Finger Lakes Regional EMS Council
Jan 25, 2010
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Mr. Vice Chair, you do have enough for quorum. (___________) How many do we need, just one more? There is 17 here, right. (_________) I believe we should be all set. Do a roll call or we can double check. If we're not all set, please let somebody know. We'll start at 1840 and we'll do roll call. Everett Ferguson. Here. Ken Beers is excused. Mike Moss. Here. Terry Phillips. (__________) I think we have quorum. We'll see if runs down and grab him because he's not on my list so see if he can pop up. Ken Kelly. Here. John Van Auker. Brian Mace. Here. Matt Sproul here. Diane Gary. Here. Laurie Crane. Here. Ella Guthrie. Here. Bill Liddle. Here. Gloria Lance. Here. Griff Mangan is excused. He's here. Proxy. Okay. Jackie Dishaw is on my excused list. Bill Comella is on my excused list. Chris Leven is on my excused list. Sharon Aumick. She resigned. Still on my list, we'll now cross her name off. She did resign. Sande Johnson. Here. Ed Wedge. Here. Mike Healy. Here. Jim Reed. Here. Kevin Esparza. Here. Chris Warriner. She's on the excused list. Cheryl Alting is on the excused list. I saw Dr. Davidoff somewhere, I think he's going to pop in. Terry Phillips. Yes. Donna Spink. I saw her around. And that's it. Did I miss anybody? I'll write you on the list. Okay. I believe we have a quorum especially since Terry came down. Excellent. Does that work for you, sir? That works for me. We did not have a meeting the last time because there was not enough quorum so we need to approve the minutes from September. Mr. Chairman, Everett Ferguson from Ontario County, I'd to correct the ___ from the last non-meeting, my name is Everett, E-V-E-R-E-T-T. It was from the prior meeting which was held in September. I think it is appropriate that we make a correction to the minutes. I think what she's done, ____ be removed from _________. _______. Give it me and I'll personally take care of it. I don't know what we're doing in Lewis County. Paragraph 2. I'll have to look at it. Therefore, I would make a motion that we make those changes to the minutes. Does somebody want to second it? Brian Mace seconded it. Any questions? Any discussion? Okay, all those in favor of changing the minutes to what Mr. Ferguson said to take out the Lewis County, fix his name and Oak Hill CON. All those in favor say aye? (Ayes) All those not in favor say nay? Any abstentions? Thanks, they were passed. Thank you everybody for coming to have a quorum this evening. Committee reports. Treasurer. The treasurer is excused tonight. I think everybody received the treasurer's report on line at least. Any discussion on the treasurer's report? I'd make a motion to accept the treasurer's report. Motion to accept the treasurer's report. Do we have a second? Discussion. Discussion. I think it is important to call the attention that we had ___ a net loss of $37,286, recognizing cash flow __________, expenses are up, revenue is down. _______. (_________) So noted. With that, Mr. Chairman, I would call the question. All the ________ you call in the question. (___________) All those in favor of the treasurer's report say aye? (Ayes) All those not in favor nay? Any abstentions? (_________) Vibrate mode. All treasurer report. We will look into that as well. Training and Education Report. _________ report, Mr. Chairman, I'll entertain any questions. Any questions? Move to approve. Second. All those in favor say aye? (Ayes) Not in favor say nay? Any abstentions? Excellent. Executive Committee report. (_________) Okay, the report that I submitted, what we basically went over is kind of what you guys went over this evening with the auditor, went over their report. They did not come to our meeting, in order to save some money. We just went over the report and if there were any questions to talk to her. We didn't have any questions. The report seemed thorough and quite explanative. So we had her come this evening. It's pretty much what we talked about. Yes, Mr. Ferguson. Mr. Chairman, I would move that we accept the Executive Committee's report. Second. Any discussion? All those in favor? (Ayes) All those not in favor say nay? Any abstentions? Public relations. We have correspondence going around. Just take a look at that because the next one is REMAC. (____________) All right, what would you guys like know? We're at the REMAC Committee report section. You just want to give everybody a head's up on what's going on in REMAC. Well, you know, we were doing pretty good as far as protocol revisions. We were on top of things. I think we had some really good drafts done and pretty much ready to get past the REMAC and then onto the next phase. At the last REMAC meeting which unfortunately I had to miss because of the just wonderful stomach bug, which if some of you have not had yet, I hope you don't. We got delayed. There were several physicians that raised some concerns about the protocols. So we're sort of