In     li@ilill lkiiiiiiiiiiii,


   EmergencyA4edical Services
   Regional Conference

   Buffalo, New York                                 February 1973


                                       FIRST ANNUAL REGIONAL CONFERENCE
                                       ON EMERGENCY MEDICAL SERVICES

                                       sponsored by

                                       Lakes Area Regional Medical Program, Inc.

                                       New York State Department of Health

                                       and

                                       Erie County Department of Health
                                       Emergency Medical Care Committee

                                       January 31, February 1, 2 and 3, 1973

                                       Statler Hilton Hotel, Buffalo, New York
                                       Golden Ballroom, Terrace Room

                                    A

                                      Objectives

                                      To motivate individuals as well as organizations to develop
                                      greater concern about Emergency Medical Services.
                                      To promote the establishment of well-coordinated
                                      county committees.
                                      To develop interest in and support for Emergency
                                      Medical Services.


                      CONTENrs

                       CHAPTER                                                                                               PAGE

                                         PERSPECTIVES, a Total System
                                         foreword                  .......................................................   iv

                                         SEIZE THE DAY
                                         introduction                 ....................................................   v

                             1           FIRST ENCOUNTERS
                                            regional involvement               ...........................................   1
                                            regional viewpoints              .............................................   2

                             2           CHALLENGE
                                            before the emergency               ...........................................   3

                             3           RESPONSE
                                            view from Albany                 .............................................   5
                                            learning from experience              ........................................   6

                             4           VOICES
                                            panel discussions               ..............................................   8

                             5           INTERLOCK
                                            workshop reports                 .............................................   1 1

                             6           TRENDS
                                            making it work                ................................................   14

                             7           PARTICIPANTS                    .................................................   18


                     PERSPECTIVES- a Total System

                    f oreword

                                                                    This conference served  as  a  prelude  to  the  community  action  now
                                                                  developing  throughout  the  Lakes  Area  region.  It   established   the
                                                                  perspective of a 'total system' of emergency medical services t at  ea  s
                                                                  with the patient at the point of incident through to the return  of  that
                                                                  patient to full time participation  in  the  community  as  a  productive
                                                                  individual. This perspective provides a  framework,  a  viable  perimeter
                                                                  within  which  persons  involved  in  emergency  medical   services   can
                                                                  develop a working sense of integral participation.

                                                                     Each phase of this system is dependent  upon  the  individuals  behind
                                                                  the total process. The  continuum  of  high  quality  care  is  dependent
                                                                  upon  individuals,  not  equipment.  Cooperation  between  those  indivi-
                                                                  duals is essential. Cooperation is not an ideal to be pined for, it is  a
                                                                  prerequisite  to  be  demanded  by  each  constituent  of  the  emergency
                                                                  medical services system. It is the artery to improved  emergency  service
                                                                  and it cannot be delegated; it must be contributed spontaneously.

                                                                    Throughout  western  New  York  and   northwestern   Pennsylvania,   we
                                                                  continue to see evidence of a trend toward  regional  cooperation  within
                                                                  the Emergency Medical Services  constituency.  The  spontaneity  of  this
                                                                  cooperation provided the initial  momentum  behind  this  conference  and
                                                                  will certainly provide the real  initiative  for  an  improved  Emergency
                                                                  Medical Services System throughout  the  Lakes  Area  region.  May  these
                                                                  pages provide the proper testimony  to  that  enthusiasm  and  productive
                                                                  spontaneity.

                                                                                                                   John I
                                                                                                                       Ex
                                                                                              Lakes Area         al Medical  Program,  Inc.

                                                                              v


                                                                                                                 SEIZE lFiE DAY

                                                                                                                  introduction

                          Seizing an opportunity and  making  it  work,  these  are  the  pathways
                      that a conference can offer. A successful  conference  can  be  informative,
                      productive,  and  exciting.  The  First  Annual   Regional   Conference   on
                      Emergency Medical  Services,  held  February  1-3,  1973,  in  Buffalo,  New
                      York, was all three.

                          It brought people representing the range of  professions  and  organiza-
                      tions  involved  with  emergency  services  into   what   became   a   major
                      'confrontation'. This confrontation  enabled  people  to  juxtapose  indivi-
                      dual roles into a perspective of  combined  effort,  and  to  examine  where
                      and why that combination fails.

                          People exchanged expertise that brought health care deficits to I  ight,
                      deficits that were outside the realm of individual roles and priorities.  It
                      decentralized  thought  and  broadened  involvement.  And  it  provided   an
                      exchange of  ideas  that  will  be  the  foundation  of  an  improved  emer-
                      gency health care system.

                          Nurses, physicians, public health personnel,  volunteer  firemen,  Civil
                      Defense   and   Red   Cross   representatives,   ambulance   and   emergency
                      squad  members,  hospital  administrators,  police  officers  -  206  people
                      attended this four-day conference, and they made it wor

                                                                                   v


                                                                                                                         @(,,Io  u  \irERS

                                                                                             r,,,,a-,%gion<jl invol!/ernent
                   program participants chat informally

                      In April 1971, William E.  Mosher,  M.D.,  Commissioner,     be done systematically. Agencies such  as  the  Lakes  Area
                   Erie County Department of  Health,  appointed  the  members     Regional Medical Program,  Inc.,  have  the  resources  and
                   of the Erie County Emergency  Medical  Care  "Blue  Ribbon"     professional expertise to  help  encourage  and  coordinate
                   Committee. This committee and  the  program  staff  of  the     such efforts. John R.F. Ingall, M.D., Executive  Directorof
                   Lakes  Area  Regional  Medical  Program,   Inc.   became   in-  the Lakes  Area  Regional  Medical  Program,  Inc.  emphasized
                   volved in writing a grant request for funds  to  establish  an  the  need  for  a  systematic  approach   that   can   channel
                   Emergency  Medical   Services   Project   with   three   major  emotional involvement into  a  more  realistic  and  effective
                   phases:  research,  Medical  Emergency  Technician   training,  effort. "We want to know what  the  problem  is;  we  want  to
                   and  emergency  medical  communications.  This  grant  request  state it, to state our needs and to document  them  to  insure
                   was  submitted  to  the  Regional  Advisory   Group   of   the  that we are responding to them when  we  state  the  solution.
                   Lakes  Area  Regional  Medical   Program,   Inc.   and   after  We  want  to  know  where  we  are  going  and  what  must  be
                   lengthy consideration found its  way  to  the  Regional  Medi-  done to get there. We want to know  the  time  frame  we  have
                   cal Program  Services  division  of  HEW  in  Washington.  The  to work with and the investment, not only  in  hard  cash  but
                   program was funded in June 1972.                                in staffing time, necessary to make ti)at  a  reasonable  time
                                                                                   frame. We must be able to judge our performance."
                   Blue Ribbon Committee                                              It is not always enough to seize an  opportunity;  one  has
                      This  Blue  Ribbon  Committee  initially  looked  to  those  to be able to make it work. in order for  a  collective  effort
                   people that could be involved  in  the  problem  of  emergency  to work, the need, the priority of needs,  and  the  objectives
                   medical service. They were each partially involved in  solving  must be  clearly  established  and  understood.  The  work  of
                   different facets of that  problem  and  individual  priorities  the Blue Ribbon  Committee  speaks  well  for  a  constructive
                   often had to be  subsumed  into  a  broader  perspective.  The  federal-state-local partnership in  meeting  documented  emer-
                   focus was on a 'total' system in which  individual  priorities  gency needs.
                   were assimilated and effectively  strengthened.  This  had  to


