i
                                                                                                                                             '!I iiiiiIii                    II                  ill', iiii
                                                                                                                                                          -K               I it!




                                                                                                                 220




                                                                                                       iliti-es in an
                         IIclassification and expansion or modification of fac
                         2  integrated fashion;  components for organization and management
                         3  of the system,  for evaluation of  the system,  and then for

                         4 1 expansion.
                         51                It is  really a very compl.ete package that this
                         /  first project 42 present@.
                         0
                         7                 Sortie comments about the individual. components of the
                         8package:   'ei.rst,  the organization,  Dr.  D-Lmick,  a corisu.'J --L-ai-it for
                         9this  revic@i groul-1,  is -,oroject director.                 It is  obvi.ciis thFt he
                         10 !has T)rr)@,ieed the very      great iri,-Detus for the de%,@elopmenlk--                the

                         II I, entire program in Alc-@ana,.
                         12                Planning for the entire program is  -i.n three
                         131First,  title is  a demonstration ar-o@t  in the Biri,@,-iincTham
                         41 and then coordination of fivc e--oi-iticluotis  citics,  and                           tli
                         15 rest o.'L -fef L'arso,-. Cc)ti.nty,  at-ila-  then  finally the CIIP B ag, nc)r
                          circa.   ':'.Fiat en(-,o!-,inas.,-,c:r-  Uiis  county  arc.,,a, and further.
                         16
                         17                The                  of                 edL,.catj.OT-, has the usual@

                          methods O'Z.                   L-@,iuca4@--ioi, -lnd pul)!..-.c

                                                                        states, I  i,,                                  to
                         191                                o f i.. r,-
                         20                                               i-ir..@ a;ll. a:-,   L@:-@ c@-r tli ir

                         21

                                           rn                  I
                         '/-'2              .hey

                                       s t                             C.-,, C:,   F"   ,Irl
                         23ii

                         2 4                        T"I                'r,

   cc -




    1T.(ta-8 .                                                               22 1

          r

                I             Training, they hope to have seven rescue units in
                2 this first  small area, training enough elements to staff them,
                3 and have a  coordinative training program in the area.
                              They have become very much interested in mobile
                4
                5 primary care units, and give some interesting but usual
                6 statistics on the number of deaths from coronary disease prior
                  to getting to the hospital, the length of time it takes to get
                7
                8 to the hospital, the fact that emergency equipment like the
                  local fire department 90 percent of those emergency vehic es
                9
               10 reach the v.Lctim    they use the term "victim" in this
                  circumstance, rather than "patient" -- in,).ess  than  three
               11
                 iminutes.
               12
               13             So, they want to move their entire mobile coronary
                  care units  in the direction of having them instantly available,
               14
                  staffed w.-Lth good communications with physician  monitors.
               15
                              They hope to provide eight mobile units with ET@,lTs
               16
               17 and ecluipifteiit  for them, as well as monitoring stations that
               18 are portable, with physicians n-toi-iitorin(3 them.
                              DR. 1-iClIr@RLIS: Is ti).is telernetered  monitoring
               191
                 I
                 I            DR. BESSON:  What do you mean by         Two-way
               201
                 1coi,,airitini-catiori?
               21             DR. S C TILS    The r)l-@ysician    not )3c@ on
               22

                  vehicle?
               23
                              D l@ , @3 I'@ S S 0@,7 li @i o -L-h(=
               241
  @ce-Feder@)t Reporters,  fric.
               25









                               DR. BESSON:  Yes.
                2              DR. SCHERLIS:@    Purely for coronary care?
                               DR. BESSON:  No, they are emergency rescue vehicles,
                3
                4  but they are called  coronary  care  unit  vehicles  and  I  suppose
                5  they are equipped for more than coronary care but I can't
                6  really answer your question.
                7              DR. S,CHERLIS.-:  This is a critical question at least
                8  in  my  mind.
                9              DR. BESSON:  They are equipped for it.  I don't know.
                10             DR. SCliERLIS--  Maybe I can dig that up.
                11             DR. BESSON: I  get  the  impression  that  --  they  are
                   called coronary care unit vehicles but I think they are equipped
                12
                13 for that plus other emergencies.
                141            They go into great detail giving plans-for
                ,51hospital coordination, for management, for intercommunity
                16 Irelations, for legislation, for description of existing
                   Isystems, the accomplishments in the past, and go on for 247
                17 1
                   !Daqcs of what is really a very @qcll- tho@,Lig]-t@L. out program and --For
                18 i@ 11
                   I,,,@hich Dr. I)iiiiick certainly deserves high grades.
                19
                20             Letlo-      al:)out b-odgc.,t information a moment.  Th"
                   components  of the budget which come  to  a  total  --  project  46,
                21 this                                                            11
                22       f irs-I-- project -- 1.2 iRil.lion for the first, 1.0 for t'
                23 -,(-,corLci year,139 for the third year, and a total. of .1.2 million
                24 for             7c.,Pi-s arc--, town ok'        cipf-,r@,tio@i@-,,
                                 i@,,oi-i't qo into to@-3           but central
                251





    rnf-, a -


                    Operations requests 394,000, of which the bulk, 128,000, is
                    made uD of salaries for project director, executive officers,
                2
                3   administrative officers, and so forth.
                              And operations center equipment, equipment for
                4
                    coronary care, 54,000.  Consultant fees, 87,000.
                51            The component of public information is going to be
                6
                7   subcontracted.  It just said subcontracted to a consultant firm
                    experienced in the field.  They don't go any further than that
                8
                9   except to say that that amounts to $107,000.
                10            Emerg6ncy medical training will be    .the Dunlop 18-houd
                    @course with three programs, 20 students each.
                    I         Mobile CCU  will  have  monitors  and  two  medical
                12  1
                13  residents, if you please, as riders on the mobile CCU vans,
                14  hoping to give El@l-Ls training right on the spot, as well as
                15@ providing medical care.
                16             The $30,000 that they have  prograi,%med  for  two
                    second-year residents as r@,,,Onitoi-sf two second-year residents as
                17,
                                                  -ve some question a)Dout  that. I am
                181 riders on these th4-rgE,, I ha
                    1
                19  not sure that this is the qu(-@stioi-i raised here on our funding
                    sheet, tuition charges sl,,,ould be disallowed 'Lo-- project 46.
                20
                    so,         that refers to aiac)tlier one, I don It know.
                21
                               They speak of ca"c,(-@r 1,3ddc,,rs i,-,ov'-nff, there. People
                22  1
                    1up in tlic-, junic-),- college svsteii f rr)ri 1'.I",,Ts to higher things ax,,d
                23
                            ti-,e-y ho.-)@ to p@--v Fc;Tne.
                241
  @ce,-Fedetal Repofteis,  life.inc,).,%.rc questions ziboi.).t. BLi-t if it,, i,@@ 7,lith
                25,1




                                                                                    22 4
    mea



                 I  guess it is okay with me.
                 2              They have a program for rescue training which I th       4 nk
                 3  is  all  right,  communications.  They  have  some  80,000  --   purchase
                 4  and maintain system over a three-year period, that is going to

                 5  come to approximately 80,000.
                 6              Transportation,  they  want  to  buy  eight  ambulances   for
                 7  112,000, and pay 48 EMTS, 75 percent of their salary while they
                 8  were on a training basis and the ambulance people, will pay 20
                 9  percent of their salarv, and that comes to a total of $82,000.
                101             So that  while  this  is  an  extremely  ambitious  program,,
                11 lit is very  comprehensive, and it is very ambitious fiscally.
                12              I would grade the program as a 4.5 or a 5.        I think
                13 lit is a very comprehensive program.  I will defer making a
                14  decision on numbers unless you force me to.
                15              DR.  - SCIIERLIS,. I won't force you to do anything.

                16  We  will  need   numbers
                171             DR.  DESS014:  Do I need a secondary revi@,iqer on that?
                                DR. SCIIEPJIS:    Let's have a secondary ravisher of
                19  tha@. nroiect, if \.,.e might, Dr. Roth.   Do you have any comments
                zu              DR. ROTII-  No, I have nc)thii7ig to add.    I five to
                21  adm-'@-t t'ilit I cli(i i)ot have these N,7:i-th me. I had 80 T-)o-,,inds of
                22  these things  the  du,,, I-)c,-core I left to go to the @,jest coast ajid
                                 g  4a,  and then -Llr-) Texas, and then here c).
                23  back to Gcior                                             nd I just

                    cou@.cin't (-@irr,,,  the-r,-t.
                241

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                25                    C; I E PI           ire cc@rt@,ii-ri




       mea--12                                                                                                                                         225



                                   you can clarify.  We'll get to that, I guess.
        CR 6307
        End #19                    2                     DR. BESSON:  We can take them up separately.

                                   3


                                   4


                                   5


                                   6


                                   7


                                   8


                                   9


                                   10




                                   1 2
                                   131

                                   14


                                   15
                                   ]6i
                                   17@
                                   181


                                   19


                                   20


                                   211


                                   22


                                   23


                                   24

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    CR.6307                                                                                         226
        20
        ik  1

                                       DR.   SCIIER.ruIS:    What    is    your    funding    recommendation


                         on this, then?
                     2
                     3                 DR.   BESSO'LI:   You    want    a    funding    recommendations    I
                         will bring    that up in context of the project 43.
                     4
                     5                 DR. SCHERLIS:   Fine, however, you prefer doing that.
                                       DR. BESSON:   Project 43 is an entirely different
                     6@
                     7   kettle of fish and it is a very elusive proposal.   I spent
                     8   several  hours  before  I  got   the   drift   of   it   and   I   may   not   have
                     9   it   right   yet.   It   apparently   begins    historically    with    a    1964
                   10    State   Department    of    Ilealth    medical    self-help    training    course
                   11    which tried to improve training of individuals and also set
                   12    up   an   ambulance   training   program.   Ai-id   then   1967,    Binxi.-Lngham
                         developed an EIIS committee which Nvas chaired by Diinic)@.
                   13
                   14    1968, the State Ilealtli Dep;artm,,@nt did a survey of L;MS and
                   15    reco Lm-.ic-iided so,-is legislation regarding                        In    1970,
                   16    apparently the T?,!Zgiolial lliad-@(ial Progr,-ty,-, discovered Diilic],@,
                   17    following a study of car(fi.,ac                           effo@ts by the
                      I  univer-@.-)..ty            tha;-_ l@ller, )Decpri@e            in.    Tl,,ey
                   181
                   19    becaxrc. ifi,vol.Nfed tl-ic4,n,           a         of card,-@-@c               and
                         that         to v(-@ry deel@                   :;..n E$IS.   T'.-,ey set ul@
                   201

                                     in oti@iei- area,,.3                              e
                   21 1                                          _,yen to coo  kiy@.att        oi:,;@ E@.@IS

                   22
                                                      tilt,,                        in  1971           @-I;Lt
                   2 @j

                                                                          C "t r -1"@ I"               L
                                             pb-z:-;,F age.  of  ;@.@in  a C t \@714    t I-). c, @i c))" i
                   241
   cc-Fed,,-ial Repottefs,  Inc.                  of
                   251



  eak ,2                                                                  22 7


               I  ambulances.  They said, well, if we have to develop standards
               2   for ambulances we'd better get some advisory committees so
               3   they appointed a statewide advisory committee which was also
               4   chaired by Dimick, and his impetus then led  them to move
               5   from the development of ambulance regulations and standards
               6   as authority for this act to the establishment of an interest
               7   on a statewide basis in training programs, communications, tran;-
               8   portation, and equipment.
               9             Now, this program, then, is to enable the State
              10   Department of Public Health, via this extended authority, which
              11 I they really don't have, but nonetheless it is good that they
              12@  are -nvolved, to contract out these various aspects of their
                   interest, a training program at 104,00,0, the development olr--
              13                                                     h,
              14   a demonstration area at 125,000, to provide what they call a
              15   contingency fund for the development of local. EMS
              16   to prov@-de training of emer(,fc@i-icy vehcj-les, to provide
              17   cations and evaluation syste,,co.
              18                   t'ixi-tL is the Treat of -L-1-ic prc)grE,,-L, but the c, a-@-c
                   a     o--@' fuzzy edg@-@s -co it: cind if' I' %Caere to read fro-A@,@l t'sic-
              191
                 1
                   -,oroprisal@      thc,                 in ou-,, T@@jel-t. -;,i,ys,
              20
                   "To                p)..                               -Lhc
              21
              22               ari.@i
              2311                               y@"1.1@@. T(@)    p
                                                     I)-,      t 4 C'@   C,
              2411

  %ce - Fede
      @ral  Reportefs,  In.
                    q,,i -p,. i @i                C)              I    )-I
                             and ta'c@,
              25



  c,- ak3                                                                          Z$




                    EMS.,,
                 2             And they  say  that  will  be  accomplished  by  staffing
                 3  the Department of Public Health, beefing it up for creating
                 4  their division of EMS.  They are developing some kind of
                 5  statewide plan which they are n@L. very explicit about to draft
                 6  regulations which will  implement  thig  statewide  act  for  anibu-
                 7  lance standards, to  train  the  general  public  in  medical  self-
                 8  help, and Pjtierican Red Cross, to e>,.tend the Elir2 training of the
                 9  81    Dun'@op programs throuql-icut the  state,  hopefully,  and  to
               io   contract with hospitals to develop courses for their emergency
               11   room personnel, to inform the public by creating what th-ey
               12   call road shows, to coordinate various agencies involved in
                    EliS, and to develop a demonstration area which will produce
               131
               ,4@  full scale E'L:.IS.
               151              Novi, this effort is,  in  their  words,  to  complement
               161  the previous project, 42.     1 L-hin)@ their budgeting progtaia  is
                  I v(--ry L(,)ose atid to,,-.ally uiiseparable, as far as I am concerned.
               17;
                  1
                  1
               181  1 a-r"" p a)          .1                    "250,0r,)O slush A'und
                                say tl-ie--,, %,ii-il for.-   worthy              h e,,7
               19i

                    h
               20:
                                  g to do for z,,I.l f)f
               21


               22
               23                  to   I"-@i-kd               and i@(-; id il@

               24
                                                                 pi,L    I)C@
     F(@,deri@@  Reportirs,   Ir,
                                                   ?4,  ic, o t t cI
                 5
               2



             -.4                                                                                                                                                                 2 29



                                     I      state health departments for t,ings that are rightly t'
                                     2                                So while we have two                             programs that are  said  to  be
                                     3      complementary, that I would be much  more  inclined  to  look  to
                                     4      program No. 42 as being the  nucleus  for  a  statewide  program,
                                     51     fund generously, and then lot it spread.
                                     6                                However, the area.,                        11 statewide             area, has had  such  a
                                     7      momentum that I would at the same  time  hate  to  discourage  it
                                     8      by not providing some fund,, for 43.  So I would compromise
                                     9      by providing some funds for Ilroject 43, the ste@.I'-ewide program,,

                                            as follows.

                                                                      DR. SCIIE@1,IS:                    3'.s 43 the seitie at 46?
                                  12                                  DR. BESSOIZ':                 47.
                                  13                                  DR.                           Thac i.s the.                            as 4 7
                                  14                                  DR. SCI-,'ERI,,IS:                 46 is the same as 42.
                                  15                                  DR.      H 'L 14.t 1 A         Pighc .

                                  1 6                                 DR.
                                  17@                                 DR.      S C F@      L, I S         46 is k2 ar?.ei 47 is 43.
                                  181                                 DR.      B L7S                                    r2l-,ey                        61.@,0,000 for t'!,Ie.
                                  19        ve r                 I    wc:hu@,d                                          "Df  the

                                                            --v   L'or  the---,
                                  20   1                      1
                                            to                                                                                             j.z-iat,                  251,1, 00@')
                                  21

                                                                                                                                                                                 c,
                                  22
                                                 0   0 "j, 'V' - T:)  0 "I a,. k,.L                                                                                f
                                  23

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                                  24
          Fed(-.ral Rcl)cttcrs, Inc.  l'
                                                                                                                                                                   c,@, t   c n
                                  25




                                                                    230
  e ak', 5


                 program and an indication of 1-io,,ri the E,,','iT program is going to
               2 be cost-sliared with the institutions and the ambulance services

               3 that are going to use these people.
               4            DR. SCIlEt@IS:  Before you go into the figures,
               5 could I ask Dr. 'Onse, have you had some contact with the

               6 Alabama group?

               7            DR. ROSE:  Yes.
               8            DR. SCIIERLIS:  Could you answer a question I had
               9  before, is this dedicated for pure. coronary care?
               1 0          DR. ROSE:  They do carry other equipment on the
               11 vehicle but it is specifically set up for such things as --
               1 2          DR. SCHERLIS: If somebody calls and they have cl-iesti
               131 pains, that ambulance goes out.
               14           DR. BESSON:  Yes.
               15           DR. SCIIERLIS:  Suppose somebody else has call,
               16 the -ti(al,ii.cle does not go ou-L. for that-?
               17           DR. BESSON: It does go out..
               18           DR.          Ti@ is is corcii,,a:cy
               19i          DR.           is ;-LI.SO (-,D:c;-,,7ing Ei rrf@dical rc.,si.derit,
               20@ so it; c-c,,irds it is
                                            c,-(@ in       o,@ di,,-LI
               21
                                                             %ti@,)-Lil@d nc)-L be
               22


               23
               24           D.   II."'                             1-id, w
  l@cc,-Fcdf,fal Repoftets,  Irc,i?
               251t






       6



                               DR. BESION:
                2              DR. Sfk,'IIFPJIS Is there any justification for that
   is           3   number of vehicles and the staff necessary for all those
                4   vehicles,  any justification -that they need and         have
                5   enough calls to make that item that can be justified in terms
                6   of costs?  most communities have moved away from this, the
                7   concept of a dedicated vehi-IL,.    That was an excellent concept
                8   at the time when there were Y,,iaterials being,collated on a
                9   research basis but at this title, most thinking is in terms of
                10  upgrading training to other peo,ole, not to have the physicians
                11  on board.  it was very expensive to have this expensive a
                1 2 vehicle devoted pii--rely to coronary care.   I would be very -Liuch
                13  in favor of eliminating what fi:a.,c@,ition of this appears to be
                14@ related to that.    I think tlaey have eight ifolter Av@ionics
                15  tape reco-c,-,,L-rs prcis@,nt at the cos-L-. of $10 ,000. I think that

                16  is gui.).ding it a. bil--@
                17              TI-icl,--e is enough           riov7 froi-,i the suppoi:'-t-l@Lng
                18            @;.@ve air. the,                        Dr. 1,7aglc-,Is
                1 9            's g.@L-e@@)UP,         group,  You corn gc) oi-i ant,.t

                20
                21               D R .  F, -S C)         U@ ill(4 "I-i-' s in

                22                         -a-
                23                                                                    I
                                   T                                         T     -L
                24       t

         Rp;poftcrs,  Inc.
                25                                     T


        a!I-:7

                                justification for that number, how they picked out that
                          2     number. I think we can. make an arbitrary cut of this whole
                          3     program, I think, -t 3.2 million, although it is an                                     excellent
                          4     program, that is f ar too much.
                          5                       DR. SCHERLIS: The nearest of eight mobile ana

                          6     coronary care
                          7                       DR. DESSON: The              sequence of events that leads to th@
                          8     justification of this is that three minute time they go to
                          9     great length %to point out is the time that fire departments
                          10    can get to a person, end thev figure the number of lives that
                          I I   they can save if they can match that kind of distance lill.lether
                          12    it is cost effective or not,-I have my doubt.
                                                  DR. GIIIBLL: That points ou-L the basic flaw.
                          13
                                                               "arice systef@t performing                                         Why
                          14    Let's use the ariibu.
                          151   build eight special @.rtibul.aiices? lqhy )iiiiiiic it when you can
                                -L@c,c- @-i-h,-it you hEzve?      .'L  thi,-L)-.  that  is  th,@  basic                 of the pro--
                          161
                             I                                                          -
                          17    PO.7, al.
                          I I                                                                         sliow                ag.@c

                             I  D,-.' .  G i1).
                          19'


                          2 0
                                                                                           C C L@;--@ -L. 1,  f         p ',2
                          21
                                                   E-, (Jr,,                         C),@@ ties                         l@'Ci (7) -1 1 i
                          22

                                                                                                                        n  i-i @i
                          231


                          24


                          25@




    c al,,                                                                                                           2 3 3




                             they have gone  that route.
                         2                    DR.  BESSO',I:       I    i-inOterstand    what    you     are     saying.
                         3                    DR.   SCIIERLI@-:   Bc(,,,ause   I   tlij.n),:   a    few    years    ago    this
                         4   would have       been something that would have been looked at with
                         5   a great deal of interest but certainly  for the  last few years
                         6   the    emphasis    has    not    been    on    the    dedic,3,ted    vehicle     but     an
                         7   upgrading     of     existing     emergency     systems.     And      this      is      why
                         8   that    rosy    glow    that    you    imply    pervades    Alabwna     might     be     fa(5.i.ng

                         9   a bit.
                       10                     Dr.  Joslyn?
                       11                     DR.  JOSLYN:   I was          reviewing       these       two        applications
                         21   and   I   thinl@   I   feel   as    Dr.    Besson    does,    that    they    are    two    quite
                       13    different applications,  altliouc,@l-i they                       complementary.            1
                       14    share his  concern  abouL@  the  fuzziness of the  statewide,  no.  43,
                       15    and the beauty  and coml..)].eteness  of the                                    No.  42.
                             I           I  feel able.  42 was  dc-sigi-i@-CA for co,nplc@te  ft-@.d           4 ng at  tl'l,--
                       16
                       17    @3.5                lcvel ar,(J I                   -v7@.s  d,@,sign@d to be      s@mi.tted

                             u,-  ' ; '.,
                       1 8           i --s    I  cannot jud@3-c-@                  they  rc@al.'ty          ct.--,d   us
                                           to  fvti-3.d          or                               it -1k.-o      to
                       19
                                       you                                                 are  'they            or  @,v
                       20i
                           I


                       21
                                          a     II   'L  cl 0   y s    Li  1)
                       22

                             tc;                                                              C)"G"            C.L
                       23

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                       24

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                             C,.
                       25i




                                                                                                        2 34
    a]-,


                           talk   about   this.   It   is   designed   for   a    complete    system    in
                     2     Birmingli-@rt and a few areas right next door.               I    think    that is
                     3     the   reason   there    are    two    applications,    because    the    second
                     4     application, as Dr. Besson pointed out,  comes from a completely
                     5     different point of view.   It is more of a gr-ass roots,
                     0     broad based application that is having trouble knowing exactl,,,
                     71    where   it   is   or   what   they   need   because   they   don't   have   the
                     8     expertise and the quality.   1-uid I just wondered whether P,!,:Ps
                     9     is in any position to fund the Dirriiixigliam one, since the
                     101   BirminglizM   application   says   right   off,    they    have    a    super!D
                     11    EMS system right now,  far bett,.E-,r tYia),i most placp-s in the
                     12    coui-ijL-.ry.   They just want to            it perfect and they
                     13                                                                         re F@,3k4,-icT
                           Grant to ans@,.,er soictc- of the                  that people c-2@
                     14@   a:Dout, you know, what is the direction we are- going.

                     15                   DR. SCII)L
                                                     RIJTS:    I think --

                                                                                    am t'
                     16                   DR. JOSIzYI4:     I don't 3@xiov,,.                              OA-,t

                     171   "ii temple; of-- the                    of  the@;e.  t@,7o
                                                                  c,, a,, i         bo-Lh      -Lhc-t@r,.i aii(@L ic)4t,":'-@


                     19
                     20ii
                           us                              0

                     21 1  'r L     t.)@-Z".T@.LVe

                     22                             a@n nc.-@il-.

                                                                  c)f z,, bacteria c)-@@
                     23


                     24

            I  RC-por  tets,   Inc.
             et   @o   25
                        I  to  t,l li, f@        :L




                                                                               235
    c,R 6 3 0 7


    Take 21
    dw 1        1               DR. SCHERLIS:  What steps of the total program

                2   do they actually cover?


                3               We have heard a great deal about the transporta-

                4   tion system.

                5               You said it is a total e-rtiergency system?

                6               DR. JOSLYN:  In Birmingham?

                7               DR. SCliERLIS:  What else is incorporated?

                8               DR. BESSO.N:  Employee training, public information


                9   and consumer education.


               10               DR. JOSLYN:  Transportation.

               11               DR. BESSON:  Transportation and communication.

               12               DR. JOSLYN:   Re cue operations.   They are talking

               13   about developing a career I.eCi'dcr.

               14               DR. SCHEIR-LIS: WI@ici'l the ai-nbialance is called, it is


               15   frofji the nearest hospital, -Ls that correct?

               16               DR. Br@'SSON: Not necessarily.
               17@              DR. JOSLYN:  The@, a3-e go@-iig to look at all of
               181  Birrni),ighEm and dE-cidc! @,,Iier(.@ exactly ai-@t!Dtilai-ices need to be
                 I
               19   @,2.acc.@(3 I,(-.) give the best,    i.i,i tiric, coverage, if I

               20

               21               DR. SC'@ll@'Y,"L--YS Are err,(--r@,,-ency i-oonis part of the

               22

               23               DR. JOSL@"p@: TI-i(-,,.-c-@      much emphasis on

                                                 t .
               24   e c@ 1: q E, y

        fl,epoitc(s, Ific.
               25               DR. J@C)S7t":III E,@ cl            E@,,id iTiFtybe




                                                                            23 6


    d'w2

                    could help me with this.
                 2             I had the impression most of these ambulances
                 3  related to one emergency rocm.
                               DR. SCHERLIS:  This is what I was driving at.
                 4
                 5             DR. ROTH:  Since I did not have a chance to go
                 6  into this in depth, I don't want to prolong this
                 7  discussion, but this relates in a fascinating fashion to me
                 8  to the opportunity that some of us had to go into depth in
                 9  the Russian plan, with its dedicated vehicles of eight
                 10 varieties.
                 11            I might say that I believe this is more coronary
                 12 emergency units than. supply the whole City of Moscow.  But
                    the figures that come out from the Russian system in terms
                 13
                 14 of theri. salvage rate, and so on, are fantastically good, if
                 15 we can believe them, you know.
                 16            We are involved in trying to get some knowledgeable
                 17 people from this country who l-,no@i ouil, results, in taking the
                 18 ar.-,'@ularLce out and     the          back to the source
                 19 of expertise, as contracted to the Russian. system which -Ls
                    @La.k@-ng 'the c-,x-,r3r"--ise with
                 20
                 21            Thr@y ha@7,@, physicians and the t)---ain,@d
                 22 speci-a3..-I-E-,ts on each oi-..c, of emerg(-@lic,,@7 types of cambul,a.llccs
                 23 And to me, this is a-ri i.i-inova@-,J-'@,,e of this thing, @i,3
                    a                                              to
                 241

  ,',.ce-Fedefal reporters, Inc.
                 25




                                                                                237


    dw 3


                 I              I think it would be awfully interesting to see

                 2   this sort of thing done.


                 3              DR. GIMBLE:  It has been done 20 or 30 times in


                 4   the last five years, there are similar projects of this

                 5   nature, currently funded in this country.

                 6              DR. SCIIERLIS:  This is the thing that troubles me.

                 7   And that is, with the health dollar for emergency services

                 8   available, the supply we have, I would rather they spoke to

                 9   a transportation system where they upgrade the existing

               10    emergency staff to handle cardiovascular emergencies as well

               11    as otehrs rather than going into the dedicated group, because

               121   there are a lot of second thoughts, I think.

               13               The lives are saved, I grant that, but I don't @.1-ii.n@

               14    they have to be saved by a dedicated vehicle.  I thin),, this

               15    is overkill, or oversave, I gu!ss is a better word.

               16               DR. BESSON:  May I        a motion?

               17               DR. SCHEII'LIS:  k-ly other concern is -- May I bring

               18    this up?

               19               DR. BESSO',"4: Yes.

               20               DR. SCIJIE'E'@LI"@ .@ici scaianii-i@l tli.i-s, you !,,avc qoi-

                     tlll-oUg
                           1-1 4 tI don't see         _@l-.e@7 relate to tl)e problem
               21
   0
               221   bringing this individual w".r) i.s gel--tirig cardiopulmonary

               23    rE:@z-,uL-,ci-tal-ic)r, into the eriercic.@,ic-,, roopi. I,.7hat happens in the

                            Cy @--C)Olll?
               24      r @ c; ri

  ce-Fedefal i-@p-pc)rters,  l@ic.
                                DR. ]-')ESSO.@\'@       it
               25





    d@ 4


                I              DR. SCHERLIS:  If the staff can't carry on the

                2   emergency service, if they aren't geared to handle it, this
   0            3   is why we are talking about a system of care under a
                4   regional medical program.

                5              We are looking at a system, not at this phase

                6   of transportation.  You will frustrate every emergency

                7   technician unless you have a system built into it of a

                8   continuum of care.

                9              DR. BESSON:  I don't pick up where they take over

              10    as soon  as TER is mentioned.

              11               DR. ROSE:  I think this might be part of the

              12    constraings of the contract program again.

              13               DR. SCHERLIS:  Let them have their constraings.  I

              14    don't think we have ours.

              15               Dr. Matory?
              16               DR. Y@TORY:  So far as the emergency serV4Ce is
              17    concerned, one of the problems they have is that a.significant

              18    number of the 13 hospitals in Birmingham do no@t-. have emergency
              19    rooms.  And I am not sure but what that may fortify that

                    need for havina better ambulance capaiDi.l.it-ies.
              20                  1
              21               DR. SCHERLIS:  The point I would make that if they
                    spoke of  asystem of having transportation -- decided they
              22
              23    would  have three or four emergency rooms in that system and
              241   ac@arc--,d, -@-,o han@ll.c- -thc catastrophe when it was brought there,
  ce-Fedetal Reporters,  Inc. I would subscribe to this as being a way of upgrading it.
              25




                                                                                 239



     dw 5        1               But if they are just isolating this and having an
                 2   academic approach in one area and zero elsewhere, it isn't a

                 3   system.
                 4               DR. MATORY:  I think they lean towards that
                 5   because they speak of strengthening the categorization
                 6   principle.
                 7               One other thing, I was just wondering if perhaps,
                 8   could I offer the alternative of  instead  of  wiping  out  all
                 9   of the coronary care units, perhaps there may be some
               10    proportion, one, two, that remain as part of that
               11    demonstration.

                                 DR. SCHERLIS:  Dr. Bosson?
               12

                                 DR. BESSON:  I think that is a reasonable
               13
               14    approach.   I share your concern about  this  degree  of  money
               15    on a program which doesn't need demonstration.
               16                But there is more than  just  the  Birmingham  area
               17    we are talking about, we arc -talking about a five-city
               18    area, and eventually a larger conglomeration of maybe three
               19    counties, is that correct, or five counties.

                                 DR. JOSLYN:  Aren"L- these five cities suburbs?
               20

                                 DR. SCliERLIS:  It is Greater Birmingham we are
               21    talking about.
               22
               23                DR. JOSLYN:  The counties, as I got it to mean,
               24    are the counties in              proper, tapering off, the
  @ce- Federal Reporters,  Inc.Iloca:L- directly around it.
               25@




                                                                                    24 0


     (iw6


                                  DR.  BES@-ON:  I  don't  know  what  the  geographic

                 2    area is that  these  mobile  CCUs  are  going  to  address,  but
                 3    I would be personally  happy  to  cut  down  both  on  the  number,

                      and maybe if we think  in  terms  of  two  rather  than  eight,  at
                 4
                 5    least it  is  the  equivalent  of  what  Moscow  has.  That  might
                 6    be an approach.  I don't know what else,
                 7                DR.  SCHERLIS:  The  Chair  would   vigorously   oppose
                 8    any support of a  dedicated  vehicle,  even  one,  and  I  am  a
                 9    cardiologist, I would like the record to show that.
                10                But having just spoken Of that, there was a
                11    film that came out which was supposedly for systems of
                12    care, to save a life, and having had the support of American
                13    Heart, re-shot in great measure so it-addresses a total
                14    system of care rather than a dedicated vehicle.
                15                I think to support a dedicated vehicle concept
                161   at this tire  is  against  the  whole  concept  of  making  your
                171   emergency medical technicians be able to handle that type- of
                   I  situation as well as others.
                181
                19                This is the sort of training we are talking about.
                20                This is the  course  of  training  that  -is  certainly
                21    recommended, the only one I t@ii-nk we should support.
                                  Furthermore, if  we  are  going  to  talk  here  about
                22
                231   transportation in brir-gix,.g them to emergency rooms, which
                   I  Erei-i't able to handle the      !I of  care  necessary,  you  are
                241
  ,ce- Federal Reporters,  life.
                      going to have them just dyiy-,.() in the, emorgei-icv room instc@ad
                25




    dw 7                                                                      24 1



                I   of in the street and I don't think that   is commendable as
                2   an approach either..
                3              DR. BESSON:  Okay.  I will accede to the

                    representative from the cardiology section, with greater
                4
                5   wisdom.
                6              MR. MATORY:  I was aware that we were fighting
                7   that battle all along.
                8              DR. HINMAN:  Approximately 300, a little over
                9   300 thousand tied up, as best I can estimate, in the dedicated
               10   ambulances.
               11              If you use a figure of 112 thousand for ambulances,
               12   43 thousand for equipment, 95 thousand direct costs for

                    mobile coronary care training, half of the other --
               13
               14              DR. BESSON:  I will let you do the figuring but
               15   if that is one of the conditions for the award, I would
               16   certainly go along with that.
               17              DR. SCHERLIS:  Anothek strong condition, they have

                    to survey their emergency roorti,s and I think we can lay that
               18
               19   down, can't we     survey their emergency rooms and integrate
               201  that with their system of care, if any support is given.
               21              I couldn't support just transportation.
               22              DR. ROSE:   That is a rat-l-ier massive effort in
               23   itself.
               24              DR. SCIIE,@,T-,IS:  My c)wn fc@eli.i-ig is that this was
  ce - Fedeial Reportets, Inc. r)ut together for a contract and it doesn't fit over guidelines.
               25





                                                                      ,Z4 Z



    d@:
                1           This is the concern I really have.
                21          DR. BESSON: But on the other hand, we are
                3  asked to address ourselves to this project as it is
                   presented to us.
                4
                5           DR. SCHERLIS:  Surely.
                            DR. BESSON:  My -recommendation, as I wrote it
                6
                7  down, is that we don't fund this at all and let HSMHA
                8  play with it, bit that we can't do.
                9            DR. SCHERLIS:  Do you have a comment?
                10           VOICE:  I was at their RAG meeting when this was
                11 discussed and it did come out, this was originally developed
                121 for the contract group, and there was some discussion between
                   the Birmingham proposal, the one down state, and during the
                13
                14 process of all this discussion, they agreed to submit them
                   both places butit originally was developed for the
                15
                16 contract.
                17           DR. SCHERLIS:  It really doesn't speak for the
                18 total system of care.
                19           DR. BESSON:  Well, it has subsystems, and if we
                20 eliminate the subsystem of the mobile CCUs with ill of the
                   additional funding that irc,-)iriges on that without giving you
                21                          1:
                   a number and have you work that out, with those   -ions
                22                                              condi4L.
                23 for the award, A, elimination of CCUs and B, beefing up the
                       -)act to the EP,, @@,     L.
                   af)prc               td ati leas- an inventory of ER
                24
   Ace - Fedeial Repotters,  Inc. then I would accept that as
                251




                                                                               24 3



      dw 9                      DR. HINMAN:  That would be approximately $900,000
                2    for the first year.

                3               DR. SCHERLIS:  Dr. Joslyn?

                4               DR. JOSLYN:  Another question is, it seems this

                5    -- although this is submitted by the state-wide RMP --

                6    addresses only Birmingham, even in Phase II and III.

                7               I wonder about -- in other words, it seems to me

                8    it was submitted as a contract proposal for Birmingham and

                9    doesn't address the state.

                10              I don't suppose it is my rule to    put a condition

                11   on but I wonder if one of the things, that they be.more

                12   serious about the spread of this proposal to the whole


                13   state.

                14              I share Dr. Bessonts concern that this one is

                15   more likely maybe to succeed and spread out across the
                16   whole state maybe than the other one because the other one is
                17   much younger and much less well formed, but I don't think in

                18   the form it is presented, it addresses a state-wide EMS

                19   SyStE-'M in the least, it addresses a city-wide system at a

                20   sophisticated level.
                21              DR. SCHERLIS:  At this point you have suggested
    0           22@  for Project 43 $150,000, isn't that right?
                23              DR. BESSON:  Right.

                24              D R. li 1 N   one year funding only.

  Ace-Federal Reporter,,,,  Inc.
                25!             DR. SCIIEI@LIS:  I have a feeling @,:Iiat you are trying
                  I





                                                                           244
    ci@ 10      I                                                                I

                   to do is come up with some sum of money for th-i-s other pro-4ect

                   and yet we find it hard to -ustify on any of the guidelines
               2                              i
               3   that we have followed to date.
                              I would submit that if we support this, we are
               4
               5   being rather inconsistent.
               6              DR. BESSON:  You wanted a number.
               7              DR. SCHERLIS:  Some of the numbers that I  ave at
               8   hand are very low.
               9              DR. SCHERLIS: You make  your  recommendation.  I
              10   am only functioning as a moderator, with a vote.
              11              DR6 BESSON:  I think we have a meeting of the
              12   minds, and I think it is a double bind that we are in,  and
              13   we are also constrained by time.
              14              So I think as a proposal, if it comes to nine
              15   hundred thousand, that seems like a lot of money for the first
              16   year for the City of Birmingham and we can just arbitrarily

                   cut it from there.
              17
                              They are going to need less central  operations,
              18
              19   I suppose, if they are not going to have the CCUs to play
              20   with, less of the transportation.
                              DR. SCHERLIS: @iy own feeling is let this go  in
              2 1
              22   as a contract proposal which is       they drafted it for
              23   because it-- doesn't fit our outlines.
                              DR. BESSON: Can 't we de-Fer action on this  and
              24
  ce-FedeFal Reportefs, Inc. not give a figure?
              25i
                I




                                                                                                                                                    24 5

        d'w   'll


                               I                            DR.  SCHERLIS                 T et's not support it.
                                                                                          Ai


                               2                            DR.  HINMAN:    What  do  you  mean  by  defer  action?    Re-

                               3      fer it to the Council without recommendation?


                               4                            DR.  BESSON:    Without  recommendation,  to  integrate

                               5      it -- I think council can make a decision based on the

                               6      conditions that we apply on the award, the conditions on the

                               7      funding level for 43, and as far as 42 is concerned, if HSMHA

                               8      is not going to fund it, then I think the Council can operate

                               9      on the basis of the conditions that we have-offered.

                            10                              DR. SCHERLIS:  I don't think they are going to be

                            11        able to.

                            12                              DR. ROSE:  They won't know at the time that the

                            13        council meets whether HSMIIA is going to fund it or not.

                            14                              DR. SCHERLIS:  Is any of that $150,000 available

                            15        for general planning of an emergency  medical  system  which

                            16        is where I think they are at, as I read that.

                            17                              DR. BESSON:  The 47?

                            18                              DR. SCHERLIS:                Yes.

                            19                              DR. BESSON:  They talk about a demonstration area.

                            20                              I assume this can be th.,-- demonstration area, par

                            21        excellence, and I have deleted that from the proposal.
      0                     22                              DR. HIN'P'iAN: The notes I have about 47 are  one

                            23        year at $150,000 with the advise to sharpen  the  EMT  cost,

                            24        local council.-,, -,Dublic erlucat.'Ioii, v@ith no salaries and no
    ce -Federal Reporters,  Inc.      demonstration  project.
                            25




                                                                                                                          24 6




                          I                       DR.  BESSON:    Right.
       dw 12
                          2                                  Okay,  that we  can  set aside.
                          3                       Talking  about  42,  If  the  best we  can  do by
                          4     eliminating the mobile  CCUs  is  to  cut  it  from  1.2  to  $900,000,
                          5     that  still  is  --
                          6                       DR.  SCHERLIS:    I  don't  see what we  get with that.
                          7                       DR.  BESSON:   Let me  just then  arbitrarily give  a
                          8     figure of       $300,000,  which  is  25  percent of their request.
                          9                        That  is  hardly  consistent with  the  sharpness  of
                       10       the whole proposal,  but maybe  I  have  been  led  astray by
                       11       the  rhetoric.
                       1211                       DR.  SCHERLIS:            Dr.  McPhedran,  can  I  get an  opinion
                       13       from you on  this?
                       14                         DR.  McPHEDRAN:           I  don't know how you would
                       15       decide  --  I  don't know how               one  decides  thi@-igs  like  that.
                       16       I  don't  see how we  are  going to decide  it any better in
                       17       council  than we  can decide  it here.
                       18                          I  think  if we make  an-arbi-trary  award here,  that
                       191      council will probably  be  reliev-ed  that we  made  this  arbitrary
                       201      award and  it will  go  in.
                       21                         DR.  SCHEPNLIS:    Dr.  Josl.yn?
                                                  DR.  JOSLYN:    Chc@ckiiig back on,tl@)e  demonstration
                       22
                       23       area  for ilroject  47  or  the  state-@,,,ide one,  that  is  to be  a  ru-.-,-i'@
                       24       deiytons'L-Iration,  which  seems  to me quite  diff(z-,rent  from

   ce  Federal Reporters, Inc.  Bi,rminc-ham.
                       25




                                                                            247
    (-I@ i3

                I               I am just raising that point in which we are
                2  saying Birmingham can be the demonstration area for the
                3  state-wide one.

                              I think they need coordination but I am not sure
                4
                5  that was the point they had then they designed it.
                6             DR. SCHERLIS:  My own suggestion is the hard
                7  one, and that is, it is a good grant request, but I don't know
                8  if they are requesting it from the right people in terms of
                9  what they are asking for.
              10              This is my view.
              11              DR. BESSON:  I would like to defer action but
              12   apparently we are not going to do that.
              13              We are going to have action.
              14              DR. SCHERLIS:  If we say no, that doesn't prevent
              15   them from coming in later?
              16              DR. BESSON:  Later when, next cycle?  Three months
              17   from now?
              18              DR. HINiviAN:  Four months, we are on a tri-
              19   annual basis now .instead of quarterly.
              20              DR. BESSON:  Defer it to HSMIIA funding and if HSILIIA
              21   doesn't fund it and review it, next cycle.

                              DR. SCHERLIS:  Vii-th the liinitationsthat we have
              22
              23   placed on it.  It must come in as a system.
                              DR. BESSONI:  Number 47 @@ith the rec@-),mi,,ie-ndatioi-i
              24

  re Fedefal Repofters, Inc. that we made.
              25




                                                                              2 48




    dw 14                       DR. SCHERLIS:  Dr. Rose?

                                MR. TOOYIEY:  I will second the motion.
                21              DR. SCliERLIS:  Yes.
                3
                4               DR. MATOPY:  Point of information.
                5               Your statement that it was not applicable to the
                6   guidelines  was based upon what, area involved, or what?
                7               DR. SCHERLIS:  I think if we are going to talk
                8   about an EMS, emergency medical  system,  that  even  though  you
                    can support one phase of it, it has to be  tied  in,  as  I  view
                9
                    it, into the entire system.
                10
                11              And this B specifies  it is to the problem of
                12  one categorical  area,  essentially,  coronary  disease,  without
                13  the total phases of emergency room  on  one  end,  coronary  care
                14  unit on the other, a stratification of care in these areas,
                15  following recommended TCHD contracts, and so on.
                16              To me, it-establishes a high priority on one
                17, limited aspect of the total emergency system, and the
                18  emphasis we have had right along is that it shoulL.d not be
                19  categorization.
                20              This is one of the objections we have had to
                21  trauma as an isolated approac'i'l, and this, again, doesn't
                    go to coronary care and dedicated vehicles.
                22
                23              DR. iNL7@.T()RY: I am sure those of you who read
                241 that -- I didn't read it, but I say coronary care was one of
  P,ce- Federal Reporters, Inc. them, and I felt it @ias to coronary care.
                25




                                                                             249
       'I 5


                1              DR. SCHERLIS:  I think this was its major focus.

                2              DR. BESSON:  It is not its major focus.
                31             DR.  SCHERLIS:  According to what you have mentioned,

                4   it is.

                5              MR. TOOMEY:  He is talking about the equipment.

                6              DR. BESSON:  There are six or seven components,

                7   as far as equipment is concerned, yes.

                8              DR. HINMAN:  I am uncomfortable.

                9              DR. SCHERLIS:   We haven't made any  motion  yet.

               10   Would I  accept separation --

               11              DR.  BESSON:  I am going to move adjournment.

               12              DR.  SCHERLIS:  You recommended $300,000.

               13              DR.  BESSON:  I recommended deferring it  to  the

               14   next cycle if HS@IHA doesn't fund. If HSMHA  funds,  we  are

               15   off the hook, for Project 46.

               16              For 47, $150,000.  3.5 for 47.  4.0.
               17@             DR. ROSE:  We are likely not to have that.
               18              DR. HINMAN:  It is possible.

               19              DR. BESSON:  Okay.

               20              If I have to- give a mtrLc-,r, then, with all of tl-ie.. co,@-nts

               2 1  that we have had, and the blush taken off this  rose,  -From

               22   I..2, 25 percent is the figure that I suggested.

               23              DR. SCHERLIS:  $300,000.
               241             DR. BESSON:  Right.
  @ce- Federal Reporters, Inc. DR. SCIIERLI,@3: Is thE@re a se-ond. to tha."-".1
               25@
                 1




                                                                             250

       A
    dw  16       ii


                I               DR. MC PliEDRAN:  Second best one year funding.

                2               DR. SCHERLIS:  Who would be in favor for Project

                3   42, $300,00 with a rating of 4?

                4               (Chorus of ayes.)

                5               DR. SCHERLIS:  All right, that passes.

                6               And a hundred and fifty thousand dollars for

                7   Project   43.

                8               DR. BESSON:  Yes.

                9               DR. SCHERLIS:  Was that for one year?

              10                DR. BESSON:  Project 47, yes.

              11                DR. SCHERLIS:  42 was for what?

              12                DR. BESSON:  One year.

              13                DR. SCHERLIS:  All right.
              14                We now have the peculiar dilemma of having
              15    several more projects to review and time having run out.

                                I wonder what -- I know we can finish in 45 minutes,
              161

              17    but that cuts out the plane travel.
              18                DR. HINMAN:  The problem that we have is that we ha  7e
              19    to go to council two weeks from today, three weeks from

                    today, whever it is, and we have to give them some sort of
              20        .4
              21    answers about these applications,

                                DR. SCHERLIS:   Yes.
              22

                                I have no problera,
              23                DR. MC PHEDI-Illz',14: I can stay.
              241
  ,c-.e-Federal Reportets,  lrc. DR. SCHERLIS: Who else has to leave?
              251
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                                                                          251




    dw 17                     DR. ROTH:  Only plane I have is 5:45.

                              DR. SCHERLIS:  All right.
              2
              3               And you go where?

                              DR. ROTH:  Erie, Pennsylvania.  The last plane
              4
              5    I can get out is at 6:00.
              6               DR. HINI@I:  With three, -that still is some
              7    representation.
              8               DR. BESSON:  How about you, Bob?

                              MR. TOO@IEY:  My plane leaves at 9:00, so I am
              9
              I 0  all right.
              11              DR. SCHERLIS:  Well, Dr. Roth, you are primary
              12   reviewer for some of the remaining ones.

                              DR. ROTH:  Some of mine are real short.
              13
    end 21    14

              15


              16


              17


              18


              19


              211

              22


              23

              2411
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                                                         DR. SC11r,"T,-FS:             @-1c,                           cl@c)             bv
                                                                                                                                                          on @7, .


                                   The      first      is      eastern      br,@nc.,I-i,       tli@it           be  A2.bELny,  cind  so  on,


           ,<XXXX
                                                         DR.  llOST@.;:       Tha@L.    i    s    the  Lirst  section  i-n  Volunie

                                4  of  your  book.

                                5                        DR.        PESSON:         Albany         is asking  for  a  six-month  grant

                                6  of        $109         thousand,         direct         'Lundirig,  -incl  then  for  a  -L-wo-year  (,,re@rit

                                7  rcqi).est      of      3,.5      riillion,      running      from       December       of       '72       at       the

                                8  end  o,4  six  i-,..onths  to  December   '74.

                                9                        The  general  plan  for  Alban@r                              I  will  just  read

                             10    bri(-.'L  exceri-)ts  --  is,   from  the  summary,                                 am  reading,   "A  tl-ir,@e
                             I 't !3rc-@ai-  s-L-.u.(Iv  to  investigate  the  design  and  imp'Lc--,inenta,tio.-i  of  I
                             12            fo@,,-  the  capitol  district,  consisting  o'                                          ti-,e,,;  Ciesc---i.be

                             13    to  bc!  t,.,.,,o  m@Ajnr  components,  external  to  the  hospit<@l

                             14    irternal.

                             15                          The     external  is  I)asj,(--allv  the  use  of  a  r,-ij-i-d

                             16                        p).an     an-,t  T)relijrLinary  care  in  a                             And.      their       the

                             17    internal  si;r.@tc-m  is  the                                            of                        a  four-bcd,.

