i '!I iiiiiIii II ill', iiii -K I it! 220 iliti-es in an IIclassification and expansion or modification of fac 2 integrated fashion; components for organization and management 3 of the system, for evaluation of the system, and then for 4 1 expansion. 51 It is really a very compl.ete package that this / first project 42 present@. 0 7 Sortie comments about the individual. components of the 8package: 'ei.rst, the organization, Dr. D-Lmick, a corisu.'J --L-ai-it for 9this revic@i groul-1, is -,oroject director. It is obvi.ciis thFt he 10 !has T)rr)@,ieed the very great iri,-Detus for the de%,@elopmenlk-- the II I, entire program in Alc-@ana,. 12 Planning for the entire program is -i.n three 131First, title is a demonstration ar-o@t in the Biri,@,-iincTham 41 and then coordination of fivc e--oi-iticluotis citics, and tli 15 rest o.'L -fef L'arso,-. Cc)ti.nty, at-ila- then finally the CIIP B ag, nc)r circa. ':'.Fiat en(-,o!-,inas.,-,c:r- Uiis county arc.,,a, and further. 16 17 The of edL,.catj.OT-, has the usual@ methods O'Z. L-@,iuca4@--ioi, -lnd pul)!..-.c states, I i,, to 191 o f i.. r,- 20 i-ir..@ a;ll. a:-, L@:-@ c@-r tli ir 21 rn I '/-'2 .hey s t C.-,, C:, F" ,Irl 23ii 2 4 T"I 'r, cc - 1T.(ta-8 . 22 1 r I Training, they hope to have seven rescue units in 2 this first small area, training enough elements to staff them, 3 and have a coordinative training program in the area. They have become very much interested in mobile 4 5 primary care units, and give some interesting but usual 6 statistics on the number of deaths from coronary disease prior to getting to the hospital, the length of time it takes to get 7 8 to the hospital, the fact that emergency equipment like the local fire department 90 percent of those emergency vehic es 9 10 reach the v.Lctim they use the term "victim" in this circumstance, rather than "patient" -- in,).ess than three 11 iminutes. 12 13 So, they want to move their entire mobile coronary care units in the direction of having them instantly available, 14 staffed w.-Lth good communications with physician monitors. 15 They hope to provide eight mobile units with ET@,lTs 16 17 and ecluipifteiit for them, as well as monitoring stations that 18 are portable, with physicians n-toi-iitorin(3 them. DR. 1-iClIr@RLIS: Is ti).is telernetered monitoring 191 I I DR. BESSON: What do you mean by Two-way 201 1coi,,airitini-catiori? 21 DR. S C TILS The r)l-@ysician not )3c@ on 22 vehicle? 23 D l@ , @3 I'@ S S 0@,7 li @i o -L-h(= 241 @ce-Feder@)t Reporters, fric. 25 DR. BESSON: Yes. 2 DR. SCHERLIS:@ Purely for coronary care? DR. BESSON: No, they are emergency rescue vehicles, 3 4 but they are called coronary care unit vehicles and I suppose 5 they are equipped for more than coronary care but I can't 6 really answer your question. 7 DR. S,CHERLIS.-: This is a critical question at least 8 in my mind. 9 DR. BESSON: They are equipped for it. I don't know. 10 DR. SCliERLIS-- Maybe I can dig that up. 11 DR. BESSON: I get the impression that -- they are called coronary care unit vehicles but I think they are equipped 12 13 for that plus other emergencies. 141 They go into great detail giving plans-for ,51hospital coordination, for management, for intercommunity 16 Irelations, for legislation, for description of existing Isystems, the accomplishments in the past, and go on for 247 17 1 !Daqcs of what is really a very @qcll- tho@,Lig]-t@L. out program and --For 18 i@ 11 I,,,@hich Dr. I)iiiiick certainly deserves high grades. 19 20 Letlo- al:)out b-odgc.,t information a moment. Th" components of the budget which come to a total -- project 46, 21 this 11 22 f irs-I-- project -- 1.2 iRil.lion for the first, 1.0 for t' 23 -,(-,corLci year,139 for the third year, and a total. of .1.2 million 24 for 7c.,Pi-s arc--, town ok' cipf-,r@,tio@i@-,, i@,,oi-i't qo into to@-3 but central 251 rnf-, a - Operations requests 394,000, of which the bulk, 128,000, is made uD of salaries for project director, executive officers, 2 3 administrative officers, and so forth. And operations center equipment, equipment for 4 coronary care, 54,000. Consultant fees, 87,000. 51 The component of public information is going to be 6 7 subcontracted. It just said subcontracted to a consultant firm experienced in the field. They don't go any further than that 8 9 except to say that that amounts to $107,000. 10 Emerg6ncy medical training will be .the Dunlop 18-houd @course with three programs, 20 students each. I Mobile CCU will have monitors and two medical 12 1 13 residents, if you please, as riders on the mobile CCU vans, 14 hoping to give El@l-Ls training right on the spot, as well as 15@ providing medical care. 16 The $30,000 that they have prograi,%med for two second-year residents as r@,,,Onitoi-sf two second-year residents as 17, -ve some question a)Dout that. I am 181 riders on these th4-rgE,, I ha 1 19 not sure that this is the qu(-@stioi-i raised here on our funding sheet, tuition charges sl,,,ould be disallowed 'Lo-- project 46. 20 so, that refers to aiac)tlier one, I don It know. 21 They speak of ca"c,(-@r 1,3ddc,,rs i,-,ov'-nff, there. People 22 1 1up in tlic-, junic-),- college svsteii f rr)ri 1'.I",,Ts to higher things ax,,d 23 ti-,e-y ho.-)@ to p@--v Fc;Tne. 241 @ce,-Fedetal Repofteis, life.inc,).,%.rc questions ziboi.).t. BLi-t if it,, i,@@ 7,lith 25,1 22 4 mea I guess it is okay with me. 2 They have a program for rescue training which I th 4 nk 3 is all right, communications. They have some 80,000 -- purchase 4 and maintain system over a three-year period, that is going to 5 come to approximately 80,000. 6 Transportation, they want to buy eight ambulances for 7 112,000, and pay 48 EMTS, 75 percent of their salary while they 8 were on a training basis and the ambulance people, will pay 20 9 percent of their salarv, and that comes to a total of $82,000. 101 So that while this is an extremely ambitious program,, 11 lit is very comprehensive, and it is very ambitious fiscally. 12 I would grade the program as a 4.5 or a 5. I think 13 lit is a very comprehensive program. I will defer making a 14 decision on numbers unless you force me to. 15 DR. - SCIIERLIS,. I won't force you to do anything. 16 We will need numbers 171 DR. DESS014: Do I need a secondary revi@,iqer on that? DR. SCIIEPJIS: Let's have a secondary ravisher of 19 tha@. nroiect, if \.,.e might, Dr. Roth. Do you have any comments zu DR. ROTII- No, I have nc)thii7ig to add. I five to 21 adm-'@-t t'ilit I cli(i i)ot have these N,7:i-th me. I had 80 T-)o-,,inds of 22 these things the du,,, I-)c,-core I left to go to the @,jest coast ajid g 4a, and then -Llr-) Texas, and then here c). 23 back to Gcior nd I just cou@.cin't (-@irr,,, the-r,-t. 241 ce-Fe,deial Reportf,,rs, I-,ic. 25 C; I E PI ire cc@rt@,ii-ri mea--12 225 you can clarify. We'll get to that, I guess. CR 6307 End #19 2 DR. BESSON: We can take them up separately. 3 4 5 6 7 8 9 10 1 2 131 14 15 ]6i 17@ 181 19 20 211 22 23 24 Fedoi?l Repo@tcis, Inc. 25', CR.6307 226 20 ik 1 DR. SCIIER.ruIS: What is your funding recommendation on this, then? 2 3 DR. BESSO'LI: You want a funding recommendations I will bring that up in context of the project 43. 4 5 DR. SCHERLIS: Fine, however, you prefer doing that. DR. BESSON: Project 43 is an entirely different 6@ 7 kettle of fish and it is a very elusive proposal. I spent 8 several hours before I got the drift of it and I may not have 9 it right yet. It apparently begins historically with a 1964 10 State Department of Ilealth medical self-help training course 11 which tried to improve training of individuals and also set 12 up an ambulance training program. Ai-id then 1967, Binxi.-Lngham developed an EIIS committee which Nvas chaired by Diinic)@. 13 14 1968, the State Ilealtli Dep;artm,,@nt did a survey of L;MS and 15 reco Lm-.ic-iided so,-is legislation regarding In 1970, 16 apparently the T?,!Zgiolial lliad-@(ial Progr,-ty,-, discovered Diilic],@, 17 following a study of car(fi.,ac effo@ts by the I univer-@.-)..ty tha;-_ l@ller, )Decpri@e in. Tl,,ey 181 19 becaxrc. ifi,vol.Nfed tl-ic4,n, a of card,-@-@c and that to v(-@ry deel@ :;..n E$IS. T'.-,ey set ul@ 201 in oti@iei- area,,.3 e 21 1 _,yen to coo kiy@.att oi:,;@ E@.@IS 22 tilt,, in 1971 @-I;Lt 2 @j C "t r -1"@ I" L pb-z:-;,F age. of ;@.@in a C t \@714 t I-). c, @i c))" i 241 cc-Fed,,-ial Repottefs, Inc. of 251 eak ,2 22 7 I ambulances. They said, well, if we have to develop standards 2 for ambulances we'd better get some advisory committees so 3 they appointed a statewide advisory committee which was also 4 chaired by Dimick, and his impetus then led them to move 5 from the development of ambulance regulations and standards 6 as authority for this act to the establishment of an interest 7 on a statewide basis in training programs, communications, tran;- 8 portation, and equipment. 9 Now, this program, then, is to enable the State 10 Department of Public Health, via this extended authority, which 11 I they really don't have, but nonetheless it is good that they 12@ are -nvolved, to contract out these various aspects of their interest, a training program at 104,00,0, the development olr-- 13 h, 14 a demonstration area at 125,000, to provide what they call a 15 contingency fund for the development of local. EMS 16 to prov@-de training of emer(,fc@i-icy vehcj-les, to provide 17 cations and evaluation syste,,co. 18 t'ixi-tL is the Treat of -L-1-ic prc)grE,,-L, but the c, a-@-c a o--@' fuzzy edg@-@s -co it: cind if' I' %Caere to read fro-A@,@l t'sic- 191 1 -,oroprisal@ thc, in ou-,, T@@jel-t. -;,i,ys, 20 "To p).. -Lhc 21 22 ari.@i 2311 y@"1.1@@. T(@) p I)-, t 4 C'@ C, 2411 %ce - Fede @ral Reportefs, In. q,,i -p,. i @i C) I )-I and ta'c@, 25 c,- ak3 Z$ EMS.,, 2 And they say that will be accomplished by staffing 3 the Department of Public Health, beefing it up for creating 4 their division of EMS. They are developing some kind of 5 statewide plan which they are n@L. very explicit about to draft 6 regulations which will implement thig statewide act for anibu- 7 lance standards, to train the general public in medical self- 8 help, and Pjtierican Red Cross, to e>,.tend the Elir2 training of the 9 81 Dun'@op programs throuql-icut the state, hopefully, and to io contract with hospitals to develop courses for their emergency 11 room personnel, to inform the public by creating what th-ey 12 call road shows, to coordinate various agencies involved in EliS, and to develop a demonstration area which will produce 131 ,4@ full scale E'L:.IS. 151 Novi, this effort is, in their words, to complement 161 the previous project, 42. 1 L-hin)@ their budgeting progtaia is I v(--ry L(,)ose atid to,,-.ally uiiseparable, as far as I am concerned. 17; 1 1 181 1 a-r"" p a) .1 "250,0r,)O slush A'und say tl-ie--,, %,ii-il for.- worthy h e,,7 19i h 20: g to do for z,,I.l f)f 21 22 23 to I"-@i-kd and i@(-; id il@ 24 pi,L I)C@ F(@,deri@@ Reportirs, Ir, ?4, ic, o t t cI 5 2 -.4 2 29 I state health departments for t,ings that are rightly t' 2 So while we have two programs that are said to be 3 complementary, that I would be much more inclined to look to 4 program No. 42 as being the nucleus for a statewide program, 51 fund generously, and then lot it spread. 6 However, the area., 11 statewide area, has had such a 7 momentum that I would at the same time hate to discourage it 8 by not providing some fund,, for 43. So I would compromise 9 by providing some funds for Ilroject 43, the ste@.I'-ewide program,, as follows. DR. SCIIE@1,IS: 3'.s 43 the seitie at 46? 12 DR. BESSOIZ': 47. 13 DR. Thac i.s the. as 4 7 14 DR. SCI-,'ERI,,IS: 46 is the same as 42. 15 DR. H 'L 14.t 1 A Pighc . 1 6 DR. 17@ DR. S C F@ L, I S 46 is k2 ar?.ei 47 is 43. 181 DR. B L7S r2l-,ey 61.@,0,000 for t'!,Ie. 19 ve r I wc:hu@,d "Df the --v L'or the---, 20 1 1 to j.z-iat, 251,1, 00@') 21 c, 22 0 0 "j, 'V' - T:) 0 "I a,. k,.L f 23 t h,, t 24 Fed(-.ral Rcl)cttcrs, Inc. l' c,@, t c n 25 230 e ak', 5 program and an indication of 1-io,,ri the E,,','iT program is going to 2 be cost-sliared with the institutions and the ambulance services 3 that are going to use these people. 4 DR. SCIlEt@IS: Before you go into the figures, 5 could I ask Dr. 'Onse, have you had some contact with the 6 Alabama group? 7 DR. ROSE: Yes. 8 DR. SCIIERLIS: Could you answer a question I had 9 before, is this dedicated for pure. coronary care? 1 0 DR. ROSE: They do carry other equipment on the 11 vehicle but it is specifically set up for such things as -- 1 2 DR. SCHERLIS: If somebody calls and they have cl-iesti 131 pains, that ambulance goes out. 14 DR. BESSON: Yes. 15 DR. SCIIERLIS: Suppose somebody else has call, 16 the -ti(al,ii.cle does not go ou-L. for that-? 17 DR. BESSON: It does go out.. 18 DR. Ti@ is is corcii,,a:cy 19i DR. is ;-LI.SO (-,D:c;-,,7ing Ei rrf@dical rc.,si.derit, 20@ so it; c-c,,irds it is c,-(@ in o,@ di,,-LI 21 %ti@,)-Lil@d nc)-L be 22 23 24 D. II."' 1-id, w l@cc,-Fcdf,fal Repoftets, Irc,i? 251t 6 DR. BESION: 2 DR. Sfk,'IIFPJIS Is there any justification for that is 3 number of vehicles and the staff necessary for all those 4 vehicles, any justification -that they need and have 5 enough calls to make that item that can be justified in terms 6 of costs? most communities have moved away from this, the 7 concept of a dedicated vehi-IL,. That was an excellent concept 8 at the time when there were Y,,iaterials being,collated on a 9 research basis but at this title, most thinking is in terms of 10 upgrading training to other peo,ole, not to have the physicians 11 on board. it was very expensive to have this expensive a 1 2 vehicle devoted pii--rely to coronary care. I would be very -Liuch 13 in favor of eliminating what fi:a.,c@,ition of this appears to be 14@ related to that. I think tlaey have eight ifolter Av@ionics 15 tape reco-c,-,,L-rs prcis@,nt at the cos-L-. of $10 ,000. I think that 16 is gui.).ding it a. bil--@ 17 TI-icl,--e is enough riov7 froi-,i the suppoi:'-t-l@Lng 18 @;.@ve air. the, Dr. 1,7aglc-,Is 1 9 's g.@L-e@@)UP, group, You corn gc) oi-i ant,.t 20 21 D R . F, -S C) U@ ill(4 "I-i-' s in 22 -a- 23 I T T -L 24 t Rp;poftcrs, Inc. 25 T a!I-:7 justification for that number, how they picked out that 2 number. I think we can. make an arbitrary cut of this whole 3 program, I think, -t 3.2 million, although it is an excellent 4 program, that is f ar too much. 5 DR. SCHERLIS: The nearest of eight mobile ana 6 coronary care 7 DR. DESSON: The sequence of events that leads to th@ 8 justification of this is that three minute time they go to 9 great length %to point out is the time that fire departments 10 can get to a person, end thev figure the number of lives that I I they can save if they can match that kind of distance lill.lether 12 it is cost effective or not,-I have my doubt. DR. GIIIBLL: That points ou-L the basic flaw. 13 "arice systef@t performing Why 14 Let's use the ariibu. 151 build eight special @.rtibul.aiices? lqhy )iiiiiiic it when you can -L@c,c- @-i-h,-it you hEzve? .'L thi,-L)-. that is th,@ basic of the pro-- 161 I - 17 PO.7, al. I I sliow ag.@c I D,-.' . G i1). 19' 2 0 C C L@;--@ -L. 1, f p ',2 21 E-, (Jr,, C),@@ ties l@'Ci (7) -1 1 i 22 n i-i @i 231 24 25@ c al,, 2 3 3 they have gone that route. 2 DR. BESSO',I: I i-inOterstand what you are saying. 3 DR. SCIIERLI@-: Bc(,,,ause I tlij.n),: a few years ago this 4 would have been something that would have been looked at with 5 a great deal of interest but certainly for the last few years 6 the emphasis has not been on the dedic,3,ted vehicle but an 7 upgrading of existing emergency systems. And this is why 8 that rosy glow that you imply pervades Alabwna might be fa(5.i.ng 9 a bit. 10 Dr. Joslyn? 11 DR. JOSLYN: I was reviewing these two applications 21 and I thinl@ I feel as Dr. Besson does, that they are two quite 13 different applications, altliouc,@l-i they complementary. 1 14 share his concern abouL@ the fuzziness of the statewide, no. 43, 15 and the beauty and coml..)].eteness of the No. 42. I I feel able. 42 was dc-sigi-i@-CA for co,nplc@te ft-@.d 4 ng at tl'l,-- 16 17 @3.5 lcvel ar,(J I -v7@.s d,@,sign@d to be s@mi.tted u,- ' ; '., 1 8 i --s I cannot jud@3-c-@ they rc@al.'ty ct.--,d us to fvti-3.d or it -1k.-o to 19 you are 'they or @,v 20i I 21 a II 'L cl 0 y s Li 1) 22 tc; C)"G" C.L 23 Ei 24 ,,e- Federal C,. 25i 2 34 a]-, talk about this. It is designed for a complete system in 2 Birmingli-@rt and a few areas right next door. I think that is 3 the reason there are two applications, because the second 4 application, as Dr. Besson pointed out, comes from a completely 5 different point of view. It is more of a gr-ass roots, 0 broad based application that is having trouble knowing exactl,,, 71 where it is or what they need because they don't have the 8 expertise and the quality. 1-uid I just wondered whether P,!,:Ps 9 is in any position to fund the Dirriiixigliam one, since the 101 BirminglizM application says right off, they have a super!D 11 EMS system right now, far bett,.E-,r tYia),i most placp-s in the 12 coui-ijL-.ry. They just want to it perfect and they 13 re F@,3k4,-icT Grant to ans@,.,er soictc- of the that people c-2@ 14@ a:Dout, you know, what is the direction we are- going. 15 DR. SCII)L RIJTS: I think -- am t' 16 DR. JOSIzYI4: I don't 3@xiov,,. OA-,t 171 "ii temple; of-- the of the@;e. t@,7o c,, a,, i bo-Lh -Lhc-t@r,.i aii(@L ic)4t,":'-@ 19 20ii us 0 21 1 'r L t.)@-Z".T@.LVe 22 a@n nc.-@il-. c)f z,, bacteria c)-@@ 23 24 I RC-por tets, Inc. et @o 25 I to t,l li, f@ :L 235 c,R 6 3 0 7 Take 21 dw 1 1 DR. SCHERLIS: What steps of the total program 2 do they actually cover? 3 We have heard a great deal about the transporta- 4 tion system. 5 You said it is a total e-rtiergency system? 6 DR. JOSLYN: In Birmingham? 7 DR. SCliERLIS: What else is incorporated? 8 DR. BESSO.N: Employee training, public information 9 and consumer education. 10 DR. JOSLYN: Transportation. 11 DR. BESSON: Transportation and communication. 12 DR. JOSLYN: Re cue operations. They are talking 13 about developing a career I.eCi'dcr. 14 DR. SCHEIR-LIS: WI@ici'l the ai-nbialance is called, it is 15 frofji the nearest hospital, -Ls that correct? 16 DR. Br@'SSON: Not necessarily. 17@ DR. JOSLYN: The@, a3-e go@-iig to look at all of 181 Birrni),ighEm and dE-cidc! @,,Iier(.@ exactly ai-@t!Dtilai-ices need to be I 19 @,2.acc.@(3 I,(-.) give the best, i.i,i tiric, coverage, if I 20 21 DR. SC'@ll@'Y,"L--YS Are err,(--r@,,-ency i-oonis part of the 22 23 DR. JOSL@"p@: TI-i(-,,.-c-@ much emphasis on t . 24 e c@ 1: q E, y fl,epoitc(s, Ific. 25 DR. J@C)S7t":III E,@ cl E@,,id iTiFtybe 23 6 d'w2 could help me with this. 2 I had the impression most of these ambulances 3 related to one emergency rocm. DR. SCHERLIS: This is what I was driving at. 4 5 DR. ROTH: Since I did not have a chance to go 6 into this in depth, I don't want to prolong this 7 discussion, but this relates in a fascinating fashion to me 8 to the opportunity that some of us had to go into depth in 9 the Russian plan, with its dedicated vehicles of eight 10 varieties. 11 I might say that I believe this is more coronary 12 emergency units than. supply the whole City of Moscow. But the figures that come out from the Russian system in terms 13 14 of theri. salvage rate, and so on, are fantastically good, if 15 we can believe them, you know. 16 We are involved in trying to get some knowledgeable 17 people from this country who l-,no@i ouil, results, in taking the 18 ar.-,'@ularLce out and the back to the source 19 of expertise, as contracted to the Russian. system which -Ls @La.k@-ng 'the c-,x-,r3r"--ise with 20 21 Thr@y ha@7,@, physicians and the t)---ain,@d 22 speci-a3..-I-E-,ts on each oi-..c, of emerg(-@lic,,@7 types of cambul,a.llccs 23 And to me, this is a-ri i.i-inova@-,J-'@,,e of this thing, @i,3 a to 241 ,',.ce-Fedefal reporters, Inc. 25 237 dw 3 I I think it would be awfully interesting to see 2 this sort of thing done. 3 DR. GIMBLE: It has been done 20 or 30 times in 4 the last five years, there are similar projects of this 5 nature, currently funded in this country. 6 DR. SCIIERLIS: This is the thing that troubles me. 7 And that is, with the health dollar for emergency services 8 available, the supply we have, I would rather they spoke to 9 a transportation system where they upgrade the existing 10 emergency staff to handle cardiovascular emergencies as well 11 as otehrs rather than going into the dedicated group, because 121 there are a lot of second thoughts, I think. 13 The lives are saved, I grant that, but I don't @.1-ii.n@ 14 they have to be saved by a dedicated vehicle. I thin),, this 15 is overkill, or oversave, I gu!ss is a better word. 16 DR. BESSON: May I a motion? 17 DR. SCHEII'LIS: k-ly other concern is -- May I bring 18 this up? 19 DR. BESSO',"4: Yes. 20 DR. SCIJIE'E'@LI"@ .@ici scaianii-i@l tli.i-s, you !,,avc qoi- tlll-oUg 1-1 4 tI don't see _@l-.e@7 relate to tl)e problem 21 0 221 bringing this individual w".r) i.s gel--tirig cardiopulmonary 23 rE:@z-,uL-,ci-tal-ic)r, into the eriercic.@,ic-,, roopi. I,.7hat happens in the Cy @--C)Olll? 24 r @ c; ri ce-Fedefal i-@p-pc)rters, l@ic. DR. ]-')ESSO.@\'@ it 25 d@ 4 I DR. SCHERLIS: If the staff can't carry on the 2 emergency service, if they aren't geared to handle it, this 0 3 is why we are talking about a system of care under a 4 regional medical program. 5 We are looking at a system, not at this phase 6 of transportation. You will frustrate every emergency 7 technician unless you have a system built into it of a 8 continuum of care. 9 DR. BESSON: I don't pick up where they take over 10 as soon as TER is mentioned. 11 DR. ROSE: I think this might be part of the 12 constraings of the contract program again. 13 DR. SCHERLIS: Let them have their constraings. I 14 don't think we have ours. 15 Dr. Matory? 16 DR. Y@TORY: So far as the emergency serV4Ce is 17 concerned, one of the problems they have is that a.significant 18 number of the 13 hospitals in Birmingham do no@t-. have emergency 19 rooms. And I am not sure but what that may fortify that need for havina better ambulance capaiDi.l.it-ies. 20 1 21 DR. SCHERLIS: The point I would make that if they spoke of asystem of having transportation -- decided they 22 23 would have three or four emergency rooms in that system and 241 ac@arc--,d, -@-,o han@ll.c- -thc catastrophe when it was brought there, ce-Fedetal Reporters, Inc. I would subscribe to this as being a way of upgrading it. 25 239 dw 5 1 But if they are just isolating this and having an 2 academic approach in one area and zero elsewhere, it isn't a 3 system. 4 DR. MATORY: I think they lean towards that 5 because they speak of strengthening the categorization 6 principle. 7 One other thing, I was just wondering if perhaps, 8 could I offer the alternative of instead of wiping out all 9 of the coronary care units, perhaps there may be some 10 proportion, one, two, that remain as part of that 11 demonstration. DR. SCHERLIS: Dr. Bosson? 12 DR. BESSON: I think that is a reasonable 13 14 approach. I share your concern about this degree of money 15 on a program which doesn't need demonstration. 16 But there is more than just the Birmingham area 17 we are talking about, we arc -talking about a five-city 18 area, and eventually a larger conglomeration of maybe three 19 counties, is that correct, or five counties. DR. JOSLYN: Aren"L- these five cities suburbs? 20 DR. SCliERLIS: It is Greater Birmingham we are 21 talking about. 22 23 DR. JOSLYN: The counties, as I got it to mean, 24 are the counties in proper, tapering off, the @ce- Federal Reporters, Inc.Iloca:L- directly around it. 25@ 24 0 (iw6 DR. BES@-ON: I don't know what the geographic 2 area is that these mobile CCUs are going to address, but 3 I would be personally happy to cut down both on the number, and maybe if we think in terms of two rather than eight, at 4 5 least it is the equivalent of what Moscow has. That might 6 be an approach. I don't know what else, 7 DR. SCHERLIS: The Chair would vigorously oppose 8 any support of a dedicated vehicle, even one, and I am a 9 cardiologist, I would like the record to show that. 10 But having just spoken Of that, there was a 11 film that came out which was supposedly for systems of 12 care, to save a life, and having had the support of American 13 Heart, re-shot in great measure so it-addresses a total 14 system of care rather than a dedicated vehicle. 15 I think to support a dedicated vehicle concept 161 at this tire is against the whole concept of making your 171 emergency medical technicians be able to handle that type- of I situation as well as others. 181 19 This is the sort of training we are talking about. 20 This is the course of training that -is certainly 21 recommended, the only one I t@ii-nk we should support. Furthermore, if we are going to talk here about 22 231 transportation in brir-gix,.g them to emergency rooms, which I Erei-i't able to handle the !I of care necessary, you are 241 ,ce- Federal Reporters, life. going to have them just dyiy-,.() in the, emorgei-icv room instc@ad 25 dw 7 24 1 I of in the street and I don't think that is commendable as 2 an approach either.. 3 DR. BESSON: Okay. I will accede to the representative from the cardiology section, with greater 4 5 wisdom. 6 MR. MATORY: I was aware that we were fighting 7 that battle all along. 8 DR. HINMAN: Approximately 300, a little over 9 300 thousand tied up, as best I can estimate, in the dedicated 10 ambulances. 11 If you use a figure of 112 thousand for ambulances, 12 43 thousand for equipment, 95 thousand direct costs for mobile coronary care training, half of the other -- 13 14 DR. BESSON: I will let you do the figuring but 15 if that is one of the conditions for the award, I would 16 certainly go along with that. 17 DR. SCHERLIS: Anothek strong condition, they have to survey their emergency roorti,s and I think we can lay that 18 19 down, can't we survey their emergency rooms and integrate 201 that with their system of care, if any support is given. 21 I couldn't support just transportation. 22 DR. ROSE: That is a rat-l-ier massive effort in 23 itself. 24 DR. SCIIE,@,T-,IS: My c)wn fc@eli.i-ig is that this was ce - Fedeial Reportets, Inc. r)ut together for a contract and it doesn't fit over guidelines. 25 ,Z4 Z d@: 1 This is the concern I really have. 21 DR. BESSON: But on the other hand, we are 3 asked to address ourselves to this project as it is presented to us. 4 5 DR. SCHERLIS: Surely. DR. BESSON: My -recommendation, as I wrote it 6 7 down, is that we don't fund this at all and let HSMHA 8 play with it, bit that we can't do. 9 DR. SCHERLIS: Do you have a comment? 10 VOICE: I was at their RAG meeting when this was 11 discussed and it did come out, this was originally developed 121 for the contract group, and there was some discussion between the Birmingham proposal, the one down state, and during the 13 14 process of all this discussion, they agreed to submit them both places butit originally was developed for the 15 16 contract. 17 DR. SCHERLIS: It really doesn't speak for the 18 total system of care. 19 DR. BESSON: Well, it has subsystems, and if we 20 eliminate the subsystem of the mobile CCUs with ill of the additional funding that irc,-)iriges on that without giving you 21 1: a number and have you work that out, with those -ions 22 condi4L. 23 for the award, A, elimination of CCUs and B, beefing up the -)act to the EP,, @@, L. af)prc td ati leas- an inventory of ER 24 Ace - Fedeial Repotters, Inc. then I would accept that as 251 24 3 dw 9 DR. HINMAN: That would be approximately $900,000 2 for the first year. 3 DR. SCHERLIS: Dr. Joslyn? 4 DR. JOSLYN: Another question is, it seems this 5 -- although this is submitted by the state-wide RMP -- 6 addresses only Birmingham, even in Phase II and III. 7 I wonder about -- in other words, it seems to me 8 it was submitted as a contract proposal for Birmingham and 9 doesn't address the state. 10 I don't suppose it is my rule to put a condition 11 on but I wonder if one of the things, that they be.more 12 serious about the spread of this proposal to the whole 13 state. 14 I share Dr. Bessonts concern that this one is 15 more likely maybe to succeed and spread out across the 16 whole state maybe than the other one because the other one is 17 much younger and much less well formed, but I don't think in 18 the form it is presented, it addresses a state-wide EMS 19 SyStE-'M in the least, it addresses a city-wide system at a 20 sophisticated level. 21 DR. SCHERLIS: At this point you have suggested 0 22@ for Project 43 $150,000, isn't that right? 23 DR. BESSON: Right. 24 D R. li 1 N one year funding only. Ace-Federal Reporter,,,, Inc. 25! DR. SCIIEI@LIS: I have a feeling @,:Iiat you are trying I 244 ci@ 10 I I to do is come up with some sum of money for th-i-s other pro-4ect and yet we find it hard to -ustify on any of the guidelines 2 i 3 that we have followed to date. I would submit that if we support this, we are 4 5 being rather inconsistent. 6 DR. BESSON: You wanted a number. 7 DR. SCHERLIS: Some of the numbers that I ave at 8 hand are very low. 9 DR. SCHERLIS: You make your recommendation. I 10 am only functioning as a moderator, with a vote. 11 DR6 BESSON: I think we have a meeting of the 12 minds, and I think it is a double bind that we are in, and 13 we are also constrained by time. 14 So I think as a proposal, if it comes to nine 15 hundred thousand, that seems like a lot of money for the first 16 year for the City of Birmingham and we can just arbitrarily cut it from there. 17 They are going to need less central operations, 18 19 I suppose, if they are not going to have the CCUs to play 20 with, less of the transportation. DR. SCHERLIS: @iy own feeling is let this go in 2 1 22 as a contract proposal which is they drafted it for 23 because it-- doesn't fit our outlines. DR. BESSON: Can 't we de-Fer action on this and 24 ce-FedeFal Reportefs, Inc. not give a figure? 25i I 24 5 d'w 'll I DR. SCHERLIS T et's not support it. Ai 2 DR. HINMAN: What do you mean by defer action? Re- 3 fer it to the Council without recommendation? 4 DR. BESSON: Without recommendation, to integrate 5 it -- I think council can make a decision based on the 6 conditions that we apply on the award, the conditions on the 7 funding level for 43, and as far as 42 is concerned, if HSMHA 8 is not going to fund it, then I think the Council can operate 9 on the basis of the conditions that we have-offered. 10 DR. SCHERLIS: I don't think they are going to be 11 able to. 12 DR. ROSE: They won't know at the time that the 13 council meets whether HSMIIA is going to fund it or not. 14 DR. SCHERLIS: Is any of that $150,000 available 15 for general planning of an emergency medical system which 16 is where I think they are at, as I read that. 17 DR. BESSON: The 47? 18 DR. SCHERLIS: Yes. 19 DR. BESSON: They talk about a demonstration area. 20 I assume this can be th.,-- demonstration area, par 21 excellence, and I have deleted that from the proposal. 0 22 DR. HIN'P'iAN: The notes I have about 47 are one 23 year at $150,000 with the advise to sharpen the EMT cost, 24 local council.-,, -,Dublic erlucat.'Ioii, v@ith no salaries and no ce -Federal Reporters, Inc. demonstration project. 25 24 6 I DR. BESSON: Right. dw 12 2 Okay, that we can set aside. 3 Talking about 42, If the best we can do by 4 eliminating the mobile CCUs is to cut it from 1.2 to $900,000, 5 that still is -- 6 DR. SCHERLIS: I don't see what we get with that. 7 DR. BESSON: Let me just then arbitrarily give a 8 figure of $300,000, which is 25 percent of their request. 9 That is hardly consistent with the sharpness of 10 the whole proposal, but maybe I have been led astray by 11 the rhetoric. 1211 DR. SCHERLIS: Dr. McPhedran, can I get an opinion 13 from you on this? 14 DR. McPHEDRAN: I don't know how you would 15 decide -- I don't know how one decides thi@-igs like that. 16 I don't see how we are going to decide it any better in 17 council than we can decide it here. 18 I think if we make an-arbi-trary award here, that 191 council will probably be reliev-ed that we made this arbitrary 201 award and it will go in. 21 DR. SCHEPNLIS: Dr. Josl.yn? DR. JOSLYN: Chc@ckiiig back on,tl@)e demonstration 22 23 area for ilroject 47 or the state-@,,,ide one, that is to be a ru-.-,-i'@ 24 deiytons'L-Iration, which seems to me quite diff(z-,rent from ce Federal Reporters, Inc. Bi,rminc-ham. 25 247 (-I@ i3 I I am just raising that point in which we are 2 saying Birmingham can be the demonstration area for the 3 state-wide one. I think they need coordination but I am not sure 4 5 that was the point they had then they designed it. 6 DR. SCHERLIS: My own suggestion is the hard 7 one, and that is, it is a good grant request, but I don't know 8 if they are requesting it from the right people in terms of 9 what they are asking for. 10 This is my view. 11 DR. BESSON: I would like to defer action but 12 apparently we are not going to do that. 13 We are going to have action. 14 DR. SCHERLIS: If we say no, that doesn't prevent 15 them from coming in later? 16 DR. BESSON: Later when, next cycle? Three months 17 from now? 18 DR. HINiviAN: Four months, we are on a tri- 19 annual basis now .instead of quarterly. 20 DR. BESSON: Defer it to HSMIIA funding and if HSILIIA 21 doesn't fund it and review it, next cycle. DR. SCHERLIS: Vii-th the liinitationsthat we have 22 23 placed on it. It must come in as a system. DR. BESSONI: Number 47 @@ith the rec@-),mi,,ie-ndatioi-i 24 re Fedefal Repofters, Inc. that we made. 25 2 48 dw 14 DR. SCHERLIS: Dr. Rose? MR. TOOYIEY: I will second the motion. 21 DR. SCliERLIS: Yes. 3 4 DR. MATOPY: Point of information. 5 Your statement that it was not applicable to the 6 guidelines was based upon what, area involved, or what? 7 DR. SCHERLIS: I think if we are going to talk 8 about an EMS, emergency medical system, that even though you can support one phase of it, it has to be tied in, as I view 9 it, into the entire system. 10 11 And this B specifies it is to the problem of 12 one categorical area, essentially, coronary disease, without 13 the total phases of emergency room on one end, coronary care 14 unit on the other, a stratification of care in these areas, 15 following recommended TCHD contracts, and so on. 16 To me, it-establishes a high priority on one 17, limited aspect of the total emergency system, and the 18 emphasis we have had right along is that it shoulL.d not be 19 categorization. 20 This is one of the objections we have had to 21 trauma as an isolated approac'i'l, and this, again, doesn't go to coronary care and dedicated vehicles. 22 23 DR. iNL7@.T()RY: I am sure those of you who read 241 that -- I didn't read it, but I say coronary care was one of P,ce- Federal Reporters, Inc. them, and I felt it @ias to coronary care. 25 249 'I 5 1 DR. SCHERLIS: I think this was its major focus. 2 DR. BESSON: It is not its major focus. 31 DR. SCHERLIS: According to what you have mentioned, 4 it is. 5 MR. TOOMEY: He is talking about the equipment. 6 DR. BESSON: There are six or seven components, 7 as far as equipment is concerned, yes. 8 DR. HINMAN: I am uncomfortable. 9 DR. SCHERLIS: We haven't made any motion yet. 10 Would I accept separation -- 11 DR. BESSON: I am going to move adjournment. 12 DR. SCHERLIS: You recommended $300,000. 13 DR. BESSON: I recommended deferring it to the 14 next cycle if HS@IHA doesn't fund. If HSMHA funds, we are 15 off the hook, for Project 46. 16 For 47, $150,000. 3.5 for 47. 4.0. 17@ DR. ROSE: We are likely not to have that. 18 DR. HINMAN: It is possible. 19 DR. BESSON: Okay. 20 If I have to- give a mtrLc-,r, then, with all of tl-ie.. co,@-nts 2 1 that we have had, and the blush taken off this rose, -From 22 I..2, 25 percent is the figure that I suggested. 23 DR. SCHERLIS: $300,000. 241 DR. BESSON: Right. @ce- Federal Reporters, Inc. DR. SCIIERLI,@3: Is thE@re a se-ond. to tha."-".1 25@ 1 250 A dw 16 ii I DR. MC PliEDRAN: Second best one year funding. 2 DR. SCHERLIS: Who would be in favor for Project 3 42, $300,00 with a rating of 4? 4 (Chorus of ayes.) 5 DR. SCHERLIS: All right, that passes. 6 And a hundred and fifty thousand dollars for 7 Project 43. 8 DR. BESSON: Yes. 9 DR. SCHERLIS: Was that for one year? 10 DR. BESSON: Project 47, yes. 11 DR. SCHERLIS: 42 was for what? 12 DR. BESSON: One year. 13 DR. SCHERLIS: All right. 14 We now have the peculiar dilemma of having 15 several more projects to review and time having run out. I wonder what -- I know we can finish in 45 minutes, 161 17 but that cuts out the plane travel. 18 DR. HINMAN: The problem that we have is that we ha 7e 19 to go to council two weeks from today, three weeks from today, whever it is, and we have to give them some sort of 20 .4 21 answers about these applications, DR. SCHERLIS: Yes. 22 I have no problera, 23 DR. MC PHEDI-Illz',14: I can stay. 241 ,c-.e-Federal Reportets, lrc. DR. SCHERLIS: Who else has to leave? 251 1 251 dw 17 DR. ROTH: Only plane I have is 5:45. DR. SCHERLIS: All right. 2 3 And you go where? DR. ROTH: Erie, Pennsylvania. The last plane 4 5 I can get out is at 6:00. 6 DR. HINI@I: With three, -that still is some 7 representation. 8 DR. BESSON: How about you, Bob? MR. TOO@IEY: My plane leaves at 9:00, so I am 9 I 0 all right. 11 DR. SCHERLIS: Well, Dr. Roth, you are primary 12 reviewer for some of the remaining ones. DR. ROTH: Some of mine are real short. 13 end 21 14 15 16 17 18 19 211 22 23 2411 @ce- Federal Rep(,ftefs, Inc. 25 DR. SC11r,"T,-FS: @-1c, cl@c) bv on @7, . The first is eastern br,@nc.,I-i, tli@it be A2.bELny, cind so on, , 2 3 4 Arizona. lle are now on the western branch regions. 5 The first one in that area is Arizona. Arizona 6 has requested the sum of $116 thousand for one year for the xxxxxxx 7 organization and development of an ET-IS to provide accessible, 8 adequate, and appropriate emergency care to all residents of 9 Pima County. 10 It pronoses to adopt existing technology to produce 11 a comprehensive plan for development of an integrated emergency 12 medical service for Pima County, Arizona. 13 The primar@, goal will be the development of a cost- 14 accentable organizations. structure for the provision of EMS 15 fc)5@ the som-L-rural communities, and adjacent, sparsely populate 16 rural areas outside of the Tucson metropolitan area. 17 The second goal will be developing methodology for 1 18@ -Llic-, organization of s,:)ecifi-c alternatives, for the implement- 110 a-Li.oi-i in principal metro)-.)olit--an 20 The staff rerTuest is $S:') thousand, 21 f o r a 1.)r c@,@ I -,d o%@.,ii o f t 1 iud (j,@, T Ic@ c t c o s t @-, a r o @ 1 (@ 0 tlie@iif7,,-ind. The al)y)roac"i sccr,,,s 1-o bc@ -L r(@asoiial.)Ie one. It does 22 build on existing rced.-, and as they go a on@, o 23 e ,r (7-@ I-L C'@ e, -E r-L c- t 1, @:1 c@t c; u 11. I y 24i Reporters, ltic, I tilin' at t',)c-@i.r 251 tcr--5 2 79 I process .@7ill be. It is a well organized prograiii ,-,,hich will 2 co or some 350,000 population area, of something like 90 to 3 100 scTuare miles. The organization sponsoring it is the 4 University of Arizona College of medicine. They have the 5 endorsement of the Comprehensive Planning B Agency and the 6 Governor's Highway Safety Coordinator. 7 It is a rather clearly stated project. I mention 8 the figures that I did because I think, in terms of what they 9 are talking about, they are asking for a somewhat higher sum 10 of money than they might require in terms of what thev are 11 looking at. 12 I suggested that they be rated at a level of three, 13 that in terms of the funds which tliev are requesting, as I 14 said, this is just for Pima county, and A population of some 15 350,000 -- I thin!: thev are asking for an excessive sum, but I 16 @,loulcl suggest 'that they be funded to the. level of $65 thousand. 17 This is essentially the planning phase at this time, L- I a TDrofitable use of the funds. 18 One @.yh'tch I think will Le - Is there any member of staff, here, familiar -- 19 20 VC)ICL: I a.,t,@ ',I re DR. SCI'@@@-i',LIS: The Question I going to ask you 21 is a (-uestior@ in terms of the involvement of the i-)eolDle of 22 23 ""ourity. '11:3 .11,1 feelin(-, 24 ce- Federal Reporters, Inc. E,@ at look i:7, if c@iii it along (-,ssenti.@ill,,, 25 I at a plann4ng phase which is what they are lookincT at and I 2 think with the help of the people they involve in the school 3 and the act of involvement of their B Agency, they should be 4 able to get this off the ground. 5 Are there any comments as far as other members of 6 the review group are concerned. 7 Then the motion I would make has been made in terms 8 of funding at 65. 