                  regional viewpoints

                     Kenneth  H.   Eckhert,   M.D.,   President,   Comprehensive as  the  Lakes  Area  Regional  Medical  Program,   Inc.   and
                  Health Planning  Council  of  Western  New  York,  Inc.,  dis- Comprehensive  Health  Planning  exist  to  augment   and   to
                  cussed the Partnership for  Health  Laws  passed  by  Congress help coordinate such an inclusive  network  of  participation.
                  in  1966  and  1967.  These  laws  gave   rise   to   areawide There exists  the  need  to  make  that  dialogue  formal,  to
                  Comprehensive  Health  Planning  groups.  Dr.  Eckert  concen- make it solid enough to be a sound base  upon  which  a  total
                  trated on the concept behind partnerships  in  health  -  that emergency medical system can be founded.
                  very important relationships exist  between  health  providers
                  and the communities  they  serve.  The  development  of  these   LaVerne  Campbell,  M.D.,  Regional  Health  Director,   New
                  relationships demands an active dialogue  that  can  determine York State Department of Health, referred to  the  legislative
                  priorities reflective of realistic  needs.  Emergency  Medical concept of citizens having the "right  to  receive"  emergency
                  Services generate the most  emotive  and  dramatic  visibility medical care that  would  give  them  a  "fighting  chance  to
                  in the health care delivery system. It incorporates  the  most survive". But he also stressed  that  representive  government
                  diversive elements  of  social  services  -  police,  firemen, on any level cannot do it alone, that  organizations  such  as
                  ambulance squads, civil services, Red Cross,  health  centers, the  Lakes  Area  Regional  Medical  Program,  Inc.  and   the
                  volunteer  and  commercial  health  services,   medical   pro- Comprehensive  Health  Planning   Council   of   Western   New
                  fessionals, paraprofessionals, social  clubs,  telephone  com- York, Inc. together with state and county  medical  societies,
                  panies,  etc;,  each  concerned   with   particular   mandated hospital associations, and volunteer groups must initiate  the
                  functions and priorities. This diversity creates the need  for real force behind a  total  system.  Government  provides  the
                  dialogues, understandings,  and  partnerships.  Agencies  such aid; the community must provide the action.

                                                                               2


                                                                                                                       CH-AI.LENGE

                                                                                         b 'lore @ih@a  amerg@gncy

                   Call to Action
                      A comprehensive  call  to  action  was  expressed  by  james
                   H.  Cosgriff,  Jr.,  M.D.,  Chairman,  Erie  County   Emergency
                   Medical   Care   Committee,   Director,    Emergency    Medical
                   Services Project. He cited the most important  statistics  that
                   lead  to  nationwide  concern  about  the  adequacy  of   emer-
                   gency medical care services in the  United  States.  "in  1970,
                   more  than  110,000  Americans  died  of   accidental   causes,
                   half due to automobile accidents. This was  the  third  leading
                   cause of death in all age  groups  and  the  leading  cause  of
                   death up  to  age  37,  cutting  short  an  unknown  number  of
                   potentially  productive  lives.  Six  hundred  thousand  Ameri-
                   cans  died  of  heart  disease,  of   whom   more   than   half
                   succumbed  before  medical  care  could  be   obtained.   These
                   statistics generated considerable interest in the care  of  the
                   acutely  ill  and  injured.  Through  the  exchange   of   many
                   national meetings, guidelines  were  then  established  by  the
                   U.S.  Department  of  Transportation;  the  National   Research
                   Council;  the  American  Medical   Association;   the   Depart-
                   ment  of   Health   Education   and   Welfare;   the   American
                   College of Surgeons; and  others.  Special  interest  organiza-
                   tions, such as the  Emergency  Department  of  Nurses  Associ'-
                   ation,  were  formed  as  the   need   for   community   action
                   became   apparent.   Concern   and    involvement    broadened.
                   Funds were made available through state and  local  levels  for
                   evaluating specific aspects of the problem."
                     Dr.  Cosgriff  called  for  a  "sweeping  change  in  philos-
                   ophy"  on  the  part  of  all  concerned  in  emergency  health
                   care delivery.  "The  ambulance  should  be  the  extended  arm
                   of the hospital; the emergency  medical  technician  should  be
                   the  extended  arm  of  the  physician.  To   be   operational,
                   appropriate  legislative  changes  and  training  programs  are
                   needed  along  with  reassessment  of  the   roles   for   each
                   member of the emergency care team.    The  responsibility   for
                   solutions cannot rest alone with  with  isolated  groups  -  it                                                 or cosgriff
                   must be multi-disciplined. Individuals or  groups  may  act  as
                   catalysts in guiding forces in the formation  of  an  emergency  "It is worth every dollar,  every  hour,  every  effort  your
                   care committee. This  vehicle  can  provide  meaningful  direc- community can expend to  bring  swift  and  skillful  help  to
                   tion  by  simultaneously  coordinating  both  lay  and  profes- people in urgent need.  And  the  time  for  action  is  today,
                   sional activities in the field of emergency health  services.,, before the emergency."

                                                                                 3


                                         GENERAL METHODOLOGY
                                         Inventory of Existing Health Services
                                         Assessment of Community Needs
                                         Recommendations for Appropriate Action

                                                    INVENTOR'V

                                                                             Availability & Training of
                Emergency Communications                                   Emergency Medical Technicians

                  Ambulance Dispatch                                        Hospital Emergency Facilities
                                                  Ambulance
                                                        0

                                              ASSESSMENT OF NEEDS

                                                Adequacy of Services

                                                 Day-to-Day & Disaster

                                               RECOMMENDATIONS

                                                   FOR  ACTION

                  Research & Data Coll                                        Hospital Facilitie

                                                 Communications
                                                       I     @ I         I
                 Highway and Transportation                  Training and Education

                                               Rescue Equi
                                     Ambulance &

                                                       4


                                                                                                                                     R  ESPONSE

                                                                                                             N4iew from  Albany

                         Donald  C.  Walker,  M.D.,   Director,   Bureau   of   Emergency     ci  the   need   for   the   development   of   a   comprehensive
                      Health  Services,  applied  this  same  approach  to  the   methods         state-wide   plan   to   handle   man   made    or    natural
                      used  by  the   New   York   State   Department   of   Health.   In         disasters.
                      order to enable  every  community  in  the  state  to  analyze  its
                      EMS  on  a  sound  statistical  basis,  the  Bureau  of   Emergency     On  the   basis   of   these   established   needs,   recommenda-
                      Health Services has two  evaluation  tools  at  its  disposal.  One     tions can be made. Dr. Walker  stressed  that  the  applicability
                      is  a  standard  inventory  form   of   resources   through   which     of such  recommendations  vary  with  the  location,  as  do  the
                      they have  published  a  survey  of  emergency  facilities  in  the     needs.  The  following  are  recommendations   that   have   been
                      state.  The  second  is  the  uniform  ambulance  report  form   in     made,  some  of  which  are  contained  in  current   drafts   of
                      which  they  have  documented  approximately   22%   of   all   the     proposed state legislation:
                      pre-hospital  emergency  health  care  incidents  in   the   state,     El  the  establishment  of  legislation  and   regulations   that
                      exclusive  of  New  York  City,  during  the  period   of   January         are  realistic,  with   adequate   standards   in   training,
                      1971   through   December.   These   are    the    main    problems         staffing,   equipment   and    procedures    for    ambulance
                      indicated in the survey:                                                    service,   emergency   department   facilities,   and   emer-
                      0     fragmen  ta  tion  of  emergency  patient  care  between  the         gency personnel.
                            pre-hospital    and    emergency    department    phase    of
                            management.                                                       o   affiliation   of   ambulance   services   with    appropriate
                                                                                                  hospital receiving facilities.
                      0     lack  of  integration  of  local  emergency  health  services
                            with those of other social service areas.                         El  availability   of   adequate   two-way   communication    be-
                                                                                                  tween ambulance services and emergency facilities.
                      o     the need to formalize mutual aid agreements.
                                                                                              0   development  of  a  state-wide   emergency   health   service
                      o     the  need  to  involve  local  health  officials  and  health         radio  frequency  capability   with   integration   of   cur-
                            agencies in planning and operation.                                   rently available resources.

                      cl    the   need   for   a    state-wide    compatible    emergency     El  development  of  a  realistic   costlbenefit   analysis   for
                            health services communication system.                                 commercial and volunteer services.

                      o     the  need  for   an   accurate   costlbenefit   analysis   of     0   utilization  of  an  expert  representative  advisory   coun-
                            ambulance and emergency departmen t services.                         cil on emergency health services at the state leveL

                      0     the  need  to  develop  training   programs   for   emergency     0   determination    of    the    feasibility    of    helicopter
                            medical technicians.                                                  utilization.