                             18  1 traur,)::i,  irite-,,-is-"Lve-care-  unit;   I.ocat(?d,                                                  C(-,ntor;
                             19            a                     -similar            uiiit;                 in  a                         hos,,)it@il.
                             20                                                                                    l@',-)r     a     mom@int.       Thear

                             21  1 a'y-          fO              @ix  b(--,(!@l      Lh@,y    E).rc-@
                             22    Z')O                            r e  l@) e i. 1-@ @,,i l@     'L-.  0                0 1 1    Li s           f@        :,L@
                             23      a r c. f  r  's) u d              c, z,,             o         e- s c-.,  a a.-   s ',, -c    l@, Y. i an i a ,  w ",-I      I

                             24              473 t                 ;.'JCjr);  Eric]                 t -@i- () I A @ I I    oe-              jl

    ,(,e-Fedefal R@porte(,s, Inc.
                             25          584     00@c)




    te r-2                                                                      2 3



                  I            The@, are also asking for the purchase  of  equip@tent
                  2which comes to 230,000. They  are  askin_g  for  computer  funding

                  3in one form or another of 90,000.    They are asking for the

                  4purchase of ambulance  and  communications,  coming  to  30,000.
                  5            In addition to this, theN7 are  asking  for  300,000
                  6for what they referred to as a variety of incidental expenses-.
                  7l@,asicallv, this is a request for funding a continuation of Dr.
                  8Samuel Po@.@,,@-rls research in trauma physiology.  The general
                  9thesis is that the physiological --- meticulous physiological
                  10 monitoring of massive iiijurv has focused on the  posttrauma'L--ic
                  11 respiratory distress svndrome as a cause of death.
                  12           The literature-mo@-I)iditv rate of 40 to 80 percent
                  13 in this situation has }.)ee-n reduced in this particular res,2arci-i,
                  14 intensive care unit approach, of careful physiological nion-il-,or-
                   ing to one oil the last ten  patients  with  massive  inl'uries,
                  15   r
                  16 and the research unit says -- and they make a categorical
                   statemeri'L- on page 21 of the al?-)].,i-.cation -- death from this
                  17                               1
                   cause 1-1as been virtually eliminated, although the.  basic  cause
                  18
                  -19 of death is still uiicl-',c@ar.
                  1
                  20           TI)is entire pro(jram in        is to continue that
                   res,@a.rch effort-.. "'ioi-., in r(@acaii-ig the @tl-)I@)lic@itioxi very carefi,, 1 'L
                  21
                  22 it is a magnificent piece of -won't, but -T think thit. there  are
                  23 a variety of ruses usc@,! b-@      to triggE,-r funding.

                               For --@xaT ',_)JC- ,tl-,@
                   I                           .,-,  call.e.,,l a c,c.,i@-,ol'istration
                  24i
  f%ce-@Federat Repoftefs, Inc' is liar@lli a            but @ coTil@ii-ikiatic)n of i.
                  25




         3                                                                          21



                 I    pl-i@7siol.ogical.  research  l@rogra- It  includes  two  trauma,
                                                   rt

                 2 !7,i-,,e-car(-- unit .,."(--,ds in a coi-,ti7iunity hospital, therefore- cloaking
                 3  the entire project with a mantle of it being a cor@imunit,v

                 4  project, which it hardly is.

                               it pays lip  service  to  external  hospital  care  by
                 5
                 6  physician-corimunication with onsiglit  ambulance  personnel,  but
                    very cursorilv mentioned. It  also  pays  lip  service  to  evalu@
                 7
                 8  sting the cost, morbidity and  mortality,  with  what  are  called
                 9  "ordinary ICUS," presumably comparing  them  with  what  I)r.  Powers

                10  can do @.,,hen he is there.
                11             It pays lip service  to  outfitting  a  Wiiinebigo  Camper
                12  -as a mobile ICU to demonstrate its values.    It  has  one  sentence
                13  in the entire proposal on community education.      It   proposes
                14  to establish a copirqittee, and lists in one sentence, ten  groiii.)s
                .15 which can be triggered as  "okay,"  groups,  that  will  make  up
                16  this committee.
                17             It talks alDout  accident  epidemiology  as  an  Extension
                    of a pac,-,age- zt'L- Rensselaer T-'olytechi-iic Institute, which is sai,,i
                18
                    to anr-ilvze emergency events as -)rc,(Iicted. models, but I   not
                10
                    i.j!i,@res,3o.d  N@7ith  the  detail  -Ln  that  predictive  Yiiodel,
                20
                91 IThe 129,000 N,:hi-cil is modestly requested for the first si.@@
                  I
                    months of funding gives inc@- the            of being 3-,i@rid of a
                22
                    (:',ulf of Tc)i-ikin ',?e-soluti-c)n, @,7itl-i a $1.5 million reqti(--st in the
                23
                24  baclzgrc)u.@d.
  Ace--Federal Repofte@s,  liic. It sc-crfl-@ to !,)C.@ only tlc    of  a   limitless
                25




      ter   4                                                                                                                  2  5




                              and    i-ris    tialDle    investment    that    is    -r-rel--varit    to    the    prol)]..e,,.-Is
                           2  that need  solution  in  this  area.                    @vhen  I  talked  to Dr.  Schc-,rli.3,
                           3  a          ago,  about how this might  be  set up,  he  suggested
                           4  maybe  the best we could do  is  grade  them  "A"  to  'IE"  on  'the
                           5  basis  of what we  have been  told  this morning,  and  from
                              divined,  I  would  grade  this  as  "E."
                           6@                   Incidentally,      the      technical      review       gives       this       pro-
                           7.
                           8  -potal high       marks,  but  it is with  so much  technology  in  its
                           9  approach,  it really does  not  address  the right question.   ,,@7hi-le
                            ithis  is,  then,  a remarkably,  progressive  approach  to physiology
                           10 ical     monitoring     of     death     from     massive     injuries,     I     think     it     is

                              @,7ide  of  tj-ie mark of what we  in,.-c-,-n@l  to do with R'P.@Ps  funding.
                           12
                                                So,   I    would    recoi@-Li-,,.cnd    no    funding    for    ti-,,is    project.
                           13
                           14                   DR.  SCIIERLIS:   Secondary reviewer?
                                                MR.  TOOMEY:         I   think    that    is    iiie,    and    I    could    onlv
                           1 5
                              ac,.Tree          what Dr.  Bessoii has  said.                 it  looks  to iic-.  as  though
                           16
                              it            ]De  a great T)iece  of  reE@,c,@irch,  and would be very
                           17
                                                 and very de@i--abl(-  to j,)e  continued,  but  I  just
                           18
                           19 felt    it    iqas    wide    c,@-    the    mark    as    -far    as    the    emergency    medical
                              s@.rvicet-;, were coiicc2rr,.ed.
                           20
                                                DR.  SCIEl-,,!!-[S:      I  g,,Ae@3s  the  rating,  according  to our
                           21 previev7 criteria  --
                           22

                                                                T
                                                DR.  BESSO'V          I          c) t  s c., c@  t h c! s e  sP- c t- s a    c@  I
                           23
                              will  1-iavc,  to  look                                                       a)--e  doill(,T    i 3' F@ .
                           241

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                           C.                   D P .  @) C 1i'@, I f)                                                   T) Ci i ii  t
                           251







     c,@


                   IPerhal-)s 1 am the onl@7 one confi-i@c-,d on this.  Alban\7 is ii.,,;tc-@d

                   2a                            Dr. Bessoil, ati@l Mr. Toomev, o,  this
                    's the primar@r reviewer

                   3form.

                   4             If I look at the other one, it is Dr. 1-ici).tic-draii and

                   5Dr. i3esson.


                   6             DR. MC PIIEDr-,AN:  For Albanv?

                   7             MR. TOOMEY:  I had it done.  I was secondary.

                   8             DR. BESSON:  I think I was primary.

                   9             @IR. TOOMEY:  That is right.

                   10            DR. l@OSE:  All of these were reviewed I-)v these

                   11 Irevie%.,,crs. That is a mistake.
                   I
                   12            DR. SCIIERLIS:   I see.  This is divided amoncT -L.Ilie

                   13 four, but this is the in.(Iivi-c't@ial assicTiiment.

                   14            DR. BESS@,41   I would recommend, Mr. Chairman,

                   15 that in accordance with this @,7crl,,sliect -- I assume that our

                   16 final, decisions will be on tl,,c-,se sheets, is that right?


                   17            DR. S@-IIEPLIS:  Yes.

                   18            DR. BE;SSNN:  These !.\7hitc-,- slie-c@tr,?
                   191           DR.              Yes.  IIha'L-. I E;ugcjQ-st is th@).t@

                   20 -,-ra-rAary       ha,-id  that  street  to  Dr.  Rose,  and  that  !I(-,-  be

                   21             for ti-,c              of tl-iat Si)-e-et.  @.@,ould ttiat

                   22 i-)e sa@tis-Factorv?

                   23            DR.  Rr)S'@: Yes .
                   24            DP,.            n           4-:'Ll.1, out ea(,,','l sh(--c@t@  'I'lic@

  Ace-Fed(i!at  i@epoftefs,   In c'
                   25             thil-  c(:,),, (@@3  in  J-'iiis




    ter@-G                                                                      27




                 I             DR. SCIIERLIS:  I would suggest we not have i-ndi.vi--

                 2  dual votes but a co7Tqittee vote, and on-.I.@,- the pririary revi.e%vo-r

                 3  fill it out, and that it recommend the concurrence of the

                 4 secondary reviewer and of the committee, unless of course,

                 5 we have another situation.

                 6             But, I would suggest that you have the responsibi-lit-,i

                 7 for filling this out, reflecting the committee decision.

                 8             DR. BESSON-.  I would recommend, then, a, no

                 9 recommended funding, no conditions for a@qard, and rating five


                10 or one, excuse me.

                11             DR. SCIIERLIS:  Rating oiie?

                12             DR. DESSO'LNI:  Yes.

                13             DR. SCIIERLIS:  Does the secondary reviewer coi,lciir

                14 with that recoi@riiendation?

                15             ],IT@. TOOMEY:  Yes.
                16             DR. SCIIERLIS:  Any otlicr comments from members of

                17 the revieii group?
                181            I %.fill accc-,pt that as     a motion which has !)c,,c.,!n
                19 seconded by the secondary reviE!\,,,er.
                                             .1

                20             Ai-iv fur-@ll-l--r d4@-,cussioii.1

                               Those in coz,,curr(2i-ic,.:@,, s4-.griif@i 1)@, saviii(j '@a@7o.'r
                21

                               (Chorus of aves.)
                22
                23             DR. SC'L',T2,'L',I,'ES

                               Til-ia,;'L-- took                                1
                2411

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                            1--hi.@3: If, for an@i       as p@@rt. of @U-iie
                25@






        7



                I if any of t,-ic taslr-I force of the staff @,71'ij-ch Has been involved

                2 either in summarizing these, or as -Iart,- of the DOD Brarch,


                3 wishes to -iake any comment, I would appreciate that. -So Dr.

                4 Tc,,slyn and '@ir. Nash, if vou would like to make aiiv comment

                5 Dr.  Joslvn?

                6            DR. JOSLYN:  I concur.

                7            DR. SCIIERLIS: lle would like some facts presented,

                8 rather than a strong opponent or antagonistic point of view.

                9            DR. IOSLY,@@l:  All right.

               10            DR. BESSON:  One other question, Mr. Cli@tirman.  TH-LE,

               11 distillate Will mean nothing to me after I am done-.  It may- be

               12 1-----".IDful to the staff if it is legible.  TI-iere is no --eason

               13 N,7h-@.r I have to take this home with me.

                                        1,7 C,
                             DR. ROSE:     Would appreciate very much, haviiiQ that
               14

               15 if you are riot going to need it.

               16


               17


               181
               19@

               20


               21


               22


               23


               24

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                                                                            2 1 8






                             Have N-i                                                       >


               2


               3

               4             Arizona.  lle are now on the western branch regions.

               5             The first one in that area is Arizona.  Arizona
               6 has requested the sum of $116 thousand for one year for the
   xxxxxxx     7 organization and development of an ET-IS to provide accessible,
               8 adequate, and appropriate emergency care to all residents of

               9 Pima  County.
              10             It pronoses to adopt existing technology to produce
              11 a comprehensive plan for development of an integrated emergency

              12 medical service for Pima County, Arizona.
              13             The primar@, goal will be the development of a cost-
              14 accentable organizations. structure for the provision of EMS
              15 fc)5@ the som-L-rural communities, and adjacent, sparsely populate
              16 rural areas outside of the Tucson metropolitan area.
              17             The second goal will be developing methodology for
                                                            1
              18@ -Llic-, organization of s,:)ecifi-c alternatives, for the implement-
              110 a-Li.oi-i in principal metro)-.)olit--an
              20             The staff rerTuest is               $S:') thousand,
              21 f o r a 1.)r c@,@ I -,d o%@.,ii o f t 1 iud (j,@, T Ic@ c t c o s t @-, a r o @ 1 (@ 0
                 tlie@iif7,,-ind.  The al)y)roac"i sccr,,,s 1-o bc@ -L r(@asoiial.)Ie one. It does
              22
                 build on existing rced.-, and             as they go a on@,  o
              23

                 e ,r (7-@ I-L C'@ e, -E r-L c-  t 1, @:1 c@t c; u 11. I y
              24i
        Reporters,  ltic,
                             I tilin'                       at t',)c-@i.r
              251




    tcr--5                                                                                         2 79




                    I  process .@7ill be.      It is a well organized prograiii ,-,,hich will

                    2  co or some 350,000 population area, of something like 90 to

                    3  100 scTuare miles.       The organization sponsoring it is the

                    4  University of Arizona College of medicine.   They have the

                    5   endorsement   of   the   Comprehensive   Planning    B    Agency    and    the

                    6  Governor's Highway Safety Coordinator.

                    7                 It is a rather clearly stated project.   I mention

                    8  the figures that I did         because I think, in terms of what they

                    9  are talking about, they are asking for a somewhat higher sum

                   10  of  money   than   they   might   require   in   terms   of   what   thev   are

                   11  looking      at.

                   12                 I  suggested   that   they   be   rated   at   a   level   of   three,

                   13  that  in  terms   of   the   funds   which   tliev   are   requesting,   as   I
                   14  said, this is just for Pima county, and A population of some
                   15  350,000  --  I   thin!:   thev   are   asking   for   an   excessive   sum,   but   I
                   16  @,loulcl suggest 'that they be funded to the. level of $65 thousand.
                   17                 This is essentially the planning phase at this time,

                                       L- I               a TDrofitable use of the funds.
                   18  One @.yh'tch I think will Le          -

                                      Is   there   any   member   of   staff,   here,   familiar    --
                   19
                   20                 VC)ICL:   I a.,t,@ ',I re

                                      DR. SCI'@@@-i',LIS:   The Question I          going to ask you
                   21

                       is a (-uestior@ in terms of the         involvement   of   the   i-)eolDle   of
                   22

                   23         ""ourity.

                                                           '11:3 .11,1                             feelin(-,
                   24

  ce- Federal Reporters,  Inc.
                        E,@   at        look i:7, if          c@iii       it along           (-,ssenti.@ill,,,
                   25







              I  at a plann4ng phase which is what they are lookincT at and I

              2  think with the help of the people they involve in the school

              3 and the act of involvement of their B Agency, they should be

              4 able to get this off the ground.

              5             Are there any comments as far as other members of

              6  the review group are concerned.

              7             Then the motion I would make has been made in terms

              8  of funding at 65.

              9             Is there a second?
   tdn 4ff24  10            DR. MCPJIIDRAN:  Second.
              I I


              12


              13


              14


              15


              1 6


              17


              18


              1 9


              20


              2 1


              22


              23


              24

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            1 4                                                                                                     1 5 9
      G]v@
      i'rb 1



                                                     SCT-1
                                               DR.      i.ERLIS:      l@ell, we are now going to have

                          2
                              Arkansas.
                          3                    Arkansas submitted a total of six proje--ts, which I an6

                          4
                              Mr.  Toomey      have been asked to review,  and these are a varied

                                                                  @f, tttze
                                                                                                            @ll3fOOO,


                          0    $10,000,  $33,000,  $47,000 -- a total of some $307,1000.
                          7                     If I can try to put these in some semblance of
                          8    order -- actually if you will look in the back page you will see
                          9    that it comes out to an excess of  $1 million-.
                          10                    The first speaks  to establish a coordinate education

                                      m
                               syste   of     emergency medical services  for Arkansas,  and this

                          12
                               is s(-t-tle@-I wi,th the VA hospitals.   I'm trying to get these


                               numbers in       order.
                          14t                   The application to support the state--wide e,aser(,Teric

                          5
                               radical services system to include medical @-tervices counci'L,

                          16'
                               consume.- education, transportation --- in other words, the
                          I                                                      -
                          171
                               entire support.
                                                                                                                                           PU
                          181
                                                It is designed to include some regional develorr@ien@.
                                                                                                                                           z

                          19   A preliminary worl-. scl,.edule was presented to allo,,.i time phase

                          20             and  then prose,-t-i-L the entire methodology for this.

                          21   i'@tien yoii go thi7ough this,  it is reallv very difficult to

                          22
                          II   deteryn-i-ne exactly what is specifically requested.
                          23                   rli
                                                Lhis  is  a very ar@bitious program bu-.  the entire

                          24               i,s r"?F@il-ly very pc!t@r3-@), e@3.@gaiNized.   Ar@7  1 i@,loi-it throu-ti,@
                               rr
                          25i'
                               this      felt z,c-y-:c@,tc@,d.Ly the i-ic@c,,d for a morc, (I(.,-tai--Ic-,d budget



          jrb2                                                                                                              6 0       i




                               and more indication of  exactly what was being planned.
                         2                       The  application itself  to me  seems  to be,  in a

                         3     word  that I used for it,  excessively padded.
                         4                       It emphasizes both planning and operational activi-,

                         5     ties.   Funds  are requested  for developing of  a pilot project

                         6     as well as developing a state-wide emergency medical  system

                         7     and both of  them are heavily oriented towards  the purchase

                         8     of hardware.

                         9                       The  salaries  are  something  like  $75,000,

                      10       consultants  come  to  $76,000;  the equipment to $40,000.

                      11                         They have asked for rennovation of part of  the @TA

                      1  21    f aci I i@ ty     They have  i-rclur3.ecl- rep'---cement of med,-c--!

                      13       supplies.
                      141                        As  I went through  this,  I  felt -that part of  it
                          1
                      15       should be       supported,  namely  that which emphasized essentially
                      16@      the  training  aspects more  than anything else,  and I'll come

                      171      back  to that as  I review some of  the other programs which wex,.a
                      18@      part of  this.
                      19                         Project  42,  which again is  part of  this  overall

                      20       Arkansas program,  is  asked for by  the Arkansas  Health Systems

                      2  1     Foui-i6,ation to improve emergency health  services  for a s.'-

                      22       county area in Arkansas.

                      23                         The  attempt is  to upgrade emergency                      servi,(-,(@s  to

                      24       t'.I(-@ critically-ill  or                              orl@, i-7i-Lli.@,n  -'--his
   e-Feder,,ii  Reporfe@s,  Itic.
                      25       but outside  as well,  aid  tl@cy discuss                      this  as being eclileved
                          ii







                    by rural involvement through the establishment of a hospital-,
               21
                    based ambulance, regional communications system.
               3               They speak of ambulances being placed in each
               4    rural hospital staffed on a 24-hour basis, and this would be
               5    the responsibility of the rural communities.  They emphasize
               6    that there is no communication transportation from the
               7    rural hospitals in the six-couiity area with the local regional

               8
                    hospital.
               9               Again, the request here is in terms of a great
              10    deal of funding for actual hospital personnel.  Salaries come
              11    to something like $95,000, mostly for this, and the equipment
              12    to $60,000.
              13               It is a three-year operational request which is
              14    aimed at improving emergency room facilities, general
              15    emergency services, major emergency services, upgrading

              16
                    emergency services.
              171              There is no really good description  of  just  what
              18j
                    is being planned, although they do ask  specific  support  for
              191
                1   emergency room personnel and equipment.
                I
              20ii             one problem here is that there is  no  real  system
              211   of care which is discussed.  As you go through the sheets --

              22    and I did this to again evaluate what specific items 4,ere
              231   present -- -,,ou will find that they have really not  directed
              241   themselves adequately to the criteria as outl,ine(i by the
    eliji@rat  Repo.-tefr,  liic.1
              251
                1   actual r(-@cfucsts that they had received in terms of the




     j                                                                           162




                I   outline which they should follow.

                2               My feeling on this was that  it  was  a  very  poor

                3   request and I questioned whether any support should be given

                4   to it.

                5               The next one from Arkansas  was  again  for  a  six-

                6   county area, the development of an emergency medical services

                7   system.    It was for a one-year planning project.

                8               This particular instance,  again,  it  was  a  very

                9   brief  application.  They  only  requested  funds  for  planning

              10    this in the Little Rock area.

              11                The approach appeared to be a reasonable one, but

              12    they had asked again for what I thought was an excessive

              13    smount of funding and although they did follow the guidelines

              14    more carefully, I gave this  a  rating  over  the  others,  but

              15    again do not recommend full  funding  for  it,  and  I'll  give

              16    the numbers on that in a moment.

              17                The next request was again for Arkansas.

              18                As you gather as I go  through  this,  this  is  not

              19    an overall, well organized project.  There are bits and pieces
              201   applying to different parts of the State, rather than being
              21    a well-coordinated education program.

              22                This one was an in-deptl-i study to determine  the.,

              23    need and approach to emergency care and to establish such a

              241   program in a 10-coiinty area.
    Federa I  Reporters,  Inc.
              25                They asked for one-year support in order to plan




       jrb5                                                                      16 3




                 I   an emergency medical  system  for  '-h@s  10-county  area.  This
                 2   was given in more detail, but again, there was a lack of
                 3   adequate information.
                 4               This was a rewrite of what  appeared  to  be  a  grant

                 5   this was a rewrite of the  whole  guidelines,  so  at  least  they

                 6   did follow the guidelines more adequately than the others had

                 7   but, nevertheless, there were a great many omissions.

                 8               There was nothing new or innovative about it.

                 9   I felt. there should be some  support  for  the  program  because

               10    it did address itself to planning,  and  I  think  they  at  least

               11    defi_ned what their needs were.

               12                The next was, again, part  of  a  vrogram  just  for

               13    Southeast Arkansas; in  this  particular  one,  they  asked  for

               14    funding to establish a  plan  for  an  emergency  medical  service

               15    system to involve the districts, 11 hospitals, establish

               16    new ambulance services and  upgrade  those  which  were  then  in
               171   operation.

               181               Again, although there   is evidence of  a  real  need

               19    as there is in all of these, one    can't help  but  be  impressed
               201   with the fact that there is very    little  documentation,   that

               211   the application  reports  themselves  are  really  very  sparse.

               22                And if one funds this, again it would be a

               23    priority which is rather low,  and  I  would  restrict  the  funds
               Z4@   here as wc-11 fo-- the pl,,-iiin,-ng
  :(--Federal  Ref)orters,  Inc.
               25                I thinl-, to move in-to any fii,.@ther step at the




     jrb6                                                                 164




                   present time would be unjustified.

               2              In summary, looking at all of their applications --

                              MR. TOOMEY:  I think you skipped one, Doctor.

               4              DR. SCIIERLIS:  Did I skip one?

               5              MR. TOOMEY: East Arkansas Planning and  Development

               6   District?

               7              DR. SCHERTJIS:  That was omitted from mine.

               8              MR. TOOMEY:  okay.

               9              DR. SCHERLIS:  Do you want to give that?

               10             MR. TOOMEY:  It is a one-year planning grant  or

               11  the Eastern Planning District, comprised of 12 counties,

               12  which is the second largest area in population of the State,

               13  with 371,000 people.

               14             Ambulance services in the area are operated I-)v

               15  funeral homes and private concerns. The primary  objective  of
               16@ this request is the development of a direct ambulance  service
               171 linked v7ith radio communication.
               18             The narrative speaks to the requirement of vehicle,,

               1 9 and co-,'Iliiiinicat-Lons equipmon-(. with no overall planning

               201 mechanism for the formation of development of a coordinative

               21  system within the district or with the state EMS plan.

               22'            it shows little understanding of   total e,@iic-rgency

               23  medical services system.  The monies are requested primarily
               241 for the purpose of equipment.  CoiTuit,,Inity no,(--ds and resources
   Fedeial  Repor  tois,   Ir,
               5
               2c' have not been asse@--sed.



       jrb7                                                                   16 5




                               There is no reference to linkages with the system

                2   other  than radio communications.

                3              Of the$142,000 requested,  $94,000  relates  to

                4   vehicles purchased, and $33,000 for communications equipment,

                5   and $4,000 budgeted for training purposes.

                6              DR. SCHERLIS:  All in all, I was extremely

                7   dissappointed with the Arkansas application.  There were bits

                8   and pieces.  Maybe they didn't have the time, but I don't think

                9   the program as finally put forth was one whi-ch really reflected

              10    an overall coordinated effort and I  thought  the  funding

              11    requests were certainly --- what support might be given would be.

              12    more for planning and hopefully on a more correlated basis.
              13@              Yes.@
              14               VOICE:  Project 45 was omitted.  It did not

              15    have Reg review, it was returned by the  Reg  for  further

              161   revision.
              17@              DR. SCIIERLIS:  Tliat's-why I don't have it.  Is that
              181   to be considered b,,, us or not?
              1 9              VOICE:  We didn',@- get it.

              20               DR. SCIIERLIS:  The one just reviewed is really not

              21    part of our consideration; is that correct?

                               All right.
              22

              23               The part just d'-@scussed is not a part of  our

              24    consideration, the last one reviewed, No. 45.  So we have to

    federa I rncpoi  ter$,  inc.
              25    consider  then  the  o,@-her    bn@c;f  No.   41,  which  had  requested





       rj:) ti                                                                     I b t)




                 1    $300,000 for the first year -- is that correct?

                 2               Yes.  My recommendation on that was a funding only

                 3   for planning at a rating of 2.

                 4               The next one, No. 42 -- my recommendation was that

                 5   only be funded for planning to a sum of $30,000 with a rating

                 6   of 2.

                 7               The next one, Item 42, I recommend action oh  that

                 8   one, that there be no funding for that one.

                 9               No. 43, I felt that should only be supported  to

               10    the terms of planning.  My recommendation was $25,000 there

               11    with a grade of 24

               12                Project  44,  for  which  $31,000  had  been   requested,

               13    I felt this one at least had some fuller data, and I  thought

               14    it  should  be  supported  for  the  funds  requested  for  planning,

               15    with a rating of 3.

               16                No. 45 is not subject to our consideration.

               17                No. 46 is.  My rating on that was only for planning,

               181   to a  tota'L of -- what  they  had  here,  $15,600,  with  a  grade

               19    of 2.

               20                Secondary reviewer?

               21                lie can be wide apart on these, given the funds

               22    requested,  and the comnt--tericy of draftsmanship.

               23                MR. TOOMEY:  I  was  loolring  at  something  -"  as  you

               24    were   going down the requests on the planning, I was in
    Fede ra I Rel)o r 1,@ i s, I n c.
               25    agreement,  and I figured vou were going to  --  I  don'-t  knoi,7




                                                                          L b 7






                  where you were.

               2             DR. SCIIERLIS:  Project 41, I recommended $30,000

               3  for the first year with a rating of 2.

               4             MR. TOOMEY:  That is the $300,000?

               5             DR. SCHERLIS:  Yes.

               6             Now,-then#"  Project 42 I did not recommend being

               7  funded.

               8             Project 43, I recommended $25,000 with a  rating

               9  of 2.

             10              MR. TOOMEY:  That is the $45,000?

             1 1             DR. SCHERLIS:  Yes.

             12              The request had been for 45.

             13              Project 44 had requested 31, and I thought  that

             14   was an adequate figure for planning. I gave that  a  little

             15   higher rating of 3.

             16              No. 45 we have been asked not to consider.

             171             No. 46, I agree with $15i6OO, at a rating of  2.

             18              Are they about what you were going to suggest?  Or

             19   what was vour feeling?
             201             MR. TOOMEY:  I didn't make the suggestion, but I

             21   would be in agreement.

             22              DR. SCHERLIS:  Would that be all right?
             231             MR. TOOMEY:  Yes.
             24,1            DR. Mt@,,TORY:  You have studied this a lot more

  !-Fedefat Reporters, I.-,C.
             25   closely than I, but I @.ias a li'ttJ.(-- coricr-,rne-d in that first one,




     jrblu                                                                   168




                I   they ir@deed were setting about to begin to get some  personnel

                2   trained.

                3              I was wondering if perhaps out of the  $300,000,  if

                4      I am not satisfied with your justification for

                5   only a tenth funding.  It seems they are about to get

                6   personnel training and organization.

                7              DR. SCIIERLIS:  What I was going to suggest was

                8   this as a follow-up-recommehdation. All of  this  comes  to  over

                9   $100,000 for State, and whatI thin'it should be done is that

              10    the State has to put together a  thoroughly  coordinated  program

              11    to encompass emphasis on training in an overall plan.

              12               What we have been given is individual plans that halve

              13    very little coordination and I would think the staff comment

              14    here would be that all of these should be  coordinated  into

              15    an overall view. Because a sum of $100,000 gets to  be  a  very

              16    significant sum to work with in setting up, at  this  stage,
              171   planning and training.
              18,              Would that answer your question?

              19,              DR. @1YEORY: Thit answers it, but I  just  wonder

              20    what a State can do with $100,000?  1 am very much -- of

              21    course, now you have the 45, and I suppose given better

              22    consideration, that might ','L)c another plus.

              23               But I am impressed with their realization  that  tliosc

              24    funeral ambulances have to qc) and I don't know how we are goi 9

  e-Fede,,,)l Repoftei:@,  I,-ic.
              25    to do      unless they got, @.,onqp, fiiyicling and support. Thi.s is




                                                                            1.69




               I   one of the big things we're all trying to get rid of.

               2               DR. SCHERLIS: That is a  nation-wide  program,  isn't

               3   it?

               4               DR. MKRORY: Yes. But Arkansas  seems  to  have  its

               5   share.

               6               DR. SCHERLIS:  I am open to any suggestions.

               7               DR. HINMAN:  I agree with you, Bill.  I haven't

               8   seen the application.
               91              DR. SCIIERLIS:  who is familiar with the Arkansas
              10   grant?

              11               VOICE:  I was on the site visit.  Is there a

              12   specific question that you would like to ask about this?

              13               DR. SCHERLIS:  What do you think their ability

              14   is to mount this effort?  What is their total funding at

              15   this time, in Arkansas?
              161              VOICE:  1.5.

              171              DR. SCHERLIS:  $1.5 million?

              181              VOICE: As you know from the site  visit,  that  was

              191  rather recent, they are one of the better regional medical
              20@  programs, and seem to have the capability to  plan  a  program.

              21               I suspect -- Mr. Says is the primary  Staff  person

              22   on this, but I suspect that the time constraint  had  its  affect

              2 3  on the development of
              241              DR. SCIIEIILI@@: This is one thing @,-hcit bothered men i
  -e-Fedet,it Repoiteis,  Inc.I                                                    1
              2511 is that as  you go through this, as apparently they art.? very




      jrbl2                                                                170




                   thick brants, the requests that you deal with are very small
               2   proportions of them, and one of the problems that I had in goiig
               3
                   through them is that these were in great measure, I assume,

               4
                   all prepared for  other requests.
               5                   hey going to part of that $8 million?
                              Are t

               6
                              DR. ROSE:  Yes.

               7
                              DR. SCHERLIS:  These weren't really prepared under

               8
                   our guidelines, they were prepared for something else.  While
               9
                   one can question however one can go by this-sum, nevertheless,

             10
                   if we are going to buy the guidelines, we have to follow them.
                              You are right what,you can do for $100,000, you
             12    certainly can't replace a'LIL '.he hearses with adequately-
             13
                   staffed and equinned ambulances, but I would think if they

             14
                   dolt get their other fund, at least this is a good start
             15
                   in putting together an overall program.
             16               I know their coordinator who I think is one of the

             17
                   best I have ever had the opportunity of site visiting.
             18    I am sure he can use thesc funds very adequately at ].east as @ar
             19    as planning and Coming in later for implementation.
             20               lie can come in in the very near future for
             21    innlementation.
             22               Any other comments?
             23               A motion has been madE! and I guess seconded.  All
             241
  ',-Federal  Repottr-Is,  Inc.Ithose in favor, say "aye."
             251
                1              (Chorur, of "ay(-s.")



      jrbl3                                                                    171



                                DR. SCHERLIS:  Opposed?

                 2
                                DR. ROSE:  Do you have an overall rating?
                 3              DR. SCHERLIS:  The overall rating comes to 3.
      #14Lee     4              DR,.ROSE.  3.  Okay.
     CR 6307     5

                 6


                 7


                 8


                 9


               10


               11


               12


               13


               14


               15


               16
               171
               181

               19


               20


               21


               22


               23

               241

   Fedefat   RePofters,   Inc.
               25





                                                                                                                                      172
     CR6 3 0'7


        1 5 -ter
                                                   DR.  SCIIEPI,IS:           '\Il  ric-,                          "Ls     the     next     one,


                           2    @-Ir.        Toomey.

                                                                                                                                              on
                           3                       T4R.  TOO@EY:    This  is  an  application  from V7ashingt

                           4    University         in  St.  Louis.

                                                   The  fu
                           5                                  nding  is  requested  at  $707  thousand  for  the

                           6    first  year,  293  for  the  second  year,  $314  thousand  for  the

                           7    third  year.    I  have  a  total  of  $1,316,000.

                           8                       The       grant       application       covers       an       eight       county       region
                           9    COI"Si,3tj.llg  Of  almost  50,000  square miles  around  and  including
                         joist.  Louis.    The  area  population  is  about  2.5  million  people,  in
                              1200  municipalities.

                                                   DesDite        their         separateness,         their         residences         arc!
                         12

                                li)i%ed  to  St.        Louis  throu(h            medical  services  T)atternf,,@,                   There
                         13                                                   i
                         14     are  -Qin@7  deficiencies  in medical.  services  because  of  the
                                            a.

                         15     200  independent,  political  jurisdictions.                                 Coiiceria       over       the
                                deficiencies      OIL       in       (:-,@erc,c@ncy       medical.       service       initiated       this
                         16
                         17     Trayit      request      as       mechaiiisj-n       for       coordinating       the       emergency       me3i
                                cal  services  with  goveriNIr,,icn-t,-,,  c,,rosc-@-sectorincj  for
                         18                                                                                                       jemc-,nt
                         19     of  tire,  @-2 rr,-LcA,--@,s  ooc-rat-@oi-i.
                         201@                      The  ol)ject4-,,rcs        statc-,C                                      -,in
                                                 cc-ritra"k  di.-@)-)a  cillii-i,
                                                                                               ,,n  %,,,Iiiich  i@-.  urdc-,-.-,- 1) y , a 3 j.,@4
                         21

                                re     4      E-@ C C L, !7
                                                                  to tl)r     1),,i 1, i.,i, cF;Clrv(,@cl,  to        ly  ti           area
                         22

                                        a                                                               to  L@rz,,.i.n  the  E'.mbu                             m
                         23   1                                                                                                                                 cl@n
                                (-,rc"7c,  to  ll-,h@-  Ic@vc,!.  o@'  @--f 3@: i.--,        Si.if f ic i (-n.t  i-.o       ii-f                                H
                         24                                                                                                                                     >
    ce -Federal Re@)ot ters,  Inc.                                                                                                                              m
                                               re@i@i.-tra,tion
                         25




        ?                                                                           173



                  I essential equipment as defined by the  American  College  of

                  2 Surgeons, to categorize hospitals  and  designate  receiving

                  3 stations on the basis of emergency backup  capabilities;  and  to

                  4 establish communication lii-iks between all components of the

                  5 emergency medical services system.

                  6             The plan is to be implemented in  two  phases.  The

                  7 first phase of the system to become operational in  the  core.

                  8 sector of St. Louis, in addition to gathering  information  to

                  9 extend the- system to the rest of th   e eight  countv  metropolitan

                10  St. Louis area.

                11              Extension of the system to the rest of the area
                12  for a total emergency medical system will constitute Phase 2.
                13  T-,!- proposal is a three-yc-ar funding for i:)Iiase  one  with  imple-
                14  irc-ntation of phase  two,  within  the  vear  following  activation

                15  of Phase one.
                16              In the terms of  my  evaluation,  the  a-oplicariL'  demon-
                17  st@-ated good kno,,.71ccig(,@ of a total E4'.!S System includinc),- how
                18  the various niias(--s -,..,otild !)e i.,-@tegritec' and has noted the

                                  -,n -L';Ie. T)res,,,,,stem      1.)c-- overcoT.10@. The
                19
                              @,,-:;ograr)liic area @,7aF; V.,-011     Z:Ly.)d the
                20
                    is cmimuni-'@-v liacccl, @@.-ith   re,-)r(.-s7,(--ntatioti of I-.)rovicl.(-,rs,
                21
                  I oubli-c ageiic4--os, iDIcirininq acre,-
                22                                   ,ci.,@s, and CO!-,LMunit-y interests.

                                   S   n cT
                23                        me6i-cal. sci.-@rices have been tEkcn  file

                24
  ,ce- Federal Reporters@ Inc. r,@ i,@ cl -i@ c; a 1 sr vc ca v,-i a 1) 1. ci i. na r o aAd O-, i. t,,i Oi Ek 1
                251








                       resource   have   been   identified   and    there    is    a    clear    assessment

                    2  of needs and resources based on statistics.

                    3                 The plan makes reference to how the operating

                    4  components will tie together and how additions to this system

                    5  will be coordinated.   The only weak area of the narrative

                    6  relates   to   the   improvement   of   quality    care    and linkages with

                    7  local   health    care    systems.    The    applicant    onlv partially

                    8  describes   these   linkages    and    briefly    refers    to follbwun of

                    9  non-emergencv     Patients,     and     community     disaster planning.

                   10                 Techniques    are    described    for     utilizing     financial

                   11  resources, in addition to obtaining additional financial support

                   1 2 at the expiration of this grant.   llliile this is my -- this is

                   1 3 iiv sur@-,Piarv.   lihile there are no outstanding or innovative

                   14  approac'@lir-,s to the development of the EIIIS within this area,
                   15  the   application   appears   to   be   viell   conceived,    a    well    conceived
                   1 6 plan,  a  good  organizational.  structure  w'L  lic-h  @4i.11   coordi.,-int(@,

                   17  and adr,.,Ln3.ster the system.        It i-of I(-,cts     comprehensive     planning

                   18  for @)ringing together the key                      and a disaster and I:','.IS

                   19  system,.

                                                  a large r)oi--L--i-on of the crant is used for
                   20

                   21                    of                i-,Tiu' tlio c.,cTui.@-.)inctit. Cc@mmeiitf-@ b,@r lure.!

                   22                Dr.  l@@ki)!-an,  "Tlai,s  bzi-si-cal-l-v  i.@,  a              out
                   23                      Tt        idc@iiti-f ic@,d  problems  and  has  made  an
                   241 a-@ t -ql                                                             s-c-.@o  here  i.,@

  ,ce-F(,deral Repofters,  Inc.
                   25    c) r-ic@n i-@-no -L-i D(@Tar'@i,,i(-;Pt or                      support  (.)-f




         4.                                                                                          175




                     1     ambulances.  They   appear   to   be   coming   100   percent   in    support

                     2  of ambulances in this application.

                     3               In their defense, however, cutting back on ambu-
                     411ances support would greatly woil@on the basic concept of @-his

                     5 proposal.   There   is   very   little    attention    made    to    the    emergency

                     6 roont's themselves and the follm%7up area.   I classified this

                     7 application as a verv good application.

                     8               Ilowever, I    am   concerned   about   the    amount    of    funding.

                     9 I @-iould like to hear the discussion before I make the


                  10   recommendation.

                  I  1               DR. -@l-IC Plil,]DRA@il: So  am  I.  This   was   one   of   the.   earlv

                  12   ones ti-iat I read rind I thoucThL"      that   what   was    described[    about

                  13   the ambulance service %,:as good, but that on rc,-:adina it and

                  14   rereading
                                    it, it really does not measure up to our no-i.onE,
                               I-                                                             i-


                  15   abou-'-- af@-yster:l.

                  16                 I think it is a well designed ambulance service and

                  17   tiac- amount oil -,onc,,y to )Dc@         o,,.it of that -first year budget,

                  18i7O7,  5'03, on c-cTui-)m(.,-iit;  includin,               g '-lie ambulance for

                  19 i3@6, 64'L -- that is               ha!A@     i-,-,-lli-on dollars on t,',,L-. a-mbi).-

                  20   lances, and on           c@,-iimur,,..c,-@ti-ons c-c.,,.uipmeiit, the emergency  care

                  21                 -.tric7. of@her        -Lliat li@iv,@- to go @.11 the

                  22   in or@'-,'f-@r to mile       @c2rvc "--]@is

                  2 "i               And tiaore is              200,000 in                     Of

                                             j.
                                                                                          oL   I 1
                  24

  -e"Fedefal Repoi!ers,  Inc.
                                                                            cc)s@L- for ti-ic@ a, @-@ I Ia n s
                  2  5       El'




                                                                            176

   '4


                 I           1),,i. SCIIET?,LIS: Two ninet-y-three and 31@, in the

                 2 sul)seq.ueii t- years.
                 3           DR. I-IC PHT-'D@,N:  I,Iiien I think of this amount of
                 4 money bcina requested for the first vear and then put it beside
                 5 the tri.-s3tate application, what was requested there, for the
                 6 first year, it seems to me that -- now I understand why I
                 7 feel that way in the tri-state application, because so much is
                 8 the development of planning, and linkages; whereas in this one,
                 9 a port4-on of the system, I thought was @-7011 designed, but I
                 10 really wonder if we ought to support it not because it is  not
                 11 a good part of the system,, but because it is not really the

                 12 @'lliole s,@stem.
                 13          That is the wav I feel about it.   I wonder  whether
                 14  ought to support it at all because it is such a port]-on  of
                 15 the sN@stem.  That is what I am concerned about. 1 Me-an it
                 16 just is not the .@ihole thing.  (7io not know whether the emer-
                   gencv rooms arc going to be coordinated at 7,,ll to prepare for
                 17   %
                   .ihat these ambulances will '.:)ring, for exampl(,.
                 18

                                                     4 tll
                 19          I guess they Could be l@7.L the system is (3.@sc!rj.,bod,
                 20 but @'@c! just do iio-L know.
                 21           DR. SCI@'il7,PLIS:  -@ll ri.gii'L-
                 22               TOO)'.IEY: 1 thc)ucili'k- 3-t N,.7as well written.

                                  ',,@C     t
                                     p  T
                 23           DP,.  I   ) RA'@,. l.L thought it was well written, but
                   I thoitclli,,it -J, t @,7 (i su,,@,t z3.   trc)iil)'.e
                 24

  -kce - Federal Reporters,  iiic.           Ts
                 25





                                                                             17 7





                             DR. ROSE:  Dr. Kaplan is riot here.

               2             DR. SCIIERLIS:  I gather there are differences of

               3 opinion.  V'Vlould you want to respond to this, Plr. Toomey?

               4             I do not think we have had a rating yet, reallv,


               5  for this.

               6             T@IR. TOO@IEY-  .',TY rating of the application would be

               7  probably 3.5, between three and four.

               8             DR. SCIIERLIS: lio@@,, do ,rou feel about it?

               9             DR. MC PHEDRAN:  I think for what it tries to do,

               10 it is a three, but I do not triinl-, it is a system, and I do

               11 not know that we ought to ratc- it .is a system.  That is my

               12           about it..

               13            DR. SCHERLIS:   lio@-i much of it is requested for

               14 planning in the overall, or isn't there any?

               15            DR. ",iC PIIEDRAlq: T,,flell, I do not ti-,ink there is

               16 very much.  I can tell you in just  a  second.   There is  an

               17 evaluation of +--Iii-- project, $30 thousand.  One of the field

               18        plarn@.r,-,,. total sunno--,-t is 2:ecuested for 11 4  rl

               1 9           That is 17 -thousari6 direct costs, or 19 thousand

               20 total, tc),jether . and socretE-,..i--i al help f o,,- the f iol.d

               21 planning.

               22            DR. SCII'P@LJ'S: Is .,,@iat they are go4-n@j to do

               23 @3ot iin t,',,ic-2 )relinF-,-,r)j,+--al tl,-Iat cc@rr(2ct?
               24                              T,,@ic 4.-@3 them I vic@@,,,@ it.

  ce - Fedeial Repofters, l@ic.
                                 T Ci) T V Ye@. .
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                                                                                                                                                           178

       ter-7



                                                            DR.   SCIIEI@LIS:     If  you  are  reading  this  summary,
                               2 lit  certainly  seems  the  emphasis  is  on  that,  without  there  being
                               3     further  involvement  of  the  actual  provider  areas.

                               4                            Do  we  have  a  motion?
                               5                            rl,7e  lie  somewhere  between  $700  thousand  and  no  dollars
                               6     at  this  point,  if  I  read  it  correctly.
                               7                            MR.  T00iflEY:     I  remember  now,  the  personnel  involved
                               8     in  this  for  the  first  12  months  was  $188  thousand.    Then  the
                               9     ambulances  were  41.6  thousand.     I  do  not  see  there  was  anything
                               10    specifically  in  the  area  of  planning  in  terms  of  funds  for
                               11   Ithis.
                               121                          DR.  SCIIERLIS:    There  is  some  training,   is  there  not?
                               13                           DR.  MC  PHEDRAN:    Yes.
                               14                           MR.  TOOL@EY:     There  is  considerable.
                               15                           DR.  !,,IC  PllrDRAN:    There  is  training  equipment  for  the
                               16    aiii))ulanc:---  --  it  seems  to  me  there  was                                        training  for  the
                               17    ai@tl)ulan,--i@  attendants  but  I  am  not  ev,@,n  suy-e  that  that  is  true-.
                                                            DR.  SCLIERLIS:     TI-iov  do  havc,,  a  du,,)licate-contra--t
                               181
                                    I
                                    irequest  in,   acco.-(-Iiiiq  to  our                        @,7 c,, r  i c c
                               19
                               20                                         Tl!iTDI-"Al@:     Tlicv  c7io'?
                               21                           DR.                               I   t,iiiik  it  ','7,i..I.l  -be  visited.
                                                            DR.                            i      'LiEts  i,),oL  7,oved  that  fir  alon(
                               22
                               23                           !)R.
                               24                                                                                        .3-@3  not  enough                  a

    Ace -  FedErat  Re-porters,  Inc.
                                                        -T  tlic)u  li-  il,  %.7aF-,  -t                                    as  fct.@  as  il-
                               25                                    i




                                                                            17 9





               I  that it if--, reall@,r not a E,'-.IS.

               2             DR. SCliERLIS: I can uiiders4k--and that.
               3             DR. BESSOI@: on tli(-2 si.glit-visit, I am wondering

               4  under what circumstances

               5             DR. SCIIERLILS: Contract.

               6             DR. BESSON:  For a contract?

               7             DR. l,'4t@RGULIES:  Yes.
               8             DR. BESSON:  Is there going to be any sight-visitinq

               9  of these proposals separately?
              10             DR. MARGULIES:  No, we would not have time for it.
              11             DR. SCIIERLIS:  I think what we are finding is that
              12 Isome of the programs we fault, on the basis of  not  being  a
              13  system have been submitted under differc-,i-it guidelines for a
              14  contract.  I think this is what hung us tip on Arkansas,  to

              15  a certain degree.
              16             We sort of try to see what -in that program is Ri@,lPs
              17  guideline material, rather than I,)eing part of a system that
              18  might, for exrimple, fit into the contract mechanisms.
              19             DR. @@IARCULTES.- Of c-,oul--se the contrci(,-L-.s are all

                  SU',@??-),--sed to !)c,- total E,-,7st-c@,ms.
              20
              2@l            DR. 1,T-,SSOL'4:  '.Iuch note than O'Lirs.
                             DR. @1,17kRGULI'ES: So the criti.vi-sm@3 I just heard
              22
              23        i@e           'to
              24,             0 I    -E   i',b           mur--Ikl   the
  c:e -Federal Reportels, Inc.             in 4"li.,.-@        1.),Lit thev h,.ivo
              251




                                                                                                                     18  0




                        I   gotten  a large number  -- practically every group possible,

                        2  together.   The mayors of the different muncipalities,  the

                        3  different  civic groups,  they have done some nlanning.   As  I

                        4  say,    I    cannot    speak    for    what    shows    up    in     the     application,     but

                        5  they have been working on this,  and the experimental health

                        6  system application for plannin(  for St.  Loui.s.has been approv(--d,

                        7  and there is some tieuT) between                  the     two     applicant      agencies      of

                        8  these two.

                        9                   DR.   IIEiNDRYSO,'.!:   @'4ay   I   ask    one    que'st4-on    about    this?

                     I  0                   DR.   SCIIEPLIS:   Yes.

                     11                     DR.   IIEI,7DRYSO',:4:   Is  there any evidence of any community

                     12    funCii2,-,cf,    joint funding,    local     funding,     to     go     with     this     plan?

                     13                     DR.   SCHERLIO-:   Does anybody have a comment?
                     14                     DR.   l@IC   PITIEDP\IN:   IZo,   I   did   not   sec.,    any    evidence    of

                     15    that.