9 Is there a second? tdn 4ff24 10 DR. MCPJIIDRAN: Second. I I 12 13 14 15 1 6 17 18 1 9 20 2 1 22 23 24 c,o- -Federal Reporters, Inc. 25 1 4 1 5 9 G]v@ i'rb 1 SCT-1 DR. i.ERLIS: l@ell, we are now going to have 2 Arkansas. 3 Arkansas submitted a total of six proje--ts, which I an6 4 Mr. Toomey have been asked to review, and these are a varied @f, tttze @ll3fOOO, 0 $10,000, $33,000, $47,000 -- a total of some $307,1000. 7 If I can try to put these in some semblance of 8 order -- actually if you will look in the back page you will see 9 that it comes out to an excess of $1 million-. 10 The first speaks to establish a coordinate education m syste of emergency medical services for Arkansas, and this 12 is s(-t-tle@-I wi,th the VA hospitals. I'm trying to get these numbers in order. 14t The application to support the state--wide e,aser(,Teric 5 radical services system to include medical @-tervices counci'L, 16' consume.- education, transportation --- in other words, the I - 171 entire support. PU 181 It is designed to include some regional develorr@ien@. z 19 A preliminary worl-. scl,.edule was presented to allo,,.i time phase 20 and then prose,-t-i-L the entire methodology for this. 21 i'@tien yoii go thi7ough this, it is reallv very difficult to 22 II deteryn-i-ne exactly what is specifically requested. 23 rli Lhis is a very ar@bitious program bu-. the entire 24 i,s r"?F@il-ly very pc!t@r3-@), e@3.@gaiNized. Ar@7 1 i@,loi-it throu-ti,@ rr 25i' this felt z,c-y-:c@,tc@,d.Ly the i-ic@c,,d for a morc, (I(.,-tai--Ic-,d budget jrb2 6 0 i and more indication of exactly what was being planned. 2 The application itself to me seems to be, in a 3 word that I used for it, excessively padded. 4 It emphasizes both planning and operational activi-, 5 ties. Funds are requested for developing of a pilot project 6 as well as developing a state-wide emergency medical system 7 and both of them are heavily oriented towards the purchase 8 of hardware. 9 The salaries are something like $75,000, 10 consultants come to $76,000; the equipment to $40,000. 11 They have asked for rennovation of part of the @TA 1 21 f aci I i@ ty They have i-rclur3.ecl- rep'---cement of med,-c--! 13 supplies. 141 As I went through this, I felt -that part of it 1 15 should be supported, namely that which emphasized essentially 16@ the training aspects more than anything else, and I'll come 171 back to that as I review some of the other programs which wex,.a 18@ part of this. 19 Project 42, which again is part of this overall 20 Arkansas program, is asked for by the Arkansas Health Systems 2 1 Foui-i6,ation to improve emergency health services for a s.'- 22 county area in Arkansas. 23 The attempt is to upgrade emergency servi,(-,(@s to 24 t'.I(-@ critically-ill or orl@, i-7i-Lli.@,n -'--his e-Feder,,ii Reporfe@s, Itic. 25 but outside as well, aid tl@cy discuss this as being eclileved ii by rural involvement through the establishment of a hospital-, 21 based ambulance, regional communications system. 3 They speak of ambulances being placed in each 4 rural hospital staffed on a 24-hour basis, and this would be 5 the responsibility of the rural communities. They emphasize 6 that there is no communication transportation from the 7 rural hospitals in the six-couiity area with the local regional 8 hospital. 9 Again, the request here is in terms of a great 10 deal of funding for actual hospital personnel. Salaries come 11 to something like $95,000, mostly for this, and the equipment 12 to $60,000. 13 It is a three-year operational request which is 14 aimed at improving emergency room facilities, general 15 emergency services, major emergency services, upgrading 16 emergency services. 171 There is no really good description of just what 18j is being planned, although they do ask specific support for 191 1 emergency room personnel and equipment. I 20ii one problem here is that there is no real system 211 of care which is discussed. As you go through the sheets -- 22 and I did this to again evaluate what specific items 4,ere 231 present -- -,,ou will find that they have really not directed 241 themselves adequately to the criteria as outl,ine(i by the eliji@rat Repo.-tefr, liic.1 251 1 actual r(-@cfucsts that they had received in terms of the j 162 I outline which they should follow. 2 My feeling on this was that it was a very poor 3 request and I questioned whether any support should be given 4 to it. 5 The next one from Arkansas was again for a six- 6 county area, the development of an emergency medical services 7 system. It was for a one-year planning project. 8 This particular instance, again, it was a very 9 brief application. They only requested funds for planning 10 this in the Little Rock area. 11 The approach appeared to be a reasonable one, but 12 they had asked again for what I thought was an excessive 13 smount of funding and although they did follow the guidelines 14 more carefully, I gave this a rating over the others, but 15 again do not recommend full funding for it, and I'll give 16 the numbers on that in a moment. 17 The next request was again for Arkansas. 18 As you gather as I go through this, this is not 19 an overall, well organized project. There are bits and pieces 201 applying to different parts of the State, rather than being 21 a well-coordinated education program. 22 This one was an in-deptl-i study to determine the., 23 need and approach to emergency care and to establish such a 241 program in a 10-coiinty area. Federa I Reporters, Inc. 25 They asked for one-year support in order to plan jrb5 16 3 I an emergency medical system for '-h@s 10-county area. This 2 was given in more detail, but again, there was a lack of 3 adequate information. 4 This was a rewrite of what appeared to be a grant 5 this was a rewrite of the whole guidelines, so at least they 6 did follow the guidelines more adequately than the others had 7 but, nevertheless, there were a great many omissions. 8 There was nothing new or innovative about it. 9 I felt. there should be some support for the program because 10 it did address itself to planning, and I think they at least 11 defi_ned what their needs were. 12 The next was, again, part of a vrogram just for 13 Southeast Arkansas; in this particular one, they asked for 14 funding to establish a plan for an emergency medical service 15 system to involve the districts, 11 hospitals, establish 16 new ambulance services and upgrade those which were then in 171 operation. 181 Again, although there is evidence of a real need 19 as there is in all of these, one can't help but be impressed 201 with the fact that there is very little documentation, that 211 the application reports themselves are really very sparse. 22 And if one funds this, again it would be a 23 priority which is rather low, and I would restrict the funds Z4@ here as wc-11 fo-- the pl,,-iiin,-ng :(--Federal Ref)orters, Inc. 25 I thinl-, to move in-to any fii,.@ther step at the jrb6 164 present time would be unjustified. 2 In summary, looking at all of their applications -- MR. TOOMEY: I think you skipped one, Doctor. 4 DR. SCIIERLIS: Did I skip one? 5 MR. TOOMEY: East Arkansas Planning and Development 6 District? 7 DR. SCHERTJIS: That was omitted from mine. 8 MR. TOOMEY: okay. 9 DR. SCHERLIS: Do you want to give that? 10 MR. TOOMEY: It is a one-year planning grant or 11 the Eastern Planning District, comprised of 12 counties, 12 which is the second largest area in population of the State, 13 with 371,000 people. 14 Ambulance services in the area are operated I-)v 15 funeral homes and private concerns. The primary objective of 16@ this request is the development of a direct ambulance service 171 linked v7ith radio communication. 18 The narrative speaks to the requirement of vehicle,, 1 9 and co-,'Iliiiinicat-Lons equipmon-(. with no overall planning 201 mechanism for the formation of development of a coordinative 21 system within the district or with the state EMS plan. 22' it shows little understanding of total e,@iic-rgency 23 medical services system. The monies are requested primarily 241 for the purpose of equipment. CoiTuit,,Inity no,(--ds and resources Fedeial Repor tois, Ir, 5 2c' have not been asse@--sed. jrb7 16 5 There is no reference to linkages with the system 2 other than radio communications. 3 Of the$142,000 requested, $94,000 relates to 4 vehicles purchased, and $33,000 for communications equipment, 5 and $4,000 budgeted for training purposes. 6 DR. SCHERLIS: All in all, I was extremely 7 dissappointed with the Arkansas application. There were bits 8 and pieces. Maybe they didn't have the time, but I don't think 9 the program as finally put forth was one whi-ch really reflected 10 an overall coordinated effort and I thought the funding 11 requests were certainly --- what support might be given would be. 12 more for planning and hopefully on a more correlated basis. 13@ Yes.@ 14 VOICE: Project 45 was omitted. It did not 15 have Reg review, it was returned by the Reg for further 161 revision. 17@ DR. SCIIERLIS: Tliat's-why I don't have it. Is that 181 to be considered b,,, us or not? 1 9 VOICE: We didn',@- get it. 20 DR. SCIIERLIS: The one just reviewed is really not 21 part of our consideration; is that correct? All right. 22 23 The part just d'-@scussed is not a part of our 24 consideration, the last one reviewed, No. 45. So we have to federa I rncpoi ter$, inc. 25 consider then the o,@-her bn@c;f No. 41, which had requested rj:) ti I b t) 1 $300,000 for the first year -- is that correct? 2 Yes. My recommendation on that was a funding only 3 for planning at a rating of 2. 4 The next one, No. 42 -- my recommendation was that 5 only be funded for planning to a sum of $30,000 with a rating 6 of 2. 7 The next one, Item 42, I recommend action oh that 8 one, that there be no funding for that one. 9 No. 43, I felt that should only be supported to 10 the terms of planning. My recommendation was $25,000 there 11 with a grade of 24 12 Project 44, for which $31,000 had been requested, 13 I felt this one at least had some fuller data, and I thought 14 it should be supported for the funds requested for planning, 15 with a rating of 3. 16 No. 45 is not subject to our consideration. 17 No. 46 is. My rating on that was only for planning, 181 to a tota'L of -- what they had here, $15,600, with a grade 19 of 2. 20 Secondary reviewer? 21 lie can be wide apart on these, given the funds 22 requested, and the comnt--tericy of draftsmanship. 23 MR. TOOMEY: I was loolring at something -" as you 24 were going down the requests on the planning, I was in Fede ra I Rel)o r 1,@ i s, I n c. 25 agreement, and I figured vou were going to -- I don'-t knoi,7 L b 7 where you were. 2 DR. SCIIERLIS: Project 41, I recommended $30,000 3 for the first year with a rating of 2. 4 MR. TOOMEY: That is the $300,000? 5 DR. SCHERLIS: Yes. 6 Now,-then#" Project 42 I did not recommend being 7 funded. 8 Project 43, I recommended $25,000 with a rating 9 of 2. 10 MR. TOOMEY: That is the $45,000? 1 1 DR. SCHERLIS: Yes. 12 The request had been for 45. 13 Project 44 had requested 31, and I thought that 14 was an adequate figure for planning. I gave that a little 15 higher rating of 3. 16 No. 45 we have been asked not to consider. 171 No. 46, I agree with $15i6OO, at a rating of 2. 18 Are they about what you were going to suggest? Or 19 what was vour feeling? 201 MR. TOOMEY: I didn't make the suggestion, but I 21 would be in agreement. 22 DR. SCHERLIS: Would that be all right? 231 MR. TOOMEY: Yes. 24,1 DR. Mt@,,TORY: You have studied this a lot more !-Fedefat Reporters, I.-,C. 25 closely than I, but I @.ias a li'ttJ.(-- coricr-,rne-d in that first one, jrblu 168 I they ir@deed were setting about to begin to get some personnel 2 trained. 3 I was wondering if perhaps out of the $300,000, if 4 I am not satisfied with your justification for 5 only a tenth funding. It seems they are about to get 6 personnel training and organization. 7 DR. SCIIERLIS: What I was going to suggest was 8 this as a follow-up-recommehdation. All of this comes to over 9 $100,000 for State, and whatI thin'it should be done is that 10 the State has to put together a thoroughly coordinated program 11 to encompass emphasis on training in an overall plan. 12 What we have been given is individual plans that halve 13 very little coordination and I would think the staff comment 14 here would be that all of these should be coordinated into 15 an overall view. Because a sum of $100,000 gets to be a very 16 significant sum to work with in setting up, at this stage, 171 planning and training. 18, Would that answer your question? 19, DR. @1YEORY: Thit answers it, but I just wonder 20 what a State can do with $100,000? 1 am very much -- of 21 course, now you have the 45, and I suppose given better 22 consideration, that might ','L)c another plus. 23 But I am impressed with their realization that tliosc 24 funeral ambulances have to qc) and I don't know how we are goi 9 e-Fede,,,)l Repoftei:@, I,-ic. 25 to do unless they got, @.,onqp, fiiyicling and support. Thi.s is 1.69 I one of the big things we're all trying to get rid of. 2 DR. SCHERLIS: That is a nation-wide program, isn't 3 it? 4 DR. MKRORY: Yes. But Arkansas seems to have its 5 share. 6 DR. SCHERLIS: I am open to any suggestions. 7 DR. HINMAN: I agree with you, Bill. I haven't 8 seen the application. 91 DR. SCIIERLIS: who is familiar with the Arkansas 10 grant? 11 VOICE: I was on the site visit. Is there a 12 specific question that you would like to ask about this? 13 DR. SCHERLIS: What do you think their ability 14 is to mount this effort? What is their total funding at 15 this time, in Arkansas? 161 VOICE: 1.5. 171 DR. SCHERLIS: $1.5 million? 181 VOICE: As you know from the site visit, that was 191 rather recent, they are one of the better regional medical 20@ programs, and seem to have the capability to plan a program. 21 I suspect -- Mr. Says is the primary Staff person 22 on this, but I suspect that the time constraint had its affect 2 3 on the development of 241 DR. SCIIEIILI@@: This is one thing @,-hcit bothered men i -e-Fedet,it Repoiteis, Inc.I 1 2511 is that as you go through this, as apparently they art.? very jrbl2 170 thick brants, the requests that you deal with are very small 2 proportions of them, and one of the problems that I had in goiig 3 through them is that these were in great measure, I assume, 4 all prepared for other requests. 5 hey going to part of that $8 million? Are t 6 DR. ROSE: Yes. 7 DR. SCHERLIS: These weren't really prepared under 8 our guidelines, they were prepared for something else. While 9 one can question however one can go by this-sum, nevertheless, 10 if we are going to buy the guidelines, we have to follow them. You are right what,you can do for $100,000, you 12 certainly can't replace a'LIL '.he hearses with adequately- 13 staffed and equinned ambulances, but I would think if they 14 dolt get their other fund, at least this is a good start 15 in putting together an overall program. 16 I know their coordinator who I think is one of the 17 best I have ever had the opportunity of site visiting. 18 I am sure he can use thesc funds very adequately at ].east as @ar 19 as planning and Coming in later for implementation. 20 lie can come in in the very near future for 21 innlementation. 22 Any other comments? 23 A motion has been madE! and I guess seconded. All 241 ',-Federal Repottr-Is, Inc.Ithose in favor, say "aye." 251 1 (Chorur, of "ay(-s.") jrbl3 171 DR. SCHERLIS: Opposed? 2 DR. ROSE: Do you have an overall rating? 3 DR. SCHERLIS: The overall rating comes to 3. #14Lee 4 DR,.ROSE. 3. Okay. CR 6307 5 6 7 8 9 10 11 12 13 14 15 16 171 181 19 20 21 22 23 241 Fedefat RePofters, Inc. 25 172 CR6 3 0'7 1 5 -ter DR. SCIIEPI,IS: '\Il ric-, "Ls the next one, 2 @-Ir. Toomey. on 3 T4R. TOO@EY: This is an application from V7ashingt 4 University in St. Louis. The fu 5 nding is requested at $707 thousand for the 6 first year, 293 for the second year, $314 thousand for the 7 third year. I have a total of $1,316,000. 8 The grant application covers an eight county region 9 COI"Si,3tj.llg Of almost 50,000 square miles around and including joist. Louis. The area population is about 2.5 million people, in 1200 municipalities. DesDite their separateness, their residences arc! 12 li)i%ed to St. Louis throu(h medical services T)atternf,,@, There 13 i 14 are -Qin@7 deficiencies in medical. services because of the a. 15 200 independent, political jurisdictions. Coiiceria over the deficiencies OIL in (:-,@erc,c@ncy medical. service initiated this 16 17 Trayit request as mechaiiisj-n for coordinating the emergency me3i cal services with goveriNIr,,icn-t,-,, c,,rosc-@-sectorincj for 18 jemc-,nt 19 of tire, @-2 rr,-LcA,--@,s ooc-rat-@oi-i. 201@ The ol)ject4-,,rcs statc-,C -,in cc-ritra"k di.-@)-)a cillii-i, ,,n %,,,Iiiich i@-. urdc-,-.-,- 1) y , a 3 j.,@4 21 re 4 E-@ C C L, !7 to tl)r 1),,i 1, i.,i, cF;Clrv(,@cl, to ly ti area 22 a to L@rz,,.i.n the E'.mbu m 23 1 cl@n (-,rc"7c, to ll-,h@- Ic@vc,!. o@' @--f 3@: i.--, Si.if f ic i (-n.t i-.o ii-f H 24 > ce -Federal Re@)ot ters, Inc. m re@i@i.-tra,tion 25 ? 173 I essential equipment as defined by the American College of 2 Surgeons, to categorize hospitals and designate receiving 3 stations on the basis of emergency backup capabilities; and to 4 establish communication lii-iks between all components of the 5 emergency medical services system. 6 The plan is to be implemented in two phases. The 7 first phase of the system to become operational in the core. 8 sector of St. Louis, in addition to gathering information to 9 extend the- system to the rest of th e eight countv metropolitan 10 St. Louis area. 11 Extension of the system to the rest of the area 12 for a total emergency medical system will constitute Phase 2. 13 T-,!- proposal is a three-yc-ar funding for i:)Iiase one with imple- 14 irc-ntation of phase two, within the vear following activation 15 of Phase one. 16 In the terms of my evaluation, the a-oplicariL' demon- 17 st@-ated good kno,,.71ccig(,@ of a total E4'.!S System includinc),- how 18 the various niias(--s -,..,otild !)e i.,-@tegritec' and has noted the -,n -L';Ie. T)res,,,,,stem 1.)c-- overcoT.10@. The 19 @,,-:;ograr)liic area @,7aF; V.,-011 Z:Ly.)d the 20 is cmimuni-'@-v liacccl, @@.-ith re,-)r(.-s7,(--ntatioti of I-.)rovicl.(-,rs, 21 I oubli-c ageiic4--os, iDIcirininq acre,- 22 ,ci.,@s, and CO!-,LMunit-y interests. S n cT 23 me6i-cal. sci.-@rices have been tEkcn file 24 ,ce- Federal Reporters@ Inc. r,@ i,@ cl -i@ c; a 1 sr vc ca v,-i a 1) 1. ci i. na r o aAd O-, i. t,,i Oi Ek 1 251 resource have been identified and there is a clear assessment 2 of needs and resources based on statistics. 3 The plan makes reference to how the operating 4 components will tie together and how additions to this system 5 will be coordinated. The only weak area of the narrative 6 relates to the improvement of quality care and linkages with 7 local health care systems. The applicant onlv partially 8 describes these linkages and briefly refers to follbwun of 9 non-emergencv Patients, and community disaster planning. 10 Techniques are described for utilizing financial 11 resources, in addition to obtaining additional financial support 1 2 at the expiration of this grant. llliile this is my -- this is 1 3 iiv sur@-,Piarv. lihile there are no outstanding or innovative 14 approac'@lir-,s to the development of the EIIIS within this area, 15 the application appears to be viell conceived, a well conceived 1 6 plan, a good organizational. structure w'L lic-h @4i.11 coordi.,-int(@, 17 and adr,.,Ln3.ster the system. It i-of I(-,cts comprehensive planning 18 for @)ringing together the key and a disaster and I:','.IS 19 system,. a large r)oi--L--i-on of the crant is used for 20 21 of i-,Tiu' tlio c.,cTui.@-.)inctit. Cc@mmeiitf-@ b,@r lure.! 22 Dr. l@@ki)!-an, "Tlai,s bzi-si-cal-l-v i.@, a out 23 Tt idc@iiti-f ic@,d problems and has made an 241 a-@ t -ql s-c-.@o here i.,@ ,ce-F(,deral Repofters, Inc. 25 c) r-ic@n i-@-no -L-i D(@Tar'@i,,i(-;Pt or support (.)-f 4. 175 1 ambulances. They appear to be coming 100 percent in support 2 of ambulances in this application. 3 In their defense, however, cutting back on ambu- 411ances support would greatly woil@on the basic concept of @-his 5 proposal. There is very little attention made to the emergency 6 roont's themselves and the follm%7up area. I classified this 7 application as a verv good application. 8 Ilowever, I am concerned about the amount of funding. 9 I @-iould like to hear the discussion before I make the 10 recommendation. I 1 DR. -@l-IC Plil,]DRA@il: So am I. This was one of the. earlv 12 ones ti-iat I read rind I thoucThL" that what was described[ about 13 the ambulance service %,:as good, but that on rc,-:adina it and 14 rereading it, it really does not measure up to our no-i.onE, I- i- 15 abou-'-- af@-yster:l. 16 I think it is a well designed ambulance service and 17 tiac- amount oil -,onc,,y to )Dc@ o,,.it of that -first year budget, 18i7O7, 5'03, on c-cTui-)m(.,-iit; includin, g '-lie ambulance for 19 i3@6, 64'L -- that is ha!A@ i-,-,-lli-on dollars on t,',,L-. a-mbi).- 20 lances, and on c@,-iimur,,..c,-@ti-ons c-c.,,.uipmeiit, the emergency care 21 -.tric7. of@her -Lliat li@iv,@- to go @.11 the 22 in or@'-,'f-@r to mile @c2rvc "--]@is 2 "i And tiaore is 200,000 in Of j. oL I 1 24 -e"Fedefal Repoi!ers, Inc. cc)s@L- for ti-ic@ a, @-@ I Ia n s 2 5 El' 176 '4 I 1),,i. SCIIET?,LIS: Two ninet-y-three and 31@, in the 2 sul)seq.ueii t- years. 3 DR. I-IC PHT-'D@,N: I,Iiien I think of this amount of 4 money bcina requested for the first vear and then put it beside 5 the tri.-s3tate application, what was requested there, for the 6 first year, it seems to me that -- now I understand why I 7 feel that way in the tri-state application, because so much is 8 the development of planning, and linkages; whereas in this one, 9 a port4-on of the system, I thought was @-7011 designed, but I 10 really wonder if we ought to support it not because it is not 11 a good part of the system,, but because it is not really the 12 @'lliole s,@stem. 13 That is the wav I feel about it. I wonder whether 14 ought to support it at all because it is such a port]-on of 15 the sN@stem. That is what I am concerned about. 1 Me-an it 16 just is not the .@ihole thing. (7io not know whether the emer- gencv rooms arc going to be coordinated at 7,,ll to prepare for 17 % .ihat these ambulances will '.:)ring, for exampl(,. 18 4 tll 19 I guess they Could be l@7.L the system is (3.@sc!rj.,bod, 20 but @'@c! just do iio-L know. 21 DR. SCI@'il7,PLIS: -@ll ri.gii'L- 22 TOO)'.IEY: 1 thc)ucili'k- 3-t N,.7as well written. ',,@C t p T 23 DP,. I ) RA'@,. l.L thought it was well written, but I thoitclli,,it -J, t @,7 (i su,,@,t z3. trc)iil)'.e 24 -kce - Federal Reporters, iiic. Ts 25 17 7 DR. ROSE: Dr. Kaplan is riot here. 2 DR. SCIIERLIS: I gather there are differences of 3 opinion. V'Vlould you want to respond to this, Plr. Toomey? 4 I do not think we have had a rating yet, reallv, 5 for this. 6 T@IR. TOO@IEY- .',TY rating of the application would be 7 probably 3.5, between three and four. 8 DR. SCIIERLIS: lio@@,, do ,rou feel about it? 9 DR. MC PHEDRAN: I think for what it tries to do, 10 it is a three, but I do not triinl-, it is a system, and I do 11 not know that we ought to ratc- it .is a system. That is my 12 about it.. 13 DR. SCHERLIS: lio@-i much of it is requested for 14 planning in the overall, or isn't there any? 15 DR. ",iC PIIEDRAlq: T,,flell, I do not ti-,ink there is 16 very much. I can tell you in just a second. There is an 17 evaluation of +--Iii-- project, $30 thousand. One of the field 18 plarn@.r,-,,. total sunno--,-t is 2:ecuested for 11 4 rl 1 9 That is 17 -thousari6 direct costs, or 19 thousand 20 total, tc),jether . and socretE-,..i--i al help f o,,- the f iol.d 21 planning. 22 DR. SCII'P@LJ'S: Is .,,@iat they are go4-n@j to do 23 @3ot iin t,',,ic-2 )relinF-,-,r)j,+--al tl,-Iat cc@rr(2ct? 24 T,,@ic 4.-@3 them I vic@@,,,@ it. ce - Fedeial Repofters, l@ic. T Ci) T V Ye@. . 25 178 ter-7 DR. SCIIEI@LIS: If you are reading this summary, 2 lit certainly seems the emphasis is on that, without there being 3 further involvement of the actual provider areas. 4 Do we have a motion? 5 rl,7e lie somewhere between $700 thousand and no dollars 6 at this point, if I read it correctly. 7 MR. T00iflEY: I remember now, the personnel involved 8 in this for the first 12 months was $188 thousand. Then the 9 ambulances were 41.6 thousand. I do not see there was anything 10 specifically in the area of planning in terms of funds for 11 Ithis. 121 DR. SCIIERLIS: There is some training, is there not? 13 DR. MC PHEDRAN: Yes. 14 MR. TOOL@EY: There is considerable. 15 DR. !,,IC PllrDRAN: There is training equipment for the 16 aiii))ulanc:--- -- it seems to me there was training for the 17 ai@tl)ulan,--i@ attendants but I am not ev,@,n suy-e that that is true-. DR. SCLIERLIS: TI-iov do havc,, a du,,)licate-contra--t 181 I irequest in, acco.-(-Iiiiq to our @,7 c,, r i c c 19 20 Tl!iTDI-"Al@: Tlicv c7io'? 21 DR. I t,iiiik it ','7,i..I.l -be visited. DR. i 'LiEts i,),oL 7,oved that fir alon( 22 23 !)R. 24 .3-@3 not enough a Ace - FedErat Re-porters, Inc. -T tlic)u li- il, %.7aF-, -t as fct.@ as il- 25 i 17 9 I that it if--, reall@,r not a E,'-.IS. 2 DR. SCliERLIS: I can uiiders4k--and that. 3 DR. BESSOI@: on tli(-2 si.glit-visit, I am wondering 4 under what circumstances 5 DR. SCIIERLILS: Contract. 6 DR. BESSON: For a contract? 7 DR. l,'4t@RGULIES: Yes. 8 DR. BESSON: Is there going to be any sight-visitinq 9 of these proposals separately? 10 DR. MARGULIES: No, we would not have time for it. 11 DR. SCIIERLIS: I think what we are finding is that 12 Isome of the programs we fault, on the basis of not being a 13 system have been submitted under differc-,i-it guidelines for a 14 contract. I think this is what hung us tip on Arkansas, to 15 a certain degree. 16 We sort of try to see what -in that program is Ri@,lPs 17 guideline material, rather than I,)eing part of a system that 18 might, for exrimple, fit into the contract mechanisms. 19 DR. @@IARCULTES.- Of c-,oul--se the contrci(,-L-.s are all SU',@??-),--sed to !)c,- total E,-,7st-c@,ms. 20 2@l DR. 1,T-,SSOL'4: '.Iuch note than O'Lirs. DR. @1,17kRGULI'ES: So the criti.vi-sm@3 I just heard 22 23 i@e 'to 24, 0 I -E i',b mur--Ikl the c:e -Federal Reportels, Inc. in 4"li.,.-@ 1.),Lit thev h,.ivo 251 18 0 I gotten a large number -- practically every group possible, 2 together. The mayors of the different muncipalities, the 3 different civic groups, they have done some nlanning. As I 4 say, I cannot speak for what shows up in the application, but 5 they have been working on this, and the experimental health 6 system application for plannin( for St. Loui.s.has been approv(--d, 7 and there is some tieuT) between the two applicant agencies of 8 these two. 9 DR. IIEiNDRYSO,'.!: @'4ay I ask one que'st4-on about this? I 0 DR. SCIIEPLIS: Yes. 11 DR. IIEI,7DRYSO',:4: Is there any evidence of any community 12 funCii2,-,cf, joint funding, local funding, to go with this plan? 13 DR. SCHERLIO-: Does anybody have a comment? 14 DR. l@IC PITIEDP\IN: IZo, I did not sec., any evidence of 15 that. DR. SCIlEi@,'"IS ol,,ay. 16 17@, Dj@ .T.'@C PJIT'@DPAN: And as it was pointed out -in Dr. ,8 note, tlierc-,@ might be o'-her sources -f-cr goti-.incl, them I.ookc-,d into, but not spoken o-f-- in the 19 20 21 DP,. SCI-@El'@l,!S: -think our ci.-iteri-a liavc-@ tc-, i.ncludc@ 22 23 Yc-,s? 241 D T-,, @7'@ 71,' Ir. tr-) T):r. e - Fedeial Reporteis, Inc. @ 25 Z-icc(7,rui,ng to Dr. Caplan's lie ",,Fes" t',,ie 181 first three Questions of financial support, which had to do with 2 utilization of other potential funds. 3 DR. SClIr-@'RLI-D: Yes? 4 DP,. ROSE: I do not have anything. 5 DR. SCHERLIS: Do we have a recommendation from one 6 of the reviewers so we can move ahead on this? 7 DIR. TOO,"@IE-Y: All right. I am a little bit hungup 8 on the fact that despite what you said, Dr. Margulies, as far 9 as total systems are concerned, @@re have also looked at, and 10 it savs in the guidelines, to look at systems and subsystems, 11 and I look upon this as part of the subsystem. 12 I also remembered being concerned with the amount 13 of money being put in for the ambulances. I also did check 14 bacl@, and there is provision for training people for a period 15 of @somc-@,7here in the neighborhood of five or six hundred I?eoi,? c durin,,i the course of tile three vc@ars -J'or this particular 16 program. And im@ nrobl-ei-,i is the saT-,,c thinc eiied up 17 @j that @,7@is op ,8 iiid that' is, the is dependent upon the 19 ambulances and to ',.i-.ve t'l@ic, Pe(,-Pl.e @,@i..tliout the imb-Lil,-n(-,(,-.c; really ,,,-) ld ruin the j-)rojecl- u 20 I do not YOU --i,t bacl,: in terms of the 21 i-i-icit this i.@- a total subEi-kist-.c.,-l tli(@- who Cy t'TI. 22 fact 4- s cl, 23 I :Ic) not see lioT.@,, vou pick I-)iecc@ of it. This if, my . ZIV@,@ 4 24 ce-Federal Repoiteis, Inc. reco)-Imc@ndincT Ei gr-a,'Il-nj foi- it of 3--1/2 'or 4, sortio@,,7here 25 182 I in that range, as a project. But I do not knout how to piclz 2 out the dollars for it. 3 DR. MC PHEDRPlq: Could ,,7e not recommend that they 4 try to get support for some of this equipment elsewhere? 5 I mean, at least that would help out some, if they could get 6 some from the Department of Transportdtion? -Could they not 7 do that? Is that not conceivable? 8 DR. SCIIERLIS: And then what recommendations would 9 you mal,:e? Let us assume if they could get the equipment else- I 0where, what would you say? I I DR. @',IC PHEDPTN: It still is not an emergency 12 mcl(licELl system. That is what you arc-- trying to tell me? 13 DR. SCIIERLIS: No, I am not. 14 DR. MC PHEDRAN: But I feel that way about it, it is 15 a real problem. 16 i:,'@R.@ TOO@lil,@@'Y I recommend approval of funding on -- 17 with the contingency that thc--v ,;r-,cure the funds for ambulances 18 19 DR. E;C!!Ej.@LIS: concern is iL wci tal.k about the 700 we talk the 800, t',L@Lt is one r)oj.i-it five, and 201 1 21 that i@3 a good fraction of the total available, and if they 22 go 1.)%, our ,@tric-L raiil-,ii-ig, that ist -%nr 23 i -1 'that would exhaust i,,iost of the funds. D.c@'. '.IC @say, sL,.t-),,-@ort the 241 ,c,e-Fedetal Reporters, Inc. 25 for., t,ic- -Fi,rst year if can cT(:@t-- the 18 3 -ter-12 I they can come back and see about the second or third year. 21 DR. SCITERLIS: I doubt if they would have time to 3 gear up to get the equipment in that period of time. 4 DR. MC PHEDRAN: You do not think so? 5 DR. 1,TARGULIES: It just depends on how far they 6 have gone with DOT, what the potentialities are. If they 7 can get it here, like all these situations, they are not going 8 to get there. I think we can easily find out how far thev 9 could go in the other direction. 10 DR. SCHERLIS: lqell, the recommendation 11 DR. MC PHEDRAN: I would favor sup .F)c)rting it for 12 just a year to support the personnel costs. Maybe they -- I 13 do not know whether all of the kinds of personnel they described 14 would really be useable under these circumstances if they did 15 not leave the equipment, but supposing, for example, they had -- 1 6 th(--@y ,,,anted to get the project director and secretarial sup@Dort, 17 1 @@.11-10 @,7ould -- or the planner, @.!hoov(-,r @iould be required; to see 18 sources al@' funds could 1-c@ taT.)pc-d for getting the 19 0 T-)rl c-, n r a y,@Nar, and see I .,could sur),)@-.rt that f@') 20 'I 21 (j@, after tliEit. This ir@ the )@@in6, of ar@- h I would favor. @)r ()ac 22 TOOj-'@f-'Y: I think the contc@,".t of the 23 -rc,@5,Durcc@:3 that they ticre are steps that can be @o i,.ia'j@--, a r c% i--i s y s t c,,-,,L out of it. Al-iO, 1 24 ,ce- Federal Reporters, Inc. -e l@i,tli Dr. 25 r @,, -,' 18 4 1 DR. SC17ERLIS: You mean --- we still do not have a 2@number on that, though. This is one of the problems that I 3 have. 4 DR. MC PIIEDRAlq: Okay. 5 MR. TOO!.IEY: You have 188,000? 6 DR. MC PIIEDRAN: That is their total personnel 7 request, which includes a project director at a total of fortv 8 grand, a jeep dispatcher for 15 and a half, ten dispatchers, 9 for a total of 100 they cannot use them all. lle do not 10 have the ambulances. The dispatchers, we cannot use. The 11 secretary, he can use. 12 DR. SCIIAERLIS: I share the concern about putting all 13 this amount of money into one aspect of a system of care with- 14 out putting significant funds into the total planning, a,,-id what 15 happens when these patients hit the emergency room, and hit 16 the rest of the medical echelons of care. 171 Now, really, DR. @',C PIIEDI@'IVT: lio@,7 a out s@Lil@norti-27ic the I)rojc-@ct 18 -3 cli-rec4-or and sc@cretar4al hel tl-i@it i.F,; 43,000, and a field 19 20 z-vstc@,-i,@ r)].@iriner, 20,00,0, t", at N,7oul@, about $70 tl).ouszii-,,d, 2 1a!3- toc.-TeL'hc-r. DR. SCIIE@P\L!S: Even if vc)u raised 100,000, in terms 22 0 at least 1,7orkir.,-j on i s@,rt(@m or' care, this, I thin'j,,- ,,jould 23 241 i ,-,e- Federal Reporters, liic. some 25i I I 185 r - 1 MP,. TOO'.IEY: I thin'., tlic@v have 52,000 down here, as 2 I read it. is 3 DR. SCHERLIS: That comes to about 150. 4 DR. DESSON: A procedural question, Mr. Chairmai-i. 5 If we are arguing about hiring secretaries and 6 dispatchers for each application, we would not get anywhere. 7 DR. SCIIERLIS: I agree. I am trying to say that 8 700,000 seems lil-,e an inordinate number. 9 DR. MRGULIES: If I understand what you are saving, 1 0 7'1-1 a 'L --you are talking about -- giving thein whatever is necessary I Ito extend their planning and develo,) a fuller s@Irste-n; and :L 12 1tli(-%r can Simplify it in -,or@ie otl-icr- why.. rL-inc,, bi,,,t- if your want 13 to talk in those terms, and cive us freedom to i-ic-cotiatc-,, 14 a reasonable level 15 DR. SCIIERLIS: We arc! tall-king about a sum of 150 16 tliousard to 200 thousand, at a rating of three? 17 Is that satisfactory? 18 D2,. ','C Sr'IIT-' 19 DR. All ti-iosc@ in favor, say ",.eye. 20 (cliorus of a,,,es.) 21 Di'@'. SI'TT@'@j,-, @@ll ri( I t. 22 T.,@To@,i, iriteri.-,ount@i-i.j-i arc@a@, IJT'cc)i,,iciv -Irid Dr . 111-15 23 241 ce -Federal Reporters, Inc.I 25i 1 281 Swl I DR. SCliEPLIS: Any further discussion? 21 All right. I glaess that, takes care of Arizona. 0 Next is Hawaii. 4 DR. HINMAN: California. 5 DR. SCHERLIS: I am sorry, California. > 6 Mr. Toomey. 71 MR. TOOMEY: California has two projects,that they > 8 are proposing. The first one I have here in front of me is the 91 South Central,Multipurpose Health Services Corporation.- project,-. 10 iio.-,92, withsfund3.ng requested of $292,000 in the first year, 11 $309,000 in the second year, and $291,000 in the third year. 12 The grant covers 33 square miles in central Los 13 Angeles, a population of 330,000, 80 percent black, 10 percent 14 Mexican American, 10 percent other groups. 151 Between 30 and 35 percent of the families receive 16 welfare assistance, 40 percent are in the income category of 17 $4,000 annually. 181 The median age is 24 years with unemployment of 40 19 percent for males, ages 16 through 19 years, while 15 to 20 20 percent for males ovet age 20. 21 The median educational level is eight years, eiait 22@ years of school. 231 Infant and neonatal death rate in the target areas 24@ are the second and th4-rd Iiiglie,,3t in then country. ice.-Ff-,detal Rer.)oitefs, Inc. It is a povertyarea and medicably under served-v74-th 25 2 8 2 sw2 I a considerable deficit in the emergency services. The bulk 2 of the emergency care is provided by USC, L.A. County General 3 Hospital, Harvard General Hospital, and the new Martin Luther 4 King Hospital with which support from the grant will provide 5 facilities and services. 6 The objectives of this application are the estab- 7 lishment of a neighborhood treatment and transportation service 8 through development of a four-pronged effort., which will 9 include providing improved emergency services by coordinating 10 emergency services now existing, optimal use of existing 11 emergency personnel, consultation from highly skilled pro- 121 fe8sionals to improve communication between hospitals and 13 emergency vehicles. by training and upgrading capabilities of 14 emergency care personnel, develop a cadre of 24 physicians to 15@ handle emmergency in medical care centers and hospitals and to upqrade emergency cat people by creating career ladders, 16 17 development of community educational programs, and a research, 18 development and evaluation system to assess, upgrade, design, measure, and improve the emergency care existing in the 19 20 operational aspects of this project. The plan vjill be implemented through a four phase 21 program over a period of three years with initial efforts in 22 research activities for detailed planning, purchasing equipment 23 1 training personnel, dev;elooing corr'@-qiuni-ty educational programs, 241 Federal Reporters Inc. I and organizing community co;mn,lj-ttee-s. 25 sw3 I The second phase effort will include operational 2 aspects of the plan for operation of communication system, and 3 emergency vehicles. 4 The third phase involves training of personnel and 5 implementation of the long-range,planning efforts. 6 In summary.- this application-app-ears,to be-developed 7 as a community outreach program, involving many community 8 agencies in predominantly a black and Mexican-American popu- 9 lation. 10 The project is not developed very well or factual in 11 content. 12 The applicant does not display a very effective or 13 workin ts of an emergency medical g knowledge of the componen 14 services system. There is little identification as to the 15 existing resources and components now in operation or how 16 those components will be integrated into a totla emergency 17 medical system. 18 Specific resources are not identified and there is 19 no reference to communication resources or ambulance services 20 available within the area. 21 There is not integration as to the various linkages 22 in the approach to the delivery system. 23 This application represents a haphazard compilation 24 of unrelated data with Yio apparent overall plan for the devel- ,ce- Federal Reporters, Inc. opment and implementation of an emergency medical. system in the 25 28 4 sw4 I area. 21 The project should require additional clarification, 3 more indepth analysis, as to identification of needs and a 4 definite plan for the development of the emergency medical '5 services system. 6 I don't think there is any doubt from reading the 7 application that there is a need for services in the area. 8 My memory as I remember the budget is that a tre- 9 mendous amount of money was provided in terms-of salaries to 10 people in each of these phases to work in the emergency rooms, 11 and if my memoryis correct, Dr. McPhedran, they were expecting 12 PMP to provide not just the training, but the employment of 13 people to work in the emergency departments. 14 I think as an application, it probably would get a 15 2, a 2.5 as a rating, and I would feel very strongly that 16 further planning in picking out the areas in which the appli- 17 cation is deficient and making an effort to develop a better 118 and more adequate plan would be a desirable action. 19 I would recommend that this be done. 20 T would recommend that $50,000 be allocated right 21 now, or at this.time, for that kind of planning. 22 DR. SCHERLIS: Dr. VicPhedrai-i? 23 DR. MC PIIEDRAN: I think that is reasonalbe. 24 I didn't think that the thixig,as written was sati!r.- Ace - Federal Reporters, Inc. 25 -Factory, hu@. I would hate not to provide any funds i-o Assist 28 5 SW5 1 with planning, because it is quite evident that a lot needs to 2 be done. 3 I think the need is tremendouw. It puts tomething 4 together, but it isn't really a system,,and I think that it 5 would be suitable to -- of course, if we give a rating of 2 6 and recommend that money -- I guess it is unlikely that any 7 will come, right? 8 DR. HINMAN: Is that recommendation $50,000? 9 DR. MC PHEDRAN: We will give it a rating of 2. 10 DR. SCHERLIS: You concur with a rating of 2? 11 DR. MC PHEDRAN: Yes. Either 1 or 2. 12 The plan as proposed is I will say 2. 13 DR4 SCHERLIS: Is that stated then? $50,000, one 14 year? 15 DR. MC PHEDRAN: Yes. 16 DR. SCHERT41S: And a rating of 2? 17 DR. MC PHEDRAN: Yes. 18 Is that all right? Is that okay? 19 MR. TOOMEY: Yes. 201 DR. SCIIERLIS: Is that concurred with? MR. TOOMEY: Yes. 21 DR. SO-HERLIS: All right. So be it. 22 23 MR. TOOMEY: I believe the comments from.the staff 24 su-@vey also would support this. @ce -Federal F@eportets, Inc. "The project needs" -- this is the concluding 25 2 8 6 SW6 1 statement -- "The project needs, truly needs, further reworking 2 and some indepth analysis of their problem." 