back into revision mode. Bob, when he's feeling a little bit better is going to try and get us all together. Face to face. Yes, just give me a date and we'll set a meeting up. And we're going to try and get these done. The goal being to still try and have them in place by the mid or the later part of the summer if we can. Of course, I'm not sure if all of you know that the SEMAC, the State meetings now are down to only three times a year as part of the cost saving where they used to be five times a year, we only have three opportunities a year to get those protocols to the Medical Standards Committee and then onto SEMAC and SEMSCo so we're probably - we're not going to make it to February, there's no way we can make the February. We might, might be able to catch what the May or June meeting? Yes. So that will be the next goal and the last opportunity would be October, something like that. So we're going to try and catch that May meeting if we can. After speaking with a couple of people that are concerned about protocols, I think they sort of exaggerated the limit the REMAC may make. They sent me a whole list of concerns. They were minor concerns. They were not major concerns. They were, you know, a question about dosing, peds dosing and some of them I think, you know, all of you have read protocols and when you read protocols over and over and over again, after a while they become a blur, you kind of lose track of where you are and you keep looking at the same thing and say I've already looked at this, I know it's okay, but you just don't realize that it isn't okay. For example, one of the fractions was a dose on a drug that was inappropriate for a pediatric patient, but it was in the adult protocols. So if you look and you say well, this is the adult dose, it's appropriate, you have to go to the peds protocol where there is a different dose. So I think it's a matter of meeting and going through those things. I think we'll get through them. We've got some good protocols I think there. I think there's going to be some changes that the practitioners in the field are going to be happy with. It's going to give you guys some new drugs to work with. Bringing Zofran in which is an anti-emetic for people that are nauseous/vomiting. It's a great drug for pediatric patients. We're bringing steroids back. You know people that are chronically treated with steroids, there's a lot of people out there that are chronically treated with steroids and they stop their steroids because they've run out of the medicine because they're sick for whatever reason, they become acutely ill, and I think we miss this a lot of times and it's something we need to be on top of. We have the opportunity to replenish their steroids. There are also several children in the state, actually a number of children in the State that are congenitally adrenally deprived and that was one of the things that the State was pushing for, that every one at the paramedic level be able to provide steroids for children. We have looked at some of our psychiatrically challenged patients. We've got some protocols there we would like to put in place. I think we really did a nice job with these protocols. Everyone that contributed to the Protocols Committee had input and I think they're some good protocols. The differences that we have as a Protocol Committee and a few docs, I really truly think are not as bad as we first thought. The first word was no, we don't like the protocols at all and that's not the case. There's some corrections that need to be made, and I think we can do that still and get them out on time. So we're hoping to move ahead with that. One of the things I want to push for is I want to do a pilot project on CPAP. Every state around us has EMTs and certified first responders providing CPAP. Anyone can put CPAP on. _____ at home. There's no reason why a certified first responder or EMT gets to a scene and has someone with severe respiratory distress and can't put a CPAP mask on that patient. It's one of the simplest procedures we can teach people to do. And early CPAP can definitely make a difference from when that patient needs to be intubated, spending time on the ventilator, having all the complications of ventilation, we're trying to operate equipment to the point where they may go home with today. So we're going to push that project. No one else in New York State has pushed it yet. We're going to try and push that through. It's one of our projects I think we're going to do. And as followup on Ketamine, Finger Lakes Region pushed through Ketamine which is a sedative hypnotic. It's a very safe drug. It's been used for years, but was not on the State's list of approved drugs on their formulary. After many years, many, many years of pursing this, probably pushing eight or nine years already. We got it through Medical Standards, we got it through SEMAC, we got through SEMSCo, we got it through the Bureau of Narcotic Enforcement and we're almost to the point where