                                            DR.   SCIlEi@,'"IS      ol,,ay.
                     16
                     17@,                   Dj@  .T.'@C PJIT'@DPAN:   And    as   it   was    pointed    out    -in    Dr.
                     ,8                     note, tlierc-,@ might be o'-her                       sources  -f-cr goti-.incl,

                           them                                  I.ookc-,d   into,   but   not   spoken   o-f--    in    the
                     19


                     20
                     21                     DP,.  SCI-@El'@l,!S:       -think our ci.-iteri-a liavc-@  tc-, i.ncludc@

                     22
                     23                     Yc-,s?
                     241                    D T-,,      @7'@ 71,' Ir.           tr-) T):r.
   e - Fedeial Reporteis, Inc. @
                     25    Z-icc(7,rui,ng  to Dr.  Caplan's                     lie               ",,Fes"             t',,ie





                                                                                            181



                     first three Questions of financial support, which had to do with

                  2  utilization of other potential funds.

                  3               DR. SClIr-@'RLI-D:  Yes?

                  4               DP,. ROSE:    I do not have anything.

                  5               DR. SCHERLIS:  Do we have a recommendation from one

                  6  of the reviewers so we can move ahead on this?

                  7               DIR. TOO,"@IE-Y:  All right.   I  am  a  little   bit   hungup

                  8  on  the  fact  that  despite  what  you  said,   Dr.   Margulies,   as   far

                  9  as total systems are concerned, @@re have also looked at, and

                 10  it  savs  in  the  guidelines,  to   look   at   systems   and   subsystems,

                 11  and I look upon this as part of the subsystem.
                 12               I also   remembered   being   concerned   with   the    amount
                 13  of money being put in for the ambulances.   I also did check
                 14  bacl@,  and  there  is  provision  for  training   people   for   a   period
                 15  of @somc-@,7here in the neighborhood of five or six hundred I?eoi,? c

                     durin,,i the course of tile three vc@ars -J'or this particular
                 16
                     program.  And im@  nrobl-ei-,i is the saT-,,c thinc               eiied   up
                 17                                                     @j that @,7@is op
                 ,8             iiid that' is,        the            is   dependent   upon   the
                 19  ambulances and to     ',.i-.ve t'l@ic, Pe(,-Pl.e @,@i..tliout the imb-Lil,-n(-,(,-.c; really

                     ,,,-) ld ruin the j-)rojecl-
                       u
                 20

                                  I do not               YOU       --i,t bacl,: in terms of  the
                 21

                           i-i-icit this i.@- a total subEi-kist-.c.,-l   tli(@- who  Cy  t'TI.
                 22  fact 4-                                                             s cl,
                 23  I :Ic) not see lioT.@,, vou    pick    I-)iecc@ of it.  This if, my

                                                                 . ZIV@,@                4
                 24
  ce-Federal Repoiteis, Inc. reco)-Imc@ndincT Ei gr-a,'Il-nj foi- it of 3--1/2 'or 4, sortio@,,7here
                 25




                                                                               182



                I in that range, as a project. But I do not  knout  how  to  piclz

                2  out the dollars for it.

                3             DR. MC PHEDRPlq: Could ,,7e not recommend that  they

                4 try to get support for some of this equipment elsewhere?

                5 I mean, at least that would help out some, if they could get

                6 some from the Department  of  Transportdtion?  -Could  they  not

                7 do that?  Is that not conceivable?

                8             DR. SCIIERLIS:  And then what recommendations would

                9 you mal,:e?  Let us assume if they could get the equipment else-

               I 0where, what would you say?

               I I            DR. @',IC PHEDPTN: It still is not an emergency

               12 mcl(licELl system.  That is what you arc-- trying to tell me?

               13             DR. SCIIERLIS:  No, I am not.

               14             DR. MC PHEDRAN:  But I feel that way about it, it is

               15 a real problem.

               16             i:,'@R.@ TOO@lil,@@'Y I recommend approval of funding on --

               17 with the contingency that thc--v ,;r-,cure the funds for ambulances

               18

               19             DR. E;C!!Ej.@LIS:  concern is iL wci tal.k about the

                  700      we talk        the 800, t',L@Lt is one r)oj.i-it five, and
               201                                              1

               21 that i@3 a good fraction of the total  available,  and  if  they

               22 go 1.)%, our ,@tric-L raiil-,ii-ig, that ist

                              -%nr
               23             i -1 'that would exhaust i,,iost of the funds.

                              D.c@'. '.IC               @say,   sL,.t-),,-@ort the
               241

  ,c,e-Fedetal Reporters,  Inc.
               25 for., t,ic- -Fi,rst year if  can cT(:@t-- the




                                                                            18 3
   -ter-12



                I they can come back and see about the second or  third  year.
                21           DR. SCITERLIS:  I doubt if they would have time to
                3 gear up to get the equipment in that period of time.

                4            DR. MC PHEDRAN:  You do not think so?

                5            DR. 1,TARGULIES: It just depends on how far  they

                6 have gone with DOT, what the potentialities are.  If they
                7 can get it here, like all these situations, they are not going

                8 to get there. I think we can easily find out  how  far  thev

                9 could go in the other direction.

              10             DR. SCHERLIS:  lqell, the recommendation

              11             DR. MC PHEDRAN:  I would favor sup
                                                               .F)c)rting it for

              12 just a year to support the personnel costs.  Maybe they -- I
              13 do not know whether all of the kinds of personnel they described

              14 would really be useable under these circumstances if they did

              15  not leave the equipment, but supposing, for example, they had --

              1 6 th(--@y ,,,anted to get the project director and secretarial sup@Dort,
              17 1 @@.11-10 @,7ould -- or the planner, @.!hoov(-,r @iould be required; to see

              18       sources al@' funds could 1-c@ taT.)pc-d for getting the

              19  0   T-)rl c-, n

                                                    r a y,@Nar, and see
                             I .,could sur),)@-.rt that f@')
              20                       'I
              21  (j@, after tliEit.  This ir@ the )@@in6, of ar@- h I would favor.
                                                         @)r ()ac

              22                 TOOj-'@f-'Y: I think     the contc@,".t of the
              23  -rc,@5,Durcc@:3 that they      ticre are steps that  can  be

                        @o i,.ia'j@--, a      r c% i--i s y s t c,,-,,L out of it.  Al-iO, 1
              24
  ,ce- Federal Reporters, Inc. -e l@i,tli Dr.
              25          r @,,  -,'





                                                                               18   4




                1             DR. SC17ERLIS: You mean --- we still do not have  a
                2@number on that, though.  This is one of the problems that I
                3 have.

                4             DR. MC PIIEDRAlq:  Okay.

                5             MR. TOO!.IEY:  You have 188,000?

                6             DR. MC PIIEDRAN:  That is their total personnel
                7 request, which includes a project director at a total of fortv

                8 grand, a jeep dispatcher for 15 and a half,  ten  dispatchers,

                9 for a total of 100      they cannot use them all.  lle do not

               10 have the ambulances.  The dispatchers, we cannot use.  The

               11 secretary, he can  use.
               12             DR. SCIIAERLIS: I share the concern about putting all
               13 this amount of money into   one aspect of a system of care with-
               14 out putting significant funds into the total planning, a,,-id what
               15 happens when these patients hit the emergency room, and hit
               16 the rest of the medical echelons of care.
               171            Now, really,
                              DR. @',C PIIEDI@'IVT: lio@,7 a out s@Lil@norti-27ic the I)rojc-@ct
               18                                                    -3

                  cli-rec4-or and sc@cretar4al hel tl-i@it i.F,; 43,000, and a field
               19
               20 z-vstc@,-i,@ r)].@iriner, 20,00,0, t", at N,7oul@, about $70 tl).ouszii-,,d,

               2 1a!3- toc.-TeL'hc-r.
                              DR. SCIIE@P\L!S: Even if vc)u raised 100,000, in terms
               22
                  0  at least 1,7orkir.,-j on i s@,rt(@m or' care, this, I thin'j,,- ,,jould
               23


               241
                 i
  ,-,e- Federal Reporters, liic.
                                           some
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                                                                             185
     r - 1




                             MP,. TOO'.IEY:  I thin'., tlic@v have 52,000 down here, as


               2 I read it.
   is          3             DR. SCHERLIS:  That comes to about 150.
               4             DR. DESSON: A procedural question, Mr.  Chairmai-i.

               5             If we are arguing about hiring secretaries and

               6 dispatchers for each application, we would  not  get  anywhere.

               7             DR. SCIIERLIS:  I agree.  I am trying to say that

               8 700,000 seems lil-,e an inordinate number.

               9             DR. MRGULIES:   If I understand what you are saving,

              1 0 7'1-1 a 'L --you are talking about -- giving thein whatever is necessary

              I Ito extend their planning and develo,) a fuller s@Irste-n; and :L
              12 1tli(-%r can Simplify it in -,or@ie otl-icr- why.. rL-inc,, bi,,,t- if your want
              13 to talk in those terms, and cive us freedom to i-ic-cotiatc-,,

              14 a reasonable level

              15             DR. SCIIERLIS:  We arc! tall-king about a sum of 150

              16 tliousard to 200 thousand, at a rating of three?

              17             Is that satisfactory?

              18             D2,. ','C


                                 Sr'IIT-'
              19             DR.            All ti-iosc@ in favor, say ",.eye.

              20             (cliorus of a,,,es.)

              21             Di'@'.  SI'TT@'@j,-, @@ll ri( I t.
              22             T.,@To@,i, iriteri.-,ount@i-i.j-i arc@a@, IJT'cc)i,,iciv -Irid Dr .
       111-15
              23

              241
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              25i
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                                                                              281




        Swl     I              DR. SCliEPLIS:  Any further discussion?
                21             All right.  I glaess that, takes care of Arizona.
   0                           Next is Hawaii.
                4
                               DR. HINMAN:  California.


                5              DR. SCHERLIS:  I am sorry, California.
                                                                                              >
                6              Mr. Toomey.

                71             MR. TOOMEY: California  has  two  projects,that  they
                                                                                              >

                8  are proposing.  The first one I have here in front of me is the

                91 South Central,Multipurpose Health Services Corporation.- project,-.

               10  iio.-,92, withsfund3.ng requested of $292,000 in the first  year,

               11  $309,000 in the second year, and $291,000 in the third year.

               12              The grant covers 33 square miles in central Los

               13  Angeles, a population of 330,000, 80 percent black, 10 percent

               14  Mexican American, 10 percent other groups.

               151             Between 30 and 35 percent of the families receive

               16  welfare assistance, 40 percent are in the income category of

               17  $4,000 annually.

               181             The median age is 24 years with  unemployment  of  40

               19  percent for males, ages 16 through 19 years, while 15 to 20

               20  percent for males ovet age 20.

               21              The median educational level is  eight  years,  eiait
               22@ years of school.
               231             Infant and neonatal death rate in  the  target  areas
               24@ are the second and th4-rd Iiiglie,,3t in then country.
  ice.-Ff-,detal  Rer.)oitefs,  Inc. It is a povertyarea and medicably under served-v74-th
               25




                                                                           2 8 2





       sw2     I  a considerable deficit in the emergency services.  The bulk

               2  of the emergency care is provided by USC, L.A.  County  General

               3  Hospital, Harvard General Hospital, and the new  Martin  Luther

               4  King Hospital with which support from the grant  will  provide

               5  facilities and services.

               6             The objectives of this application are  the  estab-

               7  lishment of a neighborhood treatment and transportation service

               8  through development of a four-pronged effort., which  will

               9  include providing improved emergency services  by  coordinating

              10  emergency services now existing, optimal use  of  existing

              11  emergency personnel, consultation from highly skilled pro-
              121 fe8sionals to improve communication between hospitals  and
              13  emergency vehicles. by training and upgrading  capabilities  of

              14  emergency care personnel, develop a cadre of 24  physicians  to
              15@ handle emmergency in medical care centers and hospitals and to

                  upqrade emergency cat people by creating  career  ladders,
              16
              17  development of community educational programs, and a research,
              18  development and evaluation system to assess,  upgrade,  design,

                  measure, and improve the emergency care  existing  in  the
              19
              20  operational aspects of this project.

                             The plan vjill be implemented through a four  phase
              21

                  program over a period of three years with initial  efforts  in
              22

                  research activities for detailed planning, purchasing equipment
              23
                1 training personnel, dev;elooing corr'@-qiuni-ty educational programs,
              241
    Federal Reporters Inc.  I
                  and organizing community co;mn,lj-ttee-s.
              25








          sw3   I             The second phase effort will include operational

               2  aspects of the plan for operation of communication  system,  and

               3  emergency vehicles.

               4              The third phase involves training of personnel  and

               5  implementation of the long-range,planning efforts.

               6              In summary.- this application-app-ears,to be-developed

               7  as a community outreach program, involving many community

               8  agencies in predominantly a black and Mexican-American popu-

               9  lation.

              10              The project is not developed very well or factual in

              11  content.

              12              The applicant does not display a very effective  or

              13  workin                            ts of an emergency medical
                        g knowledge of the componen

              14  services system.  There is little identification as to the

              15  existing resources and components now in operation or how

              16  those components will be integrated into a totla emergency

              17  medical system.
              18              Specific resources are not identified and there  is

              19  no reference to communication resources or  ambulance  services

              20  available within the area.
              21              There is not integration as to the various  linkages

              22  in the approach to the delivery system.
              23              This application represents a haphazard  compilation
              24  of unrelated data with Yio apparent overall plan for the  devel-
  ,ce- Federal Reporters,  Inc. opment and implementation of an emergency medical. system in the
              25




                                                                          28 4






        sw4    I  area.
               21           The project should require additional clarification,
               3  more indepth analysis, as to identification of needs and a
               4  definite plan for the development of the emergency medical

               '5 services system.
               6             I don't think there is any doubt from reading the
               7  application that there is a need for services in the area.
               8             My memory as I remember the budget is that a tre-
               9  mendous amount of money was provided in terms-of salaries to
               10 people in each of these phases to work in the emergency rooms,
               11 and if my memoryis correct, Dr. McPhedran, they were expecting
               12 PMP to provide not just the training, but the employment of
               13 people to work in the emergency departments.
               14             I think as an application, it probably would get a
               15 2, a 2.5 as a rating, and I would feel very strongly that
               16 further planning in picking out the areas in which the appli-
               17 cation is deficient and making an effort to develop a better
               118 and more adequate plan would be a desirable action.
               19             I would recommend that this be done.
               20             T would recommend that $50,000 be allocated right
               21 now, or at  this.time, for that kind of planning.
               22             DR. SCHERLIS:  Dr. VicPhedrai-i?
               23             DR. MC PIIEDRAN:  I think that is reasonalbe.
               24             I didn't think that the thixig,as written was sati!r.-

  Ace - Federal Reporters, Inc.
               25 -Factory, hu@. I would hate not to provide any funds i-o Assist




                                                                         28 5




         SW5  1  with planning, because it is quite evident that a lot needs to

              2   be done.

              3              I think the need is tremendouw.  It puts tomething

              4   together, but it isn't really a system,,and I think that it

              5   would be suitable to -- of course, if we give a rating of 2

              6   and recommend that money -- I guess it is unlikely that any

              7   will come, right?

              8              DR. HINMAN:  Is that recommendation $50,000?

              9              DR. MC PHEDRAN:  We will give it a rating of 2.

              10             DR. SCHERLIS:  You concur with a rating of 2?

              11             DR. MC PHEDRAN:  Yes.  Either 1 or 2.

              12             The plan as proposed is I will say 2.

              13             DR4 SCHERLIS:  Is that stated then?  $50,000, one

              14  year?

              15             DR. MC PHEDRAN:  Yes.

              16             DR. SCHERT41S:  And a rating of 2?

              17             DR. MC PHEDRAN:  Yes.

              18             Is that all right?   Is that okay?

              19             MR. TOOMEY:  Yes.
              201            DR. SCIIERLIS:  Is that concurred with?

                             MR. TOOMEY:  Yes.
              21

                             DR. SO-HERLIS:  All right.  So be it.
              22
              23             MR. TOOMEY:  I believe the comments from.the staff

              24  su-@vey also would support this.
  @ce -Federal F@eportets,  Inc. "The project needs" -- this is the concluding
              25




                                                                             2 8 6





       SW6      1  statement -- "The project needs, truly needs, further reworking

                2 and some indepth analysis of their problem."

                3             The second California project is from Loma Linda

                4 University School of Medicine and the California RMP.

                5             The funds requested are a total of a  hundred  and  --

                6             DR. HINI,4AN: '$170,350.

                7             MR. TOOMEY: I have $162,0.00 for the  first  year  and

                8  nothing for the second and third year.  I don't know what

                9  happens on that. That@is from the application-itsdlf.

              10              Well, this grant covers region 6 of California,

              11  which includes four counties of some 45,000 square miles of

              121 mountains, desert, agricultural land, urbanized community,

              13  26 percent of the state.

              14              The resident population represents some 6 to 10
              151 percent of  the total California population.

              16              During weekends, holidays, and vacation, the popu-

              17  lations of  the more populas remote areas may increase ten-fold.

              18              Due to the isolation of much of the area, serious

              19  obstacles are presented in  providing  adequate  emergency  health

              20  care services.

              21              Communication services provided  to  this  four-county

                  are are linked by a common coninLunication network  for  emergency
              22

              23  vehicles, which includes higli@,@,-.@y patrol, local police, fire and

              24  ambulances.

  -e -Federal Repotters,  Inc.
              25              The specific objectives which have been listed--iri








       sw7       I   order to reduce the morbidity and mortality by increasing

                 2 availability and accessability of emergency medical care, to

                 3 improve communication through a central dispatch system.

                 4             The system is  here.  Two-way  radios  in  all  ambu-

                 5 lances, an emergency  radio  telephone  system  for  remote  areas.

                 6             To facilitate  rapid  and  effective  patient  handling

                 7 and evacuation by use  of  helicopters,  and  fixed  wing  aircraft,

                 8 military air-lift capability.

                 9             To publish listings  of  all  available  emergency  care

                 10 of services in the  region  for  personnel  involved  and  transpor-

                 11 tation of patients, to formalize agreements amon   g   hospitals
                 Ii21 in handling of  emergency  patients  and  among  ambulance  drivers
                 13 for effective transportation.

                 ]4i           To increase and upgrade manpower by refresher

                 15 courses for  ambulance  drivers  by  offering  associatd.degrees  in

                 16 coordination with other programs for traning employees.

                 17            The project plan is      "Project consists of mounting

                 18 a number of smaller projects," each of which appears to have

                 19 relevance to the entire four-county area, but many of which wil..

                 20 be executed in only one county.

                 21            Thelproject includes  the  establishment  of  a  central

                   emergency  communications  center,  a  WPTTS  line,  a  year-long
                 22

                 23 test of the helicoter operation  based  in  a  remote  desert  area,

                 24 a 20-liour medical. re@-resh(--r course for ambulance drivers,  and

  ce-Federat Repurtefs,  Inc.
                 25 -@:o Associate in Arts degree  courses  at  two  local  community

                  I




                                                                          2 8 8





        SW8    1  colleges.

               2             The narrative participations discusses the various

               3  components and elements of an EMS system,however, it does not

               4  indicate how the various phases will be integrated, nor does

               5  it identify the deficiencies in the-present system.

               6             The specific geographic area has been:identified,

               7  however, there is little discussion as to broad representation

               8  of providers, public agencies, planning agencies, and  community

               9  interests.

              10             The narrative only partially delineates the various

              11  community needs and resources.

              12             There is limited data as to the assessments of  these

              13  needs and resources.

              14             Within the project description the applicant  deline-

              15  ates how operating components will be coordinated with  existing
              16@ components already in operation. _
              171            Linkages with local health daresystems have not  been
              181 described nor is there evidence of invol%rment with community
              19@ disaster plans.
              201            The applicant partially describes.techniques for
              21  utilizing existing financial resources and methods for obtaining

                  additional financial support after the grarit expires.
              22

                             The narrative does not give evidence of assurance  of
              231
              24  quality of car being provided or the delineation after plan i,-.o
  ce-F(,,deral Repoiters,  Inc. evaluate the effects of this system.
              25







        SW9    1             This project was developed to serve a  four-county

               2  covering 40,000 square miles, but eliminated the primary area

               3  having the highest rate of traffic just as delineated in  the

               4  statistical section.


               5             Emphasis appears to be on providing services to San

               6  Benardino area for the establishment of a central emergency


               7  medial communications center.


               8             There are many facets to this plan which contradict

               9  other areas in the developing of the total EMS system.

              10  Contradictory areas includ the methods of financial  support,

              11  the coordinated working relationship with community  agencies

              121 in subregional areas.
              13             There is no evidence of any plan for the integration

              14  or coordination with the areas documented as having the great-'

              15  est need for an emergency medical services system.

              16             This plan should be reviewed in more depth and
              17@ further documented with clarification of the contradictory
              18  points.

              19             The summary by the staff, Dr. Kaplan, says,  "This

              20  project purports to be interested in a four-county area,  but

              21  in fact appears to be onlv interested in San Bernardino County

              22  and those parts of Riverside County which can be conveniently

              23  included.

              24             "The evidence for this @irises. ftoii,. the tact they ar

  ..f,,-Federal  Re,,)oiters,  Inc.
              25! only setting up one central emergency medical  communications




                                                                             29 0





        swlo   1  system in San Bernardino County."

               2              In additional. their statement on page-29 concerning

               3  Mono County and the simple two-line endorsement from Mono

               4  County further supports this.
               5              Further, the letter from the 17th states that thier
               6  review and comments are.-based on a November '18 communication.
               7  It would seem if Mono County were truly involved the letter

               8  of endorsement would have been based on a much more recent

               9  review of the plans.

              10              This is also applicable to Marin..
              11              There.-Are"other-comments, but he ends by sayind,
              12  "Finally, thre is no indication in this plan of any integration
              13  or coordination with other parts of the surrounding area or

              14  potential state plans."
              15              I felt that this also was -- should get a rating of
              16  2.5, and  I felt also that the funding should be for the
              17  continuation of the planning with particular reference to
              18  including those counties that were more remote from San

                  Bernardino.
              19
              201             DR. SCHERLIS:   What was the sum?
              21              MR. TOO,@IEY:  $50,000?

                              DR. MC PHFDRAN:  That is more than their 01
              221 year request that I have.
              23
              24              DR. Jil,41@IAN: The 01     request wc-ts $44,000.
  cc- -Federal Reporters,  liic. MR. TOOIIEY:  I have it down as $'L62,725.
              251




                                                                            29 1





         swll   I             DR. SILSBEE:  I think that is probably in terms of

                2 the project director looking at the first year, and his form

                3 16 relates to the regions' year.

                4             It is a six month figure.

                5             DR. HINMAN:  $44,000 is only a six-month figure?

                6             So your recommendation is for $50,000 for the first

                7 12 months   of the project?

                8             DR. SCHERLIS:  Is that right?

                9             MR. TOOMEY:  That is correct, sir._

              10              Dr. McPhedran?

              11              DR. SCHERLIS:  Dr. McPhedran?

              121             MR. MC PHEDRAN:  Yes.

              13              I haven't got anything to add to the discussion.

              14  IVhere they have identified the greatest need because of remote-

              15  ness and so forth, it hasn't been addressed in the application,

              16  how this Proposed system would connect up with any other parts
              171 of medical care.
              is I            of course, I suppose there really isn't very much,

              19  but it just isn't.clear.

              201             So,I have rated it low.  I gave it a 2, and I am
              21  going to plead ignorance about how big a sum $50,000 for the

                  first year would amount to.
              22

                              Is that a reasonable figure?
              23
              24              DR. SCHEPLIS:  I think in terms of what we have bec--;ii

  ce- Federal Reporters,  ltic.
              2 5 discussing, it is very




                                                              2 9 2





      swl2   I           DR. MC PHEDRAN: Okay.

             2           DR. SCHERLIS:  Is there concurrence from both


             3 reviewers?

             4           DR. HINMAN:  Is there::.a disparity between their

             5 ratings?

             6           DR. SCHERLIS: What was your rating?
             7           DR. MC PHEDRAN:  2 and 2.5. That is not a big

             8 disparity.

             9           DR. HIN1,14P.N:  I just want one figure.
             10          MR. TOOMEY:  2.25.  I think both these projects are
             11 really critical projects as I read them.  I think they need

             121 further study.
             13          DR. HINDIZ@N:  Do you think they ought to be 3, then,

             14 for the planning phases?

             15          Is that that I hear you say?

             16          MR. TOOMEY:  I said 2.5.
             17          MR. HINYTAN: You wnat 2.5 for both of them?

             18          MR. TOOMEY: Yes.

             19          DR. MC.PHEDRAN:  Okay.
             2oi         DR. IIIN@il-.I'i:  I 'had it dbwn'for 2 for the 92.  I N4i!"t

             21 change it.
        25   22          I am getting a Ii.ttle fatigued.
             23          DR. SCHERLIS: Two point five rating for both, and
               five thousand for each of the plans. Is that correct?
             24

 are - Federal Reporters,  Inc.
             25




        3 C@                                                                                                                 2 9




                                                                                      Ilox@ York?   Bc--sson  ai-id Too,-r.(@y,


                         2
                         3                       If  any of  the  (,,,on,,@@ultants would  like  to enter the
                               discussion        as  far is  any  ol: ti-Lc,  technical  aspects  of this,
                         4
                         5     we would  alipreciate  their patieiice,  if you have  any  familiarity
                               or help you can give  us with this.
                         6
                                                 DID,.  BESSOii:   Okay.         Six    projects  for this  applicatir,.)
                         7
                               requesting  fimding  from July  '72  to July  173  of  306,000.                                The
                         8
                         9     six p--oj,--cts  are:
                         10                      1.   The  developitic-nt  of  a  regional  co-Lmci.1  for Bl@,IS.
                         11                      2.    The  deniclopiiient of council  components  in B

                         2     z,@c.1c@r-c;y  areas.
                         13                      3.    The  development of a c,,>irLnurkicatiorts.-systc-iiis.
                         14                      4.    Pidvanced IET training.
                         15.1                    5.    Public educatic),-i  @-hrougli the PxtQr@-can '.Rp-e, Cross.1
                         16 II                   6.    Publ-Le education through  tl-ic,  Amp-ri,can                  Heart
                            I  Assoc:iatibn.
                         17!
                         18                                      O",)jc-,C@--ivcs 3.vc as i2                        here., pi.v@,.@
                                                   SUOCOmporient partfz,                            i)-ig  Glances,
                         191                                                                      y-
                            I  @- v a  -it i n g,  E   c @,r,    c n t       ul@ I i c L@@diic.Fti-cn,  first  aid,  @ieliera'L
                         20 1
                            I  CC),@1)"@OS  in             ai.,                     iiiipzov
                         21
                               n c.   @-.i c @, t i        f          1 i t y       ir, naii--- vocalic evaluation
                         22
                         23                                                              involved i.ri               c(-nta.,,-@,11-
                                                          t-h
                         2411

              rZepoft,)ts,  Inc.
                         25




  e ak. 2                                                                                         3 0


                    I  de,,7elop is .-- this wil.'L. be the gi.-ouy) tha,,- devf,--.'Lops  and  coordi-

                    2  nates  the  model  i-)rograin   in   th,-@   Syractise.-,Cortland-Binghamton

                    3  area  for  training,  co@-nmunicatiol.".S,   t--qkii.pment   standards,   system

                    4  of detection notification and dispatch.   All of these will be

                    5  to  test  the   program   components,   evaluate   them,   and   if   and   when

                    6  that is done, expand them.

                    7                There   is   a   relative   poor   history   of    regionalization

                    8  in  this  area  and  a   history   of   a   I.ack   of   general   coordination.

                    9  But  this  is   a   proposed   effort   at   $40,000.   This   is   probably

                  10   worthwhile.

                  II,                Second is they hope          expand this to develop @ir(-,a

                  12   councils, as well as       @-t  regional.  council  to   inventory   the   local

                  13   needs a,-,d resources and relate to the regional couiicil for

                            @iig these needs.   They want to d@.ivelop a plan fo.-: the
                  14@  meet'
                     I locals to do what the regional N,,iill do regarding
                  15 1
                  16   notification, and so for-@li.   Tlicy are going to --pli-l@- costs here

                  17   with  Corap  planning and P14IO's bi'Ll will, come to $57,000 for

                  18   a yea--.

                  19                 The ---Iiird
                  2    hL-$.v@a        group, zi PIYIP            z7@.3.1e,  F-I -)u,t  th,@ i., r),q  o@,'7
                    0                                                               t
                  21                      @,re ve,-.y s@z@.nt                 i@q
                  22   in one si@@all aspecll-- of this                     They request 29,000
                  23   fo-" on,-- 'i,ieeir. This                       for two students at

                                    r e                                                 li-I c, I -
                  24                                                                          is
  ,@L - Fedetat Rp-porters, Itic.                 tj
                                                                            tha-@.
                                                       gUi@.                         I  air  not
                                     L
                  251
                     I





  e a.!3



                 I   where we stand.

                 2                DR. ILARGULIES:    I think  wp-  could  allow  there  if  they


                 3   are essential to the program, yes.
                 4@               DR.  BESSON:  A  fourth  program   is   developing   a   radio
                 5   communications   system   in   this    Syracuse-Cortland-Biz--.ghamton

                                                                           11@)l- .  .
                 6   area, so that a physician any be directed --  iiysician may

                 7   direct care at the scene and enroute. "

                 8                Now,  this  includes  the  purchase  of   11   base   stations

                 9   at  $4600  a  piece,  17  mobile  stations  at  $1600  a  piece,   six

                 10  tape recorders  at  $900  a  piece  for  hospitals,  br@ti,.ch(@s  and
                 ill so forth, for a total cost of $99,000, all of which is very
                 12  latid,-AlDle, but there are  endless  costs  in@7o'@vc-d  in  hardware

                 13  purchase for private institutions.
                 14               Nonetheless,, I assume that is okay with this commit-
                 151 tee.  It is essential to the development of a ftincioning
                 16  program.  So in that light, I think that, is probably reasonable
                 17               'L@hen,  there  are  two  major  r)ubl-Lc  education  programs
                 181 in first aid.  That is Ped Cross first aid.  There are 25
                 1 9 cha-,-3t@rs 0,Lc Pc@d Cross. is Red C:roo-s right?  I fee'L as though I

                     should be           Dluc Cross.              J-Liric@ 1970 and 1.971.,
                 20                1
                 21  they trained 3,000 people, @aid there are m@@iy              ilifor-n-ta-,-D7
                     tra.@i.i-) cl-, perhaps an e ual          So i-l. t%7(3 CVUCSI@ there are
                 22
                 23  6,000 peoplc,- trained in th'L,.,y ef)"ort  at  first  aid,  tley  are

                     requ,.r.,stii-,g $C,,000, s,,) zt'k-, a  a
                 241
                   I
  c,,e-FL,detal Reporte,,s, Inc.' The                        a.Iso is            z-+. public
                 251
                   l@




      4                                                                             32

                   I education campaign on card-i.o-puliroiiai-y L@esuscitatiori.  They I-iav@
                   2 had 30 classes between 1970 and '71 and 453 certified CPR
                   3 people.  They want 50 additional courses at 29 --- at 20,000.
                   4 In general, this is an attempt in central New York to produce
                   5 a coordinate education program.  It is very sketchy and very
                   6 slapdash but it is  far better than nothing and though it is
                   71 inadequate on a grade of one to five, I would gradt-@ this three,
                   8 And I would recommend full fending.  It is of interest to note
                   9 that the hectic pacc, that was engendered by the submission
                   101 of this application between hpr-il 19 and the time of the
                   11 F@(-,;bruary 24th letter sent the coordinator to a hospital with
                   12 iiliat was described as nervous exhaustion.
                   13           i@d then by 4-26 when the application finally came
                   14, in, there was an addendum saying, "P.S., he is much better,
                   15 thanlt you."  And somebody finished the application and sent it
                   161in.
                   17@           DR. SCHEI?L!S:  That is for o,-ic-@-yaar fui-..ding?
                                                            e -
                   181           DR. BESSC)II..- (Si. It     @,(--rgent-y riedi.cal servic(.---s
                   19 @lirough integration o-.L@ i+".s    Gets into a
                   20 system         a 17 coi:inty        The I:j'-'Lan, I thi,@illl-., ha  I,)O-exi
                   21 dc@@@elo-l),@d a@ an ev@il.@i6Ltiori.  tire most ess@-ntial
                   22ic,l' this systeri is a            of @i
                   23 worj.-' Wlth an             aiid a;,Lil.)ulanc-c-. cori@@.tiuri4-cL4tioi-i on a,
                   24 regional-       what

  Ace-Fedefai  Rerortets,  liic.
                   25



     5                                                                                 33


                    weak in the area of quality ac@rurance and evaluation.         There
                 2  is a need for local and regional organization which will
                 3  spend approximately two-thirds of the money requested.
                    Potentie-,l resources not (-,',ocu7if@,ented, however, the model
                 4
                 5  program area and services are adequately listed.  The
                 6  application centered around two major components, an advanced
                 7  emergency medical technician trainin4 program  and a coliu-nunica-
                 8  tions system.
                 9               The application appears to b6 innovative in the
                10  area of EIIT training due to the lack of physicians and
                11  emergency room facilities in the north country.  Applica,@it
                              the priority of training              iprrtc,-nt for proj@-er
                1 2 stresses                               over equ
                13! irnplem@.3ritation and coordination of the total system.      It
                   Iappears that a total communication system in this region         is
                14i
                15  needed and the applicant has planned for an effective
                16  4 irplerr,.erLtation.
                171              Hoviever, applicc,.nt, refers to how the areas should
                                corro-,.iinicittion program btit little         is priced

                    on the           r...-tec'liaiisrcLs fo@.-- future, expansion into rural
                19!
                           and ipprol:)riate trair.-i.x-@g of personnel pi--'.or to
                20:
                   1
                               2@ L i o ii oI i e e q k i: L f a c eT I i e ap I i c a t i o ns
                2 1

                                       d    t rk-@, c i-i ta
                2 2           a 0 I-. s                         c',eiit- f      o-l- rc-,@ S.,Z;Urc;@
                                  c@'-- i,@,,resen,t rep@o,.--@,rces, ir,-@tl-todr, oA'
                23
                                areas, arid         c@f         fc)r  ti,le
                24@

     Fedeial
         Repoftpfs,  Inc.        or@  the       s       thcl
                25 1




      .6                                                                                          3 4



                       this basis, tha,;-- T- would agree with the three rating.

                   2                 DT@.  SCIIERLI.II:  Would   you   suggest   full   funding?   Do

                   3   you think they can utilizt-- that effectively from some of the
                   4   points that you have made?

                   5                     TOO.'4rY:  Yes.

                   6                 DP,. SCI-IT-,'I@IS:  hl-io would be in charge of this over-

                   7   all plan, the Pi.@@IP itsel@A"
                   8                 DR. BESe-01; :   They   will   develop   a   regional    council.

                   9                 DR. SCHERLIS:  Thalk-. will be 4-t?

                  10                 MR. T00ilrY:  And then subcouncils,.'

                  11                 DR.   BESSON:   And   then   subcoun--ils,    in    coordination

                  12   with. the Co,-op planiiIi.rig, local areas.

                  13                 DR. SCIIERTAIS:    Dr. Joslyn?

                  14                 DR.   JOSLYN:   I   jusi:   wondered   whether   the   committee

                  15   has the rig'Llt or thc- intention in any of these where there are
                  16              olacaj-,s that are clearly separated, to iT,-)J,:e any dis-
                  171             as to which programs %-iarrant funding and which do
                  181  not?   in othe.r words, this has a total budget of a little over
                  19   2,V'O,'oCO 1)@c,,,-@ 3'.t is.r-loarly brokE@ii down into s-t,,., rroj,--Cts in

                  20

                  21                       you knout, does tlic,- cor,-aiii.ttec@ liE4ve @-ny

                  22   @,E, tl,,@t-@y go aloxig iri different regions to say th@-tl.-

                  23   pi-cj,:--Icts        f-iirdiiig, others do note
                  241                DY". S(I'll."@i@T,"J,S: would         we do. 7gi I  c,,)rtc-c"--

  ce-Fedefat Rei)ort(,,ts,  Iric,
                           t ',-@ 4 S
                  25                 T        h@-@@ye no              i.i,i supi-) ti-i.iiq a



       7                                                                            35



                 I  recommendation  that a certain project not be  funded  or  anotiic-r

                 2  project be cut  significantly.   I thiiil@ in this type  of  review,

                 3  we would have that ability.

                 4             DR. BESSOI.I:  Mr. Chairman --

                 5             DR. SCIIE.RLIS: Not necessarily  the  wisdom  but  the

                 6  ability.

                 7             DR. BTSSON:  I think Dr. Joslyn's i,.)oi-nt is @,7ell-

                 8  taken  in  that  as  I  went  through  the  six  components,  I   made   a

                 9  comment abou-'"- the individual funding request for each.  @co

               10   re-i.terat(-,,, the regional council should be funded, the local

               11   councils  should   be   funded,   particularly   since   we   are   splitting

               12   costs iz:i.th  Comp                                  C)
                                     planning, tl-ic-. advanced ti-ainiri(7, f r technicians

               13   if stipe.-4,ds  are oltay, and I think they are, should be funded.
               14@             Radio COIW.ILLiicatioiis, I ha-ve so,-tic hesitation about

               15   the purclase of all this ecluipirent, but I thinl@ that it is an

               16   4n!@egrall. part o-4 thl-,ir system.  Pul:)l-j'-c  education,  I  think  that
               17@  is where I mention a k)argaiii at a dollar a piece for Red

               181  Ci-oss training and 20,000 fc)r A,;cL,-@rican Ileart Associcition
               191  progran@L also.

               20              One of til,@@ problems with c,,ziit),-al new York is

               21   fact th@x.-- they need          to gc@-t their tec@tl-i into,  to  do

               22   thii@igs  on  a  cooperative  baE-,is,  This  iF,  tile  first  indication
               23   tlieLt th(--y might be able to i-rourit s@uch an effo@@. I   think   they

                        'd be ericol.'-!-a-
               241  si-iou            ri c2.  A.-,.d in passing, too, I roi.glzi- mal-,e

  ,ce- Federal Reporters,  iiic.
               25   a n oi @.-, r c o rm, e n




  eak 8




                  I               As I  have  x(-,viewed  all  of  these  applications  and

                  2  wondered about how          can  assist  in  this   national   neglected

                  3  disease,  I  thought  our  function  would  probably  be   best   served

                  4  by our acting as a catalytic agent and be generous in our

                  5  funding of seedlings, rather than single, massive Programs.  In

                  6  that sense, if there is a program that I encountered which had

                  7  any merit at all which wasn't just a ruse for getting some

                  8  bucks out of the Veds, and would produce an op
                                                                          ,portunity  to   do

                  9  just what x%,,IPs started  to  do  many  years  ago  in  planning  and

                10   developing mi organization for creating regional concepts, then

                11   I thought it was meritorious enough to get at least some

                12   m-@-@i3-es, rather than turning theni off completely.

                13                In that light then,  I  think  central  New  Yox,!-,  needs

                14           This may be an indication of how we might do it.

                                                                  -more o@ a system o  care
                15                DR, SCHE@TIS:  This speaks i

                16   certainly as .,oiTayed to the

                17                DR.  BESSON:   Yes.   It   addresses   components   parts

                18   zLnd integrates them.
                19                DR. SCIIEPLIS: Tlie rocoim-nondati@oi-,, is a ra@.irg  of
                20   ti),rec, wilt-II-i ful.1 funding. l@y cc@nditions@ for the-    ?
                21   Ol:)v-,@ously tlic- q@,iestioii of stip, rids  for  training  you  wish  to

                22   loo),
                23                DR. BES'-"ON:  I don't think         is conditioned.
                24                    SCIIE!Uj'-".13:  A-s as you i,-rc-, conceited, this is

  ,ce-Federat Repotters,  Inc.
                25





                                                                                                      37



                    I                 DR.   BESSON:   It   is   a   one-year   request.   They   have    a

                    2  three-y(aa--   request -- rio, it is all one-year,.   The only
                    31 condi-t.-i.(.)rs would I.)e to do a good
                    4                 DR.   SCHERLIS:   Pny   other   comments   from    raembers    of

                    5  '---he  comm.;-ttee?  I  will  accep%-.  this  as  a  motion   and   a   second.

                    6  Any fuxtlier discu@-s4..on?

                                           those 4
                    71                All          ..n favor say #!,aye."

                    8                 (Chorus of ayes.)

                    9                 DR. SC-SIALT-ZLIS:   All right.

                  10                  Do you ha@,7r-, any coiftmc-lit at this point?

                  ii                  DR.  IIARGTJL@&ES:   The   only   comment   I   would   make   here,
                  121  now -,---hat your action has l@c)i completed, is that I think that

                  13  the  reasons   for   doing   it   make   very   good   sense.   It   is   a   region

                  14, Which has had problems in the past.               It is under new

                  15   ship, and this ,iill gi.ve them something they can bite                        We

                  16   w-Ll.1 have to talk wi@L.h tl-ieifi shut what thev ini---ert(i to 6o i,n

                  17   the future, whether this is a part of the future prograri de%relo-'

                                              4
                  181  ipe.-it.   But for thi-,--@ regio.,-i, it is just as well they

                  19   beyo,Aid  a   year.

                  20i                 I-,lR. STOLOV.   T,-ic,        tl-iey are 2riki%@'lg for

                  21   yza--- funding is that k4-he regai-cria'L advisory group and

                  22   conffL-iit-ee  asks
                                               i, only         in  for  on@--year  finding   dt),e   to

                  23   the i-ipttire that there is no apl)c@.i.i,,L@-,d                 coordi-n,"@tor.

                  24

  ce  Feder-,31 Reporte.@s,  Inc.
                  25   r,@     tc@, d a cc) n s u I  t-,(:) 11    O'Tl.        I f@       PI@'@,11',




    eak  10
                                                                                                                                                33


                             I     and      their      plans      for       th-3ir                      which  -.s  due  in  here  July

                             2     lst,  that  they  may,  in  all  lil-.eld-hood,  continue  this  as  a majo-.-

                             3     part  of  their  overall  program,  sl-,o,,ild  they  have  a  three-year

                             4     plan.    But  that  was  it.

                             5                        DR.  SC11r.IILIS:    Ne>.t  is  Connecticuk@.
                             6                        DR.  BESSON:    One  other  comment  I  would  like  to
                             7     make  in  this  connection  that  sti,uclc  me  aboLi@.-  this  application
                             81    and     orie      other-      application,      Illinois,      when      we      come      to      it,      is

                                                               I     moved      in                                                        ".t
                             9     that  es  P--'@!Ps                            to      --      since      the      St.      Louis      meeting,
                           10      and  I  don't  know           what  has  been  happening  in  the  past  year  --
                           111     new  ar@,a,,-  o'L  fc)--us,  and  if  our  area  is  health  delivery,
                           12 @l   throi,@,c4hou-L"    the    cc,,untr.,l    we    arc,    seeing     perha,-,-jco     a-     reaction     to     thzi
                           13                      on  the  one  hayid  in  the  turbulence                       in  the  core  staff,
                           141     w-Lt-.Ii             N.@ho                       cz-.i-ne  on  to  PI.,IP  in  z*  categorical
                           151     fash"@on     now     having     t,@     look     at     a     ni-,.,ch     broader     view     of     !-reach
                           16                          and  als@c,,  or@  'g.:lie  oi,-Iicr '.),ard,  or,  the                                 sector,
                           17      whorls  there  are  grolLxy3@-,,                   i-ic-,               were      very      stro:-ig       who
                                   a,riLi        Lagi-rn,'-ng  to                                               has                  in         health
                           181

                                   dc-, 1 4 V-@@
                                                                  S  SC
                                                                                 o   i-,h@@     l,c.@gr@.rrs  we  got,  in  at  least
                           19
                               I   t @i e  z -op 1 i c a t          -"t  I   h   a z ,  C a 3,                ii d  Put g e r s ,  @,7 l(i c-,, i-c-@  c-
                           20
                                   priv,-,"k-.e  secLc),@  is                                          -Wheat  resistz,,.,-icci  to
                           21

                                   4
                           22                  on.
                           23                                                                                       I  think  oAr  all  O,-

                           24!i
                               I
    @ce -Federal f@epor ters,  Inc. cl I      cl,@,   1                                C) .-r              r  P04@ c@ i'c-
                           25






                                                                              39


                I and qua'Lity o--F care.            think wherever: we I-lave an
                2 opportunity to dele-lop linkages with the providers, particu-
                3 la.-ly, which are very weak in many parts of the country, in
                4 this non-tli_-eatening area, for exaraple, we should encourage

                5 it.
                6            Now, for an area li,]-Ie central New York that can meaii
                  a great deal. So whatever encouragement we can give  them  in
                7
                8 dollars, even though we don't give them encouragement in dollars
                9 for other programs that may be. just as meritorious, I  think

              10  we should.
              11             DR. I-IARGULIE8:  I would like to recognize Dr.

                                                I
              12 1Yelley from Ohio State I.-la:3 arrl-%,ad, one -of our consultants.

  end 4                      DR. KELLEY:  Thank you.
              13


              14
              151

              16


              17





              19


              20


              21


              22


              23


              24

  @ce-Federal Repcftets, ir,
              2





                                                                                       4 0



         r
                                DR. SCT.,E@aL",S: A 1 I., r:@ g hC(@n.,-,,@ct-icut, Dr@


                 2  Mc@Phadran.
                                DR. MC PHEDI@N:  The Co"n(@cti.cut request is
                 3                                                                 @or
                    one @ear, total funds, 328091--@, and it is mainly organizatic)i-ial
                 4
                    and exl.)lor-atory.  II-11 sav at the beginning that I rated
                 5
                 6  this at three, perhclT)s lower than  the  sta@Lf  revie@v7,  and  I'll
                 7  stF',.Le..at the outset the reasons for this are, I have scioe
                 8  questions about why no interrelationship between this an--I
                 9  another program, another project I reviewed, that is, Tri;Fta-te.
                101 T. am not sure I really understand             And also there  ay-c,.
                    c@C.,,-@@2 intrinsic problems withi-i.1 tl)e region itself.

                                 m
                                 jhe inten-t-, of the r)rojec-t-- is to, as stated on  the
                121
                131       !5, or anize statewide EMS syctz@Eqs --.- dc@'velo.,,-) and
                     - Ci        hrough regional re@iu'Lat@,,)-", and management mechanisms
                141 0  c'-'-"Ze, t
                    and     launch an operational E,'-,fS d,@yrtc)rist-@ati..on ii- i  the  south
                151
                   i
                        4- -a l
                    cenu@    reoion, that is, met,-io-.polit@in      Hav,(-@-,i@, and siarround.-
                16 1
                   I                        y                             @he
                   ,iiig regions.  And the  intend to %@To:r@!r, through 'L         traurDa
                171


                18
                                 This is       a            or@7and-zationel
                19                                    .1
                               to           the f2:a@LE,,wc)@@k @c-,r a statewide
                20
                2  1                     7-Ind,       )f
                22        c@ F, e,,@?7 l@'aven area.
                                                                                        4Fnc,
                                 ,@rt is c-;ta4l@(-,cl tl-iat it- i@-, ho,-,ed t' @it the
                23

                             @T,
                                             o 2       i-i             be        t
                24

                                                          can't
                25






                                                                                                     4  1


           ar2
                        of the state through this EMS coiisorti.-cir.            The consortium
                    2,  which   is   proposed   will   build   on   the   one   which   is   now   working
                    3   and which is centered around the Yale trauma program.
                    4                 Now, some of the problems, questions that I had
                    51  about  this,  are  now   v7ell   --   what   can   be   learned   --   how   much
                    6   one  can  expect   to   learn   from   the   New   Haven   area   to   extend   to
                    7   the   rest   of   the   state.   I   wonder   whether   this   is   a    realistic

                    8   idea.
                    9                 I   don't   really   understand   also   why,    if    they    could
                   10   propose   this   activitv,for   one   vear   --    I    don't    really    under-
                        stand  what   is   going   to   happen   after   the   one   year.   It   seems   a
                        little   strange   to   me   that   these   monies   are   requested    for    one-
                   12
                   13   year activities.   I don't really see exactly what is going
                   14   to   happen   after   that.   There   are   plans   for    funding    from    chair
                        sources   spoken   about   on   the   application,   but   that   part    of    it
                   15
                   16   didn't seem definite or det,-,.4-].P-d enough for me to                 understand
                        exactly where thev are going frori there.
                   17@                         .1
                      I                So thi'-s is essentially a planning and organizational
                   19   Period for     which   funds   are    requested.    Some    general    plans    for
                        the state as a                some               plans, and  @i  de,-ctc-)ns-tra-
                   20                                         t
                   21   @-ion projr@cL-. for- part o.rL tl-i e s --L--a-L-.e are  included. I have
                      1 a'l"e,-.dy gi.vcln -:,-.he amount, I think.      I    recommend    its    funding
                   22    -L

                           tH reservation.
                   2311
                                       I hope that we c@.n                  IL-@@is mattc,@- of  i-ntci--
                   24,
  ,ce-Fede(al Repo@teis,I
                                                 and coonera-ti.on..     it  is diL"-c'i,,@ul-t for m,@  as
                   25





                                                                                   42

        ar3

                 I someone who was born and brc@04 i-n the northeast to understand
                 2 why there  isn't evidence in @"liese two applications, Tristate
                 3 and Connecticut, of more conversation between the two of
                 4 them. I would have  thought  there  would  be  some  pertinent
                 5 issues they should discuss  together.  But  I  don't  see  any
                 6 evidence of that. Maybe  it  would  just  make  the  application

                 7 too big.