3 The second California project is from Loma Linda 4 University School of Medicine and the California RMP. 5 The funds requested are a total of a hundred and -- 6 DR. HINI,4AN: '$170,350. 7 MR. TOOMEY: I have $162,0.00 for the first year and 8 nothing for the second and third year. I don't know what 9 happens on that. That@is from the application-itsdlf. 10 Well, this grant covers region 6 of California, 11 which includes four counties of some 45,000 square miles of 121 mountains, desert, agricultural land, urbanized community, 13 26 percent of the state. 14 The resident population represents some 6 to 10 151 percent of the total California population. 16 During weekends, holidays, and vacation, the popu- 17 lations of the more populas remote areas may increase ten-fold. 18 Due to the isolation of much of the area, serious 19 obstacles are presented in providing adequate emergency health 20 care services. 21 Communication services provided to this four-county are are linked by a common coninLunication network for emergency 22 23 vehicles, which includes higli@,@,-.@y patrol, local police, fire and 24 ambulances. -e -Federal Repotters, Inc. 25 The specific objectives which have been listed--iri sw7 I order to reduce the morbidity and mortality by increasing 2 availability and accessability of emergency medical care, to 3 improve communication through a central dispatch system. 4 The system is here. Two-way radios in all ambu- 5 lances, an emergency radio telephone system for remote areas. 6 To facilitate rapid and effective patient handling 7 and evacuation by use of helicopters, and fixed wing aircraft, 8 military air-lift capability. 9 To publish listings of all available emergency care 10 of services in the region for personnel involved and transpor- 11 tation of patients, to formalize agreements amon g hospitals Ii21 in handling of emergency patients and among ambulance drivers 13 for effective transportation. ]4i To increase and upgrade manpower by refresher 15 courses for ambulance drivers by offering associatd.degrees in 16 coordination with other programs for traning employees. 17 The project plan is "Project consists of mounting 18 a number of smaller projects," each of which appears to have 19 relevance to the entire four-county area, but many of which wil.. 20 be executed in only one county. 21 Thelproject includes the establishment of a central emergency communications center, a WPTTS line, a year-long 22 23 test of the helicoter operation based in a remote desert area, 24 a 20-liour medical. re@-resh(--r course for ambulance drivers, and ce-Federat Repurtefs, Inc. 25 -@:o Associate in Arts degree courses at two local community I 2 8 8 SW8 1 colleges. 2 The narrative participations discusses the various 3 components and elements of an EMS system,however, it does not 4 indicate how the various phases will be integrated, nor does 5 it identify the deficiencies in the-present system. 6 The specific geographic area has been:identified, 7 however, there is little discussion as to broad representation 8 of providers, public agencies, planning agencies, and community 9 interests. 10 The narrative only partially delineates the various 11 community needs and resources. 12 There is limited data as to the assessments of these 13 needs and resources. 14 Within the project description the applicant deline- 15 ates how operating components will be coordinated with existing 16@ components already in operation. _ 171 Linkages with local health daresystems have not been 181 described nor is there evidence of invol%rment with community 19@ disaster plans. 201 The applicant partially describes.techniques for 21 utilizing existing financial resources and methods for obtaining additional financial support after the grarit expires. 22 The narrative does not give evidence of assurance of 231 24 quality of car being provided or the delineation after plan i,-.o ce-F(,,deral Repoiters, Inc. evaluate the effects of this system. 25 SW9 1 This project was developed to serve a four-county 2 covering 40,000 square miles, but eliminated the primary area 3 having the highest rate of traffic just as delineated in the 4 statistical section. 5 Emphasis appears to be on providing services to San 6 Benardino area for the establishment of a central emergency 7 medial communications center. 8 There are many facets to this plan which contradict 9 other areas in the developing of the total EMS system. 10 Contradictory areas includ the methods of financial support, 11 the coordinated working relationship with community agencies 121 in subregional areas. 13 There is no evidence of any plan for the integration 14 or coordination with the areas documented as having the great-' 15 est need for an emergency medical services system. 16 This plan should be reviewed in more depth and 17@ further documented with clarification of the contradictory 18 points. 19 The summary by the staff, Dr. Kaplan, says, "This 20 project purports to be interested in a four-county area, but 21 in fact appears to be onlv interested in San Bernardino County 22 and those parts of Riverside County which can be conveniently 23 included. 24 "The evidence for this @irises. ftoii,. the tact they ar ..f,,-Federal Re,,)oiters, Inc. 25! only setting up one central emergency medical communications 29 0 swlo 1 system in San Bernardino County." 2 In additional. their statement on page-29 concerning 3 Mono County and the simple two-line endorsement from Mono 4 County further supports this. 5 Further, the letter from the 17th states that thier 6 review and comments are.-based on a November '18 communication. 7 It would seem if Mono County were truly involved the letter 8 of endorsement would have been based on a much more recent 9 review of the plans. 10 This is also applicable to Marin.. 11 There.-Are"other-comments, but he ends by sayind, 12 "Finally, thre is no indication in this plan of any integration 13 or coordination with other parts of the surrounding area or 14 potential state plans." 15 I felt that this also was -- should get a rating of 16 2.5, and I felt also that the funding should be for the 17 continuation of the planning with particular reference to 18 including those counties that were more remote from San Bernardino. 19 201 DR. SCHERLIS: What was the sum? 21 MR. TOO,@IEY: $50,000? DR. MC PHFDRAN: That is more than their 01 221 year request that I have. 23 24 DR. Jil,41@IAN: The 01 request wc-ts $44,000. cc- -Federal Reporters, liic. MR. TOOIIEY: I have it down as $'L62,725. 251 29 1 swll I DR. SILSBEE: I think that is probably in terms of 2 the project director looking at the first year, and his form 3 16 relates to the regions' year. 4 It is a six month figure. 5 DR. HINMAN: $44,000 is only a six-month figure? 6 So your recommendation is for $50,000 for the first 7 12 months of the project? 8 DR. SCHERLIS: Is that right? 9 MR. TOOMEY: That is correct, sir._ 10 Dr. McPhedran? 11 DR. SCHERLIS: Dr. McPhedran? 121 MR. MC PHEDRAN: Yes. 13 I haven't got anything to add to the discussion. 14 IVhere they have identified the greatest need because of remote- 15 ness and so forth, it hasn't been addressed in the application, 16 how this Proposed system would connect up with any other parts 171 of medical care. is I of course, I suppose there really isn't very much, 19 but it just isn't.clear. 201 So,I have rated it low. I gave it a 2, and I am 21 going to plead ignorance about how big a sum $50,000 for the first year would amount to. 22 Is that a reasonable figure? 23 24 DR. SCHEPLIS: I think in terms of what we have bec--;ii ce- Federal Reporters, ltic. 2 5 discussing, it is very 2 9 2 swl2 I DR. MC PHEDRAN: Okay. 2 DR. SCHERLIS: Is there concurrence from both 3 reviewers? 4 DR. HINMAN: Is there::.a disparity between their 5 ratings? 6 DR. SCHERLIS: What was your rating? 7 DR. MC PHEDRAN: 2 and 2.5. That is not a big 8 disparity. 9 DR. HIN1,14P.N: I just want one figure. 10 MR. TOOMEY: 2.25. I think both these projects are 11 really critical projects as I read them. I think they need 121 further study. 13 DR. HINDIZ@N: Do you think they ought to be 3, then, 14 for the planning phases? 15 Is that that I hear you say? 16 MR. TOOMEY: I said 2.5. 17 MR. HINYTAN: You wnat 2.5 for both of them? 18 MR. TOOMEY: Yes. 19 DR. MC.PHEDRAN: Okay. 2oi DR. IIIN@il-.I'i: I 'had it dbwn'for 2 for the 92. I N4i!"t 21 change it. 25 22 I am getting a Ii.ttle fatigued. 23 DR. SCHERLIS: Two point five rating for both, and five thousand for each of the plans. Is that correct? 24 are - Federal Reporters, Inc. 25 3 C@ 2 9 Ilox@ York? Bc--sson ai-id Too,-r.(@y, 2 3 If any of the (,,,on,,@@ultants would like to enter the discussion as far is any ol: ti-Lc, technical aspects of this, 4 5 we would alipreciate their patieiice, if you have any familiarity or help you can give us with this. 6 DID,. BESSOii: Okay. Six projects for this applicatir,.) 7 requesting fimding from July '72 to July 173 of 306,000. The 8 9 six p--oj,--cts are: 10 1. The developitic-nt of a regional co-Lmci.1 for Bl@,IS. 11 2. The deniclopiiient of council components in B 2 z,@c.1c@r-c;y areas. 13 3. The development of a c,,>irLnurkicatiorts.-systc-iiis. 14 4. Pidvanced IET training. 15.1 5. Public educatic),-i @-hrougli the PxtQr@-can '.Rp-e, Cross.1 16 II 6. Publ-Le education through tl-ic, Amp-ri,can Heart I Assoc:iatibn. 17! 18 O",)jc-,C@--ivcs 3.vc as i2 here., pi.v@,.@ SUOCOmporient partfz, i)-ig Glances, 191 y- I @- v a -it i n g, E c @,r, c n t ul@ I i c L@@diic.Fti-cn, first aid, @ieliera'L 20 1 I CC),@1)"@OS in ai., iiiipzov 21 n c. @-.i c @, t i f 1 i t y ir, naii--- vocalic evaluation 22 23 involved i.ri c(-nta.,,-@,11- t-h 2411 rZepoft,)ts, Inc. 25 e ak. 2 3 0 I de,,7elop is .-- this wil.'L. be the gi.-ouy) tha,,- devf,--.'Lops and coordi- 2 nates the model i-)rograin in th,-@ Syractise.-,Cortland-Binghamton 3 area for training, co@-nmunicatiol.".S, t--qkii.pment standards, system 4 of detection notification and dispatch. All of these will be 5 to test the program components, evaluate them, and if and when 6 that is done, expand them. 7 There is a relative poor history of regionalization 8 in this area and a history of a I.ack of general coordination. 9 But this is a proposed effort at $40,000. This is probably 10 worthwhile. II, Second is they hope expand this to develop @ir(-,a 12 councils, as well as @-t regional. council to inventory the local 13 needs a,-,d resources and relate to the regional couiicil for @iig these needs. They want to d@.ivelop a plan fo.-: the 14@ meet' I locals to do what the regional N,,iill do regarding 15 1 16 notification, and so for-@li. Tlicy are going to --pli-l@- costs here 17 with Corap planning and P14IO's bi'Ll will, come to $57,000 for 18 a yea--. 19 The ---Iiird 2 hL-$.v@a group, zi PIYIP z7@.3.1e, F-I -)u,t th,@ i., r),q o@,'7 0 t 21 @,re ve,-.y s@z@.nt i@q 22 in one si@@all aspecll-- of this They request 29,000 23 fo-" on,-- 'i,ieeir. This for two students at r e li-I c, I - 24 is ,@L - Fedetat Rp-porters, Itic. tj tha-@. gUi@. I air not L 251 I e a.!3 I where we stand. 2 DR. ILARGULIES: I think wp- could allow there if they 3 are essential to the program, yes. 4@ DR. BESSON: A fourth program is developing a radio 5 communications system in this Syracuse-Cortland-Biz--.ghamton 11@)l- . . 6 area, so that a physician any be directed -- iiysician may 7 direct care at the scene and enroute. " 8 Now, this includes the purchase of 11 base stations 9 at $4600 a piece, 17 mobile stations at $1600 a piece, six 10 tape recorders at $900 a piece for hospitals, br@ti,.ch(@s and ill so forth, for a total cost of $99,000, all of which is very 12 latid,-AlDle, but there are endless costs in@7o'@vc-d in hardware 13 purchase for private institutions. 14 Nonetheless,, I assume that is okay with this commit- 151 tee. It is essential to the development of a ftincioning 16 program. So in that light, I think that, is probably reasonable 17 'L@hen, there are two major r)ubl-Lc education programs 181 in first aid. That is Ped Cross first aid. There are 25 1 9 cha-,-3t@rs 0,Lc Pc@d Cross. is Red C:roo-s right? I fee'L as though I should be Dluc Cross. J-Liric@ 1970 and 1.971., 20 1 21 they trained 3,000 people, @aid there are m@@iy ilifor-n-ta-,-D7 tra.@i.i-) cl-, perhaps an e ual So i-l. t%7(3 CVUCSI@ there are 22 23 6,000 peoplc,- trained in th'L,.,y ef)"ort at first aid, tley are requ,.r.,stii-,g $C,,000, s,,) zt'k-, a a 241 I c,,e-FL,detal Reporte,,s, Inc.' The a.Iso is z-+. public 251 l@ 4 32 I education campaign on card-i.o-puliroiiai-y L@esuscitatiori. They I-iav@ 2 had 30 classes between 1970 and '71 and 453 certified CPR 3 people. They want 50 additional courses at 29 --- at 20,000. 4 In general, this is an attempt in central New York to produce 5 a coordinate education program. It is very sketchy and very 6 slapdash but it is far better than nothing and though it is 71 inadequate on a grade of one to five, I would gradt-@ this three, 8 And I would recommend full fending. It is of interest to note 9 that the hectic pacc, that was engendered by the submission 101 of this application between hpr-il 19 and the time of the 11 F@(-,;bruary 24th letter sent the coordinator to a hospital with 12 iiliat was described as nervous exhaustion. 13 i@d then by 4-26 when the application finally came 14, in, there was an addendum saying, "P.S., he is much better, 15 thanlt you." And somebody finished the application and sent it 161in. 17@ DR. SCHEI?L!S: That is for o,-ic-@-yaar fui-..ding? e - 181 DR. BESSC)II..- (Si. It @,(--rgent-y riedi.cal servic(.---s 19 @lirough integration o-.L@ i+".s Gets into a 20 system a 17 coi:inty The I:j'-'Lan, I thi,@illl-., ha I,)O-exi 21 dc@@@elo-l),@d a@ an ev@il.@i6Ltiori. tire most ess@-ntial 22ic,l' this systeri is a of @i 23 worj.-' Wlth an aiid a;,Lil.)ulanc-c-. cori@@.tiuri4-cL4tioi-i on a, 24 regional- what Ace-Fedefai Rerortets, liic. 25 5 33 weak in the area of quality ac@rurance and evaluation. There 2 is a need for local and regional organization which will 3 spend approximately two-thirds of the money requested. Potentie-,l resources not (-,',ocu7if@,ented, however, the model 4 5 program area and services are adequately listed. The 6 application centered around two major components, an advanced 7 emergency medical technician trainin4 program and a coliu-nunica- 8 tions system. 9 The application appears to b6 innovative in the 10 area of EIIT training due to the lack of physicians and 11 emergency room facilities in the north country. Applica,@it the priority of training iprrtc,-nt for proj@-er 1 2 stresses over equ 13! irnplem@.3ritation and coordination of the total system. It Iappears that a total communication system in this region is 14i 15 needed and the applicant has planned for an effective 16 4 irplerr,.erLtation. 171 Hoviever, applicc,.nt, refers to how the areas should corro-,.iinicittion program btit little is priced on the r...-tec'liaiisrcLs fo@.-- future, expansion into rural 19! and ipprol:)riate trair.-i.x-@g of personnel pi--'.or to 20: 1 2@ L i o ii oI i e e q k i: L f a c eT I i e ap I i c a t i o ns 2 1 d t rk-@, c i-i ta 2 2 a 0 I-. s c',eiit- f o-l- rc-,@ S.,Z;Urc;@ c@'-- i,@,,resen,t rep@o,.--@,rces, ir,-@tl-todr, oA' 23 areas, arid c@f fc)r ti,le 24@ Fedeial Repoftpfs, Inc. or@ the s thcl 25 1 .6 3 4 this basis, tha,;-- T- would agree with the three rating. 2 DT@. SCIIERLI.II: Would you suggest full funding? Do 3 you think they can utilizt-- that effectively from some of the 4 points that you have made? 5 TOO.'4rY: Yes. 6 DP,. SCI-IT-,'I@IS: hl-io would be in charge of this over- 7 all plan, the Pi.@@IP itsel@A" 8 DR. BESe-01; : They will develop a regional council. 9 DR. SCHERLIS: Thalk-. will be 4-t? 10 MR. T00ilrY: And then subcouncils,.' 11 DR. BESSON: And then subcoun--ils, in coordination 12 with. the Co,-op planiiIi.rig, local areas. 13 DR. SCIIERTAIS: Dr. Joslyn? 14 DR. JOSLYN: I jusi: wondered whether the committee 15 has the rig'Llt or thc- intention in any of these where there are 16 olacaj-,s that are clearly separated, to iT,-)J,:e any dis- 171 as to which programs %-iarrant funding and which do 181 not? in othe.r words, this has a total budget of a little over 19 2,V'O,'oCO 1)@c,,,-@ 3'.t is.r-loarly brokE@ii down into s-t,,., rroj,--Cts in 20 21 you knout, does tlic,- cor,-aiii.ttec@ liE4ve @-ny 22 @,E, tl,,@t-@y go aloxig iri different regions to say th@-tl.- 23 pi-cj,:--Icts f-iirdiiig, others do note 241 DY". S(I'll."@i@T,"J,S: would we do. 7gi I c,,)rtc-c"-- ce-Fedefat Rei)ort(,,ts, Iric, t ',-@ 4 S 25 T h@-@@ye no i.i,i supi-) ti-i.iiq a 7 35 I recommendation that a certain project not be funded or anotiic-r 2 project be cut significantly. I thiiil@ in this type of review, 3 we would have that ability. 4 DR. BESSOI.I: Mr. Chairman -- 5 DR. SCIIE.RLIS: Not necessarily the wisdom but the 6 ability. 7 DR. BTSSON: I think Dr. Joslyn's i,.)oi-nt is @,7ell- 8 taken in that as I went through the six components, I made a 9 comment abou-'"- the individual funding request for each. @co 10 re-i.terat(-,,, the regional council should be funded, the local 11 councils should be funded, particularly since we are splitting 12 costs iz:i.th Comp C) planning, tl-ic-. advanced ti-ainiri(7, f r technicians 13 if stipe.-4,ds are oltay, and I think they are, should be funded. 14@ Radio COIW.ILLiicatioiis, I ha-ve so,-tic hesitation about 15 the purclase of all this ecluipirent, but I thinl@ that it is an 16 4n!@egrall. part o-4 thl-,ir system. Pul:)l-j'-c education, I think that 17@ is where I mention a k)argaiii at a dollar a piece for Red 181 Ci-oss training and 20,000 fc)r A,;cL,-@rican Ileart Associcition 191 progran@L also. 20 One of til,@@ problems with c,,ziit),-al new York is 21 fact th@x.-- they need to gc@-t their tec@tl-i into, to do 22 thii@igs on a cooperative baE-,is, This iF, tile first indication 23 tlieLt th(--y might be able to i-rourit s@uch an effo@@. I think they 'd be ericol.'-!-a- 241 si-iou ri c2. A.-,.d in passing, too, I roi.glzi- mal-,e ,ce- Federal Reporters, iiic. 25 a n oi @.-, r c o rm, e n eak 8 I As I have x(-,viewed all of these applications and 2 wondered about how can assist in this national neglected 3 disease, I thought our function would probably be best served 4 by our acting as a catalytic agent and be generous in our 5 funding of seedlings, rather than single, massive Programs. In 6 that sense, if there is a program that I encountered which had 7 any merit at all which wasn't just a ruse for getting some 8 bucks out of the Veds, and would produce an op ,portunity to do 9 just what x%,,IPs started to do many years ago in planning and 10 developing mi organization for creating regional concepts, then 11 I thought it was meritorious enough to get at least some 12 m-@-@i3-es, rather than turning theni off completely. 13 In that light then, I think central New Yox,!-, needs 14 This may be an indication of how we might do it. -more o@ a system o care 15 DR, SCHE@TIS: This speaks i 16 certainly as .,oiTayed to the 17 DR. BESSON: Yes. It addresses components parts 18 zLnd integrates them. 19 DR. SCIIEPLIS: Tlie rocoim-nondati@oi-,, is a ra@.irg of 20 ti),rec, wilt-II-i ful.1 funding. l@y cc@nditions@ for the- ? 21 Ol:)v-,@ously tlic- q@,iestioii of stip, rids for training you wish to 22 loo), 23 DR. BES'-"ON: I don't think is conditioned. 24 SCIIE!Uj'-".13: A-s as you i,-rc-, conceited, this is ,ce-Federat Repotters, Inc. 25 37 I DR. BESSON: It is a one-year request. They have a 2 three-y(aa-- request -- rio, it is all one-year,. The only 31 condi-t.-i.(.)rs would I.)e to do a good 4 DR. SCHERLIS: Pny other comments from raembers of 5 '---he comm.;-ttee? I will accep%-. this as a motion and a second. 6 Any fuxtlier discu@-s4..on? those 4 71 All ..n favor say #!,aye." 8 (Chorus of ayes.) 9 DR. SC-SIALT-ZLIS: All right. 10 Do you ha@,7r-, any coiftmc-lit at this point? ii DR. IIARGTJL@&ES: The only comment I would make here, 121 now -,---hat your action has l@c)i completed, is that I think that 13 the reasons for doing it make very good sense. It is a region 14, Which has had problems in the past. It is under new 15 ship, and this ,iill gi.ve them something they can bite We 16 w-Ll.1 have to talk wi@L.h tl-ieifi shut what thev ini---ert(i to 6o i,n 17 the future, whether this is a part of the future prograri de%relo-' 4 181 ipe.-it. But for thi-,--@ regio.,-i, it is just as well they 19 beyo,Aid a year. 20i I-,lR. STOLOV. T,-ic, tl-iey are 2riki%@'lg for 21 yza--- funding is that k4-he regai-cria'L advisory group and 22 conffL-iit-ee asks i, only in for on@--year finding dt),e to 23 the i-ipttire that there is no apl)c@.i.i,,L@-,d coordi-n,"@tor. 24 ce Feder-,31 Reporte.@s, Inc. 25 r,@ tc@, d a cc) n s u I t-,(:) 11 O'Tl. I f@ PI@'@,11', eak 10 33 I and their plans for th-3ir which -.s due in here July 2 lst, that they may, in all lil-.eld-hood, continue this as a majo-.- 3 part of their overall program, sl-,o,,ild they have a three-year 4 plan. But that was it. 5 DR. SC11r.IILIS: Ne>.t is Connecticuk@. 6 DR. BESSON: One other comment I would like to 7 make in this connection that sti,uclc me aboLi@.- this application 81 and orie other- application, Illinois, when we come to it, is I moved in ".t 9 that es P--'@!Ps to -- since the St. Louis meeting, 10 and I don't know what has been happening in the past year -- 111 new ar@,a,,- o'L fc)--us, and if our area is health delivery, 12 @l throi,@,c4hou-L" the cc,,untr.,l we arc, seeing perha,-,-jco a- reaction to thzi 13 on the one hayid in the turbulence in the core staff, 141 w-Lt-.Ii N.@ho cz-.i-ne on to PI.,IP in z* categorical 151 fash"@on now having t,@ look at a ni-,.,ch broader view of !-reach 16 and als@c,, or@ 'g.:lie oi,-Iicr '.),ard, or, the sector, 17 whorls there are grolLxy3@-,, i-ic-, were very stro:-ig who a,riLi Lagi-rn,'-ng to has in health 181 dc-, 1 4 V-@@ S SC o i-,h@@ l,c.@gr@.rrs we got, in at least 19 I t @i e z -op 1 i c a t -"t I h a z , C a 3, ii d Put g e r s , @,7 l(i c-,, i-c-@ c- 20 priv,-,"k-.e secLc),@ is -Wheat resistz,,.,-icci to 21 4 22 on. 23 I think oAr all O,- 24!i I @ce -Federal f@epor ters, Inc. cl I cl,@, 1 C) .-r r P04@ c@ i'c- 25 39 I and qua'Lity o--F care. think wherever: we I-lave an 2 opportunity to dele-lop linkages with the providers, particu- 3 la.-ly, which are very weak in many parts of the country, in 4 this non-tli_-eatening area, for exaraple, we should encourage 5 it. 6 Now, for an area li,]-Ie central New York that can meaii a great deal. So whatever encouragement we can give them in 7 8 dollars, even though we don't give them encouragement in dollars 9 for other programs that may be. just as meritorious, I think 10 we should. 11 DR. I-IARGULIE8: I would like to recognize Dr. I 12 1Yelley from Ohio State I.-la:3 arrl-%,ad, one -of our consultants. end 4 DR. KELLEY: Thank you. 13 14 151 16 17 19 20 21 22 23 24 @ce-Federal Repcftets, ir, 2 4 0 r DR. SCT.,E@aL",S: A 1 I., r:@ g hC(@n.,-,,@ct-icut, Dr@ 2 Mc@Phadran. DR. MC PHEDI@N: The Co"n(@cti.cut request is 3 @or one @ear, total funds, 328091--@, and it is mainly organizatic)i-ial 4 and exl.)lor-atory. II-11 sav at the beginning that I rated 5 6 this at three, perhclT)s lower than the sta@Lf revie@v7, and I'll 7 stF',.Le..at the outset the reasons for this are, I have scioe 8 questions about why no interrelationship between this an--I 9 another program, another project I reviewed, that is, Tri;Fta-te. 101 T. am not sure I really understand And also there ay-c,. c@C.,,-@@2 intrinsic problems withi-i.1 tl)e region itself. m jhe inten-t-, of the r)rojec-t-- is to, as stated on the 121 131 !5, or anize statewide EMS syctz@Eqs --.- dc@'velo.,,-) and - Ci hrough regional re@iu'Lat@,,)-", and management mechanisms 141 0 c'-'-"Ze, t and launch an operational E,'-,fS d,@yrtc)rist-@ati..on ii- i the south 151 i 4- -a l cenu@ reoion, that is, met,-io-.polit@in Hav,(-@-,i@, and siarround.- 16 1 I y @he ,iiig regions. And the intend to %@To:r@!r, through 'L traurDa 171 18 This is a or@7and-zationel 19 .1 to the f2:a@LE,,wc)@@k @c-,r a statewide 20 2 1 7-Ind, )f 22 c@ F, e,,@?7 l@'aven area. 4Fnc, ,@rt is c-;ta4l@(-,cl tl-iat it- i@-, ho,-,ed t' @it the 23 @T, o 2 i-i be t 24 can't 25 4 1 ar2 of the state through this EMS coiisorti.-cir. The consortium 2, which is proposed will build on the one which is now working 3 and which is centered around the Yale trauma program. 4 Now, some of the problems, questions that I had 51 about this, are now v7ell -- what can be learned -- how much 6 one can expect to learn from the New Haven area to extend to 7 the rest of the state. I wonder whether this is a realistic 8 idea. 9 I don't really understand also why, if they could 10 propose this activitv,for one vear -- I don't really under- stand what is going to happen after the one year. It seems a little strange to me that these monies are requested for one- 12 13 year activities. I don't really see exactly what is going 14 to happen after that. There are plans for funding from chair sources spoken about on the application, but that part of it 15 16 didn't seem definite or det,-,.4-].P-d enough for me to understand exactly where thev are going frori there. 17@ .1 I So thi'-s is essentially a planning and organizational 19 Period for which funds are requested. Some general plans for the state as a some plans, and @i de,-ctc-)ns-tra- 20 t 21 @-ion projr@cL-. for- part o.rL tl-i e s --L--a-L-.e are included. I have 1 a'l"e,-.dy gi.vcln -:,-.he amount, I think. I recommend its funding 22 -L tH reservation. 2311 I hope that we c@.n IL-@@is mattc,@- of i-ntci-- 24, ,ce-Fede(al Repo@teis,I and coonera-ti.on.. it is diL"-c'i,,@ul-t for m,@ as 25 42 ar3 I someone who was born and brc@04 i-n the northeast to understand 2 why there isn't evidence in @"liese two applications, Tristate 3 and Connecticut, of more conversation between the two of 4 them. I would have thought there would be some pertinent 5 issues they should discuss together. But I don't see any 6 evidence of that. Maybe it would just make the application 7 too big. DR. SCHERLIS: Let's have the secondary reviewer 8 and then we'll throw this open for discussion. Dr. Besson. 9 10 DR. BES.-DON: To reiterate sone of what Dr. McPhedran has already presented, thev do want to organize a 1 1 12 statewide EMS program through what they describe as regional 13 regulation and management, and then create a single demonstra- 14 tion program in the south central portion of New Ilaven. 15 Number three is to develop an EIIT training program and then 16 create what they call a consortium between the Yale trauma !organization, New Haven Health Care, Incorporated, which is a 17 18! newly funded experimental health services delivery system, 19i apparent'Ly, and Dunlop Assot-i-a-Les, who are now nationally !@-Ell@-ous, to organize, train, and prodkice and implement an 20 iactioxi program regionally. 21 1 22 And then the final program is to have a year to iorgai-i@.zc- an analysis on tl,.(,- content of this demonstration 23 1 ! 24 @ce--Fede.rat Reporters, Itic. Now, as I looke6 at tli(.3 I-)r(--akdown for 25 4 3 a r this @300,000 - $328,000 the% reqti(-,st, pages 14 to 16 of the le 2 application, are the onlv places where a budget is mentioned, 3 and it is extremely sketchy and no breakdown. 4 The New Haven Health Care, Incorporated, program 5 is also described in a very sketchy fashion. They merely mention it, that thev will consider it with the newly funded 6 1 7 experimental health services delivery system, and they 8 1describe it, but it is apparently a new organization that has 9 a very fussy goal. While I haven't seen the EHSDS, I am not 10 sure how much they can cut the mustard. They have very sketchy information, as Dr. McPhedran has -pointed out, on the 11 12 development of either statewide, regional or interregional 13 program. 14 Their information on their E@IT training which they describe as one of their corn-oonent parts, is described in one 15 line, practically. Thev speak of the implementation of an 16 L EIAS system component to facilitate, organize an erect 17 training throughout the state, although Dunlop Associates, 19 of c,,(---)urse-, has .i good track record, and presumably will help 20 them in their developmental port:,'-on. I 1 21 They have no -,Lnforr,-Lat.@Lon on how they will relate ito t@,@ 'L'@'Lle @--caurrLa Procirain.. And then they very poj-gnantly 22 1 1 1sta@te %,7ant funds br@ceuLe the Departinei-it of Transportation 21 m,3.y p,;ia@3e@ AnO, t-I-)c-@@, say besides the 241 ce- Federal Repo@tcrs, [fic.I ID@i@.-.ar-L-merit of Triai@s-oorta.-tion f,.,@nr3s sl-iould 25 1 - - 4 4 Ei -r A used for 'Iiighway accidents and .)-Lirchase of related equipment, 2 and "we have a broader mission." I think the entire application is verv limited in 3 4 description, and I would be interested in funding them only 5 on conditions that they provided more details on how they 6 expect -- there has to be some more meat on these bones they 7 present. 8 But again I can be charitable and say the applica- 9 i-Lion was -just put together in the usual. case for this whole I 0 series. 11 DR, SCHERLIS: May I ask a question? As I view 12 Ithe document, apparently this was really put together for the 13 Departmen'l- of Transportation in !lay of 171, with some ,4 introductory statements at the front. Is that correct? 15 lBecause I was looking for the budget, I was curious how they 1 6lwe-re going to spend this in a year and Tiot tie un people who entered the program, wondering about the second or third vear. 17 181 And, again I could no ID-czdget here at all iexcept for the sheets wlij.ch are surnr.i.k;inglv specific abou4.- 19' 20 s a 3. a. r y Ft."' a@vages, $17'2,3J,2, I-,i,,t yet nothing th.z@,t 'i-n ax,.y -idicatE,@i ow they a)- L L. ii h r',,,,@d at figured, 21 DR. BESS014i They hEci an ongoing prc),Di:,a.m with th,,@ 22 IDepartment of Transportation, and Ya'!-e P-L-0g.TEM,, 23 and this is an e;,."-,r@n-si.on 241 i @ce,-Federal Peprftc-Ts, lric.IDR. SCTLii;,RLIS: Dr. (;irrble'.-, Do you have aii,,7' concc,lDt 251 4 5 of how those nu,,@,bers were arrived at', DR. GIMBLE: I found the whole application was very 2 3 scant in detail and though their general motives looked like 4 they were in agreement with RPS goals, most of it lacked 5 detail of any sort, including the budget. 6 DR. BESSON: The other thing, Mr. Chairman, that 7 might be appropriate with this application is that since -- 8 the bulk of this application involves a continuation of the 9 Department of Transportation program with the Yale Trauma 10 program, and since th'Ls is just a tentative exploration of 11 the development of an EMS system on a statewide basis with a 12 demonstration program, with the experircental system, it might 13 be that in asking for more details on how they e,-,pect to go 14 about it, that we might ask them to use other funds for this, for the year, and see whether they are i,eally going to add 15 16 to what has already been done with the Yale Trauma program of 17 the past. DR. SCHERLIS: Is all this tyauma--ori.ented, if we 181 1 9 are going to speak about a system of care? 20 The c-,ii.-i:r@iit Trauma system is, 21 but I was a little -a)-)out ho@, F@,t@-plicabl,@ w,'ic@,t they are 22 going to do in the I-Ia-\7(@-n E@rr--zi, not being very familiar with ConnE--c+---i-ciit i.ri But I am sure the rest 231 I of CciinE,-cti.out doosn'-L. the Haven and thi,-@ 24 1 @,e -Federal Reptifters, lric.isys,@,e,,@t is going to be modcl-,,3cl. very n 2511 .@ly on the New Have ar Tnea-I UR t).i t) I it 5-B I area. I x,7as hesitant about 110'Y7 aT)i 'Licible it would be to the 2 rest of the reaion? 40 3 DR. SCHERLIS:-.- Dr. Rose? 4 DR. ROSE: Would you like comments from the branch, 5 the general terms, about M,4P? Might that be helpful, how this 6 might tie in? 71 DR, SCIIEPJj'tS:- I think it might be helpful if we 8@had some general background. My concern has been voiced by L-oth 9 .reviewers. 10 The budget, and is this going to be essentially 11 trauma with the Yal.e--,-Nlew Iliaveii area as a model, with less over- 12 all svstc@, involvement? 13 DR. FAATZ: I think generally for years and years 14, New Haven has been probably the -nost heavily studied to@;n on 151 the east coast, and I think TRZYP is probably following that same 161, tradition. 17i@ The New Haven soutli ceii-"ral area of Connecticut is 18 being set up as a demonstration for the rest of the state 19 because Yale is there, and -i-t is the cisiest to get to. 20 @T Z!7,' in -tb.j,s- 21 al)out the facL Coniicr-1--i.c,-,t has in itE@ Td@P this general dr--si@r, 22 o,@ lin)tages between @tlie. entire state from vou havc-- described to me, it @;ec-!i,,ts lo p@,eh 23 Sic Ctru@",t,@@Lrct set iLlf) ign,oL,@,d ba 241 @c(,- Federal Reporters, Iiic. T ',t urldc--,.--stai-id i-.!,iat. 25 di.f f croi-Lt I 4'7 2 ti E@. z-@ I would have thought that that hospital- system that 2 they are trying to design would have been quite a good vehicle 3 -Lor statewide emergency medical. systems. 41 DR. MC PIIEDRAli: It is not clear that thev have set 5 up so-nething so much different but they have set up something 6 just with no relationship to that. It doesn't have enough 7 specific details to tell if it is different, really. 8 DR. BESSON: That is the impression that IL get. I 9 am very restless about the fact that again -,- and I may sEV tl-lls 10 a few more times,Len, over the next eight hours -- that now 11 that P,"APS is moving out into the area of health delivery,, we 12iare realiv going to be testing whether the linkages that we 131speak of in such glowing terms in M.IPS are really there. 14 Now, if they are really there, Dr. Clark should li@.-tv,-- 15 just fallen right into the skeleton that we talk about that is 16 oing to be so useful. If thc-v are a sham, which I personally 9 17;beli--ve they have been in Connecticut for some time --- I thii-ii< 18.lthey have been a ruse for the niedi.cftl- schools to buy some 19 addi tional- sal,--ried people the linkages don It rea"4. l@.@ 20 !exist for TDut-c:i.r).g this kind of delivery syste-m onto that 21 skeleton. 22 No7,i, I C.or.'t know liov,7 else to J..ool-, cit. Connecticut. 23 Clarj4,, is a iDy-e@-ty bright guy and I think that they are just not 24 to r,,,ove ou-@ zi o--?-ganizatic)n ce Fedetal Repo@tefs, Inc. 25 and q,,@t into health delivel-)r. 4 8 mea- 3 So they flounder around and look for an organization 2 that is not even funeied, and v7ant to contract with them to do it. 3 Well, all I can say is, this is what core staff, if the linkages 4 are there, should be able to just move right into. 5 So the fact they are not makes me a little bit leary 6 that they do have the linkages competence. 7 DR. SCliERLIS:, Yes? 8 DR. FAATZ: I thin],, the Connecticut regional medical program was only peripherally involved in developing 9 this project, if at all. I think it was developed by a e 10 trauma and other people. I I 12 The R14P is being used as a vehicle to get funding,, 13 And Dr. Clark and the Dean of Yale and those people signed off on the request, and it came in. But I-ZVTP I believe was not 14 15 involved in the development of the program. 1 6 DR. SCIIERI#IS. . I as]-, this only for information. 17 Is my interpretation of the indirect costs, 66 percent at Yale 18, 1 DR. DESSON: Yes. 191 I DR. Is that 20, DR. BESSON: Thai: -'I-s correct. 21 22 DR. SChElU,!S: I I hesitate over th-A.s one t-o get more d'-'.-Le c t i o n to rA. and the rieT@oers of the 23 l@ this of c,@ir(,? I v7r-)Ul.d tt-ip,@t %@,.i.thi 24 @f,e - Fedr-ili Reporters, Inc. all the @tu(3ic-s on in that area tIlOF@(-- of yo,,@) 25i e, th4 S lwho can se is a th4ck. document filled with questionnaires, L lbut no data. Isn't that correct? 2 DR. MC PliEDRAN: That is correct. 3 DR. ROSE: Can I comment for just a moment? 4 DR. SCHERLIS: - Yes 5 DR. ROSE: Actually the questionnaires represent a 6 statewide survey. I tried very hard to get some results from 71 the survey figuring that you all would need this. 8 DR. SCHERLIS: Yes. 9 DR. ROSE: It turns out they will not be available I 0 @until next month. So, the questionnaires have been used. DR. SCHERLIS-. I was curious how they arrived at need in terms of this request for -unds. 13 DR. BESSON: They have some preliminary idea. They 14 have a preliminary analysis of this survey which is the thing 15 that has been ongoing between the -- funded bv the Department 16 of Trai-isnortation. 17 This was submitted 1, 1971 -- submitted by the 18 Yale ProqraTn. tt--) the,. Pic-!pat,tmerit o:F Trpnsportatir,3n, ties 1 9 entire thing. they do have a preliminary analysis, and I 201 ju t can't 21 DR. SCliEPI',!S- Yot@ all agreed on a grade 3. 22 DR. BESSON: Oh, here, excuse mc-,, !,Ir. Cha,4.ryT!-in. 231 ITlac-@ prc,.Iiiiti,n,@irv analv!74S -his data has Pinpointed of all o' L L- 24' 1 T-C 'k ,-e-Federal Rc,,@)o@,ters, Inc. of 25 50 riiea-5 organization, uninformed public, no linkacT(@s, and no objective I - L - I standards to evaluate. 2 1 3 1 Now, if thev were to address, ever, on that prelir@tina_rv basis, some of these objectives, they would have an 4 5 entirely different program. 6 DR. SCIIERLIS--.. I have some concern at this point, 7 ,Ln that while you have recommended a rating of 3, you have 8 also recommended full funding -- would there want to be some reconsideration of whether or not if you are going to make a 9 10 recommendation we might not restrict this to just some seed 11 Imoney to begin to set up some developmental --- 12 DR. IIC PHEDRA,:,I: That was my recommendation. I don 13 lknow whether Dr. Besson concurs on a rating of 3. 14 DR. BESSON: I concur on a rati@ig : of 3, or maybe onE 15 as low -- maybe two-a.nd-a-ha.1f, but my sugg(@stion was to approve 16 the application but rec-ruest that T-1@-IIIS no new funding and fund it out of core. 17 DR. SCIlEi@TIS-1 Tii, ol@-her w-ords, yc)u are saying it is 18, 1 i 191 a good application but you aren't any nc--,,,i- fucidi-rig? 201 DR. BESSON: They hz,,ve nlicinty of i@o3i;-y. As I 21 remember that Coiin--cticut -applica-'@l-li@o,.i, it %,7a@3 in the seven 22 23 DP. 24' Federal Reporters, Inc.1ti,@n by 25ii DR. MC PIIEDP--@l,!: Yes. I don't know whether -- can we Ido that? I am not sure vie can. 2 DR. IIARGULIES: That actuallv would pose a problem 3 4 because if there is anything that that program needs, it is a 5 stronger program staff. That is one place where they don't / have any fat; they are very weak. And we have been pushing 0 7 them hard to strengthen that program staff. 8 So, you might look for other sources of funding than 9ithat, if you want to. I think that would not help that program. 10 DR. MC PHEDRAN: Maybe that program -- maybe the 11 Connecticut regional medical program shouldn't have let this 12 come in under their name if they weren't going to have more 13iinput into it. Maybe they can be faulted for that. 14@ But as stated in the@note from the eastern operations 151branch, they apparently -- this is not something that has been central to their interests, this kind of activity, in the past. 1 6lAnd maybe -.- I don't knout, if it hasn't been central to their 17 II linterestf3, it perhaps would be a disservice to them to say it is 18' la good thing to do, go ahead and do it, with your present 19I @monevs and present .staff. That might just injure the rest of 20! I Ithe proarpm, or 4i,,hey might feel it would injure- the reE.@t of the 21 program. 22 Perhaps it would be better to zipp.-ccve 4-t %Title soine 23 @fuiidir@ wolLi).c@ s.,:7-c-m eiic)ii(;h to c-iiabl.c, term to c,.7et qt,-:irte,,l 1 241 c@,--Federai Repoftois, Inc. !with r-,art of it at rate. I Cion't knc)-@,7 that @,.lould 25 inezi.-7 DR. SCHERLIS-. There isn't enough? 2 3 DR. 14C PIIEDRAN: There isn't enough data to tell. 4 -DR. SCliERLIS: If they had a gross figure here of 5 120,000 or 450,000 I think we would be just as lost as to how 6 they were going to spend the money. DR. BESSON! They don't tell us what they are going 7 to do with the money. They don't have any budgetary breakdown, 8 it will be all going into the Yale slush fund. Excuse me. And 9 o besides, the EJISDES Program, if it has been funded -.- and I assume it has been -- that is what this experimental system management board is supposed to do anyhow, so -vyliat. .E, i@4P 12 P-Lit4t-l-ing money into that pot 13 1 1 14 DR. MC PREDRAI@4: Experimental health services 15 delivery? DR. BESC-ON: Yes. 16 DR, SCHE',QLIS:. Any other comments? DR. BESSON: T,-7hat i@s tl@e motion? DR. SCHEI@IS- There is no -,@otion. 191 20 1 I @,,loiider if there is so.-ne mecl-i,@,il-"- T.,. suq,z cte,,a by P,14PS that co,,xl.d arrivc, figu,-r@ th@,,t can _I e. 2 1 tj,ia-t-- would be realistic to help them, say, for example, get 22 tli@- statc-t.