Mission: Lifeline Wyoming Stakeholder Committee …wcm/@swa/documents/...Mission: Lifeline Wyoming...

Mission: Lifeline Wyoming Stakeholder Committee Meeting July 11, 2013

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Teleconference / Webinar Conference Call Number 877-686-1381, Participant Pass Code 2997862852#

www.heart.org/mlwyoming [email protected]

Co-Chairs: Dr. Michael Eisenhauer, Casper Dr. Muhammad Kahn, Cheyenne

Dr. Daniela Gerard, Gillette Dr. Chris Krell, Kemmerer Staff Liaison: Scott Nelson and Ben Leonard

1. 11:05 am Welcome Michael Eisenhauer Exhibit 1A April 4th MLWY Meeting Minutes

Exhibit 1B MLWY Stakeholder Roster Exhibit 1C MLWY Voting Proxy Form Exhibit 1D AHA Ethics Policy Exhibit 1E AHA Conflict of Interest Policy Background: Review roster and update as needed. Action:

Welcome all

Review and approve minutes from previous meeting

Review and update the draft Committee roster

Review and updates regarding MLWY Initiative

2. 11:10 am Challenge Fund Raising Abbey Dobler Exhibit 2A

Action: Information Only

3. 11:20 am Participation Updates Diana Ramirez Derek Smith

Exhibit 3A Eligible EMS Participants Exhibit 3B Eligible Hospital Participants Exhibit 3C Participation Map (To Be Presented) Background:

The current status of participating hospitals and agencies and their business document status. Action:

Review Exhibit 3A, Exhibit 3B, and Exhibit 3C

http://www.heart.org/mlwyoming

mailto:[email protected]


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4. 11:30 am Wyoming DOH Office of EMS Updates Andy Gienapp Exhibit 4A EMS Request Approval Letter

Background: The Wyoming Department of Health, Office of EMS is to discuss or present updates related to Emergency Medical Services and healthcare. Information Only

5. 11:45 am Networking Lunch Daniela Gerard Buffett available please have lunch and will reconvene in this room at

12:15 6. 12:20 pm Equipment Advisory Council Scott Murphey Co-Chairs: Scott Murphey (EMS) and Tom Richards (Hospital)

Exhibit 6A EAC Goals and Responsibilities Exhibit 6B EAC Purchase Process Overview Exhibit 6C Equipment Grant Agreement – information only, (To Be Presented) Exhibit 6D Cycle 1 Funding Process – (To Be Presented) Background: Goals of the EAC include assessment and distribution of the equipment necessary to ensure a statewide AMI/SCA system is adequately addressed. Information Only

7. 12:35 pm Conference Planning and Education Cindy Osborne Lori Terwilliger

Co-Chairs: Cindy Osborne (EMS) and Lori Terwilliger (Hospital) Exhibit 7A CPE Goals and Responsibilities Exhibit 7B CPE Educational Assessment (To Be Presented) Background: Goals of the CPE include assessment of the educational needs of each discipline and the development, planning, and implementation of the educational curriculum and statewide educational conferences. Action:

Review to amend and/or approve Exhibit 7B


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8. 1:05 pm Protocols and Quality Improvement Russ Christiansen Co-Chairs: Russ Christiansen (EMS) and Colleen Rodgers (Hospital)

Exhibit 8A PQI Goals and Responsibilities Exhibit 8B BLS Protocol (To Be Presented) Exhibit 8C MLWY Preliminary Data Overview (To Be Presented) Background: Goals of the PQI is to collect EMS and Hospital STEMI/N-STEMI and Sudden Cardiac Arrest data and identify opportunities for improvement. Action:

Sharing final BLS Protocol Exhibit 8B

Open discussion on Exhibit 8C

9. 1:45 pm Review Meeting Dates and Select Next Meeting Location Daniela Gerard

Action:

Committee members to ensure upcoming meetings are on their schedule - and accept calendar notices sent from AHA staff by email

Quarterly in 2013 and 2014 - 1st Thursday of every third month

Original Dates Proposed New Date

October 3, 2013 November 7, 2013

January 2,2014 January 30, 2014

April 3, 2014 April 24, 2014

July 10, 2014 July 24, 2014

October 2,2014 October 23, 2014

January 8, 2015 January 22, 2015

April 23, 2015 (last meeting of initiative)

10. 2:00 pm Review of Action Steps Michael Eisenhauer Information only

11. 2:05 pm Updates AHA Staff Background:

Staff and MLWY Stakeholders will provide updates and to announce local meetings and conferences

Information only o Statewide AHA happenings: o http://mlnetwork.heart.org/groups/home/1086 o www.yourthecure.com

Standardized messaging of our Mission

Public Awareness

12. 2:15 pm Adjourn

http://mlnetwork.heart.org/groups/home/1086

http://www.yourthecure.com/

Mission: Lifeline Wyoming Stakeholder Committee Meeting April 4, 2013

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Teleconference / Webinar Conference Call Number 877-686-1381, Participant Pass Code 2997862852#

www.heart.org/mlwyoming [email protected]

Co-Chairs: Dr. Michael Eisenhauer, Casper Dr. Muhammad Kahn, Cheyenne

Dr. Daniela Gerard, Gillette Dr. Chris Krell, Kemmerer Staff Liaison: Scott Nelson and Ben Leonard

Organizations Attendees

???? Karen Dezon??

Ambulance Service - Powell Hospital ED Nathaniae Reib

American Heart Association Julie Blakie

American Heart Association Loni Denne (teleconference)

American Heart Association Kathy Hill

American Heart Association Ben Leonard

American Heart Association Scott Nelson

American Heart Association Diana Ramirez

American Heart Association Suzanne Salazar

American Heart Association Wendy Segrest

American Medical Response Cindy Osborne

Billings Clinic Susan Amundsen

Billings Clinic Diana Parker

Campbell County EMS Gregg Mentzel

Campbell County EMS - Campbell County Memorial Hospital

Daniela Gerard

Campbell County Memorial Hospital Lorna Thomas (proxy for Deb Tonn)

Carbon Co. EMS Candace Hofmann

Centennial Valley Ambulance Andrea Kern

Cheyenne Regional Medical Center Charlie Retz

Cheyenne Regional Medical Center Melissa Tschimperle

City of Torrington EMS Christy Gutierrez

City of Torrington EMS Darin Yates

Community Hospital Peggy Jolovich (teleconference)

Dayton Rescue Unit Marc Ketcham (proxy for Jonathan Miles)

Eastern Idaho Regional Medical Center Scott Lambertsen (teleconference)

Eastern Wyoming Ambulance Service, Inc Wade Wells (teleconference)

Evanston Regional Hospital Darin Lenford??

Fremont County Ambulance Lauri Wempen

Guardian Flight Keith Finch (teleconference)

Guernsey Volunteer Ambulance Service Sharon Holloway

Hulett EMS Keith Noback

Ivinson Memorial Hospital Sandy Knapton

http://www.heart.org/mlwyoming



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Jackson Hole Fire EMS Wendy Blair (proxy for Mike Moyer)

Laramie Fire Department EMS Jim Hoflund

Marbleton-Big Piney Clinic - Sublette County Rural Health Care District

Vicky Marshall (teleconference)

Marbleton-Big Piney Clinic - Sublette County Rural Health Care District

Ron Gatti (proxy for Vicky Marshall)

Medical Center of the Rockies Jerre Johnson (teleconference)

Medical Center of the Rockies Kristi Ramsey (teleconference)

Memorial Hospital of Carbon County Wendy Thorvaldson

Memorial Hospital of Converse County Robynn Scheehle (teleconference)

Memorial Hospital of Converse County Toni Harms (proxy for Robynn Scheehle)

Memorial Hospital of Converse County EMS Carlos Mesa

Memorial Hospital of Sweetwater County Phil Reints

Mills FD EMS Jake Bigelow

Moorcroft EMS Dorothy Baron

Moorcroft EMS Sheila Hansen

Moorcroft EMS Keith Noback

Natrona County Fire Protection District Richard Ratcliff

Newcastle Ambulance Service Roger Hespe

Niobrara Health & Life Thomas Hoskins (proxy for Amber Keller)

North Big Horn Hospital Janet Ward (teleconference)

North Big Horn Hospital June Minchow (proxy for Janet Ward)

North Big Horn Hospital Ambulance Service June Minchow (proxy for Scott Murphey)

OEMS Trauma Prog Kelli Perrotti

Osage Volunteer FD EMS Keith Noback

Pinedale Clinic - Sublette County Rural Health District

Vicky Marshall (teleconference)


Ron Gatti (proxy for Vicky Marshall)