we're having to go to the Commissioner, and we have just, I think a few officials left. I think we're gaining ground so, I think we may get Ketamine pushed through. Ketamine is something that if you are trapped in a car, it's cold, you cannot get out of that car, you're in pain, and people are trying to extricate you and you know, I've seen this from both ends, almost everyone in this room I'm sure has been in the same situation. The fire department gets there, EMS gets there, you start to cut the car, you move to something, the patient screams because it hurts and everything comes to a grinding halt. What have we done now? Well, we're _____ and the longer we slow that extrication the longer it takes to get that patient to ____ care. It may be the difference between the life and death. Certainly the longer that we leave that patient out in the cold, the longer that we let them bleed, the longer that we don't get them the proper care we're not doing them any good. Ketamine is a drug that could be used very safely, a dose of Ketamine can be given intramuscularly, it can be given through an IV, it doesn't affect the respiratory system. It really doesn't affect the blood pressure or the heart rate significantly. These people are basically now so sort of cut off from their pain, it basically turns the switch off. Does it hurt you? Yes. Do you want me to stop? I don't care, and that's almost what Ketamine does. It's used in so many other places. New York has been resistant to it, but I think we're close to getting that approved as well. So the bottom line is for this little region out in the middle of nowheres I think we're making some really good headways and I think we're doing some good things, and I hope we can continue to do that. As far as basic care in this region, it is continued to be quality care. There have been some issues. I'd love to bring those issues up, I can't. I will tell you that there have been some issues that have been some serious issues, but I will tell you that despite what I've said about the State in the past, they're on top of it, they've taken care of those issues. And I think by taking care of those issues I hope that not only do we take care of those specific issues, but that we send - we send the signal out there that, you know, we're a mellow place to work, we're going to provide good care. If you don't provide good care, go work elsewhere. We're going to continue to provide good care here. And I think that's the signal we're getting out there. I hope that's the signal. That we are going to continue to provide hopefully good protocols, the right meds, the right equipment and hopefully continue to provide good care. So I've I rattled off enough. Do you guys have any questions or concerns about REMAC, care, equipment, anything whatsoever? I know I don't get out here all that often and stuff, but at least when I do get out here please pick my brain as much as you can, I wish you would. Anything, guys? Sir. My name is Kevin Esparza from Ontario County. I just was curious about the steroid that you were talking about. What particular steroid? We're probably going to go Solu-Medrol. You know, you can probably use Solu-Medrol, Solu-Cortef or Decadron. The Solu-Medrol is relatively cheap. We had our national shortage of Solu-Medrol about five years ago so I don't expect that to cycle through again for another five or ten years. I think it will be available. It's easy to dose and, you know, it's a simple drug work with and it's cheap. It's the push of the State - there was actually a group that approached the State and said, listen, there's a lot of kids in the State with congenital adrenal deficiency and the truth of the matter is there's a fair number. I don't have the exact number, there's probably several thousand in the State and any one of us riding in an ambulance in the State, any one in the State could come across one of these kids, they can be at day care, they can be at school, they could at home. These kids with minimal, minimal illness can pretty much drop and look like they're going to die, they become flaccid, they become pale, they become sweat, they become hypotensive, tachycardic. The kid will look terrible. The same thing that you see in adults who are chronically steroid dependent for whatever don't get their steroids. Maybe they've had the stomach bug and they haven't been able to keep their steroids down for a couple of days. When the adrenal glands are normal, they respond to the body's activity from minute to minute, you know, hey, I have to go answer the phone across the room, I've got to run, the adrenals kick out a little more steroid. The adrenals know that they're going to get the same dose of steroid every day, and they don't and they stop working. The whole pituitary and adrenal access just stops, you know, we don't need to work we're getting, we can be lazy and it takes a while for it to kick back in, if it is going to kick back in. So if you're steroid dependent and you're