                              DR.  SCHERLIS:  Let's  have  the  secondary  reviewer
                 8

                   and then we'll throw  this  open  for  discussion.  Dr.  Besson.
                 9
               10             DR. BES.-DON:  To reiterate sone of what Dr.
                   McPhedran has already presented, thev  do  want  to  organize  a
               1 1
               12  statewide EMS program through what they describe as regional
               13  regulation and management, and then create a single demonstra-
               14  tion program in the south central portion of New Ilaven.
               15  Number three is to develop an EIIT  training  program  and  then
               16  create what they call a consortium between the Yale trauma
                  !organization, New Haven Health Care, Incorporated, which is a
               17
               18! newly funded experimental health services delivery system,
               19i apparent'Ly, and Dunlop Assot-i-a-Les, who are now  nationally
                  !@-Ell@-ous, to organize, train, and prodkice and implement an
               20
                  iactioxi program regionally.
               21 1
               22             And then the final program is to have a year to
                  iorgai-i@.zc- an analysis on tl,.(,- content of this demonstration
               23 1
                  !
               24
  @ce--Fede.rat Reporters, Itic. Now, as I looke6 at tli(.3        I-)r(--akdown for
               25





                                                                            4 3



       a r

                  this @300,000 - $328,000 the% reqti(-,st, pages 14 to 16 of the
                      le
                2 application, are the onlv places where a budget is  mentioned,
                3 and it is extremely sketchy and no breakdown.
                4            The New Haven Health Care, Incorporated, program
                5 is also described in a very sketchy fashion.  They merely
                  mention it, that thev will consider it with the newly  funded
                6                     1
                7 experimental health services delivery system, and they
                8 1describe it, but it is apparently a new organization that  has
                9 a very fussy goal.  While I haven't seen the EHSDS, I am  not
              10  sure how much they can cut the mustard.  They have very
                  sketchy information, as Dr. McPhedran has -pointed out, on the
              11
              12  development of either statewide, regional or  interregional

              13  program.
              14             Their information on their E@IT training which they
                  describe as one of their corn-oonent parts, is described in  one
              15
                  line, practically. Thev speak of the implementation  of  an
              16   L
                  EIAS system component to facilitate, organize an  erect
              17
                  training throughout the state, although Dunlop  Associates,
              19  of c,,(---)urse-, has .i good track record, and presumably will help
              20  them in their developmental port:,'-on.
                 I                                                                  1
              21             They have no -,Lnforr,-Lat.@Lon on how they will relate
                 ito t@,@ 'L'@'Lle @--caurrLa Procirain.. And then they very poj-gnantly
              22 1                      1
                 1sta@te     %,7ant funds br@ceuLe the Departinei-it of Transportation
              21
                  m,3.y p,;ia@3e@               AnO, t-I-)c-@@, say besides the
              241
  ce- Federal Repo@tcrs,  [fic.I
                 ID@i@.-.ar-L-merit of Triai@s-oorta.-tion f,.,@nr3s sl-iould
              25 1                   -               -




                                                                                       4 4


        Ei -r A


                    used for 'Iiighway accidents and .)-Lirchase of related equipment,

                 2  and "we have a broader mission."

                                 I  think  the  entire  application  is  verv  limited  in
                 3
                 4  description,  and  I  would  be  interested  in  funding  them   only
                 5  on conditions that they provided more details on how they
                 6  expect -- there  has  to  be  some  more  meat  on  these  bones  they

                 7  present.
                 8               But again I can be charitable and say the applica-
                 9 i-Lion was -just put together  in  the  usual.  case  for  this  whole
                I 0 series.
                11               DR, SCHERLIS:  May I ask a question?  As I view
                12 Ithe document, apparently this was really put together for the
                13  Departmen'l- of Transportation in !lay of 171, with some
                ,4  introductory statements at the front.  Is that correct?
                15 lBecause I  was  looking  for  the  budget,  I  was  curious  how  they
                1 6lwe-re going to spend this in  a  year  and  Tiot  tie  un  people  who
                    entered the program, wondering about the second or third vear.
                17
                181              And, again I could        no ID-czdget here at all
                   iexcept   for the sheets wlij.ch are surnr.i.k;inglv specific  abou4.-
                19'
                20  s a 3. a. r y Ft."' a@vages, $17'2,3J,2, I-,i,,t yet nothing th.z@,t 'i-n ax,.y

                     -idicatE,@i ow they a)- L            L.
                    ii         h            r',,,,@d at     figured,
                21             DR. BESS014i  They hEci an   ongoing  prc),Di:,a.m with th,,@
                22
                   IDepartment of Transportation, and           Ya'!-e       P-L-0g.TEM,,
                23

                    and this is an e;,."-,r@n-si.on
                241
                   i
  @ce,-Federal Peprftc-Ts,  lric.IDR. SCTLii;,RLIS:  Dr. (;irrble'.-,  Do you have aii,,7' concc,lDt
                251






                                                                                                                        4 5



                            of how those nu,,@,bers were           arrived at',

                                            DR.  GIMBLE:   I       found the whole application was very
                       2
                       3    scant    in    detail    and     though     their     general     motives     looked     like
                       4    they were in agreement with RPS goals, most of it lacked
                       5    detail    of    any     sort,     including     the     budget.
                       6                    DR.     BESSON:     The     other     thing,     Mr.     Chairman,      that
                       7    might    be    appropriate    with     this     application     is     that     since     --
                       8    the    bulk    of    this     application     involves     a     continuation     of     the
                       9    Department of Transportation program with the Yale Trauma
                      10    program,    and    since    th'Ls    is    just     a     tentative     exploration     of
                      11    the    development    of    an    EMS    system    on    a    statewide    basis    with    a
                      12    demonstration program, with the experircental system,  it might
                      13    be   that   in   asking   for   more    details    on    how    they    e,-,pect    to    go
                      14    about it,  that we might ask them to use other funds  for this,
                            for   the   year,    and    see    whether    they    are    i,eally    going    to    add
                      15
                      16    to what has already been done with the Yale Trauma program of

                      17    the past.
                                            DR.    SCHERLIS:     Is     all     this     tyauma--ori.ented,     if     we
                      181
                      1 9   are going to speak about a system of care?
                      20                                        The c-,ii.-i:r@iit         Trauma      system      is,
                      21    but   I was a little                       -a)-)out  ho@,  F@,t@-plicabl,@  w,'ic@,t  they are
                      22    going  to do in the                        I-Ia-\7(@-n E@rr--zi,  not being very
                            familiar with ConnE--c+---i-ciit i.ri                         But I am sure the rest
                      231
                          I of CciinE,-cti.out doosn'-L.                     the          Haven           and     thi,-@
                      24  1
   @,e -Federal Reptifters, lric.isys,@,e,,@t is going to be modcl-,,3cl. very                                         n
                      2511                                                                .@ly   on   the    New    Have






            ar
    Tnea-I
    UR  t).i t) I
    it 5-B
                 I area. I x,7as hesitant about 110'Y7 aT)i 'Licible it would be to the

                 2 rest of the reaion?
   40            3            DR. SCHERLIS:-.- Dr. Rose?
                 4            DR. ROSE: Would you  like  comments  from  the  branch,
                 5 the general terms, about M,4P? Might that  be  helpful,  how  this

                 6 might tie in?
                 71           DR, SCIIEPJj'tS:-  I think it might be helpful if we
                 8@had some general background.  My concern has been voiced by L-oth
                 9 .reviewers.
               10             The budget, and is this going to be essentially
               11  trauma with the Yal.e--,-Nlew Iliaveii area as a model, with less over-

               12  all svstc@, involvement?
               13             DR. FAATZ:  I think generally for years and years
               14, New Haven has been probably the -nost heavily studied to@;n on
               151 the east coast, and I think TRZYP is probably following that same
               161, tradition.
               17i@           The New Haven soutli ceii-"ral area of  Connecticut  is
               18  being set up as a demonstration for the rest of the state
               19  because Yale is there, and -i-t is the cisiest to get to.
               20                               @T  Z!7,'      in -tb.j,s-
               21  al)out the facL Coniicr-1--i.c,-,t has in itE@ Td@P this general dr--si@r,
               22  o,@ lin)tages between                        @tlie. entire state
                   from       vou havc-- described to me, it @;ec-!i,,ts lo p@,eh
               23
                                    Sic Ctru@",t,@@Lrct      set iLlf)
                   ign,oL,@,d     ba
               241

  @c(,- Federal Reporters,  Iiic.
                                T     ',t urldc--,.--stai-id i-.!,iat.
               25  di.f f croi-Lt    I





                                                                                                           4'7
            2
       ti E@. z-@




                                       I   would   have   thought   that    that    hospital-    system    that

                    2   they   are   trying   to   design   would   have   been   quite    a    good    vehicle

                    3   -Lor statewide emergency medical. systems.

                    41                 DR.   MC   PIIEDRAli:   It   is   not   clear   that   thev   have   set

                    5   up   so-nething   so   much   different   but   they   have    set    up    something

                    6   just with no relationship to that.   It doesn't have enough

                    7   specific details to tell if it is different, really.

                    8                  DR.   BESSON:   That   is   the   impression   that    IL    get.    I

                    9   am very restless about the fact that again -,- and I may sEV tl-lls

                   10   a few more times,Len, over the next eight hours -- that now

                   11   that P,"APS is moving out into the area of health delivery,, we
                   12iare realiv going to be testing whether the linkages that we
                   131speak of in such glowing terms in M.IPS are really there.

                   14                  Now, if they are really there, Dr. Clark should li@.-tv,--
                   15   just   fallen   right   into   the   skeleton   that   we   talk    about    that    is

                   16   oing   to   be   so   useful.   If   thc-v   are   a   sham,   which    I    personally
                        9

                   17;beli--ve   they   have   been   in   Connecticut   for   some   time   ---   I   thii-ii<
                   18.lthey have been a ruse for the niedi.cftl- schools to buy some

                   19   addi tional- sal,--ried people                  the linkages don It rea"4. l@.@

                   20 !exist for TDut-c:i.r).g this kind of delivery syste-m onto that

                   21   skeleton.

                   22                  No7,i, I C.or.'t  know  liov,7  else  to  J..ool-,  cit.  Connecticut.

                   23   Clarj4,, is a  iDy-e@-ty bright guy and I think that they are just not
                   24               to r,,,ove ou-@         zi                                 o--?-ganizatic)n

   ce Fedetal Repo@tefs,  Inc.
                   25   and q,,@t into health delivel-)r.





                                                                                         4 8
      mea- 3


                                So  they  flounder  around  and  look  for  an   organization
                 2   that is not even funeied, and v7ant to contract with them to do it.
                 3   Well, all I can say is, this is what core staff, if the linkages
                 4   are there, should be able to just move right into.
                 5              So the fact  they  are  not  makes  me  a  little  bit  leary
                 6   that they do have the linkages competence.
                 7               DR. SCliERLIS:,  Yes?
                 8               DR. FAATZ:  I thin],, the Connecticut regional
                     medical program was only peripherally involved in developing
                 9
                     this project, if at all.  I think it was developed by  a e
                10
                     trauma and other people.
                I I
                12               The R14P is being used as a vehicle to get funding,,
                13   And Dr. Clark and the Dean of Yale and those people signed off
                     on the request, and it came in.  But I-ZVTP I believe was      not
                14
                15   involved in the development of the program.
                1 6              DR. SCIIERI#IS. .  I as]-, this only for information.
                17               Is my interpretation of the indirect costs,
                     66 percent  at Yale
                18,
                   1             DR. DESSON:  Yes.
                191
                   I             DR.                Is that
                20,
                                 DR. BESSON:  Thai: -'I-s correct.
                21
                22                DR. SChElU,!S:    I        I hesitate over th-A.s  one  t-o
                     get more d'-'.-Le c t i o n to rA. and the rieT@oers of the
                23
                                  l@ this            of c,@ir(,?  I v7r-)Ul.d    tt-ip,@t %@,.i.thi
                24
  @f,e - Fedr-ili Reporters, Inc. all the @tu(3ic-s      on in that area       tIlOF@(-- of yo,,@)
                25i








                           e,   th4 S
                lwho can  se        is a th4ck. document filled with questionnaires,
                                           L
                lbut no data.  Isn't that correct?
               2
                             DR. MC PliEDRAN:  That is correct.
               3
                             DR. ROSE:  Can I comment for just a moment?
               4
                             DR. SCHERLIS: - Yes
               5
                             DR.  ROSE:  Actually  the  questionnaires  represent   a
               6
                 statewide survey. I  tried  very  hard  to  get  some  results  from
               71 the survey figuring that you all would need this.
               8
                             DR. SCHERLIS:   Yes.
               9
                             DR. ROSE: It  turns  out  they  will  not  be  available
              I 0
                @until  next month.  So, the questionnaires have been used.

                             DR. SCHERLIS-.  I was curious how they arrived at

                 need in terms of this request for -unds.
              13
                             DR. BESSON:  They have some preliminary idea.  They
              14
                 have a preliminary analysis  of  this  survey  which  is  the  thing
              15
                 that has been ongoing  between  the  --  funded  bv  the  Department
              16
                 of Trai-isnortation.
              17
                             This was submitted     1, 1971 --  submitted  by  the
              18
                 Yale        ProqraTn. tt--) the,. Pic-!pat,tmerit o:F Trpnsportatir,3n, ties
              1 9
                 entire thing.       they do have  a  preliminary  analysis,  and  I
              201
                 ju t  can't
              21
                             DR. SCliEPI',!S- Yot@    all agreed on a grade 3.
              22
                             DR. BESSON:  Oh, here, excuse mc-,, !,Ir. Cha,4.ryT!-in.
              231
                ITlac-@ prc,.Iiiiti,n,@irv analv!74S -his data has Pinpointed
                                           of all o'
                                                   L L-

              24'
                1
                               T-C
                                 'k
  ,-e-Federal Rc,,@)o@,ters,  Inc.  of
              25





                                                                                 50
    riiea-5


                   organization, uninformed public, no linkacT(@s, and no objective
                I      -                                 L    -                       I
                   standards to evaluate.
                2 1
                3 1           Now, if thev were to address, ever, on that
                   prelir@tina_rv basis, some of these objectives, they would have an
                4
                5  entirely different program.
                6             DR. SCIIERLIS--..  I have some concern at this point,
                7  ,Ln that while you have recommended a rating  of 3, you have
                8  also recommended full funding -- would there want to be some
                   reconsideration of whether or not if you are going to make a
                9
               10  recommendation we might not restrict this to just some seed
               11 Imoney to begin to set up some developmental ---
               12             DR. IIC PHEDRA,:,I:  That was my recommendation.  I don
               13 lknow whether Dr. Besson concurs on a rating of 3.
               14             DR. BESSON:   I concur on a rati@ig : of 3, or maybe  onE
               15  as low -- maybe two-a.nd-a-ha.1f, but my sugg(@stion was to  approve
               16  the application but rec-ruest that T-1@-IIIS no new funding and
                   fund it out of core.
               17
                              DR. SCIlEi@TIS-1 Tii, ol@-her w-ords, yc)u are saying it is
               18,
                  1                                                                   i
               191 a        good application but you aren't                 any nc--,,,i-
                   fucidi-rig?
               201
                              DR. BESSON:  They hz,,ve nlicinty of i@o3i;-y.  As I
               21
                   remember that Coiin--cticut -applica-'@l-li@o,.i, it %,7a@3 in the seven
               22


               23

                              DP.
               24'
     Federal Reporters,  Inc.1ti,@n  by
               25ii









                                DR. MC PIIEDP--@l,!: Yes. I  don't  know  whether  --  can  we
                  Ido that?  I am not sure vie can.
                 2
                                DR.  IIARGULIES:  That  actuallv  would  pose  a   problem
                 3
                 4 because if there is anything that that program needs,         it  is  a
                 5 stronger program staff.  That is one place where they          don't
                 / have any  fat;  they  are  very  weak.  And  we  have  been  pushing
                 0
                 7 them hard to strengthen that program staff.
                 8              So, you might look for other sources of funding than
                 9ithat, if  you  want  to.  I  think  that  would  not  help  that  program.
                10              DR.  MC  PHEDRAN:  Maybe  that  program  --  maybe  the
                11 Connecticut regional medical program shouldn't have let this
                12 come in under  their  name  if  they  weren't  going  to  have  more
                13iinput into it.  Maybe they can be faulted for that.
                14@             But  as  stated  in  the@note  from  the  eastern  operations
                151branch, they apparently -- this is not something that has been
                   central to their interests, this kind of activity, in the past.
                1 6lAnd maybe -.- I don't  knout,  if  it  hasn't  been  central  to  their
                17 II
                  linterestf3, it perhaps would  be  a  disservice  to  them  to  say  it  is
                18'
                  la good thing to do, go ahead and do it, with your present
                19I
                  @monevs and present   .staff.  That  might  just  injure  the  rest   of
                20!
                  I
                  Ithe  proarpm, or 4i,,hey might feel it would injure- the reE.@t of the
                21

                   program.
                22
                                Perhaps it would be better to zipp.-ccve 4-t %Title  soine
                23 @fuiidir@      wolLi).c@ s.,:7-c-m eiic)ii(;h to c-iiabl.c, term to c,.7et qt,-:irte,,l
                  1
                241
  c@,--Federai Repoftois,  Inc. !with  r-,art  of  it  at rate. I  Cion't  knc)-@,7 that  @,.lould
                25






       inezi.-7



                                            DR.  SCHERLIS-.   There isn't enough?
                      2
                      3                     DR.  14C PIIEDRAN:   There isn't enough data to tell.
                      4                     -DR.  SCliERLIS:       If they had a gross figure here of
                      5   120,000 or 450,000 I think we would be just as  lost as to how
                      6   they were going to spend the money.
                                            DR.  BESSON!   They don't tell us what they are going
                      7
                          to do with the money.   They don't have any budgetary breakdown,
                      8
                          it will be all going into the Yale slush fund.   Excuse me.   And
                      9
                      o   besides, the EJISDES Program,  if  it has been funded -.- and I
                          assume it has been -- that is what this experimental  system
                          management board is  supposed to do anyhow,  so -vyliat. .E, i@4P
                     12
                          P-Lit4t-l-ing money into  that pot
                     13                     1                                                                               1
                     14                     DR.  MC PREDRAI@4:   Experimental health services
                     15   delivery?
                                            DR.  BESC-ON:   Yes.
                     16
                                            DR,  SCHE',QLIS:.       Any other comments?

                                            DR.  BESSON:   T,-7hat  i@s  tl@e motion?

                                            DR.  SCHEI@IS-          There is no -,@otion.
                     191
                     20  1                                            I @,,loiider if there      is so.-ne mecl-i,@,il-"- T.,.
                                             suq,z  cte,,a by P,14PS that            co,,xl.d arrivc,           figu,-r@
                           th@,,t can             _I e.
                     2  1
                           tj,ia-t-- would be   realistic to help them,  say,  for example,  get
                     22
                           tli@-  statc-t.-.,@-Oe consortium.,  since tl@e --.ipplicat-ioll ability of               the
                     23(l
                                                    -c,@ms       ':)e,                  i@3,  th
                                                                                                 O. race St
                     24'
   ce--F'eder,,l Repofteis,  Inc. q-@,i @r:3 t1-@ p -a:c t c.) i. t                 L  C. ot          to
                     25








                  statewide consortium that tliev described going for a year,  and
                21 then as Dr. Besson suggests, maybe the experimental. health
                 .services delivery people would find enough of their own money t
                31
                4 begin the demonstration model.
                             Could we say that we would approve  it for that  part
                5
                / of it which would put the statewide consortium  into  operation?
                0
                             DR. SCHERLIS:   I think that is a reasonable request.
                7
                             DR. MC PHEDRAN:  I do n't know about the numbers, how
                8
                9 to put a figure on that.
                             DR. SCHERLIS:   I think we need a dollars  figure  on
              10
              11  that, to know what kind of a staff they would need to,i.linplement
              12  that.
                             DR. MIARGULIES: The situation with  the  experimental
              13
                  health service delivery system is that it has onlv been recently
              14
                  approved, to the best of iuv knowledge.  So';-f it depends upon
              15
                  that, there is also a question of whether it might not be
              16
              17  better to limit  wh.at they do until that develops into some
                 lbe@ter relationship.  Be6ause it did go through with the

                  Coor(?4 1A
                         ting Review Committee just the last time.
              191
                 I           So nothing really has happened yet, alt@-houch they
              201
                  have been workir@i@i at it for a year.
              21
                             DR. BESSON:  I second that motion.
              22 1
                 I           DR. SCHERI,IS:  In      words title Piotion is to t-11-ie
              23
                  e f ft@ , i -I ti'm b e r o n e , t ii e r @i t i if-, to -d -o r, 3c; o, t,@- h c.-r.,@
              241
  ce-Federil Reporte.,s, Inc. I in th@it I-,)al'L park, ind that tlic.@@ si,,f@p,@rt be limited to
              25,i





                                                                                                                54
      ro,@ e a - !.@      11                                                                                                  I

                          a consortium as  its tiaj,@-r ef 'Loi:-t.


                                            Wl,,,at was  the other


                                            )R.  BESSON:   Not consortium,  the statewide EMS.

                                            DR. MC PIIED-TZAN:   When they say consortium,  that is
                       4
                          what they  are talking about.
                       5
                                            DR.  BESSON:   Consortium is             used   as    the    key    word    for
                       6
                          the trauma Unit, New Haven Health Care Incorporated,  and Dunlop
                       7
                          Associates.
                       8
                                            DR.  SCHERLIS:   Shall we say a total statewide EMS.
                       9
                                            DR.     MC     PHEDRAII:      Planning,      development      and      planning
                      10
                          phase.
                      1   1
                                            DR.    SCHERLIS:    That    would     be     limited     to     a     planning,
                      12  developmental     phase     for     total     statewide      EMS.      Is      that      correct?
                      131
                                            DR.  BESSOil:   Yes.
                      14
                                            DR.    SCHETZLIS:    What    level    of     funding,     just     so     we'll
                      15
                          Ihave a number here.   They have been arbitrary in                          their         request
                      1   6
                          for funds,  so we can be arbitrary here.
                      17
                                            DR.  I.,IC PHED@.@:   The total amount they  asked for was
                      181
                          1                                                                                                   1
                          328.   Do Lou think z,, half or a third of' that is  reasonable?
                      191                   DR.  SCHERLIS:   That is extremely generous  for this
                      20@
                          !(-c-vf:!Iopmexita',- planning phase bu-'t-l that may  speak of iiiy own
                      21
                          @Moil-day morni-nq feeling,  as far as  fundi.iig goes.
                      22
                                            DR.  GIP-1j,I,E-.   I have    a feeling  it is going to  lead to
                      23
                          ithe swn(-                   Ci@n you worO,. it air such a way to precludr,-
                      241!
                          iL
                                                       @.,..nt,@ the Ya'tc-@ Tra,@-iica
   ce - Fedefil Reporters, life. l@
                      25ii




     yncl a- L V                                                                           55



                   I              DR.  BESSON:  I  thought  that  was   part   of   the-motion,
                   2 that-the conditions were tiiaLt these moneys only be used for

                   3  these purposes.

                                  DR. MC PHEDRAN:  Statewide planning.
                   4
                   5              DR.   SCHER@IS:   Statewide   planning   development    phase

                     for  total   EMS.
                   6
                   7@             DR. MC PHEDRAN:  Yes.
                   8              DR. SCITERLIS:  This  is  not  limited  by  any   means   and
                   9 in fact it   should  not  be  under  to  be  trauma-based,  but  a   total

                 10  system   base.
                 11               Is  that  separated  from  the   present   orientation   Of
                 12  the Yale funds?
                 13               DR. GITIBLE:   I'm  not  sure,  if  the  people  that   are
                    'doing the planning are in this  in the Yale program.
                 141
                 15               DR.  SCHERLIS:  Would  you  say  that   the   planning   be
                 16  centered through the regional medical program core office.?
                 17  Would that give them ancth.e@-- loan?
                                  DR. YIARGULIES:  That it be done by the regional
                 1811
                 191 medical program.
                    I                        -                                                  I
                                  DR.               I+,-. be done bv ',--he regional  medical
                 201
                 21  program and that ce."Ll,-nq @)c 50 to 1-00.
                                  DR. FP-4TZ:   I       a fctclinq in the discussion,
                 22
                     maybe I have something no)Dody else h,.)..s
                 231

                                  I
                                  )R.           You        tli(-.@ only extz@,Y-i-L r,,:)py,  tl'lillk.
                 24'

  @c;e -Fedefat Repofteis,  Inc.
                     If that is   a breal,-dowii of the progrzms, I ha@rc-@ ,i-(-?ver seen
                 25;







                             DR. SCHERLIS:  I have that front sheet but that is
                2 all.  Is that why you've had that knowledgeable look on your
                3iface?
                             DR. BESSON:  They come up with 19,000; I guess that
                4

                  is their component.
                5
                6            What is this Connecticut State Deparpment of Health?
                7IIs that their statewide program?
                             DR. MC PHTDRAN:  I think that is the statewide --
                8
                9 wait a minute; that is the EP,IT part of it.
              10             DR. BESSON:  The EMT had been previously put together,
              11             DR. MC PIIEDTWQ:  It will be continued through the
              12  Connecticut State Department of Health.
                             DR. BESSON:  Connecticut Regional Medical Program is
              I'@irequesting 19,OOU.   You were about ten times too generous.
              1 4
              15             DR. I-IC PIIEDRAN:  Flight.
                             DR. HI14MAN:  We can put a ceiling of 100,000 and ask
              161
                 istaff to negotiate the actual figure necessary to do it.  I
              171
                 ltliink that would be a fairly clear directive.
                 1
              18,
                             DR. Sl@'HERLIS:  Is that an adequate directive for
              19

                  St,-.-ff?
              20
              21             'DR. ',IAI@,TJLIES:  Yes.
                             DR. BESSON:   I thiiii-c 3-00,000 is too much in the
              22
                  14ght of this budgetary breakdown.
              23
                             DP..              do not liav(-@ tho@c-, c(-,,pa.es.
              241
  ce Fedeial Repof teis,  lr@c. DR. '(3ESSON:  Hcre, orgcinizi@'.-i-on and deve'ioT:)ment (-)f
              251









                  state and local.

               2             DR. MC PIIEDRAN:  -EMS.
               3             DR. BESSON:  EMS.
                             DR. MC PHEDRA-N:  This is also Connecticut State
               4
               5 IDepartmen-L-.
               6             DR. JOSLYN:  How much were they asking  or t e
               7  organization?  Is that still 19?
               8             DR. MC PIIEDRAN:  No --
               9             DR. BESSON:  They speak of this as corLponeiits I)ut:
              10  they don't tie the components to what we have had here.
              11             DR. SCHERLIS:  I suggest you look at that, and the
              12111 rest of us will help ourselves to coftee.
              13             Perhaps you can come up with a figure.  Apparently
              14  you have the only copy extant here of that docLu-nent.

                              (Recess.)
              15@
                             DR. SCIIFP\LIS.-  Let's (let started.
              16,
              171            Dr. Besson and Dr. @4cPhedran, have you wo,rl-led out a
                  joint resolution?
              191            DR. @IC P.'uIEDRAN:  The figure we found from sheets
                 iwhich were supplied, the direct cost f-'          19,000.  This
              20 1;                                      i,.gi.Are was
                 I
                 lwas a figure specifically for the StatE@l@ide plax-in-Ln@l for EIIS
              21 1
                 !through the Connecticut Reaioiial Medical Proaram.  That is the
              22
                 ilii.nstitiat-i.on affiliation wli-ch is listed.
              23i

                             It 4 S
                                   component 5, l@C)m@ii-i     5, of this }-)u@,'tc
              24@l
  -ce - Federal Reij,-,tefs.  Inc, TliEtt is the fiaiir(3 '-hc.,rc@, J-9,000 direct cost,
              25






                                                                                                                                                           5 8
                  3


                                                            DR.  SCIIE.UIS:    The  recommendation  is  for

                                                            DR.  MC  PHEDRAN:    Fundinq  of  that.
                                     2
                                     3                      DR.  SCHERLIS:    funding  for  t)-iat?
                                     4                      DR.  MC  PHEI)RA-N:    Yes.
                                     5                      DR.   SCHERLIS:    The  funding  would  be  restricted  to
                                     6that    item      as  specifiedlin  the  ',-judcfet?    We  don't  have  to  have
                                     7excessive         working  on  that.    That  has  been  seconded  by  the
                                     ,Isecondary         reviewer.
                                     91                     DR.  GI@@BLE:    Nineteen  thousand?
                                     I
                                     i                      DR.  SCHERLIS:    Yes,  direct.    We  have  lost  tvio  Of
                                     'I 10 our  reviewers.    While  we  are  waiting,  will  each  of  you  please
                                     ilfill  out  your  lunch  requests.    Restrict  your  items  to  those

                                                   on  the  form.
                                     131
                                     1
                                     1
                                     1                      The motion  has  been  made,  reviewing  the  budget,  that
                                     141
                                     15 ii they he  funded  for  that  itei-  which  is  in  terms  of  helping  to
                                     @plan     their  total  E.,,,IS  Program  which  came  to  1.9,000.
                                     161
                                     1
                                                            That  was  seconded  by  the  secondary  reviewer.
                                     17
                                                            Any  further  discussion?
                                     18,
                                                            All  those  in  f avor  say  ciye.
                                     191
                                     20                     (Chorus  of  ayes.)
                                                            DR.  SCIIEP\t7,-LS-.    Opi.,3osed?

                                                            j',IR.  TOO'I'.IrY:    I,Ihat @,?as  the  ra'O--ing?
                                     22
                                                            DP,.  MC  PIIEDI',)-@l:    Three.
                                     23
                                                            DR.                            TI-ic  rank                wi-iat?
                                     241

    @@c(,-Fedef@31   r,.F-po[tcfs,    @nc.
                                     25,li                  DR.  MC                             l'ie  said  t\.io--and--a--l@.,:ilf.





    m ;j, 4-



                 I            DR. SCliEPLIS:  Two-and-a--tialf.
                              DR. ROSE: Is that for the approval as presently set
                 21
                 3lup?
                 4            DR. SCHE]ZLIS:  I don't know.  Is that for the total
                 5program or  as presently set up?
                 6            In other words --
                 71           DR. MARGULIES:  It was for the tota
                              MR. MC PHEDRAN:  For the total.
                 8
                 9            DR. SCHERLIS:  What range would you attach to that
               10 present, limited,restricted recommendation?
               11             DR. MC PHEDRAN:  I think that was satisfactory.  I
                  lwould give that 3 to 4, that part of it, Myself.
               12             DR. SCHERLIS:   IWould that be satisfactory, their?
   CR  6307    13
   Lnu ib-B                   DR. BESSON:  Three.  I would agree to three.
               14@
               15i
               161
               171
                  1

               191

               20'
   0           21
               22


               23


               24'1

  @ce- - Fed eral  Reportefs,  liic.
               25@,




    URb,IL,'/                                                                  ;!52
    Lee#22




                               DR. SCiiE?,I,IS:  Dr. Roth?  Which one would you like

               2   to begin?
      xxxx     3               DR. ROTH: Florida. I hope I  can  dispose  of  this
               4   very quickly, because on the basic assumption  that  funds  are

               5   not available for the satisfaction of all grant requests, I woltld

               6   take the position that Florida is not being discriminated agaiiLst

               7   if the request is denied, because Florida is a  resubmission

               8   of a grant which has gone throubh council, which has been

               9   approved by council as a regular RMP operation.

               10              The Florida position is 'that they should not  be

               11  discriminated against because if they could get the funds from

               12  this,.it would liberate the other funds for them to carry  on
                                                                                           0

               13  some other, unrelated projects.

               14              I think this would be nice if you had unlimited fun@

               15  ing but my sentiment is to say that that is too bad, not  to

               16  fund it.  It is an excellent application.
               171
                               DR. SCHERLIS:  I thought it iias a rather plaintive

               18  statement to say that got the mo:iey b3fore they knew they

               19  could get it from another             But I concur with you

               20  co,,@ipl.etely, that they are z,,"-recidy in this and wl-iat they want
               211 -Jc;uble funding in a wa3r sc th@-@y can spin the money for

               22  @oii@@c-thi,,ig else.

               23              Staff have any cc>,Ti,,r@IEnt?

               24i             VOICE:  Dr. SI.oan           i.n t.li--.t

  'Ice-Federal Reporters,  Inc.
               25              MR. TOONIEY':  She d@-,;.d?





















      JRJ.3 @ 2                                                               25 3


                ii
               I I
                 I             DR. SCIIERLIS:  Fine.

               2               Florida is taken care of.

   i@@         3               NToicE:  wliat kind of rating?

               4               DR. SCHERLIS:  No money, no rating.

                 I
    5 j @,@ A -6 - ;




                                                                                     2 6 1


             2




                 2                DR. HIN@IAN:  WE! haven't finished up the South
                 3@ Central Branch.  Illinois, Georgia.
                 4                MR. TOOMEY:  Wisconsin.  How did Wisconsin get in


                 5  the South Central Branch?

                 6                DR. HINMAN:  Central emphasis.  Georgia should be

                 7  next, I believe.

                 8                DR. SCHERLIS:  The Chair would be in favor of

                 9  entertaining a suggestion we have a five-minute break.

                I 0               MR. TOOMEY:  I so move.

                11                DR. SCHERLIS:  So ordered.
                121               (Recess.)

                13                DR. SCHERLIS:  We will do Georgia, now.

                14                I am the primary reviewer for Georgia.

                15                Georgia  posed  a  dilemma  for  me.  They  state   that
                161 in Georgia,   large areas of the state do not have adequate

                17  emergency medical services available and those services which

                181 do  exist   are4ndeed substandard.
                                   L

                                  So in conjunction with  the  Office  of  CliP,  Emercf,-
                19                                                                       nc@,

                    @'e2.-ViCe Division of -Lh,@ Georgia State Public I-,Te.@alth  DepartrLe
                20                                                                       nt,

                21  State Highway Safety Coordin,:ii-oa-, they developed a plan

                22  for a comprehensive    E@-IS systei,,i for the region.

                23                They are aiming at supporting emergency room

                24  s(--rvi-cc@, i,-,acku@ facilities and             to ap
                                                                           ply dcf iii@.t

  c(, - Federa I R,2por ters,  Inc.
                                                                        L-i'ain)-ng
                25  ce. c, transportation,                                        of




                                                                           2 6 2




                I personnel, development of physical mechanisms, so on,  and  the

                2 Georgia regional medical program will provide initial salary

                3 support and training for emergency medical technicians to

                4 supplement ambulance and communications equipment provided

                5 by the Highway Safety Bureau to provide intensive care

                6 capability, life support systems, monitoring to  enhance  the

                7 ambulance capabilities.  They would charge fees for the

                8 ambulance services in the subsystems.

                9             The project in a bit more detail asks for  --  as
              101 far as funding is concerned -- a level of $242,000 for the
              11  first year, 343 for the second, and $356,000 for  the  third.

              12  Most of the support is actually for ambulance personnel.

              13  I had some serious questions about this, because first  of  all

              14  there is the problem of what happ@ns when this grant subsides.

              15  I see no more reason for there being any likelihood of
              16@ support 2-1/2 years from now as compared to the  present  time.
              171 They ask for equipment in terms of dispatch  equipment  which

              18  comes to approximately $30,000.

              19              There ;Ls excellent documentation in the  request

              20  as far as the needs for the funding. My concern  is  that  this

              21  essentially relates to ambulance support, rather  than  being
              221 a total system. When one looks at the  budget,  the  requests
              23  that were originally put in appear to be aimed at another sourc
              24  for fund.iig, rather than to the type of emergency med-Lcal systc,4

  ce-Federal Reporl,-2rs,  Itic.
              2,5 which is being looked at the -or-E,,-,erit time.





                                                                            26 3


                 1


                I              They have already purchased some 40 ambulances.

                2 As I have said their aim is -to develop and demonstrate the

                3 effectiveness of a multi-county  emergency  medical  service

                4 system.  The yellow sheets were reviewed by Dr. Sloan,,

                5 and part of her comments state, again, what I have reiterated.

                6 She states that they havetouched all  the  basis  of  government

                7 and local support, reiterates the sums that have been involved

                8 as far as requests are concerned.

                9              My biggest problem relates to the fact t at so

              10  much of the funds requested really look at  the  support  of
              11  ambulance personnel as the main item, rather than anything
              12i else.  I want to get the detailed budget so that I can document
              13  that for you. If you find it before I  do,  that  will  be  just

              14  fine.
              151              Part of the difficulty I am having  relates  to
              16@ the fact that the grant is not put toQether very well.
              17               Here it is, budget justification.
              181              Their ambulance personnel will be in  terms  of
              19  total coverage of the ambulances for a complete, round-the-
              20  clock coverage.  This comes -41-@o a base salary of same $245,000.
              21  This concerns me, that in essence,  we  areproviding  the  staff

              22  support for their ambulance System.
              23               I think this goes well beyond what the P-IIP should
              24@ basically be requested -to do. It does  not  address  itself
                 I                                                                  I
  cc-Federal Reporters,  Inc.I                                               Cal Y,
              251 as it should to the tota.1 system of care but more  speci.fi   I




                                                                              2 64


          tv 5   1


               1  as I have indicated, just -to raamrrting the ambulances, and this

               2   is where most of the funding is.

               3               Also for equipping the ambulance service.

               4               My own feeling, as far as this grant request was

               5   concerned, was that it did not merit support as a total

               6   system, that I would be much more in favor of their looking

               7   towards a plan.  It gets down to what we have discussed

               8   previously.  I don't think the RMPs can be in the business of

               9   staffing the ambulances around the country, as this request,

               10  I think, would put us in the position of doing.

               11              My initial feeling had been to fund this at a

               12  very low level, and after having heard the various reviews

               13  today, I'still feel that way.

               14              Do you have any comment?  You haven't had a chance

               15  to review this, have you?

               161             MR. TOOMEY:  NO.  I have just read this.

               17              DR. SCHTRLIS:  Who in staff has had contact with t-E

               181 Georgia system?
               191             VOICE:  I had a little contact, Doctor.
               201             DR. SCliERI,IS:  Do you have any background on this

               211 grant itself?
               221             VOICE:  No, sir, I don't.

                                                                               I)o 4
               23@             MR. TOOMEY:  I think from a philosophic stand

                           with you.
               24  I agree

         Reportefs,  Inc.
               25              DR. HINMAN:  I am trying to find the backup, and




                                                                                                                                                       2 65



                      L.Y  v


                                    I  can't  find  this  letter.

                              2                              DR.   SCHERLIS:    You  see,  my  concern  is  that  the

                              3     County  Board  of  Commissioners  says  after  2-1/2  years,  we  will

                              4     pick  up  the  support  of  that  staff.    And  my  concern  is,  you  know

                              5     why  not  now?    Why  should  we  pick  up  the  24-hour  --  at  least

                              6     the  main  coverage  as  far  as  these  individuals  go?    My  feeling

                              7     is  they  do  merit  some  support  more  in  a  planning  phase  than

                              8     actually  supporting  these  individuals.    And  there  is

                              9     enough  element  here,  as  you  look  through  it,  of  bits  and  pieces

                             10     of  a  total  system,  that  I  recommend  more  limited  support,

                             11     possibly  to  the  sum  of  $50,000,   so  they  can  move  this  along

                             12     for  the  first  year.

                             13                              Do  you  have  any  comment  on  that?
                             14i                             MR.  TOOMEY:    Just  a  comment  of  agreement.
                             15                              DR.   SCHERLIS:    All  r3ght.

                             16                              If  that  is  satisfactory,  then  we  will  move  on.
                             17                              DR.  HINMP.N:     You  are  recommending  50,000  for  the

                             18     first  year            and  what  rating?
                             19                              DR.   SCHERLIS:    But  not  the  support.     I  suggested
                             201    three.     But  not  for  support  of  the  actual  ambulance  drivers.
                             21     I  think  that  has  to  come  from  other  sources.    Most  of  the  fundirg

                             22     would  be  for  that  and  I  think  they  should  emphasize  the
                             23     training  aspects.     It  will  go  much  further  than  paying  the

                             24     salaries  of  individuals.

    ce - Federal Reporters,  Inc.
                             25                              All  right?





                                                                          20b


        ty 7    11


                I            MR. TOOMEY:  Was there any amount provided for

                2training purposes?  Because along with the planning for the --

                3            DR. SCHERLIS:  They have a very highly detailed

                4schedule here as far as lectures and background and training,

                5and this would be of some help.  They do discuss specific

                6material that would be part of their program. The problem is

                7that they have put most of their money into salary support

                8for the ambulance crew, rather than in the training.  I think

                9we should suggest this is the area they should emphasize.

              10             MR. TOOMEY:  The planning would provide for the

              11 development of budgets for training programs.

              12             DR. SCHERLIS:  Right, the training.

              13             MR. TOOMEY:  As well as other facets.

              14             DR. HIN@IAN:  Just to understand, this is basically

              15 planning and some training.

              16             DR. SCHERLIS:  Yes.

              17             DR. HINMAN:  50,000 for one year only with a

              18 rating of 3.0?

              1 9            DR. SCHERLIS:  Right.

              20             DR. IIINIIAN: Okav.

              21             The next one will be on

              22             DR. SCHERLIS:  He can come back in, then.  Dr.

              23 McPhedran can return.
              241            DR. IIIN@U@N: The record should show that Dr.
  ce -Federal Reporters, Inc.
              25 lMcPhedran was out of the room duri.nq that review.





                                                                                    29 3




  fee  O.'i u 7                                                                         d

  ir             2                                                              ?

                 3              The next application is ifawaii.  Before I      start   to

                 4 review this, I have gone through this at least five times,

                 5 page by page, to look for a breakdown of budget, here.
                 6              Who is Hawaii?  Anyone here spoken for Hawaii?

                 7              Do you  have  any  breakdown  of  budget  aside  from  the

                 8 large  folding  slieet?  Because  they  come  to  sums  of  money  that

                 9 go down to the very  last  dollar,  like  $871,  arid  I  have  no  way
                 10 of knowing -- I can't project their costs, which is a perturbing            -m7

                 11 feature to me.
                 121            All right.  The  proposal,  itself,   is   submitted   in
                                                                                                       F4
                 13 relationship to the  Statc@  of  Hawaii,  and  it  comes  in  from  the

                 14 liawaii ivedical Association.
                 151          They  nave prorated a program over some four years ii-i
                 16,la very well organized manner, so that they have indicated their
                 171,cjoals for each of the specific years in some detail.
                                '!'here has recen                                       ing@
                 181                             tly been  a  forum  in  Hawaii,  a  meet'
                 19 wliicli  discusses  tiie.emergency  medical  services  or  that   area,
                 20 and I reviewed the I?rograi,,i in it, they PLIT in a great (.-).eal  of
                 21 @tll(-' cor@terlt'
                 22 i.          It strikes me  as  having  been  a.  very  well  organized
                 23 lprc)c
                       .jrarii coop(--rated with by many differen--  agencies,  and  this

                                   that ,r)rc),',)abl.,,), )AelT)ed their a great deal.
                 2 4

  ,,ct!-Fedt,tat Pepotteis, In-
                                The planning               cinel their sponsors @qere
                 251





                                                                               2 9 4




      jr 2        widely representative of the State of Hawaii.  I'm sure this

               2 helped move them along in their total planning phase.

               3              Their detailed program  I'll  report  on  very  briefly.

               4              What they propose to do, for example, during the

               5  first year  is to train their  ambulance  service  personnel  in  EMT

               6  before the  start of their program.

               7              They discuss this in  terms  of  emergency  medical

               8  facilities, in terms of  their  ambulances,  in  terms  of  training

               9  them with EKG telemetry, cardiopulmonary resuscitation.

               10             They will set up.emergency communicate   ons during

               11 this time, and develop an  EMS  advisory  committee,  and  develop  a

               12 comprehensive orogram  for  collecting  data.  This  is  first  year.

               13             The second year they talk in terms of additional

               14 training, additional  involvement  of  the  neighboring  islands,  as

               15 well as Oahu. There are ambulances  being  set  up  as  far  as
               161advance communications and treatment.
               17             They then introduce the concept of a trauma center

               18 and there is contained  in  their  application  a  detailed  discus-

               19 sioa of a shock and trauma center,  which  is  at  the  Queen's

               ?o Medical Center, which is the large teaching hospital in Honolulu
               21IIt is one which apparently has  been  planned  for  some  time.
               22'            The sum of money for this I am not sure of.  Some@,7her(@

               23 there sticks a figure of  approximately  $400,000  in  my  mind  but

               24 as I have indicated      here it is -- as  I  have  indicated  there

  @-,e Feder;il Repotters, Inc.1
               25,,s no brea.i@(down of total budget except this one item, that   corL.,ies




                                                                                 2 9 5




  jr 3          1 from the first  year  to  $253,000  for  the  trauma  unit.  And  then

                2  subsequently, sums of $76,000 for the second year and $79,000

                3  for the third, these  are  essentially  in  terms  of  personnel  for

                4  the latter,.,two years.

                5              The first  year, most of this is in terms of facilities

                6  and equipment.  For example, remodeling costs, $194,000.

                7  Equipment, a total of something like $89,000.  I think we'll

                8  have to address ourselves to that item specifically.

                9              The trauma center would be the second year, with

               10  again the development of emergency medical communications.

               11              The third year, additional training program.  A

               12 Itrauma center would then be operative.  The Iourth year the

               13 evaluation of the fisc&l-analysis would be the most important

               14 part of their program.

               15              They request over a period of 3 years sums which are

               16  as   follows: $777,000   for the first year; second, $982,000; the

               17  third, $382,000.  And as I read this, I had a gut reaction that

               18  their overall planning and program looked very good with the

               19 exception of the shock-tratima unit, which requires renovation

                       Construction.  I don'@- know i.l@' this could be supported.
               20  anu

               21              The other problem that  I  had,  although  I  rated  this
               22  3. 5, was in terms of the sul)T)oc,,--, because I have no grasp of

               23  their budget.  That is @7hy I as]'-Ieci.
               241      Perhaps it was oinitte(i       my b(Dok.  But I leafed through
  7e - Federal Reporters,  lrc.
               25@ this not only at lioi-ic, but herc--,, page if ter page, and I' ve- -done





                                                                                29 6



  jr 4              this three and four times.  I can find no indication of a de-
                2  tailed budget except for the trauma center which is the one
                3   unit that I don't think should be supported because of the

                4   renovations to the building.
                5              DR. HINMAN:  Three fifty for the trauma.
                6              DR. SCHERLIS:  Yes.  My own feeling about that is
                7   that having visited Hawaii and having surveyed their cardio-
                8   pulmonary resuscitation programy I had the opportunity of
                9   going to their major islands, and I guess I hit at least three

               101  or four.-hospi-tals in@each.
               11            . I am impressed with the fact that they have already
               12   set up excellent links, that the hospitals work with eac
               13   other, that they are training their emergency systems to re-

               14   late to the hospitals.
               15              They do have good CPR programs which again has
               16   helped set up a     networl@ so when you go with someone from
               17   Honolulu he has access to everybody in the islands and it lends
               18   itself very nicely for an overall emergency medical system.
               19              They do have the concept of the hub center, there
               20   are physicians who go out from Honolulu to the islands in
               21   specialities and obviously flying back to Honolulu.
               22               I have an overall good reaction, but I had difficulty
               23   in translating that to dollars because there is no budget.
               24   don't knov7 what it takes to work out this program.      -Lf I'vc@

  ,e-Federal Re-,porters,  Iiic.
               251  L)ef--n narrow in not seeing it, apparently you've not found-it
                  I




                                                                                  2 9 7


  jr 5              either.  If they can show with their training program, they
                2 have to set uD essentially five or so areas, one on each island
                3  to work it through -- I can see where they might very readily

                4  come to a budget of $3- or $400,000.
                5              But I have a Problem saying this is what you should
                6   spend when they don't tell me what they want to spend.  There
                7   was no budget in this that I could find.
                8              VOICE:  Dr. Scherlis, we just received in, and I

                9   think it is upstairs,   the form 16 s.
               10              DR. HI14M]Ui:  We have a form 1.6 but it doesn't tell

               11   you anything.
               12              VOICE:  That doesn't break it down.
               13               DR. SCHERLIS:  I have this one-fold sheet, and that
               14   doesn't tell rLie, and then as I go through the back, 1-iere and
               15   there they set up on the islands emergency vehicles, which they
               16   are in need of, with telemetry, but these come to small sums,

               17   $10- or $12,000 each.
               18               There is the other item of some $400,000 for the
               19   trauma unit, which, I don't think should be supported.  Arid then
               20   1 have problems looking at where the other 300 go to.  I give
               21   tlie,@ri a high rating but my concern is I can't translate that in
               22   terms of dollars because I don't know what they want the mai-iey

               23   for.
               24               DR.               I'(.-,rliapr4, what you can do is to

  :e - Federif Reporters,  Inc.
               25   actually c-nc-@,c)r       that        with the understanding that






  jr 6          1  we will seek a budget and see if it is a reasonable figure and
                2  bring it into the council that way.  It may be an omission.