Platte County Memorial Hospital Khery Otero

Powell Valley Healthcare June Minchow

Powell Valley Healthcare - EMS Scott Bagnell

Rocky Mountain Ambulance Service LLC Rick Ballard

Salt Creek Emergency Services Jaime Jones

Sheridan Area Rural Fire Department Marc Ketcham

Sheridan Fire Rescue Rick Ballard (proxy for Terry Lenhart)

Sheridan Memorial Hospital Jennifer Rasp-Vaughn (teleconference)

Sheridan Memorial Hospital Big Horn Heart Center

Sharon Krueger (proxy for Jennifer Rasp-Vaughn)

South Lincoln County EMS G. Christopher Krell

St. John's Medical Center Wendy Blair (proxy for AJ Wheeler)

St. Vincent Healthcare Theresa Ketterling

Star Valley Medical Center Mike Kentner (teleconference)


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Star Valley Medical Center Ron Gatti (proxy for Mike Kentner)

Sublette County EMS Ron Gatti (proxy for Kenna Tanner)

Sublette County EMS Gretchen Schmid

Sundance EMS Keith Noback

Sundance EMS (Crook County Medical Services District)

Ken Maston

Sweetwater Medics LLC Ron Gatti

Town of Burns EMS Erica Maddison

Town of Pine Haven Ambulance Service Keith Noback

Town of Pine Haven Ambulance Service Tom Schanefelt

University of Colorado Hospital Kim Marshall

University of Texas Health Science Center James Langabeer

University of Utah Hospital and Clinics Dawn Young

University of Wyoming Derek Smith

Upton Fire Department Roger Hespe (proxy for James Sindlinger)

Veterans Affairs in Cheyenne Jerry Zang

Washakie County EMS Mike Bryant

Washakie Medical Center Jane Pomeroy (teleconference)

Weston County Health Services Piper Orsborn (teleconference)

Weston County Health Services Roger Hespe (proxy for Piper Orsborn)

Wyoming Cardiopulmonary Services, P.C. Michael Eisenhauer

Wyoming Departmet of Health Office of EMS Andy Gienapp (teleconference)

Wyoming Medical Center Deb Giles (proxy for Julie Cann Taylor)

Yoder Ambulance Becky Halfhill

1. 11:05 am Welcome Dani Gerard Exhibit 1A Jan 30 MLWY Meeting Minutes

Exhibit 1B MLWY Stakeholder Roster Exhibit 1C MLWY Voting Proxy Form Exhibit 1D AHA Ethics Policy Exhibit 1E AHA Conflict of Interest Policy Background: Review roster and update as needed. Action:

Review minutes from previous meeting

Review and update the draft Committee roster Minutes:

Reviewed minutes from January 30, 2013, approved as is

Please make sure to send your organization’s voting member if one does not appear for your organization on the Stakeholder Roster

o Please make sure to inform those agencies within your region


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that do not show a voting member about the Mission: Lifeline Wyoming initiative

Scott Nelson introduced as Hospital Director for the Mission: Lifeline Wyoming initiative

Proxy form was introduced as an alternative for voting members that are not able to attend in person to any of the Stakeholder meetings and to meet the participation requirement of the MOU, those forms must be sent with proxy to the meeting and collected at the meeting by AHA staff

o Furthermore it is not intended to be used as an alternative when an EMS agency is requesting for mileage reimbursement if a proxy was sent in your stead from another agency (i.e. Voting member from Albin Rescue is proxy to voting member from American Medical Response, mileage reimbursement will only be given to Albin Rescue), however if proxy is from same agency mileage reimbursement is allowed (i.e. Voting member from Albin Rescue sends proxy from Albin Rescue, mileage reimbursement is given to Albin Rescue)

2. 11:10 am Participation Updates Muhammad Khan Exhibit 2A Eligible EMS Participants

Exhibit 2B Eligible Hospital Participants Exhibit 2C Mission Lifeline Registration Process Background: The current status of participating hospitals and agencies. We will also talk about ML Registration forms Action:

Review Exhibit 2A and Exhibit 2B

Review required documents for Mission Lifeline Registration Minutes:

Reviewed exhibits 2A & 2B asked for help from Stakeholder to reach out to their organizations or organizations in their region to inform them of missing forms (i.e. MOU)

Reviewed exhibit 2C for those new to the process o The Mission: Lifeline forms are only for PCI hospitals to complete

3. 11:20 am MLWY Business Document Review Michael Eisenhauer Exhibit 3A Credit Worthiness Form (aka E1 Form)

Exhibit 3B Data Payment Request Background:


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To ensure all business documents are properly filled out, we will review these forms and answer any questions.

Action:

Review the Exhibits

Address any questions Minutes:

Reviewed Credit Worthiness Form (aka E1 Form) stated to group o page 2 of 5 is for AHA staff to complete o page 4 of 5 do not choose Merchant Credit Card, choose either

Direct Deposit or Check

o page 5 of 5, if W9 and mailing address will be used for both hospital and EMS make sure to use two forms (i.e. Memorial Hospital of Converse County and Memorial Hospital of Converse County EMS),

Choose “Vendor/Supplier” Not required but may choose to complete if organization

is “Governmental Entity” or “Non-Profit Entity” and if organization is a minority/woman owned business

Choose net pay option, if one is not chosen then Net 30 will be used

Reviewed Data Payment Request o EMS agencies may start using it now for mileage reimbursement,

but only if MOU and Credit Worthiness forms complete o Hospitals will start using once data is submitted, but only if MOU

and Credit Worthiness forms complete o Fax number will change and will be sent to Stakeholder

11:30 am Lunch

4. 12:15 pm Equipment Advisory Council Chris Krell

Exhibit 4A EAC Goals and Responsibilities Exhibit 4B EAC Needs Survey Results(to be presented) Exhibit 4C EAC Decision Matrix Exhibit 4D EAC Recommended Awarded Applications (to be presented) Background: The survey results are reviewed. Equipment Funding Applications were sent to hospitals and EMS agencies and are up for approval. Action:

Review EAC Survey Results

Review EAC Recommended Awarded Applications


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Minutes:

Email to Stakeholder exhibit 4B

Reviewed the hospital applications this morning at subcommittee meeting and the approved funds from that meeting are as followed

Hospital Level Amount Description Approved Elected

Campbell County Memorial Hospital

ACH $23,999 LN Basic $11,999 elected to downgrade

Memorial Hospital of Sweetwater County

ACH $11,999 LN Basic $11,999

North Big Horn CAH $26,606 Heartstart Telemed

$3,496 elected to downgrade

Powell Valley Healthcare

CAH $3,496 Heartstart Telemed

$3,496

Sheridan Memorial Hospital

PCI $11,999 LN Basic $11,999

South Big Horn Critical Access

CAH $23,999 LN Basic $11,999 elected to downgrade

St. Johns Medical Center

ACH $23,999 LN Basic $11,999 elected to downgrade

Total approved by EAC Subcommittee $66,987

Motion to approve the hospitals listed and the total amount of $66,987, motion approved

o Subcommittee felt these needs should be met first and will meet again for the remaining ask at a later time

Subcommittee was not able to review the EMS applications this morning and agreed to reconvene after the Stakeholder meeting

Motion to submit a document through surveymonkey or something similar which will state the approved EMS equipment funds from the EAC subcommittee, motion approved

Q: Is the organization only allowed once to submit for equipment funds? o A: No, it may submit as many times as we have openings for

equipment funds. The only requirement is to complete an MOU and the survey need assessment.

Note: AHA does not endorse any one vendor, all vendors are created equal, it’s whatever the organization’s needs are that matter


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5. 1:00 pm Protocols and Quality Improvement Dani Gerard Exhibit 5A PQI Goals and Responsibilities

Exhibit 5B Sample ML System Reports Exhibit 5C Non-PCI Hospital Data Entry Tool (to be presented) Exhibit 5D BLS 12 Lead protocol (to be presented) Background: The PQI Survey results are reviewed. Action:

Information only Minutes:

Reviewed exhibit 5D, this document is to be used as a review tool not a teaching tool, Wyoming Department of Health Office of EMS will need to review the document to ensure it meets requirements, add “Adult” to title “BLS Protocol for acquiring 12-Lead ECG’s”, once reviewed by Dept of Health and title changed will bring forth to the PQI subcommittee for vote

Reviewed exhibit 5B, report system for PCI and Border PCI hospitals

Reviewed exhibit 5C, report system mandatory for ACH however it is not mandatory but encouraged for CAH, abstractors are asked to sign up or submit information to receive a secure login to this report system

o We are working with Wyoming Department of Health Office of EMS to try and use WATRS for EMS reporting, however at this time we ask that EMS drop off patient information (i.e. run sheets) at the hospital for reporting purposes

6. 1:15 pm Conference Planning and Education Muhammad Khan Exhibit 6A CPE Goals and Responsibilities

Background: Provide updates only. Action:

Information only Minutes:

At this time CPE is on hold until protocols are approved and equipment disbursed

o Once this is complete CPE will be working on creating educational materials for the protocols and training sessions for equipment

Also in the works is developing the first conference in 2014


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7. 1:30 Review Meeting Dates and Select Next Meeting Location Chris Krell Action:

Committee members to ensure upcoming meetings are on their schedule - and accept calendar notices sent from AHA staff by email

Quarterly in 2013 and 2014 - 1st Thursday of every third month o July 11, 2013 (Location TBA).