off your steroids, minimal stress, urinary tract infection, gastroenteritis, bigger stress, an MI something like that, you're going to be sick. You're going to be real, real sick, forget about what that little stress was that stressed you. Being off steroids you're going to be really sick. We recognize that, okay, and how do we recognize it, what's your normal list of reds, well, I'm only on prednisone 10 mg a day, once I started getting sick, I haven't been able to take it in two or three days and I'm feeling lousy, all right, we load them up with 125 mg of Solu-Medrol and it's almost as miraculous as giving a diabetic who is hypoglycemic sugar. It's a very, very quick response. The kids you can turn them around from dying to being rejuvenated. So that was the push on the State level. We've been talking about steroids at the REMAC level for a number of years. Asthmatic, chronic lung disease, etc. Not as an immediate reaction and that's one of the reasons why we kind of held off with it, because if we give you steroids now or 45 minutes or an hour later in the emergency room, it's not that much of a difference. One thing we started discussing was well, you know, it's no longer maybe an hour or 45 minutes until they're seen by a physician, now maybe it's three hours, four hours, five hours. Now, we're almost starting to see a difference so we were headed in that direction anyway with steroids. The Solu-Medrol will be the drug. The loading dose will be probably 125 mg, probably ____ on children. And we will have it available by the way for the asthmatics and COPDers. Because some of the delays to be seen in the emergency room now are pretty tremendous, and you may actually see a reason in that period of time. By the way, just so everybody is aware, we're not using steroids in head injuries or spinal injuries. There were some regions that were actually still using that in some cases. We are out. That's based on the latest studies. Will that turn around again some day, who knows. The current topic of discussion is hypothermia, cooling patients with spinal injuries and certainly for those with resuscitation. We're looking at that as well. So we're trying to keep up on things. You know, again in a region, as we make changes, it's concerning for corps, for services that don't have the money either so. Everyone just has been recently hit by FIOCO2 and some of the other things that are possibly - we're trying to look out for everyone's pocketbook as well. Robert? That's it. Does anybody else have any questions for Dr. Davidoff while he's here? Well, thank you, Dr. Davidoff. I thank you folks. I'd love to stick around, but I'm going to go teach in another county. Everyone have a good night, thank you. Yes, Mr. Ferguson. For the record, I'd like to move that we accept the Medical Director's report and thank you for attending. Well, thank you. Good night everyone. Second. Good night. A second from Brian Mace. All those in favor say aye? (Ayes) All those not in favor say nay. Any abstentions. All right. State EMS Council. Okay, this was suppose to have gone out to you because it was turned in a couple of weeks ago, but it disappeared in the office somewhere so I hope you got a change to peruse it quickly tonight. A couple of highlights, under - first of all, this is the first meeting in all the years I've been there that Mr. Wronski wasn't there. He's officially retired, and Ms. Lee Burns is now acting as the head of the bureau on a temporary basis. The first thing on the first line that I want to call your attention to is that the budget is going to be cut 11% the remainder of this year and an additional 20% for next year. So it's going to be some rough sledding for a while. That's why Dr. Davidoff said we're going down to three meetings next year. At the bottom of what I have for her presentation, President Obama has signed a revised, it should be the Ryan White Act into law onto October 30th which means you can now put your designated officers back to work, I hope you didn't get rid of them before. The guidelines are suppose to be published 180 days from that date so we don't have them as of yet. Under Dr. Henry's report, the third item down, two changes to Part 800 were discussed and ____ in place. All transporting agencies are required to have AED on report and epi pen, because apparently there were some out there that weren't. Obviously with the new curriculum coming down the road, there's going to be some changes. There's a number of studies undergoing right at the moment. Going back to old boy scout days when we used tourniquets, they are probably going to be included in the new curriculum, but we're going to eliminate pressure points and elevation because they don't really work any way. You can read through the rest of this. The other thing, if you will include this when you copy this off. Okay, so that's your mandated. Any questions? Sir. I notice on the last page that diversity training that's coming. You know as much