Epi Pens

[Guest guest]

Ok, so I wasn't paying close attention if this was discussed on the list. I have

several questions

When do we think the revised rule 157.11 will go into effect?

Who will Provide medical Director oversite?

How will the pens be ordered without a Medical Director?

What if the current Medical Director does not want the pens carried.

Who will pay for the cost of carrying the pens when they go out of date ect..?

Why did it have to be put in a HB-2827 in the first place?

If you are a ALS service and already carry Epi, are you still required to carry

the pens?

Henry

[Guest guest]

Henry,

Yesterday at the Texas Ambulance Assoc. Board Meeting, Maxie said that a

syringe and needle is considered a " similar device " for purposes of this law.

Dave

Henry Barber wrote:

Ok, so I wasn't paying close attention if this was discussed on the

list. I have several questions

When do we think the revised rule 157.11 will go into effect?

Who will Provide medical Director oversite?

How will the pens be ordered without a Medical Director?

What if the current Medical Director does not want the pens carried.

Who will pay for the cost of carrying the pens when they go out of date ect..?

Why did it have to be put in a HB-2827 in the first place?

If you are a ALS service and already carry Epi, are you still required to carry

the pens?

Henry

[Guest guest]

Dave,

Help me out here, what does that mean?

Henry

Re: Epi Pens

Henry,

Yesterday at the Texas Ambulance Assoc. Board Meeting, Maxie said that a

syringe and needle is considered a " similar device " for purposes of this law.

Dave

Henry Barber wrote:

Ok, so I wasn't paying close attention if this was discussed on the list. I

have several questions

When do we think the revised rule 157.11 will go into effect?

Who will Provide medical Director oversite?

How will the pens be ordered without a Medical Director?

What if the current Medical Director does not want the pens carried.

Who will pay for the cost of carrying the pens when they go out of date ect..?

Why did it have to be put in a HB-2827 in the first place?

If you are a ALS service and already carry Epi, are you still required to

carry the pens?

Henry

[Guest guest]

The law reads that the ambulance must carry an epi-pen or " similar device " .

Maxie said that a syringe/needle and a vial of Epi was good enough to comply

with the similar device provision.

Dave

Henry Barber wrote:

Dave,

Help me out here, what does that mean?

Henry

Re: Epi Pens

Henry,

Yesterday at the Texas Ambulance Assoc. Board Meeting, Maxie said that a syringe

and needle is considered a " similar device " for purposes of this law.

Dave

Henry Barber wrote:

Ok, so I wasn't paying close attention if this was discussed on the list. I have

several questions

When do we think the revised rule 157.11 will go into effect?

Who will Provide medical Director oversite?

How will the pens be ordered without a Medical Director?

What if the current Medical Director does not want the pens carried.

Who will pay for the cost of carrying the pens when they go out of date ect..?

Why did it have to be put in a HB-2827 in the first place?

If you are a ALS service and already carry Epi, are you still required to carry

the pens?

Henry

[Guest guest]

Thank you, Maxie, for taking a common sense approach to the epi matter.

Gene

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[Guest guest]

List Members,

I wrote Maxi a couple of weeks ago regarding this rule and I am attaching his

reply

to me. I hope this helps everyone.

the intent of the law is to make sure all ambulances carry an epi pen or

simular device to treat anaphylaxis. This would not include First Responder

vehicles, but all EMS personnel are to be trained to use the epi-pen.

Since you all have epi-in a syringe I would consider that a simular device. If

your medics are using the IV route I would suggest you have the medical director

for your service add a dose that can be administered IM just in case they cant

get

a line. for adults an pedi.

We have submitted a rule for adoption based on the law that was passed.

I apologize for not getting back with you i have been out of town for a week and

i

wasnt able to get the departments e-mail to open properly. Let me know if you

have

any other concerns. I hope I addressed your concerns.

Maxie

>

>

> The law reads that the ambulance must carry an epi-pen or " similar

device " . Maxie said that a syringe/needle and a vial of Epi was good enough to

comply with the similar device provision.

>

>

>

> Dave

>

>

>

>Henry Barber wrote:

>

> Dave,

>

>

>

>Help me out here, what does that mean?

