Improvement Goals and Responsibilities
• Assess how many of the participating organizations have existing AMI protocols
• Identify process to review individual organization and system needs for a standardized regional assessment, treatment and transport protocol set
• Identify elements required for a standardized regional protocol set
• Identify process to review different protocols and start assimilating
• Identify process to evaluate implementation of and outcomes of new standardized
regional protocol set
• Assess how the region or county can create a regular and sustainable QI process to measure system performance
• Identify barriers to data collection and reporting in participating organizations (EMS)
• Identify ways to help capture and measure “system” level items like reperfusion to
recognition (R2R) or symptom onset through arterial reperfusion (SOAR)
• Assess internal QI process and frequency in participating organizations
1 | P a g e
Mission: Lifeline® Wyoming
Adult BLS Protocol for acquiring 12-lead ECG’s
Assess ABC’s first, correct life threats…
Signs and Symptoms
- Chest pain/
pressure/
tightness/discomfort
- Complaint of anxiety,
“heart racing” or
“palpitations”
- GI Symptoms- N/V
- Dizziness or syncope
- Difficulty breathing or
shortness of breath
- Weakness
- New onset stroke
symptoms (if so,
contact hospital
early)
History
- SAMPLE
- Personal or family history
of heart problems?
- Allergies (ASA)
- Current medications (that
they currently take, OR
should take)
- Is the patient diabetic?
- Onset
- Provocation/ Palliation
- Quality (description of
discomfort/pain)
- Radiation/ Region/
Referred
- Severity (1-10)
- Time (duration/repetition)
Within the first 10
minutes of patient
contact…
If your patient has
non-traumatic
pain or
discomfort
anywhere from
face to waist,
and/or shortness
of breath,
PERFORM a 12 –
Lead ECG.
Perform 12-Lead ECG acquisition (Goal is within 10 minutes of patient contact)
Transmit to receiving facility Every 30 minutes, repeat 12-Lead and
Transmit new ECG If there is a change in symptoms,
reacquire and transmit
Oxygen per protocol to keep O2 saturation >90%
Administer Aspirin per protocol
IV (if allowed by protocol)
This document is a DRAFT. Once approved by the protocol
subcommittee, it will be reviewed by AHA and then finalized.
These protocols are written and expected to be utilized as
guidelines. They cannot address every possible patient
presentation. When questions arise about your specific patient,
please contact the receiving facility for guidance/ assistance.