Note: the 2nd Thursday to avoid the 4th of July o October 3, 2013 (Location TBA) o January 2,2014 (Location TBA) o April 3, 2014 (Location TBA) o July 10, 2014 (Location TBA)

Note: the 2nd Thursday to avoid the 4th of July o October 2,2014 (Location TBA) o January 8, 2015 (Location TBA)

Note: the 2nd Thursday to avoid New Year’s Day. Minutes:

Format is working, Subcommittee meetings in the morning and Stakeholder meetings in the afternoon

Motion to hold next meeting in Riverton, motion approved o Will check if facility works for the meetings, attendance is

up/down/same

8. 1:35 Review of Action Steps Michael Eisenhauer Information only

Minutes:

Sign in sheets will always track attendance, this will be used for mileage reimbursement for EMS agencies and meeting participation requirements for all

EAC Subcommittee will continue their meeting this afternoon

All subcommittees are open to anyone who would like to participate, only those that have signed up to participate will receive notifications about the meetings and information about the subcommittee

Abstractor training changed to room 138

Make sure to complete MOUs

Voting members keep an eye out for survey regarding the EMS equipment funding will need your vote

PQI will submit documents to State authorities for approval and working on the next protocol sets

AHA staff ready to help regarding data entry o Recommended to have only one person entering data, not a

committee

CPE working on conference 2014 think about audience, time, location


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9. 1:45 Adjourn Michael Eisenhauer Information only

o Statewide AHA happenings: Senate file 147, passed our legislation

Summary of bill - Requires the Department of Health to recognized the work being done in WY

We will be looking at data next Stakeholder meeting, Ben Leonard and Scott Nelson will be working with you all in the near future to start entering data Adjourned 2:00 pm

AHA MLWY Inititative Stakeholders Voting Member Roster July 2013

Albin Rescue Carrie Deselms

Alpine Fire Department Jeremy Larsen

American Medical Response Cindy Osborne

Atwood’s Family Ambulance Del Atwood, Jr.

Big Horn Fire Dist #4 Ambulance

Bighorn Airways Inc

Billings Clinic Diana Parker

Bozeman Deaconess Hospital

Buffalo-Johnson Co. EMS

Burgess Junction Rescue

Campbell County EMS Gregg Mentzel

Campbell County Memorial Hospital Deb Tonn

Carbon County EMS Candice Hofmann

Castle Rock Ambulance Service

Centennial Valley Ambulance Andrea Kern

Cheyenne Fire & Rescue

Cheyenne Regional Medical Center Melissa Tschimperle

Chugwater Ambulance

City of Casper Fire - Casper Fire Department

City of Torrington EMS Darin Yates

Classic Lifeguard April Larsen

Crook County Medical Services District

Dayton Rescue Unit Jonathan Miles


Eastern Idaho Regional Medical Center

Eastern Wyoming Ambulance Service, Inc Wade Wells

Eden Valley Ambulance Service

Evanston Regional Hospital Angie Foster

Evansville Emergency Service Matt Gacke

Fort Laramie FD EMS

Fremont County Ambulance Lauri Wempen

Glendo Volunteer Ambulance Elizabeth VanBuskirk

Greybull EMS

Guardian Flight Keith Finch

Guernsey Volunteer Ambulance Service Sharon Holloway

Hawk Springs FD EMS Lou Hubbs

Hot Springs County Memorial Hospital

Hulett EMS Keith Noback

Ivinson Memorial Hospital Sandy Knapton

Jackson Hole Fire EMS Mike Moyer

Johnson County EMS

Johnson County Healthcare Center

LaGrange Rescue Unit

Lander Regional Hospital Brad Langdorf

Laramie Fire Department EMS Jim Hoflund

Lingle Volunteer FD

Little Snake River EMS


Lusk Ambulance Service Amber Keller

Marbleton-Big Piney Clinic Vicky Marshall

Medcor, Inc. dba Medcor at Yellowstone

Medical Center of the Rockies Brad Oldemeyer

Memorial Hospital of Carbon County Christine Midget

Memorial Hospital of Converse County Robynn Scheehle

Memorial Hospital of Converse County EMS Carlos Mesa

Memorial Hospital of Sweetwater County Phil Reints

Mills FD EMS Jake Bigelow

Moorcroft Volunteer Ambulance Service Keith Noback

Mortimore’s Ambulance Service Mark Mortimore

Natrond County Fire Protection District

Newcastle Ambulance Service Roger Hespe

Niobrara Health & Life Center Cindy Treffer

North Big Horn Hospital Janet Ward

North Big Horn Hospital Ambulance Service Scott Murphey

Osage Volunteer FD EMS Keith Noback


Vicky Marshall

Platte County Memorial Hospital Khery Otero

Powell Valley Healthcare June Minchow

Powell Valley Healthcare - EMS Scott Bagnell

Rapid City Regional Hospital Julie Poppe

Riverton Memorial Hospital Beth Metcalf


Rock Springs Fire Dept.

Rocky Mountain Ambtac

Rocky Mountain Ambulance Service LLC Rick Ballard

Salt Creek Emergency Services

Sheridan Area Rural Fire Department Marc Ketcham

Sheridan Fire Rescue Terry Lenhart

Sheridan Memorial Hospital Jennifer Rasp-Vaughn

South Big Horn Hospital

South Central WY EMS

South Lincoln County EMS Jessie Kramer

South Lincoln Medical Center Eric Boley

St. John's Medical Center AJ Wheeler

St. Mark's Hospital Pawan Sharma

St. Vincent Healthcare Theresa Ketterling

Star Valley Medical Center Mike Kentner

Star Valley Medical Center EMS Mike Fleming

Sublette County EMS Kenna Tanner

Sublette County Rural Health District Vicky Marshall

Sundance EMS Ken Maston

Sweetwater Medics LLC Ron Gatti

Ten Sleep Ambulance

Thayne Ambulance Service

Torrington Community Hospital Sommer Schilreff


Town of Burns EMS Erica Maddison

Town of Pine Bluffs EMS

Town of Pine Haven Ambulance Service Keith Noback

Uinta County EMS

University of Utah Hospital and Clinics Dawn Young

Upton Fire Department James Sindlinger

Veterans Affairs in Cheyenne Jerry Zang

Veterans Affairs in Sheridan

Wamsutter EMS

Washakie County EMS

Washakie Medical Center Jane Pomeroy

West Park Hospital EMS Larry Jones

Weston County Health Services Piper Orsborn

Wyoming Life Flight

Wyoming Medical Center Julie Cann Taylor

Wyoming Medical Center EMS Mark Meyer

Yellowstone National Park Daniel "Boone" Vandzura

Yoder Ambulance Becky Halfhill

AHA Mission Lifeline Wyoming Initiative Proxy Voting Form

Eligibility Proxy voting must follow these rules:

1. If you wish to vote by proxy, you must use this official form (a proxy form may be a copyor facsimile of the official proxy form, but must have an original ink signature in order to be official). The proxy form must be dated and signed to be valid.

2. The designated proxy holder must be a designated voting member of AHA MissionLifeline Wyoming Stakeholder Committee in good standing.

3. Please do not send this form to the AHA office. The proxy holder must present the proxyform for certification during meeting check-in. The proxy may be exercised only by the person named.

4. If you cannot attend the committee meeting, it is your obligation and privilege to vote byproxy.

Proxy Vote

I hereby appoint (proxy name)______________________________________________, my proxy,

to represent me at the (date) ________________________________ AHA Mission Lifeline

Wyoming Stakeholder Committee Meeting, and to act in my stead, authorizing this person fully

to vote and do all things that I could or might do to the same extent if personally present. I also

authorize this person to do every act whatsoever necessary or proper to be done in or upon all

matters that may lawfully come before said meeting or any adjournment thereof. Further, I

hereby revoke any proxy or proxies previously given by me to any person or persons.

Name:________________________________________________ Date:_____________________ (Please print name legibly).

