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THE REGIONAL EMERGENCY MEDICAL SERVICES COUNCIL OF NEW YORK CITY, INC.
REGIONAL EMERGENCY MEDICAL ADVISORY COMMITTEE
MINUTES
NOVEMBER 7, 2006
The Regional Emergency Medical Advisory Committee (REMAC) of New York City met
on Tuesday, November 7, 2006 at the Offices of the Regional EMS Council of NYC, 475
Riverside Drive, Lounge, New York City.
PRESENT
ALS Committee Physician
Michael Guttenberg, DO, Secretary
BLS Committee Physician
Burn Surgeon
Christopher Freyberg, MD
Roger Yurt, MD
Emergency Department Directors
Allen Cherson, DO
Fire Department, City of New York
Medical Directors
David Prezant, MD
On Line Medical Control Physicians
John Freese, MD
Emergency Medical Technicians (Basic/Paramedic)
Christopher Swanson, EMTP
Greater New York Hospital Association
President or Non-Physician Designee
Alison Burke
Emergency Physician
Phillip Hew, MD
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THE REGIONAL EMERGENCY MEDICAL SERVICES COUNCIL OF NEW YORK CITY, INC.
STAFF
GUESTS
On Line Medical Control Physicians
Josef Schenker, MD
Lewis Marshall, JD, MD, Chair
Emergency Medical Technicians (Basic/Paramedic) (2)
Anthony Conrardy, EMTP
Medical Society of the State of New York Physician
Peter Wyer, MD
New York City Police Department Physician
Charles Martinez, MD
NYS Volunteer Ambulance & Rescue Association/ District 4 & 18 (2)
Emergency Medical Technicians (Basic/Paramedic) (2)
Donald Radenberg, EMT
Martin Grillo, EMTP
Pediatric Emergency Medicine Physician
George Foltin, MD
Regional EMS Council of New York City Physician
Arthur Cooper, MD
Nancy Benedetto, MS, AC, Executive Director Administration
Marie Diglio, EMTP, Executive Director Operations
Michelle S. Klemm, Operations Coordinator
Joseph Raneri, Emergency Preparedness Coordinator
Yedidyah Langsam, PhD., Hatzalah
Jack Quigley, FDNY
Robert DiGregorio, PharmD, LIU
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THE REGIONAL EMERGENCY MEDICAL SERVICES COUNCIL OF NEW YORK CITY, INC.
ABSENT
Debra Lu, MD, SVCMC-Manhattan
David Lobel, MD, Maimonides Medical Center
Melissa Enriquez, MD, St. Luke’s Roosevelt
Josef Schenker, MD, NY Methodist Hospital
Richard McAllan, EMS/FDNY
Emergency Department Medical Directors
Jeffrey Horwitz, DO
Lewis Kohl, DO
Emergency Department Nurses
Vacant
Vacant
Emergency Department Administrators
Clifford Miller
Vacant
Fire Department, City of New York
Commissioner or Non-Physician Designee
John Peruggia
Deputy Medical Directors
Glenn Asaeda, MD
Bradley Kaufman (excused)
On Line Medical Control Physicians (2)
David Ben-Eli, MD
Emergency Medical Technicians (Basic/Paramedic) (2)
Bruce Medjuck, EMTP
Greater New York Hospital Association
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THE REGIONAL EMERGENCY MEDICAL SERVICES COUNCIL OF NEW YORK CITY, INC.
Ambulance Service Medical Director
Heidi Cordi, MD
Emergency Department Administrators
Frank Mineo, EMTP
Josephine Imperatrice
Emergency Medical Technicians (Basic/Paramedic)
Daniel Meisels, EMTP
New York City Health & Hospitals Corporation Physician
Lorraine Giordano, MD (excused)
New York State Volunteer Ambulance & Rescue Association/District 4 & 18
Ambulance Service Medical Director
Joseph Bove, MD First Vice Chair (excused)
Psychiatric Emergency Medicine Physician
Vacant
Training & Education Committee Physician
Trauma Surgeon
Eliot Lazar, MD
Vacant
United New York Ambulance Network (UNYON)
Ambulance Service Medical Director
Vacant
Emergency Medical Technician Representatives (Basic/Paramedic)
Vacant
Vacant
Prior to the meeting, a demonstration of SmartCPR was provided by John Freese, MD
from FDNY. This demonstration provided information concerning which countries would
be involved in the study, the effect of the study on the other agencies separate from the
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THE REGIONAL EMERGENCY MEDICAL SERVICES COUNCIL OF NEW YORK CITY, INC.
FDNY and if REMAC is required to make a decision concerning the study. This was
later discussed in Unfinished Business.
Dr. Lewis Marshall, Chair, opened the meeting at 6:30 PM. Dr. Marshall asked if there
were any comments or corrections to the Minutes of the October 12, 2006 meeting.
Hearing none, the Minutes were approved as written.