>

>

>

>Henry

>

> Re: Epi Pens

>

>

>

>Henry,

>

>

>

>Yesterday at the Texas Ambulance Assoc. Board Meeting, Maxie said that a

syringe

and needle is considered a " similar device " for purposes of this law.

>

>

>

>Dave

>

>

>

>Henry Barber wrote:

>

>Ok, so I wasn't paying close attention if this was discussed on the list. I

have

several questions

>

>

>

>When do we think the revised rule 157.11 will go into effect?

>

>Who will Provide medical Director oversite?

>

>How will the pens be ordered without a Medical Director?

>

>What if the current Medical Director does not want the pens carried.

>

>Who will pay for the cost of carrying the pens when they go out of date ect..?

>

>Why did it have to be put in a HB-2827 in the first place?

>

>If you are a ALS service and already carry Epi, are you still required to carry

the pens?

>

>

>

>Henry

>

>

>

>

[Guest guest]

Henry,

Dave is exactly correct...there are two wordings in 157.11...the first in the

equipment supply section that says you have to have an Epi pen or similar

device...and the syringe and 1:1000 epi equals " a similar device " .  Later in

the rule, under the responsibility plan, it says you have to show how you train

your personnel on anaphylaxis and its treatment. 

It is entering the rule approval process and hopefully, by this time next year,

it will be an actual rule....hopefully.

Dudley

Re: Epi Pens

The law reads that the ambulance must carry an epi-pen or " similar device " .

Maxie said that a syringe/needle and a vial of Epi was good enough to comply

with the similar device provision.

Dave

Henry Barber wrote:

Dave,

Help me out here, what does that mean?

Henry

Re: Epi Pens

Henry,

Yesterday at the Texas Ambulance Assoc. Board Meeting, Maxie said that a syringe

and needle is considered a " similar device " for purposes of this law.

Dave

Henry Barber wrote:

Ok, so I wasn't paying close attention if this was discussed on the list. I have

several questions

When do we think the revised rule 157.11 will go into effect?

Who will Provide medical Director oversite?

How will the pens be ordered without a Medical Director?

What if the current Medical Director does not want the pens carried.

Who will pay for the cost of carrying the pens when they go out of date ect..?

Why did it have to be put in a HB-2827 in the first place?

If you are a ALS service and already carry Epi, are you still required to carry

the pens?

Henry

[Guest guest]

Thanks that takes care of one of my questions.

Hjb

Re: Epi Pens

Henry,

Yesterday at the Texas Ambulance Assoc. Board Meeting, Maxie said that a

syringe and needle is considered a " similar device " for purposes of this law.

Dave

Henry Barber wrote:

Ok, so I wasn't paying close attention if this was discussed on the list. I

have several questions

When do we think the revised rule 157.11 will go into effect?

Who will Provide medical Director oversite?

How will the pens be ordered without a Medical Director?

What if the current Medical Director does not want the pens carried.

Who will pay for the cost of carrying the pens when they go out of date ect..?

Why did it have to be put in a HB-2827 in the first place?

If you are a ALS service and already carry Epi, are you still required to

carry the pens?

Henry

[Guest guest]

A syringe will be considered a simular device but your your Medical Director

will have to decide if your service can use a syringe. The Medical Director must

add it's use in your protocol.

Maxie Bishop, RN, LP, State EMS Director

EMS and Trauma Services

maxie.bishop@...

________________________________

From: texasems-l [mailto:texasems-l ]

Sent: Mon 11/17/2008 4:13 AM

To: texasems-l

Subject: Digest Number 4960

Texas EMS Discussion List

<http://groups.yahoo.com/group/texasems-l;_ylc=X3oDMTJkMGMyaWJwBF9TAzk3MzU5NzE1B\

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TE2ODIy>

Messages In This Digest (6 Messages)

1a.

Re: ems license number on the side of the ambulance

<https://webmail.dshs.state.tx.us/exchange/Maxie.Bishop/Drafts/RE:%20[texasems-L\

]%20Digest%20Number%204960.EML/1_text.htm#1a> From: Kimberley Cunningham

2a.