Signature:_____________________________________________

Organization:__________________________________________

Please fax to: 1-877-247-5211 or email to [email protected]

10/28/2009

AMERICAN HEART ASSOCIATION ETHICS POLICY

The purpose for this Ethics Policy is to support a culture of openness, trust, and integrity in all American Heart Association management and business practices. A well-understood ethics policy requires the participation and support of every AHA employee and volunteer. At the American Heart Association we are dedicated to working with our employees, volunteers, partners, vendors and customers to reduce disability and death from cardiovascular disease and stroke. We are committed to conducting all of the AHA’s affairs and activities with the highest standards of ethical conduct. Our AHA Code of Conduct, outlined in our Human Resource Policy Manual, provides guidance for decisions and actions during our daily work. We are committed to the responsible use of AHA assets, to provide accurate, complete and objective information, to respect the confidentiality of financial and other information, to act in good faith and exercise due care in all we do, to comply with all rules and regulations and to proactively promote ethical behavior. The American Heart Association’s Code of Ethics is built on AHA values. As such, we acknowledge our individual responsibility to ensure our collective success by practicing and promoting the following values: Integrity, Inclusiveness, Dedication, Excellence, Sensitivity, and Vision. These values reflect a shared view of how we want to operate and be seen by others. Code of Ethics The summary code of ethics includes the following provisions:

• American Heart Association employees and volunteers must: o Proactively promote ethical behavior as a responsible partner among peers in the

work environment. o Deal fairly with AHA Customers, suppliers, competitors, volunteers, and employees. o Provide constituents with information that is accurate, completely objective, relevant,

timely, and understandable. o Comply with applicable government laws, rules and regulations. o Maintain the confidentiality of information entrusted to them by the AHA or its

Customers except when authorized or otherwise legally obligated to disclose. o Accept responsibility for preventing, detecting, and reporting all manner of fraud. o Be honest and ethical in their conduct, including ethical handling of actual or

apparent conflicts of interest between personal and professional relationships. o Protect and ensure the proper use of company assets. o Prohibit improper or fraudulent influence over the External Auditor.

A link to a copy of the entire American Heart Association Ethics Policy may be found at the bottom of the homepage at www.americanheart.org and the AHA Intranet. Reporting Ethics Violations If you have questions or concerns about compliance with the subjects described in this policy, or are unsure about what is the “right thing” to do, we strongly encourage you to first talk with your supervisor, another AHA leader or the leader in the Human Resource department. If you are uncomfortable talking to any of these individuals for any reason, call the AHA ethics hotline at (866) 293-2427 to report your concerns. You may also log on to: www.ethicspoint.com. Your calls to the toll free hotline or contact through the Internet site are facilitated by a third party, Ethics Point, Inc. Reporting of ethics violations will be treated as confidential information and can be communicated anonymously.

AMERICAN HEART ASSOCIATION

CONFLICT OF INTEREST POLICY

THE AMERICAN HEART ASSOCIATION, ITS AFFILIATES AND COMPONENTS, AND ALL OFFICERS, DIRECTORS, DELEGATES, COUNCIL AND COMMITTEE MEMBERS SCRUPULOUSLY SHALL AVOID ANY CONFLICT BETWEEN THEIR OWN RESPECTIVE PERSONAL, PROFESSIONAL OR BUSINESS INTERESTS AND THE INTERESTS OF THE ASSOCIATION, IN ANY AND ALL ACTIONS TAKEN BY THEM ON BEHALF OF THE ASSOCIATION IN THEIR RESPECTIVE CAPACITIES.

In the event that any Officer, Director, Delegate, Council or Committee member of the Association shall have any direct or indirect interest in, or relationship with, any individual or organization which proposes to enter into any transaction with the Association, including but not limited to transactions involving:

a. the sale, purchase, lease or rental of any property or other asset;

b. employment, or rendition of services, personal or otherwise;

c. the award of any grant, contract, or subcontract;

d. the investment or deposit of any funds of the Association;

such person shall give notice of such interest or relationship and shall thereafter refrain from discussing or voting on the particular transaction in which he has an interest, or otherwise attempting to exert any influence on the Association, or its components to affect a decision to participate or not participate in such transaction.

(Approved by AHA Board of Directors and Delegate Assembly, June 1986)

AMERICAN HEART ASSOCIATION Record of Abstention with Conflict of Interest Policy

As a member of the AHA or Affiliate Delegate Business Session, Board of Directors, Committee, Council, Task Force or Group, the following is a record of my disclosure of a direct or indirect conflict of interest and abstention from discussion and voting on the matter at this meeting. CONFLICT:__________________________________________________________________

____________________________________________________________________________

____________________________________________________________________________

____________________________________________________________________________ ________________________________________ ___________________________________ (Name of board, council, committee or group) (Signature) ________________________________________ ___________________________________ (Date) (Print Name)

[Original to be filed with minutes of the meeting.]

Mission: Lifeline Wyoming Meeting the Helmsley Charitable Trust Fundraising Challenge

Introduction Abbey Dobler Development Specialist 307-631-2490 [email protected]

The Challenge The Helmsley Charitable Trust has challenged the American Heart Association to raise at least $200,000 from Foundations, Corporations, and Individuals for Mission: Lifeline Wyoming. This accounts for less than 4% of the overall budget. To date, $21,000 has been donated with $179,000 to be raised.

The Need Facility: $15,000 will help to cover the cost of Mission: Lifeline Educational Conferences AED’s: $66,190 will help to cover the placement of an estimated 31 AED’s based on the AED assessment and recommendations by the Equipment Advisory Council (EAC) and approval by the Wyoming Stakeholder Committee Training Materials: $33,810 for training is key to the success of Mission: Lifeline by providing health care professionals the opportunity to master protocols, equipment, treatment, and data collection Statewide Public Awareness Campaign: $85,000 to educate the public on the effectiveness of calling 9-1-1 when experiencing the symptoms of a heart attack

Every donor will be recognized and acknowledged for their support of this life-saving initiative.

How You Can Help

Recommend corporations, foundations, or individuals who may be interested in

contributing to the fundraising challenge

Introduce fundraising staff to local foundations, corporations, or individuals

Serve as a guest speaker to local Rotary Clubs, Kiwanis clubs, or similar community