-.,@-Oe consortium., since tl@e --.ipplicat-ioll ability of the 23(l -c,@ms ':)e, i@3, th O. race St 24' ce--F'eder,,l Repofteis, Inc. q-@,i @r:3 t1-@ p -a:c t c.) i. t L C. ot to 25 statewide consortium that tliev described going for a year, and 21 then as Dr. Besson suggests, maybe the experimental. health .services delivery people would find enough of their own money t 31 4 begin the demonstration model. Could we say that we would approve it for that part 5 / of it which would put the statewide consortium into operation? 0 DR. SCHERLIS: I think that is a reasonable request. 7 DR. MC PHEDRAN: I do n't know about the numbers, how 8 9 to put a figure on that. DR. SCHERLIS: I think we need a dollars figure on 10 11 that, to know what kind of a staff they would need to,i.linplement 12 that. DR. MIARGULIES: The situation with the experimental 13 health service delivery system is that it has onlv been recently 14 approved, to the best of iuv knowledge. So';-f it depends upon 15 that, there is also a question of whether it might not be 16 17 better to limit wh.at they do until that develops into some lbe@ter relationship. Be6ause it did go through with the Coor(?4 1A ting Review Committee just the last time. 191 I So nothing really has happened yet, alt@-houch they 201 have been workir@i@i at it for a year. 21 DR. BESSON: I second that motion. 22 1 I DR. SCHERI,IS: In words title Piotion is to t-11-ie 23 e f ft@ , i -I ti'm b e r o n e , t ii e r @i t i if-, to -d -o r, 3c; o, t,@- h c.-r.,@ 241 ce-Federil Reporte.,s, Inc. I in th@it I-,)al'L park, ind that tlic.@@ si,,f@p,@rt be limited to 25,i 54 ro,@ e a - !.@ 11 I a consortium as its tiaj,@-r ef 'Loi:-t. Wl,,,at was the other )R. BESSON: Not consortium, the statewide EMS. DR. MC PIIED-TZAN: When they say consortium, that is 4 what they are talking about. 5 DR. BESSON: Consortium is used as the key word for 6 the trauma Unit, New Haven Health Care Incorporated, and Dunlop 7 Associates. 8 DR. SCHERLIS: Shall we say a total statewide EMS. 9 DR. MC PHEDRAII: Planning, development and planning 10 phase. 1 1 DR. SCHERLIS: That would be limited to a planning, 12 developmental phase for total statewide EMS. Is that correct? 131 DR. BESSOil: Yes. 14 DR. SCHETZLIS: What level of funding, just so we'll 15 Ihave a number here. They have been arbitrary in their request 1 6 for funds, so we can be arbitrary here. 17 DR. I.,IC PHED@.@: The total amount they asked for was 181 1 1 328. Do Lou think z,, half or a third of' that is reasonable? 191 DR. SCHERLIS: That is extremely generous for this 20@ !(-c-vf:!Iopmexita',- planning phase bu-'t-l that may speak of iiiy own 21 @Moil-day morni-nq feeling, as far as fundi.iig goes. 22 DR. GIP-1j,I,E-. I have a feeling it is going to lead to 23 ithe swn(- Ci@n you worO,. it air such a way to precludr,- 241! iL @.,..nt,@ the Ya'tc-@ Tra,@-iica ce - Fedefil Reporters, life. l@ 25ii yncl a- L V 55 I DR. BESSON: I thought that was part of the-motion, 2 that-the conditions were tiiaLt these moneys only be used for 3 these purposes. DR. MC PHEDRAN: Statewide planning. 4 5 DR. SCHER@IS: Statewide planning development phase for total EMS. 6 7@ DR. MC PHEDRAN: Yes. 8 DR. SCITERLIS: This is not limited by any means and 9 in fact it should not be under to be trauma-based, but a total 10 system base. 11 Is that separated from the present orientation Of 12 the Yale funds? 13 DR. GITIBLE: I'm not sure, if the people that are 'doing the planning are in this in the Yale program. 141 15 DR. SCHERLIS: Would you say that the planning be 16 centered through the regional medical program core office.? 17 Would that give them ancth.e@-- loan? DR. YIARGULIES: That it be done by the regional 1811 191 medical program. I - I DR. I+,-. be done bv ',--he regional medical 201 21 program and that ce."Ll,-nq @)c 50 to 1-00. DR. FP-4TZ: I a fctclinq in the discussion, 22 maybe I have something no)Dody else h,.)..s 231 I )R. You tli(-.@ only extz@,Y-i-L r,,:)py, tl'lillk. 24' @c;e -Fedefat Repofteis, Inc. If that is a breal,-dowii of the progrzms, I ha@rc-@ ,i-(-?ver seen 25; DR. SCHERLIS: I have that front sheet but that is 2 all. Is that why you've had that knowledgeable look on your 3iface? DR. BESSON: They come up with 19,000; I guess that 4 is their component. 5 6 What is this Connecticut State Deparpment of Health? 7IIs that their statewide program? DR. MC PHTDRAN: I think that is the statewide -- 8 9 wait a minute; that is the EP,IT part of it. 10 DR. BESSON: The EMT had been previously put together, 11 DR. MC PIIEDTWQ: It will be continued through the 12 Connecticut State Department of Health. DR. BESSON: Connecticut Regional Medical Program is I'@irequesting 19,OOU. You were about ten times too generous. 1 4 15 DR. I-IC PIIEDRAN: Flight. DR. HI14MAN: We can put a ceiling of 100,000 and ask 161 istaff to negotiate the actual figure necessary to do it. I 171 ltliink that would be a fairly clear directive. 1 18, DR. Sl@'HERLIS: Is that an adequate directive for 19 St,-.-ff? 20 21 'DR. ',IAI@,TJLIES: Yes. DR. BESSON: I thiiii-c 3-00,000 is too much in the 22 14ght of this budgetary breakdown. 23 DP.. do not liav(-@ tho@c-, c(-,,pa.es. 241 ce Fedeial Repof teis, lr@c. DR. '(3ESSON: Hcre, orgcinizi@'.-i-on and deve'ioT:)ment (-)f 251 state and local. 2 DR. MC PIIEDRAN: -EMS. 3 DR. BESSON: EMS. DR. MC PHEDRA-N: This is also Connecticut State 4 5 IDepartmen-L-. 6 DR. JOSLYN: How much were they asking or t e 7 organization? Is that still 19? 8 DR. MC PIIEDRAN: No -- 9 DR. BESSON: They speak of this as corLponeiits I)ut: 10 they don't tie the components to what we have had here. 11 DR. SCHERLIS: I suggest you look at that, and the 12111 rest of us will help ourselves to coftee. 13 Perhaps you can come up with a figure. Apparently 14 you have the only copy extant here of that docLu-nent. (Recess.) 15@ DR. SCIIFP\LIS.- Let's (let started. 16, 171 Dr. Besson and Dr. @4cPhedran, have you wo,rl-led out a joint resolution? 191 DR. @IC P.'uIEDRAN: The figure we found from sheets iwhich were supplied, the direct cost f-' 19,000. This 20 1; i,.gi.Are was I lwas a figure specifically for the StatE@l@ide plax-in-Ln@l for EIIS 21 1 !through the Connecticut Reaioiial Medical Proaram. That is the 22 ilii.nstitiat-i.on affiliation wli-ch is listed. 23i It 4 S component 5, l@C)m@ii-i 5, of this }-)u@,'tc 24@l -ce - Federal Reij,-,tefs. Inc, TliEtt is the fiaiir(3 '-hc.,rc@, J-9,000 direct cost, 25 5 8 3 DR. SCIIE.UIS: The recommendation is for DR. MC PHEDRAN: Fundinq of that. 2 3 DR. SCHERLIS: funding for t)-iat? 4 DR. MC PHEI)RA-N: Yes. 5 DR. SCHERLIS: The funding would be restricted to 6that item as specifiedlin the ',-judcfet? We don't have to have 7excessive working on that. That has been seconded by the ,Isecondary reviewer. 91 DR. GI@@BLE: Nineteen thousand? I i DR. SCHERLIS: Yes, direct. We have lost tvio Of 'I 10 our reviewers. While we are waiting, will each of you please ilfill out your lunch requests. Restrict your items to those on the form. 131 1 1 1 The motion has been made, reviewing the budget, that 141 15 ii they he funded for that itei- which is in terms of helping to @plan their total E.,,,IS Program which came to 1.9,000. 161 1 That was seconded by the secondary reviewer. 17 Any further discussion? 18, All those in f avor say ciye. 191 20 (Chorus of ayes.) DR. SCIIEP\t7,-LS-. Opi.,3osed? j',IR. TOO'I'.IrY: I,Ihat @,?as the ra'O--ing? 22 DP,. MC PIIEDI',)-@l: Three. 23 DR. TI-ic rank wi-iat? 241 @@c(,-Fedef@31 r,.F-po[tcfs, @nc. 25,li DR. MC l'ie said t\.io--and--a--l@.,:ilf. m ;j, 4- I DR. SCliEPLIS: Two-and-a--tialf. DR. ROSE: Is that for the approval as presently set 21 3lup? 4 DR. SCHE]ZLIS: I don't know. Is that for the total 5program or as presently set up? 6 In other words -- 71 DR. MARGULIES: It was for the tota MR. MC PHEDRAN: For the total. 8 9 DR. SCHERLIS: What range would you attach to that 10 present, limited,restricted recommendation? 11 DR. MC PHEDRAN: I think that was satisfactory. I lwould give that 3 to 4, that part of it, Myself. 12 DR. SCHERLIS: IWould that be satisfactory, their? CR 6307 13 Lnu ib-B DR. BESSON: Three. I would agree to three. 14@ 15i 161 171 1 191 20' 0 21 22 23 24'1 @ce- - Fed eral Reportefs, liic. 25@, URb,IL,'/ ;!52 Lee#22 DR. SCiiE?,I,IS: Dr. Roth? Which one would you like 2 to begin? xxxx 3 DR. ROTH: Florida. I hope I can dispose of this 4 very quickly, because on the basic assumption that funds are 5 not available for the satisfaction of all grant requests, I woltld 6 take the position that Florida is not being discriminated agaiiLst 7 if the request is denied, because Florida is a resubmission 8 of a grant which has gone throubh council, which has been 9 approved by council as a regular RMP operation. 10 The Florida position is 'that they should not be 11 discriminated against because if they could get the funds from 12 this,.it would liberate the other funds for them to carry on 0 13 some other, unrelated projects. 14 I think this would be nice if you had unlimited fun@ 15 ing but my sentiment is to say that that is too bad, not to 16 fund it. It is an excellent application. 171 DR. SCHERLIS: I thought it iias a rather plaintive 18 statement to say that got the mo:iey b3fore they knew they 19 could get it from another But I concur with you 20 co,,@ipl.etely, that they are z,,"-recidy in this and wl-iat they want 211 -Jc;uble funding in a wa3r sc th@-@y can spin the money for 22 @oii@@c-thi,,ig else. 23 Staff have any cc>,Ti,,r@IEnt? 24i VOICE: Dr. SI.oan i.n t.li--.t 'Ice-Federal Reporters, Inc. 25 MR. TOONIEY': She d@-,;.d? JRJ.3 @ 2 25 3 ii I I I DR. SCIIERLIS: Fine. 2 Florida is taken care of. i@@ 3 NToicE: wliat kind of rating? 4 DR. SCHERLIS: No money, no rating. I 5 j @,@ A -6 - ; 2 6 1 2 2 DR. HIN@IAN: WE! haven't finished up the South 3@ Central Branch. Illinois, Georgia. 4 MR. TOOMEY: Wisconsin. How did Wisconsin get in 5 the South Central Branch? 6 DR. HINMAN: Central emphasis. Georgia should be 7 next, I believe. 8 DR. SCHERLIS: The Chair would be in favor of 9 entertaining a suggestion we have a five-minute break. I 0 MR. TOOMEY: I so move. 11 DR. SCHERLIS: So ordered. 121 (Recess.) 13 DR. SCHERLIS: We will do Georgia, now. 14 I am the primary reviewer for Georgia. 15 Georgia posed a dilemma for me. They state that 161 in Georgia, large areas of the state do not have adequate 17 emergency medical services available and those services which 181 do exist are4ndeed substandard. L So in conjunction with the Office of CliP, Emercf,- 19 nc@, @'e2.-ViCe Division of -Lh,@ Georgia State Public I-,Te.@alth DepartrLe 20 nt, 21 State Highway Safety Coordin,:ii-oa-, they developed a plan 22 for a comprehensive E@-IS systei,,i for the region. 23 They are aiming at supporting emergency room 24 s(--rvi-cc@, i,-,acku@ facilities and to ap ply dcf iii@.t c(, - Federa I R,2por ters, Inc. L-i'ain)-ng 25 ce. c, transportation, of 2 6 2 I personnel, development of physical mechanisms, so on, and the 2 Georgia regional medical program will provide initial salary 3 support and training for emergency medical technicians to 4 supplement ambulance and communications equipment provided 5 by the Highway Safety Bureau to provide intensive care 6 capability, life support systems, monitoring to enhance the 7 ambulance capabilities. They would charge fees for the 8 ambulance services in the subsystems. 9 The project in a bit more detail asks for -- as 101 far as funding is concerned -- a level of $242,000 for the 11 first year, 343 for the second, and $356,000 for the third. 12 Most of the support is actually for ambulance personnel. 13 I had some serious questions about this, because first of all 14 there is the problem of what happ@ns when this grant subsides. 15 I see no more reason for there being any likelihood of 16@ support 2-1/2 years from now as compared to the present time. 171 They ask for equipment in terms of dispatch equipment which 18 comes to approximately $30,000. 19 There ;Ls excellent documentation in the request 20 as far as the needs for the funding. My concern is that this 21 essentially relates to ambulance support, rather than being 221 a total system. When one looks at the budget, the requests 23 that were originally put in appear to be aimed at another sourc 24 for fund.iig, rather than to the type of emergency med-Lcal systc,4 ce-Federal Reporl,-2rs, Itic. 2,5 which is being looked at the -or-E,,-,erit time. 26 3 1 I They have already purchased some 40 ambulances. 2 As I have said their aim is -to develop and demonstrate the 3 effectiveness of a multi-county emergency medical service 4 system. The yellow sheets were reviewed by Dr. Sloan,, 5 and part of her comments state, again, what I have reiterated. 6 She states that they havetouched all the basis of government 7 and local support, reiterates the sums that have been involved 8 as far as requests are concerned. 9 My biggest problem relates to the fact t at so 10 much of the funds requested really look at the support of 11 ambulance personnel as the main item, rather than anything 12i else. I want to get the detailed budget so that I can document 13 that for you. If you find it before I do, that will be just 14 fine. 151 Part of the difficulty I am having relates to 16@ the fact that the grant is not put toQether very well. 17 Here it is, budget justification. 181 Their ambulance personnel will be in terms of 19 total coverage of the ambulances for a complete, round-the- 20 clock coverage. This comes -41-@o a base salary of same $245,000. 21 This concerns me, that in essence, we areproviding the staff 22 support for their ambulance System. 23 I think this goes well beyond what the P-IIP should 24@ basically be requested -to do. It does not address itself I I cc-Federal Reporters, Inc.I Cal Y, 251 as it should to the tota.1 system of care but more speci.fi I 2 64 tv 5 1 1 as I have indicated, just -to raamrrting the ambulances, and this 2 is where most of the funding is. 3 Also for equipping the ambulance service. 4 My own feeling, as far as this grant request was 5 concerned, was that it did not merit support as a total 6 system, that I would be much more in favor of their looking 7 towards a plan. It gets down to what we have discussed 8 previously. I don't think the RMPs can be in the business of 9 staffing the ambulances around the country, as this request, 10 I think, would put us in the position of doing. 11 My initial feeling had been to fund this at a 12 very low level, and after having heard the various reviews 13 today, I'still feel that way. 14 Do you have any comment? You haven't had a chance 15 to review this, have you? 161 MR. TOOMEY: NO. I have just read this. 17 DR. SCHTRLIS: Who in staff has had contact with t-E 181 Georgia system? 191 VOICE: I had a little contact, Doctor. 201 DR. SCliERI,IS: Do you have any background on this 211 grant itself? 221 VOICE: No, sir, I don't. I)o 4 23@ MR. TOOMEY: I think from a philosophic stand with you. 24 I agree Reportefs, Inc. 25 DR. HINMAN: I am trying to find the backup, and 2 65 L.Y v I can't find this letter. 2 DR. SCHERLIS: You see, my concern is that the 3 County Board of Commissioners says after 2-1/2 years, we will 4 pick up the support of that staff. And my concern is, you know 5 why not now? Why should we pick up the 24-hour -- at least 6 the main coverage as far as these individuals go? My feeling 7 is they do merit some support more in a planning phase than 8 actually supporting these individuals. And there is 9 enough element here, as you look through it, of bits and pieces 10 of a total system, that I recommend more limited support, 11 possibly to the sum of $50,000, so they can move this along 12 for the first year. 13 Do you have any comment on that? 14i MR. TOOMEY: Just a comment of agreement. 15 DR. SCHERLIS: All r3ght. 16 If that is satisfactory, then we will move on. 17 DR. HINMP.N: You are recommending 50,000 for the 18 first year and what rating? 19 DR. SCHERLIS: But not the support. I suggested 201 three. But not for support of the actual ambulance drivers. 21 I think that has to come from other sources. Most of the fundirg 22 would be for that and I think they should emphasize the 23 training aspects. It will go much further than paying the 24 salaries of individuals. ce - Federal Reporters, Inc. 25 All right? 20b ty 7 11 I MR. TOOMEY: Was there any amount provided for 2training purposes? Because along with the planning for the -- 3 DR. SCHERLIS: They have a very highly detailed 4schedule here as far as lectures and background and training, 5and this would be of some help. They do discuss specific 6material that would be part of their program. The problem is 7that they have put most of their money into salary support 8for the ambulance crew, rather than in the training. I think 9we should suggest this is the area they should emphasize. 10 MR. TOOMEY: The planning would provide for the 11 development of budgets for training programs. 12 DR. SCHERLIS: Right, the training. 13 MR. TOOMEY: As well as other facets. 14 DR. HIN@IAN: Just to understand, this is basically 15 planning and some training. 16 DR. SCHERLIS: Yes. 17 DR. HINMAN: 50,000 for one year only with a 18 rating of 3.0? 1 9 DR. SCHERLIS: Right. 20 DR. IIINIIAN: Okav. 21 The next one will be on 22 DR. SCHERLIS: He can come back in, then. Dr. 23 McPhedran can return. 241 DR. IIIN@U@N: The record should show that Dr. ce -Federal Reporters, Inc. 25 lMcPhedran was out of the room duri.nq that review. 29 3 fee O.'i u 7 d ir 2 ? 3 The next application is ifawaii. Before I start to 4 review this, I have gone through this at least five times, 5 page by page, to look for a breakdown of budget, here. 6 Who is Hawaii? Anyone here spoken for Hawaii? 7 Do you have any breakdown of budget aside from the 8 large folding slieet? Because they come to sums of money that 9 go down to the very last dollar, like $871, arid I have no way 10 of knowing -- I can't project their costs, which is a perturbing -m7 11 feature to me. 121 All right. The proposal, itself, is submitted in F4 13 relationship to the Statc@ of Hawaii, and it comes in from the 14 liawaii ivedical Association. 151 They nave prorated a program over some four years ii-i 16,la very well organized manner, so that they have indicated their 171,cjoals for each of the specific years in some detail. '!'here has recen ing@ 181 tly been a forum in Hawaii, a meet' 19 wliicli discusses tiie.emergency medical services or that area, 20 and I reviewed the I?rograi,,i in it, they PLIT in a great (.-).eal of 21 @tll(-' cor@terlt' 22 i. It strikes me as having been a. very well organized 23 lprc)c .jrarii coop(--rated with by many differen-- agencies, and this that ,r)rc),',)abl.,,), )AelT)ed their a great deal. 2 4 ,,ct!-Fedt,tat Pepotteis, In- The planning cinel their sponsors @qere 251 2 9 4 jr 2 widely representative of the State of Hawaii. I'm sure this 2 helped move them along in their total planning phase. 3 Their detailed program I'll report on very briefly. 4 What they propose to do, for example, during the 5 first year is to train their ambulance service personnel in EMT 6 before the start of their program. 7 They discuss this in terms of emergency medical 8 facilities, in terms of their ambulances, in terms of training 9 them with EKG telemetry, cardiopulmonary resuscitation. 10 They will set up.emergency communicate ons during 11 this time, and develop an EMS advisory committee, and develop a 12 comprehensive orogram for collecting data. This is first year. 13 The second year they talk in terms of additional 14 training, additional involvement of the neighboring islands, as 15 well as Oahu. There are ambulances being set up as far as 161advance communications and treatment. 17 They then introduce the concept of a trauma center 18 and there is contained in their application a detailed discus- 19 sioa of a shock and trauma center, which is at the Queen's ?o Medical Center, which is the large teaching hospital in Honolulu 21IIt is one which apparently has been planned for some time. 22' The sum of money for this I am not sure of. Some@,7her(@ 23 there sticks a figure of approximately $400,000 in my mind but 24 as I have indicated here it is -- as I have indicated there @-,e Feder;il Repotters, Inc.1 25,,s no brea.i@(down of total budget except this one item, that corL.,ies 2 9 5 jr 3 1 from the first year to $253,000 for the trauma unit. And then 2 subsequently, sums of $76,000 for the second year and $79,000 3 for the third, these are essentially in terms of personnel for 4 the latter,.,two years. 5 The first year, most of this is in terms of facilities 6 and equipment. For example, remodeling costs, $194,000. 7 Equipment, a total of something like $89,000. I think we'll 8 have to address ourselves to that item specifically. 9 The trauma center would be the second year, with 10 again the development of emergency medical communications. 11 The third year, additional training program. A 12 Itrauma center would then be operative. The Iourth year the 13 evaluation of the fisc&l-analysis would be the most important 14 part of their program. 15 They request over a period of 3 years sums which are 16 as follows: $777,000 for the first year; second, $982,000; the 17 third, $382,000. And as I read this, I had a gut reaction that 18 their overall planning and program looked very good with the 19 exception of the shock-tratima unit, which requires renovation Construction. I don'@- know i.l@' this could be supported. 20 anu 21 The other problem that I had, although I rated this 22 3. 5, was in terms of the sul)T)oc,,--, because I have no grasp of 23 their budget. That is @7hy I as]'-Ieci. 241 Perhaps it was oinitte(i my b(Dok. But I leafed through 7e - Federal Reporters, lrc. 25@ this not only at lioi-ic, but herc--,, page if ter page, and I' ve- -done 29 6 jr 4 this three and four times. I can find no indication of a de- 2 tailed budget except for the trauma center which is the one 3 unit that I don't think should be supported because of the 4 renovations to the building. 5 DR. HINMAN: Three fifty for the trauma. 6 DR. SCHERLIS: Yes. My own feeling about that is 7 that having visited Hawaii and having surveyed their cardio- 8 pulmonary resuscitation programy I had the opportunity of 9 going to their major islands, and I guess I hit at least three 101 or four.-hospi-tals in@each. 11 . I am impressed with the fact that they have already 12 set up excellent links, that the hospitals work with eac 13 other, that they are training their emergency systems to re- 14 late to the hospitals. 15 They do have good CPR programs which again has 16 helped set up a networl@ so when you go with someone from 17 Honolulu he has access to everybody in the islands and it lends 18 itself very nicely for an overall emergency medical system. 19 They do have the concept of the hub center, there 20 are physicians who go out from Honolulu to the islands in 21 specialities and obviously flying back to Honolulu. 22 I have an overall good reaction, but I had difficulty 23 in translating that to dollars because there is no budget. 24 don't knov7 what it takes to work out this program. -Lf I'vc@ ,e-Federal Re-,porters, Iiic. 251 L)ef--n narrow in not seeing it, apparently you've not found-it I 2 9 7 jr 5 either. If they can show with their training program, they 2 have to set uD essentially five or so areas, one on each island 3 to work it through -- I can see where they might very readily 4 come to a budget of $3- or $400,000. 5 But I have a Problem saying this is what you should 6 spend when they don't tell me what they want to spend. There 7 was no budget in this that I could find. 8 VOICE: Dr. Scherlis, we just received in, and I 9 think it is upstairs, the form 16 s. 10 DR. HI14M]Ui: We have a form 1.6 but it doesn't tell 11 you anything. 12 VOICE: That doesn't break it down. 13 DR. SCHERLIS: I have this one-fold sheet, and that 14 doesn't tell rLie, and then as I go through the back, 1-iere and 15 there they set up on the islands emergency vehicles, which they 16 are in need of, with telemetry, but these come to small sums, 17 $10- or $12,000 each. 18 There is the other item of some $400,000 for the 19 trauma unit, which, I don't think should be supported. Arid then 20 1 have problems looking at where the other 300 go to. I give 21 tlie,@ri a high rating but my concern is I can't translate that in 22 terms of dollars because I don't know what they want the mai-iey 23 for. 24 DR. I'(.-,rliapr4, what you can do is to :e - Federif Reporters, Inc. 25 actually c-nc-@,c)r that with the understanding that jr 6 1 we will seek a budget and see if it is a reasonable figure and 2 bring it into the council that way. It may be an omission. 3 DR. MC PHEDRAII: Excluding the trauma. 4 DR. MARGULIES: Yes. 5 DR. SCHERLIS: My own feeling about the_level of 6 support would be in terms of $3- or $400,000 for each of three 7 years but I'm arbitrary in that when I don't know what they 81 really require. 9 Can that be approved on that basis, that we will 10 come up with a number that is meaningful? 11 Is there a second to that rough motion? 12 DR. IIC PHEDRAN: Yes. 13 DR. SCHERLIS: The rating I gave was 3.5 and I 14 suggested three-year support. 15 DR. HINMAN: All right, 3.5. 16 DR. SCliERI,IS: Is there a second? End 26 17 DR..MC PIIEDRA14: I second. 18 19 20 21 22 23 24 ce - Federal Reporters, Inc. i 25 2 6 7 I DR. MC PHEDRTNL. Illinois is next? 2 Are we to Illinois, now? 3 Illinois is a proposal -- this is a proposal from 4 the Illinois Regional Medical Program to extend over three 5 years for a total of $1-1/2 million over the three years, 6 about evenly divided. It is for an extension of a current 7 trauma registry, and the beginning of an emergency system for 8 trauma. 9 The proposal is to build on this system now a system 10 which works through the state health department, department 11 of public health,, and according to the application, this is a 12 satisfactory arrangement which they wish.to extend for other 13 medical emergencies. They-want to categorize hospitals in 14 the first year, they want to decide which ones would be sui.tabl 15 for various kinds of emergencies. They want to improve their 16 transportation personnel, and to establish a coordinated 17 communication network, the exact specifications for that are 18 not given, but they are talking about a common radio frequency 19 and the use of radios, in emergency 2-ooms and ambulances. 20 There is an element of training, both for the 21 emergency personnel and also a public education effort. The 221 public education is.als.o to be conducted through the department 231 of public health, and a trauma registry, which they now have, 24 apparently was set up in a way that the means of Putti-nq @ce--Fedetal Reportefs, Inc. 25 data into it can be adapted -asilv to a registry for other t@y 9 I kinds of acute illness. They point out that the evaluation of 2 the system can be effectively done through this registry, 3 that is,, if standards are set for treatment of a certain 4 kind of medical emergency, when the help should be there, what 5 kind of help should be there, and so forth, they can decide 6 later on whether they got what they thought they should have. 7 So that this is perhaps one of the attractive 8 features of it, that is, that there is some -- there is a data 9 collecting system which is now working, which can be built 10 upon which would give 'them this kind of information. 11 I am a little disturbed because the coordinator, 12 Dr. Creditor, said that the technical review panel in his 13 area, in his region, or the review committee in this region, 14 on the basis of technical merit, gave it a rating of 3.25, 15 which is the reverse scale that we are using here. 16 In other words, 3.25 is low. Four is the lowest. 17 They submitted it anyway, they thought that there 18 were defects in details in the application, and there are, 19 indeed, some defects. The ones that I was concerned about @,,,herE 20 the information on linkages, adequate referral of non- 21 emergency patient -- cooperating in community d-Lsaster, and 22 linkage with other non-EMS systems -- that was lacking, 23 pretty much. 24 But on the whole, i guess I tiiough'L@- that. maybe the ce- Federal Rep-,rters, Inc. 25 lreview committee was harder on it than I would be. I thought 2 6 -Ey 10 I that it was better than that rather poor rating, although they 2 give me pause when they give it such a poor rating. 3 I have a.specific exception to make in the proposed 4 expenditure, and that is that some advance are proposed. 5 They have a special name. OCCVS. There is an enormous 6 amount of money proposed to be spent on them. Nine of them in 7 the first year for $126,000. 8 Now these are not, I think, quite dedicated vehicleE 9 in that they can be used for any kind of emergency, or a 10 seriously ill person who'v.7ould have to be transferred. On 11 the other hand, I am not sure that it.is clear that that kind 121 of special equipment is really necessary, and I would 13 propose that with a rating of 3 to 3-1/2 -- I will say 3-1/2 14 ar.d with the exception that we not fund these OCCVS. I don't 15 see they are absolutely essential to the program. Maybe the 16 staff can correct me if I am wrong. If that reduction is 17 made, I think they all come in the first year, isn't that right, 181 the OCCVS? 191 So that would make the first year reduced to 20 just a little over $300,000. 21 VOICE: Yes. 22 DR. MC PHEDRAN: $307,000, something like that. 23 And the 02 and 03 years I guess would stand that way. Is that 24 right? kce- Federal Reporters, Inc. 25 DR. GIMBLE: I think the expenditure for the OCC was 27 0 I the first year. I am not absolutely sure. 2 DR. HIN@IAN: They have large amounts of equipment 3 in the second and third year. 4 DR. MC PHEDRAN: I may have overlooked that. 5 DR. HIN14AN: 207,000 in the second year and 162,000 6 for equipment in the third year. I don't know what it is 7 for. 8 DR. MC PHEDRAN: They certainly do. 9 VOICE: The equipment expenditure.remains constant 10 in the second year and I think that purchase of the vans were 11 to be staggered, Dr. McPhedran. 12 DR. MC PHEDRAN: I see, okay. Well, it seems to 13 me that --- I really just don't see why in something which is 14 developing like this, that you need to start out with this 15 kind of very expensive equipment. I would still -- I would like 16 to see it deleted from the budget, to see if they can't get 17 along with the same kind of thing with more conventional 18 equipment. 19 It sounds to me like the:rest of the program that 20 they are describing -- it doesn't seem to me that any part 21 of the program would be vitiated by not having these vans, so 22 I would th 4 nk that they could be left out. 23 DR. SCHERLIS: They also include patient monitoring 24 equipment for outlying coronary care units. @ce-Fedetal Repofters, Inc. DR. MC PliEDRA14: That is part of the equipment- cost. 25 27 1 CR6307 23 -ter-I Ir folc@ TY-11 1 DR. SCHERLIS: ves. The 220,000. The rest is 2 helpfully oriented as far as training, is it not? 3 DR. IIC PIIEDR7@ll: Training and communications. I 4 must say, I was taken with this matter of the way they handled 5 collecting data, and talk about having standards set up for 6 what ought to )De outcome of care, and comparing what does 7 happen with what ought to be, if they can really establish 8 satisfactory standards. 9 We have been trying to do this just for the care 10 of neurologic patients in our division and I must say, it is 11 very hard. @le quarrel a lot about it. I hope they do not 12 fight as much as we have. 13 DR. SCHERLIS: One of the better publications I 14 have seen on local data is the one from Chicago, on the 15 emergency rooms, transportation vehicles. 16 DR. MC PHEDRAII: That is the one Gibson did? 17 DR. SCIIERLIS: Right. 181 DR. MC PIIEDRAN: Isn'-t that so? 19 DR. SCHERLIS: I thin),, so. I had the opportunity 20 to share a si-ght visit to Illinois, and their coordinator 2 1runs Ei very tight shop. With the help of his wife, controls 22 the pursestrings, at home, as well as for the unit. 23 DR. IIINIMN: Should @,;(a ask Dr. G'lmble what emphasis 241 are placing uTDoii the criticF,.'@ --are van, as i-),irt of tile ce-Federal Reporters, Inc. 25 27 2 DR. GITIBLE: They are not, they talked about the 2 total system. The overland critical care vehicles were not 3 even design ed for primary ambulance duties, but for transpor- 4 tation of patients between hospitals. 5 They discussed the stratified hospital system with 6 primary, secondary, and tertiary levels of care, or words to 7 that effect, and the use of the vans was for transportation of 8 patients between initial-care hospitals, and secondary-care 9 hospitals, and definitive-care hospitals, as part of complete 10 EMS system. 11 The objection I raised was whether or not a need 12 for such vehicles and the number had been demonstrated. It 13 had not. And they were quite expensive. 14 DR. SCHERLIS: This can await their demonstrating 15 the need. 16 DR. GIMBLE: Yes. 17 DR. SCHERLIS: What sum of support did you come up 18 wi tl-'? 19 DR. MC PH171DRAN: V7ell' taking that 126,000 out -- 20 I do not know which year it comes on. Mrs. Gimble suggests it 21 comes out of each one- of the three years. I assumed it came out 22 of the first year. I will see if I can come up with that. 23 VOICE: I think they l@iop(@-, after the three years, e "IC III]-Lcl have vans They wou'A.d A' regions woul(I 24 Of t" '%ce-Federat Reporters, Inc. start the first year with one van for each of the nine regions 251 1 27 3 ter--3. I and increase it by one for each of the vears. 2 DR. MC PHEDRAN: So what that means is three times 3 $18 thousand per year. 4 DR. SCHERLIS: It is roughly about $70 thousand a 5 year that would go to equipment. 6 DR. I-,IC PliEDRAli: Yes. 7 DR. SCIIERLIS: Is that not right? 8 VOICE: I wish it were, but I do not think it is. 9 I think they propose to buy nine vans at $18 thousand, each, 10 the first year; nine vans at $18 thousand -- and that is 11 $162 thousand. 12 DR. MC PIIEDRAN: Nine each y6ar? 13 VOICE: Yes. There are nine districts. 14 DR,SCHERLIS: I was not thinking that bad. 15 VOICE: They want to cover each district with one 16 van in the first year, one more in the second. 17 DR. IIIND4AI4-- And there is an additional cost of $20 181 thousand ayear for the telephone lines to support it. So you 19 are talking about subtracting 182,000 out of each year, is what I you suggesting. 20 21 DR. I,IC PIIEDI@;ij:,': That is what I do suggest, then. Are you sure the phone lines are lust to cover that? 22 1 1 DR. Telephone lines for OCCV Nct@,7ork, 23 .-,120,000. Ana, I.-.heii do%@7rL on the !D-L,.dget sheet, i'--- sz?,ys -- I 241 Ace-FederaiReporters,liic. tl-ioi,.iglit I saw an (-expanded part of the budget sheet -- under 25 1 it ter:- 4 I "other," it says Il@4P telephone lines, 20,000, training, 2 communications equipment, lines, etc. 3 VOICE: I think the 45,000 is related to the two. 4 DR. HINt4AN: Outlying coronary care units. 5 VOICE: I think they are hooked to these vans. 6 DR. IIINMAN: Yes., they sure are. 7 VOICE: I hate to say this. 8 DR. SCHERLIS: Do something to help this. 9 DR. MC PHEDRAN: Do you think that is also, 10 forty-five? 11 VOICE: :I think all of the equipment -- could we have 12 a motion that we could find these out, and if they are, they 13 could be deleted? 14 DR. MC PHEDRAN: Why do you not suggest that what 15 we would do is say, we would like to delete the equipment costs 16 entirely, until we can see which of these are unrelated to the 17 OCCVS, okay? If they can just do-something unrelated to that? 18 HERLIS: You are- tal'in about 262 thousand. DR. SC i@ 9 19 DR. III14I@IAN: It is 242, because we took the tele- 20 phone lines out, too. 21 DR. MC PHEDI@N. 242 for the first year? DR. SCHERLI@,: We Gould not even let them talk to 22 23 each other. 24 J-)R. j@C I gave i.t. a rating of 3.5, I thougi.l.'-, ,ce - Fedetal Reportets, Inc. that except for this large expense in equipment, I thought at 25 iqas kind of a good system. ter-1 27 5 rlpr, iO7 11 DR. SCIIERLIS: And your recommendation is as was 2 just repeated? 3 DR. MC PIIEDRAN: 242 the first year -- is that right, 4 Ed? 5 DR. HINP-L-@N: 24 2 , 97 4 . 6 DR. SCHERLIS: 330, 573, 351, 780. And the rating? 7 DR. MC PIIEDRAN: Three point five. 8 DR. SCITERLIS: Is there a second? 9 MR. TOOIIT-Y I will second it. 10 DR. IIIII@@IAN: Total of 889, 327. 11 DR. SCIIERLIS: Are you seconding it because @,ou 12 agree? 13 MR. TOO"'IEY: I am seconding because I agree. 14 DR. SCHERLIS: Let the record show that was voted i r, ii Y)nn i ii(I i I-- n,) q 57, r-(-l 186 (5 7 #lb 0 SCFIERLIS Intermountain. Time is getting tight. DP. 21 Mr. Toomey? MR. TOOIAEY: had that but I can I t f ind my summary - 3 4I am sorry. Will you give me a moment? Will the 5 DR. Sl%-IHERLIS@ secondary , reviewer like 6to begin on that one, for variety? 7 DR. MC PIIEDPAN: I will say that I thought this was 8a good proposal. Indeed it was a system. It is for a portion 9of the region, the State of Utah. 10 in going through the check list, the yellow.check 11 list, I felt that it met most of our reqIuirements for a system 12 quite satisfactorily. The numbers that we are talking about are 13 shown in the back. 14 The first year,, 250. The second, 226. The third 15 year, $193,000. 1 thought there was at least evidence of some 16, SP,@isfactory performance in virtually every category in 17@ assessing needs and resources, and in community organization. The represei,,.tati-on of consumers as such is not any more in evidence here than in perhaps just one or two other@@, 20 I @-hought that it was at ).east @-As good As most. 2@ So, to ]:)e brir@,f about it, I tlioucTlit it was a good proposal for a system, reall@7, in Utah: a health emergency 22 care for manpower tr@iinj-ncT, communication s,,rst(--%mLs, 23 24 coor6.-@.ri@itioii of t@i.0 cases 7,rr-- nc@@,,7 operating, FA foi-nlol ice-Fedefal Repoftefs, inc. c,,:r@(-zina,zation for cciordinatinq the @ull-)systers. 25 187 It would be the regional medical program itself, I think, that would do this, if I remember correctly. Here it is. 2 IThere is a county in tJtah which would be the first ph as e and which would serve to some extent as a model for the others. 4 That is called Wasatch Front, Emergency Medical System. That is 5 6 in the f irst year. And the second year, the other comprehensive health 7 planning district would be involved in the same kind of plan as 8 9 had been set up for the Wasatch Front. 10 And in the third year, it was hoped that the type of 11 model that was developed in this one county would apply to all three. 12 Mr. Toorley? 13 MR. TOOMEY: Yes. The objectives that were derived 14 that I took from this material, they include the establishment 15 of a legal body with the authority and responsibility to plan a 16 and implement a statewide emergency medical system through a 17 network of district EMS councils, and to establish a statewide 18 1 Communication system which x,!ill meet the needs of the area; to 19 establish a rapid and safe ein@,x-qency transportation system which 20 lwill meet established standards; to upgrade the quality of 21 1 hos,-ita.1 emergency departments; to establish a manpower training 22 program which will provide an appropriate type of adequately 23 ,trained personnel, to dc,,si.qn and implement a standard data 24 -.e- Federal Reporters, Inc. collection -,system which would provide inform, at-Lor-, needed f or 251 i management operation planning, evaluation and quality control, 2 to assure high quality emergency care and to evaluate and compare emergency medical svstems with other svstems of 3 4 emergency care, to provide a stable source of financial support 5 for El,',S, beginning after the third year, and as Dr. McPhedran 6 said, it was planned in three staged phases. 7 Phase one involves the development of a council to 8 form the nucleus organization to employ a staff, and that was 9 the Wasatch. 10 Phase two involves the organization of the EMS 11 network into an effective operational plan, to implement l@-iiergency services in each district. 12 13 Phase three involves the formation of a statewide EMS authority to provide leadership for continuation of the 14 15 prograip.. 16 My own evaluation was that the application:demonstrat-@s 17 knowledge of the total system and has identified deficiencies in 18 the present operating system. 19 It is a comuiiity-based program involving providers, 20 public agencies, planning agencies, and community interests. 