Interesting Popular Press Piece on Problems with EMS in the United S

<https://webmail.dshs.state.tx.us/exchange/Maxie.Bishop/Drafts/RE:%20[texasems-L\

]%20Digest%20Number%204960.EML/1_text.htm#2a> From: Bledsoe

2b.

Interesting Popular Press Piece on Problems with EMS in the United S

<https://webmail.dshs.state.tx.us/exchange/Maxie.Bishop/Drafts/RE:%20[texasems-L\

]%20Digest%20Number%204960.EML/1_text.htm#2b> From: Bledsoe

3a.

Re: epi-pens was - ems license number on the side of the ambulance

<https://webmail.dshs.state.tx.us/exchange/Maxie.Bishop/Drafts/RE:%20[texasems-L\

]%20Digest%20Number%204960.EML/1_text.htm#3a> From: Tim Hardy

4.

Question for everyone

<https://webmail.dshs.state.tx.us/exchange/Maxie.Bishop/Drafts/RE:%20[texasems-L\

]%20Digest%20Number%204960.EML/1_text.htm#4> From: budlitemedic81

5.

Blanco EMS keeps its license (Monday's Austin paper)

<https://webmail.dshs.state.tx.us/exchange/Maxie.Bishop/Drafts/RE:%20[texasems-L\

]%20Digest%20Number%204960.EML/1_text.htm#5> From: ExLngHrn@...

View All Topics

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Messages

1a.

Re: ems license number on the side of the ambulance

<http://groups.yahoo.com/group/texasems-l/message/79250;_ylc=X3oDMTJyMGFxMHJnBF9\

TAzk3MzU5NzE1BGdycElkAzEwMTUxMDEEZ3Jwc3BJZAMxNzA1MDYxMTYxBG1zZ0lkAzc5MjUwBHNlYwN\

kbXNnBHNsawN2bXNnBHN0aW1lAzEyMjY5MTY4MjI->

Posted by: " Kimberley Cunningham " kimberleyrc@...

<mailto:kimberleyrc@...?Subject=

Re%3A%20ems%20license%20number%20on%20the%20side%20of%20the%20ambulance>

kimdrey2004 <http://profiles.yahoo.com/kimdrey2004>

Sun Nov 16, 2008 6:49 am (PST)

Sent from my iPhone

Kimberley Cunningham, BS

kimberleyrc@... <mailto:kimberleyrc%40gmail.com>

On Nov 15, 2008, at 1:03 PM, THEDUDMAN@... <mailto:THEDUDMAN%40aol.com>

wrote:

> Okay,? allow me to step in here...(sorry about the length...but go

> the distance...its worth it?

>

> First, a couple of years ago, GETAC appointed a diverse group of

> people to examine the current regulatory structure of EMS and Trauma

> in Texas and make some recommendations for future changes.? One of

> the LARGE issues that came out of the work of this group was that

> across this great, vast state of ours, there is a lot of differences

> and discrepancies in the way that DSHS enforces and regulates by the

> rules.? DSHS hires the best people they can, don't get me

> wrong...but unfortunately they pay pauper's wages and as a result

> you often get a wide variety of folks for this horribly low pay.?

> This leads to a great deal of problems.? Some reported to this Task

> Force included someone taking over a service after a bad

> administrator left, called DSHS for help on verifying rules and was

> told " I am going to be coming out there in two weeks, you better

> have all this fixed or there will be serious trouble " ...yet in

> another part of the state, the program specialist replies " lets set

> up an appointment next week and we can talk through these issues and

> get them resolved " .? In other areas of the state, one person in the

> regional DSHS office agrees a solution will solve the problem being

> discussed then another person dings them at a surprise inspection 6

> weeks later (same DSHS regional office) because they don't like the

> solution that was agreed upon.? This Task Force made a

> recommendation that EMS and Trauma be brought back under a single

> department in DSHS, similar to the way the old Bureau worked prior

> to the last re-organization and some other things to help solve many

> of these issues.