                      0     the need for easy     public   access   to   the    emergency     0   retention   of   all   ambulance   services   and   resources
                            health system.                                                        under   a   grandfather   provision    with    the    gradual
                                                                                                  phasing-in   of    newly    developed    standards    through
                      0     the  need  to  orient  ambulance  personnel   of   fire   and         orientation and education.
                            police  agencies  to  the  importance  of   their   emergency
                            duties.                                                           0   development   of   a   statewide    comprehensive    disaster
                                                                                                  plan.
                      ci    the need  for  a  definitive  plan  or  procedure  for  rapid
                            transport  of  the  ill  or  injured  patient  to  a  medical     0   continuing  education  in  emergency  health   services   for
                            center.                                                               physicians,   nurses,   ambulance    attendants,    emergency
                                                                                                  personnel and for the general public.

                                                                                        5


                     learning  from  experience

                                                                    lutions   to    those Shockmobile In Use
                     Problems vary with localities, as do the so
                     problems.  No  one  type  of  ambulance  service   will   meet   the  Dr.  Nowill  described  the  efforts  in  Chemung  County,   a
                     needs  of  every  community.   Two   very   different   answers   to rural  region,  to  construct  a  method  of  emergency   medical
                     this  problem  were  described   by   Costas   T.   Lambrew,   M.D., care  delivery  for   a   less   concentrated   population.   The
                     Chief,   Division   of    Cardiology,    Nassau    County    Medical Chemung  County  Heart  Branch  of  the   Southern   Tier   Heart
                     Center  and   William   Nowill,   M.D.,   Anesthetist,   Arnot-Ogden Association   developed    and    implemented    a    Shockmobile
                     Memorial Hospital, Elmira, New York.                               Unit that literally extends the hospital  to  reach  the  people.
                        Dr.  Lambrew  described  the  efforts   in   Nassau   County,   a  Devices  in  the  Shockmobile  monitor  the  EKG  and   pulse,
                     highly  populated   urban   area,   to   construct   an   ambulatory display  them  on  a   cardioscope   and   record   them   on   a
                     network   that   would   be   comprehensive   enough   to    respond constantly playing tape.  One  channel  of  the  radio  transmits
                     to   the   population's   needs.   The    Nassau    County    Police two-way   voice   communication   between   the   ambulance   and
                     Department   Special   Emergency    Services    Bureau    transports the hospital. The  second  channel  transmits  the  electrocardi-
                     60%  of  the  county's   total   volume   of   emergency   patients; ogram.
                     while  71   volunteer   fire   departments   transport   the   other
                                                                                           There  is  a  one  year  training  course  for  the  ambulance
                     40%.
                                                                                        attendants.  Initially  they  attend  a  series  of  lectures  on
                        The  Police  system  is  manned  by   61   full   time   civilian electrocardiography.  They  are  taught  how  to   start   intra-
                     employees  of  the  police  department  and  is   equipped   by   21 venous  infusions,  pass  endotracheal  and  Levine  tubes,   and
                     vehicles  plus  two  helicopters.  The  average  response  time   of how  to  recognize  and  treat   arrhythmias.   Anesthesiologists
                     these vehicles  is  6  to  8  minutes,  while  the  average  transit teach  them  the   physicology   of   respiration   and   cardiac
                     time  is  7.4  minutes.  The  vehicles  are  bought   from   federal action.  They  observe  in   operating   rooms,   Coronary   Care
                     surplus, reconstructed, and put into service.                      units,  emergency  rooms  and   delivery   rooms,   learning   to
                                                                                        recognize  the  acute  problems  of  patients  in  these   areas.
                         The  drivers  have  basic  Emergency   Medical   Training,   140 They  undertake  continuous  periods  of  refresher  courses  and
                      hours  of  advanced   training,   and   hospital   study   covering are subject to direct  supervision  during  actual  operation  of
                                                                                        the Shockmobile.
                      cardiovascular  disease.  They  work  in   Intensive   Care   Units
                      and   learn   the   use   of   monitoring   equipment.   They   are
                                                                                        I  Similar types  of  shockmobiles  exist  in  Florida,  Washing-
                      provided  with  a  communication  package  which  consists   Or   a
                      GE  portable   radio   that   communicates   with   the   hospi   .ton,  and  West  Virginia.  Different   sizes   and   types   are
                                                                                     tais
                      and  transmits  EKG  simultaneously.  It  is  interfaced   with   aavailable  and  determined  by   local   need.   This   unit   in
                                                                                        Chemung  County   costs   $45,000   with   the   special   equip-
                      portable  defibrillator.  There  are  two  tape   recorders   which
                      will record and facilitate retrospective analysis.                ment.

                         The  total  cost   of   this   package   is   $6,000.   As   Dr.
                                                                                           Emergency  health  problems   present   communities   with   a
                      Lambrew stated,  "it  is  a  low  cost  system;  it  is  versatile,
                                                                                        challenge  -  to  organize,   to   think,   to   vocalize   those
                      portable and adaptable  to  the  needs  of  our  area.  It  enables
                      us to effectively integrate pre                                   thoughts,  and  to   coordinate   action.   This   is   community
                                                      -hospital  and  hospital  phase  of
                                                                                        response, and most important, it is effective.
                      acute care."

                                                                                        6


                                                                                                       shockmobile

                                                                     7


                                                                               ...because that guy sitting down there,
             'NOICES                                                           that little guy way down there in the comer,
                                                                               he is the person that is going to take the training
                                                                               and maybe he has an idea, a little idea,
             panel discussions                                                 and that single idea can be worth millions..

                                                                                           William Wutz, Jr.
                                                                                           Westem  New  York  Volunteer   Fire   Association

             Voices   are   the   real   force   behind    any    conference- "The Highway Act  of  1966  was  a  recognition  of  the  need
             They   reflect   ideas    and    project    the    power    that to do something  about  the  carnage  on  the  nation's  high-
             moves   ideas   into   action.   This   conference   proved   to ways.   It  asked  the  states  to  implement  highway  safety
             be   no   exception.   The   panel   discussions   created    an programs  which  were  to  be  developed  in  accordance  with
             energy  that   ignited   a   volley   of   questions,   answers, eighteen established standards.     It  made  funds  available
             and  new   ideas.   Some   highlights   of   these   discussions under two sections of the  Act:  section  402  was  the  grant
             follow:                                                          and aid assistance programs; section 403 was  a  research  and
                                                                              development program.  These  funds  are  proportioned  to  the
                                                                              states through a formula based on the  number  of  road  miles
             "Team cooperation is the key.        Emergency        department and the population of the states."
             physicians,  registered  nurses,  licensed   practical   nurses,
             emergency  medical  technicians,  and  clerk  staff  must  learn "The name of the game is reduction of  response  time.  It  is
             to think and to act together. Each one  must  learn  to  respect no platitude to talk about efforts taking  place  now  in  New
             the knowledge and skills of others."                             York  State  to  determine  exactly  what  that  means.   With
                                                                              data and information, we  will  be  able  to  know  where  our
             "We start with the prejudice that        emergency       medical priorities must  exist  in  our  own  programs:  a  communica-
             systems are not going to be the same  in  all  portions  of  the tions system?     Emergency   Medical   Technician    training
             country and that there are  very  definite  reasons  for  having programs?   new    ambulances?    better    equipment?    WHAT
             the differences."                                                SHOULD WE BE DOING?" ci