21 E.@.isting cori,,inunit@, needs and resources have been doci,@i,,ieiited and we i-7il.1 define as to how each element will be 22 coo,,:@t.-@nated with corty:)on(-,ri-@s already operational. 231 Linl@ ges with ).-next).. care systeit),s irc,- not wE,-.Il. 241 'Ac:e - Fedc@.fat Reporters, InI '- I d(--scril.)cd; ho@,ievc@r, is made to enhancing preventive 25 18 9 medical services. Specific plans have been delineated for 2 obtaining additional financial support and the prime area 3 emphasis of this application is through the provision of various continuing educational training programs, limited to 4 specific conditions. 5 6 The population is sparsely settled; the terrain is 7 mountainous. The approach for developing this system has been well 8 thought out, has clearly defined objectives, and I think as I 9 10 read it the thing that impressed me more than anything else was 11 Ithe potential for measuring the various accomplishments, methods of measuring whether or not they have accomplished the objec- 12 13 tives. 141 DR. SCliERLIS: How did you rate this proposal? MR. TOOIEY: I rated it as very good, good, which 15 16 in my opinion would be a 3.5. I saw no reason, really, not to provide them with 17@ I ithe funds that were requested. 18 DR. BESSON: Second. 19 20 DR. SCI-IEPLIS: P@y further discussion? -21 This then is for three years, 248, 222, 293. 22 Both of you were impressed with this as a system of !care as well as the other points. 231 You have heard tl-i,- @-liscuf3s@.on; all those in favor say 241 cfl,-Federal Repoiters, Inc.i .aye. 25 L ('R-6307 DR. SCIIERTIS: All -right,. That is Conr@c-,,cticu-t. 6 nb-1 2 The next program is the Lakes Area, xxx DR. MC PIIEDraN: Formerly 1,7estern New York. DR. SCHERLIS: Lakes A.rea, thank you. DR. MC PIIEDRAN: This is formerly Western New York. 51 7 year period to document emergency medical needs and to 8 develop appropriate emergency medical services in Brie County, 9New York. The proposal proposes a great 10 deal of confidence 11 in a man that has recently come onp an evaluator and Planner, 12@ by the name of Dr. Geoffrey Gibson. 13 Dr. Gibson did a study in Chicago, where lie was 14 before, I gather$ which I read in the course of doing other 15 resource, it is a study of Chicago emergency medical services 16 neeeis. It certainly is a good piece of woril,,,, I thought. I was very much interested in it. 17 Sol I can understand why, the I,akes Are 18 r@iki@ dical nrOgram is pleased to naive )-full. 19 20 ol)ed @@,-@re is devc!],.O,13 The Pronosal that has been devel bv @3.n -T raedical caz,e coiTtrtli4-tee, which advises the 21 22 cor(L.,Tlisf@ioiLor -O:F I-lealth. The co@ra-,,.4 ttee has fairly I--)road rep- f'roiTt hoc-,,)ital pc!@)].e aii(i medical society and 23 j(@aders, 24 --Federal Reporters, iiic. The proposal @o),rtr,()ILent, fc)r 25 an education component for training medical emergency teclini- nb-2 2 cians, and of course, this researcher this study into the 3 effect of the whole program on emergency medical services. 4 Now, the breakdown of the budget, for the first 5 year there is really a very large expenditure on communications equipment. The total first year budget requested is $348,000. 0 7 Of that, communications equipment eats up $207,000. M.E.T. training, the communications equipment is divided in budgetary 8 9 breakdown among the several people, several groups, who would receive this communications equipment. I 0 11 That is roughly 60 percent of the total M.E.T. 12 Training consumes $63,000 and the research and evaluation component just about the same, $63,000. 13 The whole argument in presentation is that the 141 1communications scheme or the thing they want to develop is 15i Icentral to improving emergency medical services in this region., 161 1 I think the argument is made with soin-@ effect. I 171 18 find it difficult to quarrc--l the figures that they ahve developed for the communications. If this is the central 19, 1 20 feature c>-Lr developing this pi:(:)po@-"l, as they see it. I suppose 2 1 that one is@6uld have to take t]-ic- @.@l-iole thing all together. The figures for cc),,,L,,T,,,,-iiiication equipment dropl),,3d 22 23 down sliaply the cc-coiid year, 78,000 against that figure cif over 200,000 the yoar, @@i.n(,' @L@@.hird year, 29,000. 241 There are c)thor sources for funds for 25 keeping it up. and there are other -- there are other sourcest nb-3 large contributions to communications component. 2 Not as 3 large as what R14P is asked to withstands, but nevertheless 4 large. 5 I think that as I say, the argument was made, at 6 least to me, with good effect, that this would be an important 7 direction for @-his regional medical program to take, and I 8 would rate this proposal as a three and recommend it be 9 funded if the funding can be found. That is my own feeling 10 about it. 11 That is 348,744 for the first year. The figures that are shown here on the slieet -- I x,7on't bother to read 1 21 1 13 these -- they would be on the record on this sheet. 141 DR. SCIIERLIS: How many ambulances do they plan 1 15 to putfit at the very onset? Do you have any DR. BESSON: Forty-four, 16 DR. I-IC PIIEDRAII: Forty-four. 17i DR. SC!-IERLIS: llcw many? 181 1 1 DR. BESSON: Forty-four ambulances, participating 191 1 1hospitals. 201 DR. Pi'-IEDRAN: @lait a. i,@iinute. I ayrt sorry, isrill@- 2 'iI lit just 30? 22 DR. BESSON: That is -test the first year. 23 DR@ I,IC' PIIIED',I@7.- Thii.-i-- is the @,ear. 24 "C--Fedeial P(,-PO[tC'fS, llic.IL@R. SCIIERI,IS: Tre hospi'.tal-I-)eired Eir,.ibul,aiices? 251 I DR. MC PIIEDRAI-,T: I think many of them are. nb-4 2 DR. SCHERLIS: Do they coordinate one with the other or do they just service individual hospitals? 31 4 I just happened to pick up a sheet that says 5 St. Francis Hospital and then lists DR. MC PIIEDRAN: They would be coordinated through 6 central dispatching, that is one of the points, of course, 7 about all of this elaborate communications equipment. 8 It is a central dispatching type of arrangement. DR. SCHERLIS: Right. 10 DR. MC PIIEDRt7kN: So that whether they -- how they I'l I would be based seems not so important,, they could work that 12 out. 13 DR. O-CHERLIS: Have tli.,-y already worked out the 141 assignment of channels and expressed a willingness to cooper- 15 ate one with the other? 16 DR. MC PIIEDRAN: They speak about that, that there 17 1would be an assigned frequency that would be used by all the 18 11 Icooperating parties. 19i I DR. I,IARGTJLIES: That is an area in which they are,, 2 1 Irather expert. 21 1 1 DR. TIC PHEDIZAIi': Is that right? 221 DR. MAJIGULIES: Yes. 1 23@ DR. IIC Plll',DILI,,Zq: You mc-!z,,n expert -- who is expert, 241 ce - Fedetal Rtporteis, Inc. the police? 25 DR. IIARGUI,Il@,S Prilip has had a lot o4 experience witt, nb-5 2 the use of radio communications. 3 DR. SCHERLIS: Dr. Besson? 4 DR. BESSON: Yes, this program had its genesis in 5 the appointment of %--he Blue Ribbon Committee, so-called, which 6 was an advisory committee to the Commissioner of Health. 7 As I have looked over the application and the 8 minutes of the Blue Ribbon Committee, @T see that the subcommit4.-ce 9 on communications takes up the bulk of this application. And 10 my only thinking is that some communications expert must have gotten to this subcommittee and really laid out a program I 1 12 for the development of a communications network that is 13 maybe a little bit overkill',, but I suppose that is what com-mun- 14 ication gear costs. The details are just astounding for an 15 application like this, and I think that has been the heavy 16 eriphasi'-s, as Dr. McPlibdran has already put, not only physical 17 but so far as there interest is concerned. 18 But I suppose I will have to live with the fact 19 that we are equ4.pinq ten hospitals -- participating hospitals, 201 one regional hospital, and forty-four ariil:)ulanccs, for all. this 211 cormi,,unicitions mon,@,I,- of $270,000,, since tlic,. syste-a just 22 dodsn't go unless you have tl,,@it component part arid if they are 23 on the ball to lay out this kind of elaborate system, I suppost, 241 more power to them, ce -Federal Repo, ters, lric. IThey are link ng test tc. a good training progra-ri 2511 for technicians, training 5,000 over a three year period with nb-6 21 36 hours of formal training to be given throughout -the region, 3hopefully. And -they anticipate that this Blue Ribbon Committee will continue as a coordinating committee to expand the effort 4 5 from this original area which is around in Erie County, 6around Buffalo-to the rest of Erie County and then throughout the Lakes Area Region, developing local committees as they 7 go. 8 9 1 have difficulty in swallowing the whole thing, but I suppose that if that is money going to a good cause I would 10 11 agree with the recommendation implied in Dr. McPl-iedran's 12 presentation of a C rating and full funding. DR. MC PHEDRIU4: I want to just say, one of the 13 14 concerns that I have is a concern I have about all of them, 15 really, that evaluation has to do with whether or not they will 16 be able to get the things equipped, whether or riot they will be able to get the I:)eoplc on the same frequency bv such and 17 such a time. 181 1 1 But ag-@i-n there isn't anything here that tells how 19 they are going to decide whether or not coronary lives were 20 ii I8avc4d, or accident vi.c4tims were saved. 21. -)pose they are hoping- Dr. Gibson can design sul 22 a study, But that sure isn't in -any of these applications 23 1 1threat I have been Fbl.@- to tell, and it is not in this one, 24 -e -Federal Repo! tcrs, Iiic. 25 e.L tj Ir. 6 6 DR. SCliERLIS: Do you think they are ready to start 2a system involving so.many ambulances, or.do you think that nb-7 3we might not suggest -- I am just asking this -- might not 4suggest they start with a small group, and feel their way -- 5 DR. 14C PHEDRM I think the idea wasn't they 6couldn't servelt-he whole region unless they tried to do this, and they want to try to make it a regional network from the 7 8beginning. DR. SCHERLIS: something has to come first. 9 DR. MC PHED@RM: I guess, you know, if it is 10 11 simply setting up central dispatching and then putting equip- 12 iment into ambulances and having everybody use the same assigned frequency, there might not be much need to time phase that. 13 14 DR* SCHERLIS: But the training would be a problem. In other words, what do they corL.-ft-Lini.cate? If it is just 15 dispatching, that is a questionable facit of the total system, 161 - runless training is with it. 71 DR. BESSON, Mr. Chairman, I think tli' is is an 18i ,example of an ar?)-)lication which suggest to me that knowing Igi I labout the so-called neglected disease, can be enhanced by 201 ,getting involved in this. I don't know -@f Dr. Di,mick had 211 started out that way, but he sure became an expert from having 22 1 lbe--ome involved and getting them L.iivc)lved in communications is 23 going to i,,,eke it obvi.0115@ to t,.I-.,at is- only one link 24 --F,@deral Repoitc@rs, Inc. 25 67 I And I think they will be self-corrective and -the nb-8 2@ more they get to know about it, the more they will recognize 3 that communications can't possibly function without having the other pieces of the puzzle. So while it is heavy in one area 4 5 I think it is an entry point for this region to get involved. Now, we reviewed Maine, and there big handup is 7 transportation. They are spending all their money on traris- 8 portation but obviously they will have to get to the other inarts as they recognize the state of the art and become more 9 10 familiar with it. I I DR. SCIIERLIS: Dr. l@eller? 12 DR. KELLER.- It would seem in looking over and 1 listening to a few of these, that the particular component 13@ I that is stressed depends upon the enthusiasm of some individual 14 1. 15 r a small set of individuals on the particular site. 16 The leap from that to deciding whether this is a 17 legitimate priority for the region is another thing entirely, and I don't know whet-.her anyone but someone on the scene who 181 19 @can really look over each of the components carefully and imaybf-- acquire data not currently available, could possibly 201 21 assess, What troubles me is not that particularly, because 22 I think I would a(jree that almoE,@t any Legitii,,[,-At(-i entry fill 231 lbring along @,om@- of the other components, but I am a little 24i! @c@ Federal Reporters, lt,,c. aY)oiit the re'Lativ(-i t)osii:i.c)n of the ,)5 68 nb-9 I Granting mechanisms as agains4.- Departmf2nt of Transportation 2 and other groups who have been very heavily hardware@orientated,' 3 This is the sort -- I have also had an opportunity to review anc 4 look over a great many things that have come to the Department 5 of Transportation. This is the sort of thing that ordinarily 6i falls into their granting area,, for vehicles and hardware 7 associated with communications between the vehicles in various 8 areas. 9 I am wondering why this is directed to this@par- 10 ticixi'.ar group. I haven't been able to 'fathom, in the guidelines, 11 whether this group was that hardware oriented. 12 DR* SCIIERLIS: I think that is a facbt of Sutton's 13 law. S-u-t-t-o-n. 14 Dn. KELLER: I am not that familiar with it. 15' DR. SCHERLIS: That is why he robbed banks, because 16 that is where the monev is. 1 -7 DR. MARGULIES: In defense of what they are doing, 18' we tall,,,ed before you came in about this problem of equipment. 19 It reminds me of one of the earliest issues that I same, when I 20 ca!qe @-o i@,@tips, in which there was evil, absolute standoff because 21 1the c--Lic@stion was how ca.-i you hear the expert- unless the equip- 22 mp-ii-L- i,.c; there, and then they said, well, we can't get the 23 equipment unless the e-,,pert is tli@,,-,-re. 241 1-F t Poinlk--f you say well, we are going I'@C! cf,--Fedpral Reposters, Ific. 25 1: trai-,i i,looT)le. late (ion't 1-ialle anything to us,- tlif@m in. 69 nb-10 I or you say you are going to have some equipment but nobody 2 trained in them. 3 There has to be a point of entry and some assurance 41 that something will happen. our problem, our responsibility, 5 is to make sure that it does happen. 6 One of the things we will clearly have to do very 7 quickly after this exercise is to get out to those programs 8 and carry to them the message you are talking about, 9 We will be asking, among other things, members of 10 the review committee to assist us with that kind of direct 11 visit to these programs that are going to be granted funds. 121 DR.. BESSOII: I wonder if Dr. Dimicl-, can comment on 13 that since he is one of the people that puts it all together 14 with all the component parts. 15 How do you view the review co-mmittee's approach to 1 6 maybe encouraging the thinking oj' emergency medical care 17 as a total system by funding a little piece of it and hoping 18j they will move the rest of the @,7pv? 19 DIZ. DIIIICI": I think, depending on the whole eiivir- 20 Onnental situation, where they are in the state of the art. 21 P,,nd as you said, our emphasis li,3,.s been on training and then 22 put in the hardware. Because if you put in the hardware first 23 and tli.(-y Oorlt ),-rioN@, to use it they compound 'the injury, 24 so t@) a'", E,.o on is there rigl-it. now., it sounds Fc@(leial F,eporte;s, Inc. 251 like from, whatII hear of the application, that is where the ii 70 dcf icit is,. is communication. nb-11 1 However, if they have good transportation, they can 2 utilize this already. It would depend on what is existing 3 in this area already. I wonder if someone could speak to 4 that? 5 DR. SCHERLIS: The comment was made they are going 6 to train 5000 emergency technicians over a three year period 7 and my concern there would be that certainly if they have 8 that great a need, what are the untrained individuals going to 9 do in a highly integrated,systc!m cominunicationwise unless 0 they have been trained. IVe have to start somewhere but my feeling might be 12 more of starting with both gradually instead of the budget 13 beginning with all the hardware. 14 Perhaps we should @hase@this'ii-i-ovc-.r a stepwise 15 period. I want to get your feedback on that. You have been 16@ through the grants in more detail than I have. 171 DR. BESSON: I'@ell, I think too the f acinat-ing thing 118 about @,:atchiaig j@j,'iPs relate to the regions is aparad--'Lgiu of the 19 way the center relates to the periphery, in that we are per- 201 i rni.spiv(--, we are unabjing, we use the leverage of our funding, 21i and our advi-ce to encouraging a pluralistic response to a 22 natural problem. 23 It has to be pl@u--alistic c,,i-id I think is doii,,,@.. 241 it I v,,.,ou'O,. (.Io it, On when you look @it this r Fcderat Ri?po; lots, inc.L 0 o-.'l and see 251 there is about it th@-it got 71 nb-12' this Blue Ribbon Coramittee decided that one of the problems that they had was people having to wait in emergency rooms. 21 So they said how can we correct that, aiid ;they said well, we 49 3 4 will devise a system of creating red, green, yellow alert'.- And well, how do we know what group is doing what? Well, 51 6 we'll check with each emergency room. 7 Well, they found when they did that by phone that 8 they would get busy signals and they wouldn't be able to call, 9 And they had 44 calls a day, and they found it was very coraplex, and along came this communications expert and said, 10 11 I could solve it all for you. 12 That is the genesis of their emphasis on comrfiuni- cations. And they sa@7 if communications is this vital, we 13 1 1 14 had better put our money on this horse. So I can't fault them I for that. That is their uniqueness. ]5i And I think with Gibson coming on board,. who is 161 17i really an expert, they will obviously look to the other four component parts within a year, I am sure. 18 I They will find they have all this hardware and they 19@ had il@)e,*,-ter do it right. 20i 21 DR. PJIEDR,A14: Llecause that is certainly well. 22 brought out in the Chicago study,, 11-io. lookds at all. parts of 231 it' I It i-s a good study. 241 -Fedetal Inc. re(ii.ic@@ted l@runcls.wer(-- on the- c,8-,tciei." 25 72 nb-13 of 348,000,. 231 and then 245, 2i DR. BESSON: That is correct. 3 DR. SCIIERLIS: Would you like to make your recon,- 4 mendation in view of the discussion? 5 What is your original recommendation? 6 DR. MC.PHEDIWI: I recommended funding at the level, 7 because I can't quibble with the figures, really. I don't 8 know how to revise them downward. If I though that was nec- 9 essary,, that is. So I would reconunedn it as requested. 10@ DR. BESSON: One year funding? 11 DR. 1,;IC PIIEDRAN: One year fundin(j? Well -- 12 DR. BESSOIT: Three years is 8244 13 DR. GITIBLE: Can I raise a question? 14 I have no doubt with the money you give them they will be able to set up ambulances and equip a communications 15 1 6 system. 17 1 was unsure that they had looked into what they 18 needed. I am sure they can tic them all ;together but after they tie '-,hem all together, is that going tei,be adequat(@-? Tt 19 seems hire thev are putting a lot of money into something with- 201 21 1 out having dpti to supnorf-. it. DR. 'IC PIIEDRAN: Yes. 22 23 DR. SCIIERLIS: D@ly other concern is voiced by the I training asnects of having the liz@rcITiarc- and not the softi-7arc 24 e- Federal Reportcrs, Inc. to go with it. I do li@ive concern on that point.. 25 7 3 nb-14 I MR. TOOMEY: lio\,i i{i ny counties were involved in 2 this documents 31 @vas -this the whole area? DR. BESSON: No, not by a long shot. 5 DR. MC PIIEDRAN: No, it is Erie County. 6 MR. T0014BY: Erie County? 7 DR. BESSON: I believe it is just -,this county, and then during this period of time they are going to expand it 8 9 beyond Erie County, presumably to the whole state. 10 But I thin),, for the time being, it is just Eric, 11 and contiguous counties. Not even the whole county, the 121 Buffalo area. MR. TOOMEY: They had a fellow named Dr. Sults, 13 14 S-t-l-t-s, who has done a very complete analysis of the whole 15 medical hospital emergency services. I Do they mention that in application at all? 16@ 17j DR. MC PHEDPAN: I don't recall. 14 -id of in answ@-r i:.o your 181 MR. TOO' EY: This is k@Li 10 commint. This Dr. Sults has -- I DR. GIMBLF.: There Nias an initial survey done but 201 1 1 they concluded frc)m that, if J.' correctly, that they 21 i needed El irto--c- study, which is why they reqii(z-;..st 22 :icid l@irg@2r@ ar,.ioiint for P, & D. So the- questions asked on the 231 fi-"st 241 f7 i answers for a tot;,.l sys-Leiii. edeial Repo,,tets, Inc., 251 Despite that they are spending a lot of money to put nb-15 2 i-n equipment on a system they haven't analyzed thoroughly. 3 That made me a little leary. 4 DR. MC PIIEDT@W4: This is the region shown here and 5 here is Erie County in there. This is -- it includes Erie, 6 Pennsylvania, and McKean County, Pennsylvania. 7 The rest of them are New York counties. DR. JOSLYN: This project and the funds, the 8 9 800,000 is just for Erie %'-ounty. Is that true? 10 DR. BESSON: It is for less than that, primarily 11 for the Buffalo area. And they speak a out expanding it. 12 DR. JOSLYN: That is not included in the funding 13 at this point. 14 DR. MC PHEDI@4: That is right. 15 DR. BESSON: They speak of EMT training as being 16 over a larger region and -- from their abstract, and they say, 17 "Counties surrounding Erie, New York, have expressed interest 18 in participating, and the Erie County Commissioner of Health 19 hap. informed them that, "Coursc@s would be or-,on to individuals 20, tlarouglilk-- the region. But so far as the communications are 21 concerted the ten participating 1-@-c)Fp@-tals are in the immediate area around l@-Liffalo, o,-,,- hospital, and the 44 ambu- 221 1 lances serve just thc-it EirE@,',. 23 DIZ. SCIIE!@LTI-- !Irs, Faa.tz, can you lic--I.I? us on this? 24@ .-Federal i@efior ets, Inc. DR. FAiAf.Z nc)t the last content. 25 75 DR. SCIIIERLIS: Do you have any comment at all as nb-16 2' -far as the total application is concerned, their ability to 3 carry this out or their degree of regionalization as far as the Lakes Areas are concerned? 4 5 DR. FAATZ: I think the feeling on the Eastern branci 6 is that they can probably do what they say they would like 7 to do. Ilith regard to Dr. Sults, i don't know his degree of 8 involvement with this particular application, but I know lie 9 is still working with the RMP there and is quite involved in 10 a number of their activities so I don't imagine he was shunted 11 off to the corner. 1 2 DR. SCIIERLIS: I would like the record to show that Dr. Roth left the room because of his involvement with the 13 14 area, 15 Yes? 16 DR. DIMICK: I would like to make one comment 17 regarding project summary. As Dr. Besson indicated a moment ago the radio system is sur)-,)oF,,@d to alleviate overcrowdit-ig of 18, I i emergenc@@ room facilities. And I seriously question, as one 19, who is in r-harc ency dep,,irtrtic-5iit 20 Te of a busy (@-merg and tryiTi,,T to coordinate 1-3 other hospitals in our city -,- I 21 am not so sure radio communicitioi-is is going to alleviate 22 i overcrowding of fc-x,-'ilities. The same question you are rais.Lii@l, 231 t'l,ic radio c-vptc-ii i.,@ no pana---ea for these types of problems. 24 F@e,,orters, Inc. I am siirc,! it i@@ill 'iif--113 (-Iirect ambulancE@s to loss 251 76 1 crowded facilities but not alleviate overcrowding. nb-17 2 DR. BESSON: I agree with that, it doesn't address 3 the basic question of what creates overcrowding. All they 4 want to do is facilitate knowing what the green, yellow or 5 red Allert state of each emergency room is and direct people 6 elsewhere, maybe. But that is in theory. 7 DR. SCIIERLIS: Is there any feeling from the 8 reviewers as to how many emergency technicians are trained 9 at this point who could man ambulances if they were fully 10 equipped and put into that area? 11 DR. IIC PIIEDRA14: I don't know. 12 DR. SCIIERLIS: lly big concern remains the fact that all these ambulances will be equipped at a time when the 13 14 technicians would not be trained. I think it is an over 15 generous request in terms of what we know about that area an 16 what organization is there, what still has to be done to get 17' a system of care into that area. DR. GIR,IBLE. I would ,lik(@-,@ to t,aise the question also 181 19 of do they know how many ambulances they need? 20 Are we going to equip 44 ambulanc(@@, with communication 21 when they only need 30? That would be an a@,,iful. @,iciste, Do they have data 22 showing that they need 44 .iml;.)tilarices or are t.liev just picking 23 24 the of i.TFtbi,;.I.ancps they hav-c, to have op,@,rat(@cl. "@,-Feder,ti Repofters, Iiic. 25 DR. Stk-"AIERLIS.- Mv suggestion would be one way to 7 7 approach this might be with the first year beirg budgeted less, nb--18 and let's see where they get with a few ambulances and some training, and then make the second arid third ,ear contingent 3 .2 4 upon evidences of performance and having set up a system of 5 care the first, year. 6 I would be much more willing to vote on that favor- 7 ably than on giving them what they have requested in view of the discussion of points that have been raised. 81 9 Would that be acceptable? 10 DR. MC PHEDRAN: I would go along with that. Maybe 11 reducing it by half, to half of what it is, as a reasonable 1 2 figure? Just reduce that part of it. 13 DR. SCIIF.RLIS: For'the first year? 14 DR. MC PI-IEDRAN: Right. And the second or third 15 year -- 1 6 DR. TIC PIIEI)PAli: Make it just for the first year, 17 if they can be equipped as Dr. Bessoii suggested. Perhaps that 18 would be the best way. Because by the end of that time they 19 should see if they can get enough people to run the ambulances. 201 DR. SCIII@'RLIS: ',,Ihat we arc discussing is 3-50,000,, 211 but the conditions of the a.@qardt including the 4Lacts that both 22 the equipment and training would run hand in hand, find that 23 the second or third year would be considered as based upon i@7h at -Llli,@-y have acroripli@he(I al...@o evidence of setting 24111 !I Fede ra I Rcpor tc rs, [,IC. un a tr,t,.c, emergo-,,ic@l medical ,;yF3tem --- would that be more in 25il 1 line with some discussion? nb-19 2 DR. ".,IC PHEDRAti: For the first year you would want 3 to cut the communications equipment in half? 4 DR. SCHERLIS: Yes. 5 DR. MC PHEDRAN: That would take it down to about 6 103 for that, communications,, and then leave the others, which 7 are the M.E.T. training and research and evaluation component, intact. 8 9@ DR. SCHERLIS: Ilow much is that? 10 DR. MC PIIEDRAN': In round figures, 231. 11 DR. BESSON: Plus another 14,000 for project personn(@l. 12 DR. MC PIIEDRAN: Okay. I'm sorry. 131 DR. !iINMAN: 245? 14 DR. 14C PHEDRAN-. 245. DR. BESSON: 250. 151 1 1 DR. IIINI-IAN,. I have a question for staff clari- ]6i 171 ficat--ion. Do I understand you correctly that you feel that I I in all likliliood, that the region could use the total amount 181 I requested over a three year period if they progress satis- 19 factorily, and that you are limitiii(T the first year recommended 20, 1 amount to 250,000, and the rest I)c@ing contingent upon perfor-- 21 mance during the first year? 22 DR. MC PI-IEDIb'%,-@: Yes. 21 SCIIFR,1,1!7,- I ti-iiii'i@ it ties to be revic-@.ied after 24 @@.-r(@deralReporteis,liic.i the fi-rst year. 25@ '79 ll)R. MC PIIEDIZAN: Yes. nb-20 2 DR. HINIIA.N: One! year approva'L only? DR. BESSON: One year approval only, and re-review. 31 4 DR. IIINIIAN: Okay. 5 DR. SCHERLIS: When you say,, could they use it, 6 I don't think there is an area in the United States that 7 can't Come up with a paper plan of communications and the need 8 to train emergency medical technicians. 9 I think we have to show that there is a need and 10 an ability to utilize these funds. And I think we have the feeling here that the area, 12 at least probably can use it. We aren't quite satisfied with the total demonstration of need in terms of numbers of 13 14 vehicles and so on. 15 I think the recommendation made at least would mo-,@e them towards justification of this. 16 DP,. I-IC PIIEDIUKN: Okay. 17 18 DR. SC]IERLIS: What was the rating? DR. I-IC PIIEDJZ2U4: Three. 19 20 DR. SCIILERLIS: Ichree. That has been seconded? DR@ B13SSON: Yes. 21 DR. SCHERLIS: Any further cc>lranen'@-, Mr. TooTfiey? 22 IIIZ. TOOMEY., No. 231 DR. SCifr@R1,IS: IFi tl-icr(@ concurrence. on ti-icii? 241 @t-e-Fedeial l@epoite[s, Inc. All in favor, say, aye. 25 80 nb-21 (Chorus of ayes.) 2 DR, S,'-'IIERLIS: All right. I guess Dr. Iloth can come back in the room. 4 f'R. TOOIIEY: I had not read this material, butI 5 was on a site review (there a year ago and I was impressed by Dr. Sults and I war, also impressed with the lack of 0 services in the innercity in Buffalo. These two things kind 7 8 of stood out. 19 0 (Chorus of ayes.) All right. "Louisiana, Dr. Besson. 2 DR. BESSON: Louisiana is presenting a program 3 4 for -- that involves four projects, with a total funding of 363,000 over a three-year period. 51 The four projects are updating of an existing EMS 0 6 7 system in the state, which was previously drawn up, a training 8 proposal for El-ITs, two-way communication systems, and a 9 developmental study to determine feasibility of medical helicopter evaluation services in New Orleans. 10 Apparently in 1969, the Highway Safety Commission of 12 Louisiana, in an attempt to coordinate E14S programs statewise, 13 Asked the Gulf South Research Institute to do a study of the 14 emergency medical services program in the state. I - They did submit the study and it is really an 15 excellent study. It encompasses the entire statement of the 16 17 problem with a good inventory of needs, resources, identifica- 18 tion of shortcomings in the state, and a plan for correcting 1 9 them. The study alz7,o suggests training, co,-oiunicat--ionsi 20i 21 and now with this R.N'.PS progress corciing down the line they f4unall see a way of upqradinci this 1969 study and beginning to 22 23 implement it with specific projects. 241 The .4irst project thcy su!,Dmi@. is tha4,-, of updating, ,,e-Fedeial Roportefs, !nc. which will do just the things that 1 have suggested, inventory, 25, mea-6 19 1 I develop workshops for the public and for personnel, establish 2 EMS councils &Ttong B agencies, develop a program of priorities, 3 and establish mechanisms for implementing the plan which will 4 be updated. 5 It is a one-year program and includes some evaluation 6 and requests $54,000 in direct costs. 7 I think it is a good program and I would grade this 8 a 4 on that scale of five. 9 Number 27 is a training program to train emergency 10 room staff, ambulance personnel, and to produce a coordinated statewide training program and a register as well as developing 12 standards for continuing education and recertification of EMTS. 13 There is an evaluation included in their training 14 program which is two years under the auspices of the state 15 Department of Hospitals for a total of 72,148. 16 The state Department of Hospitals has indicated that 17 they will continue the program under their funding at the end 181 of this ti-7o-year period. 19 Also, it is a well put-together program and I would 20 grade this on that same scale, and recommend full. funding on 21 that. The third nrogram is that of conniunications, project 22 28. The objectives of this program I'll siii@,,,Tftarize, in reading 23 24 this --- they have the notion t!iE-,t b(@fore, hospital or a.i-iibulance ,cc--Federal Reporteis, Inc. -es P,?end the mon for a cor@anunications system, they must 25 servi(. Cy mea- i 19 2 I have information concerning advantages of the system, cost, effectiveness, capabilities, compatibility of equipment, and 21 so on. 31 These institutions must be shown through a variety 4 5 of s@ttirigs throughout the seven CIIP areas that the communication 6@ system is a nececcity for good and efficient emergency medical services. 7 8 It is anticipated that this demonstration project lwill stimulate and commit hospitals, ambulance services and 9i lqoverntn,ental agencies to support a statewide emergency 101 communication system. So, they are requesting 94,000 ---- 122,000 for the 1 2 second year -- 94 for the first year -- to approach the 13 14 problem in this way, which involves purchasing some equipment, 15 land getting the hospitals to all become aware at leaIst of the 16 @need for communications and pick up the ball in two years. I That is project number 28, which I also think is well- 17 conceived, and gets us involved in cost-sharing with the 18 hospitals, and although a critique of this by staff felt that 19 the hospitals may not pick up the ))all, at least it is a start. 20 21 The fourth progr@iri, the helicopter evaluation !program,,, has objectives to determine the need for air medical 22 emergency patient transportation in the Greatr-@r New Orleans area 2 31 11 establish feasibility of such a Service, and determine its 241 @@c,,-Fedefil Reporters, tiic. of operation and cos-@s. 25 ,mea-18 I They consider that since the medical helicopter 2 service has been so successful in the military, this PI4P study 3lwill aim to determine if this procedure will reduce mortality, 4 and translated to the civilian role, provide a service for the State of Louisiana. 5 .They are requesting a one-year study to do this for 6 $46,000. 7 8 So, in summary, we have four projects, 26 is an 9 updating of an already existing comprehensive system and 10 beginning implementation; 27 is a training program; 28 is a two-way communication system in a variety of hospital settings, 29 is the medical helicopter service. 12 I would grade the program as maybe 4.0 and recommend 13@ full funding. 14 And initially, in their introduction I am impressed 15 with the figures that they quote, which may have been known to 16 lall of us, but I will just mcntion-them gratuitously. 171 Insuection of war figures to determine the value of 18 transportation of the whole emergency care system, the war 19 Ifigures in 1969 that were done show that eight percent of 20 casualties in l@-7orld liar II figures --. eight percent of the 211 casualties dies. Four-point-five percent died in Korea and 22 1 @only 2.5 percent are dving in Vietnam, and the implications by 23 these figures is that t-beF;e casual.ty-to--deith rates iml)lv that 24 Federa I F?eportefs, Inc. we are qain.itg on. it, and the thin,-Is that v,7e are doing in 25 194 I Vietnam that we weren't doing in World War II should be 2 replicated in civilian situations. 3 The figures are impressive, and I think backed with 4 that kind of approach, I liked the program. 5 DR. ROTH: Jerry, why do they need to,do a one-year study to establish the fact that nobody can afford the 0 7 helicopter services except the federal government? 8 DR. BESSOTI: I can't answer your question. 9 DR. ROTH: There are plenty of cost figures oh 10 helicopters. 11 DR. BESSON: I am oerfectly willing to scratch 12 137,000 from the program. @l",d -I.ike@.to -hear- from@ the secondar 13 y'reviewer. DR. SCIIERLIS:.@i The secondary reviewer, please? 14 15 That is Dr. Roth. 161 DR. FROTH: I,:.'ell.- I have not dote any of. my second area reviews. 17@ DR. SCHERTIS: Ilaven't you? All right. 18 19 DR. BESSON: I would recommend that we grade then,. as 20 and.fund them at 363, less 37,000. 2 DR. Disapproval for 29. DR. SCHEIZLIS:@ Disapproval for the helicopter study 22 ind others, grant them at 4? Any other corirtents? 231 24 DR. BESSON: I m4@-ght. acid that as the B agency or ce Federil Reportefs, Iiic.Iother endorsing grouses were asked to coirniont on these four- 251 195 I proposals, they considered that this helicopter program was last 2 in priority. 3 DR. SCliER.LIS: All right. 4 All in concurrence? 5 (Chorus of ayes.) 0 DR. $CHERLIS.: Opposed? 7 DR. HINI-IAN: $225,615 the first year, and then CR 6307 End 14rl6 8 $100,325 the second year. 9 10 11 12 13 14 15 16 17 19 20 21 22 23 24, ce-Fedefat Rf-,I)D,-ters, Inc. 25 r4aine, or. McPhedran? 9 DR. MC PliEDR)Uq: This is part of an EMS system. I 0 11 The application indicates that in the Department of Health in 12@ the state,, there is already some interest and ferment about emergency medical care system, and this proposal here is for 13 141 an ambulance attendant and other medical -- emergency medical 151 personnel training system, and also as Dr. Besson indicated prc-@vic)ii.sly, a design for an emergency transportation system 161 to be developed as part of the establishment of coordinated 171 irtedical- care systems. 181 The wish is to develop @i packaged standardize(. 191 1 20 hosp-'Ltal based trai-nirq course for use tl-irou@lliou-t the state. 211 And tJie funds requested in thc@ first year, a total of 123,000. That is h--oken down -- tlii eq-tiipni6@nt part of -that, cince we 22 can't help 12,@i intere@-,te@d i-i-i that., includes some -Vil@otapc@, 2311 24 t3 c--Fc-detal Reporters, Inc. Ab(-)ut 40 nerc-,ent of thc,-t total. t',-iat is rr:,-qii,,@ste(,,-t for 25 first year and in the second year and third,ycar of this reques tec nb-22 2 three year program, there are -io @-a,)re equipment requests and 3 the budget drops considerable. It also drops because in the 4 first vear they propose to do a transportation study using 51 a consultant whose name I have forgottent now. 6 DR. BESSON: Chi Svstems. 7 DR. MC PIIEDRAN: Chi Systems, thank you. 8 The transportation study for the state of Maine 9 is proposed for the first year at a cost of $22,000. 101 Now, I thought that the proposed course of instruc- 11 tion was worthy, and it was probably something that woul e 12 quite useful in the state, around tile state. I really didn't 13 get the feel at all of the transportation study. 14 Maybe Dr. Besson has another view of it. But it 15 seemed to me that ih the torRis that they described it in 1 6 this applications the terms were so ver-,,, general that I 171 reallv didn't get much of a feel -is to i@,hat would do, how 18i thev would go cil-)out it. And I didn't get much of a feel that 19 i wanted to stipy-)ort it. 20 iZeally what we are being FAs),@,@d to do here i-- to 21 mi.-.)nev @@-or stil-)I-)ort c)-L" two fr,7.(i-iieiits of a system, and the 22 total c@,k7si--c)yt i,7c really (lc)n@@- see iri the application or Oidn't the application., 23 see i-n '?A I Aiicl Lli4-@ rite worl@-ily@ of r"lpr)o,-@t. -' I f-eeiF,-tzi I Repor tef Inc enough about the 2f) 11 13-Lit I am not -- I giLic-s@- I _)I 82 study, and their presentation doesn't give me enough -,)f a feel nb-23 lfor it in any specific terms. 2 3 It is all so general. I do.nlt know whether I 4 want to support it or not. I would like to have help from 5 Dr. Besson about this. 6 I would have rated this fragment, that is the emer- 7 gency medical training, as a three, and recommended support 8 for it. But the other I feel very doubtful about. 9 DR. SCHERLIS: Dr. Besson? 10 DR. BESSON: I had occasion to review ilaine previously 11 and I am impressed with Dr. Chattogee's approach to the enti-r-@. 12 region and the term used by an individual is in the operations 13 branch is frugality. 14 I think that is a very applicable term. The average income per capita in the state of Maine is something like 151 3400, and one-third of the population Iias an income of under 16 5000, with over 5 percent of the people over G5 living at 17 Ithe poverty level. 181 The distribution of its population is extre@iely 191 Irural, 5 i-)erccir.,t of IL-he people in l@lairic-. living outside of the 20 urban areas. 21 Now, the emphasis in this ar)i,)lic@-tion is certainly 22 1 23 1or, transportation. They have devr@,lcped a. cc)T"IUnuiiicatioiAs net- I work @,-Iii.r-h has been 4--c to,,ich. in -@-@ry rural 24i ce -Fedefal Repo@,iirs, Inc. state. A rtixal and iiiaccessibl(,- state -- they us@-, tl-ii@ Le.rm of 25ii 8 3 1 a trip that would ordinarily take a half hour in the summer 2 ti.me and it might ordinarily take four hours in the winter nb-24 3 time and that is applicable to rural Maine. 4 So they have had a communications in the past which 5 has been developed and it is very functiona'L, They have also 6 developed a use of video physicians, let me just say, use of videotape for nlivsician training which has been excellent in 7 8 utilizing the scarce-time of physicians in being involved 9 in this kind of a program. 10 they are developing a whole medical school, I under- 11 stand, from having read an application previously on this basis. 