                3               DR. MC PHEDRAII:  Excluding the trauma.

                4               DR. MARGULIES:  Yes.
                5               DR. SCHERLIS:  My own feeling about the_level of
                6  support would be in terms of $3- or $400,000 for each of three
                7  years but I'm arbitrary in that when I don't know what they

                81 really require.
                9               Can that be approved on that basis, that we will

               10  come up with a number that is meaningful?
               11               Is there a second to that rough motion?

               12               DR. IIC PHEDRAN:  Yes.
               13               DR. SCHERLIS:  The rating I gave was 3.5 and I

               14  suggested   three-year support.
               15               DR. HINMAN:  All right, 3.5.
               16               DR. SCliERI,IS:  Is there a second?
   End 26      17               DR..MC PIIEDRA14:  I second.

               18


               19


               20


               21


               22


               23


               24

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               25





                                                                             2 6 7




                I              DR. MC PHEDRTNL.  Illinois is next?


                2              Are we to Illinois, now?

                3              Illinois is a proposal -- this is  a  proposal  from

                4  the Illinois Regional Medical Program to  extend  over  three

                5  years for a total of $1-1/2 million over the three years,

                6  about evenly divided. It is for an  extension  of  a  current

                7  trauma registry, and the beginning of an  emergency  system  for

                8  trauma.

                9              The proposal is to build on this system now a system

               10  which works through the state health department, department

               11  of public health,, and according to the application, this  is  a

               12  satisfactory arrangement which they wish.to extend for other

               13  medical emergencies. They-want  to  categorize  hospitals  in

               14  the first year, they want to decide which ones would be sui.tabl

               15  for various kinds of emergencies. They  want  to  improve  their

               16  transportation personnel, and to establish a coordinated

               17  communication network, the exact specifications for that   are

               18  not given, but they are talking about a common radio frequency

               19  and the use of radios, in emergency 2-ooms and ambulances.

               20              There is an element of training, both for the

               21  emergency personnel and also a public education effort.  The
               221 public education is.als.o to be conducted through the department
               231 of public health, and a trauma registry, which  they  now  have,
               24  apparently was set up in       a way that the means of  Putti-nq

  @ce--Fedetal Reportefs,  Inc.
               25  data into it can be adapted -asilv to a  registry  for  other





          t@y 9


                I  kinds of acute illness.  They point out that the evaluation of

                2 the system can be effectively done through this registry,

                3 that is,, if standards are set for treatment of a certain

                4 kind of medical emergency, when the help should be there, what

                5 kind of help should be there, and so forth, they can decide

                6 later on whether they got what they thought they  should  have.

                7             So that this is perhaps one of the attractive

                8 features of it, that is, that there is some -- there is a data

                9 collecting system which is now working, which can be built

              10  upon which would give 'them this kind of information.

              11              I am a little disturbed because the  coordinator,

              12  Dr. Creditor, said that the technical review panel in his

              13  area, in his region, or the review committee in this region,

              14  on the basis of technical merit, gave it a rating of 3.25,

              15  which is the reverse scale that we are using here.

              16              In other words, 3.25 is low. Four  is  the  lowest.

              17              They submitted it anyway, they thought  that  there

              18  were defects in details in the application, and there are,

              19  indeed, some defects.  The ones that I was concerned about @,,,herE

              20  the information on linkages, adequate referral of non-

              21  emergency patient -- cooperating in community d-Lsaster, and

              22  linkage with other non-EMS systems -- that was lacking,

              23  pretty much.


              24              But on the whole, i guess I tiiough'L@- that. maybe the

  ce- Federal  Rep-,rters,  Inc.
              25 lreview committee was harder on it than I would be.   I  thought




                                                                                             2 6

             -Ey   10


                    I   that it was better than that rather poor rating, although they

                    2  give me pause when they give it such a poor rating.

                    3                 I have a.specific exception to make in the proposed

                    4  expenditure, and that is that some advance are proposed.

                    5  They have a special name.   OCCVS.   There is an enormous

                    6  amount of money proposed to be spent on them.  Nine of them in

                    7  the first year for  $126,000.

                    8                 Now these are not, I think, quite dedicated vehicleE

                    9  in that they can be used for any kind of emergency, or a

                  10   seriously ill person who'v.7ould have to be transferred.  On

                  11   the other hand, I am not sure that it.is clear that that kind
                  121  of special equipment is really necessary, and I would

                  13   propose that with a rating of 3 to 3-1/2 -- I will say 3-1/2

                  14   ar.d with the exception that we not fund these OCCVS.   I don't

                  15   see they are absolutely essential to the program.  Maybe the

                  16   staff can correct me if I am wrong.   If that reduction is

                  17   made, I think they all come in the first year, isn't that right,
                  181  the OCCVS?
                  191                So that would make the first year reduced to

                  20   just a little over $300,000.


                  21                 VOICE:   Yes.


                  22                 DR. MC PHEDRAN:   $307,000, something like that.

                  23 And the 02 and 03 years I guess would stand that way.   Is that

                  24  right?

  kce- Federal Reporters,  Inc.
                  25                 DR. GIMBLE:      I think the expenditure for the OCC was




                                                                                                                                                27 0




                               I     the  first  year.    I  am  not  absolutely  sure.

                               2                           DR.  HIN@IAN:    They  have  large  amounts  of  equipment

                               3    in  the  second  and  third  year.

                               4                          DR.  MC  PHEDRAN:    I  may  have  overlooked  that.

                               5                          DR.  HIN14AN:    207,000  in  the  second  year  and  162,000

                               6    for  equipment  in  the  third  year.    I  don't  know what  it  is

                               7   for.


                               8                          DR.  MC  PHEDRAN:    They  certainly  do.

                               9                          VOICE:    The  equipment  expenditure.remains  constant

                            10     in  the  second  year  and  I  think  that  purchase  of  the  vans  were

                            11     to  be  staggered,  Dr.  McPhedran.

                            12                            DR.  MC  PHEDRAN:    I  see,  okay.    Well,  it  seems  to

                            13     me  that  ---  I  really  just  don't  see  why  in  something  which  is

                            14     developing  like  this,  that  you  need  to  start  out  with  this

                            15     kind  of  very  expensive  equipment.    I  would  still  --  I  would  like

                            16     to  see  it  deleted  from  the  budget,  to  see  if  they  can't  get

                            17     along  with  the  same  kind  of  thing  with  more  conventional

                            18     equipment.

                            19                           It  sounds  to  me  like  the:rest  of  the  program  that

                            20     they  are  describing  --  it  doesn't  seem  to  me  that  any  part

                            21     of  the  program  would  be  vitiated  by  not  having  these  vans,  so

                            22     I  would  th      4 nk  that  they  could  be  left  out.

                            23                           DR.  SCHERLIS:    They  also  include  patient  monitoring

                            24     equipment  for  outlying  coronary  care  units.
    @ce-Fedetal Repofters,  Inc.                         DR.  MC  PliEDRA14:             That  is  part  of  the  equipment-  cost.
                            25




                                                                             27 1
   CR6307


    23 -ter-I
   Ir
   folc@ TY-11
                1             DR. SCHERLIS:  ves.  The 220,000.  The rest is

                2 helpfully oriented as far as training, is it not?
                3             DR. IIC PIIEDR7@ll: Training and communications.  I
                4 must say, I was taken with this matter of the way they handled
                5 collecting data, and talk about having  standards  set  up  for
                6 what ought to )De outcome of care, and comparing what does
                7 happen with what ought to be, if they can really establish

                8 satisfactory standards.

                9             We have been trying to do this just  for  the  care
               10 of neurologic patients in our division and I must say, it is
               11 very hard.  @le quarrel a lot about it.  I hope they do not

               12 fight as much as we have.

               13             DR. SCHERLIS:  One of the better publications I

               14 have seen on local data is the one from Chicago, on the

               15 emergency rooms, transportation vehicles.

               16             DR. MC PHEDRAII:  That is the one Gibson did?

               17             DR. SCIIERLIS:  Right.
               181            DR. MC PIIEDRAN: Isn'-t that so?
               19             DR. SCHERLIS:  I thin),, so. I had the opportunity

               20 to share a  si-ght visit to Illinois, and their coordinator
               2 1runs Ei very tight shop.  With the help of his wife,       controls
               22 the pursestrings, at home, as well  as for the unit.
               23             DR. IIINIMN: Should @,;(a ask Dr. G'lmble what emphasis
               241     are placing uTDoii the criticF,.'@ --are van, as i-),irt of  tile
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                                                                           27 2




                             DR. GITIBLE: They are not, they talked about  the

                2 total system. The overland critical care vehicles  were  not

                3 even  design ed for primary ambulance duties, but for  transpor-

                4 tation of patients between hospitals.

                5            They discussed the stratified hospital system  with

                6 primary, secondary, and tertiary levels of care, or words to

                7 that effect, and the use of the  vans  was  for  transportation  of

                8 patients  between  initial-care  hospitals,  and  secondary-care

                9 hospitals, and definitive-care  hospitals,  as  part  of  complete

              10  EMS   system.

              11             The objection I raised was whether  or  not  a  need

              12  for such vehicles and  the  number  had  been  demonstrated.  It

              13  had not.  And they were quite expensive.

              14             DR. SCHERLIS:  This can await their demonstrating

              15  the need.


              16             DR. GIMBLE:  Yes.

              17             DR. SCHERLIS: What sum of  support  did  you  come  up

              18  wi tl-'?

              19             DR. MC PH171DRAN:  V7ell' taking that 126,000 out --
              20  I do not know which year it  comes  on.  Mrs.  Gimble  suggests  it
              21  comes out of each one- of the three years.  I assumed it came out

              22  of the first year.  I will see if I can come up with that.

              23             VOICE: I think they l@iop(@-, after the three years,  e

                          "IC  III]-Lcl          have       vans   They wou'A.d
                    A'             regions woul(I
              24      Of t"
  '%ce-Federat Reporters, Inc. start the first year with one van for  each  of  the  nine  regions
              251
                 1




                                                                           27 3
   ter--3.


               I  and increase it by one for each of the vears.
               2             DR. MC PHEDRAN:  So what that means is three times

               3  $18 thousand per year.
               4             DR. SCHERLIS: It is roughly about  $70  thousand  a

               5  year that would go to equipment.
               6             DR. I-,IC PliEDRAli:  Yes.
               7             DR. SCIIERLIS:  Is that not right?
               8             VOICE: I wish it were, but I do not  think  it  is.
               9  I think they propose to buy nine vans at $18  thousand,  each,
               10 the first year; nine vans at $18 thousand -- and that is

               11 $162 thousand.
               12            DR. MC PIIEDRAN:  Nine each y6ar?
               13            VOICE:  Yes.  There are nine districts.
               14            DR,SCHERLIS:  I was not thinking that bad.
               15            VOICE: They want to cover each  district  with  one
               16 van in the first year, one more in the second.
               17            DR. IIIND4AI4-- And there is an additional cost of $20
               181 thousand ayear for the telephone lines to support it.  So you
               19 are talking about subtracting 182,000 out of each year, is what
                  I      you suggesting.
               20
               21            DR. I,IC PIIEDI@;ij:,': That is what I do suggest, then.
                             Are you sure the phone lines are lust to cover that?
               22 1                                            1
                             DR.           Telephone lines for OCCV Nct@,7ork,
               23
                  .-,120,000.  Ana, I.-.heii do%@7rL on the !D-L,.dget sheet, i'--- sz?,ys -- I
               241
  Ace-FederaiReporters,liic. tl-ioi,.iglit I saw an (-expanded part of the budget sheet -- under
               25 1
                  it





   ter:- 4


               I  "other," it says Il@4P telephone lines, 20,000, training,

               2  communications equipment, lines, etc.
               3              VOICE:  I think the 45,000 is related to the two.
               4              DR. HINt4AN:  Outlying coronary care units.

               5              VOICE:  I think they are hooked to these vans.

               6              DR. IIINMAN:  Yes., they sure are.

               7              VOICE:  I hate to say this.
               8              DR. SCHERLIS:  Do something to help this.
               9              DR. MC PHEDRAN:  Do you think that is also,

               10 forty-five?
               11             VOICE: :I think all of the equipment -- could we have
               12 a motion that we could find these out, and if  they  are,  they

               13 could  be  deleted?
               14             DR. MC PHEDRAN: Why do you not  suggest  that  what
               15 we would do is say, we would like to delete the equipment costs
               16 entirely, until we can see which of these are unrelated to the
               17 OCCVS, okay?  If they can just do-something unrelated to that?
               18                   HERLIS:  You are- tal'in  about 262 thousand.
                              DR.  SC                   i@  9
               19             DR. III14I@IAN: It is 242, because we took  the  tele-
               20 phone lines out, too.
               21             DR. MC PHEDI@N.  242 for the first year?
                              DR. SCHERLI@,: We Gould not even let them  talk  to
               22
               23 each   other.
               24             J-)R. j@C        I gave i.t. a rating of 3.5, I thougi.l.'-,
  ,ce - Fedetal Reportets,  Inc. that except for this large expense in equipment, I thought at
               25

                  iqas kind of a good system.



    ter-1                                                                                           27 5


    rlpr, iO7        11



                                      DR. SCIIERLIS:   And your recommendation is as was

                     2  just repeated?

                     3                DR. MC PIIEDRAN:   242 the first year -- is that right,

                     4  Ed?


                     5                DR. HINP-L-@N:    24 2 ,  97 4 .


                     6                DR. SCHERLIS:   330, 573,  351, 780.   And the rating?

                     7                DR.  MC PIIEDRAN:   Three point five.


                     8                DR.  SCITERLIS:   Is there a second?


                     9                MR.  TOOIIT-Y     I will second it.


                  10                  DR.  IIIII@@IAN:  Total of 889,  327.

                  11                  DR.  SCIIERLIS:   Are you seconding it because @,ou

                  12   agree?

                  13                  MR.  TOO"'IEY:    I am seconding because I agree.

                  14                  DR.  SCHERLIS:   Let the record show that was voted


                  i   r, ii Y)nn   i ii(I   i I--  n,) q 57, r-(-l




                                                                           186

        (5 7
   #lb
                                                                                          0
                                SCFIERLIS  Intermountain.  Time is getting tight.
                             DP.
                21           Mr. Toomey?
                             MR. TOOIAEY:  had that but I can I t f ind my summary -
                3
                4I am sorry.  Will you give me a moment?

                                            Will the
                5           DR. Sl%-IHERLIS@          secondary , reviewer like
                6to begin on that one, for variety?
                7           DR. MC PIIEDPAN:  I will say that I thought this was
                8a good proposal.  Indeed it was a system.  It is for a portion
                9of the region, the State of Utah.
              10             in going through the check list, the yellow.check
              11 list, I felt that it met most  of  our  reqIuirements for a system
              12 quite satisfactorily.  The numbers that we are talking   about are

              13  shown in the back.
              14             The first year,, 250.  The second, 226.  The third
              15  year, $193,000.  1 thought there was at least evidence  of some
              16, SP,@isfactory performance in virtually every category  in
              17@ assessing needs and resources, and in community organization.
                             The represei,,.tati-on of consumers as such is not any
                  more in evidence here than in perhaps just one or two other@@,
              20      I @-hought that it was at ).east @-As good As most.
              2@             So, to ]:)e brir@,f about it, I tlioucTlit it was a good
                  proposal for a system, reall@7, in Utah:  a health emergency
              22
                  care         for manpower tr@iinj-ncT, communication s,,rst(--%mLs,
              23
              24   coor6.-@.ri@itioii of t@i.0 cases 7,rr-- nc@@,,7 operating, FA foi-nlol
  ice-Fedefal Repoftefs,  inc.
                   c,,:r@(-zina,zation for cciordinatinq the @ull-)systers.
              25




                                                                               187



                             It would be the regional medical program itself, I

                  think, that would do this, if I remember correctly.  Here it is.
                2 IThere is a county in tJtah which would be the first ph as e   and

                  which would serve to some extent as a model for the others.
                4
                  That is called Wasatch Front, Emergency Medical System.  That is
                5
                6 in the f irst year.
                             And the second year,  the  other  comprehensive  health
                7
                  planning district would be involved in the same kind of plan as
                8
                9 had been set up for the Wasatch Front.
              10             And in the third year, it was hoped that the type of
              11  model that was developed in this one county  would  apply  to  all

                  three.
              12
                             Mr. Toorley?
              13
                             MR. TOOMEY:  Yes.  The  objectives  that  were  derived
              14
                  that I took from this material,  they  include  the  establishment
              15
                  of a legal body with the authority and responsibility to plan a
              16
                  and implement a statewide emergency  medical  system  through  a
              17
                  network of district EMS councils, and  to  establish  a  statewide
              18
                  1 Communication system which x,!ill meet the needs of the area; to
              19
                  establish a rapid and safe ein@,x-qency transportation system which
              20
                  lwill meet established standards; to upgrade the quality of
              21  1
                  hos,-ita.1 emergency departments; to establish a manpower training
              22
                  program which will provide an  appropriate  type  of  adequately
              23
                  ,trained personnel, to dc,,si.qn and implement a standard data
              24
  -.e- Federal Reporters,  Inc. collection -,system which would provide inform, at-Lor-, needed f or
              251
                  i






                  management operation planning, evaluation and quality control,
                2 to assure high quality emergency care and to evaluate and
                  compare emergency medical svstems with other svstems of
                3
                4 emergency care, to provide a stable source of financial support
                5 for El,',S, beginning after the third year, and as Dr. McPhedran
                6 said, it was planned in three staged phases.
                7             Phase one involves the development of a council to
                8 form the nucleus organization to employ a staff, and that was
                9 the  Wasatch.
                10            Phase two involves the organization of the EMS
                11 network into an effective operational plan, to implement
                  l@-iiergency services in each district.
                12
                13            Phase three involves the formation of a statewide
                  EMS authority to provide leadership for continuation of the
                14

                15 prograip..
                16            My own evaluation was that the application:demonstrat-@s
                17 knowledge of the total system and has identified deficiencies in
                18 the present operating system.
                19            It is a comuiiity-based program involving providers,
                20 public agencies, planning agencies, and community interests.
                21            E.@.isting cori,,inunit@, needs and resources have been
                  doci,@i,,ieiited and we i-7il.1 define as to how each element will be
                22
                  coo,,:@t.-@nated with corty:)on(-,ri-@s already operational.
                231
                              Linl@ ges with ).-next)..  care systeit),s irc,- not wE,-.Il.
                241
  'Ac:e -  Fedc@.fat  Reporters,  InI
                '- I d(--scril.)cd; ho@,ievc@r,  is made to enhancing preventive
                25




                                                                            18 9



                  medical services.  Specific plans have been delineated for
                2 obtaining additional financial support and the prime area
                3 emphasis of this application is through the provision of
                  various continuing educational training programs,  limited  to
                4

                  specific conditions.
                5
                6            The population is sparsely settled; the terrain is
                7 mountainous.
                             The approach for developing this system has been well
                8
                  thought out, has clearly defined objectives, and I think as I
                9
              10  read it the thing that impressed me more than anything else was
              11  Ithe potential for measuring the various accomplishments, methods
                  of measuring whether or not they have accomplished the objec-
              12
              13  tives.
              141            DR. SCliERLIS:  How did you rate this proposal?
                             MR. TOOIEY: I rated it as very  good,  good,  which
              15
              16  in my opinion would be a 3.5.
                             I saw no reason, really, not to provide  them  with
              17@
                  I
                  ithe funds that were requested.
              18
                             DR. BESSON:  Second.
              19
              20             DR. SCI-IEPLIS: P@y further discussion?
              -21            This then is for three years, 248, 222,  293.
              22             Both of you were impressed with this as  a system of
                  !care as well as the other points.
              231
                             You have heard tl-i,- @-liscuf3s@.on; all those in favor say
              241
  cfl,-Federal Repoiters, Inc.i
                  .aye.
              25








        L


     ('R-6307                 DR. SCIIERTIS:  All -right,.  That is Conr@c-,,cticu-t.
       6
     nb-1         2           The next program is the Lakes Area,
         xxx                  DR. MC PIIEDraN:  Formerly 1,7estern New York.

                              DR. SCHERLIS:  Lakes A.rea, thank you.

                              DR. MC PIIEDRAN:  This is formerly Western New York.
                  51


                  7      year period to document emergency medical needs and to
                  8 develop appropriate emergency medical services in  Brie County,
                  9New York.
                               The proposal proposes a great
                  10                                          deal of confidence
                  11 in a man that has recently come onp an evaluator and Planner,
                  12@ by the name of Dr. Geoffrey Gibson.
                  13          Dr. Gibson did a study in Chicago, where lie was
                  14 before, I gather$ which I read in the course of doing other
                  15 resource, it is a study of Chicago emergency medical services
                  16 neeeis. It certainly is a good piece of woril,,,, I thought.
                  I was very much interested in it.
                  17         Sol I can understand why, the I,akes Are
                  18
                  r@iki@ dical nrOgram is pleased to naive )-full.
                  19

                  20                                           ol)ed @@,-@re is devc!],.O,13
                             The Pronosal that has been devel
                  bv @3.n
                            -T    raedical caz,e coiTtrtli4-tee, which advises the
                  21
                  22 cor(L.,Tlisf@ioiLor -O:F I-lealth.  The co@ra-,,.4 ttee has fairly I--)road rep-
                              f'roiTt hoc-,,)ital pc!@)].e aii(i medical society and
                  23
                           j(@aders,
                  24
  --Federal Reporters, iiic.
                            The proposal                @o),rtr,()ILent, fc)r
                  25








                  an education component for training medical emergency teclini-
     nb-2
                2 cians, and of course, this researcher this study   into  the
                3 effect of the whole program on emergency  medical  services.
                4            Now, the breakdown of the budget, for  the  first
                5 year there is really a very large expenditure on communications
                  equipment.  The total first year budget requested is $348,000.
                0
                7 Of that, communications equipment eats up $207,000.  M.E.T.
                  training, the communications equipment is divided in budgetary
                8
                9 breakdown among the several people, several groups, who would

                  receive this communications equipment.
              I 0
              11             That is roughly 60 percent of the  total  M.E.T.
              12  Training consumes $63,000 and the research  and  evaluation
                  component just about the same, $63,000.
              13
                             The whole argument in presentation is  that  the
              141
                 1communications scheme or the thing they want to  develop  is
              15i
                 Icentral to improving emergency medical services in this region.,
              161
                 1           I think the argument is made with soin-@ effect.  I
              171
              18  find it difficult to quarrc--l     the figures that they ahve
                  developed for the communications. If this  is  the  central
              19,
                 1
              20  feature c>-Lr developing this pi:(:)po@-"l, as they see it. I suppose
              2 1 that one is@6uld have to take t]-ic- @.@l-iole thing all together.
                             The figures for cc),,,L,,T,,,,-iiiication equipment dropl),,3d
              22
              23  down sliaply the cc-coiid year, 78,000 against that figure cif
                  over 200,000 the       yoar, @@i.n(,' @L@@.hird year, 29,000.
              241
                             There             are c)thor sources for funds for
              25








                  keeping it up.  and there are other -- there are other sourcest
         nb-3     large contributions to communications component.
                2                                                     Not as
                3 large as what R14P is asked to withstands, but nevertheless

                4 large.
                5            I think that as I say, the argument was made, at
                6 least to me, with good effect, that this would be an important
                7 direction for @-his regional medical program to take, and I
                8 would rate this proposal as a three and recommend it be
                9 funded if the funding can be found.  That is my own feeling
              10  about it.
              11             That is 348,744 for the first year.  The figures

                  that are shown here on the slieet -- I x,7on't bother to read
              1 21                                                                1
              13  these -- they would be on the record on this sheet.
              141            DR. SCIIERLIS:  How many ambulances do they plan
                 1
              15  to putfit at the very onset?  Do you have any
                             DR. BESSON:  Forty-four,
              16

                             DR. I-IC PIIEDRAII:  Forty-four.
              17i
                             DR. SC!-IERLIS:  llcw many?
              181
                 1
                 1           DR. BESSON:  Forty-four ambulances, participating
              191
                 1
                 1hospitals.
              201
                             DR.    Pi'-IEDRAN:  @lait a. i,@iinute. I ayrt sorry, isrill@-
              2 'iI
                 lit just  30?
              22
                             DR. BESSON:  That is -test the first year.
              23
                             DR@ I,IC' PIIIED',I@7.- Thii.-i-- is the @,ear.
              24
  "C--Fedeial P(,-PO[tC'fS, llic.IL@R. SCIIERI,IS:  Tre hospi'.tal-I-)eired Eir,.ibul,aiices?
              251





                I            DR. MC PIIEDRAI-,T:  I think many of them are.
       nb-4     2            DR. SCHERLIS:  Do they coordinate one with the
                  other or do they just service individual hospitals?
                31
                4            I just happened to pick up a sheet that says
                5 St. Francis Hospital and then lists
                             DR. MC PIIEDRAN: They  would  be  coordinated  through
                6
                  central dispatching, that is one of the points, of course,
                7
                  about all of this elaborate communications equipment.
                8
                             It is a central dispatching type of arrangement.

                             DR. SCHERLIS:  Right.
              10
                             DR. MC PIIEDRt7kN:  So that whether they -- how they
              I'l                                                                  I
                  would be based seems not so important,, they could work that
              12

                  out.
              13
                             DR. O-CHERLIS:  Have tli.,-y already worked out the
              141
                  assignment of channels and expressed a  willingness  to  cooper-
              15
                  ate one with the other?
              16
                             DR. MC PIIEDRAN: They speak about  that,  that  there
              17
                 1would be an assigned frequency that would be used by all the
              18 11
                 Icooperating parties.
              19i    I
                             DR. I,IARGTJLIES: That is an area in which they  are,,
              2  1
                 Irather expert.
              21 1
                 1           DR. TIC PHEDIZAIi': Is that right?
              221            DR. MAJIGULIES:  Yes.
                 1
              23@            DR. IIC Plll',DILI,,Zq: You mc-!z,,n expert -- who is expert,
              241
  ce - Fedetal Rtporteis, Inc. the  police?
              25







                             DR. IIARGUI,Il@,S Prilip has had a lot o4 experience witt,
      nb-5
                2 the use of radio communications.

                3            DR. SCHERLIS:  Dr. Besson?
                4            DR. BESSON:  Yes, this program had its genesis in
                5 the appointment of %--he Blue Ribbon Committee, so-called, which
                6 was an advisory committee to the Commissioner of Health.
                7            As I have looked over the application and the
                8 minutes of the Blue Ribbon Committee, @T see that the subcommit4.-ce
                9 on communications takes up the bulk of this application.  And
              10  my only thinking is that some communications expert must have

                  gotten to this subcommittee and really laid out a program
              I 1
              12  for the development of a communications network that is
              13  maybe a little bit overkill',, but I suppose that is what com-mun-
              14  ication gear costs.  The details are just astounding for an
              15  application like this, and I think that has been the heavy
              16  eriphasi'-s, as Dr. McPlibdran has already put, not only physical
              17  but so far as there interest is concerned.
              18             But I suppose I will have to live with the fact
              19  that we are equ4.pinq ten hospitals -- participating hospitals,
              201 one regional hospital, and forty-four ariil:)ulanccs, for all. this
              211 cormi,,unicitions mon,@,I,- of $270,000,, since tlic,. syste-a just
              22  dodsn't go unless you have tl,,@it component part arid if they are
              23  on the ball to lay out this kind of elaborate system, I suppost,
              241 more power to them,
  ce -Federal Repo, ters, lric.  IThey are link ng test tc. a good training progra-ri
              2511







                  for technicians, training 5,000 over a  three  year  period  with
       nb-6
                 21 36 hours of formal training to be given throughout -the region,
                 3hopefully. And -they anticipate  that  this  Blue  Ribbon  Committee

                  will continue as a coordinating committee to expand the effort
                 4
                 5 from this original area which is around in Erie County,
                 6around Buffalo-to the rest of Erie  County  and  then  throughout

                  the Lakes Area Region, developing  local  committees  as  they
                 7


                  go.
                 8
                 9            1 have difficulty in swallowing  the  whole  thing,  but
                  I suppose that if that is money going to a  good  cause  I  would
              10
              11  agree with the recommendation implied in Dr. McPl-iedran's
              12  presentation of a C rating and full funding.
                              DR. MC PHEDRIU4: I want to just say,  one  of  the
              13
              14  concerns that I have is a concern I have about all of them,
              15  really, that evaluation has to do with  whether  or  not  they  will
              16  be able to get the things equipped, whether or riot they will
                  be able to get the I:)eoplc on the same frequency bv such and
              17

                  such a time.
              181
                 1
                 1            But ag-@i-n there isn't anything here that tells  how
              19
                  they are going to decide whether or not coronary lives were
              20 ii
                 I8avc4d, or accident vi.c4tims were saved.
              21.
                                  -)pose they are hoping- Dr. Gibson can  design
                                sul
              22
                       a study, But that sure isn't  in  -any  of  these  applications
              23 1
                 1threat I have been Fbl.@- to tell, and it is not  in  this  one,
              24

  -e -Federal Repo! tcrs, Iiic.
              25  e.L tj Ir.




                                                                                6 6



                               DR. SCliERLIS:  Do you think they are ready to start
                    2a system involving so.many ambulances, or.do you think that
      nb-7
                    3we might not suggest -- I am just asking this -- might not
                    4suggest they start with a small group, and feel their way --
                    5          DR. 14C PHEDRM     I think the idea wasn't they
                    6couldn't servelt-he whole region unless they  tried  to  do  this,
                    and they want to try to make it a regional network from the
                    7
                    8beginning.

                               DR. SCHERLIS:  something has to come first.
                    9

                               DR. MC PHED@RM:  I guess, you know, if it is
               10
               11   simply setting up central  dispatching  and  then  putting  equip-
               12   iment into ambulances and having everybody use the same assigned
                    frequency, there might not be much need to time phase that.
               13
               14              DR* SCHERLIS: But the  training  would  be  a  problem.
                    In other words, what do they corL.-ft-Lini.cate?  If it is just
               15   dispatching, that is a questionable facit  of  the  total  system,
               161    -
                    runless training is with it.
                    71
                              DR. BESSON,  Mr. Chairman, I think tli'
                                                                      is is an
               18i
                    ,example of an ar?)-)lication which suggest to me that knowing
               Igi
                    I
                    labout the so-called neglected disease, can be enhanced by
               201
                    ,getting involved in this.  I don't know -@f Dr. Di,mick had
               211  started out that way, but he sure became  an  expert  from  having
               22   1
                    lbe--ome involved and getting them L.iivc)lved in communications is
               23
                    going to i,,,eke it obvi.0115@ to      t,.I-.,at is- only one link
               24

    --F,@deral    Repoitc@rs,     Inc.
               25




                                                                             67



                I             And I think they will be self-corrective and -the
      nb-8
                2@ more they get to know about it, the more they  will  recognize
                3  that communications can't possibly function without having the

                   other pieces of the puzzle.  So while it is heavy in one area
                4
                5  I think it is an entry point for this region to get involved.

                              Now, we reviewed Maine, and there big  handup  is

                7  transportation. They are spending all their money  on  traris-
                8  portation but obviously they will have to get to  the  other
                 inarts as they recognize the state of the art  and  become  more
                9
               10  familiar with it.
               I I            DR. SCIIERLIS:  Dr. l@eller?
               12             DR. KELLER.-  It would seem in looking over and
                 1 listening to a few of these, that the  particular  component
               13@
                 I that is stressed depends upon the enthusiasm of some individual
               14 1.
               15  r a small set of individuals on the particular site.
               16             The leap from that to deciding whether this is a
               17  legitimate priority for the region is another thing entirely,

                   and I don't know whet-.her anyone but someone on the scene who
               181
               19 @can really look over each of the components carefully and
                 imaybf-- acquire data not currently available, could  possibly
               201
               21  assess,
                              What troubles me is not that particularly, because
               22
                   I think I would a(jree that almoE,@t any Legitii,,[,-At(-i entry fill
               231
                 lbring along @,om@- of the other components, but I am a little
               24i!
  @c@ Federal Reporters, lt,,c. aY)oiit the re'Lativ(-i t)osii:i.c)n of the
               ,)5





                                                                                     68



       nb-9       I  Granting mechanisms as agains4.- Departmf2nt of Transportation

                  2 and other groups who have been very heavily hardware@orientated,'

                  3 This is the sort -- I have also had an opportunity to review anc

                  4 look over  a  great  many  things  that  have  come  to  the  Department

                  5 of  Transportation.  This  is  the  sort  of  thing   that   ordinarily
                  6i falls into their granting area,, for vehicles and hardware
                  7 associated  with  communications  between  the   vehicles   in   various

                  8 areas.

                  9              I am wondering why this is directed to this@par-

                10  ticixi'.ar group.  I haven't been able to 'fathom, in the guidelines,

                11  whether this group was that hardware oriented.

                12               DR* SCIIERLIS:  I  think  that  is  a  facbt  of  Sutton's


                13  law.  S-u-t-t-o-n.


                14               Dn. KELLER:  I am not that familiar with it.


                15'              DR.  SCHERLIS:  That  is  why  he  robbed  banks,   because

                16  that is where the monev is.


                1  -7
                                 DR.  MARGULIES:  In  defense  of  what  they  are   doing,

                18' we tall,,,ed before you  came  in  about  this  problem  of  equipment.

                19  It reminds me of one of  the  earliest  issues  that  I  same,  when  I


                20  ca!qe @-o i@,@tips, in which there was evil, absolute standoff  because

                21 1the c--Lic@stion was how ca.-i you hear the expert-  unless  the  equip-

                22  mp-ii-L- i,.c; there, and then they said, well, we can't get the

                23  equipment unless the e-,,pert is tli@,,-,-re.
                241              1-F   t       Poinlk--f you say well, we are  going  I'@C!

  cf,--Fedpral  Reposters,  Ific.
                25 1: trai-,i i,looT)le.  late (ion't 1-ialle anything to us,- tlif@m in.




                                                                              69


     nb-10      I or you say you are going to have some equipment but nobody

                2 trained in them.

                3             There has to be a point of entry and some assurance
                41 that something will happen.  our problem, our responsibility,

                5 is to make sure that it does happen.

                6             One of the things we will clearly have to do very

                7 quickly after this exercise is to get out to those programs

                8 and carry to them the message you are talking about,

                9             We will be asking, among other things, members of

              10  the review committee to assist us with that kind of direct

              11  visit to these programs that are going to be granted funds.
              121             DR.. BESSOII:  I wonder if Dr. Dimicl-, can comment on

              13  that since  he is one of the people that puts it all together

              14  with all the component parts.

              15              How do you view the review co-mmittee's approach to

              1 6 maybe encouraging the thinking oj' emergency medical care

              17  as a total system by funding a little piece of it and hoping
              18j they will move the rest of the @,7pv?

              19              DIZ. DIIIICI": I think, depending on the whole eiivir-

              20  Onnental situation, where they are in the state of the art.

              21  P,,nd as you said, our emphasis li,3,.s been on training and then

              22  put in the hardware.   Because if you put in the hardware first

              23  and tli.(-y Oorlt ),-rioN@, to use it they compound 'the injury,

              24  so t@)   a'", E,.o         on      is there rigl-it. now., it sounds

   Fc@(leial F,eporte;s, Inc.
              251 like from, whatII hear of the application, that is where the
                 ii




                                                                              70



                  dcf icit is,. is communication.
      nb-11     1
                              However, if they have good transportation, they can
                2
                  utilize this already.  It would depend on what is existing
                3
                  in this area already. I wonder  if  someone  could  speak  to
                4
                  that?
                5
                              DR. SCHERLIS: The comment was  made  they  are  going
                6
                  to train 5000 emergency technicians over a three year period
                7
                  and my concern there would be that  certainly  if  they  have
                8
                  that great a need, what are the untrained individuals going to
                9
                  do in a highly integrated,systc!m  cominunicationwise  unless
                0
                  they have been trained.

                              IVe have to start somewhere but my feeling  might  be
              12
                  more of starting with both gradually instead of the budget
              13
                  beginning with all the hardware.
              14
                              Perhaps we should @hase@this'ii-i-ovc-.r a stepwise
              15
                  period.  I want to get your feedback on that.  You have been
              16@ through the grants in more detail than I have.
              171             DR. BESSON:   I'@ell, I think too the f acinat-ing thing
              118 about @,:atchiaig j@j,'iPs relate to the regions is aparad--'Lgiu of the
              19  way the center relates to the periphery, in that we are per-
              201
                i rni.spiv(--, we are unabjing, we use the leverage of our funding,
              21i and our advi-ce to encouraging a pluralistic  response  to  a
              22
                  natural problem.
              23              It has to be pl@u--alistic c,,i-id I think  is doii,,,@..
              241 it    I v,,.,ou'O,. (.Io it, On when you look @it this r
    Fcderat Ri?po; lots,  inc.L                                     0  o-.'l and  see
              251
                       there  is about it th@-it got




                                                                                   71




     nb-12'        this Blue Ribbon Coramittee decided that one of the problems

                   that they had was people having to wait in emergency rooms.
                21 So they said how can we correct that, aiid     ;they  said  well,  we
   49           3
                4  will devise a system  of  creating  red,  green,  yellow  alert'.-

                   And well, how do we know what group is doing what?  Well,
                51
                6  we'll check with each emergency room.
                7               Well, they found when  they  did  that  by  phone  that
                8  they would get busy signals and they wouldn't be able to call,
                9  And they had 44 calls a day, and they found it was very
                   coraplex, and  along  came  this  communications  expert  and  said,
               10
               11  I could solve it all for you.
               12               That is the genesis of  their  emphasis  on  comrfiuni-
                   cations. And  they  sa@7  if  communications  is  this  vital,  we
               13                          1                                              1
               14  had better put our money on this horse.  So I can't fault them
                 I for that.  That is their uniqueness.
               ]5i              And I think with Gibson  coming  on  board,.  who  is
               161
               17i really an  expert, they  will  obviously  look  to  the  other  four
                   component  parts within a year, I am sure.
               18
                 I              They will find they have all this hardware and they
               19@ had il@)e,*,-ter do it right.
               20i
               21               DR.    PJIEDR,A14: Llecause that is  certainly  well.
               22  brought out in the Chicago study,, 11-io. lookds at all. parts of
               231 it'
                 I              It i-s a good study.
               241
  -Fedetal     Inc.                                  re(ii.ic@@ted l@runcls.wer(-- on the- c,8-,tciei."
               25





                                                                               72



     nb-13         of 348,000,. 231 and then 245,
                2i             DR. BESSON:  That is correct.
                3              DR. SCIIERLIS: Would you like to  make  your  recon,-
                4  mendation in view of the discussion?
                5              What is your original recommendation?
                6              DR. MC.PHEDIWI:  I recommended funding at the level,
                7  because I can't quibble with the figures, really.  I don't
                8  know how to revise them downward.  If  I  though  that  was  nec-
                9  essary,, that is.  So I would reconunedn it as requested.
              10@              DR. BESSON:  One year funding?
              11               DR. 1,;IC PIIEDRAN:  One year fundin(j?  Well --
              12               DR. BESSOIT: Three years is 8244
              13               DR. GITIBLE:  Can I raise a question?
              14               I have no doubt with the money  you  give  them  they
                   will be able to set up  ambulances  and  equip  a  communications
              15
              1 6  system.
              17               1 was unsure that they had looked into what they
              18   needed.   I am sure they can tic them all ;together but after
                   they tie '-,hem all together, is that going tei,be adequat(@-?  Tt
              19
                   seems hire thev are putting a lot of money into something with-
              201
              21 1 out having dpti to supnorf-. it.

                               DR. 'IC PIIEDRAN: Yes.
              22
              23               DR. SCIIERLIS:  D@ly other concern is voiced by the
                 I training asnects of having the liz@rcITiarc- and not the softi-7arc
              24
  e- Federal Reportcrs, Inc. to go with it. I do li@ive concern on that point..
              25




                                                                              7 3



      nb-14    I              MR. TOOMEY:   lio\,i i{i ny counties were involved in

               2  this documents

               31             @vas -this the whole area?

                              DR. BESSON:  No, not by a long shot.

               5              DR. MC PIIEDRAN:  No, it is Erie County.
               6              MR. T0014BY:  Erie County?
               7              DR. BESSON:  I believe it is just -,this county, and
                  then during this period of time they are going to expand it
               8
               9  beyond Erie County, presumably to the whole state.
              10              But I thin),, for the time being, it is just Eric,
              11  and contiguous counties.  Not even the whole county, the
              121 Buffalo area.
                              MR. TOOMEY:  They had a fellow named Dr. Sults,
              13
              14  S-t-l-t-s, who has done a very complete analysis of the whole
              15  medical hospital emergency services.
                I             Do they mention that in application at all?
              16@
              17j             DR. MC PHEDPAN:  I don't recall.
                                     14               -id of in answ@-r i:.o your
              181             MR. TOO' EY:  This is k@Li
              10  commint.  This Dr. Sults has --
                I             DR. GIMBLF.:  There Nias an initial survey done but
              201
                1
                1 they concluded frc)m that, if J.'         correctly, that they
              21
                i needed El irto--c-            study, which is why they reqii(z-;..st
              22
                  :icid l@irg@2r@ ar,.ioiint for P, & D. So the- questions asked on the
              231
                  fi-"st
              241
   f7           i answers for a tot;,.l sys-Leiii.
    edeial Repo,,tets, Inc.,
              251






                              Despite that they are spending a lot of money to put
      nb-15
                2  i-n equipment on a system they haven't analyzed thoroughly.
                3  That made me a little leary.
                4             DR. MC PIIEDT@W4:  This is the region shown here and
                5  here is Erie County in there.  This is -- it includes Erie,
                6  Pennsylvania, and McKean County, Pennsylvania.
                7             The rest of them are New York counties.
                              DR. JOSLYN:  This project and the funds, the
                8
                9  800,000 is just for Erie %'-ounty.  Is that true?
                10            DR. BESSON:  It is for less than that, primarily
                11 for the Buffalo area.  And they speak a out expanding it.
                12            DR. JOSLYN:  That is not included in the funding
                13 at this point.
                14            DR. MC PHEDI@4:  That is right.
                15            DR. BESSON:  They speak of EMT training as being
                16 over a larger region and -- from their abstract, and they say,
                17 "Counties surrounding Erie, New York, have expressed interest
                18 in participating, and the Erie County Commissioner of Health
                19 hap. informed them that, "Coursc@s would be or-,on to individuals
                20, tlarouglilk-- the region. But so far as the communications are
                21 concerted the ten participating 1-@-c)Fp@-tals are in the immediate
                   area around l@-Liffalo, o,-,,-     hospital, and the 44 ambu-
                221
                 1 lances serve just thc-it EirE@,',.
                23
                               DIZ. SCIIE!@LTI--  !Irs, Faa.tz, can you lic--I.I? us on this?
                24@
    .-Federal i@efior ets, Inc. DR. FAiAf.Z      nc)t     the last content.
                25




                                                                                              75



                                     DR.  SCIIIERLIS:  Do  you  have  any  comment   at   all   as
      nb-16
                   2' -far as the    total   application   is   concerned,   their   ability    to
                   3  carry this     out  or  their  degree   of   regionalization   as   far   as

                      the Lakes Areas are concerned?
                   4
                   5                 DR. FAATZ:   I think the feeling on the Eastern branci
                   6  is that they can probably do what they say they would like
                   7  to  do.  Ilith  regard  to  Dr.  Sults,   i   don't   know   his   degree   of
                   8  involvement   with   this   particular   application,   but   I   know   lie
                   9  is  still  working  with  the   RMP   there   and   is   quite   involved   in
                 10   a number of their activities so I don't imagine he was shunted
                 11   off to the corner.
                 1 2                 DR. SCIIERLIS:   I would like the record to show that
                      Dr. Roth left the room because of his involvement with the
                 13

                 14   area,
                 15                  Yes?
                 16                  DR. DIMICK:   I would like to make one comment
                 17   regarding project summary.          As   Dr.   Besson   indicated   a   moment
                      ago the radio system is sur)-,)oF,,@d to alleviate overcrowdit-ig of
                 18,
                    I
                    i emergenc@@ room facilities.         And   I   seriously   question,   as   one
                 19,
                      who is in r-harc                                       ency dep,,irtrtic-5iit
                 20                      Te of a                busy (@-merg
                      and tryiTi,,T to  coordinate  1-3  other  hospitals  in   our   city   -,-   I
                 21
                      am not so sure radio communicitioi-is is going to alleviate
                 22
                    i overcrowding of fc-x,-'ilities.      The same question you are rais.Lii@l,
                 231
                      t'l,ic radio c-vptc-ii i.,@  no  pana---ea  for  these  types  of  problems.
                 24
         F@e,,orters, Inc.           I am siirc,! it i@@ill 'iif--113 (-Iirect ambulancE@s to loss
                 251




                                                                           76



               1  crowded facilities but not alleviate overcrowding.
     nb-17
               2             DR. BESSON:  I agree with that, it doesn't address
               3  the basic question of what creates overcrowding.  All they
               4  want to do is facilitate knowing what the green, yellow or
               5  red Allert state of each emergency room is and direct people
               6  elsewhere, maybe.  But that is in theory.
               7             DR. SCIIERLIS:  Is there any feeling from the
               8  reviewers as to how many emergency technicians are trained
               9  at this point who could man ambulances if they were fully
              10  equipped and put into that area?
              11             DR. IIC PIIEDRA14:  I don't know.
              12             DR. SCIIERLIS:  lly big concern remains the fact
                  that all these ambulances will be equipped at a time when the
              13
              14  technicians would not be trained.  I think it is an over
              15  generous request in terms of what we know about that area an
              16  what organization is there, what still has to be done to get
              17' a system of care into that area.
                             DR. GIR,IBLE.  I would ,lik(@-,@ to t,aise the question also
              181
              19  of do they know how many ambulances they need?
              20             Are we going to equip 44 ambulanc(@@, with communication
              21  when they only need 30?
                             That would be an a@,,iful. @,iciste,  Do they have data
              22  showing that they need 44 .iml;.)tilarices or are t.liev just picking
              23
              24  the        of i.TFtbi,;.I.ancps they    hav-c, to have op,@,rat(@cl.

  "@,-Feder,ti Repofters,  Iiic.
              25             DR. Stk-"AIERLIS.-  Mv suggestion would be one way to




                                                                                                 7 7



                       approach this might be with the first year beirg budgeted less,
      nb--18           and  let's  see  where   they   get   with   a   few   ambulances   and   some
                       training,   and   then   make   the   second   arid   third   ,ear   contingent
                    3                                                             .2
                    4  upon evidences of performance and having set               up  a   system   of
                    5  care the first, year.
                    6                 I  would  be  much  more   willing   to   vote   on   that   favor-
                    7  ably than on giving them what they have requested in view
                       of the discussion of points that have been raised.
                    81
                    9                 Would that be acceptable?
                  10                  DR.   MC   PHEDRAN:   I   would   go   along   with   that.   Maybe
                  11   reducing  it  by  half,  to  half   of   what   it   is,   as   a   reasonable
                  1 2  figure?  Just reduce that part of it.
                  13                  DR. SCIIF.RLIS:   For'the first year?
                  14                  DR.  MC   PI-IEDRAN:   Right.   And   the   second   or   third
                  15   year --
                  1 6                 DR.  TIC  PIIEI)PAli:  Make  it  just  for   the   first   year,
                  17   if   they   can   be   equipped   as   Dr.   Bessoii   suggested.   Perhaps   that
                  18   would  be  the  best  way.   Because   by   the   end   of   that   time   they
                  19   should see if they can get enough people to run the ambulances.
                  201                 DR.  SCIII@'RLIS:  ',,Ihat  we  arc  discussing  is   3-50,000,,
                  211  but  the  conditions  of   the   a.@qardt   including   the   4Lacts   that   both
                  22   the  equipment  and   training   would   run   hand   in   hand,   find   that
                  23   the second or third year would be considered as based upon
                       i@7h at -Llli,@-y have acroripli@he(I     al...@o      evidence of setting
                  24111
                     !I
     Fede ra I Rcpor tc rs, [,IC. un a tr,t,.c, emergo-,,ic@l medical ,;yF3tem --- would  that   be   more   in
                  25il








               1  line with some discussion?
     nb-19
               2             DR. ".,IC PHEDRAti:  For the first year you would want

               3  to cut the communications equipment in half?

               4             DR. SCHERLIS:  Yes.
               5             DR. MC PHEDRAN:  That would take it down to about
               6  103 for that, communications,, and then leave the others, which
               7  are the M.E.T. training and research and evaluation component,

                  intact.
               8
               9@            DR. SCHERLIS:  Ilow much is that?
             10              DR. MC PIIEDRAN': In round figures, 231.
             11              DR. BESSON:  Plus another 14,000 for project personn(@l.
             12              DR. MC PIIEDRAN:  Okay.  I'm sorry.
             131             DR. !iINMAN:  245?
             14              DR. 14C PHEDRAN-.  245.