                                                                                                               or. huntley makes a point

                                                                            8


                    "We have to take stock  of  our  local  situations  and  develop  "Physicians   responsible   for    emergency    room    coverage
                    our own strategies."                                              should  be  trained  in  medical  emergency  procedures.  He  or
                    "If the attendant has completed a  certain  level  of  training,  she  should  have  at  least  the  equivalent  training  of   an
                    he  should  be  permitted  to  perform  that  level  of   compe-  emergency medical technician." i:i
                    tency provided he is in communication with a hospital."        o  ,A  coordinated  program  of  health  care  includes  detection,
                    "The  officer  is  constantly   schooled   to   keep   up   with  treatment, and then review, review, review." n
                    changing laws, but not once is he  schooled  in  advanced  first
                                                                                      "Every injury should be treated  as  though  it  were  the  only
                    aid, unless his particular department wants him to be."           injury. You can not compromise." i:j
                    "We  have  not  done  enough,  nor  have   other   branches   of
                    county  and  city  government,  in  the  preventive  areas.  The  "A police officer is not only  a  too[  to  protect  his  fellow
                    fact that  less  than  30%  of  the  population  use  automobile  man, he is a tool to help him survive." D
                    seat belts indicates the low priority people  seem  to  have  in
                    the   attempt   to   prevent    disability    from    automobile  "in  Erie  County,  New  York,  there  are  ambulance  attendant
                    accidents." ii                                                    training classes  as  large  as  150  when  there  should  be  a
                                                                                      maximum  of  45  per  class.  We  have  an   excess   of   5,000
                    "EDNA, the     Emergency    Department    Nurses    Association,  volunteers to be trained. We will have  to  start  a  new  class
                    has  been  working   toward   education   programs   for   emer-  every  week  for  two  years  before  we  hope  to   cover   the
                    gency nurses on a national and local level." ii                   group." o

                    "The number of hospitals has gone up 14%,                         "Volunteer fire service has been in existence  since  625  B.C.,
                     the number of hospital beds has gone up 56%,                     so they are not new." 11
                     the number of patient admissions has gone up 60%,
                     the number of inpatient days has gone up 41%,
                     the  number  of  emergency  department  visits  has   gone   up  "The  Empire  State  Rescue  and  First  Aid   Association   was
                    380% between 1954 and 1971.                                       formed in 1954,  chartered  by  New  York  State  to  provide  a
                     Only 20%, maybe  25%  in  certain  areas,  can  be  categorized  means by  which  persons  from  all  the  disciplines  of  emer-
                    as clinical emergencies.                                          gency  medical  care  could  come  together  and  discuss   com-
                     Less than 10% of all patients  seen  in  a  hospital  emergency  mon  problems  such  as  training,   education,   communication,
                    arrive there by ambulance." o                                     and legislation." 0

                    "THE     HOSPITAL     EMERGENCY      DEPARTMENT      IS      BE-  "The emergency department  is  the  one  entry  point  into  the
                    COMING    A    MAJOR    SOURCE     OF     HEALTH     CARE     IN  United States'  health  care  system  that  cannot  control  the
                    THE UNITED STATES." i3                                            number and  type  of  people  that  are  admitted.  It  may  not
                                                                                      send people away; if it does  it  is  placing  itself  in  legal
                    "in  Russia   most   communities   have   coordinated   communi-  jeopardy." 11
                    cations dispatch  systems,  24-hour  services  and  a  physician
                    on every run. It would take at least 15  years  for  the  United  "it is not a matter of 'if' anymore;  it  is  a  matter  of  how
                    States   to   achieve   this   system   of   emergency   medical  rapidly  Emergency  Medical   Service   councils   develop   and
    c               services." ii                                                     WHEN." o

                                                                                   9


                         "There is an interlock in our area - nurses, doctors,
                         technicians, advisory physicians, police, firemeti,
                         ambulance and rescue squads - people fitting together,
                         working together.

                                                              1 0


                                                                                                                            iNrERLOCK

                                                                                                         workshop reports

                     An interlock is not an easy concept to  understand;  nor  is  it        (local and state), the Sheriff's Department,  legislators,
                     easily achieved. It is  a  coordination  so  complete  that  the        local  industries,  state  and  county   highway   depart-
                     operation  of  one  part  automatically  brings  about  or  pre-        ments,  health  agencies,  Red  Cross,  Chamber  of   Com-
                     vents the operation of another. If it is a human  interlock,  it        merce, Civil Defense, and local service clubs.
                     is  a  system  so  well  understood  and  developed  that   each
                     person  is  integral  to  the  total  operation.  The   workshop  Group  II.  Cattaraugus,  (N.Y.),  McKean  and  Erie,   Pennsyl-
                     provided  a  period  of  introduction   between   those   people  vania, counties
                     that are involved in  the  total  system  of  emergency  medical
                     care. It provided a time to learn the  faces  and  facts  behind  This group developed  three  main  areas  of  concern:  physical
                     this system. In turn, this  interchange  created  the  incentive  resources,  manpower  resources,  and  coordination  of  effort.
                     to further refine ideas into  coordinated  thought  and  action.
                                                                                       Physical resources:
                         The nine counties that  make  up  the  Lakes  Area  Regional      0 to develop hospital-based ambulance facilities.
                     Medical  Program,  Inc.  were  divided  into  groups   according      0 helicopter transportation feasibility  -  acquisition  and
                     to  geographical  location,  population,  and   already   estab-        maintenance costs - regional sharing.
                     lished alliances. They were charged  to  evaluate  the  deficits      0 to     survey     emergency     room     equipment     and
                     in  their  emergency  medical   service   system.   Each   group        organization.
                     presented similar needs and  priorities,  but  different  strat-      0 to update package disaster hospitals
                     egies, reflecting  individualized  methods  of  response.  These
                     are the beginnings, the start of dialogues  that  eventually  do  Manpower resources:
                     MAKE THINGS WORK.                                                       to  survey  and  organize  physician  coverage  in   emer-
                                                                                             gency rooms.
                     Group 1. Genesee, Allegany, and Wyoming Counties                        to  implement  and  to  encourage  training  of  ambulance
                                                                                             attendants   in   emergency    medical    treatment    and
                     This group  discussed  a  wide  range  of  needs  and  concluded        procedures.
                     that  an  Emergency   Medical   Service   Committee   must   in-
                     clude a representative  cross-section  of  people  and  services  Coordination  of   effort:
                     involved with the emergency system.                                   a to  coordinate  a  more  effective   communications   sys-
                                                                                             tem, hospital to  ambulance;  hospital  to  hospital;  and
                     Assessed Needs:                                                         finally, hospital to hospital between counties.
                         0  to determine the feasibility for  a  regional  helicopter      0 to   implement   written   transfer   agreements   between
                            transport system.                                                local  hospitals  and  between  county  hospitals  in   an
                         o  to  coordinate  and   equip   an   emergency   communica-        effort to coordinate shared resources.
                                                                                           0 to  coordinate  effective   Emergency   Medical   Services
                            tions system.
                         .  to  formalize  a  mutual  aid  system  that   would   co-        Committees  within  each  county   and   to   promote   an
                            ordinate  tri-county  resources  for  emergency   medical        active EMS network between counties.
                            services.                                                      0 to  promote  public  awareness   concerning   what   chan-
                                                                                             I nels  of  emergenc.y medical  care  are  available  within
                         0  to develop regional disaster planning.
                                                                                             the tri-county area.

                     Recommendation:                                                   Group Ill. Niagara County
                            Each  county  is  currently   developing   an   Emergency
                            Medical   Services   Committee.   It   was    recommended  This   group   discussed   the   formation   of   an   Emergency
                            that  such  a  committee  should  have  a  representation  Medical  Services  Council.  As  they  expressed  it:   "We   do
                            that includes physicians, nurses,  allied-health  person-  have   an   EMS   committee,   and   we   are    beginning    to
                            nel, fire and rescue squads, ambulance  services,  police  function."