12 And it is an extremely innovative approach to the use of scarce teacher manpower. They recognize the short 13@ 14 comings in their pretraining program for EMTS, and speak about 15 adding to their training by the incremental approach of block Itraininq in extrication, various aspects of EMT training, in 16 ihouse training, AOS hospital base, Red Cross, so forth, with a 171 18 good systematic training for EMT. 191 The critique of the application mentions that the ertainly 201 emphasis is upon tr,,:insportai-.,f-on -,ii(i Dr. McPhedraii c 'implies that and I don't disagree, 21 1 But I am also ix-nl)ress(id by the fact that recognizing 22 that they might get some help in creating a transportation 23i I I they apparently put out to bid amonf 24 systems groups ice-Fedefal Repoitc@rs, Iiic. Itliroughout the country what their problem is, and Chi Systems 25i of Ann'Arbo--,, @,lichigan, whom I had never heard of before, nb 25 submitted a proposal for solving their transportation problem. 2 3 I am interested in Chi System's approach to this 4 whole thing, approaching it as a very astute systems firm. 5 And I think that their submission of their study approach I 6 am im@ressed with, and the dollars involved, the $14,000. 7 1 think that is money well spent. That will buy 8 the wheels on an ambulance, but it will be very well spent if the entire transportation system is studied. Then they speak 9 Of implementing the system for individual counties, for 101 11 individual regions, as being an additional 7000, applying this 12 methodology to other regions, and then each additional region is 4000, and so forth. 13 14 I like this approach of RMP recognizing that-they ha% 15 limited expense, and buying expertise. I think that $14,000 is money well spent. 1 6 17 Their emergency room problem is also mentioned in 18 the critique as not be4-ng addressed and I agree that that is 19 the problem, that i..-, a very significant problem. 20 But in contrast to many more blessed areas in the 21 country where they have people who can staff emergency rooms 22 and have a plethora of professional physicians personnel, @laine 23 has a problem in that they liavc- physician shortage. The best '.-hey can do is qet a physician out of his 241 kce - Feder a I Rep oftets, Iiic. I-Lo aiigT@ie-r an emerqc--ncv rociiii cal-1 @.jh4ch is rel.@.Itiveli-@ 25@ I)Ilsy office 8 5 nb-26 I impossible. -@'hey have a problem in staffing emergency rooms. 2 So I see reason for not addressing that I-)articular problem, 3 but this time I think a region of this maturity will. So in general I agree that the proposal is a good 4 5 one and I wouldn't be reticent about funding the transportation 6 subcontract, and I would recoi@-aedn with Dr. McPhedran that it 7 be fully funded. DR. I-,IC PIIED@N: I go along with you about the trans- 8 portation subcontract. I just don't have a good feeling for 9 this kind of systems approach. It isn't something that means 101 I Ia great deal to me. It would mean an awful lot more to me if somebody 12 13 had written down -- had taken examples from Prest4@que Isle, 14 or Aroostook, or some place like that, you know. 15 Then I could understand it, because I know the 16 state and I could understand it. To address .it this way it lis hard for me to appreciate. But if you think it is okay, 171 11 will go along with it. 181 1 191 "Lou know, we have said that it is mostly transpor-- Itati-on. It really isn't though, most of the budget has to do 201 1 21 lwith ti@aining, and it is a small part of it that addresses I Ithis transportation study. 22 23 Those ar,@ the two items. DTZ, SCIli"13-@T,IS: )Tc)w (Io voii tliis? 24 ,c,c,-Feder,il Reportefs, Inc. I rated the t@-rari-@r)ortation -- 1 25@ 8 6 didn't know how to rate the transportation part. The ot,er 21 part I would rate as a four. nb-27 3 I thought the training was good, the training program was good. 4 5' DR. SCIIERLIS: You are n6dding your head to show 6 concurrence, Mr. Besson. 7 DR. BESSON: I would rate the whole program as four. 8 9 DR. SCIIERL')TS: You are recommending full funding? 10 DR. MC PIIEDRA14: Full funding. 11 DR. SCHERLIS: For three years? 12 DR. MC PIIEDIIAN: Yes . DR. SCHERLIS: Any considerations or recommendations 13 14 that go along with the award? 15 DR. BESSON: Spend it frugally. 16 DR. MC PIIEDI@N: Which they will. 17 DR. SCIIERLIS: Any other commL@nts? 181 All those in favor say, aye? (Chorus of ayes.) 19 DR. SCIIERLI'@13: OT.)T)OSe@l? 20 (No rcsnotise.) 21 laid ofi6 DR. SCIIEIMIS: All i:.t(.Iht. 22 23 24; -Federal Rerotte!s, Inc. 25@ 6 xxxxx The next is Memphis. Is that right? 7 DR. ROTH: I have Memphis. 8 Memphis, again, I don't know whether I got all of 9 the bottom of the hope ones. But here is another one in which 10 I would concur with Dr. Sloan's review comments when he 11 said that if need is to be taken into account, that since this 12, -one starting from Ground Zero, -4-- .n4-ght dcscrv,-- support. 13 But the requested amount is large, and the need is 14 great. It is a fragmentary program in terms of addressing 15 its total development of a full emergency medical service 16 system, and it has a dilemma in it in that it extends over 17 to Mississippi, and into some other areas, and I don't know 18 how we deal with this. 19 To break it down into compor@ents, I tried to do 20 with the elimination of some components. I couldn't come up with 2 1 anything very satisfactory. 22 I don't know what to do with this one. 23 DR. SCIIERLIS: Do you think it juc--,ti.f i.ed suppox,t? 24 DR. RC@m.-.,!: I really di,2,ii@t -L@link -t was well exiougl-i -,e-Fedeial Reportels, Inc. 25 thought out and presented, -xid. 1. g@,,,th(,@r the St,-:i@Lf reviewers 3rDt) 257 didn't think so, either. 2 DR. SCHERLIS: I had re viewed this and this is one 3 that I rated as essentially the bottom of the heap -- it was oie 4 on the bottom. 5 This was grouped together with those which I 6 think were least worthy of support. 7 Did you think there was any element of this which 8 could be salvaged in terms of helping them to arrive at a 9 plan which would be worthwhile? 10 DR. ROTH: If they could be encouraged to 11 continue their planning, I think it is manifest that they need 121 it. But again, I think we're going to have this dilemma 13 of giving them a low figure. 14 I don't see how you could come up with anything 15 better than a 2 in this and if you cut the grant request, 16 it would have to be very sharply, I believe. 17 DR. SCHERLIS: This is an area iqith real need, 18 I'm s ure. I 191 Is Mr. Van Wingle here? Do you want to 20 comment on Memphis? 21 VOICE: Mrs. Kindall is the operations officer. 22 VOICE: I don't know a great deal about it, other 23 than one thing that may.be significant here. I -r.C 241 LI 4-t seems -to be- just a portion of a program, it @ce - Fedr,,rit Reporters, Inc. carved out roles for certain l@rovidc-@r 25 is that the state has j rb7 258 I groups, and the role of the emergency room is the one identi- 2 fied for Memphis, and the activities, and it is quite logical, 3 Dr. Roth, that they would extend into Mississippi, because mosi. 4 of what Memphis does, does extend into Mississippi. 5 DR. ROTH: It is very logical, geographically, 6 a medical supply area. 7 DR. KELLER: It would be strange if it didn't. 8 DR. ROTH: Into Arkansas, too. 9 VOICE: But it is rather confined_, when you think 10 of it-in a total programmatic sense, but that is the confine- 11 ment of the master plan. 12 The Department of Transportation has a role, and 13 different groups have different roles, and the emergency room 14 has been identified at the RMP's role. 15 DR. SCIIERLIS: Some of the comments, I think, of 16 Staff are important in this regard as f@ as the narrative is 171 concerned; incompatible equipment, this not being a justifiable 18 system. 19 my own feeling is that I would like to see something 20 salvaged from it -- 21 DR. ROTH: If it would be possible to give them on 22 Items 1 and 2, the request for planning and administration and 23 survey needs -- that comes out to $67,038; I would support 24 thi@s. Ace -Fedetal Repoitets, Inc. 25 DR. SCIFERLIS: k@t),jt priority would you give that? 25 9 I DR. ROTH: For that phase of it, in order to give 2 them half a chance, could we go 3? 3 DR. SCHERLIS: Yes. 4 Any comments on this Solomon-like decision? 5 Solomon wasn't always right. 6 DR. ROSE: one year? 7 DR. SCHERLIS: Yes. I concur. I think in going 8 over this, there are'aspects of this in terms of need and 9 planning that I think do justify support. 10 I would concur with that recommendation. Lee#22 11 DR. ROTH: Okay. CR6307 12 13 14 15 16, 17 18 19 20 21 22 23 24 r-e-Fedetat Reportefs, Inc. 25 87 cr@ 6.-J,07 I;ext area is Metz-opolit.an Washington. The reports #7 2 v72111 s@iovi that Dr. Matory left during this discussion, 3 DR. DESSON: Mr. Chairman, I feel that since Dr. 4 McP!i,--aran and I are the only ones who have done any work for 5 this committee meeting, that we be given special recognition. 6 DR. SCHERLIS: I would like that expunged from the 7 rc-@corrl. xxxx 8 DR. BESSON: Metro Washington. This is an applica- 9 tion for $95,000 for a 6 month period of time. lo DR. SCIIERLIS: A question on that. Our white slieets 11 show $79,000. Would someone explain? 12 DR. BESSON: I suppose the white sheets tal:e pc-ece-- 13 dence. DR. 94 is direct, or indirect, and 79 is 14, 15 the dir(@ct funding. 16 DR. DESSON: Thank you, DR. SCHERLIS: Thank you. 171 DR. LI@',SSOI@l: They're going to contrac@L. with an Tlip-- 19 cor@).riittec-,, w'@iicl-i is going to (.-c)vl'k--ract For s(.'-r- @v, i hi-nen@ ol' iiccds 20 -,ces @l-f 1-csourc@,s and data information and development. a plaii for the metropolitan 11@Ashingtoi@ area. 21 22 The'-r -i-o @,i great e@.ctent. a reiteration 23 10f the ,,;ordi.iic f oi' ti!Cl- quid(-.,@, they have previously Su Lc, the,-n,, It -ts clearly a 24ii, II %,@o--Fede;al Rfpoftefs, liic. ii .. i - (@ c- z@ L2he-y !,,av,@ no intrinsic core coyiipc-@, 2511- 88 dh-2 I the field, and they have asked for the subcontracting organiza- 2 tions that they may work with, particularly Block McGil.)ne@rt and 3 I forget the other one, whatever i.t is, who are mariager,,ient con- 4 sultaiats for health systems of one sort or another to put 51 together a program. 6 And having worked with applications that were put 7 together by Block McGibnek,-, I think this application was writ,@.e7.l 8 by Block 14cGibney as a potential subcontract, to taking it on 9 a contingency basis. That may riot be a fair statement but I 10 think it is the best method. 11 C. Can do at the moment. The staff summai-@r critiques this as lacking a com- 12 z 131munity base for information to be implemented, and it suggests 14 revealing this comititinity base first, and I certainly agree with 15 that. But method C. has problems. 16 Beyond their soluble problems, but I intend to be ,71very charitable towards Meth(--d C i.n spite of the fact that we I !have sc>riic@ negative comments bv associated ciep,;:jrtmeiijt-- of h(-,altli 18! i 19 in Prince Georg(-@'s.Cotint,.7, z@n,-!, tlic- District o-F Coluil,)-)ia .,4edical Soci.ety, which -L would like @@.o read. to @70 20 U indicating the tei-iuoui- nature of the (,---@-fort I)v sol)cori-trac-,tor to I? 21 ut together a ystcm. 22 1' 23 III letters of .,@uppoi-t received by the program coor- dinatc,,i, o.'L- i-.1ic@ ric('tj.czil societ-,,, of the Lli.stri,ct 24 kce- Federal Repotteis, Inc.1 of Columbia sa@is, L@i a(:ri-eeinent ono- Of -'L-.l 25 8 9 dh-3 Iplan. I-leartil-y I endorse it." However, I am somewhat distressed- 2by the fact that that group will furnish the major amounts of 3the emergency services are not included in much of the earlier 4planning, namely, the physicians in the area. 5 They go on to say that, "If this prominent,omission 6can be corrected,"that is,@the medical community is not enmeshe 7in their planning effort, they would be pleased to lend their 8full endorsement to the program. Now, even the county department 9of health of Prince Georgets County says that, "The emergency 10 medical services system coordinating committee is pocked with 11 health planners who plan on a technical basis, but have no 12,emergency medical service procedures. 13 I do not mean to reflect adve.-ril.y on the members chosen for the coimrt ittee since I know many of them and they #re 14 all capable people," as Caesar was, "But the committee has no 15 pl,yS4CiallS who are active in the practice of medicine. The 16 L Icommittee has no emergency room physicians, no members from plans 17 or rescue squads, no meiDb---rs from hospitals. 18 l@ I The. oi-ily I,!D.,i taken are from Gov(4rii@'tcinl@- servicQ"@ 191 20 and I tliinl- -hat is a very @L-o-ticl-iii-ig of what is lia@?pc@ii- ing in asking -1--he nation to r(?spoiid in 6 we(.,I,@.s to a problem 211 that has a%@@sc),Tie implications. 22 Beyond N.,hat to (lo -.'--lie any morc- than tl-ic,, 23 of us dc), @,@,nd ""Aia-t is the nzt,'-Ui@c@ 241, am fz,@i-i.Itiiig @,ce - Fe@,,E,,ral RepoTtets, Inc.I I C) f -f the exi-(jenc:i.(--., f i.iig 25o !I U dh-4 I So if I put all of these rambling comments together, 2 I say that this application , written by a sub contractor for a 31 @,IP that has probably one of the worst management histories, is 4 a planning grant for 6 months. And though I would grade this 5 on the basis of 1 to 5, maybe 2, and I would note the reserva- 6 tiolls, I would still fund them fully because they need all the 7 help they --an get and this is a tremendous problem for the 8 area. 9 DR. SCHERLIS: Would you state whether or not you 10 have any conditions on that? In other words, would you go along 11 lwith some- of the letters that have been written, or do you just 12 give it without condition? 13 DR. BESSON: Well, I suppose the conditions:,ire iii- 141 her'erit in what our leverage is. All we can do is 2 things, 15 provide money, and assistance, advice, resource assistance. ,The money we do easily. We can sa@, yes or no. 16 17 The advice is a little harder. Yet, we have been itrying to do this for now many years none, Jud , and i-c is 18 y -rying to get @,lood c@u+- of a turnip. There are no conditions I 9L- - 20 that I @@;oul-(.1 Lp@-,cify on i-cioi-iies except do a good job, 21 f 1 DR, SCI'L7,,RLIS: Second alL@C@ 22 a reviewer, Mr. Toomey? MR. actually -."ol.lowe-d pretty 23, I ic". cc)orcii.rial-.A.n(-T on 24 i r@cE@-Fedefal Repo;tcis, Inc. sc@rvj,,(-es including frol@'p, 25 9 1 dii-5 District of Columbia, to contract with a independent health plar- 2 niiig organization for the development of the plan . It is an 3 application for a planning grant rather than a program grant. 4 According to page 9. of the application, the EMS 5 programs have a history of being unsatisfactory and are not 6 effective. This proposal plans to eliminate the causes for 7 these unsatisfactory systems by revealing a plan which will 8 provide the philosophy, guidelines, and@methodologies to be 9 followed to insure the development. of a regional council on 10 EMS. 11 DR. SCHERLIS: Philosophy. Identification of rules 12 particularly current and future requirements, maximum effective 13 utilization of anexses to current resources,, medical profession 14 and community patience, coordination and coi-itro:L, identification 15 of linkages with non-Et4S health care agenci.es, linkages with 16 supportive agencies, specifications of standards. 17 I won't go oil. @lie fact is that they apparently are 181 greatly in need of an orgai-i@Lzed a,i-i(I coordinated program and i-11-ie 19 indications are that tflc- first step nec,@ssary would, be@sucli a 20 study a@, they're talkincf about. And I frankly don't know wlierei iI v@oul,d rate it but I think that it is the k.@.n.d of thing that 21 we probably wo,,il.d justified -i.ii p-@.-,@,@,,-iding fiii-Lds for, for this 22 23 study to be d@,ie. 1 Z . S C.'t I.. S 24i @cf!-FedetalReportets,in !I--)er-, of (-,OTfl@-l@.l@l-.1-@,!(,--!. Arid you 25@l t.r cc)or 92 dli-'6 I it, do you share the concerns of those lettctrs? I do, to a 2 great degree. 3 DR. BESSON: Sure. I think it is the best we have 4 in method C., though, and I suppose I mentioned my feelings 5 earlier, that we are either going to rei-7ard the strong or 0 nurture the week. And I think if it is a seedling that we are 7 interested in, my personal approach is to fund all the seedlings 8 and nurture all the saplings, and straighten out the weak ones. 9 I think we have to be most cost-effective with our iolmoney, and Irather than saying no to method C, I think for $79 11 Igrand, whether we by an ambulance for Albany, or wherever at the 12 same amount of money, that this is money well spent. DR. SCHERLIS: Would you accept as one of the condi- 13 14 tions that they restructure their coordinating committee to make 15 it a much more representative group? 1 6 DR. BESS014: Sure. 17 DR. SCIIERLIS: As I look at it, it is a qoveri-imental 18 agency that has !)-men transposed to I,,.Itetro and operating an- eiiierg- ency -;ystem. -@q(-)uld that be acceptable? '2 09 PR. B.'CSSO@'@4: Absolutely. We'll accept this as a 21 imotioil. 22 Mr. Chairma.-I, rather than reiterating this, I thi,nk that in advice that would go wi,th each of those. r-undin( awards, 23 -T II think that is an opr)o--tiin41-V 'or ,ic, to -1-el.l. and tell 241 cc - Fedeial Repe@,le-is, Inc. there', and tell them again. 251@ dli- 7 1 DR4 SCIIERLIS: @"es. 2 DR: BESSON: All of thcill. 3 DR. SCHERLIS: There are no apparent con'surfiers-on. 4 this. 5 DR. BESSON: Don't you agree, Judy'? 6 DR. SILSBEE: I haven't had a chance to read the 7 application, but who is going to be -- I 8 DR. BESSON: Block P-IcGibney. 9 DR. SILSBEE: The subcontractor? 10 DR. BESSON: Yes. 11 They are going to put together a plan and come back 12 after the $79 grand are spent with a plan. .,Doesn't it bc4-lier you a little bit 1 3 DR. HINMAN: 14@ that a professional grant writing group doesn't know to get the 1 15 right group involved? . have Croaked with Block, jM 16 DR. BESSON: .1 cgibney 17llbzofore, I think they're idiots. But they're the best we have, I 1 I S',.)Ppose. I N-7ould maybe for Kai S-,7stenis to have gotten 19 iii involved Ln -,-ii.s, or so,,-ie itiore. ast,utc-, organiz@it@--oxi. If T cc)Tiii)c,-nts with Kai 20 21 Svst(@its, you impressed w@.L-1-i doculilc)@-itatiori but you 22 cicii It have any with that group, is that i :? correct? D R . 3 N - I Cic)i-4@t wi4-"'rl 24'i ce. Federal Rccioitefs, Irc. DR. SCII'@rl",@ZLT,13: Do you know 25 9 4 dh-8 I DR. BESSON: This is -the first time 1 have ever en- 2 Icountered Kai Systems,. 31 DR. SClil:"RLIS: I didn't want this to be construed o,,, 4 the record as a personal recortiraendation based on experience. 5 It is just a personal recorotrendation, right? 6 DR. B@-SSON: We'll expunge that one, too. 7 DR. SCHERLIS: Expunged. 8 There is a problem with an area like Metro. I think 9 we all know from personal experiences of the tremendous need arid we're pleased tlie're go-Lrig to do something about it. We 10@ are cor-icerned about this frankly being developmental money and 12 we don't know what will come of it biit at least it is an atteirpi. 13 I would assume.tliat RMP is close ei-iough to the scene 14@ that ho].,)efully, there would be car(:-fi-iJ. monitoring of what goes 15 on in the area. That hasn't been the h@-'Lstor-,)- of Metro, 16 has it? 171 DR. SII,SBEE: Tl-jziL has not been l@l.istory of the 181 rc-gio.,-i. I DR: ll-TN'Li'IP@'@4: Their acceptance of prc-@vious staff advi-e 19 20 has not been 21 DP,. SCII@,"IRLIS: I world hope that these tuncis would bE 22 suppic!,IIIE@i-i-ted (iuj,t@-, as a iiew fund-A.rig mechanism, at 23 I.t--ast, funds. Any c)t",i(@r 24i Fedeta I Repo( tefs, iric. 25 dh-9@ I This known as a negative lial.o effect, it comes out 2 favorably. All@ those in favo): say aye. 3 (Chorus of ayes) 0 4 Opposed? 5 DR. FAATZ: lihat is it ranging? 6 DR. SCHERLIS: Two. 7 DR. JOSLY14: And full funding? 8 DR. SCHERLIS: Yes. 9 DR. BESSON: One year, that is all I requested. end 9.7 10 DR. JOSLY7i: Yes. CR 6307 11 12 13 14 15 16 17 181 20@ 21@ 22 23@ 24 @-Fede@ial R4'PO(tf-'fS, If-IC. 251 19 6 6 0 7 41, 7ter - 1 DR. SCi'IPRI,IS: All- 2 The nc,,t area is that of oii.ssouri and I want to 3 than': Dr. Besson. Missouri submits two projects, Project -y General Hospital @"edical 4 No. 85, centers around Kansas Cii 5 center. Its purpose is as stated to provide a comprehensive xxxxxxx 6 emergency service for Kansas City, and a centralized trauma 7 service for Kansas Citv. 8 The Kansas City General Hospital would be designated 9 as a major emergency facility cat@able- of treati.ng,-imi@-tediatf2ly 10 ui-)oia arr-Lval, anv patient of a life, or limb threatening 11 Condition at anv time. The emphasis on this, both in their 12 brief summary and in the grant itself, is I-,;-cjl-ilv on trauma. The ho.-r)ital is oiDerati.nq as a major eiuerge@icN, 13 14 giving care and definitive treatment for all enierciatcies. Early screeniii c@-cr- emergency room ,Patients ,.7ith 15 9 @-e specialized treatment in trau,-Li a,@-)i,)r(7,)oria4 @.i, dru abuse, etc. 16 @-;.--,reenj-n(j- establishing an overnight o@,D,-zerv,-i.-I.-ion @,7ard 17 to the emergency room, and conducting a c@@inui-crized 18 -.-or I)rop,-,r i-ecor@li.ri,-f ,ind fc@c@, )ac@,. 19 L. - - @.1 The of money rc(-Tu(--sL, I .for i7)roj(!ct 81- i@,; 300,000 20 -ic@, hir@l 21 thc-, E, year 8 0 0 0 , tire P, and '3 0 0 , 0 0 0 22 tire pi:(-)jc-,,-L, it is cc@nt@c.@(:@cl not on the 23 e v q.), i i -k ,,i i- i 1 1,@b f7, C i t@,7 24 ,ce - Federal Reporters, Inc. 25 19 7 I little in the way of community involvement. The lineages, 2 themselves are onlv partial, as best I could determine from the 3 review. Some 250 thousand is requested for salaries for the 4 emergency room and trauma center, which significant sum is 5 obviously for the in-ser,,rice area of the hospital. 6 There is very little evidence to me of regionaliz- 7 ation in this. It does not speak to a system of total emergency 8 care, but much more to trauma, itself. There is some indication 9 of problems in handling the ambulatory patients which come 10 to the eniergencl room. But basically, this is oriented almost cor-@iiDlott--I@i, towards the 17\ansas City Hospital in the in-trauma,' 12 and the support of the staff of the emergency area and the traurctd center, as I have indicated, comes to most of the sum. 13 14 I did not give that any recommendation as far as 15 rating. I do not thing it speaks to a system of care, and I i.t-- is all for the l-,ansas@ Ci,t@;, Gener,-tl Hospital @.,,.i.tliout 16 171 bei.,,,g part of what our guidelines would rE-,@comiiic@nt. The second project is oiir@ Vehicle centers zi@--ounl the 181 XXX-@xxx Lc-st(@r r7@. Cox T@@edical Cc@nt(-,.-. 7@)roject rec@ucisis a sum 19 - o 2 0 ,l fl--illion for the first 1.4 for trip secoi,d, 900,000 for the tll,"-rd, for i tiei-L o--@ to 21 04 e v (I 1-114S is rojoct 'lo. 87 -.-- Ij-t@rarcl-i oi-. emc,.r,( eric@7 22 an m s c v i c ea c i 1 i t i- ci ni@i c,, ca 4- cl e i- cf o n c vt r @i s T-) o r - 23 t i@ 7" c@ rLI , air -to 241 @e- Federal Rel)orteis, Inc. ID(.@ to 25 3 198 I for 33 counties in rural southwestern llissouri, which would 2 include an emergency transportation network plus emergency 3 medical facilities. 4 It would include six equipped ambulances, three 5 eciuiiDncd busses, md one helicopter, and they want to establish 6 at least one major medical facility, and several satellite 7 emergency facilities, train 25 nurses in emergency treatment, 8 as well as other associated paramedical personnel, and to 9 develop a communications s,,7stem, in addition. I 0 In reviewing this, something like $500 thousand for salaries, 37G,000 for equipment, includes 30 @i.,-,ibulance atten- 1 2 Ciant:-7,, 25 nurses, and individuals to man the helicopters, 13 as well. There will be three p'liases in terms of T-iolDile units. 14 Family health car(-- is discussed as well, and actuall,, 15 when you read about tiie this would be three busses ,,I-iich .,.,ouJd be us , -medical 16 11, ed to service nori-ei,-ierc .jency I - 17 na,tients, and also funds are requested for family health care 18 statio s, circuit riders. In reviewing this, a'-t-iiouq:,i -it is submitted as 19 of an e.,-,iergencN), medical i-i-- really d-I.sc7.iisses total 20 and discusses it i.i-, @i di,i@fer(@,nt %,ia@? than one 21 CE'rc 1 I @@;ould uid(--I.iiiEs. It is a three--vear 22 i roi-i-)2-o it co-,ir@,litriity hosr)it:.Z,-I, wits' 23 c (i u f; as not 241 Federal Reporters, Inc. but funds for ilatii-%r IIE?ali-tli care 25 19 9 1 to transport patients from the rural area to the hospital, 2 itself. 3 There are points of value in this, in that there is 4 active involvement of the community. The area served is rural, 5 involving some 700,000 neople, but my concern is that it 6 tackles a much larger area than just emergency medical ysstems, 7 and even when it approaches emergency medical systems, there 8 are large areas not discussed., such as the training program, 9 physician coverage, equipment which would be on some of the 10 emergency equipment discussed. 11 Before recommending any funding on that, I would 12 1 like to have the secondary reviewer m, ake any comments which he 13 woul,d feel appropriate. That is T,,Ir. Toomey. 14 MR. TOO-TAEY: I would -- Ifelt the same @.7Eiv you 15 did about the I'\ansas City General Ilospital, they were a,,;king funds to irirjrove the services within the hospital. but without 16 17 mucir concern for an emergency niclical services system, a,-, 18 far as the area was concerned 19 I think I felt -- I do not lcnoi.@ how you feel, but I felt that tlii-@, i-)2-c)-,)o,@,al@ from tl.-ic@ Lester Cox C(@ntcr 20 1 in SiDringfi.el@: (,i) was very @Lnt(@,rc@sti.ng, but it really had 21 onl,r one part of it devoted to providin(, an emergency medical 22 23 service for the. arc-,a. care 5t,@,-t.-;on prol-)o@iz-,,' 24 ce-Fedeial Repoftefs, Inc. T felt the circuit 25 200 ter-5 I rider was not exa-tly pertinent. one thing do not know, 2 did you mention the fact that this is the second time this 3 proposal has been submitted, and the letters of 4 DR. SCHERLIS: For '68 and '69. 5 MR. TOO!,,IEY: The letters written in support of it 6 were dated in 168 and '69 with the statement that the people 7 who suiD orted the thing were supporting it now. @p 8 DR. SCHERLIS: Tlie-@.7 still like it. 9 MR. T0014EY: Ye-S. 10 DR. SL-IIIERLIS: They have -- the intent is to make 11 health care service available a7tong those PeoT)le who live in 12 the hinterland sectors. And I would concur that these 13 are very valuable goals, this is not what we are addressing ol,,r- 14 selves to under the 17,'Iij'S guidelines. 15 MR. r."00",IEY: In su,-,,,.-.iarv, what I said, the portion 16 of this proposal which deals the development of Et centrall-,,,, 17 controlled and coordinated syE;te.--Il oil ambulance services for 33 counties, in a desirable project I)c-@rliai-)s, but the health 18 @@cuit I- I 9 care stations @trid the I-)hzsici--.r. c:L. ider are interesting, 20 !",Oul-(,, !.)c of scin.,c-@. value, but are not ay)T.?rol)r-Late and r(.ala- 21 t e. cl ti c, r c) j c 22 DR. Sl,-Iilj'@PLIS: Did the sum? 1,@hat 23 f 24 Tr.)O,",'Y: oi),e @ce-Fedeial Repoiters, Inc. 25 J, 201 ter--6 DR. SCliERLIS: A million, forty-five? 2 -@,IR. TOOMEY: Dio, I did not recommend the sum. 3 DR. SCIIERLIS: I gave this a rating of two and 4 suggested somewhere between -- I had fully suggested 75,000 5 to help get the planning going, because I think there are some 6 parts in here that can be put together. But I would not 71suggest it 90 to the Lester E. Cox Medical Center, but rather 8 the regional medical program office, for planning. 9 MR. TOOPIEY: I would support that.- 10 DR. SCIIERLIS: The motion then is $77 thousand for II i.,,Fo. 2, at a rating of two. That is actually application 87, 121to keep it accurate-. 13 The sum of $77 thousand for a priority of two, and 14 the other Project 85, no support. 15 Second revic\qers? 16 P@'tP,. TOOMEY: Yes, ol-,ay. DR. SCIIERLIS: An,,7 comments? 17 1 181 DR. PESSO@L: I did not. I DR. SCIII-PLIS: Yes, sir? Di,. l@eller? 191 20 DP,,. K I ju!7,t %,:,,int to ask @.,7itYi respect to 21 cuidelinc,,s, @l;e h ve h@.d just oiAe or other T)roje(-"-s today 22 Ithat seem to e,-,iT)hasize the interface enierg,f@ricy medical 23 centers and the rest of the lic-%al.tli care iDvstem. Il@ I under- 24 our ti-iit oiic-tiii.nj @-lic iro @ce -Federal Reporters, Inc. 25 202 I DR. SCIIERLIS: Yes. 2 DR. KELLER: I just had a moment to look this througl,, 3 and it is avery complicated application, and I am sure that 4 there are many difficulties. But, is there something in 5 here that can be funded.- That help is to emphasize the desira- 6 bility and the importance of this kind of linkage? 1-7liat I 7 am afraid of is that in i-,iany of the programs that have been 8 presented, the people who are specifically enthusiastic for 9 emergency medical services will gain such ascendancy in these 10 things, that eventually the linkage between that an t e 11 rest of the health care delivery system will begin to be 1 2 deemphisized. 1 3 DR. SCIIERE.IS: Yes. I view the system as being not 14 just in the emergency aspect and ending in the emergency -- 15 when the emergency is tal:c-ri care of. But it should certainly 16 go the ciitia:e loop. I think some of the guidelines enil)l-iasize this (.is well. 17 18 I think in this particular instance, the first one onl.v looks at 'a very small --- not just as,,@ec@L., but a physical area as 19 nart of the system. 20 , 21 As such, I thing it falls outside 'of the guidelines. 22 The second one the prc)j:)lci-.i of being a '68 - '69 a.i--)plicat.Lo,,i, i.@,liicli tlif2,y, sa@., everybody still a(irccs with. Secondly, it there- 23 24 @- o r (@ @.o c-., snot have tlic- '@-.0 itself in ter,-is @ce-Fedetal Repoiters, !nc. I-, 4- f,,-,uct-,. h@is ((-.)nc ii,ito that- of -lie c ,Ut y( @ .3 25 c, r - 8 20 3 I planning and training as-,)ects look like they should be salvaged. 2 I felt as a secondary reviewer these could best be moved from 3 the responsibility of the Cox Hospital to the regional program office, itself, so we get -- we would hope we would'get a 4 5 better correlation with the other services in the state. 6 It has aspects that are interesting that might be 7 favorably look upon under general regional medical program 8 supports, like area health centers. but this is not part of 9 what %lie can support under our present meclinisnt, at least within our responsibility todav. I 0 I I TIR. TO R)MEY: Can I comment just a moment? DR. SCHERLIS: Sure. Yes. Please do, Plr. Toomev. 12 13 MR. T00i'IEY: The first program was just internal 14 operations of the emergency room, and I do not consider that 15 to be part o'L@ our responsibility. The other one is more of la con.-eptua'@ thought. I am rather amazed at one institution 16 i in ST)rinqfield i-7ariti.ftg to accept a- responsibility for coordin- 17 aiii@ulai-ice servicc-!s and other services to in a 18 t 19 33 colAnty area, and to the degree that i..t is m"7 c),.)i.nion, that the lio; r) i -La I s %@i 1 1 d-i-,-@(-tion of sharing 20 @i. - @)C MOVII'I(J II tl - -1 .. " I -i,c(.@s ar,,,L in the direction, of :Fi-iic'ij.ng a r,.-,,,-ijc)r institution @,:71-lo 21 -ccep-Ls a major in intecirai:iiig vp,,.-.i.c)us kinds -)f services, 22 23 ambulance and other '-'e ma,,, @i- 1,@ol nice ai.. i-r,7,LLi, o-, Glen sa,, , "P,'ove. 7 24 -ce- Federal Reporters, Inc. i -L 1. ratti 25 27 f i@-oiTt the c@ I 204 than looking at what seems to be coming in the future, which 2 is the enlaracd role of institutions covering and with a 3 responsibility for a larger area than they have had in the 4 past. 5 I do not know what the answer is to it, but I end #17 6 think it is one of those things that is happening. 7 8 9 10 1 1 12 1 3 14 15 16 17 18 19 20 21 22 23 241 ce Fedetal Reportets, Inc. 25 2 9 9 DR. SCHERLIS: All right. 2 Next is Mountain States' three projects. We're on the 3 home stretch now, I hope. 4 All right, Mountain States' request is for three projects 51 which come to the following: $375,000 for project 26. 6 DR. HINMAN: That is all three combined. 7 DR. SCHERLISI Oh, okay. All right. There are 8 three different components; one from Idaho, the other from 9 Montana, the third from California and Nevada. The general 10 objectives are to develop a comprehensive emergency medical 11 service planning Program for Montana, increase the existing 12 emergency council advisory activity, initiate needed training, 13 inventory all emergency facilities, form an area-wide planning 14 co=iii.ttee,for project.@resourQes. Staff and-:vol,unteer;would-be 15 from otherisourcet,@-And they have-other funding for that. 16 And for Montana, the following comments were made. This 'lar to the other states, as 1 will indicate. It is 17 is Simi 18 essentially the same as Idaho. They give only the barest out- cn 19 line. There is a very poor breakdown as far as salaries are 20- concerned. They requested a total of $142,000 for their 2 11program. I 221 They requested specifically to support a staff' of five 231 members in the Dc@partment of lleal@1-1-i and Environmental sciences, 24 eight in the coordination of five cinercfen(-, -.y medical service e - Fedc,,r,,Al Repr,,rtcrs, lrc. 25 planning ccaaii@-ttc--es in the state s,,,pl)orti.yic@ training of 3 0 0 2 @M I emergency facility personnel, inventory the state resources, 2 provide ambulances and equipment, and then there is a $70,000 3 budget item to purchase ambulances. This actually is not in 4 the budget. It appears to come from federal sources. 5 I would concur in the fact that I would not fund the 6 budget request at this time because, essentially, they should 7 be much more in line with planning. If you go through the 8 yellow sheets, and these are interesting because most Of the 9 responses in terms of understanding the EMS system are on the 101 negative side. In fact, most of the comments of staff were on 11 the negative side, as far as the entire project is concerned. 121 This was Montana. 13 In terms of Idaho, again, this is a very similar one to 14 Montana. They specifically ask for funds for an emergency 151 health services advisory board. They want to provide EMT 16 training, EMS physician and nurse training, coronary care 171 evaluation, emergency rooms, coronary car@ units and other 181'hospital facilities, classifv and evaluate emergency rooms in 19 Idaho, collect and tabulate data. 20 I rated tliii more favorably than I did the one from 21 Monta.ha, They had requested some $178,000, which I thought 22 wa-, somewhat excessive. They have requested mobile coronary 23 care Vehicles, and I felt this should be under a separate 4@und- 241 inc,. Tll 4 C ., was on -- if you want to check, it is on page 45 E,-Federal Repofte@s, Inc. 251 their ai TheN, do haN.,(, good dEi.-La on the amb-Lilanr(--@s, 3 01 JY, 3 good data as far as a lot of their information is concerned. 2 The goals were very well-stated, as well. This looks a@little 3 better as far as being more of an emergency medical systero.. 4 They do have better planning than the others. @Although they 5 are emphasizing only part of the EMS system, they do define 6 some of the other needs. I thought all in all this was a 7 reasonable approach. 8 The third was Nevada and California. This request was 9 for $55,000 for year 1, $62,000 for the second year Here ioi they specifically asked for funds for a program coordinator, III FMT.training and EMS committees to coordinate their planning 12 of a total. system. Actuall.y, although there is a need defined 18 in their grant, the grant request, they don't address themselves 14 very well to a total system. 15 My feeling here was to give them a low rating, although 16 they need their funds. I felt this was overall a poor presen- 17i tation. 18 What I came up with then, as far as California and Nevada 19, was concerned is that that would not be funded, but in terms 20 of the Idaho component where they had requested $173,000, is 21 that this be rated as three with a request for $1,00,000. I The third, Montana, I had a dilerriiiia on this one. My own 221 23 react-Lon was to rate this two. I thought their request for 24 funds was excess)-vo:,, and in cor:@E,,aring -',,.t to the- ones that came Fede ra I Re pof te i s, I ii c. 25 in from the same area, it should be refu@,ed. I suggc@st a @tm 3 0 2 JM 4 of $50,000. 2 DR. HINMAN: Do I understand you corre.-tly? You are 31 recommending one-year Planning for two of the components? 4 DR. SCHERLIS: And zero for the third. The other 5 was 100, and the other 50. 6 Is there any member of the staff who could speak to Idaho 7 or Montana, as far as how they have moved along with their 8 emergency systems planning at this point, aside from what is 9 present in the grant application? 10 Do you have any feeling on that? 11 VOICE: I was out there to a RAG meeting just 12 recently when these projects were pushed through the RAG, and 13 at that @-ime, the pro3ects were wer--e heavily loaded with 14 equipment requests. That was the essence of it, basically, 15 and they had not followed or not had any idea. what the EMS 16 guidelines were at the time. Subsequent to staff input they 17@ went back and reworked them a little bit, and I think they have 18 taken out most of the equipment and are tryinq to plan aspects. 19 DR. SCHERLIS: These look thick, but they are all 20 appendi@. material, and there is a lot of padding of related 21 and unrelated material. 22 VOICE: I think there surely is 23 DR. SCHERLIS: The requests are scant, and I think 24 more i.n terms of planning, and I thi@ril,@ they ccin probably move Fed,,ia 1 Repof ters, lrc. 25 or, tha@,. 30 3 JM 5 VOICE: The Idaho one has been conceptually worked 2 out much 'Longer than the other two. I think you hit them in 3 the descending order they ought to be. Idaho, Montana, and 4 Nevada. 5 DR. SCHERLIS: Right. Is there a second to that 6 motion? 7 DR. MC PHEDRAN: I second. 8 DR. SCHERLIS: I think we have struck.the coronary 9 units, ambulances, from that program. 101 Any further discussion? % 3 0 7 1 DIZ. SCiil@l@.1,'3: next is New Jersey. 'D l@ 17 2 2 DP,. liC Pll.'r, 7Vi There are two pieces here. one is 3 according to their numbering system, 028 Emergency TItedica."L 4 Service System Plan, 029 is a Computerized Shock and 5 Assessi,.ient of Treatment. 6 I would say in summary that these are either 7 rated -- I will rate them as one or "can't rate them," and 8 would not recommend them for,any funding. 9 In the Emergency Medical. System Plan, there is -.i,,.ply not enough information really to tell an-vtl-iinq about lo s@ 11 Ineeds or resources, let alone to relate the different resources @l 12 lone to another. 13 It is a proposal to evaluate these things, but 14 sc-er,,s t_qat like the other regions, they might have accumulated 15 enou(ii-i information sort of to give us a feeling thit they had some 1,aint idea what the problems might be, other tlia)-i that 16 17!there are serious problems of deprived people in urban centers. 1 real.ly --- I c:ot,llc3.n't tell mu(.,.!]-i of ai-iytl).in( al.,otit 181 19 la stc-i-te that I really know a lot: about, frorc, having been i I any t4mes. I ust is Enough 20 lenr,)ug4lil- detail here, to warra:it 21 lis the -art of i.t-- that I tl-tix)l-. wou'4-,,@@i. !)e might I)c! a,,,:)T)ropr.@k,.e-to 22 2 3 f o): s f u,.. ni n g e o t h r a s t u d v a 1) r . G i .11 c o t Ni. j-, ,-,f.:,-Fedefal Repotters, I,.ic. tliiiik it was Dr.-. that rc-@-,r2l-ew(-@d tll@i,s No. 251 2 1 SO@Lbody else, I'm sorry. A study of a method of evaluating 2 @patients in shock and using a computer system for deciding on 3 the effective treatment, and it is a clinical study, and I 4 think not appropriate for RMP funding. 5 So in summary, I wouldn't recommend any funding for 6 either one and rate them both as one. 7 lqhat they have produced here stands in contrast to 8 what I gather -- eastern operations said this is a region that 9 has had good management capability in the past. And it doesn't 10 come through. 11 DR. SCHERLIS: Dr. Besson? 12 DR. BESSON: Yes. I agree with the physiological 13 monitoring. 14 This is a reflection of the kind of thing Albany 15 wanted to cio and I think it is inappropriate for 1'JAP, and 16 notl).j.ng further need be said about that. 17 The other program, the integrated program, so 18 called, means to survey transportation by an interagency 19 council, develop a plan for training, assess eriE@rgenc,,r 20 roo@-L,,-, and identify the needs ol@ t]-i-c poor working with model 21 cities an@l coictliurii-ty Cievelopriorit ci.ti.@,s, 20 in Eill, to improve 22 the emergency rendered to the poor. 23 I view this as a dev,@l.opi,-,oi@ital grant, this proportion 24 lo' it, ai-ici '@ a(3ro-c4 i)l:,. rc@vicwcr, -f, - Federal f3p-poftL'@.,, lfic. 25 i)r. Giy,,@ble, that thc@ ci),tire is e@.-trorci(-@ly sketchy and 9 8 jr 3 1 scant, althoLt(-ih Liew Jersey does have a good program coordinator 2 and in general has been a relatively mature region. 