organizations to share information about Mission: Lifeline


Institution Received MOU Received E1 Forms

Albin Rescue 2/2/2013 2/8/2013

Alpine Fire Department 11/28/2012 5/7/2013

American Medical Response 11/13/2012 4/8/2013

Atwood’s Family Ambulance 12/20/2012 5/7/2013

Campbell County EMS 11/27/2012 11/28/2012

Carbon County EMS 2/26/2013 6/12/2013

Centennial Valley Ambulance 11/28/2012 4/22/2013

City of Torrington EMS 11/8/2012 4/4/2013

Dayton Rescue Unit 2/20/2013 5/14/2013

Eastern Wyoming Ambulance Service, Inc 2/26/2013 4/9/2013

Eden Valley Ambulance Service 11/30/2012 4/10/2013

Evansville Emergency Service 10/29/2012 4/11/2013

Fremont County Ambulance 12/12/2012 12/12/2012

Guardian Flight 2/28/2013 Declined Payment

Guernsey Volunteer Ambulance Service 12/17/2012 4/15/2013

Jackson Hole Fire EMS 11/7/2012 11/8/2012

Laramie Fire Department EMS 1/5/2013 6/21/2013

Memorial Hospital of Converse County EMS 11/15/2012 4/8/2013

Mills FD EMS 3/13/2013 4/11/2013

Moorcroft Volunteer Ambulance Service 11/15/2012 4/30/2013

Mortimore’s Ambulance Service 2/25/2013 6/20/2013

Newcastle Ambulance Service 2/12/2013 4/4/2013

North Big Horn Hospital Ambulance Service 12/20/2012 12/20/2012

Rocky Mountain Ambulance Service LLC 12/17/2012 12/17/2012

Salt Creek Emergency Services 2/19/2013 7/1/2013

Sheridan Fire Rescue 12/17/2012 12/17/2012

South Lincoln County EMS 3/29/2013 4/17/2013

Star Valley Medical Center EMS 2/4/2013 4/29/2013

Sundance EMS 11/15/2012 4/30/2013

Sweetwater Medics LLC 11/15/2012 4/4/2013

Town of Burns EMS 11/13/2012 6/21/2013

Town of Pine Bluffs EMS 11/28/2012 11/28/2012

Town of Pine Haven Ambulance Service 11/15/2012 5/7/2013

Upton Fire Department 2/8/2013 2/8/2013

Wyoming Medical Center EMS 2/2/2013 4/4/2013

Yoder Ambulance 1/16/2013 4/25/2013

Washakie County EMS NEED 4/4/2013

Castle Rock Ambulance Service 12/7/2012 NEED

Classic Lifeguard 2/27/2013 NEED

Glendo Volunteer Ambulance 2/20/2013 NEED

Hawk Springs FD EMS 4/23/2013 NEED

Hulett EMS 11/15/2012 NEED

Lusk Ambulance Service 11/20/2012 NEED

MLWY EMS Eligible to Receive Payment

MLWY EMS Need E1 Forms

MLWY EMS Need MOU

Institution Received MOU Received E1 Forms

Natrond County Fire Protection District 4/3/2013 NEED

Osage Volunteer FD EMS 3/4/2013 NEED

Powell Valley Healthcare ‐ EMS 12/17/2012 NEED

Sheridan Area Rural Fire Department 12/17/2012 NEED

Sublette County EMS 11/19/2012 NEED

Thayne Ambulance Service 11/28/2012 NEED

Uinta County EMS 2/26/2013 NEED

Yellowstone National Park 2/14/2013 NEED

Big Horn Fire Dist #4 Ambulance NEED NEED

Bighorn Airways Inc NEED NEED

Buffalo‐Johnson Co. EMS NEED NEED

Burgess Junction Rescue NEED NEED

Cheyenne Fire & Rescue NEED NEED

Chugwater Ambulance NEED NEED

City of Casper Fire ‐ Casper Fire Department NEED NEED

Fort Laramie FD EMS NEED NEED

Greybull EMS NEED NEED

Johnson County EMS NEED NEED

LaGrange Rescue Unit NEED NEED

Lingle Volunteer FD NEED NEED

Little Snake River EMS NEED NEED

Rock Springs Fire Dept. NEED NEED

Rocky Mountain Ambtac NEED NEED

South Central WY EMS NEED NEED

Ten Sleep Ambulance NEED NEED

Wamsutter EMS NEED NEED

Wyoming Life Flight NEED NEED

MLWY EMS Need All Forms

Institution Hospital Type Received MOU E1 Form HR Form DRC Form SDRC Form

Cheyenne Regional Medical Center PCI WY 2/7/2013 3/25/2013 2/7/2013 2/7/2013 2/7/2013

Wyoming Medical Center PCI WY 12/19/2012 4/4/2013 12/19/2012 12/19/2012 12/19/2012

Billings Clinic PCI Border 1/11/2013 4/22/2013 1/11/2013 2/17/2013 2/17/2013

Eastern Idaho Regional Medical Center PCI Border 12/5/2012 7/2/2013 5/21/2013 5/21/2013 5/21/2013

Medical Center of the Rockies PCI Border 12/17/2012 4/25/2013 1/3/2011 12/17/2012 12/17/2012

Rapid City Regional Hospital PCI Border 2/4/2013 5/13/2013 9/26/2012 11/5/2012 2/7/2013

St. Mark's Hospital PCI Border 11/13/2012 6/11/2013 11/28/2012 12/11/2012 12/7/2012

St. Vincent Healthcare PCI Border 2/20/2013 4/8/2013 1/26/2007 4/16/2013 4/16/2013

University of Utah Hospital and Clinics PCI Border 3/25/2013 4/16/2013 12/12/2012 12/12/2012 12/12/2012

Bozeman Deaconess Hospital PCI Border NEED NEED 4/4/2012 NEED NEED

Campbell County Memorial Hospital Acute 11/27/2012 11/28/2012 Not Req'd Not Req'd Not Req'd

Evanston Regional Hospital Acute 12/26/2012 4/10/2013 Not Req'd Not Req'd Not Req'd

Ivinson Memorial Hospital Acute 12/1/2012 4/11/2013 12/18/2012 Not Req'd Not Req'd

Memorial Hospital of Sweetwater County Acute 2/6/2012 5/7/2013 Not Req'd Not Req'd Not Req'd

Sheridan Memorial Hospital Acute 11/7/2012 5/3/2013 11/7/2012 11/7/2012 Not Req'd

St. John's Medical Center Acute 12/4/2012 3/29/2013 Not Req'd Not Req'd Not Req'd

Lander Regional Hospital Acute 11/15/2012 NEED Not Req'd Not Req'd Not Req'd

Riverton Memorial Hospital Acute 2/22/2013 NEED Not Req'd Not Req'd Not Req'd

Crook County Medical Services District CAH 12/12/2012 4/30/2013 Not Req'd Not Req'd Not Req'd

Medcor, Inc. dba Medcor at Yellowstone CAH 1/19/2013 4/22/2013 Not Req'd Not Req'd Not Req'd

Memorial Hospital of Carbon County CAH 2/26/2013 6/11/2013 Not Req'd Not Req'd Not Req'd

Memorial Hospital of Converse County CAH 11/15/2012 4/8/2013 Not Req'd Not Req'd Not Req'd

North Big Horn Hospital CAH 12/20/2012 12/20/2012 Not Req'd Not Req'd Not Req'd

Platte County Memorial Hospital CAH 5/28/2013 5/28/2013 Not Req'd Not Req'd Not Req'd

Powell Valley Healthcare CAH 12/17/2012 6/20/2013 Not Req'd Not Req'd Not Req'd

South Big Horn Hospital CAH 12/10/2012 5/13/2013 Not Req'd Not Req'd Not Req'd

South Lincoln Medical Center CAH 3/29/2013 4/17/2013 Not Req'd Not Req'd Not Req'd

Star Valley Medical Center CAH 11/6/2012 4/29/2013 Not Req'd Not Req'd Not Req'd

MLWY PCI WY Eligible to Receive Payment

MLWY Border PCI Eligible to Receive Payment

MLWY PCI Border Need Forms

MLWY Acute Eligible to Receive Payment

MLWY Acute Need E1 Forms

MLWY CAH Eligible to Receive Payment

Institution Hospital Type Received MOU E1 Form HR Form DRC Form SDRC Form

Weston County Health Services CAH 12/19/2012 2/11/2013 Not Req'd Not Req'd Not Req'd

Hot Springs County Memorial Hospital CAH 2/13/2013 NEED Not Req'd Not Req'd Not Req'd

Marbleton‐Big Piney Clinic CAH 12/6/2012 NEED Not Req'd Not Req'd Not Req'd

Niobrara Health & Life Center CAH 11/20/2012 NEED Not Req'd Not Req'd Not Req'd

Pinedale Clinic ‐ Sublette County Rural Health D CAH 12/6/2012 NEED Not Req'd Not Req'd Not Req'd

Sublette County Rural Health District CAH 12/18/2012 NEED Not Req'd Not Req'd Not Req'd

Washakie Medical Center CAH 4/8/2013 NEED Not Req'd Not Req'd Not Req'd

West Park Hospital EMS CAH 12/7/2012 NEED Not Req'd Not Req'd Not Req'd

Johnson County Healthcare Center CAH NEED NEED Not Req'd Not Req'd Not Req'd

Torrington Community Hospital CAH NEED NEED Not Req'd Not Req'd Not Req'd

Veterans Affairs in Cheyenne VA NEED NEED Not Req'd Not Req'd Not Req'd

Veterans Affairs in Sheridan VA NEED NEED Not Req'd Not Req'd Not Req'd

MLWY CAH Need E1 Forms

MLWY CAH Need Forms

MLWY VA Need Forms

Wyoming Board of Medicine Serving the public and practitioners since 1905 130 Hobbs Avenue, Suite A • Cheyenne, WY 82002 Phone: 307-778-7053 • Fax: 307-778-2069 • Toll free within Wyoming: 800-438-5784 Email: [email protected] • Website: http://wyomedboard.state.wy.us

May 8, 2013 Via E-mail ([email protected]) Andy Gienapp, MS, NREMTP Administrator Office of Emergency Medical Services 6101 Yellowstone Rd., Suite 400 Cheyenne, WY 82002 RE: EMS 2013-21 – Requests for Action Dear Andy: At its meeting on April 12-13, 2013, the Wyoming Board of Medicine considered the requests for approval posed to it by your agency in your letter dated April 11, 2013. I am pleased to report the Board took the following actions: Item #1: Lead ECGs and aspirin The Board approved the permanent inclusion of the following in the scope of practice of EMT Basic:

1. Use of 12-lead electrocardiograph (ECG) machines, and the transmission of the information from ECG testing to receiving hospitals. EMT Basics may not provide interpretation and/or subsequent interventions based upon the presenting rhythm; however, they may provide other interventions that are authorized and appropriate based upon the chief complaint, and physical assessment, of the patient.

2. Oral administration (p.o.) of aspirin in the presence of a patient’s complaint of chest pain or presumptive myocardial infarction.

3. Epinephrine auto-injectors

a. Obtaining and stocking epinephrine auto-injectors under the authority of the respective service’s Physician Medical Director; and,

Matthew H. Mead Governor

Andy Gienapp, MS, NREMTP May 8, 2013 Page 2 of 2

b. Administering epinephrine via auto-injector to adult and pediatric patients exhibiting signs and symptoms of anaphylaxis.