                   Recommendations:                                                   Group V. Erie County, New York
                         .clarification of direction
                         .community representation                                    The  Erie  County  Department   of   Health   Emergency   Medical
                         .funding resources                                           Care  Committee  was   formed   in   April,   1971.   Researchers
                         *documented data to formalize need                           have  Surveyed  eighteen  Erie  County  hospitals  and  four   in
                         aregional  coordination  of  an  EMS  network  for  disaster Niagara and  Cattaraugus  counties;  fifty-three  volunteer  fire
                         planning and shared resources                                ambulance/rescue  squads;   and   three   emergency   first   aid
                         .an  effective   communications   system   -   hospital   to squads.  Emergency   Medical   Technician   training   began   in
                         ambulance and hospital to hospital                           October  1972.   Educational   materials,   equipment,   supplies
                                                                                      and  training  aids  were  secured.  Physician  instructors  were
                  Group IV. Chautauqua County                                         recruited  and   Erie   Community   College   is   now   granting
                                                                                      three  credits  for  the  course.  A  cardiac  care  project  was
                  This  group  indicated  that  they  were   in   the   process   of  developed. Purchase,  installation  and  operation  of  an  emer-
                  forming  an   Emergency   Medical   Services   Council   and   had  gency  medical   communications   system   is   anticipated   for
                  addressed themselves to  the  needs  and  priorities  involved  in  1973.
                  its formation.
                                                                                      With  this  background  of  activity,  this  group  stressed  the
                  Recommendations:                                                    need   for   two   types   of   communication:   technical    and
                         *inclusive representation  by  those  people  and  organiza- interpersonal.
                         tions  directly  and  indirectly  involved   in   emergency
                         medical services                                             Recommendations:
                         *comprehensive  inventory   of   area   services   and   re-      Emergency  Medical  Services  Councils   should   not   only
                         sources                                                           foster  a  wide  representation,  but  individualized   con-
                         *regional sharing  of  specialized  resources  and  services      tacts between the represented constituencies.
                         *training  of   ambulance   attendants   in   both   vehicle      Communications    cannot    exist    without     cooperation
                         operation and emergency medical treatment                         between    communicators:    cooperation    cannot     exist
                         *clarification of legal status for  volunteer  fire  depart-      without   understanding;   and   understanding   is    based
                         ments t at often provide emergency transportation                 upon shared knowledge.
                         *coordination   and   development   of   existing   communi-
                         cations system as it functions in emergency medical  New Committments:
                         service                                                           To  formalize  a   more   comprehensive   dialogue   between

                                                                                                       Chautauqua county group in discussion

                                                                                  12


                       the components of their emergency medical  services
                       system; to educate those components and to  up-date
                       that education as individual roles are expanded.
                       To promote personal cooperation  by  holding  peri-
                       odical sessions where informal dialogues  can  take
                       place that will express individual  prejudices  and
                       needs.
                       To "OPEN THE COMMUNICATIONS".

                                                                        13


                 To motivate greater  concern;  to  promote  county  councils; continue  to   grow.   Communications   are   being   opened.
                 to develop support;  to  stimulate  a  trend  toward  an  im- Dialogues are continuing throughout  the  entire  Lakes  Area
                 proved emergency medical services  system  -  the  objectives region. The conference which  was  informative  and  exciting
                 of this conference were clearly not  meant  as  'ends'.  They is proving the real force of its productivity. Evidence of this
                 provide the beginnings - of dialogues, efforts, and  actions. trend  toward  an  improved  region-wide  Emergency   Medical
                                                                               Services System is evidence  of  a  successful  First  Annual
                    The  growth  of  a  trend  depends  upon  the  people  who Regional Conference on Emergency Medical Services.
                 understand its direction and believe in it enough to make  it

                                                                                  --k

                                                                                                                          emergency     room

                                                                             14


                                                                                                           emergency technician training

                                                                            15


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     ,,ce                                                                                                                                       regional   press    clippings

                                                                                                  17


                  Speakers
                                                                                    William L. Glaszier, M.D.
                  John C. Border, M.D.                                              Vice-President of Medical-Dental Staff
                  Director, Trauma Research Center                                  Tri County Memorial Hospital
                  E.J. Meyer Memorial Hospital                                      Go@vanda, New York
                  Buffalo,  New   York
                                                                                    Harvey D. Grant
                  LaVerne E. Campbell, M.D.                                         Senior Instructor
                  Regional Health Director                                          Delaware State Fire School
                  New York State Department of Health                               Emergency Care Training Coordinator
                  Buffalo,  New   York                                              Dover, Delaware

                  James H. Cosgriff, Jr., M.D.                                      Robert W. Harris
                  Chairman, Erie County Emergency Medical Care Committee;           Executive   Director
                  Director, Emergency Medical Services Project;                     Western New York Hosptial Association
                  Chairman, New York State Technical Advisory Committee on          Buffalo,  New   York
                     Emergency Medical Care
                  Buffalo,  New   York                                              Irvin E. Hendryson, M.D.
                  Kenneth H. Eckhart, M.D.                                          Director, Priority Health Care
                  President, Comprehensive Health Planning Council of               University of New Mexico, School of Medicine
                     Western New York, Inc.                                         Albuquerque, New Mexico
                  Buffalo,  New   York                                              Henry C. Huntley, M.D., M.P.H.
                  Robert F. Ehinger, M.D.                                           Director, Division of Emergency Health Services
                                                                                    Health Services and Mental Health Administration
                  Assistant Regional Health Director                                United States Department of Health, Education and Welfare
                  New York State Department of Health                               Rockville, Maryland
                  Buffalo,  New   York
                  Roger Fenion                                                      John RIF. Ingall, M.D.
                                                                                    Executive   Director
                  Coordinator, Emergency Health Services                            Lakes Area Regional Medical Program, Inc.
                  Erie County Department of Health                                  Buffalo,  New   York
                  Buffalo,  New   York

                                                                                    David C. Krieman
                  Mildred Fincke, R.N., B.S.                                        Emergency Medical Care Representative
                  Director of Emergency/Ambulatory Nursing Services                 New York State Department of Health
                  Allegheny General Hospital                                        Buffalo,  New   York
                  Pittsburgh, Pennsylvania
                                                                                    Costas T. Lambrew, M.D.
                  John Guevin                                                       Chief, Division of Cardiology
                  President, New York State Ambulance Owner's Association           Nassau County Medical Center
                  Troy, New York                                                    East Meadow, Long Island, New York

                  Geoffrey Gibson, PhD.                                             Edward Lauman, Communications Coordinator
                  Sociology Department                                              Bureau of Emergency Health Services
                  State University of New York at Buffalo                           New York State Department of Health
                  Buffalo,  New   York                                              Albany,   New   York

                                                                               18


                      William E. Mosher, M.D.                                             Martin   B.    Gerowitz
                      Commissioner                                                        Comprehensive Health Planning Council of Western New York, Inc.
                      Erie County Department of Health                                    Buffalo,    New    York
                      Buffalo,   New    York
                                                                                          Geoffrey Gibson, Ph.D.
                      F.    James     Murphy                                              Department of Sociology
                      President, Western New York Hospital Association                    State University of New York at Buffalo
                      Buffalo,   New    York                                              Buffalo,    New    York

                      William No@vill, M.D.                                               Robert    W.     Harris
                      Anesthetist                                                         Executive      Director
                      Arnot-Ogden Memorial Hospital                                       Western New York Hospital Association
                      E I m i, a, N e@v York                                              Buffalo,    New    York

                      Edward    V.     Regan                                              E. Ray Hodge
                      County       Executive                                              Buffalo Area Chapter
                      Erie County                                                         American   Red    Cross
                      Buffalo,   New    York                                              Buffalo,    New    York