3 Again 1 am charitable in saying that this was the 4 result of the precipitous nature of the Droposal submission, 5 and I am a little bit more charitable in not faulting the 6 region as Dr. McPliedran might be in not giving them any funding. 7 I think the fact that they do have a model cities 8 program that is working, that is interested in becoming 9 attached to this kind of effort, I think the fact that they are 10 using the model cities in their community development orograpi 11 las an entry point for not only providing emergency services 12 for the poor,, but addressing the nation-wide utilization of 13lemergexicy services as an access point, which is an entirely 14@different question, and one which has to be answered -- we 15 ]can't overlook it by talking just at the lof-tv level of pro- 16 viding emergency medical services. 171 Many people use it as an access point. So, while 181thcre is no recognition of that asl-)(-ct of it in tliz-ir proposal, I 19 and the whole thing is v(--@ry I think it is int-ol-est-i@.ng 20 that l@Z@P is talking to cori--up)(-@rs- @!il.l ral.-,icily bring 21 Ito their a-tt(--nt."Lon. And with their maturit,@, I" 1,7oul.d be inclined to riavl)e 22 23 Irather than not giving thei-. any to give them os I.y. r so fun(i'ng of the --,r--c;c)nCi 2 4 11 '-' @e Federal Reporters, Inc.I DR. I'Low rr!uci-,. that b-@-? 251 1 9 9 I DR. iiC PliEDRZ@14: jr 4 About $40,000. 2 DR. BESSOL4: $40,000, yes. 3 DR. GII-IBLL,: Are you. talking about 28 now? Proposal 4 02 .8? 5 DR. BESS014: Yes. Fund nothing for 29. 6 DR. SCIIERLIS: The agreement is zero funding level 7 for the shock study. 8 DR. MC PliL,DRA14: Okay. 9 DR. SCIIEJ.ZLIS: Arid now you are talking in terms o 10 getting this off the ground, the general proposal; an you are ii I recommending how much? 12 DR. LESSON: lqe have two motions. 13 DR. MC PHEDI@N: I agree with you, I think that is 14 an important part of it. I think-that is an important oppor- 15 tun@l-ty that they have. This is a problem everybody has and 161 ti.-iey dici audress that as a specific objective more than rt,:iny 17 of the other plans did, I guess. 181 Okay,, I'll c-i@icrici -airLe. I'll go along with that. 19 Still, it is hard to anything for something wl-Lil-,,ii 20 I still Firi(i I can't rate. 21 I find sort of an internal ii-icon.,;ist(@iiry 22 1 recommending a.ny funds at all for something that I would rate 23 so low. 24 DR. You co,,ild rate 29 scl-.),.i.r@-,tely f3:()ii-t 2(@. Federii Re[)otters, itic. 25 DR. i',IC PI-IlIDf,AL4: Yes. I've done that. jr 1 DR. SCF-,ERLIS: I think the rating we should have is 2purely on that fragment of the approved project. 3 DR. !,IC PliEDRAI@: Yes. Okay. 4 DR. GIMBLE: I would like to comment. They mention 5a specific problem in New Jersey: The independence of the 0volunteer emergency squads. And most of their application 7appears to be directed at improving the quality of service 8rendered by these squads. 9! The thing I find unfortunate, though I think it is 10 a good opportunity to get all the squads together in terms o 11 lqetting cooperation,, this isn't very strongly put foIrth in the 121application. I think that is the most important part of the 13 application. 14 If they could use this as a vehicle for cooperation 151between squads and between emergency rooms and hospitals, it 16 would ',,e important. 17 1 get the feeling it is overlooked in this cipplica.-- 18 tion and I think a recommendation to that effect, rather tliE,.@i 191 just support the squal,".,-; on an X amount of money for each squad 20 to improve their education. 21 But somehow they should be 1-iool@c-,d in,-co getting their 22 Itogetiier for a cooperative venture, more than just a training 23 amount. 241 DR. I agree with that. I see the only ce-Fede@al iieporters, Iiic.I 25 !virtue of this application, $40,000, will be to help them -get- n 6 off the ground, and also to sit down at-id talk with some urbc-A 2 poor. once they sit down and talk with them, I'm sure they 3 will get the answer, "Gee, where have you been? We're glad 4 you asked." And from then they will submit a much more rele- 5 vant application next year. 6 DR. SCHERLIS: Do-you have any comments about the 7 New Jersey area, Mrs. Faatz? 8 DR. FAATZ: No. 9 DR. SCIIERLIS: What is the rating then, the two of 10 you? 11 DR. MC PIIEDI@N: Well, as part of a system, I guess 12 I might rate these parts as a 2 or 3. But as the whole, -- 13 028 is this whole plan, that is the number altogether. 141 DR. SCIIERLIS: Yes. 15 DR. MC PIIEDPAN: As a whole, I don't think you 16' could give it that high a rating. But these portions of it., 17 where the talk about identifying a.,,id trying to do something y 18 about Pro]Dlen,,,s of urbari poor, to correct thi@:-, abuse of LMex- 19 gency room systems, to do soi@iel.-.1i.i,ng to devise s(.)nie system 0 20 do that, to ciot @4w@iv from tlicijk-., @@e could r@-Ite that as 2. 0 21 DR. SCIIERI,!S: Do Y(-)Il accept that as a 2 rating'@ 22 DR. Bl-'SSO'.,': Sure. 23 DR. Dr. 24 DR. whether,: you @,ioulC, like to ec)n,- F(,dera I Repo@ ters, liic. 251 sider brcaj',.in(i do-,@n 028; @'ou are able to break tiliat c;.own- if jr 7 1 you would like. 2 DR. BESSON: You v7ould rate the physiological moni- 3 toring as one7 As zero? What is the'least? 4 DR. MC PilEDRAN: Zero. 5 DR. SCHERLIS: Zero. 6 DR. 14C PHEDI@N: It is inappropriate. 7 DR. SCIIERLIS: I think we could accept zero. 8 DR. BESSOII: The other is 2.5. I would go along 9 with that. 10 DR. SCIIEALIS: Is that satisfactory? DR. ROSE: That is for the whole 028 project? You 12 don't want to place any restrictions as to what kind of activi- 13 ties they will be doing in that project? 14 DR. BESSOIT: No. 15 DR. GIMBLE: I didn't find enough material to break 16 down, unfortunately. 17 DR. SCHERLIS: We are talking about making a start 18 on a system of care, and trying to get into the @iri,,bulance 19 problem a,.nd hoping the train-Lng might be the wedge to maJrovc the Dt,-,@.rilop E.@-IT Course, and t",,en 19 4 t I I 4 20 r T i-7 in .r Tiie@i, i--;.eed funds form: c-,nic-r(.,rc!n--y room 21 22 pac@@age for coordiiicti.(-,xi and '.-or teaching -.ids. As j'cii, as c@ 3, il s c c o r-,,l r P, c t i v, -t i @,@ s , t 1 -i s@- t 71 t ci I--) 1 @l @l I 11 i n g a c t i'V' -L- i c@, 3 23 to i@c-@ I.)laiis, +--,) seat 24 .Ace - Federai Repoitefs, Inc. 25 r 3 120 co@tivenl' that vou in re-ati.cii to the tri-stcite area 2 interstate coordination. 3 This is one of the few applications where one 4 particular region will look to contiguous regions and use some 5 of its funds for interregional. cooperation, which is very 6 laudable. A-- I have looked over their budcc-@j-ary use of monies .J 7 for personnel, I am impressed by the trai.nin(j of the people 8 and their T)a.st experience. It is quitc- impressive. Their 9 gc-i-ieral budget figures are in keeping with the fri.igalitv of 10 I.Ilngland Region. 11 They are ask-i-i-icj- for 72,000 for a project which I 12 gradc, a,i, at least,, a '113," if not a "B+," rour, four and a 13 half. rour point five. I would recommend full@ funding. 14 DR. SCIIERLIS: All right. DR. BESSON: And is cheap at twice the price. 15 16 DR. SCIIERLTS- 17 TO,'),@IBY: I had only two areas of c(-)i-icern. one i,jas t--iie rc)o7-11 operation regulations by 18 19 aii,,l tli.( othc@r @Dlip. 20 c-.)'L the fo@7 nonmedical I-le' a_', 4 -iti.c@.nt@, c in -y room. 21 c@irc cf p@ c t I r ti 3 @5 a o d. Ei p -p 1 i ct i o r@ 2 2 2 3 ,-or it 24 @cr-@-Fedf@rat Repoters, Inc. TC)" I .1 (3. 25 121 4 I be a )-,@arcjairi. I recoi-.irtic!n.-l it and I would give it a four. 2 DR. SCIIERLIS: 7iny other comments 3 Dr. @Toslvn, any comments on this? 4 DR. JOSLYN: No. 5 DR. jl.IATORY: I %@7ould like to agree with the comment 6 about the professional capability of the group doing this. 7 They are very fine people. 8 DR. SCI-IERLIS: Thank you very much. 9 P.11 those -in favor, lilease inCicate by saying, Flaye.11 10 (Ci'lorus of ayes.) 11 DR. SCIIERI,IS: Opposed? 12 DR. JOSLY!Q: I,,Ihzit -is tl)(@- 13 DR. SCHERLIS: Four. 14 DR. BESSr.)Il: Four Point tw(-,nty-f ivc,. 15 DR. SCHERLIS: There are so f ew above that this 16 I'lil) stand out whether it is 'E@oizr or 4.25, if my i-@emor@r serves 17 me co-rrectl-,,,. 181 At this time, unless ar,@roi@ir@ Objects serioi.,,-,I@,, 19 @-idjourn for lunch a-,-,(.1 iii,-ivb@ we can beg'i-l-i at- @71 u a r @L- i:, 20 o c@,nc@ 2 1 thou recessed, to 22 ,I' T) M this -,ariE,, Cl@,ty, 2 3 2411 -Fc-dc,,ral Feporters, Inc. 25 pmp Cie te. io And in te t resources. that it rm,@ Of Is rilos t e to likel@ to be abi P-rorni . I Po.1, n t arn to ing 12 to The requested P-ri de., X the Populat@ amount is rel 14 on to be served. a ti telling $2,250,000 ve " i L- in 'relat .-requests to e ly Sm to be e:cellent. carr$es follo 1, But the 76 re Would $63,800 ,Dp. .re tC, 4 SCII.V@.Z3: and Seern 0 Por d one yea-, ea.r "1,200,000 -Ad Ives $246, 000. them all vo You ccrne th you are ,reco. tyear. of th this 2 dollars CZ2@O orne.rgenc C?ci felt jrb3 25 4 1 beginning with a solid basis of training personnel first. 2 MR. TOOMEY: Is this Georgia? 3 DR. SCHERLIS: This is Minnesota, first. 4 DR. HINMAN: You are recommending the first year 5 only? 6 DR. SCHERLIS: 63. 7 DR. HINMAN: with rating of 4? 8 DR. ROTH: Yes. 9 DR. HIIIAN: Okay. 10 DR. SCHERLIS: I agree with that. That was one of 1 1the nicer ones to read, 1. think, in terms of content. 12 Any dissenting opinion on that? 13 All right. 14, That is Northlands. l@ The next oner alphabetically, for you, at least, 16 is Ohio Valley. DR. ROIIH: Ohib Valle things. This Y is another one of these is a li,-,Iited area in Northern Kentucky. 'resources are close to zero, 20 ly the grant application is very pc)o' there --,Lr@ "O documentation tilaf- they 21 can @)-roduce or that they c@ll c@,ro-- for the emergencies they. 22 bringr in. 23 feel probE'bly it is one of those situations 0 24 "-Federal Repotiers, Inc. t u 3 cl to tlielll out cOr@qPlotej.,V. 25 o,,ci e rn to continue to do jrb5 256 DR. ROTII: Yes. 2 DR. SCHERLIS: Any comments? 3 The recommendation has been made, Ohio Valley, 4 $20,000, with a rating of 2. That is one year. 5 All right. 2 5 5 I planning. And I think you haie to rate the program sort of 2 minimally, perhaps a 1. I would like to give them some arbi- 3 trary figure 41 DR. SCIIERLIS: They requested $62,000? 5 DR. ROTH: $63,800, is what they have requested. 6 I know the RPM. I have site reviewed it; I know they have 7 a good core group, and one of their needs is to diversify 8 and regionalize a little further than they have been able to 9 do. 10 I'll come out with a figure of $20,000, over the 11 top of my head. 12 DR. SCHERLIS: That is what I wrote down, off the 13@ top of my head. I thought they might rate a 2 on the basis of 14 hope. 15 DR. ROTH: Yes. 16 DR. HINMAN: "2" is the figure? 17 DR. ROTH: That is perfectly all right with me. 18 DR. ROSE: May I remind you the implication of 19. that is that the $20,000 is now low in priority? It is not li,Ke-' 20 that the money would be funded because of the priorit-y. 21 Do you see what I am saying? 22 DR. SCHERLIS: The statement has been made that 23 with that low priority, $2,000 would probably be the funding; 241 is that the point? ,ce -Federal Repc)itefs, Inc. 25 DR. IJIDIAN.@ "2", and $20,000, then? z 111) 9 Dr. Scherlis: All right. The next state is Oklahoma d',i-5 Mr. Toomey. In fact, vou have the next one as well. @OU,@ Dakota. Mr. Toomey? 4 MR. TOOMEY: The funding is requested for a $104,000 5for the first year, $124,000 for the second year, and $64,000 6for the third year. 7 It should be noted this proposal was originally sub- 8initted in advance of '72, prior to the development of guideline 9for submission of proposals. The proposal was also submitted a 10 part of a regular funding request application to ralp as of 11 February 1. 172. 12 This project proposal is part of the total anniver- 13 sary application for the fourth operational year to be acted 14 upon by the 1972 national Advisory Council. 15 Okay, considered to be a rural state, has half of it 16 total inhabitants in 3 standard metropolitan statistical areas, 17 including Oklahoma City, Tulsa, and Lawton. Of the state pop- ulatio,l of 2 and a Half million, ap 18 proxiiriately 65 percent live 19 in cities of 10,000 or more. 20 Topography influence as the location of the inhabit- 21 ants with the bulk of the population on the axis from the north 22 east to the southwest corners. The Northwest Quadrant is large 23 wheat farr,@is and cattle ranches and the southeastern, extensive 24 and ru(jcje.,,-t hill ranged, ,e-Ft,acral Rer)orters, fyic. ".'lie statc's medical lie,-II-I.h community y)arallu,"@ 'L.@ i 25 210 dh-6 I general population where half of the city:centers in the state 2 live in 30 -minutes drive of a large medical center. Approximate- 3 1ly 20 percent of the inhabitants of the state are locatbd'in 4 one third of the geographical area do not have immediate access 5 to specialized services and facilities or live beyond a 30 mile 6 range. 7 The primary objedtive of this request is to raise the 8 standards of emergency medical care transportation to each city 9 in the state, to have access to medical services through provid- 10 ing advanced emergency training by physicians for ambulance 11 attendants. 12 Specific@6bjectives.include development of a program 13 providing comprehensive training to evaluate the skills of all 14 ambulance service personnel in Oklahoma. The plan,, the mecha- 15 nish, is the development of a 72 hour EMS training program sus- 16!tained as a cor,,munity-based, physician-oriented course to raise I - ,skills of personnel conunesurate with the emergency medical re- 171 18 spor)sibiliies of individuals already engaged in providing care 19 and. transportation services. 20 11 This course of instruction includes academic instruc- ition as well as Practical exercises in accordance with the cur- 21 22 riculum developed by the American Coll(@ge of Surgeons Corco..ilittee Ion Trauma. 23@ The evaluations, the application has not derionsl,-i-cite.,"@ 24 ,ce- Federal Repoftf@rs, Inc. a t)-iorough. knowledge and understanding of an emergency r,.ierlical. 25 211 dh-7 I service system or discussed the various components and elements 2 of this system. Does not describe how the various pliases will 3 be integrated into the current system, nor has he identified 4 present definitions in the present system. 5 The specific geographic area to be served has been 6 identified as a state-wide proposal, however, there is inade- 7 quate information to determine community organization and lead- 8 ership to include a broad repetition of procedures, public 9 agencies, and community interests. 10 The application has identified facilities and equip- ment currently rendering emergency service and has briefly ident- ified other resources, and existing medical services. But the 1 21 13 current deficiencies have not been addressed. The plan does 14 not clearly delineate how the various components will be coor- 15 dinated with components already operational or how new additional 16 will affect the total system. Linkages with local health care systems to assure 17 adequate provisions for referring and follow up of emergency 181 191 patient needs and in cooperation with disaster planning and 201 long range growth have not been referred to or described. 21 The application briefly speaks to obtaining addition- 221 al financial support with the initial grant request and for 231 future support after the grant expires. 24.@ There is not adequate information to determine tl-ic Federal Reporters, Inc. . quality of care to be providc@(i oi- to determine an effective pl@),i; 25@l I 212 dh-8 1 for evaluating the various elements. 2 I have a note to refer to Dr. Kaplan's comments. 3 "Unfortunately this complete project is nothing more 4 than just a projection. While it is well developed, well organ- 5 ized, competently organized, and stated to be top priority, it 6 does not meet our priority for the EI,4S application. The Appli-. 7 cant,has submitted a state-wi.de plan. However, this plan, based 8 on criteria that an ideal plan should identify problems, estab- 9 lish objectives, and give details on the ways_to meet the objec- 10 tives, is not in fact a plan. 11 The applicant.does not directly relate his projection 12 to this plan. Furthermore, the project which is designed to 13 train ambulance attendants doesn't give any indication of a 14 communications system which would stimulate these ambulance 15 attendants to act. It does not give any indication as to what ty-oe of communications would exist between the ambulance and the 1 6 17 hospital or the ambulances home base. 18 It does not give any indication as to the quality of 19 emergency rooms to with the attendants trained in this project 20 would bring their patients. 21 Finally, the applicant does not give any indication of how these trained personnel will be deployed in relationship 22 the needs of tire. involve(7,, communities. 23 to DR. SCIIFRLIS: Your recommendation then is? 241 -ce-Fedefal Reporters, iric. Or Dr. @!cPhedran? 25 2 1 3 dh-9 DR. MC PIIED.@N: I agree. You recommend no funding, 2 is that correct? 3 MR. TOOMEY: Yes. OCR 6307 end #18 4 DR. MC PHEDRAN: I agree. 5 6 7 8 9 10 12 13 14 15 16 17 18 19 201 211 22 231 241 .Ice-Fedetal Reportets, Inc. 251 have One I... state, ore@ do tj@e fri that to se gon. 170@ e tl,7e h Ile ould ha ve -ke to orc7er. .feel -ZS complete, $S32,000. y out of gh t:. i o @go specj 'n request szste@ ci i fic: 2( -o @zlzlication -LO netw,,,, 2 unable a t@vo ol 0 'o os-P@ t@.Z Tva 22 ide Onlezgen"5, - to 110, ?Actions -a to PC sr t a-re of a Th ti- y qr0 ,e sic 1, Pro 2 oguip",,e 3c@Ct th, :. 0 ons for I:e P C.",r) 4-0 JM 6 3 04 I emergency medical communications in Oregon. 2 The communications system will be organized to utilize 3 Oregon's Association of Hospital Councils. An agreement has 4 been drawn up as far as this participation is concerned. This, 5 then, is a straight forward request in that regard. It is 6 purely for the network and it is limited to that approach. It 7 only speaks purely of the equipment. There is no indication 8 actually of anything else in this, and for what it is, it is. 9 But it is extremely limited in its approach. 101 Repeatedly, as I went through this, my comments were that 11 Ithis did not talk to a broad system at all. There wasn't any 121 evidence that they were going to relate to a broad sy,stem. I 13 do not have a favorable response to it. It did not follow the even 14 criteria or the guidelines in terms of saying how this 15 would fit into the over all program. It is a very limited 16 project in terms of background data. Most of the -'Lnformation 171 is in terms of supporting letters. Then it goes into what the 181 equipment would be. There is very little, if any, support 191 requested as far as staff is concerned because all of this 20 ,,iould be through contributed areas. 211 Basically, what they ask for are the vehicles and eqtiip- and that is - can't find this to be anything 22 men4 about it. 1 23 more than a circumscribed part of the system. 24 Now, if this opc),:e to the entire system --iid s,-:Ii@d that -Fe.(Jc-i,3! .1@eporters, Inc. 25 this was the area of the greatest priority at the presc,,it-- I I JM 7 305 they Vere I time while this was going on@stepwise going to do other things, 2 I might react differently. But this addresses itself purely to 3 the package request for some technical equipment, and even 4 though it is part of, they say, the comprehensive plan, I see 5 it in a very limited way. 6 I do not recommend support of this one. 7 VOICE: This application was forwarded shortly 8 after the first of the year, and they chose not to revise it. 9 DR. SCHERLIS: Before the guidelines? 10 VOICE: Yes. 11 DR. HINMAN: They did have an opportunity to relate 12 it. 13 DR. SCIIERLIS: They did? 14 DR. HIN@IP-N: Yes, sir. 15 DR. ROSE: A number of very specific statements 16 suggested some documentation. 17 VOICE: A number of telephone calls were made. 18 DR. TOOMEY: Once again, is this a hospital planning 19 group, basically? It reads like that. 20 DR. SCHERLIS: It comes in from the Oregon State 21 Health Divis-Lon. 22 DR. 14ARGULIES: It sounds like something the @NIP 23 dutifully sent on. 24i DR. SCIIERLIS: T have that feeling be@c@-use the e -Federal Reporters, Inc. 25 project coordinators from the Oregon Division, hospital. i 306 cont 27 1 coordinator, assistant coordinator, are all from that area with ill,W lee #6307 2 all the salaries donated to the project because essentially j@ 3 there is nothing that goes on with the project. 4 Essentially they buy equipment and install it. There 5 is no evidence on the training. 6 VIhat are they going to talk about once they set up 7 the communication, because even that -- this isn't part of a 8 total training program, it doesn't relate to emergency 9 facilities. I recommended no support. 10 MR. TOOMEY: As a hospital person, I get concerned 11 by the limited vision of some of the hospital-based or 12 hospital-involved applications. 13 That is why I thought that the one you have on 14 Springfield, Missouri, was so different because it was looking 15 at S09LCtliing broader than the inside operation of a hospital. 16 DR. SILSBEE: Dr. Scherlis, there is an EMal training 17 project in their regular application. 18 DR. SCHERLIS: Yes, I now. 19 DR. IIC PIIEDRA!I: I was ou o regon on a program 20 site visit a month or so ago and I am surprised that they 21 haven't worked this up differently. 22 DR. SCIIEIZLIS: Do you have their application there? DR. MC PliFDRAI@: I am not disagreeing with what you 23 24 said about it, I'it-i jusL surprised. ce.-- Federal Reporters, Inc. DR. SCiiE-RLIS: It perturbs me, because this could be 251 jr 1 part of their total system and what they want is that part of 2,of it but they don't approach it in a well-coordinated way de- 3 spite the communication from l@IPS. 4 DR. 14ARGULIES: It does suggest that basically they 5 aren't terribly interested in it. 6 DR. MC PliEDRAN: I think so. We all thought it was 7 a good program staff. 8 DR. SCIFERLIS: Well, is there a second? 9 DR. MC PIIEDRZ@N: I'll second it. 10 DR. TOOI%IEY: I agree. "nd DR. 8CIiERLIS: We ate the whole thing. 11 )f 27 12 (Whereupon at 6 p.m., the meeting was adjourned.) 13 14 15 16 17 18 191 201 21 22 23 24 @e@ Federal Reporters, Inc. 251 122 jrbi 1 AFTE'@RNOON S'FSSION (1:00 2 DR. SCHERLIS: Wc, will mo-@i-e right along as best 3 we can. xxxxx 4 Rochester is next for consideration. 5 DR. McPIIEDRAN: Yes. 6 DR. SCIIERLIS: Rochester, Dr. McPhedtan. 7 DR. McPHEDRAli: This is a set of four projects for 8 which support is being asked, each project for three years. 9 I think it may be of interest that @-he total. annual @IP Budget 10 in this region is given on the left, a figure that we haven't 11 referred to before. 858, 806. 12 If you take Year One, these four projects would 131 add a total of about -- not quite $250,000. This would be a 14 big increase in total funding. 15 A good deal of this is on a contract basis for 16 various kinds of activities. The activities are in really 17 three spheres. I There are four projects in three k4,nds of activity. 181 1 191 one is to develop an emergency care and coiflii@un-@-.catiori rvs-L(,Nni 20 usi-.ng some modern --c)mmiiriicati.oit tecILI@iology. And ttiere is e, fair-sized proportion of the first vear expe,)-,diturc- wh-Lch is 21 devoted to that, $30,000 iii eqtlipi7,lerit out of the $1.00,@I)OO 221 1 first-ye@-,r .-r--quest for that portion. 23 Tha,@, ent,-rgen@@y c 'I@C CO'.'r,,T'IL,,n@'@, cation to 24, cn set up t@-V,'o-,way conrluni@czLtior;s lir,,)-zirt@g hosnita.Js, crnprgc,@ncy 251 J.L 123 rooms, and attendants, and to develop a manpower training progi:ai 2 for continuing the in-.service education of emergency personnel, 3 and to develop standard procedures for handling emergencies 4 both outside of the hospital and to some extent inside the 5 hospital. 6 This proposal lacks details of such important things 7 as how the training program is to be actually constructed, and 8 the assistance-in sharp contrast to some of the other programs 9 that I've reviewed in which there was sufficient detail to 10 really tell what it is they intended to do with the training I I money. 12 Then, the second kind of activity excuse met, 13 that first activity is to be contracted out to an organiza- 14 tion which is called the Southern Tier Health Services Corpora- 15 tion, which is largely -- it consists largely of the directors 16 of several hospitals, about five hospitals. But that, again, 17 doesn't seem to really represent the whole region, because 181 that is only about a fifth or a fourth of the total number of 19 hospitals that are in the region. 20 So that it seems as if there is some doubt that 21 the Southern Tier Health Services Corporation really represent 22 even the hospitals fairly, or proportionately, in the region. 23@ The Southern Tier Ueal.th Services Corporation is al@bo 241 a subcontracto,,- for one of t%@@-c) '@-clr@phone referral services e-Fedefal Repo.@ters, iric. I 251 and for this element, for the year, $61,000, this i-sa general referral service to be provided by this health service 2 corporation, and part of it will be to assemble the necessary 3 data so that an appropriate referral can be made, but the 4 main purpose is a telephone center which would respond to any 5 kind of health information at any time. 6 The training of the kinds of operators who would 7 perform this service is mentioned but again not described in 8 sufficient detail for me to be able to get much of a feeling f)r 9 it. 10 The third of the four projects is another telephone 11 answering system. This is to unify and refplace several crisi 12 phone services, one a poison control center, but also a teen- 13 hot-line and I think a suicide prevention -- I have forgotten 14 if this is in this one or not. 151 But this is a crisis phone service. It is hard to 16 see from the application why this crisis phone service could 1711 not somehow have been unified with the general information and 181 referral services, whether there oughtn't to be some iiiter- 19@ relationship. 20 This brings up @--he general point about the whole 21 application, that it is hard to see interrelationships between the several kinds -- the several projects. 22 23 The last element in the request is a planning and 24 devc@lop,,nc,,iii--al elei-r@crit, and 'L2-L. concerns itself %,.7itii developing e- Federal R(@porters, Inc.1 25 comprehensive programs for determinations of i-,iaii,@)ower needs, j rb @-i 125 facilities ne-eds, transportation, data collection, and analysis; 2 and setting up a model for evaluation. 3 Now.- the phones -- you can break this down several 4 ways, but the first element that I talked about, the 5 emergency care and communications, is $100,000 the first year, 6 43 and 30 the second and third, or a total of 173. 7 The two phone referral services, putting them 8 together, come to a grand total of about 270, and the planning 9 and developmental comes to a grant total of 132. Three-year I 0 request is 573 -- $573,000.- 11 Their relationship to each other and their relatior- i2 ship to the rest of the program is difficult to ascertain. It 13 seems to me that individually, they have each one of 14 them has moderate -- some merit. 15 For example the emergency care and communications 16 one is certainly no worse than the one that we have funded at 17 a much higher level in Western New York, Lakes area. My 181 feeling about them separately and individually is that they 19 rate "C"', that is, a "3" rating for -- I would rate a 3-ratin-- 20 for the planning and development, a 4 -- excuse i-,ie; I'm going 21 the wrong direction -- 22 A 2-rating for the telephone services, and a 3-rating 231 again for the first element, that is the emergency care and 24i coiL-ctunications. Fedeta! Reporters, Inc. 25 I wish that the telephone services could be '@rb5 I combined and somehow reduced and total expenditure, it seems 2 to me, the total amount that is being asked is very high. And it seems to me it could be done on a more 4 limited basis for much less money, and I would like to recom- 5 mend that the funding be, instead of now totalling about 265, 6 as I say, closer to $50,000 or $75,000 for the both of them, 7 DR. SCIIERLIS: Is that per year? Is that single 8 years? 9 DR. MC PHEDRAN: I was thinking about the total 10 amounts but perhaps it would be more intelligent to say that 11 for the first year, that is cutting them to about $10,000 for 12 each of them instead of their projected present level of 13 $16,000 for one and $54,000 for the other. 14 So I would -- I think I would recommend that the 15 emergency care and communications, which I would say rates 16 a "C" -- that that recommended funding be as is, a $173,787; 171 but the telephone referral services be -- 181 DR. SCHERLIS: Could you give us the number? 191 DR. MC PIIEDRA@N: 30B and 30C, that they be somehow 201 combined into a single telephone referral system, and tha"- 211 their support be much reduced. 22 DR. SCIJET@U, T- S@qas that $50,000? 231 DR. BESSON: There is a little problem there 1.)ecau k@ 941 they are f-or different areas of region. e-Fedef,if Repolt:?ts, Inc,I 2511 DR. iviC PIIEDPI\j\': I see what you mean. One is the 3rnb 127 I Southern Tier and the other is the Genesee County. 2 DR. BESSON: They have nothing to do with each 3 other as far as telephone linkages. 41 DR. MC PHED-RAN: Yes. 5 DR. BESSON: Maybe it would be helpful if before 6 we get to funding, if I might give some comments on this. 7 DR. MC PIIEDRAN: Please do. 8 DR. BESS014: Okay. 9 As Dr. McPhedran has said, there are four parts 10 to this application and at the risk of reiterating some, I'll 11 say there are two general areas of this Rochester regional 12 medical program that are included. 13 one is the area of Monroe County, which is around 14 Rochester, and the other is the Southern Tier Area which 15 encompasses four counties. The first two projects, 30A and B, 161 are -- first is the emergency care and communication net work ]7i for these three counties on a contractual basis with Southern 181 Tier. 191 The second is a health information referral and 2011 counseling service for the same area, contracting with the 21 Southern Tier, again. 22 If you'll look at the map of it -- in the applica- 23 ti.on on pa ge 3, you will see how removed geographically these 2411 two areas are. @--Fedeial Repoftets, 2511 So the Southern Tier is the southern portion of thi. map, and then Project No. 3, community health information and 2 crisis phone services for Ilonroe County and surrounding areas, 3 is also on contract to what is called the Health Association of 4 Rochester and Monroe County, which is a consortium of volunteer 5 agencies. 6 The fourth project is finally getting to the 7 regional medical program of Rochester, planning and development 8 component, for the ten-county region, the entire region. 9 Now, as I read through the application -- and gear 10 with me for a minute while I give you my sequential thinking 11 to come to my conclusion -- I was impressed with the way the 12 letters of endorsement all said the same thing: 13 "Please accept the letter in evidence of our 14 support." 15 There are four letters which say the same thing. 16 I said to myself, where do these letters originate? They were 17@ all addressed to Southern Tier Health Services, Inc. 181 So I thought, this looks as though the Southern 1 191 Tier Health Services, Inc., acts like some organized group 20 and on page 12, I find that Southern Tier Flealtli Services, 21 Inc., is a not-for-profit corporation %@7hich was just approved 22 by the Corporate C(r,@mission@r with specific functions being 23 listed on page 12, implementation of community health delivery 2411 system, physical managoinc-n@-, @,C).x-,:iin:L@;trati've mo-.ziageTr,.ent, e-F;-,derat Repoftr@is, Inc. 251 monitoring placement of r)at-ictn'L,7, i.-nd j..ni.t-Lat-Lon of ne(@,dd-cl 129 11 experimental health delivery innovations; so I said this must 2 be an experimental system. 3 But then I looked at the next page, where it des- 4 cribes Southern Tier Health Services Corporation, and it says, 5 "Board of Directors of this corporation is made up of 12 people 6 from the hospitals and 12 people from the community." 7 And thereby is sprung the trap of who this corpora- 8 tion is, which is a consortium of four hospitals interested 9 in feathering the wrong nests, it seems to me, and they have 10 the primary ob4ective of developing and managing a comprehensi e .i r 11 personal health services system ostensibly of the community, 12 but it seems to me fortunately -- redounding to the ultimate 13' benefit of the area encompassed by these four hospitals. 14 Now, On this Board of Directors there are four 15 administrators as you say, four board of directors,.and four 16 physicians -- they don't say who the physicians are, but 17 presumably I would think they are with bos.pital orientations, 18 so that this corporation really is not a community effort, 19 although it happens to have 12 corporate members -@- community 20 members on it. 21 So the question that was raised in my mind about 22 these two projects, 30A and 30D, which are going to be 231 subcontracted to this corporation, is how representative can a 2411 four--hospital coalition be., in rl-)e@.-,king for ',--he community with @-F(,@defat Rcpoftefs, Inc. 25 this It-lirid of reT)resent@it,,Iori? J.L Li 17 13 0 I Now, that deals with my paranoid nature about these 2 first two projects. 31 The Project 30C is also going to be subcontracted tD 4 a health association which is a consortium of voluntary 5 agencies that is going to work with Strong Memorial Hospital 6 to do something thathas already been on-going, which is the 7 provision of a crisis-care phone and community health informa- 8 tion coordinative functions, which has been on-going. 9 And as they break down the number-of calls and 10 what,they are,about, and who they helped and how many people, 11 it seems to be a useful kind of effort. 12 I am also impressed that in their budgetary requesti 131 for this, they are going to be on an extensive cost-shari,ng 14 program with Strong Memorial Hospital in Rochester. 15 Finally, the fourth program, 30D, planning and 16 development, is to do what this group should have been ]7i doing right along, which is to look at the entire ten-coiintv region and say, what can we do to put together a coordinated systera7 191 201 Putting that all together, suggests to me that I 21 would be delighted to fund the planning and development and 22 get them thinking in global terms. 23 1 would be leary of funding a four-hospital 24 a,-id cor.,L,-,@unicat-'@oi-, nc@ti,!Ork which I think i.!i @-Fc,deral Reportefs, In C. what of a ruse for doing -- haviiip,- Li hospital buy so,-fie equipme- t 251! jrblo I for developing its own internal coimrtunica-tions network 21 and linking it with a very meritorious program, namely, 3 inter-liospital communication. 4 As far as the third program is concerned, I like 5 it, but again, I wouldn't be interested in maybe buying a thre@- 6 year project, but maybe one-year. So I have somewhat of a 7 different approach to this, Dr. McPhedran, and we'll put 8 it up for grabs. 9 DR. MC PHEDRAN: You think that the Southern Tier 10 Health Services Corporation, that is the first one, that it 11 is so unrepresentative as to just be unacceptable as an agency 12 for doing this? 1 3 DR. BESSON: As I view what is happening to the 14 thrust of RMP nationally, or the experimental systems program, 15 or comprehensive health planning, I see that there are a 16 varieity of consortia being developed to address community 17@ health problems. 18@ Now, all of these organizations exist in this area, 19 Why should we fund a four-liospital coalition witli a board that 2 0 is made up of 12 people fro5,a the hospitals, and 12 from t e 2 1 commune tv? 22 I 'would dare say that the 12 from the community 23 will never be there entirely but the 12 from the hospitals w l@l 24 alwp,@rs be there, sr, that th-@-s is a hosy-,ital--dirc.@ctecl effort. e- Federal R(@porteis, ftic. 251 Now that N,.iou:Ldn't be bi,@d if these were all I 13 2 community hospitals, but they are not. 2 one is S@L.. Jos(@ph's Hospital, one is -- I don't 3 know which the others are. But it has a hospital orientation, 4 which I think is a different slant on what RMP is trying 5 to do in having a broad-based community representation. 10 Now, that falts them slightly, but I am a little 7 suspicious that this is not the vehicle we ought to be encoura- 8 ging. We should be encouraging RMP to be the vehicle, or 9 COMP planning, or some kind of group to work- together. 10 DR. SCHEIZLIS: Yes? 11 DR. JOSLYN: I don't know whether I should be raising 12 this, but I have not read this application, but just from what 13 we are talking about here, it struct me first that her,-- is a 14 community, whether or not it be hospital-dominated -- and I 15 would like to know what the other hospitals are in this four- 16 county area, and whether or not they are involved, or maybe -- 17 I don't know if there are other hospita"-s -- but it strikes ME 18 that here is an area that is active. 19 . Now I would like it coordinated w,-th, you licnow, 20 whatever programs are going on in the total FI,IP but it seems 21 Me one of the things we have been arguing for is that you 221 cannot bring- a plan, whether it is developed by the RMP or a 231 consuitirit, and drop it onto an area. 241 And I am wondering if, this e,-Fedetal Repoitprs, lric. 251 is growing up ought at I-e;Ast to be met lialfwci.@,r, in the that jrbl2 133 I sense that -- I just don't know -- I can't judge from here -- 2 whether this is really a meritorious group or not. 3 DR. MC PHEDRAN: It is just that there are a lot 4 more people in the area, that is the point that Dr. Besson is 5 making. 6 There are other hospitals and 7 DR. JOSLYN: In that four-dounty area? 8 DR. BESSON: I don't know. All I know -- 9 DR. MC PHEDRAN: There are. 10 DR I.I BEISSON: This is a group of four hospitals --,hat 11 are opportunistic enough to create a non-profit corporation, 12 and T think that we are creating a -- somth4-ng that should be 13 aborted right noa. 14 That is not a coirmunity-representative group. It 15 doesn't have the linkages that we are after. After all in the 16 guidelines we say we should have provider, payer, public, and 17 DR. MC PHED@.N: All provider. 181 DR. BESSON: But this is just a bia.sed group. 19i I don't think they can come up with any community answers. 20 DR. SCI'&EPLIS: Ithink we have to keep referring 21 back to the ETIS guidelines which were given to this group 22 because these were the bases for which the various offers had 23 been made. 24 Dr. Gi,-,@Lble, you revie@,@c!d this project, I believe? Ff,-(Ierat Ref)ortcts, Inc. 25 DR. Thc- only conuiicri-t 1'. c,@).fi i,,ieke, on this j rD.L -i 134 particular point, I had mentioned that of 28 hospitals in 2 the region, five are actively involved. 3 DR. SCHERLIS: How many hospitals? 4 DR. GIMBLE: Twenty-eight in the region, and five 5 are actively involved. And much emphasis is the University 6 of Rochester, that's Strong. There appears to be active 7 participation of the CIIPB agency. 8 DR. BES80N: In one project only.,, 9 DR. GIMBLE: The other problem as-you have already 10 mentioned, is the very poor interrelationsh@p@,lbetween the 11 proposals. It is alluded to but I think they mention-that 12 the emergency care service will be linked to the telephone 13 services and that is as far as the linkage is described in the 14 text. 15 I had lots of doubts about the entire project. 16 DR. SCHERLIS: What sort of statement do we get 1 7 from you two in this regard? 18@ DR. MC PHEDRAN: I guess what we agree on, on 30D, 19 we would recommend it for funding as is. I gave it the A-ragiiig 20 of 3. 21 DR. BESSON: agree with that, full funding. 21 DR. MC PIIEDRAN: On 30C, I was mistaken about where 23 that was, and I think that we -- I would go along with Dr. 24. Bosson's recorrLwendation for 01, and not 02 and 03, as is, for Federal Reporters, Inc. 25 54. -- giving that a rating of c also. I - Irbl4 I -i DR. BESSON: Okay. 2 DR. MC PIIEDRAN: Or 3. 3 DR. DESSON: Okay. 4 DR. MC PHEDRAN: For 30A and 30BO, if it is not 5 sufficiently representative of the community as a whole, the 6 Southern Tier Health Services Corporation, perhaps the thing 7 to do is simply not to recommend them for funding because 8 they don't meet the EMS guidelines. 