>

> Next, how is DSHS going to prove that you have kept your medications

> and fluids at a " constant " temperature.? The 157.11 rule states that

> every agency has to have a plan to do this (has been in there since

> pre-2001)...and unless I am mistaken, it has not changed.? Still, we

> get wrong messages being sent to EMS providers and now we are going

> to have ambulances delaying their responses because they have to re-

> load the units (or spend a bunch of money on on-board AC unit retro-

> fits) before they can roll out...or like my agency used to

> do...accidentally respond to a call with all the drugs still back at

> the station...This drug and fluid thing has driven me crazy for

> years...can anyone tell us how much heat (or cold) for how long

> actually can cause issues?? Also, have you ever done a temperature

> study to see exactly how hot or cold the back of your ambulance gets

> (inside the drug box)?? We did, and even on the hottest of hot days

> in South Texas August we only?reached an air temperature of 92

> degrees.? The other thing...why doesn't the heat and cold of the UPS

> truck do damage?? Why is it just the heat and cold in the back of

> the ambulance?

>

> Now, on to my point on the EMS License Numbers on the side of the

> truck.? Way back when Terry Bavousett was still the EMS Director for

> Texas, rule 157.11 came up before GETAC for its 3 year review.? The

> EMS Subcommittee started reviewing and updating this rule.? This was

> a really busy and hectic time for GETAC and TDH because the re-org

> was hitting the ground and there was a lot of other political things

> going on.? Besides 157.11, there were several other rules up for

> review including the certification rule, education provider rule,

> first responder rule and the air medical (157.12 and 157.13).? The

> Air Med providers were forming into a task force and starting to

> review their own rules, and there were a lot of issues surrounding

> this as well.?

>

> TDH came into these meetings with some things they wanted to see

> done.? First draft they wanted to have the Official Company name

> (the owners) on the side of the truck as well as the name they were

> operating under in 6 " letters.? There was a problem (and what do you

> know there still is) with people operating under a name (say ABC

> Ambulance) and then when they got in trouble with CMS or TDH, they

> would re-label the trucks with XYZ Ambulance and get back to

> operating.? Limited staff and resources made it very difficult to

> keep up with these losers.? So, myself and a few others suggested

> that for some people you would not be able to get all of this

> information on the side of a Type II ambulance (van).? Can you

> imagine " TWO GREAT GUYS MAKING MONEY, INC dba DUDLEY AND GENE'S

> AMBULANCE SERVICE " in 6 " letters on the side of a van?? We

> suggested, because of this, that we try and come up with a different

> way to accomplish the same goal.? TDH stated they would review this

> and bring back some suggestions.?

>

> Then, 3 months later, when the rule came back, I believe this change

> was in there that the EMS Provider number had to be " prominently "

> displayed on both sides of the truck with a TX in front of it.?

> Unfortunately (and this is a horrible excuse but it is the truth)

> the EMS Committee probably never discussed this again because with

> all the changes and the unknown new process for moving rules forward

> to be approved, and the pressure to get all these big rules through

> and done as quickly as possible...we addressed some other big topics

> but never visited this...sending it to GETAC for approval.? It then

> took it 4 or more years to finally get approved as a new rule and we

> were all surprised when we were told of this change.?

>

> I do agree with Gene, it is not a big deal, its stupid and it is

> easy to fix...BUT...it is the principal of the thing. Here are my

> points:? How many police and fire vehicles have their TCLEOSE or

> TCFP license numbers on side of them?? What difference will this

> make?? Who is going to see it...compared to the 10 " letters (like

> our units have) displaying the agency name?? The EMS Provider number

> does not tell you what unit you had a problem with...just the

> agency.? If you want to know the specific unit, you have to find the

> OTHER 2 " numbers prominently displayed on the front and back of the

> unit (called a license plate).? What definition of " prominently

> displayed " will be used?? Gene, don't know where you put yours, I

> have seen them on the front lower corner of the box, by the belt

> line, on the fender, on the door, above the rear wheels...and then

> color...so I put BLACK letters on my navy blue truck...to me that is

> prominent...don't see our DSHS folks allowing that one to slide.? Do

> they have to be reflective?? Not very prominent at night...of course

> we never have issues at night so I guess it is only important during

> the day during DSHS office hours.?