CORRESPONDENCE REPORT
The Offices of the Council received the following correspondence:
‣ Membership:
• The following members requested to be excused: Glenn Asaeda, MD; Jay
Reich, MD
‣ From NYS DOH:
• Public Notice from New York State Department of Health, Bureau of EMS,
Operations Unit, to be read into the REMAC Minutes of the following
enforcement actions:
Name EMT # Penalty Violation of County of
Residence
Jeffrey C.
Mondo
338694 Suspended for 3 years
effective 10/5/2006. The
suspension is stayed.
Placed on 3 years
probation effective
10/5/2006. Assessed a
civil penalty of
$1,500.00
PHL 3002 (2-b)
and 10 NYCRR
Part 800.16 (c)
Erie
Gerard T.
Mazurkiewicz
Jr.
129477 Revoked effective
10/20/06
PHL Article 30
and 10 NYCRR
Part 800
Erie
Paul V.
Corczyca
318971 Suspended for three (3)
years effective
10/20/06. The
suspension is stayed.
Placed on probation for
three (3) years effective
10/20/06. Assessed a
civil penalty of
$1,500.00
PHL 3002 (2-b)
and 10 NYCRR
Part 800.16 (c)
Erie
Norman K.
Daye
326487 Suspended for one (1)
year effective 10/16/06.
10 NYCRR
Part 800.16 (c)
Bronx
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THE REGIONAL EMERGENCY MEDICAL SERVICES COUNCIL OF NEW YORK CITY, INC.
The suspension is
stayed. Assessed a civil
penalty of $250.00
and 800.16 (d)
Hector L.
Perez, Jr.
237693 Suspended for six (6)
months effective
10/26/06. The
suspension is stayed.
Placed on probation for
(3) years effective
2/14/04. Assessed a
civil penalty of
$2,000.00
10 NYCRR
Part 800.15 (b)
and 800.16 (a)
Chautauqua
• Public Notice from New York State Department of Health, Bureau of EMS,
Operations Unit, to be read into the REMAC Minutes of the following
enforcement actions:
Name Agency # Penalty Violation of County of
Operation
Lawrence-
Cedurhurst Fire
Department
Inc.
2959 Assessed a
civil penalty of
$2,000.00
Public Health
Law Article
3005 (1)
Nassau
‣ A letter from the DOH was received to have our office verify the Level of Care
(LOC) authorizations of ambulance services in our region and to clarify the
content of written notices issued by our REMAC regarding the approvals, or
acknowledgement of change of a service’s LOC.
‣ A copy of a letter from the DOH was received regarding the Appeal of NYC
REMAC/SEMAC Approval of a Single Paramedic Staffing on Non-transporting
FDNY EMS ALS units. According to the DOH, after reviewing the record and
considering the merits of the appeals the SEMAC decision was affirmed. The
REMAC did require an evaluation of the practice upon its implementation,
rather than the typical prior evaluation.
‣ From FDNY:
• A memo was received from David Prezant, MD, Office of Medical Affairs FDNY,
regarding the Review of Asthma and BLS Albuterol Administration. This memo
also includes Asthma for BLS presentation on CD, Difficulty Breathing algorithm
for quick review for ARD and REMAC BLS Protocol #407-Asthma-for the
implementation of Albuterol.
• An email was received to state that the next Paramedic REMAC oral exam will
take place at Fort Totten, Queens on November 21, 2006 at 9am.
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THE REGIONAL EMERGENCY MEDICAL SERVICES COUNCIL OF NEW YORK CITY, INC.
‣ A letter was received from Michael Vatch, Chief Executive Officer from SeniorCare
Emergency Medical Services to advise the Regional EMS Council that effective
September 1, 2006, SeniorCare Emergency Medical Services Inc. will be
transferring all off-line Medical Direction responsibilities from Michael Guttenberg,
DO to Joseph Schenker, MD.
The Office of the Council sent the following correspondence:
‣ Agendas, Minutes and associated attachments for the October 2006 meetings.
‣ A faxed letter was sent to Michael Jeffries, EMTP to indicate he is still REMAC
certified. Mr. Jeffries lost his REMAC card.
‣ A faxed copy of the Appeal of NYC REMAC/SEMAC Approval of a Single Paramedic
Staffing on Non-transporting FDNY EMS ALS units was sent to Dr. Lewis Marshall.
‣ The following physicians were issued On Line Medical Control Cards: Jose Torres
Jr., MD and Gregorio Alvarez, MD
‣ Announcement the next Paramedic REMAC oral exam will take place at Fort Totten,
Queens on November 21, 2006 at 9am to ALS/REMAC physicians.
SUBCOMMITTEE REPORTS
Advanced Life Support Committee (Michael Guttenberg, MD, Chair)
The ALS Committee met immediately prior to REMAC. Dr. Guttenberg reported the
following:
• The ALS Committee approved C&C’s proposed criteria for physician Regional
Examiners, sent back by ALS on October 12 for clarification of distinction between
requirements for board-certified physicians and senior residents. The proposed
criteria was approved by ALS as the following in italics:
REMAC Physician Examiner Criteria
Qualification
EM Resident
non-EM
EM Attending
(Senior)
Attending
NYS Medical License X X
DEA Number X X
ACLS X X
PALS X X
OLMC Course
Completion X X X
OLMC Certification X X
Board Certification/
Board Preparation X X
- A vote was conducted and the motion was approved.