as I do about that. They now have a subcommittee that's dealing with diversity and they're putting something together to put out into the regions. What it's going to be, I don't know. What it's purpose is going to be, it may be cause diversify in our presentation. How they're planning on accomplishing that I do not know. Unfortunately ___________ Motion to accept. Second. Okay. All those in favor? (Ayes) All those not in favor? Any abstentions? Thank you. Legislative Review. By-law changes, anything special like that. I guess not. There is none. Because there is no legislative committee. Program Coordinator's report. My report was sent out via email and also there's a hard copy here. I'll entertain any questions that anybody would have. Any questions for Bob? Move we accept it. Second. Just a note, I'm in the process of finishing the second quarter report right now and we'll be vouchering the State for roughly $35,000 and being that we took a $35,000 advance, we're actually going to be getting back just around $17,000. We have a rather large chunk of money still available and the State would like us to spend that down so that we only have about 20% left when we go into the third quarter so I'll be spending down this quarter and it won't be that hard to do because we obviously have the auditor to pay for, the conference coming up. We have some other big expenses that we've put off this quarter so we'll be making some purchases this quarter to spend the money down. Okay. Motion on the table. Seconded. Any further discussion? All those in favor say aye? (Ayes) Those not in favor say nay. Any abstentions? Excellent. Everybody should have the FLCC's Director Report. Did anybody not get a copy? Motion it be accepted. Second. Second. Motion on the floor to accept. It has been seconded. Any discussion? All those in favor say aye. (Ayes) Those not in favor say nay. Any abstentions? Nominating Committee? Do we have anybody? We have one application and I apologize to you folks, I took this home and then this morning remembered I hadn't talked to the individual yet. Therefore, I will be bringing him back for the March meeting after we've had a chance to discuss what his intentions are. So I apologize for that. Motion to accept the apology. Could I ask what county? Ontario. We will have all those vacancies in Seneca? Yes. I had an individual who was from Seneca County, that individual was suppose to attend our last meeting, did not do so and I've heard nothing from that individual so I'm going to try to recontact. There's the committee report. You're interviewing a person who wants to be on the committee - Council. Do we have a motion to at least accept the report - Motion. Second. There we go. Any discussion? Next meeting we'll go over somebody who would like to join. All those in favor say aye. (Ayes) All those not in favor say nay. Any abstentions? Stay tuned for that one in March. Old Business? Do we have any old business? Yes, Mr. Ferguson. Mr. Chairman, Everett Ferguson, Ontario County, I'd like to make a motion that the Council accept the audit as presented in the pre-meeting presentation. Second. Seconded by Brian Mace. Any discussion? All those in favor? (Ayes) All those not in favor? Any abstentions? Okay. Any other old business? Everybody's quiet. New business? What I'm looking at is under new business on my sheet, it says CME vetting process and then CME class reimbursement guidelines. I generated these policies and taken them initially to the Executive Committee, and REMAC, because of some current concerns about some classes that were going on and requests for payment on classes. The CME Medical Educational Reimbursement Guidelines is what I've titled one policy and it says that the Finger Lakes Regional EMS Council ____ shall pay for the following expenses related to continuing medical education sponsored by the Finger Lakes Regional EMS Council and Program Agency: 1. Course announcements and expenses related to mailing the course announcements. 2. Certificates of attendance and expenses related to mailing those certificates. 3. Instructor/presenter wages or stipends which is the normal prevailing wage for the instructors. We do with certain classes, when we do some of the ALS classes, some of the presenters that come in do get a slightly higher wage because their wages have been set through the college for and through the programs for other ___. The equipment and/or related supplies necessary for the presentation. When we do an advanced airway class, if we're going to do an advanced airway class, and we need tracheas, we would buy tracheas, scalpels, Chux, all the associated expenses. The Regional Council and Program Agency cannot pay for provider reimbursement to any agency or group for costs related to refreshments and/or food served at a presentation. That's just standard and that's a State thing. We just - we can't. If this comes out of the fact that there was some presentations that were going on and part of the