>

> My largest aggravation is this:? I think this looks, feels and

> tastes horrible from a profession stand-point.? We have such a

> problem in our industry that we are grasping at stupid straws in an

> attempt to solve our problems.? You don't see these numbers

> displayed on police cars, firetrucks, hospitals, doctor office

> doors, or anywhere else there are enforcement issues.? Lastly, this

> is going to make rule-breakers out of the agencies who attempt to do

> the right thing.? You see, probably 75% (totally made up but feels

> good) of EMS Providers in Texas are attempting to do it right.? It

> is just in the larger municipal areas where the problems are?way out

> of control.? In all these areas you have agencies (like those who

> post on here) who attempt to do the right thing.? They cooperate and

> assist DSHS, they self-report problems, they do their best to follow

> the rules, they get upset when they get dinged during surprise

> inspections, and this is one more regulatory hurdle ALL of us good

> guys will work to clear...despite differences of opinion of the DSHS

> enforcement people, despite the extra work, and despite the

> aggravation.?

>

> AND, it is these same good guys who will get dinged on this new

> regulation when their crew washes?2 or 3 letters?off in 18 months

> (because they didn't have the funds to get them done like their

> lettering so they used 2 " sticky numbers from walmart)?and then gets

> a call and runs into DSHS people at the ED...or upon the hiring of a

> new program specialist in their region, gets dinged because they are

> not prominently displayed and has to spend 4 or 5 hours over the

> next couple of days explaining to all the new staff that the old

> DSHS people who are now off in jobs making living wages, felt it was

> okay but the new group doesn't...leading eventually (because us good

> guys don't like to rock the boat for the poor DSHS people who are

> over-worked and under-paid) to us having to take the numbers we have

> had on the trucks for 2 years off and putting brand new numbers on

> that are off-standing colors and reflective for $120 from our local

> graphics shop thereby making more work for the guys who are doing

> this correctly...MEANWHILE...Two Great Guys Making Money are still

> throwing our parents and grand-parents into the back of crappy

> trucks not equipped to do their jobs with people who shouldn't even

> be in this business let alone caring for our loved-ones sitting next

> to them toting them from one facility to another violating every

> Medicare and Medicaid rule out there, just not to the level that

> gets attention, and dodging DSHS issue after DSHS because they don't

> and won't spend the money to do the job right...but gosh-durn-

> it...they have a 2 " TX number prominently displayed on the side of

> their meat wagons...

>

> I will repeat, I agree with Gene...this is petty and minor...BUT

> ENOUGH IS ENOUGH....where do we draw the line in the sand?? What

> little minor thing comes next?? If this had any chance of improving

> the state of affairs?for EMS in Texas, I would be trumpeting it?from

> the highest point in the land...but it doesn't.?

>

> So, want some fun?? Come to the GETAC EMS Committee meeting in Ft.

> Worth next Sunday at 1300.? This item is on the agenda, and it is a

> great opportunity for stakeholders to voice their concerns and non-

> concerns to DSHS regarding this issue (or any other).

>

> It promises to be fun and exciting!!!

>

> Dudley

>

> RE: Re: ems license number on the side of the

> ambulance

>

> I was sitting in the room a few weeks ago when a DSHS person came to

> inspect our ambulances. He said we would have to put the number on

> the box, and it should be in 2 " numbers, but he said there was

> nothing telling us where other than it had to be plainly visible and

> on both sides. He said they were recommending it be on the front

> fenders, but we could put it where ever.

>

> But what he stressed more than anything was not the number on the

> truck. He wanted us to understand that the new rule was going to

> require us to maintain temperature control for our drugs and fluids.

> Something else new is that all ambulances have to have epi-pens for

> treating anaphylaxis, and even ECA's have to be trained to do it. We

> already do that, so no problem, and we carry out drug bag into the

> station when we're not running, but we're going to have to find a

> way to keep the fluids at room temperature. Carrying them in and out

> might be too much.

>

> So, not putting the number on the box, or making it the same color

> as the box would probably draw fire from a DSHS swat team, but from

> what he was saying, we would get in a lot more trouble if we didn't

> maintain temperature control for our drugs.

>

> --

>

>