                             DR. BESSON:  250.
             151
                1
                1            DR. IIINI-IAN,.  I have a question for staff clari-
             ]6i
             171  ficat--ion. Do I understand you correctly that you feel that
                I
                I in all likliliood, that the region could use the total amount
             181
                I requested over a three year period if they progress satis-
             19
                  factorily, and that you are limitiii(T the first year recommended
             20,
                1
                  amount to 250,000, and the rest I)c@ing contingent upon perfor--
             21   mance during the first year?
             22

                             DR. MC PI-IEDIb'%,-@:  Yes.
             21                  SCIIFR,1,1!7,- I ti-iiii'i@ it ties to be revic-@.ied after
             24
  @@.-r(@deralReporteis,liic.i the fi-rst year.
             25@




                                                                           '79





                              ll)R. MC PIIEDIZAN:  Yes.
     nb-20
               2              DR. HINIIA.N:  One! year approva'L only?
                              DR. BESSON:  One year approval only, and re-review.
               31
               4              DR. IIINIIAN:  Okay.
               5              DR. SCHERLIS:  When you say,, could they use it,
               6  I don't think there is an area in the United States that
               7  can't Come up with a paper plan of communications and the need
               8  to train emergency medical technicians.
               9              I think we have to show that there is a need and
               10 an ability  to utilize these funds.
                              And I think we have the feeling here that the area,
               12 at least probably can use it.  We aren't quite satisfied with
                  the total demonstration of need in terms of numbers of
               13
               14 vehicles and so on.
               15             I think the recommendation made at least would
                  mo-,@e them towards justification of this.
               16
                              DP,. I-IC PIIEDIUKN:  Okay.
               17
               18             DR. SC]IERLIS:  What was the rating?
                              DR. I-IC PIIEDJZ2U4:  Three.
               19
               20             DR. SCIILERLIS:  Ichree.  That has been seconded?
                              DR@ B13SSON:  Yes.
               21
                              DR. SCHERLIS:  Any further cc>lranen'@-, Mr. TooTfiey?
               22
                              IIIZ. TOOMEY.,  No.
               231
                              DR. SCifr@R1,IS:  IFi tl-icr(@ concurrence. on ti-icii?
               241
  @t-e-Fedeial l@epoite[s,  Inc. All in favor, say, aye.
               25























                                                                            80




     nb-21                   (Chorus of ayes.)

              2              DR, S,'-'IIERLIS:  All right.

                             I guess Dr. Iloth can come back in the room.

              4              f'R. TOOIIEY:  I had not read this material, butI
              5   was on a site review (there a year ago and I was impressed

                  by  Dr. Sults and I war, also impressed with the lack of
              0

                  services in the innercity in Buffalo.  These two things kind
              7
              8   of stood out.




                                                                                19 0




                               (Chorus of ayes.)

                               All right.  "Louisiana, Dr. Besson.
                2

                               DR. BESSON:    Louisiana is presenting a program
                3
                4  for -- that involves four projects, with a total funding of
                   363,000 over a three-year period.
                51
                               The four projects are updating of an existing EMS                0
                6
                7  system in the state, which was previously drawn up, a training
                8  proposal for El-ITs, two-way communication systems, and a
                9  developmental study to determine feasibility of medical
                   helicopter evaluation services in New Orleans.
               10
                               Apparently in 1969, the Highway Safety Commission of
               12  Louisiana,  in an attempt to coordinate E14S programs statewise,
               13  Asked the Gulf South Research Institute to do a study of the
               14  emergency medical services program in the state.
                  I        -   They did submit the study and it is really an
               15  excellent study.  It encompasses the entire statement of the
               16
               17  problem with a good inventory of needs, resources, identifica-
               18  tion of shortcomings in the state, and a plan for correcting
               1 9 them.       The study alz7,o suggests training, co,-oiunicat--ionsi
               20i
               21  and now with this R.N'.PS progress corciing down the line they f4unall
                   see a way of upqradinci this 1969 study and beginning to
               22
               23  implement it with specific projects.
               241             The .4irst project thcy su!,Dmi@. is tha4,-, of updating,
  ,,e-Fedeial Roportefs,  !nc. which will do just the things that 1 have suggested, inventory,
               25,




     mea-6                                                                 19 1


                I develop workshops for the public and for personnel,  establish
                2 EMS councils &Ttong B agencies, develop a program of priorities,
                3 and establish mechanisms for implementing the plan which  will

                4 be updated.
                5            It is a one-year program and includes some evaluation
                6 and requests $54,000 in direct costs.
                7            I think it is a good program and I would grade this
                8 a 4 on that scale of five.
                9            Number 27 is a training program to train  emergency
              10  room staff, ambulance personnel, and to produce a  coordinated
                  statewide training program and a register as well as developing
              12  standards for continuing education and recertification of EMTS.
              13             There is an evaluation included in their training
              14  program which is two years under the auspices of the state
              15  Department of Hospitals for a total of 72,148.
              16             The state Department of Hospitals has indicated that
              17  they will continue the program under their funding at the  end
              181 of this ti-7o-year period.
              19             Also, it is a well put-together program and I would
              20  grade this on that same scale, and recommend full. funding on
              21  that.
                             The third nrogram is that of conniunications, project
              22
                  28.  The objectives of this program I'll siii@,,,Tftarize, in reading
              23
              24  this --- they have the notion t!iE-,t b(@fore, hospital or a.i-iibulance
  ,cc--Federal Reporteis,  Inc. -es P,?end the mon for a cor@anunications system, they must
              25  servi(.               Cy




    mea- i                                                                   19 2



                I have information concerning advantages of the system, cost,
                  effectiveness, capabilities, compatibility of equipment, and
                21 so
                    on.
                31           These institutions must be shown  through  a  variety
                4
                5 of s@ttirigs throughout the seven CIIP areas that the communication
                6@ system is a nececcity for good and efficient emergency medical
                  services.
                7
                8            It is anticipated that this demonstration project
                 lwill stimulate and commit hospitals, ambulance services and
                9i
                 lqoverntn,ental agencies to support a statewide emergency
              101
                  communication system.

                             So, they are requesting  94,000 ---- 122,000 for the
              1 2
                  second year -- 94 for the first year -- to approach the
              13
              14  problem in this way, which involves purchasing some equipment,
              15 land getting the hospitals to all become  aware  at  leaIst of  the
              16 @need for communications and pick up the ball in two years.
                 I           That is project number 28, which I also think is well-
              17
                  conceived, and gets us involved in cost-sharing with the
              18
                  hospitals, and although a critique of this by  staff  felt  that
              19
                  the hospitals may not pick up the ))all, at least it is a start.
              20
              21             The fourth progr@iri, the helicopter evaluation
                 !program,,, has objectives to determine the need  for  air  medical
              22
                  emergency patient transportation in the Greatr-@r New Orleans area
              2 31                                                                  11
                  establish feasibility of such a Service, and determine its
              241
  @@c,,-Fedefil Reporters,  tiic. of operation and cos-@s.
              25






    ,mea-18
                 I             They consider that since the medical helicopter
                 2 service has been so successful in  the  military,  this  PI4P  study
                 3lwill aim to determine  if  this  procedure  will  reduce  mortality,
                 4 and translated to the civilian  role,  provide  a  service  for  the
                   State of Louisiana.
                 5
                              .They are requesting a one-year  study  to  do  this  for
                 6
                   $46,000.
                 7
                 8             So, in summary, we have four projects, 26 is an
                 9 updating of an  already existing comprehensive system and
               10  beginning implementation; 27 is a training program; 28 is a
                   two-way communication system in a variety of hospital settings,

                   29 is the medical helicopter service.
               12              I would grade the program as maybe 4.0 and recommend
               13@ full funding.
               14
                               And initially, in  their  introduction  I  am  impressed
               15
                   with the figures that they quote,  which  may  have  been  known  to
               16 lall of us, but I will just mcntion-them gratuitously.
               171
                               Insuection of war figures  to  determine  the  value  of
               18
                   transportation     of the whole emergency care system, the war
               19 Ifigures in 1969 that were done show that eight percent of
               20
                   casualties in l@-7orld liar II figures --. eight percent of the
               211
                   casualties dies.  Four-point-five percent died in Korea and
               22 1
                  @only 2.5 percent are dving  in  Vietnam,  and  the  implications  by
               23  these figures is that t-beF;e casual.ty-to--deith rates iml)lv  that
               24
     Federa I F?eportefs,  Inc. we are qain.itg on. it, and the thin,-Is that v,7e are doing in
               25





                                                                            194



               I Vietnam that we weren't  doing in World War II should be
               2 replicated in civilian situations.
               3             The figures are impressive, and I think backed with
               4 that kind of approach, I liked the program.
               5             DR. ROTH:  Jerry, why do they need to,do a one-year
                 study to establish the fact that nobody can afford  the
               0
               7 helicopter services except the federal government?
               8             DR. BESSOTI:  I can't answer your question.
               9             DR. ROTH:  There are plenty of cost figures oh

              10 helicopters.
              11             DR. BESSON:  I am oerfectly willing to scratch
              12 137,000 from the program.
                             @l",d -I.ike@.to -hear- from@ the secondar
              13                                               y'reviewer.
                             DR. SCIIERLIS:.@i The secondary reviewer, please?
              14
              15             That is Dr. Roth.
              161            DR. FROTH:  I,:.'ell.- I have not dote any of. my second
                 area reviews.
              17@            DR. SCHERTIS:   Ilaven't you?  All right.
              18
              19             DR. BESSON:  I would recommend that we grade then,. as
              20   and.fund  them at 363, less 37,000.
              2              DR.          Disapproval for 29.
                             DR. SCHEIZLIS:@  Disapproval for the helicopter study
              22
                  ind     others, grant them at 4?  Any other corirtents?
              231
              24             DR. BESSON:  I m4@-ght. acid that as the B agency or
  ce Federil Reportefs, Iiic.Iother endorsing grouses were asked to coirniont on these four-
              251




                                                                            195




               I proposals, they considered that this helicopter program was last

               2 in priority.

               3             DR. SCliER.LIS: All right.

               4             All in concurrence?


               5             (Chorus of ayes.)

               0             DR. $CHERLIS.:  Opposed?

               7             DR. HINI-IAN:  $225,615 the first year, and then
    CR 6307
    End 14rl6  8 $100,325 the second year.

               9


              10


              11


              12


              13


              14


              15


              16


              17





              19


              20


              21


              22


              23


              24,

  ce-Fedefat Rf-,I)D,-ters,  Inc.
              25



                                            r4aine,  or. McPhedran?
                 9

                             DR. MC PliEDR)Uq:  This is part of an EMS system.
              I  0
              11  The application indicates that in the Department of Health  in
              12@ the state,, there is already  some  interest  and  ferment  about
                  emergency medical care system, and this proposal here is for
              13
              141 an ambulance attendant  and  other  medical  --  emergency  medical
              151 personnel training system,  and  also  as  Dr.  Besson  indicated
                  prc-@vic)ii.sly, a design for an emergency transportation  system
              161 to be developed as  part  of  the  establishment  of  coordinated
              171
                 irtedical- care systems.
              181
                            The wish is to develop @i packaged standardize(.
              191
                 1
              20  hosp-'Ltal based trai-nirq course for use tl-irou@lliou-t the state.
              211 And tJie funds requested in thc@ first year, a  total  of  123,000.
                  That is h--oken down -- tlii eq-tiipni6@nt part of -that, cince we
              22
                  can't help    12,@i intere@-,te@d i-i-i that., includes some -Vil@otapc@,
              2311
              24

                                                                                         t3
  c--Fc-detal Reporters, Inc. Ab(-)ut 40 nerc-,ent of thc,-t total. t',-iat is rr:,-qii,,@ste(,,-t for
              25








                        first year and in the second year and third,ycar of this reques
                                                                                                              tec
         nb-22
                     2   three   year   program,   there   are   -io   @-a,)re   equipment   requests   and

                     3  the   budget   drops   considerable.    It    also    drops    because    in    the

                     4  first vear they propose to do a transportation study using
                     51 a consultant whose name I have forgottent now.

                     6                 DR. BESSON:   Chi Svstems.

                     7                 DR. MC PIIEDRAN:   Chi Systems, thank you.

                     8                 The transportation study for the state of Maine

                     9  is proposed for the first year at a cost of $22,000.

                   101                 Now, I thought that the proposed course of instruc-

                   11   tion was worthy, and it was probably something that woul                          e

                   12   quite useful in the state, around tile state.   I really didn't

                   13   get the feel at all of the transportation study.

                   14                  Maybe Dr. Besson has another view of it.   But it

                   15   seemed to me that ih the torRis that they described it in

                   1 6  this applications the terms were so ver-,,, general that I

                   171  reallv   didn't get much of a feel -is to i@,hat                   would do, how
                   18i  thev would go cil-)out it.   And I didn't get much of a feel that
                   19   i wanted to stipy-)ort it.

                   20                  iZeally what we are being FAs),@,@d to do here i-- to

                   21         mi.-.)nev @@-or stil-)I-)ort c)-L" two fr,7.(i-iieiits of a system,  and  the

                   22   total  c@,k7si--c)yt i,7c really (lc)n@@- see iri the application or Oidn't

                                   the application.,
                   23   see    i-n

                   '?A I               Aiicl Lli4-@                             rite worl@-ily@ of r"lpr)o,-@t.
                   -' I
      f-eeiF,-tzi I Repor tef Inc
                                                                          enough about the
                   2f) 11 13-Lit I am not -- I giLic-s@- I   _)I




                                                                                                  82




                       study,  and   their   presentation   doesn't   give   me   enough   -,)f   a   feel
         nb-23        lfor it in any specific terms.
                     2
                     3                It is all so general.   I do.nlt know whether I
                     4 want to support it or not.   I would like to have help from
                     5 Dr. Besson about this.
                     6                I  would   have   rated   this   fragment,   that   is   the   emer-
                     7 gency medical training, as a three, and recommended support
                     8 for it.   But the other I feel very doubtful about.
                     9                DR. SCHERLIS:   Dr. Besson?
                   10                 DR. BESSON:   I had occasion to review ilaine previously
                   11  and  I  am   impressed   with   Dr.   Chattogee's   approach   to   the   enti-r-@.
                   12  region  and   the   term   used   by   an   individual   is   in   the   operations
                   13  branch is frugality.
                   14                 I think that is a very applicable term.   The average
                       income per capita in the state of Maine is something like
                   151
                       3400,   and   one-third   of   the   population   Iias   an   income   of   under
                   16
                       5000, with over 5 percent of the people over G5 living at
                   17
                      Ithe poverty level.
                   181
                                      The distribution of its population is extre@iely
                   191
                      Irural, 5 i-)erccir.,t of  IL-he  people  in  l@lairic-.  living  outside  of  the
                   20

                       urban     areas.
                   21
                                      Now,  the  emphasis   in   this   ar)i,)lic@-tion   is   certainly
                   22 1
                   23 1or,  transportation.  They  have   devr@,lcped   a.   cc)T"IUnuiiicatioiAs   net-
                      I work @,-Iii.r-h has been         4--c           to,,ich. in       -@-@ry   rural
                   24i

   ce -Fedefal  Repo@,iirs,  Inc.
                       state.   A rtixal and iiiaccessibl(,-  state -- they us@-, tl-ii@ Le.rm of
                   25ii




                                                                            8 3



                1 a trip that would ordinarily take a half hour in the summer
                2 ti.me and it might ordinarily take four hours in the winter
       nb-24
                3 time and that is applicable to rural Maine.
                4            So they have had a communications in  the past which
                5 has been developed and it is very functiona'L,  They have also
                6 developed a use of video physicians, let me just say,  use  of

                  videotape for nlivsician training which has been excellent  in
                7
                8 utilizing the scarce-time of physicians in being involved
                9 in this kind of a program.
              10             they are developing a whole medical school, I under-
              11  stand, from having read an application previously on this basis.
              12             And it is an extremely innovative approach  to  the

                  use of scarce teacher manpower.  They recognize the short
              13@
              14  comings in their pretraining program for EMTS, and speak about
              15  adding to their training by the incremental approach of block
                 Itraininq in extrication, various aspects of EMT  training,  in
              16
                 ihouse training, AOS hospital base, Red Cross, so forth, with a
              171
              18  good systematic training for EMT.
              191            The critique of the application mentions  that  the
                                                                     ertainly
              201 emphasis is upon tr,,:insportai-.,f-on -,ii(i Dr. McPhedraii c
                 'implies that and I don't disagree,
              21 1
                             But I am also ix-nl)ress(id by the fact that recognizing
              22
                  that they might get some help in creating a transportation
              23i         I
                 I        they apparently put out to bid amonf
              24                                               systems groups
  ice-Fedefal Repoitc@rs, Iiic. Itliroughout the country what their problem is, and Chi Systems
              25i







                  of Ann'Arbo--,, @,lichigan, whom I had never heard of before,
       nb 25
                  submitted a proposal for solving their transportation problem.
                2
                3             I am interested in Chi System's approach to this
                4 whole thing, approaching it as a very astute systems firm.
                5 And I think that their submission of their study approach I
                6 am im@ressed with, and the dollars involved, the $14,000.
                7             1 think that is money well spent.  That will buy
                8 the wheels  on an ambulance, but it will be very  well  spent  if
                  the entire  transportation system is  studied.  Then  they  speak
                9
                  Of implementing the system for individual counties, for
               101
               11 individual regions, as being an additional 7000, applying this
               12 methodology to other regions, and  then  each  additional  region

                  is 4000, and so forth.
               13
               14             I like this approach of RMP recognizing that-they ha%
               15 limited expense, and buying  expertise.  I  think  that  $14,000

                  is money well spent.
               1 6
               17             Their emergency room problem is  also  mentioned  in
               18 the critique as not be4-ng addressed and I agree  that  that  is
               19 the problem, that i..-, a very significant problem.
               20             But in contrast to many more blessed  areas  in  the
               21 country where they have people who  can  staff  emergency  rooms
               22 and have a plethora of professional physicians personnel, @laine
               23 has a problem in that they liavc- physician shortage.
                              The best '.-hey can do is qet a physician out of  his
               241
  kce - Feder a I Rep oftets, Iiic.  I-Lo aiigT@ie-r an emerqc--ncv rociiii cal-1 @.jh4ch is rel.@.Itiveli-@
               25@ I)Ilsy office




                                                                             8 5



       nb-26    I impossible. -@'hey have a problem in  staffing  emergency  rooms.
                2 So I see reason for not addressing that I-)articular  problem,
                3 but this time I think a region of this maturity will.

                              So in general I agree that the proposal  is  a  good
                4
                5 one and I wouldn't be reticent about funding   the transportation
                6 subcontract, and I would recoi@-aedn with Dr. McPhedran  that  it
                7 be fully funded.

                              DR. I-,IC PIIED@N:  I go along with you about the trans-
                8
                  portation subcontract. I just don't  have  a  good  feeling  for
                9
                  this kind of systems approach.  It  isn't  something  that  means
               101
               I Ia great deal to me.
                              It would mean an awful lot more to  me  if  somebody
               12
               13 had written down -- had taken examples from  Prest4@que  Isle,
               14 or Aroostook, or some place like that, you know.
               15             Then I could understand it, because I know the
               16 state and I could  understand it.  To address  .it this  way  it
                 lis hard for me to appreciate. But if you  think  it  is  okay,
               171
                 11 will go along with it.
               181
                 1
               191            "Lou know, we have said that it is mostly  transpor--
                 Itati-on. It really  isn't though, most of the budget  has  to  do
               201
                 1
               21 lwith ti@aining, and it is a small part of it that addresses
                 I
                 Ithis transportation study.
               22
               23             Those ar,@ the two items.
                              DTZ, SCIli"13-@T,IS:  )Tc)w (Io voii tliis?
               24
  ,c,c,-Feder,il Reportefs, Inc.               I rated the t@-rari-@r)ortation -- 1
               25@




                                                                        8 6



                 didn't know how to rate the transportation part.  The ot,er
               21 part I would rate as a four.
       nb-27
               3            I thought the training was good, the training

                 program was good.
               4
               5'           DR. SCIIERLIS:  You are n6dding your head to show

               6 concurrence, Mr. Besson.
               7            DR. BESSON:  I would rate the whole program as

                 four.
               8
               9            DR. SCIIERL')TS:  You are recommending full funding?
              10            DR. MC PIIEDRA14:  Full funding.
              11            DR. SCHERLIS:  For three years?
              12            DR. MC PIIEDIIAN:  Yes .

                            DR. SCHERLIS:  Any considerations or recommendations
              13
              14 that go along with the award?
              15            DR. BESSON:  Spend it frugally.
              16            DR. MC PIIEDI@N:  Which they will.
              17            DR. SCIIERLIS:  Any other commL@nts?
              181           All those in favor say, aye?
                            (Chorus of ayes.)
              19
                            DR. SCIIERLI'@13:  OT.)T)OSe@l?
              20
                            (No rcsnotise.)
              21
  laid ofi6                 DR. SCIIEIMIS:  All i:.t(.Iht.
              22


              23


              24;

   -Federal Rerotte!s,  Inc.
              25@




               6
     xxxxx                   The next is Memphis.  Is that right?

               7
                             DR. ROTH:  I have Memphis.

               8
                             Memphis, again, I don't know whether I got all of
               9  the bottom of the hope ones.  But here is another one in which
              10  I would concur with Dr. Sloan's review comments when he

              11
                  said that if need is to be taken into account, that since this
              12, -one   starting from Ground Zero, -4-- .n4-ght dcscrv,-- support.
              13             But the requested amount is large, and the need is
              14  great.  It is a fragmentary program in terms of addressing
              15  its total development of a full emergency medical service
              16  system, and it has a dilemma in it in that it extends over

              17  to Mississippi, and into some other areas, and I don't know

              18  how we deal with this.

              19             To break it down into compor@ents, I tried to do

              20  with the elimination of some components.  I couldn't come up with

              2 1 anything very satisfactory.

              22             I don't know what to do with this one.

              23             DR. SCIIERLIS:  Do you think it juc--,ti.f i.ed suppox,t?

              24             DR. RC@m.-.,!:  I really di,2,ii@t -L@link -t was well exiougl-i
  -,e-Fedeial Reportels,  Inc.
              25  thought out and presented, -xid. 1. g@,,,th(,@r the St,-:i@Lf reviewers




       3rDt)                                                               257





                   didn't think so, either.

               2               DR. SCHERLIS:  I had re viewed this and this is one

               3   that I rated as essentially the bottom of the heap -- it was oie

               4   on the bottom.

               5               This was grouped together with those which I

               6   think were least worthy of support.

               7               Did you think there was any element of this which

               8   could be salvaged in terms of helping them to arrive at a

               9   plan which would be worthwhile?

              10               DR. ROTH:  If they could be encouraged to
              11   continue their planning, I think it is manifest that they need
              121  it.  But again, I think we're going to have this dilemma
              13   of giving them a low figure.
              14               I don't see how you could come up with anything
              15   better than a 2 in this and if you cut the grant request,
              16   it would have to be very sharply, I believe.
              17               DR. SCHERLIS:  This is an area iqith real need,

              18   I'm s ure.
                 I
              191              Is Mr. Van Wingle here?  Do you want to

              20   comment on  Memphis?
              21               VOICE:  Mrs. Kindall is the operations officer.
              22               VOICE:  I don't know a great deal about it, other
              23   than one thing that may.be significant here.
                 I             -r.C
              241              LI 4-t seems -to be- just a portion of a program, it
  @ce - Fedr,,rit Reporters,  Inc.        carved out roles for certain l@rovidc-@r
              25   is  that  the state has




       j rb7                                                               258



                I   groups, and the role of the emergency room is the one identi-
                2   fied for Memphis, and the activities, and it is quite logical,
                3   Dr. Roth, that they would extend into Mississippi, because mosi.
                4   of what Memphis does, does extend into Mississippi.
                5              DR. ROTH:  It is very logical, geographically,

                6   a medical supply area.
                7              DR. KELLER:  It would be strange if it didn't.

                8              DR. ROTH:  Into Arkansas, too.
                9              VOICE:  But it is rather confined_, when you think
                10  of it-in a total programmatic sense, but that is the confine-

                11  ment of  the master plan.
                12             The Department of Transportation has a role, and
                13  different groups have different roles, and the emergency room

                14  has been identified at the RMP's role.
                15             DR. SCIIERLIS:  Some of the comments, I think, of
                16  Staff are important in this regard as f@ as the narrative is
                171 concerned; incompatible equipment, this not being a justifiable

                18  system.
                19             my own feeling is that I would like to see something

                20  salvaged from it --
                21             DR. ROTH:  If it would be possible to give them on
                22  Items 1 and 2, the request for planning and administration and
                23  survey needs -- that comes out to $67,038; I would support

                24  thi@s.

  Ace -Fedetal Repoitets,  Inc.
                25             DR. SCIFERLIS:  k@t),jt priority would you give that?




                                                                             25 9




                I              DR. ROTH:  For that phase of it, in order to give

                2  them half a chance, could we go 3?

                3              DR. SCHERLIS:  Yes.

                4              Any comments on this Solomon-like decision?

                5  Solomon wasn't always right.

                6              DR. ROSE:  one year?

                7              DR. SCHERLIS:  Yes.  I concur.  I think in going
                8  over this,  there are'aspects of this in terms of need and
                9  planning that I think do justify support.

              10               I  would concur with that recommendation.

    Lee#22    11               DR. ROTH:  Okay.
    CR6307
              12


              13


              14


              15


              16,


              17


              18


              19


              20


              21


              22


              23


              24

  r-e-Fedetat Reportefs,  Inc.
              25




                                                                                               87




      cr@ 6.-J,07
                                    I;ext area is Metz-opolit.an Washington.          The reports
       #7
                   2  v72111 s@iovi that Dr. Matory left during this discussion,

                   3                DR. DESSON:   Mr. Chairman, I feel that since Dr.

                   4  McP!i,--aran and I are the only ones who have done any work for

                   5  this committee meeting, that we be given special recognition.

                   6                DR. SCHERLIS:   I would like that expunged from the


                   7  rc-@corrl.

      xxxx         8                DR.   BESSON:   Metro   Washington.   This    is    an    applica-

                   9  tion for $95,000 for a 6 month period of time.

                  lo                DR. SCIIERLIS:  A question on that.   Our white slieets

                  11  show $79,000.  Would someone explain?

                  12                DR. BESSON:      I  suppose  the  white  sheets   tal:e   pc-ece--

                  13  dence.

                                    DR.              94 is direct, or indirect, and 79 is
                  14,

                  15  the dir(@ct   funding.

                  16                DR. DESSON:  Thank      you,

                                    DR. SCHERLIS:  Thank you.
                  171

                                    DR. LI@',SSOI@l:  They're  going  to  contrac@L.  with  an  Tlip--

                  19                        cor@).riittec-,, w'@iicl-i is going to (.-c)vl'k--ract For  s(.'-r-
                     @v,                                                         i hi-nen@ ol'  iiccds
                  20    -,ces @l-f 1-csourc@,s and data information

                      and development.        a plaii for the metropolitan 11@Ashingtoi@ area.
                  21
                  22                The'-r                     -i-o @,i great e@.ctent. a reiteration
                  23 10f the ,,;ordi.iic
                                       f oi' ti!Cl- quid(-.,@,         they have previously Su

                                Lc, the,-n,, It -ts clearly a
                  24ii,
                     II
  %,@o--Fede;al Rfpoftefs, liic.  ii
                     .. i - (@ c- z@ L2he-y !,,av,@ no          intrinsic core coyiipc-@,
                  2511-




                                                                                                             88



           dh-2       I    the    field,    and    they    have    asked    for    the     subcontracting     organiza-

                      2   tions    that    they    may    work    with,    particularly    Block    McGil.)ne@rt    and

                      3  I forget  the other one, whatever i.t is, who are mariager,,ient con-

                      4  sultaiats for health systems of one sort or another                             to     put
                      51 together a program.

                      6                   And    having    worked    with    applications     that     were     put
                      7  together by Block McGibnek,-,  I think this application was writ,@.e7.l

                      8  by   Block    14cGibney    as    a    potential    subcontract,    to    taking    it    on

                      9  a   contingency   basis.   That    may    riot    be    a    fair    statement    but    I

                     10  think it is the best method.

                     11                   C.   Can do at the moment.

                                          The   staff   summai-@r    critiques    this    as    lacking    a    com-
                     12                                          z
                     131munity base for information to be implemented, and it suggests
                     14  revealing    this    comititinity    base    first,    and    I    certainly    agree     with
                     15  that.   But method C.  has problems.
                     16                   Beyond    their    soluble    problems,    but    I    intend    to    be
                     ,71very   charitable   towards   Meth(--d   C   i.n    spite    of    the    fact    that    we
                         I
                         !have sc>riic@ negative comments bv associated ciep,;:jrtmeiijt-- of h(-,altli
                     18!
                         i
                     19  in  Prince  Georg(-@'s.Cotint,.7,  z@n,-!,   tlic-   District   o-F   Coluil,)-)ia   .,4edical

                         Soci.ety, which -L would like @@.o read. to @70
                     20                                                               U indicating the tei-iuoui-

                         nature of the (,---@-fort I)v             sol)cori-trac-,tor to I?
                     21                                                                      ut together a

                           ystcm.
                     22  1'
                     23                   III letters of .,@uppoi-t received by the program coor-

                         dinatc,,i, o.'L-                       i-.1ic@ ric('tj.czil societ-,,, of  the  Lli.stri,ct
                     24

   kce- Federal Repotteis,  Inc.1
                         of Columbia sa@is,                           L@i a(:ri-eeinent         ono-              Of -'L-.l
                     25




                                                                                                8 9


       dh-3            Iplan.   I-leartil-y I endorse it."   However, I am somewhat distressed-
                       2by the fact that that group        will furnish the major amounts of
                       3the  emergency services are not included in much of the earlier
                       4planning, namely, the physicians in the area.
                       5             They go on to say that, "If this prominent,omission
                       6can be corrected,"that is,@the medical community is not enmeshe
                       7in their planning effort, they would be pleased to lend their
                       8full   endorsement   to   the   program.   Now,   even   the    county    department
                       9of health of Prince Georgets County says that, "The emergency
                       10 medical services system coordinating committee is pocked with
                       11 health planners who plan on a technical basis, but have no
                       12,emergency medical service procedures.
                       13            I  do  not  mean  to  reflect   adve.-ril.y   on   the   members
                       chosen  for  the  coimrt  ittee  since  I  know  many   of   them   and   they #re
                       14
                       all capable people," as Caesar was, "But the committee has no
                       15
                       pl,yS4CiallS  who   are   active   in   the   practice   of   medicine.    The
                       16    L
                       Icommittee has no  emergency room physicians, no members from plans
                       17
                       or rescue squads, no meiDb---rs from hospitals.
                       18 l@
                       I             The. oi-ily I,!D.,i taken are from  Gov(4rii@'tcinl@-  servicQ"@
                       191
                       20 and I tliinl- -hat is a very @L-o-ticl-iii-ig            of what  is  lia@?pc@ii-
                       ing in asking -1--he  nation  to  r(?spoiid  in  6  we(.,I,@.s  to  a  problem
                       211
                       that has a%@@sc),Tie implications.
                       22
                                     Beyond N.,hat to (lo          -.'--lie        any morc- than tl-ic,,
                       23
                              of us dc), @,@,nd                                 ""Aia-t is the nzt,'-Ui@c@
                       241,                        am       fz,@i-i.Itiiig
   @,ce - Fe@,,E,,ral RepoTtets, Inc.I                                                                    I
                                               C) f
                         -f the exi-(jenc:i.(--.,  f    i.iig
                       25o





                                                                           !I U





      dh-4      I            So if I put all of these rambling  comments  together,

                2 I say that this application , written by a sub contractor  for  a
                31 @,IP that has probably one of the worst management histories,  is
                4 a planning grant for 6 months.  And though I would grade this

                5 on the basis of 1 to 5, maybe 2, and I would note the reserva-

                6 tiolls, I would still fund them fully because they need all the

                7 help they --an get and this is a tremendous problem for the


                8 area.


                9            DR. SCHERLIS: Would you state whether  or  not  you

               10 have any conditions on that?  In other words, would you go along

               11 lwith some- of the letters that have been written, or do you just

               12 give it without condition?

               13            DR. BESSON:  Well, I suppose the conditions:,ire iii-
               141 her'erit in what our leverage is. All we can do is 2  things,
               15 provide money, and assistance, advice, resource assistance.
                  ,The money we    do easily.  We can sa@, yes or no.
               16

               17            The advice is a little harder. Yet,  we  have  been
                  itrying to do this for now many years none, Jud , and i-c is
               18                                              y

                  -rying to get @,lood c@u+- of a turnip.  There are no conditions
               I 9L-                    -
               20 that I @@;oul-(.1 Lp@-,cify on i-cioi-iies except do a good job,

               21 f
                  1          DR, SCI'L7,,RLIS: Second alL@C@
               22                                     a reviewer, Mr. Toomey?

                             MR.                      actually -."ol.lowe-d pretty
               23,
                  I
                                            ic".     cc)orcii.rial-.A.n(-T    on
               24 i

  r@cE@-Fedefal Repo;tcis, Inc.
                             sc@rvj,,(-es including              frol@'p,
               25





                                                                                               9  1



         dii-5        District of Columbia, to contract with a independent health plar-

                   2  niiig organization for the development of the plan             .   It is an

                   3  application   for   a   planning   grant   rather   than   a   program   grant.

                   4                According   to   page   9.   of   the   application,   the    EMS

                   5  programs   have   a   history   of   being   unsatisfactory   and   are   not
                   6  effective.   This   proposal   plans   to   eliminate    the    causes    for
                   7  these   unsatisfactory   systems   by   revealing   a   plan    which    will
                   8  provide    the    philosophy,    guidelines,    and@methodologies    to    be

                   9  followed  to   insure   the   development.   of   a   regional   council   on

                  10  EMS.
                  11                DR. SCHERLIS:   Philosophy.   Identification of rules
                  12   particularly    current    and    future    requirements,    maximum    effective
                  13  utilization   of   anexses   to    current    resources,,    medical    profession
                  14  and community patience, coordination and coi-itro:L, identification
                  15  of linkages with non-Et4S health care agenci.es, linkages with
                  16  supportive agencies, specifications of standards.
                  17                I won't go oil.      @lie  fact  is   that   they   apparently   are
                  181 greatly in    need of an orgai-i@Lzed  a,i-i(I  coordinated  program  and  i-11-ie
                  19  indications  are  that  tflc-  first  step   nec,@ssary   would,   be@sucli   a
                  20  study a@, they're talkincf about.           And I frankly don't know wlierei
                     iI v@oul,d  rate  it  but  I  think  that  it  is  the  k.@.n.d  of  thing  that
                  21
                      we probably wo,,il.d justified -i.ii p-@.-,@,@,,-iding fiii-Lds for, for this
                  22
                  23  study to be d@,ie.

                                      1 Z . S C.'t I.. S
                  24i

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                     !I--)er-, of                        (-,OTfl@-l@.l@l-.1-@,!(,--!. Arid you
                  25@l               t.r cc)or




                                                                                                                        92




        dli-'6         I   it,    do    you    share    the    concerns    of    those    lettctrs?    I    do,    to    a

                       2   great degree.

                       3                     DR.  BESSON:   Sure.   I  think it  is  the best we have

                       4    in    method    C.,    though,    and    I     suppose     I     mentioned     my     feelings

                       5    earlier,  that we are either going to rei-7ard the strong or

                       0    nurture the week.   And I  think if  it is  a seedling that we are

                       7    interested    in,    my    personal     approach     is     to     fund     all     the     seedlings

                       8    and    nurture    all    the     saplings,     and     straighten     out     the     weak     ones.

                       9                     I  think we have to be most cost-effective with our
                      iolmoney,  and         Irather than saying no to method C,  I  think  for $79
                      11    Igrand,    whether    we    by     an     ambulance     for     Albany, or    wherever     at     the
                      12    same    amount    of    money,    that    this    is     money     well spent.

                                             DR.     SCHERLIS:     Would     you     accept      as one    of     the     condi-
                      13
                      14    tions     that     they     restructure      their      coordinating      committee      to      make
                      15    it a much more representative group?

                      1  6                   DR.  BESS014:       Sure.
                      17                     DR.   SCIIERLIS:    As    I    look    at    it,    it    is    a    qoveri-imental
                      18    agency   that   has   !)-men    transposed    to    I,,.Itetro    and    operating    an-    eiiierg-

                            ency -;ystem.   -@q(-)uld that be acceptable?
                      '2 09                  PR.    B.'CSSO@'@4:    Absolutely.     We'll     accept     this     as     a
                      21  imotioil.
                      22                     Mr.  Chairma.-I,  rather  than reiterating  this,  I  thi,nk

                            that    in    advice    that    would    go    wi,th    each    of    those.    r-undin(     awards,
                      23                                                                                         -T
                          II  think   that   is   an   opr)o--tiin41-V   'or   ,ic,   to   -1-el.l.         and       tell
                      241
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                      251@









      dli- 7     1             DR4   SCIIERLIS: @"es.


                 2             DR: BESSON:  All of thcill.


                 3             DR. SCHERLIS:  There are no apparent con'surfiers-on.

                 4 this.


                 5             DR. BESSON:  Don't you agree, Judy'?

                 6             DR. SILSBEE:  I haven't had a chance to read the


                 7 application, but who is    going to be --                              I

                 8             DR.   BESSON:  Block P-IcGibney.


                 9             DR. SILSBEE:  The subcontractor?


               10              DR. BESSON:  Yes.

               11              They are going to put together a plan and come back

               12  after the $79 grand are spent with a plan.

                                              .,Doesn't it bc4-lier you a little bit
               1 3             DR.   HINMAN:
               14@ that a professional grant writing group doesn't know to get the
                  1
               15  right group involved?

                                              . have Croaked with Block, jM
               16              DR.   BESSON:  .1                            cgibney
               17llbzofore, I think they're   idiots.  But they're the best we have,
                  I                                                                       1
                   I S',.)Ppose. I N-7ould    maybe for Kai S-,7stenis to have gotten
               19 iii involved Ln -,-ii.s, or so,,-ie itiore. ast,utc-, organiz@it@--oxi.

                                                If T               cc)Tiii)c,-nts with Kai
               20

               21  Svst(@its, you      impressed w@.L-1-i     doculilc)@-itatiori but you

               22  cicii It have any                    with that group, is that
                  i
               :?  correct?

                               D R . 3   N -  I Cic)i-4@t   wi4-"'rl
               24'i
  ce. Federal Rccioitefs,  Irc. DR. SCII'@rl",@ZLT,13: Do you know
               25




                                                                             9 4



      dh-8      I             DR. BESSON: This is -the first time 1 have ever en-
                2 Icountered Kai Systems,.
                31            DR. SClil:"RLIS: I didn't  want this to be construed o,,,
                4 the record  as a personal recortiraendation based on experience.

                5 It is just  a personal recorotrendation, right?

                6             DR. B@-SSON:  We'll expunge that one, too.

                7             DR. SCHERLIS:  Expunged.
                8             There is a problem with an area like Metro.  I think

                9 we all know from personal experiences of the tremendous need

                  arid we're pleased tlie're go-Lrig to do something about it.  We
               10@
                  are cor-icerned about this frankly being developmental money and
               12 we don't know what will come of it biit at least it is an atteirpi.
               13             I would assume.tliat RMP is close ei-iough to the scene
               14@ that ho].,)efully, there would be car(:-fi-iJ. monitoring of what goes
               15 on in the area.   That hasn't been the h@-'Lstor-,)- of Metro,

               16 has it?
               171            DR. SII,SBEE: Tl-jziL has not been   l@l.istory of the
               181 rc-gio.,-i.
                 I
                              DR: ll-TN'Li'IP@'@4:  Their acceptance of prc-@vious staff advi-e
               19

               20 has not been
               21             DP,. SCII@,"IRLIS: I world hope that these tuncis would bE
               22 suppic!,IIIE@i-i-ted (iuj,t@-,  as a iiew fund-A.rig mechanism, at
               23     I.t--ast,   funds.

                              Any c)t",i(@r
               24i

    Fedeta I Repo( tefs, iric.
               25







     dh-9@       I             This known as a negative lial.o effect, it comes out

                 2 favorably.  All@ those in favo): say aye.

                 3             (Chorus of ayes)
   0
                 4             Opposed?

                 5             DR. FAATZ:  lihat is it ranging?


                 6             DR. SCHERLIS:  Two.

                 7             DR. JOSLY14:  And full funding?


                 8             DR. SCHERLIS:  Yes.

                 9             DR. BESSON:  One year, that is all I requested.

       end 9.7  10             DR. JOSLY7i:  Yes.
       CR 6307
               11


               12


               13


               14


               15


               16


               17

               181
               20@
               21@

               22
               23@
               24

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                                                                                  19 6

     6  0 7


   41, 7ter -
                 1             DR. SCi'IPRI,IS: All-

                 2             The nc,,t area is that of oii.ssouri and I want to

                 3  than': Dr. Besson.  Missouri submits two projects, Project

                                                       -y General  Hospital  @"edical
                 4 No. 85, centers around Kansas Cii
                 5 center.  Its purpose is as stated to provide a comprehensive
   xxxxxxx
                 6 emergency service  for  Kansas  City,  and  a  centralized  trauma

                 7  service for Kansas Citv.
                 8             The Kansas City General Hospital would be designated
                 9 as a major emergency facility cat@able- of treati.ng,-imi@-tediatf2ly
               10  ui-)oia arr-Lval, anv patient of a life, or limb threatening
               11  Condition at anv  time.  The  emphasis  on  this,  both  in  their
               12  brief summary and in the grant itself, is I-,;-cjl-ilv on  trauma.

                               The ho.-r)ital is oiDerati.nq as a major eiuerge@icN,
               13
               14             giving care and definitive treatment for all
                   enierciatcies.  Early screeniii  c@-cr- emergency room ,Patients ,.7ith
               15                                 9

                             @-e specialized treatment in trau,-Li
                   a,@-)i,)r(7,)oria4                            @.i, dru  abuse, etc.
               16
                          @-;.--,reenj-n(j- establishing an overnight o@,D,-zerv,-i.-I.-ion @,7ard
               17
                             to the emergency room, and conducting a c@@inui-crized
               18
                                     -.-or I)rop,-,r i-ecor@li.ri,-f ,ind fc@c@, )ac@,.
               19               L. -             -                  @.1
                               The      of money rc(-Tu(--sL, I .for i7)roj(!ct 81- i@,; 300,000
               20

                                                                               -ic@, hir@l
               21  thc-,   E,   year  8  0 0 0 , tire P,    and '3 0 0 , 0 0 0

               22
                                          tire pi:(-)jc-,,-L, it is cc@nt@c.@(:@cl not on the
               23               e  v q.), i i
                       -k       ,,i    i- i 1 1,@b                        f7, C i t@,7
               24

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                                                                                        19 7




                   I  little in the way of community involvement.  The lineages,

                   2 themselves are onlv partial, as best I could determine from the

                   3 review.  Some 250 thousand is requested for salaries for the

                   4 emergency room and trauma center, which significant sum is

                   5 obviously for the in-ser,,rice area of the hospital.

                   6              There is very little evidence to me of regionaliz-

                   7 ation in this.  It does not speak to a system of total emergency

                   8 care, but much more to trauma, itself.  There is some indication

                   9 of problems in handling the ambulatory patients which come

                 10  to the eniergencl room.  But basically, this is oriented almost

                     cor-@iiDlott--I@i, towards the 17\ansas City Hospital in the in-trauma,'

                 12  and the support of the staff of the emergency area and the

                     traurctd center, as I have indicated, comes to most of the sum.
                 13

                 14              I did not give that any recommendation as far as

                 15  rating.  I  do not thing it speaks to a system of care, and I

                           i.t-- is all for the l-,ansas@ Ci,t@;, Gener,-tl Hospital @.,,.i.tliout
                 16
                 171 bei.,,,g part of what our guidelines   would rE-,@comiiic@nt.
                                 The second project is oiir@ Vehicle centers zi@--ounl the
                 181
    XXX-@xxx         Lc-st(@r r7@. Cox T@@edical Cc@nt(-,.-.   7@)roject rec@ucisis a sum
                 19                                            -


                     o
                 2 0    ,l fl--illion for the first         1.4 for trip secoi,d, 900,000

                     for the tll,"-rd, for i        tiei-L o--@                            to
                 21

                     04 e v         (I 1-114S is rojoct   'lo. 87 -.-- Ij-t@rarcl-i
                                                                                 oi-. emc,.r,( eric@7
                 22               an

                     m       s c v i c ea c i 1 i t i- ci ni@i c,, ca 4- cl e i- cf o n c vt r @i s T-) o r -
                 23

                     t      i@ 7" c@ rLI , air  -to
                 241
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                 25




         3                                                                                        198




                   I  for 33 counties in rural southwestern llissouri, which would

                   2   include an emergency transportation network plus emergency

                   3   medical facilities.

                   4                 It would include six equipped ambulances, three
                   5   eciuiiDncd   busses,   md   one   helicopter,   and   they   want   to   establish

                   6   at least one major medical facility, and several satellite

                   7   emergency   facilities,    train    25    nurses    in    emergency    treatment,

                   8   as   well   as   other   associated   paramedical    personnel,    and    to

                   9   develop a communications s,,7stem, in addition.
                  I 0                In   reviewing   this,   something   like    $500    thousand    for

                       salaries,   37G,000   for   equipment,   includes   30   @i.,-,ibulance    atten-

                  1 2  Ciant:-7,,  25   nurses,   and   individuals   to   man   the   helicopters,
                  13   as  well.  There  will  be  three  p'liases   in   terms   of   T-iolDile   units.
                  14                 Family health car(-- is discussed as well, and actuall,,
                  15   when you read about tiie                       this   would   be   three    busses

                       ,,I-iich .,.,ouJd be us                                   , -medical
                  16 11,                     ed to service nori-ei,-ierc
                                                                          .jency
                     I                                             -
                  17   na,tients,   and   also   funds   are   requested   for   family   health    care

                  18   statio s, circuit riders.
                                     In  reviewing  this,  a'-t-iiouq:,i  -it   is   submitted   as
                  19
                       of an e.,-,iergencN), medical             i-i-- really d-I.sc7.iisses  total
                  20

                              and discusses it i.i-, @i                   di,i@fer(@,nt %,ia@? than  one
                  21   CE'rc
                     1 I         @@;ould                     uid(--I.iiiEs.  It is a three--vear
                  22
                                                     i roi-i-)2-o it co-,ir@,litriity hosr)it:.Z,-I, wits'
                  23
                        c (i u  f;               as                          not
                  241
     Federal Reporters, Inc.        but funds for ilatii-%r IIE?ali-tli care
                  25





                                                                                19 9




                1  to transport patients from the rural area to the hospital,

                2  itself.

                3              There are points of value in this, in that there is

                4  active involvement of the community.  The area served is rural,
                5  involving some 700,000 neople, but my concern is that it

                6  tackles a much larger area than just emergency medical ysstems,

                7  and even when it  approaches  emergency  medical  systems,  there

                8  are large areas not discussed., such  as  the  training  program,

                9  physician coverage, equipment which would be on some of the

               10  emergency equipment discussed.
               11              Before recommending any funding on that, I would
               12 1 like to have the secondary reviewer m, ake any comments which he

               13  woul,d feel appropriate.  That is T,,Ir. Toomey.

               14              MR. TOO-TAEY: I  would  --  Ifelt  the  same  @.7Eiv  you
               15  did about the I'\ansas City General Ilospital, they were a,,;king

                   funds to irirjrove the services within the hospital. but without
               16
               17  mucir concern for an emergency niclical services system, a,-,
               18  far as the area was concerned
               19              I think I felt -- I do not lcnoi.@ how you feel,  but

                   I felt that tlii-@, i-)2-c)-,)o,@,al@ from tl.-ic@ Lester Cox  C(@ntcr
               20                    1
                   in SiDringfi.el@: (,i) was very @Lnt(@,rc@sti.ng, but it really had
               21
                   onl,r one part of it devoted to providin(, an emergency medical
               22
               23  service for the. arc-,a.

                                                          care 5t,@,-t.-;on prol-)o@iz-,,'
               24

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                                                                     T felt the circuit
               25




                                                                              200
   ter-5


               I  rider was not exa-tly pertinent.  one thing        do not know,
               2 did you mention the fact that this is the second time this

               3 proposal has been submitted, and the letters of

               4             DR. SCHERLIS:  For '68 and '69.

               5             MR. TOO!,,IEY: The letters written in support of  it

               6  were dated in 168 and '69 with the statement  that  the  people

               7  who suiD orted the thing were supporting it now.
                        @p

               8             DR. SCHERLIS:   Tlie-@.7 still like it.


               9             MR. T0014EY:  Ye-S.

              10             DR. SL-IIIERLIS: They have -- the intent is to  make

              11  health care service available a7tong those PeoT)le who live  in

              12  the hinterland sectors.  And        I would concur  that  these
              13 are very valuable goals, this is not what we are addressing ol,,r-

              14  selves to under the 17,'Iij'S guidelines.
              15             MR. r."00",IEY: In su,-,,,.-.iarv, what I said, the portion
              16  of this proposal which deals       the development of Et centrall-,,,,
              17  controlled and coordinated syE;te.--Il oil ambulance services for
                  33 counties, in a desirable project I)c-@rliai-)s, but the health
              18

                                                     @@cuit I-
              I 9 care stations @trid the I-)hzsici--.r. c:L. ider are interesting,
              20  !",Oul-(,, !.)c of scin.,c-@. value, but are not ay)T.?rol)r-Late and r(.ala-

              21  t e. cl ti c, r c) j c
              22             DR. Sl,-Iilj'@PLIS:  Did           the sum?  1,@hat

              23

                                                                              f
              24                  Tr.)O,",'Y:                   oi),e

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                                                                                   201

   ter--6



                               DR. SCliERLIS:  A million, forty-five?