9 DR. 8CHERLIS: Do you concur in those recommenda- 10 tions? 11 DR. BESSON: I do. 12 DR. SCHEP,-LIS: Any other comments from members of 13 the review group? 14 All those in favor please say "aye." 15 (Chorus of "ayes.") 16 DR. GIMBLE: "A" and "B" are disapproved 171 because they don't meet the recommendations of the guidelines. 18j DR. SCIIIEI@T IS: Yes. 19 DR. GIMBI-.IE: Project "C" is a 3-rating for one year 20 and the next project --5or thrc@c years? 21 DR. MC PHED.RM: Three years. 22 DR. SCIlEr@IS: I thought that was going to take Oll Lee 23 1 much longer. CR6307 24 f, -Federal Reporters, Inc. 25 214 CR 6307 0 19 DR. SCIIERL-ILS.: All right. Any dissenting voice? ON 2@ Well, then, go ahead to South Dakota. 3 Mr. Toomey, again. 4 Following South Dakota, I assume Alabama. Is that 5 the correct order? 0 DR. HINMAN: Yes, sir. 71 DR. S;CHERLIS:. Alabama will be next, so contain 8 youtL@-elf.. 91 MR. TOO@IEY: The University .ofSouth Dakota is the 101applicant. The funding is requested for the first year, 470,000 11 and I have none in the second and third vear. 12@ Is that right? 13 DR. MC PHEDRAN: That's right. 14 MR. TOOIEY: South Dakota does not have an effective 15 emergency health service; hence this grant wi.11 cover the entire 16 state. 171 The basic problems are those of small rural popula- 18!tions with large geographic directions. There are very few 19@train(,@d ambulance drivers or emerg(@ricy technical personnel 20:r,lanning the ambulances of the existing emergency transl-)ortati.on 21 system. 22 There is little public knowledge as to lifesaving 23 techniques in the utilization of ainl.-ulance and training 24 techniques. Ffdeiz4l Reportc,,ts, l@)c 25 Generally South Dakota ltas f(@@v 1-iost-)it-als and they I have varying capabilities. It has a high tourist population in 2 the summer months with a high incidence of traffic accidents. 3 The state geographically encompasses an area the size 4 of Delaware, Maryland, Virginia, and West Virginia, but has only 5 1/17th the population. 11 The specific objectives of this project include the 0 7 establishment of medical technician and training programs, the 8 establishment of hospital technician training programs, 9 categorization of present hospital emergency services, establish lo ment of health consumer education programs, and the purchase of 11 medical equipment for ambulances. The planning process includes three phases of 12 13 implementation: Phase one includes planning, demonstration and 14 procurement; phase two, the implementation and utilization of 15 the planning demonstration projects and procured resources;And 16 phase three, the operational phase. 17 All three phases encompass the total components of an 1 8 EMS system including consumer education, ambulance purchase and 19 equipment procurement, classification, categorization of emergency health services, emergency medical training, 201 21 standardization of emergency services, communications develop- 22 1inen-t, physicians' assistants program, integration of emergency health services components into the curreftt system. 231 -Lhe narrative docs not indicate how the,Nrarious -Federal Repot ters, Inc. p-ha!ses v7il@l 1.)e integrated into the existing system. 25 mea-3 216 The geographic area has been described. However, 2 there is only partial reference to involvement by providers, 3 public agencies, planning agencies, and communities. 4 The narrative does not define existing medical 5 service areas in the region. However, it does partially speak to potential resources, and the assessment of needs and 0 7 resources in the area. 8 There are not adequate facts to document statements 9 referred to in the narrative. There's inadequate information o 'dinated 10 to determine how the operating components will be c or with already existing elements of an EMS system, 12 The narrative does not describe the linkages with 13 local health care systems nor is there adequate information to i4 determine whether there's cooperation in community disaster 15 planning or preventive medical systems. The ap lication speaks briefly to the point of p 17 utilizing additional financial resources and for obtaining 18 additional financial support after the expiration of this grant. 19 There is no general, overall innovative approach to 201 21 the development of an EMS system in this area or any assurance 22 as to the quality of care to be rendered. 23 Once again, to turn to the staff evaluation --- while this application has mciny good ideas, z).s an p@)licat;-on, as a 24@ ,ce- Federal Reporters, In,,. plan and as a tool to achie\re a total. EMS systeyn, it in iny 25, I I me a. - 217 I opinion fails. 2 There does not appear to be sufficient depth in the 3 description of the problem of EMS in South Dakota. Statements 4 are made but they aren't backed with facts. 5 For example, they state many lives are lost, but 6 don't state how many, where, why, when, and so on. 7 The applicant talks about utilizing PERT, PPBS, 8 management by objectives. They have demonstrated its use. 9 The application needs better organization, a clearer 10 definition of problems, needs and objectives and a clearer 11 picture of a total EMS plan and a better interpretation of the 12 1 EMS elements. 13@ DR. SCHERLIS-: Dr. McPhedran? 14 DRI. MC PHEDRAN: I agree essentially with the 15 evaluation, that it is a portion of what we would want to have 16 in an Bl@,is 'but not the whole thing. ]7i Notice that the projected budget for year one is 1 18 greater than the total annual budget for the South Dakota 19 regional medical plan. Is that right 20! 21 DR. HINI, Yes, sir, but I think there should be 22 a co n-,i(-,nt made. 23 South Dakota is in a planning phase, not an 24 operational phase. They have just sl3liL@- froir, Nebtasl-,a last year. ,@e-Fedetal Repoftefs, Inc. 251 Dr.,. MC PIIIEDRAN: I %,ias going to b,-,-ing this out, that 218 I this is really essentially a brand new region. I would not like 2,to recommend that they get no funds; I just think that this is 3 an enormous amount to expect them to spend sensibly at this 4 time. 5 DR. S.CHERLIS.:@ What would be the rating of this? 6 MR. TOOIIEY: I would say it would get 2 to 2.5. 7 DR. MC PHEDRAN. I gave it a 2. .SCliERLIS-.-, . Would you agree 8 DR. on 2? 9 Two is the rating. 10 MR. TOOT-EY: I think they should be given a planning 11 grant. 12 DR. SCIIERLIS." What sum would youthinkwould be 13 MR. T0014EY: My estimate would be $50,000. 14 DR. SCIIERLIS Dr. McPhedran, what would your 15 feeling be on that? 1 6 DR. MC PHEDPAN: Yes. 1 7 DR. 5CIIERLIS These are num!Ders from the air but 18 at least they are based somewhat on the project itself. 1 9 DR. MC PHEDPJ@N: On looking at the figures, that is sort of about half of what they liaCi requested for I)ersonnel -FC,3- 20 1 21 1the first year. 22 I think that is a figure. 23 DR. SCIIEPLIS@- Do we have comments from the group 241 on tIL-,Ii s? il@e -Federal Rei)oltefs, Inc. DR. Did you say 150? 251 1 219 i,nea--6 . I ii i-if ty - DR. MC PHEDRAlil: 1 DR. SCHERLIS: Fifty? 2 3 DR. 14C PHEDRAN: Fifty is what I said. @1F.RLIS: All riaht. DR. SC 1 4 136 o r - 1 S(,'I',YE@LIS Tri-Statc@? 2 DR. PIIEDIU,,N I think this is a, very good 1 I 4 3 proT)os,.1.1 a)-id I v@ould rate it as a four to f ivc-1. L-.hii-Lk it @@c of the t%@)o or three best that I reviewed among the 4 5 one@, I did as primary and secondary reviewers 6 The proposal is a large proT?osal. It is a pro-c-c-t .i 7 number and t-l-le requested funds are over about @850 L--Al@(Dusaii<3. 8 on the average for each of three years, or a total of $2.54 /0 Mil.lici@.!, for the three state area in Massachusetts, Rhode 10 Island, and Ne@q lIzcioshi.re. found in going through the ratin@f sheets, tli(@ liat this proposal real'.v addressed T,, 0 S- t i2 vello@,, sheets here, t, 13 of t@i,@ Particular questions very It wE@s ;-i deL'-aile,,i proposal and took up virtually everv aspect of mergence, 14 1- to emergencies, designing of educc-@ticii r c i o@ r; 16 I t @..,a s no4- innovative, L-,u-L -1 do r4c)t really fl, 17 18 tc) L,@l an,,, ("-U, is a P,@ll th- f actc.,,,- ir@ :ell -rr,,-@4-Jy 19 20 o -Li t I i i iu' T Jc-i vcr@, s, tr o i@q@ x I_)U ;Lil.c;o @t 21 c)f- 2 It 23 24 ct,--Fr,deraf Repo(to@is, i-@ic, c 1 a Ci f o r c@ n IC C@, s - a @i- C. 4 '10 vc' Or 251!' e r - 2 13 7 I di-.r-fo,,7(-@nt in ,-!aE@s,-ichi-isetts, it is t-le Department of Pul lic 2 Ilealth, and i 1-1 Thode Island, i'- is largely the Hospital 3 ,Issociation of Rhode Island,,- and also, I think, the Medical 4 Societv. 5 And in New Hampshire, beginnings have already been 6 made in some emergency planning -- actually in all three states 7 'I--hey have, but in New Hampshire, some planning for emergency 8 medical systems centering around a project in Hanover have 9 already been begun. 10 I thought this was a very good proposal in nearly 11 every respect. IL-. is an aivful. lot of money. P-ly word. And 12 yet, I roa2.ly just do riot know how to suggest that it would be 13 i-)ared do,,7n..@ I guess I would recommend that it be funded in 14 e@iclt-l of three years, but it seems to me, inconceivable that 15 @@i(a have invthi-iig like tl-ie of money thit-. col-li,,_i 116 r@.@et these deTiands for requested funds. I do not like to be in tle position of su,- 171 18 arbitrary rc@ciiictic,.,n, but I guess th@it is I 19 DR. SCTI I think @,7o have b(,ci-i call. 20 T 1. !'I -ri C)o y L D:i@l. YoiL Dr. saw, L 21 DR. ;'IC 22 T Ily conce 23 D@l SC[ ryi ir3 the ol,)vi.ous t@li@.it -17 241 .-E gc) 'kce -Federal Repo;tefs, Inc. ljzi@ this to COT-it.@,,.-act 25 tc,r-3 13 8 I DR. BESSO',q: '!'here has b@,c-n a contract ap,,-)licatio,-i 2 from Boston. 3 DR. SCIIERLIS: It does not include this? 4 STOLOV: They are complimentary because they 5 are not included in the projects. 6 DR. SCI-IERL@7S: All ri-t7,1-it. Secondary revie@,,7er? 7 DR. BESSON: l,et ,is see. 8 This is a complex and.a v(,-rk.7 excellent application, 9 and if -.r can make a crack at breaking it down, and see if 10 we can come to grips with funding a little bit, I would say 11 that it is composed of three major efforts. 12 one is to subcontract to B Agencies in the 131 t4a.,7,@,aci)usetts Department of Pul:)lic Ileal.tl-i, its equivalent in 14 New Ilar@i,@shire, and its equivalent in Rhode island, for indi- 15 vidual project e-Lcforts in their ireas. Two, is to attemi-)t through to provide a cooi:- 16 effort in the L--ri--statc@ )-..@asis for I.ool:i,-ig to the tri-- 1 7 (A " ,81 @,;tc-itc, -@,,i-cas as a single, glosDal a,-ca that has certain y)):C' 7 19 in and coor(l-il:).,Iti.ve activities. @i -@)ro,-,r T@n for E)3,@iriri)-xig r,,nCi 20 1) a].! 21 22 if %vc, 1(-@-I)k at these t'ir(:,c- offer! tl c 3 231 do,,.iil -1: o 241 %ce- Federal Repc)rtp-rs, itiI " I of th(-@ii.- o@@i-). 25- ter-4 1-39 I Massachusetts, Central -@.lassaciusetts, North Sliore, Greater 2 Boston, Middleborough, Amer.-i.m@-,c Vallev, New ilarnpshire, and 3 lzhode Island. 4 Each of the B agencies in Tia.ssachusetts, as well as 5 the I)epartment of Public Health, are going'to do a little piece 6 of the problem, as they see it-- locally. Now, the sophistication 7 of each of these groups varies from the sublime to the ri.clicu- 8 lous. New 'I'lampshire has had some work in the past and thev 9 are quite mature. 10 Some B agencies in @lassachuscti--s are Dust embryonic. 11 Arid there is a great variation in the degree of competence in 12@ei--h of them. But yet, tri-state Rr4P is saying, let us let 13 ea,;Ii locality set up its o%in program while we learn about 14 @.7hat to do in viewinu the en@-.4-re tri-state area as a sinrtlc- 1 15 r@,clric)n and %.7e @.7ill. enc@,.T.)ass L",icir acti.v-i.tieE; eventually into an o7iorall plan, i%lhich I L-Iiinl- j.!7 -i ],.auc,al-or-,,r wa,:, of alDproac.Iiing 16 the individual pieces without u,,3uriDing locals' i-)rc-.rogati.ves. 17 The D(@I)artr,,iont of Pul)li.c ilcalt-ii, 18' 19 @tl-,c, other hz,@s. had its liti.-Ijl,.e tl-iingE, they C).rc@ lencc- --@,ul,-iti.c)n F@nd which the, 20 .7 t@ave oro,'"Iu,,-cci T-)a.ss@-tce of a Fouse bill, c-,i- 21 it is I-)enCti-iiq, to set E'IS Aclvisorv 13oct).--d for the st-atc@. 22 iT'-,ov are ii-iv,)lve(i in of lic(-,,nsu,,,.-e for e-,-,,,@rqc@ncv 23 L year n 24'. .e- Federal "pofters, inc. t -L <7, t ecl, c---- a 7-, l@--lila c.@ ,)ii 25 ter-5 140 services, and do nto overlap N-7i.tl-i the B agencies, with what 2the B agencies are doing. 3 So that, for this T)ortion of the application, tliev will subcontract to these groups and hope fUll-,7 in time, bring 41 -i 5them all up to the same level of maturity. Now, they make some 6interesting comments about what the possible alternatives are 7so far as their funding is concerne . 8 T@'or example, they say, in their narrative, that if 9this program cannot be funded in toto, they would suggest that 10 each state develop its free standing emergency medical services, 11 which is one alternative for ti@, to follow in trying to figure 1 2Out "O@-I to get out of this 9.1)@iey also go on to sa,@, in their narrative, that if no fundinc 'lal)le elsewhere, 13 f is avai the- state will be self-supporting within a three-year period, 14 which is very encouraging at least, for them to say that they 151 lwil.1 rqoun-L this amount of Fioiiey at the end of three years; 16 171bo---h of which I think are very reasonable and mature statements 181 to So far as the c)t,it@, t@.;,o i-)rocrai-,,.@,, are concerned, the 19 i - j icc--,,,-i-tral ccc)rOi-nation of trainin-, and the planniric and c-,ial.uc-,t-.Lon 20 21 of thcT.,-L, -rL ir(-,- meritorious. Tl,,c-@ planning and 22 e,,7aluatio,-i, I think, is pdr-Li,c!-k@larly so. They F4p-,-ak of eval..iicl- tiori as a Iiinction of 'IL-.ri.-stj.)..te medical proc 11-i- 23 inc 241 Ace-Federal Reporters, Inc. 4 T)r,-.)c er, a ad j- c@l- i ng,- @l c)(,-, i-,s Ln 25 141 pro3ect achievement as a separate look, and then finally, doing 2 what they call, impact evaluation. 3 I think that this' is meritorious enough as a moth- 4 odology for looking at emergericv medical care systems that if 5 thev can do what ti-iev sa-,7 the-,7 will do in some detail, that 6 it will T)rovide a verv nice model nationally. 7 DR. MC PIIEDPJUT: Except they say about the impact, 8 they do not "think they can manage it." This last part, which 9 sounds the thir,@g that the,,,,7 have ov-er everybody else, 10 say thev do not "think they can do it with their pre- 11 @.achi.nerv," so it would hive -to come outside of this application 121 DI@. BESS014: I @,@oulCi at least encoura(le th@,,iLi '@v 1 3--r-iillv funding that'- portion of it, and I suv)l)osc@- --- I do no-L@. 14 ii-lo@.7 to reach a number N-ii.t@il this, it is Et difficult ques- 15, t(,) grai.-)r)le @,?itli. If there is-, ).iiv T,.ic@ri7t to the notion 16 tli@tt @,,7e ought to dc-,vc-lon as large a dcL@-Ficit as we can I)y a@--, i-,ii-,iay as we can, riiavl)e @.7e can turn off funds 17 18 and r?ut tl-ie,,ii in here so @.-.Ye 1 @.7cl.l I--,,uv the x,,,hole 9 20 1, Ic. C l@: II L IY (@ s L,'D Vs 2 1 t-.e@f f o;)servai-,.! c.)ij. lan po\iic,-@-- 2 2 from the and j.-tE 23 f @nd tc) 11--l-ic 24 Ace-Fedeial Rep,,rters, Inc. Hand dc; C co r -o Irlici 2 5 3 142 I have a sophisticated evaluator on this. And maybe this is where 2 staff could aid.. 3 But, we looked also to the staff out in the Rhode 4 island area, the core staff out in the liew Hampshire area, 5 and we felt maybe, since -thev did assist, there could be some 6 fine lines drawn. However, not being the technical budgetary 7 person on this, I just threw this out as a methodology of how we wor,e looking at the co-amuni-t@,, base, manpower thing too; 8 9 knowing the ambitious budget here. DR. B-ZSSON: They are really approaching the both 10 from the point of view of encouraging each locale to do their 1 1 own thing, and yet saying to themselves, \.jell we are going to 12 coordinate the entire effort and at the end of a -,,-c!ar or so, 13 they all should have enough maturit:@7, so that we can look tO. 14 the devel,onineiit of a tri-state-vTi6e coordinated system, which, 15 16 think, is ve nice. 17 @,4hat did ,,,ou recoi,.-ciiei-id.? 18 D)7,,. !,,'IC : I' fi,-il-"i it inil-)c)@ssible to recoi-@,,m.end reduced in aii@, intelligent N.,,av. I go along with 19 cert,),,Ii,43,-,,,, fully sul).@or@L---I-nq ,-.',le c-,7E-Ilua4-@ioll p@l),'.'tS. I am 20 l'iand,..,ic, I -,ure they \,,,ould not get 21 22 full funding there is n(.-,t (@c)irg to 'j.)c2 that kind of mc)nc,",, and I think can recor-,,%,!Ilic.@,ii(-l @.,Iiatever kind of funding 23 24' c 1,@) c@ a -I- I o!L., t o tI I s (,e Ftderal Reporteis, ltic. 7,@ h t- i-i e tlii s? 25 14 3 I DR. I-IC PIIEDRAN: t. 'our to f i.vc@. I think it is 2 very good. 3 DR. SCHERLIS: Mr. Besson? 4 DR. BESSON: I am going to give it, maybe a four. 5 I am going to reserve "fivc@" for Alibama. 6 DR. SCHERLIS: The rating is four. I think it is 7 unrealistic to think in terms of full funding for this. 8 We might jeopardize a great deal by doing that. 9 What is your feeling on this, Dr. Rose? 10 DR. ROSE: Dr. Ilinifiaii mi-cjht speak to this. 11 DR. SCHERLIS: Yes. 12 MR. STOLOV: I kyio@.7 do not use a formula fu-.idin( 13 as other IIEI,.7 programs have used, but as a yardstick, I i,7ou d 14 like to th.-o%v out- a factor, Dr. Besson, who has al@,7ays lo(.)ke 15 at thinc aii@itative manner. Tri-state regional. medical _Is in a qu - 16 -@rogram ranks 31 out of 56 regions in terms of funding, per 17 capita funding, pe-r- that tl,iree-,-statc@, region. 18 This is jusjt-- a fict to si).pT-)I(:--i,@ient -- that iia-y or 19 naK,, riot hc-@lp ,,ou @7ith 20 obfuscates our entire 21 proble,-,i. DR. IZ@T-,SSON: That do vou mean bv treat r(-,mark? 22 1 23 MR. SI'0'7-,,,OV: I di, not Jrno@.7 or not vou v,,anted soft f@-tct-- to h,,-,,J-"-) 24 kce-- Federal Reporters, tr@c. 25 IT do not '@nc,@,7 i' it is out (@)f 14 4 DR. 'I-lave a concern. If you look at the 2 breakdown of the budget as per year one, the verv beginning 3 of the application 4 DR. SCHERLIS: Opposite page ten. 5 DR. IIINI@L: -- opposite page ten, you will see 6 in the first vear, $251 thousand for planning and organization, 7 and almost $600 is allotted for things that might be considered 8 o,-irtiall implementation. I just wondered if 1,7e have a mixture y 9 hero, and are dealing with an attempt -- they have 119 thousand 10 for data collection, and agencies; 251 thousand for planning 11 and or(-j,-,n-fza t4 on, and thev are -immediately going into education, 12 some (-,crui.r)p,,,en@'. 13 DP,. BESSO'@,: Excuse me, Ed. They are dealing with 14 such a mixed bag here, tliev do not (To from that to education. 15 It is that thev are allo@,,ing each region to submit their own 16 budget for their particular needs, and I think @,71-iaL- thc-,y lia\lc@ 17 timul..ctted so tli@it cl-,-@lht r(@,- doric- is gotten everybody s here, 18 there are not c@i..cfht -- s pliiF; 3--T7 19 Island, are siil),-iii.t.tiiig a I),Li,(3.cfet. 20 It ha,@.@onfq to add u,,) -to 251,,O(,'O, but t'!-i,@,t includes 21 -,,loi.,. kno,,,.,-, they are C\iorNoiie's ';'-)-@iciget, and then on 22 top of tl,,.,,at, -For con-dj,.n@.I'L-,e(i -,n(-,i co,).-L-, @,L I @:i L'-ioii, it is, 23 it!.-ic,.y are 24 Ace-.-Federal Repo(teis, In 2 c5' 14 5 year on,--? 2 DR. BESSON: Yes. 3 DR. GIP-,IBLE: The most encouraging part of the 4 application is the small amount that has been allocated to 5 equipment purchases, so it looks like they said, we are going 6 to plan a lot and buy very little the first year, and it looks 7 like thev are doing it. 8 DR. SCIIERLIS: I just wonder if they asked for 9 $10 million, if our support of $10 million would be realistic, 10 and T question whether our recommending $850 thousand or $847 11 thousand is realistic. 121 T think I would l,i.k(@ to 1-ir).vE., a motion ra(.3(, for a 13 sum, and if th-- r(-@co2-,-,mendation includes thit, if additional 14 funds c@re available, they should be funded up to so and so, 15 1 at a high I-.)riori-'$--y. 16 DR. RO,@@E: It mi,7jli-L- Y)c@ easier for the commit L'. e c 17 to make a recommendation and lot the amount of funds ]De I-iai-icl'Lee(,-,@. 18il adriiiiistrativo.-I-,.,, the @udcimen4l-- in terms of 1-io%,., ,iiticli fiii-id@, 19 t'l-lev are cToing to be able to qc@t. 20 DR. SCIIETRILIS: @@ie d,D 21 DR. the tliiiicT I,S r,.ierito- OUS. 22 DR. :'> C',-'L@ 13 L I SCi ask a -,or C'@t tlli.S )C)41,t? a motion 23 DR. 1, t 24 ce - Federit Repoitets, Iric. @n. 25 14 6 ter-11 I DR. MC PTIEDP,7ill: I feel so foolish recommending an 2 arbitrary figure based on nothing. I have no way of basing it. 3 All I can do is say, it is a meritorious iDrogram and maybe 4 these things -- maybe they can consolidate some of this plan- 5 nin( , organizational activity. Maybe, it would not have to 6be so costly. 7 DR. SCHERLIS: Are @,ou recommending full support 8as rectuested? 1-@7ith a rating of four? 9 DR. IIC PIIEDRAN: I am rating it as. four and re,-ili.ziicr, 10 that full support is just not going to happen, could not 11 possibly happen. 12 DR. SCIIERLIS: Dr. Besson? 13 DR. BESSON: I have a different view of this. I 14 do not view this -- it happens to 1),,a trj--state, but it would 15 1)(-, likc-- sayincT, x,7ell, what is the eastern operations branch, 16 x-7hat ,,ind of Et I,)rogra,@-q do thev h@av-e? Tlic,@), do not have a single 171prograin, tliev have 27 nrograms. 181 We do not have singlc@ program here, \,,le have ten 19 @rograyis, so tliEit the number that I @,7ould use @.,lc)ul(a be ]-)rec',i- 20 on tha-'L-1 E,,s an underlying I tl-.iiij-, that til,@ 4- C)r 21 'Prc)-,(z,!ct -;.s i-t(,-r 9, the 4--'iiing is meritorious, and it i I i.@, 22 I to I,,c- forces'. to give a @'igurc-, I woill(,l li,-,v@- to say I r. 23 tIc-, full thing and lot the @,!hc@rc, they 24 D l@ C,@ I I @q I @'C)U to ce -Federal Reporters, Inc. ul.1 :entering si.,@ll 25 tc!r-1-2 14 7 I it is quite apparent. 2 Any further discussion from members of the Review 3 Croup? 41 All those in favor, say "ave." 5 (Chorus of a@.,es.) 6 DR. SCIIERLIS: opposed? 7 DR. BESSON: I would also remind the Chairman 8 that 9 DR. SCIIERLIS: I do not believe you recommended 10 the wliole ti-iing. 11 DR. BESSOIT: it is only one @,.Ting on a B52. 12 DR. Urij@ort.urritely, we do not even have c-i end #12 13 motor on aB52, an engine. 14 15 16@ 17@ 18 19 20 is 21 22 23 241 @@ce - Federal Rei)otters, liic. 25 1.4 8 CR t)307 DR. SCHERLIS: All right. @\7irginia. #13 dii-1 2 DR. ROTH: That one is mine. 3 DR. SCHERLIS: Dr. Roth on Virginia. 4 DR. ROTH: I think the.important thing to point out to begin with about Virginia is that we're talking about a total 5 request of $30,250, It is a highly hypothetical applicet--,-on, 0 z on behalf of a council which says that it is in the early 7 8 phases of initiating the organization of a ccnmiunityemergency 9 medical services council. And in the.makin'gs@, it has covered 10 that whole planning problem, if approved and funded, would be 11 turned over to this council. 12 It has not been approved by the RAG, and although 13 we have only a request for this $30,250, it rates a substantial 14 operating grant of $244,415.90, for a total 3 yc@z,,x- amount. 151 It is distinctly a matter of building upon (:!)L-.i,-@tin@. I s(@-rvi.ces. It is pretty sophisticated in the use of, for 161 helicopter service is availa!Dle i,n the area. But it is my 171 i-eelj4-ng that it is such a relatively small aTnoux-).@. ti-tat if -,(-,.I-ie 181 19 only matter befor(--,Iu@ riov,7 is the approval of the $30,250, 2 to 4, ]:)ecause it-. lia!-= @,@ou'd @,,i.ve the proc- .3 20 L a a. ),,ase o-i@ accoirt-)Ii-,@imert, ai-i,@,' recommend full finding. 21 1, DR. I v7oLil(I like to add o.@,-te Dr. 22 23 The ulanniiig portions of this have been I-)y Cl-!P and amid 1-iav(-, bc,,--,i-i 4 ,ce - Fedeiii Repofte.-s, Inc.I DR. ,.Iicet @t (,hec,,)@ 25 149 dh-2 I "yes,"' Is that correct? 2 DR. HINMAN: The earlier ones didn't. The firs' JO(T- 3 ing sheet didn't. 4 DR. SCHERLIS: But that is a subsequent change in ti-i 5 operating'data that we received. The present log sheets state 6 that they have been reviewed by RAG. 7, DR. SILSBEE: It is the planning portion only. 8 DR. SCIIERLIS: That is all we are tall@ing about, 9 planning, at this time. I am secondary reviewer on this and I 10 also review it as essentially a planning phase, since they state 11 Ithey want to eN?aluate,, categorize, and coordinate their existing 1 2 emergency. services, and I think in view of the fact that thisi 13 is a planning phasef and they have devoted considerable thought 14 on how to go about it, I would coi,iciir v7ith the feeling of the 15 primary reviewer on this and would also recommend support for 16 the sum requested which is for one year, a total of $30,,250. 17@ I would concur with that recoiiimendati on. 18 DR. ROTIJ: This I would ass,uic..f-, malres no commitments 9 -i.ncf but tho@ -is. IIon our part for anvt'l'i. c)perati-ox 20 DR. SCIIE.'Rj'iTS: Ti-iis i,-,- pti..,@-c-ly for one yc-,,@ir. Any othc5- coriin(--,rits on Virgi.i-iia? 21 thought it was 3. 22 L DR. IIOTIII: 3. That's good. 23 SClil;:!"LIS: Ariy otli,,@:c 241 i.t:e- Federal Repo@ters, Inc. All those in favc)r -,ziy ziyo@, 25, 150 clh-3 I 2 All right. Next is West Virginia, Dr. Roth. That is 3 a series of 3 projects. 4 DR. ROTH: West Virginia is a series of 3 very 5 sketchy requests, the first for a rural, multi--county -- and it 0 .Ls actually 4 counties -- in Northern West Virginia, and the 7 second cne is for actually a single county building @,7ithin a 8@single hospital, primarily, have access to taking care of emer- 9 gency cases. And the final third one is a state wide progr@irtt,l 10 or it would have state wide application ability, to train emerge,, I I cy i-fiedi-@,il technicians. 12 The probl.em here, it-isn't fair to poke fun at a 13 gr@int request, but I would say-that the grantsmanship il.lusti-a- z 14 t(-@d here was unsophisticated in the extreme. Dr. Besson poixit,.,(@c:L!, l@ out that he had a series of letters which were like fill'Lr@g III 16 !-,!-allies, ind that has clearly been the operation here in West V i- r @i 17; 18, Somebody, a coordinator, wrote a letter and ,;aid "I 19 thi.iik i-t be nice if yoi,-, all. sent back something along ti@@@is 20 so they fill copied letter, and just cl-iange@i the 21 Fine. -out-- .-;-n the names. DR. S"""IIEPLIS: A lot of these are trom voluntary 22 i: a. r c@-)ar 23 t]7,orlts, too. 2 4 es @'n a. cf,, -Federal Rel)cjf ters, iric. -,hcir(-, ar(-- 20 2il. 25!; 15 1 dh-4 I from individual nei-,-,bers of a -iewly formed Dodridge County einer- 2 gency squad. The letters go something like this: 3 "We have this emergency squad formed, and it would 4 be nice if we just had a radio that we could find out where it 5 is we are supposed to be going, and if we could see that we 6 could have a doctor or somebody in the hospital when we got 7@ back." 8 There is one delightful one where the young lad savs, 9 "We hope to finish our class soon on heart de- f 4bulatioii, in tlic-@ 10 care of heart patients. And as a member of the class, I realize 11 the great need for conmiunicati.ons." 12 This is the heart of this request. So youarc given 13 a situation in which you have virtually no medical personae 1 to 14 provide the care, and once you can herd it in, you have prac- 15 tically nothing except hearses available to be the mechan-,.sili!7, ok. 16 transportation. @ou have bad roads, you have a relativt,@l,y sa 1711 T)opulati,)n -- I'm ,,,,re you don't have an awful lot of transiert, I - travel, 18 so you're not worring so much about automobile accidents 19 and c;,@ on as you rely be ak)c)ut,. myocardial infractions arid indus- 20 trial accidents, and tli,.!,ncTr,, of that sort. But it is a testizi@,:)ny to ax.)-;c--ct need ii-i an area wliic',, 21 22 lac.!-,f7, resources of all kinds, and the requc@st,, even though inod- 23 est, translates ii-t:o i fairly high ratio in terms of dollars to noT)ulation. 24 I3ut if need is on(! of the qiiali.fi.ca@j-o,-is for kce@Feder,,)l Reportets, Inc. I woulc-" .-,ay this ran<-jet; 4 I)I,iis in acted, -Iri(3 vc,..r@ kill, 25 dh-5 I in terms of the resources to work with which tempers your en- 2 thusiasm, or at '..east your predictions, about how much will come 3 of it. But I think for an application with a strongly Appala- 4 chian flabor, that it deserves our consideration. 5 The 3 are somewhat complimentary. The one for a 6 single county, Jackson County, and a single hospital., really, 7 @tO my way of thinking, there is scant use in correcting all 8 these emergencies unless you have somewhere to take them with 9 sortie kind of care to give. 10 'And they certainly need the instructioi-i@ of the 11 emergency medical technicians. So I would lump them all. to- 12 Igether as being, to a degree, somewhere relatedt tending towards 1 3systematisation. 141 By taking a figure of practically zero for the state 1510f the art but a figure of 4 for the de-ree of the need I would icolne out averaging that off with aboi).t a 2 and recon-L-q(-iid f uiic.- 16@ 17 ing. DR, SCHEP\TISZ. For all 3? 181 1 9 DR. IZOT@-,i: For all 3. 20 DA* I am, secondary I -ilso 21 arrived a-!,-- a grace .DE 2. I was very,concerned al--out the ini.- ti.al 2 requests Llo-.- furidj.r-.g, -1@.i.rst of all in of who is to 22 Ido the The first ol-io, for was to be done 23 IDY, @-,s I @t-iitc-r-orc@t i@L, a staff @i-ri -tl-io. of 24 @ce.-Federai Rc@pufters, lilc. 25! 15 3 dh-6 1 agree, some training should be done. I felt more 2 and more as I read,it that they should have one training center, 1% that was the Davis and Elkins College, for a sum of $28,000, 4 rather -than dispersing this in 3 different areas with different 5 levels of ability and I would concur with 2, but I thought the 6 total funding should be about $30,000, because I didn't have 7 some concern about dispersing the training into the other areas. 8 What was your reaction about the action of Stonewall 9Jackson I-lospital as far as being able to carry out the program? 10 DR* ROTIIA: It was apparent to me throughout the Ithing that they're going to have to import talent to do -- they I 'just don't have the capacity there. And this Davis Elkins Col- l 21 1lege thing seeried to me to be by far the best. 131 DR. SCIIERLLS.- I was concerned for example, in 15 the first one under training, they stated the 4 physicians in Louis Colinty, the !one physician in @)odridge County, and the 1 6 17 national health corps physician in C-il,,iter County, which is the if !total medical compli-inei-ite 1-jave @agr(l..(-,C). to conduct training cour-- 181 19 ses for these men. Thc@vli-e goiii(7 t-o dc,.liv(.:.,r t",'ie 82 hour course. This 20 21 requires, I tliinle-I more i--',-)j,lity t.li@iii t'li(-@y can i-tiu.ster, f or. t',Iat- 22 sort of a training effo.,:-k@. 23 DR. B-CSSON: I @,7oxider- not be worth- in @-hc, :idvi.cc? 1--o -t.-@h.i.s to work jointly wit'-II the 241 @ce - Federal Re of ters, Inc.I I p 25 1 state of ,'Aaine on -their is very si,rlil r, -and their 154 dh-7 solution, which is perhaps ideal for this kind of area. if thc@ 2 are production video tapes, there is no reason why the videc 3 tapes can't be used in West Virginia in these rural counties, 4 just as well,as they're used in Maine. 5 DR. SCHERLIS: The second one, they say ""'Upon fund- 6 ing of this application the hospital will recruit and immediately 7 train 80 emergency technicians" and again I question their 8 ability, without the sort of help that you referred to. 9 My suggestion would be that we go along with the third 10 Iregional training center, which is the Davison-Elkins Group, an maybe expand their program @-or@.iewhat so they can incorporate I traini-nc the others. I have a certain reluctance as far as the! 1 2 f funds they have requested for the first 2 hospitals, 131 amount o 14 concerning what might come out of it when they are done. 15 DR. ROTII: I I 11 agree -with this, completely. 16 It has always been a. problem to rii(-2 to think 17 Jerry Besson spoke about our issuing the @-c-.&,di.ings, or watch .ng them. There isn't even a seedling here to nourish, y--u h,@a7.,c, 18@ i 19 to start doing sorae planting. DR. S'-!iERLIS: is anyone h--rc from -the West V;-rgi.n-',.ai 20 area could coi-,ir@i,@nt? 21 22 Dr. lic@yi(aerson, cto you w,2@@i-L to cony(ti(-2yt on the probl(@l.(I@l I of thi-s I,)roject? 231 1 DR. 24 kce-Fecferal Reporters, Inc. ' been irt,3dc- are accurate. f have b(-@c@)i, sc,!iiiriing application 251 15 5 dli-B I her(-- for a few minutes. The fact that they have submitted 3 2 proposals that are very similar in nature and have essentially 3 all the same working necessities brings me again to Dr. Roth's 4 consideration of the need. 5 Now actually, the heart of all this is employment of 6 former military types to function as emergency medical service 7 technicians. This may give this thing a bit more rooting than 8 if they were to be starting at scratch and wandering around gilooking for people to train. In the light of-that and in view 10 of the need, would it be practical to fund just one of the 3 11 proposals? 1 2 Number 18, the first one, goes in the direction of 131trying to provide priority health care services for rural com- 4tieS 141mun.L that have none, or counties. Tlie@price tag on this onel 15 is said to be $6,000. And even though there is spotty support 16 for doing it, if they can in fact apply it, previous military 0 W4 Wor'l@ -It 171 corpsman, and if they can find a physician -v7li .runni,.)@'i t L @ 18i !!E,@ project, to me @'- would be worth doing. Because then it r-ticlht- f,)ro-..Ti(le-the impetus to en,%,i:-gizo activi ties in the re- 19 gior,@s cl@ proposals. 201 1 i@4,R. TOOMEY: The tliing that bothers me, and it is not 21 1 on my list to read and I I,.avei-ilt read it --- the thi-rig that both- 22 ets me is that knowing that i'lest Virginia has a state %,aide 23 PI orc,,an 41;lal@@4on fiindect uiad@r tli(-- 214+ @ce-Fedc@int Reportets, Inc. 511 11 Act zird f rom I hear , it quite 2 pp, 15 6 dh-9 I that there has been, as I would read it, little contact between 2 this project and the Appalachia Project, or the Applachian 3 program. And with the fifth or sixth years of expenses under 4 the Appalachian Health Program, which is a specific section of 5 the Appalachina Region National Development Act, it seems that 6 they should have been farther down the road than what apparentl 7 has come out from this RMP. 8 My point is that I think that they ought to look at 9 each other. 10 DR4 SCHERLIS: Any comment from staff on that? 11 Yes? 1 2 VOICE: TI)e application as it is does not reflect the true working relationship that exists between RYiPs and the 13 14 Appalachian TCIIPA.Agency. Ti-ie application does reflect the 15 cooperation between the IU,.IP and the local B Agency, which is group 4-0 16 the -- the liaison @iian working with the advisory a- the 17 B Agency in determining the local needs and priorities. Someone made a coni-,Itient about why do we have 3 Liini-lzir 18 proposals from 3 separate areac;. Well, N,@lien @Vest@vitginia 1-1-@"e-.C" 19 20 field ,;ta4Lf very effee--t4-vc!ly, '@-hci-e "Ls a field man assign('-(.'k 21 to these areas, he has quite z@@ bit of knowledge in E?6,IS. fore 4 22j So there -his one reason -these particular lpro,nosal.s come frorti that particular area. And one other thing 23 I- - I ,4-C)O. 'Phe W(-@s- Virgini,-, n-it?cli.cil prog@t:am lias just ro..ceril.1' 241 @l-e- Federal Repofteis, Inc. 25 restated their objf@cti,@7c-.@@, aiic:i on(@, of -thc@,i.r proposed arc--a-objc,,C@t- 157 dh-10 I ives is the emergency medical service. 2 DR. IIINMAlq: Norm, are you saying that there are 3 laccountive working relationships between the Applachian Health 4 Program Planning Council and the West Virginia PJIP? 5 VOICE: Have definitely. 6 DR. ROTH: Beyond how much Virtue it-is, but that first 7 project , the 4 county project, serving a population of 103,000 8 people, working out at about 73 center per capita in an area 9 where, as far as I know, there is very little overall support 10 given. The second one works out somewhere inbetween $3 and 11 12 $4 per capita and I would be willing to drop that one out 13 completely. But somehow or other 1 would like to do something 14ltO get those rad 40 Sets into these pseudo ambulances, to get ,5@ something into that 4 cou@ty area of West Virginia, I DR. SCIIERLIS: I really think in terms of the 4 cLunl@-!",., 16 17@ area, that is as far as there bei.xig.adeqtiate information or they're ,-eall.y having paid attention to the good lines in havinc 181 19 at the time all. system care, t.1-ierc, are se)-ious shortco,-ni.nq8. Aiid ve-t, pea-i-iaps ti-ic--y should liev(, enough fun('4s to. 20 21 z,.-t !.east a staa:-;'_- of about 6 full 22 i pat,--h@,rs, 2 parzir,-Ii@di.c,,;, It is a I,)i).dget @.iliich,, whil.e -Lt adds I e d to @,'76,000, I qu stioii @,rhctlic@r o,,. not t) r,,,y might better siDei. 231 soTic of t)iosc funds fo-i@- 241 kce -Fedeial Reportf,,ts, Inc. 25 DR. l@OTli: They cou).d do a deal less- dh-11 I half of that. 2 DR. SCIIERLIS: This .,)hat I feel and I think if we 3 could talk in terms of putting more into planning and getting 4 a small course started, than perhaps a reasonable sum instead 5 of $76,000 might be something like $35,000. But for quality 6 of training I still think that Davison Elkins looks good. 7 DR. ROTE: Yes. 8 DR. SCHERLI S: And the first one would be for $35,000, 9 and the second is zero, the third for $28,000-and crossing out 10 the second. I'll put that on as a motion. $35,000 for the 11 first one, zero for the second phase, the third phase, $23,0 12 as requested and that rating was 2, 2 for each of those. 13i Any further suggestions? 141 (]\To response.) 15 All right, all in favor 16@ (Chorus of ayes.) 171 Opposed? 18 We now ,Ytove out.of the eastern brancl-i regions into 19 sou,th central l@raiicli regior,, and the irrepressible Dr. end -al3 CP-@ 6307 20 21@ 22 23, 24 4ce-Fcderal Repn,;,,ei.,, Inc. 25 Too, 17 r DR. SCIT still in sovth centr,,, IT", 'LIS: IliSCOnSi_ -"j.scollsi _n ttec, 20 Xt has a t 1, s reqlle :Dtec3 of 21 f j.. r 0 Zi C"? t 22 1 11,11,7C, ',ear. 'I to, 23 to o _t? ou Pece t cO., 'I) to t c cn Ol't cn 2 7 6 t r emergency medical services system,. it is factual, has clearlv 2 defined objectives and methods for evaluating the effective- 3 ness of a total, comprehensive operating system. 4 It includes in its formulation -- it includes efforts 5 1),v the people in the Highway Safety Program, Comprehensive 6 171calth Planning Agency, the Hospital Association, P-le-dical 7 Societv, Governor's task force, a health program and policy 8 council, greater '.Iil.waukee agencies and I,,Iil@iaukee Countv '@"Tedical 9 Society. 10 The applicant reTiresents the "- the application 11 represents the efforts of ke@7 groups of health providers in 12 tho development of this program over the past five vears. 13 think it i.s the best one I have read. I give it a rating 14@ Of 'Live and.would recommend full funding. 15 DR. SCIIERLIS: Dr. McPhedraii? 1 6 DR. ',",C Pil@D-?.AZ4: I concur. It is one of the t@-jo 171 tha@L. I read. 1 18, il)Yll. SC411EI-ll,)"L'S @,@7hEit the other one? D,7 . C P 1) i-)),ouq'it tr, -state @.ia-s verN,7, verv 19 g C) h i s t too, and it has }@,c-en long in 20, P"' 2 1 .1-1 1 1 rating I gave ti-i-stac,@,. I 22 23 I do no-L- think T. gc,-Iv-c it a @i o Li -1 'a' ,7 @t s 241 --e-Fedc-ial Repofters, Inc. 25 27 7 3 I ay),nlication, where the argliricnt is luilt up about how the thing 2 is to be ti-me-phased, and w'tia 4- thc@ metl'iods are, what are 3 the assumptions on ..,,hich each step is based, and how these 4 assumptions can be validated. 5 It is really very good. 6 MR. TOOMEY: It provides for an organizational 7 structure to carrv it out from the start to the finish. 81 DR. SCIIERLIS: IIhat about the money recommendation? 9 !,IR. T00i@'-,EY: I concur with the funding. It seems 10 for,tlie nroject, in relationship to some of the requests for 11 other funding, this is quite reasonable. 12 DR. SCHERLIS: All right. The record should show 13 that they will be funded as reciuestcd, for three years? 14 MR. TOOMEY: Yes, sir. 15 DR. SCIIERLIS: A13. right. 16 DR. IIhat is the rating? 17 Pli@. TOO"IEY: Did we submit it? 18 DR. SCHERLIS: Bet@,7een four ind five. 19 DR. !@IC P'tll7@DRT-@,'-@: I sa-,7 4.5, and yoti are going 20 to say fv@', right? 21 DR. SCIILRLIS: let iii--, mal-,e that five, then. Df@ . TT I'@T@.@' I 22 23 DR. SCIIE@T-"LIS: The staff has suggest we use -the nurrfl:)cr f i -,7 (- , . .. . since than, us -.- @@7e have ',-)c2en cTi.vL3 -ri @l 24 ce- Federal Reporters, Inc. @,i).c)ta niii,,i))cr of fives. 25 Ha@ we used up all of our twos and threes? DR. ROSE: Right, several times over.