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THE REGIONAL EMERGENCY MEDICAL SERVICES COUNCIL OF NEW YORK CITY, INC.
• The ALS Committee granted permission to the C&C Committee to provide a written
funding proposal to REMAC for consulting a professional or academic exam
preparatory service to design a REMAC orals exam template to ensure validity and
defensibility of the exam. C&C will evaluate preparatory services and present a
candidate to ALS/REMAC for approval; C&C’s Review & Appeals Subcommittee will
consult with the service on development of the exam format.
- A vote was conducted and the motion was approved.
• The ALS Committee voted to allow the REMAC Liaison to provide courtesy
notification of impending REMAC expiration to paramedics, while reminding them of
their responsibility to maintain certification. On the first business day of each month,
the Liaison will identify paramedics whose REMAC certifications will expire the
following month but have not registered for the next Refresher exam. The Liaison will
send to these paramedics a reminder to register for a Refresher exam, via postal mail
to their last known address (see attached form letter).
- A vote was conducted and the motion was approved.
The next meeting of the ALS Subcommittee will be on Tuesday, January 23, 2007 @
5:00 hours at 475 Riverside Drive, New York, New York.
REGIONAL COUNCIL UPDATE
The Regional Emergency Medical Services Council of New York City met on October
24, 2006.
The Council voted on Three Transfers of Operating Authorities:
• St. Vincent’s Catholic Medical Centers (Staten Island campus) Hospital EMS
(0584) to Richmond University Medical Center
• St. Johns Queens Hospital EMS (0584) to Caritas Health Care Inc.
• Mary Immaculate Hospital EMS (0584) to Caritas Health Care Inc.
The three hospitals will have certificates that clarify that they will be operating in their
original territories.
The next meeting is scheduled for November 28, 2006 at 475 Riverside Drive, New
York, New York.
JOINT REGIONAL COUNCIL/REMAC QUALITY IMPROVEMENT COMMITTEE UPDATE
The members of the QA Committee did not attend the scheduled meeting. According to
Marie Diglio, the committee has not met since last year. Marie Diglio is attempting to
organize a meeting of all members.
The next meeting is scheduled for November 16, 2006.
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THE REGIONAL EMERGENCY MEDICAL SERVICES COUNCIL OF NEW YORK CITY, INC.
STATE EMS COUNCIL/SEMAC UPDATE
The next SEMAC/State EMS Council meeting will be held on December 13 th and 14 th ,
2006.
UNFINISHED BUSINESS
• SEMAC has upheld REMAC’s decision regarding the Appeal of Single Paramedics
in a non-transporting unit.
SmartCPR
The Committee later discussed the SmartCPR presentation that was provided by Dr.
John Freese prior to the meeting. He discussed the “method of logic” that the machine
uses to determine if CPR or a shock is advisable first. He also discussed the various
countries that FDNY will be participating with in the study. The FDNY is still waiting on
approval from IRB to participate. Also, some of the concerns that developed from the
presentation are as follows:
1. How will the FDNY obtain data from other agencies?
2. Does REMAC have to approve research studies in our territory?
3. Is the proposed SmartCPR addition a protocol change?
- After discussion, a motion was made to approve the study contingent upon pending
IRB approval with the intended protocol change to remain in effect for the duration of
the study. Upon completion of the study, the committee agrees to consider a regional
change in protocol. A vote was conducted and the committee voted unanimously to
approve the motion.
• A TAG was created to determine what REMAC Research Guidelines should be. The
members involved are: Dr. Wyre, Dr. Prezant, Dr. Cooper, Dr. Langsam, and Alison
Burke.
EMT and Paramedic Recertification Cycle
A suggestion was made to have REMAC move forward to align the three-year and fiveyear
recertification cycle for EMTS and Paramedics.
According to Dr. Cooper, this is a major opportunity for a research project that can lead
us to better educating EMTs and Paramedics.
Dr. Prezant stated that FDNY had two goals in mind when conducting the five-year
cycle. One of the primary goals was the monetary concerns that develop from having an
employee out of work to take classes. However, FDNY also understands that there are
hidden costs, such as providing CME’s every month and determining which CME’s are
applicable to EMTs and Paramedics. Also, they have to prepare drills and figure out a
way to have on-duty EMTs/Paramedics respond.
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THE REGIONAL EMERGENCY MEDICAL SERVICES COUNCIL OF NEW YORK CITY, INC.
NEW BUSINESS
According to Dr. Prezant, FDNY is conducting a new research study/demonstration
project that is using new carbon monoxide units. There will be no change in the
protocols. They are only collecting data for the first few months.
The REMAC Committee entered into an Executive Session to discuss the alleged
incident that took place at the August Paramedic written exam.
The meeting adjourned at 7:50 pm. The next meeting of the REMAC Committee will be
held on January 23, 2007.
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