                2              -@,IR. TOOMEY: Dio, I did not recommend the sum.

                3              DR. SCIIERLIS:  I gave this a rating of two and

                4  suggested  somewhere between -- I had fully suggested 75,000

                5  to help get the planning going, because I think there are some

                6  parts in here that can be put together.  But I would not
                71suggest it 90 to the Lester E. Cox Medical Center, but rather
                8 the regional medical program office, for planning.

                9              MR. TOOPIEY:   I would support that.-

                10             DR. SCIIERLIS:  The motion then is $77 thousand for
                II i.,,Fo. 2, at a rating of two.  That is actually application 87,

                121to keep it accurate-.
                13             The sum of $77 thousand for a priority of two, and

                14 the other Project 85, no support.

                15             Second revic\qers?

                16             P@'tP,. TOOMEY:  Yes, ol-,ay.

                               DR. SCIIERLIS:  An,,7 comments?
                17                                1
                181            DR. PESSO@L:   I did not.
                   I           DR. SCIII-PLIS:  Yes, sir?  Di,. l@eller?
                191
                20             DP,,. K        I ju!7,t %,:,,int to ask @.,7itYi respect to
                21 cuidelinc,,s, @l;e h ve h@.d just oiAe or    other T)roje(-"-s today
                22 Ithat seem to e,-,iT)hasize the interface          enierg,f@ricy medical
                23 centers and the rest of the lic-%al.tli care iDvstem.  Il@ I under-
                24        our                          ti-iit    oiic-tiii.nj @-lic iro

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                                                                           202




                I            DR. SCIIERLIS:  Yes.

                2            DR. KELLER:  I just had a moment to look this througl,,

                3 and it is  avery complicated application, and I am sure that

                4 there are many difficulties.  But, is there something in
                5 here that can be funded.- That help is to emphasize the desira-
                6 bility and the importance of this kind of linkage?  1-7liat I
                7 am afraid of is that in i-,iany of the programs that have been
                8 presented, the people who are specifically enthusiastic for

                9 emergency medical services will gain such ascendancy in these

              10  things, that eventually the linkage between that an  t e
              11  rest of the health care delivery system will begin to be

              1 2 deemphisized.
              1 3            DR. SCIIERE.IS:  Yes. I view the system as being not
              14  just in the emergency aspect and ending in the emergency --
              15  when the emergency is tal:c-ri care of.  But it should certainly

              16  go the ciitia:e loop.
                             I think some of the guidelines enil)l-iasize this (.is well.
              17
              18  I think in this particular instance, the first one onl.v looks
                  at 'a very small --- not just as,,@ec@L., but a physical area as
              19

                  nart of the system.
              20  ,
              21             As such, I thing it falls outside 'of the guidelines.
              22  The second one     the prc)j:)lci-.i of being a '68 - '69 a.i--)plicat.Lo,,i,
                  i.@,liicli tlif2,y, sa@., everybody still a(irccs with.  Secondly, it there-
              23
              24  @- o r (@ @.o c-., snot have tlic- '@-.0     itself in ter,-is
  @ce-Fedetal Repoiters,  !nc.      I-,   4-   f,,-,uct-,. h@is ((-.)nc ii,ito that-
                  of -lie c         ,Ut  y( @  .3
              25




       c, r - 8                                                                                                           20   3



                          I  planning and  training as-,)ects  look  like  they  should be  salvaged.
                          2  I  felt as a  secondary reviewer  these could best be moved  from
                          3  the responsibility of  the Cox Hospital to the regional program
                             office,  itself,  so we get -- we would hope we would'get a
                          4
                          5  better  correlation with the other  services  in the state.
                          6                    It     has     aspects     that     are     interesting     that     might     be
                          7  favorably  look upon under general regional medical program
                          8  supports,  like area health centers.  but this  is not part of
                          9  what %lie  can support under our  present meclinisnt,  at least
                             within our responsibility  todav.
                       I  0
                       I  I                    TIR.  TO R)MEY:   Can  I  comment just a moment?
                                               DR.     SCHERLIS:     Sure.      Yes.      Please      do,      Plr.      Toomev.
                       12
                       13                      MR.  T00i'IEY:   The  first program was  just  internal
                       14    operations        of    the    emergency    room,    and     I     do     not     consider     that
                       15    to be part        o'L@ our  responsibility.   The other one is more of
                           la     con.-eptua'@     thought.     I     am     rather     amazed      at      one      institution
                       16  i in ST)rinqfield i-7ariti.ftg  to  accept a- responsibility  for coordin-
                       17
                                      aiii@ulai-ice  servicc-!s  and  other  services  to                             in a
                       18     t
                       19    33  colAnty area,  and  to  the degree  that  i..t is m"7                      c),.)i.nion,  that
                             the lio; r) i -La I s %@i 1 1                              d-i-,-@(-tion of  sharing
                       20              @i. -                @)C  MOVII'I(J    II  tl -   -1 ..  "
                           I -i,c(.@s  ar,,,L  in the direction,  of         :Fi-iic'ij.ng a r,.-,,,-ijc)r institution  @,:71-lo
                       21    -ccep-Ls  a major                  in intecirai:iiig vp,,.-.i.c)us  kinds  -)f  services,
                       22
                       23    ambulance  and  other
                                               '-'e ma,,, @i-  1,@ol nice  ai..  i-r,7,LLi,  o-,  Glen         sa,,  ,  "P,'ove.
                                                                                                                   7
                       24
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                       25              27  f i@-oiTt the                                                                c@
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                                                                                                                                                       204



                                   than looking at what seems to be coming in the future, which

                              2    is  the  enlaracd  role  of  institutions  covering  and  with  a

                              3    responsibility for a larger area than they have had in the

                              4    past.

                              5                          I do not know what the answer is to it, but I

      end #17                 6    think it is one of those things that is happening.

                              7


                              8


                              9


                             10


                             1 1


                             12


                             1 3


                             14


                             15


                             16


                             17


                             18


                             19


                             20


                             21


                             22


                             23

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                                                                                2 9 9





                               DR. SCHERLIS:  All right.

                2       Next is  Mountain  States'  three  projects.  We're  on  the

                3  home stretch now, I hope.

                4       All right, Mountain  States'  request  is  for  three  projects
                51 which come to the following:  $375,000 for project 26.
                6              DR. HINMAN:  That is all three combined.


                7              DR. SCHERLISI  Oh, okay.  All right.  There are

                8  three different components; one from Idaho, the other from

                9  Montana, the  third  from  California  and  Nevada.  The  general

               10  objectives are  to  develop  a  comprehensive  emergency  medical

               11  service planning  Program  for  Montana,  increase  the  existing

               12  emergency  council  advisory  activity,  initiate  needed  training,

               13  inventory all  emergency  facilities,  form  an  area-wide  planning

               14  co=iii.ttee,for project.@resourQes.  Staff  and-:vol,unteer;would-be

               15  from otherisourcet,@-And they have-other funding for that.

               16       And for Montana, the following comments were made.  This

                         'lar to the other states, as 1 will indicate.  It is
               17  is Simi


               18  essentially the same as  Idaho.  They  give  only  the  barest  out-
                                                                                                cn
               19  line.  There is a very poor breakdown as far as salaries are

               20- concerned.  They requested a total of $142,000 for their


               2 11program.
                 I
               221      They requested specifically to  support  a  staff'  of  five
               231 members in the Dc@partment of lleal@1-1-i and Environmental sciences,

               24  eight in the coordination of five cinercfen(-,
                                                               -.y  medical  service

  e - Fedc,,r,,Al  Repr,,rtcrs,  lrc.
               25  planning ccaaii@-ttc--es in the state s,,,pl)orti.yic@ training of




                                                                          3 0 0
          2
       @M


               I emergency facility personnel, inventory the  state  resources,
               2 provide ambulances and equipment, and then there is  a  $70,000
               3 budget item to purchase ambulances. This actually  is  not  in
               4 the budget.  It appears to come from federal sources.

               5      I would concur in the fact that I would not fund the

               6 budget request at this time because, essentially,  they  should

               7 be much more in line with planning.  If you go through the

               8 yellow sheets, and these are interesting because most  Of  the

               9 responses in terms of understanding the EMS system are  on  the
             101 negative side.  In fact, most of the comments of staff were on
             11  the negative side, as far as the entire project  is  concerned.
             121 This was Montana.

             13       In terms of Idaho, again, this is a very similar  one  to

             14  Montana.  They specifically ask for funds for an emergency
             151 health services advisory board.  They want to provide EMT

             16  training, EMS physician and nurse training, coronary care
             171 evaluation, emergency rooms, coronary car@ units and other
             181'hospital facilities, classifv and evaluate emergency  rooms  in

             19  Idaho, collect and tabulate data.

             20       I rated tliii more favorably than I did the one from

             21  Monta.ha,  They had requested some $178,000, which I thought

             22  wa-, somewhat excessive. They have requested  mobile  coronary
             23  care Vehicles, and I felt this should be under a separate 4@und-

             241 inc,. Tll 4 C
                         ., was on -- if you want to check, it is on page 45

  E,-Federal Repofte@s,  Inc.
             251 their ai
                                     TheN, do haN.,(, good dEi.-La on the amb-Lilanr(--@s,




                                                                              3 01
        JY, 3



                  good data as far as a lot of  their  information  is  concerned.

                2 The goals were very well-stated,  as  well.  This  looks  a@little

                3 better as far as being more of an emergency medical systero..

                4 They do have    better planning than the  others.  @Although  they

                5 are emphasizing only part of the EMS system, they do define

                6 some of the other needs.  I thought all in all this was a

                7 reasonable approach.

                8      The third was Nevada and California.  This request was

                9 for $55,000 for year 1, $62,000 for the second year      Here
              ioi they specifically asked for funds  for  a  program  coordinator,
              III FMT.training and EMS committees  to  coordinate  their  planning

              12  of a total. system. Actuall.y, although there is  a  need  defined

              18  in their grant, the grant request, they don't address themselves

              14  very well to a total system.

              15       My feeling here was to give them  a  low  rating,  although

              16  they need their funds. I felt this  was  overall  a  poor  presen-
              17i tation.

              18       What I came up with then, as far  as  California  and  Nevada
              19, was concerned is that that would not be  funded,  but  in  terms
              20  of the Idaho component where they  had  requested  $173,000,  is

              21  that this be rated as three with a request for $1,00,000.
                I      The third, Montana, I had a dilerriiiia on this one.  My own
              221
              23  react-Lon was to rate this    two. I  thought  their  request  for

              24  funds was excess)-vo:,, and in cor:@E,,aring -',,.t to the- ones that came

   Fede ra I Re pof te i s, I  ii  c.
              25  in from the same area, it should be refu@,ed.   I suggc@st a @tm




                                                                             3 0 2
        JM 4




                  of   $50,000.
               2              DR. HINMAN:  Do I understand you corre.-tly?  You are
               31
                  recommending one-year Planning for two of the components?
               4              DR. SCHERLIS: And zero for  the  third.  The  other

               5
                  was 100, and the other 50.
               6       Is there any member of the staff who could speak to Idaho
               7  or Montana, as far as how they have moved along with their
               8  emergency systems planning at this point, aside  from  what  is
               9  present in the grant application?
              10       Do you have any feeling on that?

              11              VOICE:  I was out there to a RAG meeting just

              12  recently when these projects were pushed through the RAG, and

              13
                  at that @-ime, the pro3ects were wer--e heavily  loaded with
              14  equipment requests.  That was the essence of it, basically,
              15  and they had not followed or not had any idea. what the EMS

              16  guidelines were at the time. Subsequent  to  staff  input  they
              17@ went back and reworked them a little bit, and I think they have
              18  taken out most of the equipment and are tryinq to plan aspects.

              19              DR. SCHERLIS: These look thick, but  they  are  all

              20  appendi@. material, and there is a lot of padding of related

              21  and unrelated material.

              22              VOICE:  I think there surely is

              23              DR. SCHERLIS:  The requests are scant, and I think

              24
                  more i.n terms of planning, and I thi@ril,@ they ccin probably move
    Fed,,ia 1 Repof ters,  lrc.
              25  or, tha@,.




                                                                         30 3
       JM 5



                            VOICE:  The Idaho one has been conceptually worked

              2  out much 'Longer than the other two.  I think you hit them in

              3  the descending order they ought to be.  Idaho, Montana, and

              4  Nevada.


              5             DR. SCHERLIS:  Right.  Is there a second to that


              6  motion?


              7             DR. MC PHEDRAN:  I second.


              8             DR. SCHERLIS:  I think we have struck.the coronary

              9  units, ambulances, from that program.

             101      Any further discussion?








      %


       3 0 7             1                    DIZ.  SCiil@l@.1,'3:    next is  New Jersey.

                                                             'D l@
          17 2           2                    DP,.  liC Pll.'r,  7Vi     There  are  two pieces here.                  one  is

                         3  according  to  their numbering  system,                        028 Emergency TItedica."L

                         4  Service   System Plan,                 029     is     a     Computerized     Shock     and

                         5  Assessi,.ient of Treatment.

                         6                    I    would    say    in    summary     that     these     are     either

                         7  rated --  I will rate  them as  one or  "can't rate  them,"  and

                         8  would not recommend them for,any  funding.

                         9                    In the Emergency Medical.  System Plan,  there  is

                             -.i,,.ply not enough  information really  to tell  an-vtl-iinq about
                       lo  s@
                       11 Ineeds  or resources,  let alone  to relate  the different resources
                          @l
                       12 lone  to  another.
                       13                     It is  a proposal  to evaluate  these  things,  but

                       14   sc-er,,s  t_qat   like the other regions,  they might have accumulated

                       15  enou(ii-i  information sort of  to give us  a  feeling  thit they had

                            some  1,aint idea what the problems                    might be,  other  tlia)-i that
                       16
                       17!there  are  serious  problems  of deprived people  in urban centers.

                                              1  real.ly ---  I  c:ot,llc3.n't tell mu(.,.!]-i of ai-iytl).in(  al.,otit
                       181
                       19 la stc-i-te  that I  really know a  lot:               about,  frorc, having been
                          i
                          I  any  t4mes.         I   ust                                 is  Enough
                       20

                          lenr,)ug4lil-  detail     here,  to warra:it
                       21
                          lis  the -art of          i.t-- that I  tl-tix)l-. wou'4-,,@@i. !)e    might I)c!  a,,,:)T)ropr.@k,.e-to
                       22
                       2 3  f o):        s   f u,.. ni n g

                                                 e o t h  r        a s t u d v  a   1) r .  G i   .11 c o       t    Ni.    j-,

   ,-,f.:,-Fedefal Repotters,  I,.ic. tliiiik  it was  Dr.-.       that rc-@-,r2l-ew(-@d  tll@i,s                    No.
                       251






     2         1  SO@Lbody else, I'm sorry.  A study of a method of evaluating
               2 @patients in shock and using a computer system for deciding on
               3 the effective treatment, and it is a clinical study, and I

               4 think not appropriate for RMP funding.

               5             So in summary, I wouldn't recommend any funding for

               6 either one  and rate them both as one.

               7             lqhat they have produced here stands in contrast to

               8 what I gather -- eastern operations said this is a region that

               9 has had good management capability in the past.  And it doesn't

              10 come through.


              11             DR. SCHERLIS:  Dr. Besson?

              12             DR. BESSON:  Yes.  I agree with the physiological

              13   monitoring.

              14             This is a reflection of the kind of thing Albany

              15 wanted to cio and I think it is inappropriate for 1'JAP, and

              16 notl).j.ng further need be said about that.

              17             The other program, the integrated program, so

              18 called, means to survey transportation by an interagency

              19 council, develop a plan for      training, assess eriE@rgenc,,r

              20 roo@-L,,-, and identify the needs ol@ t]-i-c poor working with model

              21 cities an@l coictliurii-ty Cievelopriorit ci.ti.@,s, 20 in Eill, to improve

              22 the emergency       rendered to the poor.

              23             I view this as a dev,@l.opi,-,oi@ital grant, this proportion
              24 lo' it, ai-ici '@ a(3ro-c4 i)l:,.              rc@vicwcr,

  -f, - Federal f3p-poftL'@.,,  lfic.
              25 i)r. Giy,,@ble, that thc@ ci),tire   is e@.-trorci(-@ly sketchy and




                                                                                  9 8


  jr 3           1 scant, althoLt(-ih Liew Jersey does have  a  good  program  coordinator
                 2  and in general has been a relatively mature region.

                 3             Again 1 am  charitable  in  saying  that  this  was  the

                 4 result of the precipitous  nature of the Droposal submission,

                 5 and I am a little bit more charitable in      not faulting the

                 6 region as Dr. McPliedran might be in not giving them any funding.

                 7             I think the fact  that  they  do  have  a  model  cities

                 8 program that is working, that is interested in becoming

                 9 attached to this kind of  effort,  I  think  the  fact  that  they  are

               10  using the model cities in their community development orograpi
               11 las an entry point for not only providing emergency services

               12  for the poor,,   but addressing the nation-wide utilization of

               13lemergexicy services as an access point, which is an entirely
               14@different question, and one which has to be answered -- we

               15 ]can't overlook it by talking  just  at  the  lof-tv  level  of  pro-

               16 viding emergency medical services.
               171             Many people  use  it  as  an  access  point.  So,  while
               181thcre is no recognition of that asl-)(-ct of  it  in  tliz-ir  proposal,
                  I
               19  and the whole thing is v(--@ry            I think it is int-ol-est-i@.ng

               20  that l@Z@P is talking to cori--up)(-@rs- @!il.l ral.-,icily bring
               21 Ito their a-tt(--nt."Lon.
                               And with their maturit,@, I" 1,7oul.d be inclined to riavl)e
               22
               23 Irather than not giving thei-. any             to give them
                                                             os I.y.
                    r so fun(i'ng of the --,r--c;c)nCi
               2 4 11 '-'
  @e Federal Reporters,  Inc.I DR.              I'Low rr!uci-,. that b-@-?
               251
                  1





                                                                                                                                                                9 9





                                 I                           DR.  iiC  PliEDRZ@14:
     jr  4                                                                                       About         $40,000.
                                 2                           DR.   BESSOL4:              $40,000,  yes.
                                 3                           DR.   GII-IBLL,:    Are  you.    talking  about  28  now?    Proposal

                                 4   02
                                        .8?
                                 5                           DR.   BESS014:     Yes.     Fund  nothing  for  29.
                                 6                           DR.   SCIIERLIS:     The  agreement  is  zero  funding  level

                                 7    for  the  shock  study.

                                 8                           DR.  MC  PliL,DRA14:     Okay.
                                 9                            DR.   SCIIEJ.ZLIS:     Arid  now  you  are  talking  in  terms  o
                              10      getting  this  off  the  ground,   the  general  proposal;   an    you  are
                              ii   I  recommending  how  much?
                              12                              DR.   LESSON:    lqe  have  two  motions.
                              13                              DR.  MC  PHEDI@N:                    I  agree  with  you,   I  think  that  is
                              14       an  important  part  of  it.     I  think-that  is  an  important  oppor-
                              15       tun@l-ty  that  they  have.     This  is  a  problem  everybody  has  and
                              161      ti.-iey  dici  audress  that  as  a  specific  objective  more  than  rt,:iny

                              17       of  the  other  plans  did,   I  guess.
                              181                              Okay,,   I'll  c-i@icrici  -airLe.                  I'll  go  along  with  that.
                              19       Still,   it  is  hard to                                            anything  for  something  wl-Lil-,,ii

                              20        I  still         Firi(i  I  can't  rate.
                              21                                I  find  sort  of  an  internal  ii-icon.,;ist(@iiry
                              22   1    recommending  a.ny  funds  at  all  for  something  that  I  would  rate

                              23        so  low.
                              24                                DR.                         You  co,,ild  rate  29  scl-.),.i.r@-,tely  f3:()ii-t  2(@.

         Federii Re[)otters, itic.
                              25                                DR.   i',IC  PI-IlIDf,AL4:     Yes.               I've  done  that.





  jr            1           DR. SCF-,ERLIS: I think the rating we should have is
                2purely on that fragment of the approved project.
                3           DR. !,IC PliEDRAI@: Yes.  Okay.
                4           DR. GIMBLE:  I would like to  comment.  They mention
                5a specific problem in New Jersey:  The independence of the
                0volunteer emergency squads. And most of their application
                7appears to be directed at improving the quality of service

                8rendered by these squads.
                9!          The thing I find unfortunate, though I think it is
                10 a good opportunity to get all the squads together in terms o
                11 lqetting cooperation,, this isn't very strongly put  foIrth in the
                121application.  I think that is the most important part of the

                13 application.
                14       If they could use this as a vehicle for cooperation
                151between squads and between emergency rooms and hospitals, it

                16 would ',,e important.
                17           1 get the feeling it is overlooked in this cipplica.--
                18 tion and I think a recommendation to that effect, rather tliE,.@i
                191 just support the squal,".,-; on an X amount of money for each squad

                20 to improve their education.
                21           But somehow they should be 1-iool@c-,d in,-co getting their
                22 Itogetiier for a cooperative venture, more than just a training

                23 amount.
                241          DR.          I agree with that.  I see the only
  ce-Fede@al iieporters,  Iiic.I
                25 !virtue of this application, $40,000, will be to help them -get-













                                                                              n
     6           off the ground, and also to sit down at-id talk with some urbc-A
               2 poor.  once they sit down and talk with them, I'm sure they
               3 will get the answer, "Gee, where have you been?  We're glad
               4 you asked."  And from then they will submit a much more rele-

               5 vant application next year.
               6             DR. SCHERLIS:  Do-you have any comments about the

               7 New Jersey  area, Mrs. Faatz?

               8             DR.  FAATZ:  No.
               9             DR. SCIIERLIS:  What is the rating then, the two of

              10  you?
              11             DR. MC PIIEDI@N:  Well, as part of a system, I guess
              12  I might rate these parts as a 2 or 3.  But as the whole, --
              13  028 is this whole plan, that is the number altogether.
              141            DR. SCIIERLIS:  Yes.
              15             DR. MC PIIEDPAN:  As a whole, I don't think you
              16' could give it that high a rating.  But these portions of it.,
              17  where the  talk about identifying a.,,id trying to do something
                           y
              18  about Pro]Dlen,,,s of urbari poor, to correct thi@:-, abuse of LMex-
              19  gency room systems, to do soi@iel.-.1i.i,ng to devise s(.)nie system  0
              20  do that, to ciot @4w@iv from tlicijk-., @@e could r@-Ite that as 2.
   0          21             DR. SCIIERI,!S:  Do Y(-)Il accept that as a 2 rating'@
              22             DR. Bl-'SSO'.,':  Sure.
              23             DR.             Dr.
              24             DR.                   whether,: you @,ioulC, like to ec)n,-

    F(,dera I Repo@ ters, liic.
              251 sider brcaj',.in(i do-,@n 028;  @'ou are able to break tiliat c;.own- if








  jr 7         1  you would like.

               2            DR. BESSON:  You v7ould rate the physiological moni-

               3 toring as one7  As zero?  What is the'least?

               4            DR. MC PilEDRAN: Zero.


               5            DR. SCHERLIS:  Zero.

               6            DR. 14C PHEDI@N: It is inappropriate.

               7            DR. SCIIERLIS: I think we could accept zero.

               8            DR. BESSOII:  The other is 2.5.  I would go along

               9 with that.

              10            DR. SCIIEALIS: Is that satisfactory?

                            DR. ROSE:  That is for the whole 028 project?  You

              12 don't want to place any restrictions as to what kind of activi-

              13 ties they will be doing in that project?

              14            DR. BESSOIT:  No.

              15            DR. GIMBLE:  I didn't find enough material to break

              16 down, unfortunately.

              17            DR. SCHERLIS:  We are talking about making a start

              18 on a system of care, and trying to get into the @iri,,bulance

              19 problem a,.nd hoping the train-Lng might be the wedge to maJ<e them

              20 iless independent.

                            DR. BESSOL.@l; I don't know that it would be approl:)rial@---
              21

                 for us to say, "You can only @,io-i-k on component 4."
              22

                            I think we 1-iave to ci-ve them this amount of money
              23

                      the advice.
               4 w' t'l

  -e. - Fedefat R,,poi ters,  Inc.
              25            DR. SCIiEl'\.LIS.  That -t-.Iiev try to set up z,, system of





                                                                           10 3





  jr             care.
                 2          DR. BESSON:  Yes, and let them do the best they can.
                 3          DR. SCHERLIS:  Right.  Any further discussion?

                 41         All those in favor, say aye.

                 5          (Chorus.o'L ayes.)
                 6          DR. SCIIERLIS:  All right.  That is New Jersey.

                 7Next is New York I-letro.


                 8


                 9


                 10


                 11


                 131

                 14


                 15


                 16


                 17


                 18


                 19


                 20


                 21


                 22


                 231
                 24@
  '(:c--Fedetal Reporteis, I" 1.i
                 25i





                                                                                        205




      xxxxxx
      CR 6307                    DR. SCliERLIS:  We now move to New Mexico, Mr. Toomey
      dli-i      2 land Dr. McPhedran and the seconda--y reviewer.
                 3               MR. TOOMEY:  The application is New Mexico --
                 4               DR. lll!iYP,,N: Let  the  record  show  that  Dr.  iiendryson,

                 5   left the room during the review.

                 6               DR. SCHERLIS:  Don't go far.

                 7               MR. TOOMEY:  Funding is requested for $425,000,the

                 8  first  year',  and  $139,000  the  second  year,   $147,000   the   third

                 9   year.                                                -
                10               This  grant  request  was  from  a   previous   grant   funded
                III! in 191,11 to study the health delivery system 3f the state of
                12 lNew Mexico.  Due to the 1968 grant, quality of existing EMS
                13   services have improoved but there are still 11 counties where

                14   no EMS systems are available.
                                 Therefore,  this   request   is   requesting   primarily   for
                ]5i
                161  the establishment of an EMS by using a model developed in a
                17   similar community of New Mexico providing primary medical care,
                                                                                                         t%i
                181  comnu,-ii.cations, transportation, and hospital emergency linkages
                19   for those rural counties without these services.                                   0
                                 Ne@@7 Mexico has a 1.21,000 square miles and is the fift
                20
                     largest  sj@-ate  in  the  nation.  The  economy   perairaters   include
                21 1
                     ranching,  farming,   mining,   oil   production,   light   industry,   it
                92 1
                23   has e. population of a million, airillion, 20 thousand.          Tt   is
                   i L)y        b@,, t'l-i(@ Rockv          of wl-iich roiigliJ,y a third  of
                24,
  cc -Federal Reporters, Inc.I
                   . ti;'@ central pc)rtioii of tlic-@ st.@-,tc-! i@3 ()rctir.)ied b@7 mountain terrai-l-i
                251




                                                                             20 6




       dh-2     I with the remainder configuration of the state being flat plain.
                2 The 3 majorlethnic groups comprise  the  population  including
                3 lwhite, white Spanish, and Indians.
                4            The primary objective of this  grant  application  is
                5 to establish an EMS system in 7 rural commu  nities employing the
                6 model tested in San Rafael County, and to  improve  the  quality
                7 of existing EMS systems in the state of New Mexico, with iden-
                8 tification of present weaknesses and other  components  of  the

                9 total health care delivery system.
               10            Second area objectives include  the  development  of
               11 data relating to emergency ambulance care crisis and to create
               12 12 working pilot projects to attack the problem,, to evaluate the
               13 6fficiences of the plan's training program  that  concerns  time
               14 and resources in its delivery; enhance  the  availability  and
               15 accessability to the e ucational experience,  to  establish  a
               16 regional coordinating center to standardize and develop training
               17 and treatment methods; to influence improvement  of  the  total

               18 health care system.
               19            The plan primarily emphasis is  the  development  of
               20 more administrative control and internal organization  'Lor  ad-
               21 ministering a total EMS. Of the  $483,000  requested  for  the
               22 first vear, only approximately $80,000 ;.s  for  equipment.  The
               23 remainder is $400,000 for pc-rs(,-i-inel training, instruction, and
               241 fringe benefits.
         Reportets,  Inc.    The narrative describes a geographical ire:.a to  be
               25





                                                                                 Izu



        dh-3       served, however, the only portion I delineate is a clear under-

                2  standing as to how the various elements will be integrated, or

                3  the identified deficiencies within the present system overcome.

                4              The application  is  a  community  based  program,  has
                5  broad representation and involvement from providers, public

                6  agencies  and community interests.
                7              Existing medical service resources and needs have been
                8  identified  and  documented.  The  plan  defined  how  the  various
                9  operating  cooperatives  will  be  coordinated  and  tied  together
                10 with already operational cooperatives.  Linkages with local
                11 health care  systems  to  assure  adequate  referran  and  o  ow  up

                12 of treatment.
                13             Emergency treatment is only partially described and
                14 lbriefly referred to in regard to iiiaster plans.
                15             The narrative includes techniques to utilize existing
                16 ;financial resources and a@means of obtaining additional financial

                   support.
                17
                               All local state and national operating standards are
                18
                   complied with, evaluation procedures and techniques for det,ermir-ii,-
                19
                20 ing the effect of  this  system  are  perhaps  the  weakest  section
                  I
                  'of the proposal.
                2 11
                22             This  grant  request  narrative  includes  many  details
                   about @tl-ie various coun4--.i.es @,7i-ticli require careful sorting and
                231
                  1
                  1review to gain any underE;tai@di.ng of' the application, or a
                24i
                  1
  kce-Fedef.it Repo@ters, Inc. I@l-irle3--standiiig of the application, even though the  application
                25






      dh-4      I appears wordy and pale, it appears to meet  the  criteria  o'  an.
                2 EMS system which is designed to meet the needs of the population
                3 and topography in the state of New Mexico, and  it  is  my  recom-
                4 mendation that it be given -- I'll wait until  we  have  the  sec-
                5 ondary reviewer.
                6             DR. MC PHEDRAN:  I rated it a 4.  I won't repeat what
                7 Mr. Toomey has said. I want  to  underscore,  though,  the  commun-
                  ity involvement. There is evidence  in  this-applicatiorl  of  com-
                8
                9 munity input that I found in no other applications that I re-
              10  ceived.
              11              DR. SCHERLIS:  It isn't just the lateness of the hour?
              1 2             DR. MC PHEDPAN: No. I think  it  is  very  good.  This
                  is one of the 2 or 3 best, and I was particularly impressed Witt)
              13
              14  that.
              15              DR. SCHERLIS: What level of  funding  do  you  suggest,
              16  Mr. Toomey?  Do you have a suggestion on that?
              17              MR. TOOMEY: I do hav(@-a  suggestion  that.  I  suggest
                  that it be funded as requested.
              18
              19              DR. SCHERLIS: You both recommend  full  funding  and  a
                  rating of  4?  That is one of the best re%riex,.@s we have had in
              20
              2 1 terms of the re4-,orr@.m@ enciation.
                              All those in f avcir say ciye.
              22
              23              (Chorus of ayes.)
              241             Opposed?

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      Mj.,L-1                       DR. SCHERLIS:  Dr.  Bessor,,  mcitro@n,-)2.2Ltan  New  York.

                  2                 DR.  BESSON:  Let  the  record  show  that   I   can   leave

                  8   at 1:00 as    soon as I am   through.
                  4                 DR. SCHERLIS:   I give that a reading of one.

                  5                 DR. HIN@'iAN:  Zero.

                                    DR. BESSON:    Metropol.itan New York is asking for
                  0
                  7   two years   funding from    July, 172, to July, 174, $225,000
                  8   for a problem which may be stated thusly:  that 70 percent of
                  9   visits at the  Bronx  Municipal  Hospital  Center,  or  nationally
                 101  -- Bronx Municipal Hospital Center is what we are talking
                      about -- 70 percent of visits are to the emergency room.                            z
                 121  Primary care in the emergc-i-icy room, we all knbwjr is far
                 13   greater, up to 10 -@imes as great as costs otherwise, a.,-id it
                 14   ties up facilities.
                 15@                The alternative I have proposed in this application
                 16i  is to develop what is cal.led a triage- M.D., an R.N., or
                    I
                    I Y@,ed3.cal. coreman or technician and with three- months' t-i.-a,.ning.,
                 171
                      to triagc--,. into one of.@-Lhr(:,e categorize.,,-: ilvtz,,ic,,d.iate emergency,

                      the late emergency, or non--emergency.  The principal. investi-
                 191
                    I ga@-or or who has    b@,@-n doing this k--i.net of thi-rc  social
                 20
                      type, says that 1970 at the T,@ron@- ',Iiini,--,ipal              Centc7@r,
                 2 11
                    1
                      there         83,000 patients seen in the emergency roor,,.; and  in
                 22
                      the ric)n-cppoi,-iti@@ienit clinic, which a..i--c., the v,,alk-ins, there
                 231
                    1                                                                              1
                    1       il 0 ,   r-) at,.,-C
                 24,1
     Fadeiit f?epbf tefs,  Iric.    lqhc@n -this E-.,.ystr@m ,.,,as ir-,,,@,ti.tutf@d, -t@ci.e@ge, the
                 25@




                                                                                   1 0



      mil-2      I   emergency room census feel uniquely throughout the country
                 2   from 83,000 to 66,000, and the non-appc)iiitment clinic
                 3   appointments rose to 54,000.      She says  there is a great deal.
                 4   of value in developing this notion of triagiiag prior to

                 5   utilization of emergency room facilities.
                 6               Now this is a national problem as we all know,
                 7   and it is nice -that somebody 'Ls going to do something about it.
                 8   She proposes to prepare an operational manual, devise a train-
                 9   ing curriculum for doing triage, do a program analysis, and
                101  she describes this in some sketchy detail.  A methodology,
                11   I think, is self-evident.  But I think that the deve opmen
                12   of a tri.age methodology in a manual at one hospital for
                13   $225,000 is just totally inconsonant with the request for
                14   proposal that was sent out February 25.  It is a piece of the
                15   action, no question about it, but it is a very expensive

                16   Piece-
                171              I would consider that of one to five, I would rate
                18   this 'three on merit, but sug@lest they write a nice letter to
                19   the National Center for Health Services Research and
                20   De-,7eloproent, and asli@ them for scm,-- funds.  Because it would be
                     much more a-propriej.tr@ly funded by tha.t organization their. by
                21

                22   this.
                23               So even t)-iough T       it, I won't eat it.

                                 Dr..
                241
    -Federal Rep@,,fters, Inc.   MR. TOOillEY:  i liked it, too, and unlii@e you, I tlii-@'
                25




                                                                                    I 0 6




       rrtil-3    I  I would have at least some bites on it and either part of

                  2  It is an important part of the total system.  The utilization

                  3  of emergency  rooms  not  only  in  terms  of  their  being  brought
                  4  by plans, but also in terms of the utilization within the
                  51 emergency room itself, is so frequently inappropriate that
                  61 any effort in analysis of a subsystem of the total system,

                  7  it seems to me would be desirable.
                  8               I think there is an overriding concern on the pa--t
                  9  of too many people about the use of the emergency room and
                10,  the problem is not   the use of -the emergency room, but its
                11   inappropriate use.  I think whether it is triage or an ana",.Is--,E
                12   of the utilization of the emergency room, that is a desiral--le

                13   facet of the @-APs concern.

                                                                                        -eaid
                14                Too many of the applications,as I have read and
                15   them, have concerned themselves with the transportation
                16   and coreLroi-iricition,,, ,ind not enough of them with what goes  on
                17@  inside t@)(@, emergency room to take  care  of  the  people  who  do
                181  arrive at that room, at that department.
                19                I don't believe there iE;  enough  study  of  the  wal-
                     in which tl-,e facility is designc  -and I don't think -t,hE,--rc ;r,
                20 1             L I     i-               -J..                          -.
                21   enough study   yet in terms of the  sc@ivices  that  are  pro-@ide-d
                     therein.  I felt this  was rather sketchy.  I felt it was,
                22
                23   if you         typically       York, in that they w@c,@re- going  to
                     ass-.-,.gn    Ph.D.'s to e4c)          @:Lr,Cis o-f'   es    n@
                241
  cc@ Fedeta; Reporteis,  Inc. t h a. @IL-1 the- amount oj' reoi,.c-!y for the      too
                25




                                                                             10 7





      mil-4        much.

               2              But I felt it was something that  should  be  looked
   0           31  at, should be studied and analyzed and consequently I would
               4   rate it a little higher and recommend that it receive some

               5   funding.  I don't know it needs all that was proposed.

               6              DR. BESSON:  The salary -- here is one hospital, onc

               7   emergency room, and they want to have $15,000 for project

               8   director to watch the people come in and ou  t and what  happens

               9   to them, $15,000 for research associate, $3,500 for a

              10   technical writer, $9,000 for a secretary, a physician-
              11   consultant:at $100 a day, for $1.5,000 -- heck, you can provide
              121  al.1 the services for everybody for that amount.
              13              If you would, give me a reasonable kind  of  figure,
              14   Roger, I'll take a small bite.  They are asking for two

              15   hundred --
              16              DR. SCHERLIS: May 'I ask a question  on  this  point?
              17   When they come up with a manual, will that  have  any  relevance
              181  in any place except this hospital?
                              DR. MATORY: I thinl@. as all. of you have very  well
              19
              20   stated, there is  a desirability of such a study.  It is
              21   desirable not only so far -is the patients are  concerned,  but
              221  also so far as the professionals are concerned. We all feel
                   there is some other way of doing it.  We are not all sure
              231
                 1
              241  that it is safe or                     someone -cl.se -@riac@e.,
  ..e-- Federal Reporters, Inc. Ti-@.e whole idea of tria(Te,w@- talked about  for  a  longtime
              251i





                                                                                              IU8
    C R 6 3,) 7


    Irl 9 - ter
    folg i-ii.1 --- 41  but    are not convinced that triage is worthwhile.               lure are not

                   2  convinced  that  a   patient,   who   comes   -to   the   emergency r(-.)ora indeed,

                   3  should be sent away by anybori@, but the physician.

                   4                But, this ouestion needs to be answered.              one   of

                   5  the  reasons  why  it   is   difficult   to   answer   is   because we  are
                   61 not  sure  4--l-iat  there  is  a  body  of  knowledge  which  N,ou could
                   7 entrust, a I-lodi-7 of criteria that ,iou can trust to a person

                   8  other than a physician, and feel          confident that this has been


                   9  (ione.

                                    This is a  mordical---a.l)i.lit@r thing attacl@ied to this.
                  10
                  11  I@ lie is 9(,,nt away bv a nurse or corp.,nciii, and something ha.pl?c,,ris,
                  12  we Bell. are liable.     So certainly, I think -that your criticism

                                                                             -iiiilv  that  ]-ears
                      o' the a ount of dollars to b(, placed,
                  13   i-
                  14  nerit.    lic)%.7ever, I x@,onder if there is not a need to search the
                  15  b,,idclet to see certain things.
                  161               11-7he rio5-,t i@ni.-)ortant of these is the e@rali@itioii  of
                      the effect or the tri,,icje, in te@-ris of             r@,allv does hal-,-)(-,
                  17                                                               .1           , -n
                      to t'tie patient, in tori-.ir@ of  prc)T-)ati(,nt  disposition,  r),iti-or@t
                  18
                  19                     The evaluation i-ic,(--;CL:3 'to 1)(@ do.-IC over ri @ictilifi-

                                     of ti@i-@ic FAi-il in a F;j-cni,.@Fic@trit v(-J-I.U-,Ie.  Il@-,
                  2 0

                      t        (a c
                  2 1                  a ,@i(jiii-fi.c@tnt       of 'th'@i i-noneN,7 is targc!te-d
                  22  :cc)j- c@VFAlliati-oii, I %.70u!-(! lci4,.ii earlier to one hui-idr-ed

                                                     i:,)c.                  such a
                                    E@ u
                  23


                  24

  @cc@-Fedefai Repofters, Inc.
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       2                                                                      109




                  ot",,,@rs @,',arouc.1-iout -t'l-le. coiintr,,,.

               2              DI!. SCI',.T@,RLIS: yp-@-
                              I               it you are suggesting then, is a
                                  TOO'1'7Y: lI
               3
               4  redirection of the -tudy in terms o'L the net results subsequent
               5  to the triagc, rather than the mechanisms for triage?
               6              DR. ',I-@TORY: I liavc- not read enough to see how  much
               7  evaluation is in this, but I thin!-, c,%,,aliiition is a key point

               8  in this.
               9              MR. TOO",IIEY: No, it says that, "This project is  not
               10 intended to evaluate the triage sN,,f7,tem as it operates at the
                  Bronx ',,Iunicip@il Hospital Center, in comparison to no sv8tein
               11
               i 2or to other triage.   Rather the goal is to  document  and  codifv
                  operating procedures of an -nngoi.iici systeRt and specify the
               13
                  training program for the triage ,.-,rofe-ssic.)nzils staffing that
               14


                  svste7t.
               15   ,
                                  there it s@-,/s,  'll@IVI!IuajL-.ioii is no3L-- appropriate.
               16

                  -,'Loi'litorin(
                            @-i is a-@pro-)i:,iat(@."
               17
               18             D      E)          4-s a si-cjni@l-l.ci,,.nt point L-, c,, c -. u s c,
                  @,,,hat t'iev rest,,, ;-tre         3-ol?iiig @t      a,-i(i on  page
               19                         -L   is
                  nii,@e- a.,g @,n    oT- '-he                   --J(- (,IiCi     -D
               20
               21               -c i(-,,Z @l'- VC!                                  J
                      tiic@,i7  1.)reak  i.@" tir).
               22
                                                         tlic@v (jo clo@,ji-i in t)ii,.@,
               23


                   c)r i
               241

            ter-, tric.
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                                                                           110




              I  the -luril,)er of dol'La@t-@, t@lie,,,, are to save natioiiall-,,,,
                     1.                          Toii

              2  be all right.  if it. was not for $225 thousand  I  would  s,-:iy

              3  all right.

              4             I am questioning N!.Thetlier @@TPs is the vehicle  for

              5  funding S (,- Tl 0 t 1-iinq like this, though, whether we have the ,Doi,,Ier

              6  to be generous if it is needed, k,7hc-tiior we suggest they az)pl,,,

              7  for the Ilational Cc@nter for  funding  --  these  are  the  nature

              8  of my questions, Dr. .1@latorv.

              9             Otherwise, I agree with you.

              10            DP,. !-I.',%TORY: If you say there is not a signicicaiit

              I 1  evaluation of this and tiliev set out st,-:Ating the,,i are not @foii-.(

              12 to evaluate it; to me, it @,icak(,-ns tlic@ @,i'Aic)le pl--ograri. -It  is

              13 @,erv desirable but to me, it has no value unl.cs@, there is a

              14 significant -.-iount of evaluation to it.

              15            DP-,. BESSC)'@-I'll:  This is a health services deliv(-,r,,,

              16              pro@4r,3!,-,i that has great i-tier-i.-t, but lics out of ties

              17 ')Urvi(--x,7 o,47 if read our gui.dol.irir@s, ii-i(l loo)@ at this,

              181 th,@-,,,7 are tl,,7(-, uriiverE.;-s.
              19            E)  S C I 1I'L i SI   soi,).e I,-)i.,-oblem this.

              go            DR.          T-C)%@7 11-.)OUt
                                                                    -i I?


              21            DTZ.       S:  7kF@ I read t--"ic@ b,7tck(irbti@id of the

              22 -prc,-,jec4k--                 it is i.ii the orez.-, of SL-Lit@il-sti.c,--,

              23             resource!).. -TljliiE-,@ iE, noL. a-ri. @-,@cciderit room or eT.ier(Tenclr

                                                  J,)O),,, 4at
              24                                                     e-

  @e-Fedeial Repoftet-, Inc.
              25








                           I                            B@@'SSO,@;:     But    she    is     going     to     use     pli@@Eician     cori-

                           2   sultants  to create  the  branching rtanual.

                           3                     DR.  SCIIERI,IS:    All medicine  is  a  branching manual.

                           4   1    do    not    want    to    be    involved     with     thit-.     b@-yond     the     point,     but

                           5   I    @o    not    know    if    a    simple    program    is     going     to     be     the     ansvier.

                           6   I  was @,7onderina  if  you might  exnound                      on  thit a bit?    I  do not

                           7   kiiov@, what you have when you  are done                        with  this,  even  if  the

                           8   success  is  achieved  by her  d(--f,-ni.tion.

                           9                     1,7hat    do    vou    liav,--    at    the    end    of    the     $200,000     -)lus?

                         10    !,.s    I    read    it,    the    proposal    seeks    funds    which    @,7ill.    en,-il)lc-    us     to

                         11    doveloi@)  a manual  of  procedures,  to develop  a  syllabus  for

                         12    training  triage  professionals,  -iii(I  to  -,is.,3es  the  triz).c
                                                                                                                          fe  f-,y@3ter,@,.

                         13                      DR.  'r4-,'kTORY:    The I-)robl.on with  that,  of  course,

                         14    this  is  available,  anci  particularly  the  Chicago group have done

                         15    this.    T@nd  they have  outlines  o@-i  just @.7hat @./a,3  done..                         So

                         16    again,      Lt would  have value  if  this  is  developed  and utilized  and

                         17    evaluated.

                         18                      It does  not  d4 stur.3 i- c.,  -that  she  is  no'-  a part o-

                         19                                           t@              t
                         20                      I)?,.  SCI".@ E L@, I S   T  i a -t  i E, r o l@  a'@,)  I.,,7  a  beneficial  c,'@fcc'L-,

                         21

                                                 D@.                             are                     her        fifteen        grand
                         22

                         23    L)r?

                         24                      DR.
    ,-e-Fpdctal Repo-. ters,  I,-lc. 4-0
                         25        '@lic value  of                    a                      is  not                  ,i  part (,):L'





                                                                                                                       11   2




                        I   the ,-)hysician-car(:,-  svst(,--Tp..        But to me,  tl-.@is  i.s  a plus.              it

                        2   gives her  a better o-,)portunit,.?  to iiake  a good overvie@@., and  if'

                        3   she    i-,     going     to     use     consultants     liberally,     she     can     perhaps,

                        4   (e-  the whole program together witl-i  less prejudice.
                        51                   MR.  TOO-'@,@-FY'    The    tl-iing    that    impresses    me    i.s     the
                        6   fact  that this  study  is not ar)nli.cable  to  all emergency roorls.
                        7   It would  seem to me  it is very applicable  to -those public

                       18   hospitals    in    the    large    cities     in     this     country,     or     the     large

                        9   oublic hospitals  in the  laraer cities.
                       10                    I    would    agree    that    the     monitoring     and     follcn,iar)     is
                       1 1  Something  that would be desirable.                       But,     @,7hile-     all     emergency
                       12            have problems,  I (lo not  thiri'f:                       are    an@7    that     have

                            as great problems  as  the municipal  find  the cit-i7-countv
                       13

                       14   hos@.)itals  that do exist,
                       15@                   I  can see  this has  a value  in those areas.                         spc-@cif ic-li
                       16   all-,7  ii,. terms  of  a manual,                       and  secondly,  as  far  as  t'-,;2
                            ability o     r - -   ai-id  I   agree   wilk--',,a   @7ou   on   the   evaluation,   I   ,7er@),
                                          L
                       17
                       18   much agree.          Beca.use,  even  in  the  s,.iiall  cities                      vou     -3i-V
                       19   relativ-l,i  active-                         rc-)orif-,,  and you do
                            of                      tl,,erc  is  a   great   ro2.uc-Laice   -@-o   rc2.@i-   on   -?eo:?!.c@@
                       20

                            (-)tlier  than nh.,t7siciE,,nr3  to do t.11,@
                       21
                                             ,And  the-,i  Eire not                                    C      c@ r-T un t 1, -
                       22
                                         if  this N-!cre  I.o,)J-,.c@d tl,-),@n  LiE;          of
                       23


                       24

   ce-Fedetal Rc-porters, Inc.
                            a                 @,trciF7 s  (.)]-I  tire ever           c),-'      tri@i,,ic,
                       25




                                                                                                                                                                I 1 3
       ter-6 -



                                 I      it      @,?()uli.d      have      valued      to       rian@,7       other       organizations.       But       I       ant

                                 2    in  agreement,   I  do  not  think  this  !-.and  of  studv  should  cost

                                 3   anywhere  from  $200,000  to  $250  thousand.                                              I  think  you  should

                                 4   be  able  to  get  it  done  for  somev7here  in  the  neighborhood  of

                                                      i-                                                           -ind.
                                 5   twenty,          fifty,   and  on(--  hundred  thous,

                                 6                           DR.            PIIEDRAN:             @-ir.   Cl-i@i.Lrman,  we  could  spend  a  lot

                                 7   more  time  with  this.                         In  the  interests  of  cx,@-)edi-tii-ig,   I  would

                                 8   defer          to          the          secondaryIreviewers  figure,   and  if  you  said  fifty

                                     to  a  hundred  tliousai-id  dollars,   I  would  accept  fift-,7,  which  is
                                 9

                              10     o@,ie-ti-i.@..rd  of   the  re@UC5ted  amount,   of  156  for  tv,@o  years.