related costs that we were going to be asked as Program Agency was going to be asked to shoulder was the cost of feeding people, and when we found out what the cost was for feeding people, it was, oh, my god. So I just wanted to put in writing that would be there. Mr. Chairman. Yes, Mr. Ferguson. Mr. Chairman, I'd like to make a motion that we accept the policy as presented on the class reimbursement guideline. Second. Is there any discussion on this? Everybody understands? Does anybody want to see it quick before they take a quick vote? No other discussion, the motion is on the floor. All those in favor say aye. (Ayes) All those not in favor say nay. Any abstentions? Okay. The second policy which was a draft and approved by - this one was approved by the Executive Committee and was not approved by the REMAC. There were several physicians that offered objection to the policy. They felt that it was too restrictive, and they voted it down. They thought that we were overreacting and the policy was not something that was needed. Basically what it says, I'll read it - it's a process for how a program gets vetted so that the Council and the Program Agency provides the credit and the educational background for that. The proposed Continuing Medical Educational Program must be pertinent to current topics and the curriculum for either basic or advanced providers. It is preferred that the presentations should be applicable to all providers, but is recognized that for some areas such as cardiology or pharmacology this might not be feasible. 2, the topic of the CME must address topics that currently fall within the scope of the 2008 Edition of the New York State Department of Health Bureau of EMS Basic Life Support Treatment Protocols, the Finger Lakes Regional EMS Council Advanced Life Support Protocols or addressing inventory or reporting guidelines such as HIPAA. As treatment protocols ____ guidelines at the Federal, State and Regional levels are revised, CME classes will reflect these changes. 3. Any continuing medical education class that is to be sponsored by the Finger Lakes Regional EMS Council must be submitted to the Training and Education Committee for review and approval. This submission will include a copy of the presentation as well as all reference material used to develop the class. If the proposed CME covers a new skill that has been approved by the Department of Health or is part of a pilot program, the proposed curriculum and competency test, skills evaluation will be part of the presentation. 4. Training and Education will review the proposed CME for presentation for compliance with State and Regional treatment protocols, also any curriculum that might be developed to accompany the CME must meet the State and Regional guidelines. 5. If there are any discrepancies or concerns, the CME will be forwarded to the REMAC physicians for their review. If there are no discrepancies, it will be forwarded to the REMAC physician for their review and comment at their next regularly scheduled meeting. If there are no questions or concerns raised by the physicians at the meeting, the CME will be considered approved and the CME ___ will be assessed to the presentation. This assessment will reflect the amount of time for completion of both lecture and skill teaching and testing. 6. All approved continuing medical education classes will be listed on the Region's web site. 7. Regionally approved continue medical education classes that are part of a pilot program may only be taught by a regionally approved CIC. The CIC must sign off on any skills evaluation sheets that are part of the training. We were going to make one addition to that and that is physician or approved subject matter experts. We were going to add after the word CIC. Continuing medical education classes sponsored by the Region will be open to all individuals within the region. 9. The Regional Office will be responsible for advertising, presentation, finding the faculty or agency to host the presentation, provide any and all handouts and provide certificates of attendance to those at the presentation. 10. A minimum attendance of 10, a requirement of 10 individuals must be provided to the Regional Office before any regional sponsored class will be scheduled. Basically all I did was put down in writing what we've been doing all along with the exception of making a set of ways that somebody who wants to do a presentation in the region has to bring it first to Training and Ed which is evaluated by Mr. Kelly and Ms. Spink and anyone else and then it goes onto REMAC to be evaluated and get input from the physicians as well. While we've done it in the past for a lot of the topics, some of the topics have been presentations that folks have got, but anybody new who comes in now and says, hey, I've got this really dynamite presentation I want to give. It's got to come to us. It's got to go to Training and Ed. They've got to sign off on it. It's got to go to REMAC and be signed off