                      Lawrence   R.    Rose, M. D.                                        Patricia   Shine   Hoff
                      Project Manager, Emergency Medical Services,                        Lakes Area Regional Medical Program, Inc.
                      Regional Medical Program, Health Services and Mental                Buffalo,    New    York
                         Health Administration
                      Rockville,    Maryland                                              Onalee    H.    Johnson
                                                                                          School    of    Nursing
                      Captain Shirl J. Stephany                                           State University of New York at Buffalo
                      United States Coast Guard                                           Buffalo,    New    York
                      Assigned  to   National   Highway   Traffic   Safety   Administration
                      Emergency Medical Services Division                                 Lance  J.   Kohn,   Sr.
                      Washington,       D.C.                                              Empire State Rescue and First Aid Association
                                                                                          First Aid Captain-lst Vice President Grand Island Fire Co.
                      Richard J. Stoll                                                    3509   Wallace    Drive
                      Past President, Empire State Rescue and First Aid                   Grand Island, New York
                        Association                                                       David    C.     Krieman
                      Buffalo,   New    York                                              Emergency Medical Care Representative
                      Donald C. Walker, M.D.                                              New York State Department of Health
                      Director, Bureau of Emergency Health Services                       Buffalo,    New    York
                      New York State Department of Health
                      Albany,    New    York                                              Raymond    A.     Nowak
                                                                                          New York State Ambulance Owner's Association
                      Planning     Committee                                              Troy, New York
                      James H. Cosgriff, Jr., M.D.
                      Erie County Emergency Medical Care Committee                        Michael         Summers
                      Director, Emergency Medical Services Project;                       Western New York Police Conference
                      Chairman,  New   York   State   Technical   Advisory   Committee   on
                       Emergency Medical Care                                             Richard   F.   Treccase
                      Buffalo,   New    York                                              Executive Officer Erie County Medical Society
                                                                                          Buffalo,    New    York
                      Roger J. Fenion
                      Coordinator, Emergency Health Services                              William  A.  Wutz,  Jr.
                      Erie County Department of Health                                    Western New York Volunteer Fire Association
                      Buffalo,   New    York                                              Buffalo,    New    York

                                                                                         19


                     Anthony    Zerbo,    Jr.                                              JLJlianna Bednarz
                     Lakes Area Regional Medical Program, Inc.                             Lakes Area Regional Medical Program, Inc.
                     Buffalo,    New     York                                              2929 Main Street
                                                                                           Buffalo, New York
                     Registrants
                     @l,'illiam       Abraham                                              Joseph J. Belczak
                     Volunteer        Fireman                                              Fire Chief
                     @@iestern    New    York Emergency Medical Association                North Tonawanda Fire Department
                     Buffalo,    New     York                                              28 Hyland Avenue
                                                                                           N. Tonawanda, New York
                     Raymond     J.     Allen
                     27 latest  State  Street                                              Frederick Biddell
                     @',Iellsville, New  York                                              Emergency Medical Services System
                                                                                           Buffalo, New York

                     Anita and Florence Anderson
                     M.E.T.                                                                H. Stanley Biryla
                     @Vellsville,  New   York                                              Rescue Captain
                                                                                           Hillcrest Fire Co. O.P.
                     Donald    C.    Anderson                                              57 Green Meadow Drive
                     Supervisor                                                            Orchard Park, New York
                     Go,,,ianda Ambulance Service Corp.
                     Go@,ianda,   New    York                                              Alan  latt
                                                                                           Cal-span Corporation
                                                                                           4455 Genesee Street
                     Douglas     H.     Baker                                              Buffalo, New York
                     President
                     LaSalle Ambulance Service Inc.                                        John Bleecher
                     1609     Main     Street                                              Medical Emergency Technician
                     Buffalo,    New     York                                              Eggertsville Hose Company
                                                                                           230 Lamont Drive
                     Virginia Barker, R.N., Ed.D.                                          Buffalo, New York
                     Dean, School of Nursing
                     Alfred,     New     York                                              Sandra Bogdanowicz
                     @Iiilliarn    Barndollar                                              Emergency Medical Services System
                     240 N. Ellicott                                                       Buffalo, New York
                     Williamsville, New York                                               Neil Bohnert
                     Eve Bayle                                                             Spencer Hospital
                     Sister's Hospital                                                     Meadville, Pennsylvania
                     2  1  57   Main   Street                                              Alfred L. Brandt, M.E.T.
                     Buffalo,    New     York                                              Instructor-Also, American Red Cross Instructor
                     Robert    Jay     Beebee                                              Kenmore Volunteer Fire Dept. Rescue Squad
                     Lakes Area Regional Medical Program, Inc.                             194 Washington Avenue
                     2929     Main     Street                                              Kenmore, New York
                     Buffalo,    New     York                                              David Buck
                     Leslie A. Beck                                                        Lakes Area Regional Medical Program, Inc.
                                                                                           2929 Main Street
                     Jamestown Fire Department
                                                                                           Buffalo, New York
                     199 Hazeltine Avenue
                     Jamestown, New York

                                                                                          20


                    Arny     Burgett,     RN                                          William D. CoLiell
                    69 Oak Street                                                     Assistant Chief
                    Wellsville,  r@evv  York                                          Orchard Parl< Fire Co. Rescue Squad
                                                                                      17 Harvard Place
                    Phyllis Burley                                                    Orchard Park, New York

                    Philil:) J. Burns                                                 William    Crage
                    Administrator                                                     Lakes Area Regional Medical Program, Inc.
                    Doctors Hospital                                                  Buffalo, New York
                    300 Two Mile Creek Road
                    Toiia,4vanda, New York                                            Dennis    Crosby
                                                                                      Allied Chemical Corporation
                    Virginia    B.     Brown                                          78 Grand BOLJlevard
                    Chautauqua Opportunities, Inc.                                    Cheel<towaga, New York
                    12   Blanchard    Street
                    Mayville,    New    York                                          Walter Curry
                                                                                      EMS Coordinator
                    Lloyd Cannedy                                                     Central New York Regional Medical Program
                    Administrator                                                     71 6 East Washington Street
                    Bradford        Hospital                                          Syracuse, New York
                    Bradford, Pennsylvania
                                                                                      Robert A. Dame
                    Miss  Joyce  Carey,   RN                                          Medical Department-F irst Aid Instructor
                    Charge   Surgical   E.R.                                          Ford Motor Company-Buffalo Stamping Plant
                    Children's      Hospital                                          78 Errington Terrace
                    Buffalo,    New     York                                          Orchard Park, New York

                    Miss  Joyce  Carey,   RN                                          E.H.    Deuchler
                    485    Hewett     Avenue                                          Fire Alarm Dispatcher
                    Buffalo,    New     York                                          Civil Defense
                                                                                      222 Hartford Avenue
                    John Clarkson                                                     Kenmore, New York
                    Jamestown Police Department
                    Jamestown, New York                                               Harold     Dewey

                    Isabelle   M.   Clifford                                          Carlton A. Dick
                    Director, Home Health    Services                                 Chief of Training
                    Erie County Health Department                                     Buffalo Fire Department
                    147  Marine   Drive   6D                                          671 Eggert Road
                    Buffalo,    New     York                                          Buffalo, New York

                    Jerry Close                                                       Beverly   Drezek
                    State   University    of New York at Buffalo                      Emergency Medical Services System
                    Buffalo,    New     York                                          Buffalo, New York

                    Margaret D. Connelly, R.N.                                        Rose Dziekonski
                    Public Health Nursing Service                                     Emergency Medical Services
                    Belmont,    New     York                                          Buffalo, New York

                    George M. Cooper, M.D.
                    Assistant Medical Director                                        Frank R. Episcopo, M.D.
                    Erie County Dept. Social Services                                 Veterans Administration Hospital
                    5800 Lake Shore Road                                              Erie, Pennsylvania
                    Hamburg,    New     York

                                                                                     21


                  James Ehinger, M,D.                                             Janet  L.   Gelsinger
                  Mercy Hospital E.R.                                             Lakes Area Regional Medical Program, Inc.
                  666 Main Street                                                 Buffalo,   New   York
                  West Seneca, New York
                                                                                  Mary Giles, DNS
                  Mr. and Mrs. Erwin (Shockmobile)                                Jones Memorial Hospital
                  Elmira, New York                                                Cooks Road
                                                                                  Alfred Station, New York
                  Roy H. Fabry
                  E.J. Meyer Memorial Hospital                                    Alberto J. Gonzales, M.D.
                  462 Grider Street                                               Buffalo Columbus Hospital
                  Buffalo, New York                                               300  Niagara   Street
                                                                                  Buffalo,   New   York
                  Fred C. Fahey
                  President                                                       John N. Good
                  Mohawk Ambulance & Oxygen Service Inc.                          Chautauqua County Department of Health
                  787 State Street                                                Environmental Health Services
                  Schenectady, New York                                           Health & Social Services Building
                                                                                  Mayville,  New   York
                  George C. Feisthamel
                  EMS Coordinator                                                 Mrs. Patricia Gordon, RN
                  Mid State Committee on Area Wide Health Planning                St.  Jerome  Hospital
                  800 Park Avenue                                                 16 Bank Street
                  Utica, New York                                                 Batavia,   New   York