Although the Board did not place any limitations on the use of epinephrine auto-injectors, you are encouraged to monitor the implementation of this portion of the scope of practice. If at any time you believe limitations, protocols or guidelines are appropriate, please bring your concerns to the attention of the Board for possible further action.

Item #2: Changes in Level of Service

The Board reviewed two requests for changes in level of service:

1. Upgrading of Fremont County EMS from Intermediate level service to Paramedic level service. The Board approved this request.

2. Authorization for the Mills Fire Department (MFD) to utilize paramedics on an intermittent basis. The Board was concerned that MFD reportedly has not completed the transition process outlined in the Scope of Practice approved by the Board in 2011. Rather than approve the use of paramedics on an intermittent basis while the implementation by MFD of the 2011 Scope of Practice changes is still in process, the Board prefers to revisit the request at its meeting in August 2013. If by that time MFD has submitted and received approval for the clinical protocols, and has completed the specified transition process, the Board will gladly revisit the matter. Therefore, the Board deferred action on this request.

I hope the Board’s decisions are helpful to you and address your requests and concerns. The Board’s next regularly-scheduled meeting is set for August 1-3, 2013, in Cheyenne, and as always you are welcome to present – either in person or via letter – requests for review and approval to the Board for consideration at that meeting. In the meantime, if you have any questions or we can be of any assistance to you, please do not hesitate to let me know.

Best regards,

Kevin D. Bohnenblust Executive Director

Cc: Board of Medicine Members Jessica Frint, Assistant Attorney General – Board Counsel

Mission: Lifeline Wyoming Equipment Advisory Subcommittee October 29, 2012

1 | P a g e

Equipment Advisory Goals and Responsibilities Goal of this subcommittee is to review EMS and hospital resource gaps and develop a plan to allocate grant funding.

Identify equipment requirements for successful transmission of 12-lead ECG for all EMS Agencies.

Identify requirements for hospitals to obtain transmission of 12-lead ECG from EMS Agencies.

Identify additional equipment and training requirements and address.

Mission: Lifeline Wyoming Equipment Purchase Process Overview (Revised 06.27.2013)

Page 1 of 1

The April 4th Equipment Advisory Council (EAC) and Wyoming Stakeholder Committee (WSC) reviewed the first cycle of equipment grant applications and voted on the proposed funding allocation. This document lists the officially approved equipment to be funded and a description of the purchasing process. Changes to an approved list cannot be made without including the WSC. Each EMS agency and hospital will purchase the equipment and AHA will reimburse the agency or hospital for the purchase. Funding will only be issued for the equipment and amount that was officially approved by the EAC subcommittee and WSC Voting Representatives. An Equipment Grant Agreement will be sent to awarded EMS agencies and Hospitals. EMS agencies and hospitals are to order their approved equipment or software. Upon successful order of the equipment the vendors will create a “proforma” invoice. EMS agencies and Hospitals will send a copy of the proforma invoice along with the completed the Equipment Grant Agreement to: [email protected]. Alternatively, you can fax the documents to Diana’s attention at 1-877-247-5211. Once AHA has these documents, the payment process will begin. EMS agencies and hospitals should plan on receiving payment within 30 days of submission. A Credit Worthiness form must be completed and on file with AHA before payment will be issued. If you have any questions, please don’t hesitate to contact us. Ben Leonard, NREMT-P EMS Director, Mission: Lifeline Wyoming Quality Improvement Initiatives SouthWest Affiliate [email protected] O) 877-610-3990 C) 307-333-3641 F) 877-247-5211

Scott Nelson, B.S., NREMT-P Hospital Director Mission: Lifeline Wyoming Quality Improvement Initiatives SouthWest Affiliate [email protected] O) 307.222.8416 C) 303.883.6829 F) 866.703.1718




Mission: Lifeline Wyoming Equipment Grant Agreement

American Heart Association, Inc. – the Dallas office of the Southwest Affiliate (“AHA”), 8200

Brookriver, Suite N 100 Dallas, TX, hereby awards a grant to _________________________

(“COMPANY”), at the street address ____________________________, subject to the following terms

and conditions:

1. The grant funding this equipment is for the period from June 1, 2012 through June 30,

2015. Upon receipt by AHA of this signed Grant Agreement, COMPANY may arrange

to purchase approved equipment or software for delivery within 30 days and payment with a 60

day payment arrangement in accordance with the Equipment Grant Agreement provided by

AHA. Upon successful delivery and installation of the equipment and receipt of the final invoice,

COMPANY must deliver to AHA the signed Equipment Grant Agreement, a copy of their

original application for EMS & Hospital Equipment Funding AHA agrees it will pay

COMPANY the amount for the approved equipment ordered within thirty (30) days of

receipt (see Attachment A for dollar amount). 2. COMPANY is legally incorporated in WY, SD, MT, ID, UT,CO (please circle one) , is a

corporation in good standing with their respective State and the AHA Mission: Lifeline Wyoming

initiative at the time of this grant Agreement, and agrees it will maintain this status throughout the

term of this Agreement. If COMPANY is a non-profit organization, COMPANY confirms

further it is not a Type III supporting organization within the meaning of IRC Section

4943(f)(5)(A).

3. COMPANY will use grant funds only for activities that are consistent with its grant application

submitted to the AHA and as outlined in Attachment A. COMPANY will not use the grant funds

for political support or to carry on lobbying efforts of propaganda, or to otherwise attempt to

influence any legislation, within the meaning of IRC Section 4945 and the Treasury Regulations

thereunder. Further, COMPANY will not use grant funds to engage in, support or promote

violence, terrorist activity or related training of any kind.

4. No substantial variances, including the timing of expenditures, will be made from the grant

application without the AHA’s prior written approval.

5. COMPANY will inform the AHA immediately, in writing, of (i) any change in or challenge to its

corporate status, adverse change in its standing with their regulating state or if it becomes a Type

III supporting organization, (ii) any change in its organizational leadership or key personnel, or

(iii) any material change or adverse development relative to its financial condition, operations,

activities or affairs. No payment hereunder shall be required to be made at any time after

COMPANY ceases to be a legal corporate entity, has an adverse change in its standing with the

State of Texas or if it becomes a Type III Supporting Organization.

6. COMPANY will have full control of the disposition of the grant and accepts responsibility for

complying with this Agreement’s terms and conditions. This grant is earmarked for COMPANY

and may not be transferred to any other entity or person, except as may be specified in

Attachment A. COMPANY will maintain a separate accounting of the use of grant funds to

enable confirmation of its proper expenditure of the grant funds.

7. COMPANY will submit an annual report using the template provided by AHA and outlining its

progress towards the plans detailed in the grant application and a summary of how the grant funds

have been expended. These reports are due 60 days after the end of each calendar year starting

with the year ended December 31, 2013.

8. COMPANY acknowledges and agrees that any equipment provided hereunder by AHA will,

upon delivery, be owned by COMPANY, and COMPANY solely will be responsible for the

upkeep, maintenance, repairs, safety, insurance and operability of such equipment. COMPANY

also acknowledges and agrees that the AHA does not endorse, impliedly or expressly, any brand

or manufacturer of any equipment that may be provided hereunder.


9. COMPANY agrees to respond within 30 days of request to interim inquiries and requests for

information from the AHA regarding uses of the grant funds, compliance with the terms of the

grant and progress made towards achieving the goals of the grant.

10. COMPANY acknowledges that the AHA and its representatives have made no actual or implied

promise of funding or renewal of funding in addition to amounts provided under this Agreement.

11. It is understood that by signing this grant Agreement, COMPANY agrees that it will conduct all

activities to be funded by this grant in compliance with all applicable United States, state and

local laws, as well as in compliance with the laws of any location or jurisdiction in which

COMPANY is operating, including applicable anti-terrorist financing and asset-control laws,

statutes and executive orders.

12. COMPANY agrees to ensure that all potential recipients and participants of COMPANY’s

programs and services have access to programs and receive equitable services without regard to

race, sex, education, ethnicity, socio-economic status, religion, ability/disability, sexual

orientation, gender self-identification, age, country of origin, first language, marital status,

citizenship or immigration status.

13. If COMPANY wishes to publicize this grant, COMPANY must contact the AHA at least 2 weeks

before the desired date of the publicity for review and approval by the AHA and The Leona M

and Harry B. Helmsley Charitable Trust (“TRUST”). COMPANY shall not issue any press

releases or otherwise make any public statement referring to this grant or using the AHA, or

TRUST’S logo without the prior written consent of the AHA and TRUST. The text of all press

releases, public announcements, statements, campaign reports or materials that mention the grant

must be approved in advance in writing by the AHA and the TRUST. COMPANY shall provide

the AHA with copies of any and all final press releases, public announcements and/or

publications related to this grant. The AHA and the TRUST may make information about this

grant public at any time on their websites or in presentations or as part of their public reports or

documents.