on and then we'll do it. The concern raised by the physicians was this was going to take too much time. Candidly I would rather take the time to see that it is done right and it's not going to leave us with some problems later on because we either taught somebody brain surgery when we weren't suppose to or we missed something that needed to be included in the program. I make a motion to approve this. There's a motion to approve this from the floor. Second. Now we have a second. Open for discussion. __________ I'll make the same statement that I did in the REMAC meeting where this got quite a heated debate. That's absolutely fine for anything that the Council wants to issue CMEs for. What that does is when it goes into somebody's pilot packet, it shows the guys on the end in Troy that this has been reviewed by physicians and _____ and that it's ____. What I'll caution is that, it does not preclude somebody from doing a presentation at an agency or regionally that hasn't been through that process. The difference being that it's not their responsibility to keep copies of the curriculum and they have to _______. CME review process for recertification. It's a good way for you guys to keep tabs on what you're going to spend your money to put out there and that's what exactly what you should do. But again just I like said - you can't prevent somebody - No, I think we all understand that, but if it's going to get the regional seal on a regional CME certificate we know that it's been through our process. And I certainly encourage that, _____ financials. Mr. Wedge. I am going to vote in favor of this because I think it's the first time we've ever articulated a process for those that we offer and the approval process is going to require more than one entity in our organization so I would very strongly support it. Any other discussion? All those in favor? (Ayes) All those not in favor say nay. Any abstentions? Any other new business? I think we have one memo from - do you have that from Mr. Peters? _____. I think I made copies of that. I'll go over that while she's finding that. Let's go over to disciplinary report from the State. Three, so we won't be here all night going over it. Here we go. Surrendered effective 01/06/2010 for violations of 10NYCRR Part 800.15(b), 800.16(a), 800.16(b) and 800.16(g), Robert Cornell from 18 Norberline Lane in Old Bethpage, New York. I don't believe I have to give their EMTs numbers. Surrendered effective 01/12/2010 violation of NY10CRR Part 800.16(c), it looks like Thomas Sykora, 29 Highland Ave in Utica. Surrendered 12/15/2009 violation of 10NYCRR Part 800.15(b), 800.16(a), 800.16(b), Robert Hanson, 1259 Whitback Road, in New York, New York, that is it. Under that we have one message, if _____ on me. From Ken Beers, Canandaigua Emergency Squad is working with ______ collecting materials for Haiti relief. What they are looking for is used backboards, stretchers, immobilization equipment, splints and other surplus EMS equipment, stuff that you don't expect to ever come back. If you want to donate anything or know where they can get any of this items to send to them, please call the Canandaigua Emergency Squad base to see what you can do for them. The phone number is 394-5860 if you're interested. If you need the number again, let me know, I can give you my cell phone number. Also, they may also be looking for volunteers in February and March to go on the relief team, if you're interested in that, feel free to call the base and talk to Mr. Beers as well. (__________) Any questions about that? Leeann is finding the memo that Ken Beers sent because he was not able to attend tonight. Go ahead. While we're waiting for Leeann, Mr. Chairman, could we welcome our State representative and see if he has any words of wisdom to impart. Stay out of the snow country. That does bring one more thing up before he does that. And that is with the audit done and everything and the memo she is bringing you before we leave because I know as soon as Mr. Zastrow gives his report somebody is going to try to adjourn the meeting. He is looking to see if we can sort of come up with some sort of a budget committee. I know it's been discussed over and over again at various different meetings that we have to form a budget for the year 2010. She's going to pass that memo around. While Mr. Zastrow is discussing all the nice things that the State is doing, take a little peruse of that and we'll go from there. (___________) Actually I'll simply just encourage you to take a look on our web page, there are a number of policy statements posted recently, not the least of which go to something Mr. _____ reported in the SEMSCo report, the SEMAC and the SEMSCo did approve _____ made the change in the regulation, added a requirement for AEDs on all in-service ambulances. Now, that's AEDs on in-service ambulances who do not already have an ALS modality for defibrillation. The same thing is for epinephrine. Every BLS rig in the State will be