                  Irwin Felsen, M.D.                                              Franklin E. Grimes Sr.
                  President, Regional  Advisory Group                             Cattaraugus County Health Planning
                  Lakes Area Regional Medical Program, Inc.                       Box 48
                  Wellsville, New York                                            Knapp Creek, New York

                  Ted Fieth, Jr.                                                  Susan Haber
                  72 South Main Street                                            Emergency     Medical Services System
                  Holley, New York                                                Buffalo,   New   York
                  Willard Flynn                                                   Wanda   S.    Hackney
                  Corporate Safety Officer                                        George  W.  Halliwell
                  Sierra Research Corporation                                     Executive   Secretary
                  247 Cayuga Road                                                 Western New York Burn Treatment Center
                  Cheektowaga, New York                                           4838 Tonawanda Creek Road
                                                                                  N. Tonawanda, New York
                  Linda Frutig
                  Kenmore Mercy Hospital                                          Jean Hanna
                  Buffalo, New York                                               708 West 34th Street
                                                                                  Erie,    Pennsylvania
                  Helen M. Fyda
                  Staff Nurse                                                     Donald Haseley
                  WNY Association of Industrial Nurses                            First   Aid   Captain
                  535 Washington Street                                           Sanborn Fire Company, Inc.
                  Buffalo, New York                                               581 1 Buffalo  Street
                                                                                  Sanborn,   New   York
                  Timothy J. Garrison
                  1257 Wehrle Drive
                  Williamsville, New York

                                                                                  22


                    Robert    A.     Hayman                                         Richard E. Hummert, Jr.
                    Research Electronics Engineer                                   Ambulance      Attendant
                    Calspan     Corporation                                         Emergency Hospital
                    4455   Genesee   Street                                         108 Pine  Street
                    Buffalo,    New    York                                         Buffalo, New York

                    William Hill                                                    Samuel T. Ingram
                    Driver     (Supervisor)
                    City Ambulance Service                                          Mary Ireland
                    300   Niagara    Street                                         Staff Nurse
                    Buffalo,    New    York                                         WNY Association of Industrial Nurses
                                                                                    535  Washington   Street
                    Robert  J.   Hochreiter                                         Buffalo, New York
                    Auto       Investigator
                    Calspan     Corporation                                         Mrs. Vera D. Johnson, RN
                    974   Dodge   Road                                              Director, Nursing and Health Programs
                    Buffalo,    New    York                                         Greater Buffalo Regional Chapter
                                                                                    American Red Cross
                                                                                    786 Delaware Avenue
                    E. Ray Hodge                                                    Buffalo, New York
                    Executive      Director
                    Greater Buffalo Regional Chapter                                Doris Jones
                    American   Red    Cross                                         Niagara Community Action Program
                    786   Delaware   Avenue                                         Project Director
                    Buffalo,    New    York                                         220 First Street
                                                                                    Niagara Falls, New York
                    Neil Hodgson
                    E.J. Meyer  Memorial  Hospital                                  Algie L. Jordan
                    Buffalo,    New    York                                         Georgia Regional Medical Program
                                                                                    938 Peachtree Street
                    Patricia S. Hoff,  R.N.                                         Atlanta, Georgia
                    Lakes Area Regional Medical Program, Inc.
                    Buffalo,    New    York

                    George   W.   Holliwell                                         William D. Kelly
                    WNY  Burn   Treatment   Center                                  Chautauqua County Civil Defense
                    4838  Tonawanda   Creek   Road                                  McCienathan  Mobil  Cts.
                    North  Tonawanda,   New   York                                  Fredonia, New York

                    George Howardell and Edwin Adams                                Bonnie Kirisits
                    Marketing/Engineering                                           Lakes Area Regional Medical Program, Inc.
                    Sierra Research Corporation                                     Buffalo, New York
                    247  Cayuga   Road
                    Cheektowaga, New York                                           Rev. Donald W. Kirkwood
                                                                                    Fire District No. 6
                    John  J.  Hufchock                                              West  Seneca,  New  York
                    EMS Coordinator, North Country Area (CHP)
                    Central  New  York    Regional Medical Program                  Robert C. Kochersberger, Ed.D.
                    746 Fulton  Street                                              Jamestown Community College
                    Carthage,   New    York                                         Jamestown, New York

                                                                                   23


                    Lance J. Kohn, Sr.                                            John A. McCraith
                    First Aid Captain-ist Vice President                          Deputy Fire Company Coordinator
                    Grand Island Fire Company                                     7 Lambert Avenue
                    3509  Wallace  Drive                                          Fredonia, New York
                    Grand Island, New York
                                                                                  Gene Madden
                    Herbert    Kranzmann                                          American Red Cross
                    41 Revere Drive                                               Jamestown, New York
                    Grand Island, New York
                                                                                  Richard Makuch
                    Mathew J. Kropp, Sr.                                          Western New York Police Association Inc.
                    North Java Fire Company                                       747 Deer Street
                    4269 Rt. 98                                                   Dunkirk, New York
                    North Java, New York
                                                                                  Thomas M. Mangan
                    Mathew J. Kropp, Jr.                                          Niagara County Community College
                    4269 Rt. 98                                                   Asst. Prof. of Biology
                    North Java, New York                                          31 11 Saunders Settlement Road
                                                                                  Sanborn, New York
                    Frederick Lamb,  Sr.
                    Sr. Instructor, Red Cross                                     Victoria Markellis, M.D.
                    360  Sunset  Terrace                                          Commissioner of Health
                    Orchard Park, New York                                        Genesee County Health Department
                                                                                  3837 Main Street
                    Mary  Langstoff                                               Batavia, New York
                    Kenmore Mercy Hospital
                    Buffalo,  New   York                                          Joan Marsh, RN
                                                                                  157 East Pearl Street
                    Mr. and  Mrs.  Lewis                                          Wellsville, New York
                    Elmira,   New   York
                                                                                  Miss Sandra Lou Maslach, RN
                    Donald R. Lewis                                               U.S. Army Nurse Corp
                    Assistant Administrator                                       125 South Martin Street
                    St. Jerome  Hospital                                          Dunkirk, New York
                    16 Bank  Street
                    Batavia,  New   York                                          Mrs. Loraine  C.  Mathewson
                                                                                  Assistant Administrator
                    Terry Link                                                    Buffalo  Columbus  Hospital
                    Boston Emergency Squad                                        300 Niagara Street
                    Boston,   New   York                                          Buffalo, New York

                    Mary   Looker,    RN                                          James McCormack, Ph.D.
                    Bradford    Hospital                                          Lakes Area Regional Medical Program, Inc.
                    Bradford, Pennsylvania                                        Buffalo, New York

                                                                                  Wilbur Mauk
                    Marion   L.   Loucks                                          Health Association of Niagara County, Inc.
                    1 18 Allenhurst Road                                          Niagara Falls, New York
                    Buffalo,  New   York
                    David  B.  Lyon                                               Anthony  A,  Merlino,  M.D.
                    President                                                     Chief of Medicine
                    Medical Oxygen Service                                        Buffalo  Columbus  Hospital
                    Quinby Park                                                   300 Niagara Street
                    Hamburg, New York                                             Buffalo, New York

                                                                                 24


                   R. Miller
                   Sierra Research                                              Diane      Pinchoff
                   Buffalo, New York                                            Lakes Area Regional Medical Program, Inc.
                   Robert Miller                                                Buffalo, New York
                   Lakes Area Regional Medical Program, Inc.
                   Buffalo, New York                                            Ronald W. Plewniak
                                                                                First  Aid  Captain
                   Mary M. Mogan                                                Harris Volunteer Fire Co.
                   Regional Director of Nursing                                 4580  Boncrest   E.
                   New York State Department of Health                          Williamsville, New York
                   584 Delaware Avenue
                   Buffalo, New York                                            Irene  Polowy,   RN
                                                                                Night Nurse - Emergency Room
                   Verna Morris, RN                                             Millard Fillmore Hospital
                   W.C.A. Hospital                                              3 Gates Circle
                   Jamestown, New York                                          Buffalo,  New  York