14. COMPANY hereby agrees, to the fullest extent permitted by law, to defend, indemnify and hold

harmless the AHA, the TRUST, their officers, directors, volunteers, employees and agents from

and against all claims, liabilities, losses and expenses (including reasonable attorney’s fees),

directly or indirectly, wholly or partially arising from or in connection with any act or omission of

COMPANY, its directors, employees or agents in obtaining or accepting the grant from the AHA,

in expending or applying the proceeds of the grant from the AHA, in operating the equipment

provided hereunder, or in carrying out the project or programs funded with grant funds from the

AHA.

15. If the AHA terminates this grant for cause, or if COMPANY ceases to be a legal corporate entity,

or ceases to be in good standing in their respective state, or becomes a Type III Supporting

Organization, COMPANY shall immediately repay the full amount of grant funds that are

unspent and surrender any equipment purchased with grant funds as of the date of the termination

or date its corporate status changes. In addition to the circumstances cited above, the AHA shall

have cause to terminate the grant if the purpose of the grant has been fully completed;

COMPANY becomes unable to carry out the purposes of the grant; COMPANY uses the grant

funds for a purpose other than those set forth in this Agreement, unless the AHA has consented in

writing to such modification; or COMPANY is in breach of any term of the grant. The AHA

reserves the right to request immediate reimbursement of any grant funds used for purposes other

than those for which the grant was made or to which the AHA has consented.

16. COMPANY acknowledges and agrees to be responsible for the upkeep, maintenance, repairs,

safety, insurance and operability of such equipment not only for the term of the grant, but for as

long as COMPANY owns such equipment. The COMPANY will be required to retain records to

attest to upkeep, maintenance, repairs, safety, insurance and operability and should be readily

available upon the request of the AHA for verification.


For American Heart Association, Inc. – Southwest Affiliate:

Signature Name/Title Date

On behalf of COMPANY, I understand and agree to the foregoing terms and conditions of the AHA’s

grant and hereby certify my authority to execute this Agreement.

By:

Signature Name/Title/Company Date


Attachment A

Funding was approved by the Mission: Lifeline Wyoming Committee as follows:

Approved and

received by

COMPANY Equipment – Brief Description

Total Cost Requested (to

include applicable sales tax

and S&H charges)

COMPANY will attach the invoice detailing the equipment that was purchased and the total purchase

price paid for the AHA to reimburse.

Name of EMS Agency or Hospital Rank Equipment WSC Approved Amount ProForma Inv Amt (Taxed amount) 12 Lead Modem 12 Lead ECG Transmission Service EMS 12 Leads Cell Boosters Amount in E1 E1 Order # Freight

Albin Rescue (Y) B 2 2 ReadyLink, 2 boosters $11,898.00 11,096.60$ 598.00$ 10,498.60$ 400.00$ 11,096.60$ 796721

Alpine ems (Y) I 2 1 Zoll X series $25,000.00 25,000.00$ 25,000.00$ 25,000.00$ 796577

Atwood Ambulance (Y) I 2 4 upgrades, 4 data plans, 4 modems $32,324.00 32,143.00$ 2,997.00$ 796.00$ 28,350.00$

Campbell County Gillette (Y) P 1 5 x modem & data plans $4,991.00 4,990.80$ 3,996.00$ 994.80$ 0.00$ 4,990.80$ 796722

Carbon County Mem Hosp EMS (Y) I 2 2 LP 15, 3 booster $50,894.00 ‐$ 1,170.00$

Centennial Valley Vol Fire Dept (Y) B 2 1 Phillips MRX basic $13,494.00 13,494.00$ 3,247.00$ 10,247.00$ 13,494.00$ 796582

City of Torrington EMS (Y) I 2 2 Zoll X Series $50,000.00 52,625.00$ 2,625.00$ 50,000.00$ 52,625.00$ 796583

Dayton Rescue (Y) B 2 1 LP 15 $24,863.00 ‐$

Eastern Wyoming Ambulance (Y) P 2 2 Zoll X Series, 4 Cell Boosters $51,920.00 53,000.01$ 3,000.01$ 50,000.00$ 1,920.00$ 53,000.01$ 796588

Eden Valley Ambulance Service (Y) I 2 1 LP 15 and 1 Upgrade $31,542.00 31,265.50$ 1,398.60$ 1,194.00$ 28,672.90$ 185.00$

Evansville Fire Department (Y) I 2 2 upgrades, 2 batteries $15,656.00 14,920.45$ 9,798.75$ 5,121.70$ 14,920.45$ 796591

Fremont County Ambulance (Y) P 1 4 Zoll X Series $100,000.00 100,000.00$ 100,000.00$ 100,000.00$ 797229

Guernsey Vol Ambulance SVC (Y) I 2 2 Phillips MRX 2 batteries $45,548.00 45,548.00$ 3,247.00$ 42,301.00$ 45,548.00$ 796710

Jackson Hole Fire/EMS (Y) P 2 2 Zoll X Series, 1 ReadyLink $55,674.00 53,000.01$ 3,000.01$ 50,000.00$

Kemmer EMS (South Lincoln County EMS – Y) I 2 1 Zoll X Series, 3 boosters $26,170.00 ‐$ 1,170.00$

Laramie Fire Department (N) I 1 Modems $6,000.00 5,209.80$ 4,015.80$ 1,194.00$ 5,209.80$ 796713

Mem Hosp of Converse County (Y) P 2 4 Zoll X Series $100,000.00 100,000.00$ 100,000.00$ 100,000.00$ 796714

Moorcroft (Y) I 2 1 Phillips MRX, 1 MRX upgrade, 2 booster $35,726.00 34,391.00$ 7,016.00$ 27,375.00$ 780.00$ 34,391.00$ 796715

Mortimore Ambulance Svc. (Y) I 2 2 Phillips MRX $45,555.00 45,548.00$ 6,494.00$ 39,054.00$ 45,548.00$ 796597

Newcastle Ambulance Service (Y) I 2 2 Zoll X Series $50,000.00 52,500.00$ 2,500.00$ 50,000.00$ 52,500.00$ 796716

North Big Horn Hospital Ambul (Y) I 2 1 Phillips MRX, 1 MRX upgrade and 3 boosters $28,446.00 26,981.00$ 4,544.00$ 21,037.00$ 1,400.00$ 26,981.00$ 796717

Pine Haven (Y) I 2 1 Zoll X Series and cell Booster $25,390.00 26,500.00$ 1,500.00$ 25,000.00$ 390.00$ 26,500.00$ 796718

Powell Valley Healthcare (N) I 1 3 Phillips MRX $67,452.00 67,452.00$ 9,741.00$ 57,711.00$ Need E1 Acct #

Rocky Mountain Ambulance SVC (Y) P 1 3 LP15 $74,588.00 76,493.60$ 4,329.80$ 2,397.60$ 597.00$ 69,169.20$ 76,493.60$ 796719

Salt Creek Emergency Services (N) B 1 1 Phillips MRX new $22,774.00 22,774.00$ 3,247.00$ 19,527.00$ 22,774.00$ 796720

Sheridan Area Rural Fire Prot Dist (N) P 1 1 LP 15 $24,863.00 ‐$

Sheridan Fire and Rescue (Y) P 1 2 LP 15 $49,725.00 ‐$

Star Valley Medical Center EMS (Y) I 1 1 Zoll X Series $25,000.00 25,000.00$ 25,000.00$ Need E1 Forms

Sublette County EMS (N) I 2 8 boosters $3,120.00 ‐$ 3,120.00$

Sundance Ambulance (Y) P 2 2 Zoll X Series $50,000.00 53,000.01$ 3,000.01$ 50,000.00$ 53,000.01$ 796799

Sweetwater Medics (Y) P 1 3 LP 15 $74,588.00 78,023.69$ 4,360.01$ 2,397.60$ 596.88$ 70,669.20$

Town of Burns EMS (N) B 2 1 LP15, 1 ReadyLink, 2 cell boosters $30,986.00 24,591.40$ 699.30$ 199.00$ 23,693.10$ 750.00$ 185.00$

Wyoming Medical Ctr EMS (Y) P 1 7 Phillips MRX upgrades $9,079.00 ‐$

Yellowstone National Park (Y) P 2 1 Phillips MRX monitor and upgrades (no temp) $44,137.00 ‐$

Yoder Ambulance (Y) B 2 1 Phillips MRX, 1 booster $22,874.00 22,484.00$ 3,247.00$ 19,237.00$ 390.00$

WSC Approved Amount‐ EMS Proforma Invoiced Total Taxable Amount 12 Lead Modem 12 Lead ECG Transmission Service EMS 12 Leads Cell Boosters