eventually mandated to carry an epi pen or if it's an ALS rig obviously they have the ability of giving epi 1:100,000 through that modality only. It's actually out in policy statements which is not regulation and it's highly recommended because it is going to come down the pike as regulation, I'm going to a venture a guess, it takes about 18 months for the regulation to be changed because of the process that it has to go through. You think the protocol approval process is a hassle, try and get a regulation changed. And I'm going to encourage you to attend the conference because I'll be going over some of the stuff in detail __________. Thank you, Mr. Zastrow. It's nice for you to come and be a resource. Okay, everybody's got the memo in front of you. Mr. Beers couldn't attend. Nobody has any motions about it or discussions. I have some questions. Bob pointed out earlier quietly that we already have a finance committee which the treasurer is suppose to chair, what has happened to that. I mean Mr. Beers' concerns certainly are noteworthy, but shouldn't the finance committee, instead of developing a budget committee. That's a questions. It's a good question. I suggest that we table this for the next meeting when the treasurer is available and also Mr. Beers will also be available at that meeting and we can maybe go into further discussion on that. Sande? When we apply for grant money, don't we spell out our tentative expenses so that the application should also be part of your package that _______ is looking over. They'll find _______ on there. Well, in a couple, just to reiterate on this memo. The textbook where it says increase of 88%, part of that has to do with when classes start and stop. The year prior to this fiscal year that we just finished. Classes started after Labor Day so I had the books drop shipped so that they would be delivered after September 1 and the bill would be paid after September 1. The August before, for this one here, classes started at the end of August so I had to get the books drop shipped to get here the 15th of August, it's just a matter of a week or two or three for books, to be delivered, as to why there would be an increase ________. Donna, shouldn't that be a wash, if you have an expense for a textbook that went into the inventory the cost would remain the same. Therefore, it won't affect your fiscal position. Sure it will because I'm paying them out of this year, you're not going to get your money back until next year. But they are still in the inventory at the time of the audit so you still have their value. Correct, but what he's looking at just a line item, okay, do you see where I'm going, Everett? Yes. Because he's not looking at accounts receivable to see if it was reflected in accounts receivable or anything. It's just all one item _________ that just depends on when the classes start as to when they are drop shipped in. And the audit next year should show that ____ we had more money come in than usual. Maybe depending on when fall classes start, yes. Okay, it sounds like maybe what we'll do is we'll instruct the treasurer to contact Mr. Beers to see if he can answer any of the questions he has about the financial questions that he has and if there are any further questions he can bring them to the next Council meeting. Just an FYI also _______ (___________) I thought Ken was on the committee. I think that's maybe part of the problem that maybe they haven't met, they haven't talked or something. I think it's hard to answer those questions without the treasurer here. Mr. Comella would know that answer best so I think what we'll do is we'll make sure Mr. Comella gets this and tell Ken if he's got any further questions to direct them towards the Executive Committee and then go from there. I guess in response to your question about writing a budget. I know when the Program Agency writes its budget we've been basically told by the State that there will be zero income over the next three years so my budget - my proposed budget that I sent to the State has to reflect that. But it says how much you're anticipating spending on different items. And that is subject to change every quarter because I can do a budget modification every quarter if I don't fall within those numbers. The budget that I send to the State is just a ballpark of where I'm going to spend money for the next year, you know, if I spend $146,000 on one line item in the first quarter, that's it for the year. (___________) And the Department of Health has basically told us, when I submitted my last three -- the three year plan that I just submitted there was to be no increase in the budget. Right, a couple of these issues were already discussed in Executive. Executive is already satisfied with the answers and the reports. A motion to adjourn. I think Executive ________. Second. There's a motion on the floor. It's been seconded. Any other discussion? All those in favor say aye. (Ayes) Those not in favor say nay. Any abstentions?