                   Mrs. Alfretta Moynikan, RN                                   Constance    Poodry
                   St. Jerome Hospital
                   16 Bank Street                                               Basil Potter
                   Batavia, New York                                            Sierra Research
                                                                                Buffalo,  New  York
                   Matthew Mrowczynski
                                                                                Thomas Power
                   Warren A. Mutz                                               Cattaraugus County Health Department
                   Medical Society County of Erie                               Olean,   New   York
                   1514 Marine Trust Building
                   Buffalo, New York                                            Joseph     Reynolds
                                                                                Telephone Lecture Network
                   Ray Nicholas                                                 Lakes Area Regional Medical Program, Inc.
                   New York State Health Department                             Buffalo,  New  York
                   Albany, New York
                                                                                Herbert  R.  Riemen
                   John Owen                                                    Assistant Vice President
                   8235 Greiner Road                                            Sisters of Charity Hospital
                   Williamsville, New York                                      2157  Main   Street
                                                                                Buffalo,  New  York
                   Donald C. Oswald
                   Member, Board of Directors                                   Frank T. Riforgiato, M.D.
                   Inter-Community Memorial Hospital                            President of Medical Staff
                   2600 William Street                                          Buffalo Columbus Hospital
                   Newfane, New York                                            300 Niagara  Street
                                                                                Buffalo,  New  York
                   N. Donald Peifer
                   Tri-County Memorial                                          Harold B. Sanderson
                   100 Memorial Drive                                           Owner and  Operator
                                                                                Seneca Ambulance & Oxygen Service
                   Shirley Pemberton                                            32 State Street
                   Emergency Hospital                                           Seneca Falls, New York
                   Buffalo, New York
                                                                                Mrs. Joyce J. Schenk
                   Ralph M. Peters                                              Friendly Lake Volunteer Fire Company
                   Assistant Supervisor                                         P.O. Box 416
                   Gowanda Ambulance Service Corp.                              Friendly Lake, New York
                   30 St. Johns Place
                   Gowanda, New York

                                                                               25


                    James  A.   Schindler                                         Dr. Donald Snyder
                    Assistant Administrator, Admin. Resident                      Project Administrator
                    Deaconess    Hospital                                         Comprehensive Care Center
                    lool Humboldt Parkway                                         7008 Errick Road
                    Buffalo,   New   York                                         N. Tonawanda, New York
                    Mrs. Ruth Schniett, RN                                        Dean C. Sommers
                    Supervisor, Out-patient Department                            Administrator
                    Children's   Hospital                                         HHA Administrative Services, Inc.
                    Buffalo,   New   York                                         233 Coronation Drive
                                                                                  Amherst, New York
                    Robert   W.   Schober                                         Russell Sparcino
                    Fire Fighter                                                  Ambulance Supervisor
                    Kenilworth  Fire  Co.                                         Emergency Hospital
                    74 Hawthorne Avenue                                           108 Pine Street
                    Buffalo,   New   York                                         Buffalo, New York

                    Norman Schuller                                               La@vrence E. Sparks
                    East Aurora Rescue Squad-First Aid                            North Tonawanda Fire Department
                    East Aurora, New York                                         North Tonawanda, New York

                    Mrs.  D.S.   Schwartz                                         Richard Stabler
                    385 Oakwood Avenue                                            Division Safety
                    East Aurora, New York                                         Sierra Research Corporation
                                                                                  247 Cayuga Road
                    Carolyn  G.   Seymour                                         Cheektowaga, New York
                    Development Department
                    County Office Building                                        Julius G. Stapf
                    Model Counties Development                                    President
                    Mayville,  New   York
                                                                                  Wilson Fire Company
                                                                                  186 Lake Street
                    Wilson W. Shaw, M.D.                                          Wilson, New York
                    W.C.A. Hospital
                    Jamestown, New York                                           Dick Stevens
                    Jasper Shealey                                                Comprehensive Health Planning
                    Emergency Medical Services                                    Syracuse, New York
                    Buffalo,   New   York                                         William F. St. John
                                                                                  325 Norwood
                    Lucia Shealey
                                                                                  Rochester, New York
                    Emergency Medical Services
                    Buffalo,   New   York
                                                                                  A. Patricia Stopen, R.N.
                                                                                  Box 190
                    Floyd Silliman                                                Wyo  ing County Board of Supervisors-Emergency Care
                    1869  Cornwall   Road                                             m
                                                                                     Training Program
                    South Wales, New York                                         400 North Main Street
                    Robert Sinclair                                               Warsaw, New York
                    Mennen-Greatbatch
                    10123   Main   Street
                    Clarence,  New   York

                                                                                  26


                  William A. Stoppani                                             Charles  P.  Voltz,  M.D.
                  Administrator                                                   Director of Out of Hospital Services
                  Inter-Community Memorial Hospital                               Sisters of Charity Hospital
                  2600 William Street                                             Buffalo, New York
                  Newfane, New York
                                                                                  Arthur Wade
                  Moir P. Tanner                                                  Grand Island  ire  ompany
                  Vice President                                                  Treasurer
                  Homemakers Upstate Group, Inc.                                  51  77  East  River  Road
                  235 North Street                                                Grand Island, New York
                  Buffalo,  New   York
                                                                                  Dan E. Waite
                  Joseph  C.  Tedesco,  M.D.                                      Niagara Mohawk Power Corporation
                  Buffalo Columbus Hospital                                       106  Point  Drive   North
                  300  Niagara  Street                                            Dunkirk, New York
                  Buffalo,  New   York
                                                                                  Mary   Wolford,   RN
                  Elaine Tette                                                    Bradford    Hospital
                                                                                  Bradford,    Pennsylvania
                  Sister Thecla
                  Asst. Director Mrs. Sirmce                                      Susan L. Walsh
                  Sisters Hospital                                                N.Y. State Senate Health Committee
                  2157 Main Street                                                Room 611612
                  Buffalo,  New   York                                            N.L.O.B.
                                                                                  State Capitol
                  Donald  B.  Thomas,   M.D.                                      Albany,   New   York
                  lst Deputy Health Commissioner
                  Erie County Health Department                                   Michael Walters
                  95  Franklin  Street                                            Emergency Medical Services
                  Buffalo,  New   York                                            Buffalo,  New   York

                  Richard F. Treccase                                             John  L.  Worden,   Ph.D.
                  Executive Officer                                               St. Bonaventure University
                  Medical Society County of Erie                                  Olean, New York
                  1514 Marine Trust Building
                  Buffalo,  New   York                                            Paul A. Wheeler
                                                                                  Director of Safety Programs
                  Joseph F. Turner, Jr,                                           Greater Buffalo Regional Chapter
                  Administrator                                                   American Red Cross
                  Lockport Memorial Hospital                                      786 Delaware Avenue
                  521 East Avenue                                                 Buffalo,  New   York
                  Lockport, New York
                                                                                  Eugene P. Wilczewski
                  Mrs. Jerrie L. Van Every, RN                                    Executive   Director
                  Head Nurse Emergency Department                                 Comprehensive Health Planning Council of Western New York Inc.
                  EDNA   Chapter   President                                      Suite 300
                  Meyer  Memorial   Hospital                                      Genesee Building
                  135  lvyhurst   Road                                            Buffalo,  New   York
                  Eggertsville, New York

                                                                                  27


                  Jeffrey  J.  Woeppel
                  Administrative Resident
                  Deaconess   Hospital
                  Buffalo,  New   York

                  Ellen K. Wolfe
                  Public Health Instructor
                  Millard Fillmore Hospital
                  School  of   Nursing
                  1290 Delaware Avenue
                  Buffalo,  New   York

                  William Wutz
                  Emergency Medical Services
                  Buffalo,  New   York

                  Kurt Mathiebe
                  Lakes Area Regional Medical Program, Inc.
                  Buffalo,  New   York

                                                                            28


            lakes area regional medical program, inc.
               new york state department of health
                 erie county department of health
                emergency medical care committee