$1,330,276.00 1,098,031.87$ 24,314.84$ 68,483.65$ 6,169.68$ 997,663.70$ 11,490.00$ 764,072.27$

EMS Funding Remaining Amount $351,053.00

Amount Entered in E1 966,690.96$

WSC Approved Date

Campbell County Memorial Hospital (Y) ACH LN Basic $11,999.00 11,998.80$ 4/4/2013 11,998.80$ 796724

Hot Springs County Memorial Hospital* CAH Heartstart Telemed $3,496.00 *7/2/2013

Ivinson Memorial Hospital* ACH LN Basic $11,999.00 *7/2/2013

Medcor Clinic at Yellowstone* CAH Heartstart Telemed $3,496.00 *7/2/2013

Memorial Hospital of Carbon County* CAH LN Basic $11,999.00 *7/2/2013

Memorial Hospital of Sweetwater County (Y) ACH LN Basic $11,999.00 4/4/2013

North Big Horn (Y) CAH Heartstart Telemed $3,496.00 2,395.00$ 4/4/2013 2,395.00$ 796725

Powell Valley Healthcare (N) CAH Heartstart Telemed $3,496.00 3,496.50$ 4/4/2013 need to wait

Sheridan Memorial Hospital (Y) PCI LN Basic $11,999.00 11,998.80$ 4/4/2013

South Big Horn Critical Access (Y) CAH LN Basic $11,999.00 4/4/2013

St. Johns Medical Center (Y) ACH LN Basic $11,999.00 4/4/2013

West Park Hospital* CAH LN Basic $11,999.00 *7/2/2013

WSC Approved Amount‐Hospitals Proforma Invoiced Total

$109,976.00 29,889.10$

Hospital Funding Remaining Amount 80,086.90$

Amount Entered in E1 29,889.10$

Mission: Lifeline Wyoming Conference Planning and Education October 29, 2012 Conference Planning and Education Subcommittee Goals and Responsibilities

1. Plan the content and schedule of a regional professional education conference for 2014

2. Plan the content and schedule of a regional professional education conference for 2015

3. Format the regional professional education conference on the latest STEMI and sudden cardiac arrest treatment and system initiatives

4. Professional a. Assess AMI emergency care knowledge gaps b. Develop an education curriculum – content and structure c. Evaluate educational outcomes

5. Public

a. Identify a public awareness campaign strategy and timeline for promotion of “911” for heart attack symptoms via third party evaluation

1 | P a g e

1.

1. Name of person completing this survey

2. Please provide a working email address that you check frequently.

3. State EMT Number or Nursing License Number (if known)

4. Please choose your discipline: mlj

EMT - Basic

mlj

EMT - Intermediate

mlj

EMT - Paramedic (includes Licensed Paramedic)

mlj

Registered Nurse

mlj

Physician

mlj

Other (please specify)

5. Please provide the EMS agency, Fire Department or Hospital where you work.

6. Please select the following patients who are at high risk of Acute Coronary Syndrome (ACS) (you may choose more than one)

fec

A 52 year old semi truck driver that is severly obese with high blood pressure.

fec

A 33 year bar tender that smokes 2 packs of cigarettes a day.

fec

A 52 year old female that has a history of diabetes.

fec

A 45 year old firefighter with high cholesterol.

fec

A 60 year old male who swims three times a week.

7. Which of the following are, or could be, signs and symptoms of a heart attack?

fec

Chest Pain

fec

Nausea

fec

Shortness of breath

fec

Back pain

fec

Abdominal Pain

fec

All of the above

8. The 12-Lead ECG should be accomplished with minutes of initial patient contact. mlj

<15 mins

mlj

<20 mins

mlj

<10 mins

9. Describe two ways time may be reduced on STEMI Patients (EMS-reduce scene time; Hospital-reduce door to needle time or door to balloon time)

1

2 10. Which of the following time elements are important to note when treating STEMI patients? (you may choose more than one)

fec

Time of inital patient contact

fec

Time of symptom onset

fec

Time of ECG

fec

In Service Time

11. Which of the following are ABSOLUTE contraindications for a patient from receiving fibrinolytic care?

fec

Active bleeding or bleeding diathesis (excluding menses)

fec

Any prior ICH (Intra-cranial Hemorrhage)

fec

Allergy to Aspirin

fec

Significant closed-head or facial trauma within 3 months

fec

Severe uncontrolled high blood pressure (unresponsive to therapy)

2.

Use this image for the question below.

1. What chest lead, or "v" lead does each letter represent? (Please answer all six rows.)

B - (4th intercostal space, right of the sternum)

F - (5th intercostal space, mid-axillary line)

D - (5th intercostal space, mid-clavicular line)

Chest lead

6

6

6

C - (Between v1 and v2) 6

A - (4th intercostal space, 6 right of the sternum)

E - (5th intercostal space, 6 anterior axillary line)

Use this image for the question below. 2. Using the diagram above, which letter represents the "J-Point"?

mlj A

mlj B

mlj C

mlj D

jml E

mlj F

mlj G

mlj H

mlj

I am

not trained to interpret 12 Lead ECG's

3. Using the diagram above, which letter represents the "ST Segment"? mlj A

mlj B

mlj C

mlj D

jml E

mlj F

mlj G

mlj H

mlj

I am


4. Using the diagram above, which letter represents the "Q Wave"? mlj A

mlj B

mlj C

mlj D

jml E

mlj F

mlj G

mlj H

mlj

I am


Use the image below to answer question #5 5. The 12 lead ECG above represents a(n)" " STEMI (you can choose more than one)

fec

Inferior

fec

Septal

fec

Anterior

fec

Lateral

fec

I am not trained to interpret 12 Lead ECG's

Use the image below to answer question 6 6. The 12 lead ECG above represents a(n)" " STEMI (you can choose more than one)

fec

Inferior

fec

Septal

fec

Anterior

fec

Lateral

fec

I am not trained to interpret 12 Lead ECG's

7. Which of the following phrases is the definition of "Preload"? mlj

A - "The stretched condition of the heart muscle at the end of diastole just before contraction"

mlj

B - "The end-diastolic blood volume at the beginning of systole"

mlj

C - "The amount of blood in the heart just before systole"

mlj

D - "An inspection of the trunk of your car before you put your bags in"

mlj

E - Answers A, B, C are correct.

Mission: Lifeline Wyoming Protocols and Quality Improvement Subcommittee October 29, 2012 Protocols and Quality Improvement Goals and Responsibilities

• Assess how many of the participating organizations have existing AMI protocols

• Identify process to review individual organization and system needs for a standardized regional assessment, treatment and transport protocol set

• Identify elements required for a standardized regional protocol set

• Identify process to review different protocols and start assimilating

• Identify process to evaluate implementation of and outcomes of new standardized

regional protocol set

• Assess how the region or county can create a regular and sustainable QI process to measure system performance

• Identify barriers to data collection and reporting in participating organizations (EMS)

• Identify ways to help capture and measure “system” level items like reperfusion to

recognition (R2R) or symptom onset through arterial reperfusion (SOAR)

• Assess internal QI process and frequency in participating organizations

1 | P a g e

Mission: Lifeline® Wyoming

Adult BLS Protocol for acquiring 12-lead ECG’s

Assess ABC’s first, correct life threats…

Signs and Symptoms

- Chest pain/

pressure/

tightness/discomfort

- Complaint of anxiety,

“heart racing” or

“palpitations”

- GI Symptoms- N/V

- Dizziness or syncope

- Difficulty breathing or

shortness of breath

- Weakness

- New onset stroke

symptoms (if so,

contact hospital

early)

History

- SAMPLE

- Personal or family history

of heart problems?

- Allergies (ASA)

- Current medications (that

they currently take, OR

should take)

- Is the patient diabetic?

- Onset

- Provocation/ Palliation

- Quality (description of

discomfort/pain)

- Radiation/ Region/

Referred

- Severity (1-10)

- Time (duration/repetition)

Within the first 10

minutes of patient

contact…

If your patient has

non-traumatic

pain or

discomfort

anywhere from

face to waist,

and/or shortness

of breath,

PERFORM a 12 –

Lead ECG.

Perform 12-Lead ECG acquisition (Goal is within 10 minutes of patient contact)

Transmit to receiving facility Every 30 minutes, repeat 12-Lead and

Transmit new ECG If there is a change in symptoms,

reacquire and transmit

Oxygen per protocol to keep O2 saturation >90%

Administer Aspirin per protocol

IV (if allowed by protocol)

This document is a DRAFT. Once approved by the protocol

subcommittee, it will be reviewed by AHA and then finalized.

These protocols are written and expected to be utilized as

guidelines. They cannot address every possible patient

presentation. When questions arise about your specific patient,

please contact the receiving facility for guidance/ assistance.

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