                              11                             DR.                         I  I,,cive  a  i,)oint,   I  ai-n  concerned  about-

                              12
                              13                             IIliat  I  hear  you  sa@7-iiig  is  that  this  is  ,inL'ormation

                              14     that  could             be  useful  in  the  loi-i(j  run.                           But,   I  do  not  see

                                                                                i(lelii,c-s  aft-or  a'-t(@i@rting  to  have  an  RT-I'-P
                              15              this  'Lits  our  qLl
                              16                -,,@7.i,th  -?rovic3.(-r  g.-ou@-Ds  to  i.ml-):r@o@7e  care                    to         E)ati.ent@,,         Vie
                              17     are  not  -i-i  the  ',.)usiness  of  funding  R&D..   I                                   tllc)llc lit
                                                                                                                                         @f

                              18                             1    juEi,L-    @,@,oriCicr    if    @,,ou    all    fc@e-l-    tl,icr(,-    if,-    ;7te.ri-@.     to

                              19
                                                           or      ot'l,@e---                         and  you  cou)..d  r(i(7,u--@-@t   @,,t  be

                                                                      a      dcve,'Lo,,,)iacrtal.      cc@.it.rc-,-ct      in      @&D,      or       s(,,,-qcc)n(2
                              20
                                     c, 1  c@    -L.C@) @jo-L-                            .,'-on,     Bii,-  I            -iiL;t                          as  to
                              21


                                                                                                                                  ',!P  to
                                              t,.,                          to                                                  y@@
                              22                               go

                                                 a t c z74,  r    J'  o  r  tI C3    e @@i c'@ o I, c-
                              23

                                                                                                                      t." C)        I  t   v o- i     @tv      s   u c@   S,
                              24                                      @,Cl                    T 1,@
    ,-e-Fedetal Repo!ters,  inc.                     Al    E; t         c@ c-
                              25




                                                                                                                   114
     t-Qr-7 -



                        I                   Perhaps  this would be  the  legitimate answer.

                        2                   DR.  BESSO'@T:      But   we   are   thE-   fat   cat,-@,   R&D   mci@,,be

                        3 does   not   have   as   many   bucl.zs   as   we   can,   and    ma,7be    as    long    as    we

                        4 have a bird in the hand,  we ouc
                                                                          .jht   to   take    it      that is what

                        5 I    gather    his    comment!-,    are,     that     the     implications     are     great

                        6 enough    so    that    if    we    could    fund    a    little    piece    of    some    program

                        7 in   i@@lew   -Jersey   because   they    are    a    "red    ink,"    a    poor    program,    we

                        8 could  fund  this,  even though it is  far  from the guidelines.

                        9                   DR.  IIIN,'4iU4.-   Except with 1,@e@v Jersey-,  I heard you

                      10  Saying   that   you    were    attempting    to    see    to    it    that    that    Ri@fiP

                      11             more with the usual and  the poor  and their problems of
                      12 laccess     to     emergency     services     viith     the      espectations      that      change
                      131would Occur as  a result of  it.
                      14                    That is quite different from developing a manual

                      15  that    will    give    you    a    method    of    doing     ti-iage.  I   do    not    see

                          lio@@i that fits what                 has  talked aboul'- in the  two or  three
                      16

                      17  publications  that have gone out on E14S.
                      18                    DR.                 I f  t'i i I' S  I c_; Illconsist(-,nt with the

                                             maybe we  are  just
                      19

                                                  SC,Ti'@@11,LIS:   Let:   us    not    ni@olong Chile discussion.
                                            DR.  l@,IATOT?Y:    I  think  if  @7c)il  '@jo   ;Dv trick (juid(-@l,iiies,
                      21

                          that    ,,oia    are    definitely    ri(lit.     On     the     other i-,@iiid,  if  the
                      22

                          -iutl)or      uld    have    indicated    that     this     is     the t-,  c2  of
                                                                                                   7p
                      21

                                    @.,()ul.d            c'-77i@cc@  t,io c)t@ic.3- m@ijo.r r,,c@tro@-)oli-taii
                      24 I'                                                                          1,               -
   -e- Federal Reporters, inc.                  ir
                      25  -Ln                        so coorci@.n@it,ccl                 '@Z@IP,  it would   il).z,@ve




                                                                                     115



                 I  type of value.  But, I do not know that this is made clear.

                 2              DR..BESSON:  Besides,  I  think'as  I  read  the   guide-

                 3 lines, I see -- and  as  I  specifically  as}-,  that  question,  this

                 4 morning -- that @.7c can fund a component of a system.

                 5              Ilow, we did not argue too much -- some -- about

                 6 tra nsportation in Maine, but communications in western Ilew

                 7 York, Lakes area.  liere is another problem which maybb.docs

                 8 not have  the  same  degree  of  advisability  but  is  a  component.

                 9              DR. SCHER@'.$IS: I  think  the  difference  is,  though,

                I 01 that i-7hile th-is is a component,  the  question  of  whether  this

                11  is really TZ&D has to be seriously considered.
                12              ])R. BESSON:   I move @,,7c-, fund them at fifty thousand,

                13 and we give them a ratina of tlirc-.e@.

                14              DR. SCIIEIZI,IS:  Mrs. r@litz?
                15              DR.  FAATZ  BEfore  you  make  your  final  decision,  I
                16 would like   to draw @7our attention to the eastern branch comments
                17 i,7i'lict") are to the effect, I think, that mc-@'L--ro York is

                                  rather troublesome organizational and  roFtiiig,3mei-it
                18

                                         have in fact,              quite P, sur,7)1.iis of
                19             and the-.

                              -'I funds over  c- i,,ext
                20

                                               I correct-,   j,.iotion and ztpl)i:ov@-
                21

                   but @-io @ui-idincT.  Tli-ink
                22

                                DR. SCIIT-'PLIS:  iT),-)rc)vc@ .;-L @,;,Ii;it?
                23


                24

     Federal Repo@tes,  Inc.
                25      c- f iii-idect (--)ut o sr Pr c)-', cc tc, (I (@f  f unO, E,




     tc-r-9




                           1                      DR.  !3CTIEPLIS:          @,Tliat  amounk"-?       Is  that  within  oux-

                           2   legal  capability?

                           3                      DR.  SILS13EE:    You  @vould  approve  it  to  $50  thousand,
                           41 and  the  decision @as  to  funding  --
                           5                      DR.       BESSO,',i:           No      additional      funds.      This       is       a

                           6   supplei-aenta'L  application.

                           7                                                                             as  El,.IS  is  concerned,
                                                  DR.  SCHERLIS:    I  gather  as  far

                           8   ..7e  should riake  that  a  request  for  funding  and  not  specify

                           91  where  it comes  from,  and  staff will i-7orl-, it out.                                I do not

                        10     think    part    of    our    consideration    should     be     that     %,i(@     have     monev
                        11     therefore,  we  should  fund  it,  it should be,  does  this -co,,,i,,ara-
                        1  2   ti.ve-1.@, merit funding.   There  should be  iiiked  into th                               4 S
                                                                                                                          -L . ,  the

                        13     comments ,nade  that there has  to be  an evaluation to a more
                        14@    adequate. degree.
                        15                        DR.    IIII'@,',IAN:    Pifty     for     the     two     years,     twentv-five

                        16     a year.
                        171                       DR.     BESSOL'@T:     Right

                                                                RTIS:
                        181                       DR.  SCliE                I,. rating of  three.   ,%n%i other  cc@,-.i7tc@nts?
                                                                                                                    1

                        19                                 TOC,'IjEY:    I Field  l'--J@,e  to                on(:,  other co!-ri-@ient

                        20     I-)c@c@llu@;e  it  !)oti@iers         a   I-Lttlc bit.

                        21                        It is hard         to,  in  -light of  the c
                                                                                                          j u -J-    i-i (L, s ,     J-

                        22     at   ti,@le   total    ei-iergc-,nc'                                 to   then               doTe,,n    oil
                        23     ()"IC  iy).s  .@ution @,.n,,!                                                                   gui.C,,("--
                        2411   I-   ,s.           yc)Li                             -,r (i),@              t' c!y  -,c,,rve.  -@ci      c
       Federil Re[)otters, Inc.'l
                        '-)5               of                trial-.  arr-,              in            of    t,lic-.  lai.-g(@r




                                                                                   117


                I  I th-i.nl@ once ).@jain, in terms c)f population, @iliicl-i prol@al.)ly is
                2  s,--v(----ral millici-i -)copl(--, utilizing, or i.n that -irea, I thin],,
                3  you have -- and if I understood correctly, somewhere in the
                4  n e  li !A.-.,orliood of 150,000 to 200,000 emergency room visits in
                5  the course of a year, which i@s probably as much as some of the
                6  s,,ialler states have -- I thinl@ you can justi.fy it, even though

                   it  is  a  01-IC'--,'IOST)ital  problem.
                7
                8              DR.  SCIIERLIS:  One type of hospital problem.

                               '%@1,R. TOOEY: Yes.
                9
                10             DR.  SCIIERLIS:  Pcrlial.)s we should try to fi.,.-iisli one
                11       rcrjion ')c'Lr.)re we have our lunch break.
   Ti. n d9
                1 2            Lunch will be no more than half an hour.

                13


                14


                15


                1 6


                17


                18
                19@
                1 0


                2 1


                2 2


                23

                24i
   -Federal 'tleportefs,  Inc.
                251




      LEE- Irl 2 3
       t-@ v 1.


                I              DR. SCHERLIS:  Any other comments, pro or con?

                2              Next is Northeast Ohio.

                3              DR. ROTH:  Northeast Ohio, this was totally different

                4 from any of  the other applications I had.  It concerned every-

                5 thing except automobile casualties and so on.  It was all
                                                                                             0

                6 planning the plan and I would  feel  that  Dr.  Sloan  probably
                                                                                             p
                7 hit Ithe problem on the head here with  a  new  coordinator,  and

                8 she ends up her  narrative evaluation of the proposal by                   0

                9 saying in this respect that she believes  he  should  be  asked

              10  to try again. And if it is a proper  thing  I  think  we  should

              11  encourage Northeast Ohio to resubmit  for  a  subsequent  cycle.

              12               DR. SCHERLIS:  All right.

              13               Yes?

              141              VOICE: Dr. Glover did  prepare  this  and  submits

              15  it back in January, long before our guidelines were out.

              1 61SO if it is not relevant, that is why.

              17               DR. SCHERLIS: I think that  explains  some  of  the

              18 'problems I had in reviewing it,  too.  I  had  not  recommended

              19 it for su-l:)Dort, either.

                               Any other comments?
              201

              2 1              Now, let me see.

                               Do you 'Have any other comments on these  others?
              22

              23               DR. ROTH:  No, I didn't.   I apologize.
              241              DR. SCIIE',.'@LIS-. tl&@rhaps cax-i i).ir),,re t-.o California.

  ce - Fcdeial Reportets, I,,iC.
                 !We still have a quo:cum and I gather th(@ three o-E us will
              25i

                  remain until the bitter end.








              'b


                                          DR.  nESSO.1@:   Noi.-t-lic-.rn       l,,@,i@;"and.   They are

                      2   r(-@qi-iesting  a one-year furidi'-@.,cj -)f
      xxxxxxx            I
                      3                   DR.   SCIII@JZLIS:   Direct   and   iiicl,.irect    is    174,    the

                      4                 172.
                      5@                  DR.  DESSON:        liow,   this   has   bp:.en    an    ongoing    program
                      6  1in norti-icrn 1,1@,w England,  and they have had three superb studies

                          of     ambulance     services     in     Vermont,     hospital     emergency     room

                      8   services in Vermont,  and then an up--to-date study of tl-je entire
                      91  ei-..iLrgc!n,--y   health   system   in   1971,   as   an    ongoing    program    in
                     10   northern           r",ngla.nd in the I.-)ast;  done by the Univorsi..ty of'
                     11   @vycrroont and one particular fellow,  whose name,  I forgeL@-.
                     12                   ]'.n an                       of      the       status       of       ambulance
                     131  service@l,  they                    that  ambulance  sc-,rvicc,,s  are
                     14                coordinated  and  prepared  in  the  Statc--@  of  Vermont,
                     15   lnd    need     a     great--     deal     of  Their  r;tucl@,,  of        hosiDi@-al

                                         roc--           bi:,.t  ti,,o  of  the  lio-nitzil.  e:,Li(,:rgericv  ro <7@Pi
                     16
                          ha@,e  @-)roblc@mc3  of  coverage,  operii--i.r,.ri,  ;-))-id  evaluation  c)f
                     17

                     181                     TDrc)gr3-,-.-t.
                     19                   T'@, I o  Lffocl-,,  c,'L  both  of  t]-ic--sE@                     am!)U,Lal"

                                               room,  @,.s  ---  oil,-         in  7't  state  @@7h c h  t h
                     2  0
                     2  1               -c@.'nti'L-- 22, T-,(3i-cc-i-it )f                 ,3urv.-i.vab"Le J-1,lj ur.j.
                          d i-           h o,-, i. -L a.L  or                    @,!Iii(--h  i@.,   a,   @r--acL-@t   of   what
                     22
                     23@

                     24

   i@ce--Fedeial Reporters,  Inc.
                         172'   rD               a s t:a t i  v L c,   thc-ti-@  I'                    of
                     251,






                                   I    progress  in  Veriqont  4-@;  that  thei.--(-l                                b(-,-c,,ii  attempts  to
                                   2  coordinate          and          develop           standards           for                         equil-)ment,
                                   3  operation,  attempts  at  standards  -,-'or  -trairii.i-ig  programs,  co@-nmun-
                                   4  ications,  and  so  fort!-i,  and  what  this  proposal  is  to  do,
                                   5  purports  to  do,   is  to  involve  itself  in  four  so-called  high-
                                   6  prioi-ity  areas:     improvement  of  the  capability  of  individual
                                   7  ambulance  districts  to  carry  out  regional  coordination,
                                   8  establish  ambulance  regulation,  emergency  room  regulations,
                                   9  and  improvement  of  existing  trai-ning  programs.
                                                            Tliev  hope  to  establish  formal  health  servi.ces
                                   10I                            I
                                   11 advisory  committees  to  replace  the  informally  established
                                   12 cOmTiiti-c-es,   to  establish  a  central  dispatch  communications
                                   13   pattern  throughout  the  state,   and  to  increase  public  knowledge
                                   14 a).)o,,it  handling  of  emergencies.
                                                            All  of  this  really  is  a  relatively  complete  pal-.,kacle.
                                   15                                                                                            .1                                -1
                                      Thei.@-  Proposal.  for  training  include  as  package  in  the  first
                                   16
                                   17 year,       for  nurse  refresher                                        foa-  en'-.ightenii,,g  I?h@),,:3.!.C,4,Eins                I
                                      to  -Uccapt  surrogates  doing  %N7oi:-Ic  in  tli(-2  @ib!--@(@ncc--!  of  the  physi-ciE-)J-I,t
                                   18
                                      or  on  his  o-11117r),,   to  i.ioi,->rovc  the  Dt,-,@.rilop  E.@-IT  Course,  and  t",,en
                                   19

                                                                                                                                          4
                                                               t I I  4
                                   20                                  r T i-7                in           .r
                                                             Tiie@i,  i--;.eed  funds  form:                   c-,nic-r(.,rc!n--y  room
                                   21
                                   22 pac@@age  for  coordiiicti.(-,xi  and  '.-or  teaching  -.ids.    As   j'cii,  as
                                          c@ 3, il  s c c o r-,,l         r  P, c t i v,  -t i @,@ s ,   t 1 -i s@- t 71 t ci  I--) 1 @l @l I 11 i n g  a c t i'V' -L- i c@, 3
                                   23
                                                                                                   to            i@c-@              I.)laiis,  +--,)  seat
                                   24

     .Ace - Federai Repoitefs,  Inc.
                                   25



      r 3                                                                            120




                    co@tivenl' that vou
                                             in re-ati.cii to the tri-stcite area


                 2  interstate coordination.

                 3              This is one of the few applications where one

                 4  particular  region will look to contiguous regions and use some

                 5  of its funds for interregional. cooperation, which is very

                 6  laudable.   A-- I have looked over their budcc-@j-ary use of monies
                                                                   .J

                 7  for personnel, I am  impressed  by  the  trai.nin(j  of  the  people

                 8  and their T)a.st experience.   It is quitc- impressive.     Their

                 9  gc-i-ieral budget figures are in keeping  with  the  fri.igalitv  of

                10      I.Ilngland Region.

                11              They are ask-i-i-icj- for 72,000 for a project  which  I
                12  gradc, a,i, at least,, a '113," if not a  "B+,"  rour,  four  and  a
                13  half.   rour point five.    I would recommend full@ funding.

                14              DR. SCIIERLIS:  All right.

                                DR. BESSON:  And       is  cheap  at  twice  the  price.
                15

                16              DR. SCIIERLTS-
                17                   TO,'),@IBY: I had only two areas of c(-)i-icern. one

                    i,jas t--iie                        rc)o7-11 operation regulations by
                18
                19                                                  aii,,l tli.( othc@r @Dlip.
                20                    c-.)'L the          fo@7 nonmedical         I-le'

                     a_', 4           -iti.c@.nt@,   c         in              -y room.
                21          c@irc cf p@                                        c

                                                t   I   r     ti 3  @5 a   o d. Ei p -p 1 i ct i o r@
                2 2
                2 3 ,-or       it

                24

  @cr-@-Fedf@rat Repoters, Inc.
                                     TC)"      I    .1 (3.
                25




                                                                                           121
         4


                    I be a )-,@arcjairi. I recoi-.irtic!n.-l it and I would give it a four.

                    2              DR. SCIIERLIS:    7iny other comments

                    3              Dr. @Toslvn, any comments on this?

                    4              DR. JOSLYN:  No.

                    5              DR. jl.IATORY:  I %@7ould like to agree with the comment

                    6 about the professional capability of the group doing this.

                    7 They are very fine people.

                    8              DR. SCI-IERLIS:  Thank you very much.

                    9              P.11 those -in favor, lilease inCicate by saying, Flaye.11

                  10               (Ci'lorus of ayes.)

                  11               DR. SCIIERI,IS:  Opposed?

                  12               DR. JOSLY!Q:  I,,Ihzit -is tl)(@-


                  13               DR. SCHERLIS:  Four.

                  14               DR. BESSr.)Il:  Four Point tw(-,nty-f ivc,.

                  15               DR.  SCHERLIS:  There are so f ew above             that this

                  16  I'lil) stand out  whether it is 'E@oizr or 4.25, if my i-@emor@r serves

                  17  me co-rrectl-,,,.

                  181              At this time, unless ar,@roi@ir@ Objects serioi.,,-,I@,,
                  19               @-idjourn for lunch a-,-,(.1 iii,-ivb@  we can beg'i-l-i at- @71 u a r @L- i:,


                  20  o  c@,nc@

                  2 1                           thou                recessed, to

                  22  ,I'      T)   M  this -,ariE,, Cl@,ty,

                  2 3


                  2411

     -Fc-dc,,ral Feporters, Inc.
                  25









                                          pmp                       Cie te.                                         io
                                                                             And in te         t resources.
                                 that it                                                 rm,@ Of
                                           Is  rilos t                  e to
                                                   likel@ to be       abi
                                                      P-rorni .             I Po.1, n t                    arn to
                                                              ing
                         12    to             The requested                                  P-ri de., X
                                   the
                                        Populat@                 amount    is rel
                       14                         on   to   be   served.          a ti
                                            telling $2,250,000                 ve " i L-            in 'relat
                              .-requests to                                            e ly Sm
                            to be e:cellent.                                              carr$es    follo
                      1,                   But the
                      76                                        re
                                                    Would                     $63,800
                                         ,Dp.               .re tC,    4
                                               SCII.V@.Z3:               and              Seern    0
                                                            Por                          d
                                                                  one  yea-,
                                                       ea.r
                       "1,200,000                     -Ad              Ives $246, 000.
                                                          them   all  vo You ccrne
                                                                                             th
                                                        you are
                                                                  ,reco.
                                                       tyear.                                  of   th
                    this
          2                         dollars            CZ2@O
                orne.rgenc                                             C?ci
                                                                                      felt


      jrb3                                                                  25 4



                1  beginning with a solid basis of training personnel first.

                2             MR. TOOMEY:  Is this Georgia?

                3             DR. SCHERLIS:  This is Minnesota, first.

                4             DR. HINMAN:  You are recommending the first year

                5  only?

                6             DR. SCHERLIS:  63.

                7             DR. HINMAN:  with rating of 4?

                8             DR. ROTH:  Yes.


                9             DR. HIIIAN:  Okay.
                10            DR. SCHERLIS:  I agree with that.  That was one of

                1 1the nicer  ones to read, 1. think, in terms of content.

                12            Any dissenting opinion on that?

                13            All right.

                14,           That is Northlands.


                  l@               The next oner alphabetically, for you, at least,
                  16  is Ohio Valley.
                                   DR. ROIIH:  Ohib Valle
                      things.    This                     Y is another one of these
                                       is a li,-,Iited area in Northern Kentucky.
                          'resources are close to zero,
                20        ly                              the grant application is very
                     pc)o'                 there --,Lr@ "O documentation tilaf- they
                21   can @)-roduce or that they c@ll c@,ro-- for the emergencies they.
                22   bringr in.

               23
                                   feel probE'bly it is one of those situations
                                                                                                0
               24
  "-Federal Repotiers, Inc. t   u 3 cl                 to        tlielll out
                                                                           cOr@qPlotej.,V.
               25
                                         o,,ci e rn
                                                                to continue to do























      jrb5                                                                256





                              DR. ROTII:  Yes.

               2              DR. SCHERLIS:  Any comments?
               3              The recommendation has been made, Ohio Valley,
               4   $20,000, with a rating of 2.  That is one year.
               5              All right.




                                                                             2 5 5





                I    planning.  And I think you haie to rate the program sort of

                2  minimally, perhaps a 1.  I would like to give them some arbi-

                3  trary figure
                41            DR. SCIIERLIS:  They requested $62,000?
                5             DR. ROTH:  $63,800, is what they have requested.

                6  I know the RPM.  I have site reviewed it; I know they have

                7  a good core group, and one of their needs is to diversify

                8  and regionalize a little further than they have been able to

                9  do.


              10              I'll come out with a figure of $20,000, over the


              11   top of my head.

              12              DR. SCHERLIS:  That is what I wrote down, off the
              13@  top of my head.  I thought they might rate a 2 on the basis of
              14   hope.


              15              DR. ROTH:  Yes.

              16              DR. HINMAN:    "2" is the figure?

              17              DR. ROTH:  That is perfectly all right with me.

              18              DR. ROSE:  May I remind you the implication of

              19.  that is that the $20,000 is now low in priority?  It is not li,Ke-'

              20   that the money would be funded because of the priorit-y.

              21              Do you see what I am saying?

              22              DR. SCHERLIS:  The statement has been made that
              23   with that low priority, $2,000 would probably be the funding;
              241  is that the point?
  ,ce -Federal Repc)itefs,  Inc.
              25              DR. IJIDIAN.@ "2", and $20,000, then?





                                                                             z 111) 9


                             Dr. Scherlis: All right.  The next state is Oklahoma

      d',i-5                 Mr. Toomey.  In fact, vou have the next one as well.


                                  @OU,@ Dakota.

                               Mr. Toomey?
                   4           MR. TOOMEY:  The funding is requested for a $104,000
                   5for the first year,  $124,000 for the second year, and $64,000
                   6for the third year.

                   7           It should be noted this proposal was originally sub-
                   8initted in advance of '72, prior to the development of guideline
                   9for submission of proposals.  The proposal was also submitted a
                   10 part of a regular funding request application to ralp as of
                   11 February 1. 172.

                   12         This project proposal is part of the total anniver-
                   13 sary application for the fourth operational year to be acted
                   14 upon by the 1972 national Advisory Council.
                   15         Okay, considered to be a rural state, has half of it
                   16 total inhabitants in 3 standard metropolitan statistical areas,
                   17 including Oklahoma City, Tulsa, and Lawton.  Of the state pop-
                   ulatio,l of 2 and a Half million, ap
                   18                                 proxiiriately 65 percent live
                   19 in cities of 10,000 or more.
                   20        Topography influence as the location of the inhabit-
                   21 ants with the bulk of the population on the axis from the north
                   22 east to the southwest corners. The Northwest Quadrant is large
                   23 wheat farr,@is and cattle ranches and the southeastern, extensive
                   24 and ru(jcje.,,-t hill ranged,
  ,e-Ft,acral     Rer)orters,      fyic.
                             ".'lie statc's medical   lie,-II-I.h community y)arallu,"@ 'L.@ i
                   25





                                                                                     210



       dh-6       I general  population  where  half  of  the  city:centers  in  the   state
                  2 live in 30 -minutes drive of a large medical center.  Approximate-

                  3 1ly 20 percent of the inhabitants of the state are locatbd'in

                  4 one  third  of  the  geographical  area  do  not  have  immediate  access

                  5 to  specialized  services  and  facilities  or  live  beyond  a  30  mile

                  6 range.

                  7             The  primary  objedtive  of  this  request  is  to  raise  the

                  8 standards  of  emergency  medical  care  transportation  to   each   city

                  9 in  the  state,  to  have  access  to  medical  services  through  provid-

                10  ing advanced emergency training by physicians for ambulance

                11  attendants.

                12              Specific@6bjectives.include   development   of   a    program
                13  providing  comprehensive  training  to  evaluate  the  skills   of   all
                14  ambulance  service  personnel  in  Oklahoma.  The  plan,,   the   mecha-

                15  nish, is  the  development  of  a  72  hour  EMS  training  program  sus-
                16!tained  as  a  cor,,munity-based,  physician-oriented  course   to   raise
                   I                                      -
                   ,skills  of  personnel  conunesurate  with  the  emergency  medical   re-
                171
                18  spor)sibiliies of individuals already     engaged  in   providing   care
                19  and. transportation services.
                20 11           This  course  of  instruction   includes   academic   instruc-
                   ition  as  well  as  Practical  exercises  in  accordance  with  the  cur-
                21
                22  riculum developed by the American  Coll(@ge  of  Surgeons  Corco..ilittee
                   Ion Trauma.
                23@
                                The evaluations, the application has not  derionsl,-i-cite.,"@
                24
  ,ce- Federal Repoftf@rs,  Inc. a t)-iorough. knowledge and understanding of an  emergency  r,.ierlical.
                25




                                                                              211


      dh-7      I  service system or discussed the various components and elements
                2  of this system.  Does not describe how the various pliases will
                3  be integrated into the current system, nor has he identified
                4  present definitions in the present system.
                5             The specific geographic area to be served has been
                6  identified as a state-wide proposal, however, there is inade-
                7  quate information to determine community organization and lead-
                8  ership to include a broad repetition of procedures, public
                9  agencies, and community interests.
               10             The application has identified facilities and equip-
                   ment currently rendering emergency service and has briefly ident-

                   ified other resources, and existing medical services.  But the
               1 21
               13  current deficiencies have not been addressed.  The plan does
               14  not clearly delineate how the various components will be coor-
               15  dinated with components already operational or how new additional
               16  will affect the total system.
                              Linkages with local health care systems to assure
               17
                   adequate provisions for referring and follow up of emergency
               181
               191 patient needs and in cooperation with disaster planning and
               201 long range growth have not been referred to or described.
               21             The application briefly speaks to obtaining addition-
               221 al financial support with the initial grant request and for
               231 future support after the grant expires.
               24.@           There is not adequate information to determine tl-ic
    Federal Reporters,  Inc.
                 . quality of care to be providc@(i oi- to determine an effective pl@),i;
               25@l
                 I




                                                                               212




     dh-8       1 for evaluating the various elements.

                2             I have a note to refer to Dr. Kaplan's comments.

                3             "Unfortunately this complete  project  is  nothing  more

                4 than just a projection. While  it  is  well  developed,  well  organ-
                5 ized, competently organized, and stated  to  be  top  priority,  it
                6 does not meet our priority for the  EI,4S  application.  The  Appli-.
                7 cant,has submitted a state-wi.de  plan.  However,  this  plan,  based
                8 on criteria that an ideal  plan  should  identify  problems,  estab-
                9 lish objectives, and give details on  the  ways_to  meet  the  objec-

               10 tives, is not in fact a plan.
               11             The applicant.does not  directly  relate  his  projection
               12 to this plan.  Furthermore, the project which is designed to
               13 train ambulance attendants doesn't give any indication of a
               14 communications system which would stimulate these ambulance
               15 attendants to act. It does not  give  any  indication  as  to  what
                  ty-oe of communications would exist between  the  ambulance  and  the
               1 6
               17 hospital or the ambulances home base.
               18             It does not give any indication as  to  the  quality  of
               19 emergency rooms to with the  attendants  trained  in  this  project
               20 would bring their patients.
               21             Finally, the applicant does  not  give  any  indication
                  of how these trained personnel  will  be  deployed  in  relationship
               22     the needs of tire. involve(7,, communities.
               23 to

                              DR. SCIIFRLIS: Your recommendation then is?
               241
  -ce-Fedefal Reporters,  iric. Or Dr. @!cPhedran?
               25




                                                                                                                                                    2 1 3




               dh-9                                      DR. MC PIIED.@N:  I agree.  You recommend no funding,

                              2    is that correct?

                              3                          MR. TOOMEY:  Yes.
      OCR 6307
           end #18            4                          DR. MC PHEDRAN:                   I agree.

                              5


                              6


                              7


                              8


                              9


                             10





                             12


                             13


                             14


                             15


                             16


                             17


                             18


                             19

                             201
                             211

                             22


                             231


                             241
    .Ice-Fedetal Reportets,  Inc.
                             251


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                                  tj@e fri              that to se            gon.
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        JM 6                                                                   3 04


                I  emergency medical communications in Oregon.

                2       The communications system will be organized to utilize

                3 Oregon's Association of Hospital Councils.  An agreement has

                4 been drawn up as far as this participation is concerned.  This,

                5 then, is a straight forward  request  in  that  regard.  It  is

                6 purely for the network and  it  is  limited  to  that  approach.  It

                7 only speaks purely of the equipment.  There is no indication

                8 actually of anything else in this, and  for  what  it  is,  it  is.

                9 But it is extremely limited in its approach.
              101       Repeatedly, as I went through  this,  my  comments  were  that
              11 Ithis did not talk to a  broad  system  at  all.  There  wasn't  any
              121 evidence that they were going to  relate  to  a  broad  sy,stem.  I
              13  do not have a favorable response  to  it.  It  did  not  follow  the
                                                             even
              14  criteria or the guidelines in terms of       saying how this

              15  would fit into the over all  program.  It  is  a  very  limited

              16  project in terms of background  data.  Most  of  the  -'Lnformation
              171 is in terms of supporting  letters.  Then  it  goes  into  what  the
              181 equipment would be. There  is  very  little,  if  any,  support
              191 requested as far as staff is  concerned  because  all  of  this

              20  ,,iould be through contributed areas.
              211       Basically, what they ask for are  the  vehicles  and  eqtiip-

                        and that is             - can't find this to be anything
              22  men4              about it.   1


              23  more  than a circumscribed part of the system.

              24        Now, if this opc),:e to the entire system --iid s,-:Ii@d that
  -Fe.(Jc-i,3!  .1@eporters,  Inc.
              25  this  was the area of the greatest priority at the presc,,it--
                 I                                                                    I




        JM 7                                                                  305



                                                 they Vere
                I time while this was going on@stepwise going to do other things,

                2 I might react differently.  But this addresses itself purely to

                3 the package request for some technical equipment, and even

                4 though it is part of, they say, the comprehensive plan, I see

                5 it in a very limited way.

                6      I do not recommend support of this one.

                7             VOICE: This  application  was  forwarded  shortly

                8 after the first of the year, and they chose not to revise it.

                9             DR. SCHERLIS:  Before the guidelines?

              10              VOICE:  Yes.

              11              DR. HINMAN:  They did have an opportunity to relate

              12  it.

              13              DR. SCIIERLIS:  They did?

              14              DR. HIN@IP-N:  Yes, sir.

              15              DR. ROSE:  A number of very specific statements

              16  suggested  some documentation.

              17              VOICE: A number of  telephone  calls  were  made.

              18              DR. TOOMEY:  Once again, is this a hospital planning

              19  group, basically?  It reads like that.

              20              DR. SCHERLIS:  It comes in from the Oregon State


              21  Health Divis-Lon.


              22              DR. 14ARGULIES:  It sounds like something the @NIP

              23  dutifully sent on.
              24i             DR. SCIIERLIS: T have that feeling be@c@-use  the
  e -Federal Reporters,  Inc.
              25  project coordinators from the Oregon          Division, hospital.

                i




                                                                                 306



  cont 27       1  coordinator, assistant coordinator, are all from that area with
  ill,W lee
  #6307         2 all the salaries donated to the project because essentially
  j@            3 there is nothing that goes on with the project.
                4             Essentially they buy equipment and install it.  There

                5 is no evidence on the training.

                6             VIhat are they going to talk about once they set up
                7 the communication, because even that -- this isn't part of a

                8 total training program, it doesn't relate to emergency

                9 facilities.  I recommended no support.

               10             MR. TOOMEY:  As a hospital person, I get concerned
               11 by the limited vision of some of the hospital-based or

               12 hospital-involved applications.
               13             That is why I thought that the one you have on
               14 Springfield, Missouri, was so different because it was looking
               15 at S09LCtliing broader than the inside operation of a hospital.
               16             DR. SILSBEE:  Dr. Scherlis, there is an EMal training
               17 project in  their regular application.
               18             DR. SCHERLIS:  Yes, I  now.
               19             DR. IIC PIIEDRA!I:  I was ou   o  regon on a program
               20 site visit  a month or so ago and I am surprised that they
               21 haven't worked this up differently.
               22             DR. SCIIEIZLIS:  Do you have their application there?

                              DR. MC PliFDRAI@:  I am not disagreeing with what you
               23
               24 said about it, I'it-i jusL surprised.
  ce.-- Federal Reporters, Inc. DR. SCiiE-RLIS: It perturbs me, because this   could be
               251






      jr         1  part of their total system and what they want is that part of
                 2,of it but they don't approach it in a well-coordinated way de-

                 3 spite the communication from l@IPS.

                 4              DR. 14ARGULIES:  It does suggest that basically they

                 5 aren't terribly interested in it.

                 6              DR. MC PliEDRAN:  I think so.  We all thought it was

                 7 a good program staff.

                 8              DR. SCIFERLIS:  Well, is there a second?

                 9              DR. MC PIIEDRZ@N:  I'll second it.

                10              DR. TOOI%IEY:  I agree.

  "nd                           DR. 8CIiERLIS:  We ate the whole thing.
                11

  )f 27         12              (Whereupon at 6 p.m., the meeting was adjourned.)

                13


                14


                15


                16


                17


                18
                191
                201


                21


                22


                23


                24

  @e@ Federal Reporters, Inc.
                251




                                                                             122


    jrbi

                1                       AFTE'@RNOON S'FSSION             (1:00

                2              DR. SCHERLIS:  Wc, will mo-@i-e right along as best


                3  we can.


     xxxxx      4              Rochester is next for consideration.


                5              DR. McPIIEDRAN:  Yes.

                6              DR. SCIIERLIS:  Rochester, Dr. McPhedtan.

                7              DR. McPHEDRAli:  This is a set of four projects for

                8  which support is being asked, each project for three years.

                9  I think it may be of interest that @-he total. annual @IP Budget

              10   in this region is given on the left, a figure that we haven't

              11   referred to before.  858, 806.

              12               If you take Year One, these four projects would
              131  add a total of about -- not quite $250,000.  This would be a

              14   big increase in total funding.

              15               A good deal of this is on a contract basis for

              16   various kinds of activities.  The activities are in really

              17   three spheres.
                I              There are four projects in three k4,nds of activity.
              181
                1
              191  one is to develop an emergency care and coiflii@un-@-.catiori rvs-L(,Nni
              20   usi-.ng some modern --c)mmiiriicati.oit tecILI@iology.  And ttiere is e,

                   fair-sized proportion of the first vear expe,)-,diturc- wh-Lch is
              21

                   devoted to that, $30,000 iii eqtlipi7,lerit out of the $1.00,@I)OO
              221
                1  first-ye@-,r .-r--quest for that portion.
              23

                               Tha,@, ent,-rgen@@y c 'I@C CO'.'r,,T'IL,,n@'@, cation to
              24,
                                                                                            cn
                   set up t@-V,'o-,way conrluni@czLtior;s lir,,)-zirt@g hosnita.Js, crnprgc,@ncy
              251




       J.L                                                                     123




                    rooms, and attendants, and to develop a manpower training progi:ai

                2   for continuing the in-.service education  of  emergency  personnel,

                3   and to develop standard procedures for handling emergencies

                4   both outside of the hospital and to  some  extent  inside  the

                5   hospital.

                6              This proposal lacks details  of  such  important  things

                7   as how the training program is to be actually constructed, and

                8   the assistance-in sharp contrast to  some  of  the  other  programs

                9   that I've reviewed in which there  was  sufficient  detail  to

              10    really tell what it is they intended to do with the training

              I I   money.

              12               Then, the second kind of activity      excuse  met,

              13    that first activity is to be contracted out to an organiza-

              14    tion which is called the Southern  Tier  Health  Services  Corpora-

              15    tion, which is largely -- it consists largely of the directors

              16    of several hospitals, about five hospitals.  But that, again,

              17    doesn't seem to really represent  the  whole  region,  because

              181   that is only about a fifth or a fourth of the total number of

              19    hospitals that are in the  region.

              20               So that it seems as if there  is  some  doubt  that

              21    the Southern Tier Health Services Corporation really represent
              22    even the hospitals fairly, or proportionately, in the region.
              23@              The Southern Tier Ueal.th Services Corporation is al@bo
              241   a subcontracto,,- for one of t%@@-c) '@-clr@phone referral services
  e-Fedefal Repo.@ters, iric.  I
              251   and for this element, for the         year, $61,000, this  i-sa







                   general referral service to be provided by this health  service

               2   corporation, and part of it will be to assemble the  necessary

               3   data so that an appropriate referral can be made, but the

               4   main purpose is a telephone center which would respond to  any

               5   kind of health information at any time.

               6             The training of the kinds of operators who would

               7   perform this service is mentioned but again not described in

               8   sufficient detail for me to be able to get much of a feeling f)r


               9   it.


             10              The third of the four projects is  another  telephone

             11    answering system. This is to unify and refplace  several  crisi

             12    phone services, one a poison control center, but also a  teen-

             13    hot-line and I think a suicide prevention -- I have  forgotten

             14    if this is in this one or not.
             151             But this is a crisis phone service. It  is  hard  to

             16    see from the application why this crisis phone service could
             1711  not somehow have been unified with the general information  and
             181   referral services, whether there oughtn't to be some iiiter-
             19@   relationship.

             20              This brings up @--he general point about the whole

             21    application, that it is hard to see interrelationships  between

                   the several kinds -- the several projects.
             22

             23              The last element in the request is a planning and

             24    devc@lop,,nc,,iii--al elei-r@crit, and 'L2-L. concerns itself %,.7itii developing
  e- Federal R(@porters, Inc.1
             25    comprehensive programs for determinations of i-,iaii,@)ower needs,




       j rb @-i                                                              125





                   facilities ne-eds, transportation, data collection, and analysis;

               2   and setting up a model for evaluation.

               3               Now.- the phones -- you can break this down several

               4   ways, but the first element that I talked about, the

               5   emergency care and communications, is $100,000  the  first  year,

               6   43 and 30 the second and third, or a total of 173.


               7               The two phone referral services, putting them

               8   together, come to a grand total of about 270,  and  the  planning

               9   and developmental comes to a grant total of 132.  Three-year

              I 0  request is 573 -- $573,000.-

              11               Their relationship to each other and their relatior-

              i2   ship to the rest of the program is  difficult  to  ascertain.  It

              13   seems to me that individually, they have       each one of

              14   them has moderate -- some merit.

              15               For example the emergency care and communications

              16   one is certainly no worse than the one that we have funded at

              17   a much higher level in Western New York, Lakes area.  My
              181  feeling about them separately and individually is that they
              19   rate "C"', that is, a "3" rating for -- I would rate a  3-ratin--

              20   for the planning and development, a 4 -- excuse i-,ie; I'm going

              21   the wrong direction --

              22               A 2-rating for the telephone services, and a 3-rating

              231  again for the first element, that is the emergency care and
              24i  coiL-ctunications.
   Fedeta!  Reporters,  Inc.
              25               I wish that the telephone services could be





         '@rb5



                I    combined and somehow  reduced  and  total  expenditure,  it  seems

                2    to me, the total amount that is being asked is very high.


                                 And it seems to me it  could be done on  a more

                4    limited basis for much less money, and I would like to recom-

                5    mend that the funding be, instead of now totalling about 265,

                6    as I say, closer to $50,000 or  $75,000  for  the  both  of  them,

                7                DR. SCIIERLIS:  Is that per year?  Is that single

                8    years?

                9                DR. MC PHEDRAN:  I was thinking about the total

               10    amounts but perhaps it would  be  more  intelligent  to  say  that
               11    for  the first year, that is cutting them to about $10,000 for

               12    each  of them instead of their projected present level of

               13    $16,000 for one and $54,000 for the other.

               14                So I would -- I think I would recommend that the

               15    emergency care and communications, which I would say rates

               16    a "C" -- that that recommended  funding  be  as  is,  a  $173,787;

               171   but the telephone referral services be --

               181               DR. SCHERLIS:  Could you give us the number?
               191               DR. MC PIIEDRA@N: 30B and 30C, that they be somehow
               201   combined into a single telephone referral system, and tha"-

               211   their support be much reduced.

               22                DR. SCIJET@U, T- S@qas that $50,000?
               231               DR. BESSON:  There is a little problem there 1.)ecau k@

               941   they are f-or different areas of       region.
  e-Fedef,if  Repolt:?ts,  Inc,I
               2511              DR. iviC PIIEDPI\j\': I see what you mean. One is  the




    3rnb                                                                           127




                 I   Southern Tier and the other is the Genesee County.

                 2               DR. BESSON:  They have nothing to do with each

                 3   other as far as telephone linkages.
                 41              DR. MC PHED-RAN:  Yes.

                 5               DR. BESSON:  Maybe it would be helpful if before

                 6   we get to funding, if I might give some comments on this.

                 7               DR. MC PIIEDRAN:  Please do.

                 8               DR. BESS014:  Okay.

                 9               As Dr.  McPhedran  has  said,  there  are  four  parts

               10    to this application  and  at  the  risk  of  reiterating  some,  I'll

               11    say there  are  two  general  areas  of  this  Rochester  regional

               12    medical program that are included.

               13                one is the area of Monroe County, which is around

               14    Rochester, and the other is the Southern Tier Area which

               15    encompasses four counties.  The first two projects, 30A and B,
               161   are -- first  is  the  emergency  care  and  communication  net  work
               ]7i   for these  three  counties  on  a  contractual  basis  with  Southern

               181   Tier.

               191               The  second  is  a  health  information  referral  and

               2011  counseling  service  for  the  same  area,  contracting  with  the

               21    Southern Tier, again.

               22                If you'll look at the  map  of  it  --  in  the  applica-

               23    ti.on on pa ge 3, you will see how removed geographically these


               2411  two areas are.

  @--Fedeial Repoftets,
               2511              So the Southern Tier is the southern portion of thi.









                    map, and then Project No. 3, community health information and
                2   crisis phone services for Ilonroe County and surrounding areas,

                3   is also on contract to what is called the Health Association of

                4   Rochester and Monroe County, which is a consortium of volunteer

                5   agencies.

                6              The fourth project is finally getting to the

                7   regional medical program of Rochester, planning and development
                8   component, for the ten-county region, the entire region.

                9              Now, as I read through the application -- and gear

              10    with me for a minute while I give you my sequential thinking

              11    to come to my conclusion -- I was impressed with the way the

              12    letters of endorsement all said the same thing:

              13               "Please accept the letter in evidence of our

              14    support."

              15               There are four letters which say the same thing.

              16    I said to myself, where do these letters originate?  They were
              17@   all addressed to Southern Tier Health Services, Inc.
              181              So I thought, this looks as  though  the  Southern
                1
              191   Tier Health Services, Inc., acts like  some  organized  group

              20    and on page 12, I find that Southern Tier Flealtli  Services,

              21    Inc., is a not-for-profit corporation %@7hich was just approved

              22    by the Corporate C(r,@mission@r with specific functions being

              23    listed on page 12, implementation of community health delivery
              2411  system, physical managoinc-n@-, @,C).x-,:iin:L@;trati've mo-.ziageTr,.ent,
  e-F;-,derat  Repoftr@is,  Inc.
              251   monitoring placement of r)at-ictn'L,7, i.-nd j..ni.t-Lat-Lon of ne(@,dd-cl




                                                                          129


               11  experimental health delivery innovations; so I said this must

               2   be an experimental system.

               3              But then I looked at the next page, where it  des-

               4   cribes Southern Tier Health Services Corporation, and it says,

               5   "Board of Directors of this corporation is made up of 12 people

               6   from the hospitals and 12 people from the community."

               7              And thereby is sprung the trap of who this corpora-

               8   tion is, which is a consortium of four hospitals interested

               9   in feathering the wrong nests, it seems to me, and they  have

             10    the primary ob4ective of developing and managing a comprehensi e
                                 .i                                              r
             11    personal health services system ostensibly of the  community,

             12    but it seems to me fortunately -- redounding to the  ultimate

             13'   benefit of the area encompassed by these four hospitals.

             14               Now, On this Board of Directors there are four

             15    administrators as you say, four board of directors,.and  four

             16    physicians -- they don't say who the physicians are, but

             17    presumably I would think they are with  bos.pital orientations,

             18    so that this corporation really is not a community effort,

             19    although it happens to have 12 corporate members -@- community

             20    members on it.


             21               So the question that was raised in my mind about

             22    these two projects, 30A and 30D, which are going to be
             231   subcontracted to this corporation, is how representative can a
             2411  four--hospital coalition be., in rl-)e@.-,king for ',--he community with
  @-F(,@defat  Rcpoftefs,  Inc.
             25    this It-lirid of reT)resent@it,,Iori?




        J.L Li 17                                                          13 0





               I              Now, that deals with my paranoid nature about these

               2   first two projects.

               31             The Project 30C is also going to be subcontracted tD

               4   a health association which is a consortium of voluntary

               5   agencies that is going to work with Strong Memorial Hospital

               6   to do something thathas already been on-going, which  is  the

               7   provision of a crisis-care phone and community health informa-

               8   tion coordinative functions, which has been on-going.

               9              And as they break down the number-of calls and

               10  what,they are,about, and who they helped and how many people,

               11  it seems to be a useful kind of effort.

               12             I am also impressed that in their budgetary requesti

               131 for this, they are going to be on an extensive  cost-shari,ng

               14  program with Strong Memorial Hospital in Rochester.

               15             Finally, the fourth program,  30D, planning and

               16  development, is to do what this group should have been

               ]7i doing right along, which is to look at the entire ten-coiintv

                   region and say, what can we do to put together a coordinated

                   systera7
               191
               201            Putting that all together, suggests to me  that  I

               21  would be delighted to fund the planning and  development  and

               22  get them thinking in global terms.

               23             1 would be leary of funding a four-hospital

               24              a,-id cor.,L,-,@unicat-'@oi-, nc@ti,!Ork which I think i.!i

  @-Fc,deral   Reportefs,   In
               C.  what of a ruse for doing -- haviiip,- Li hospital buy so,-fie equipme- t
               251!




     jrblo




                I    for developing its own internal coimrtunica-tions network
                21  and linking it with a very meritorious program, namely,
                3  inter-liospital communication.
                4              As far as the third program is concerned, I like

                5  it, but again, I wouldn't be interested in maybe buying a thre@-
                6  year project, but maybe one-year. So I  have  somewhat  of  a
                7  different approach to this, Dr. McPhedran, and we'll put
                8  it up for grabs.

                9              DR. MC PHEDRAN:  You think that the Southern Tier

              10   Health Services Corporation, that is the first one, that it
              11   is so unrepresentative as to just be unacceptable  as  an  agency
              12   for doing this?

              1 3
                               DR. BESSON: As I view what is  happening  to  the

              14   thrust of RMP nationally, or the  experimental  systems  program,

              15   or comprehensive health planning, I see that there are a

              16   varieity of consortia being developed  to  address  community
              17@  health problems.
              18@              Now, all of these organizations exist in  this  area,
              19   Why should we fund a four-liospital coalition witli a board  that

              2 0  is made up  of 12 people fro5,a the hospitals, and 12 from t e

              2 1  commune tv?

              22               I 'would dare say that the 12 from the  community

              23   will never  be there entirely but the 12 from the hospitals w l@l

              24   alwp,@rs be there, sr, that th-@-s is a hosy-,ital--dirc.@ctecl effort.
  e- Federal  R(@porteis,  ftic.
              251              Now that N,.iou:Ldn't be bi,@d if these were all
                I




                                                                            13 2





                   community hospitals, but they are not.

               2               one is S@L.. Jos(@ph's Hospital, one is -- I don't

               3   know which the others are. But it  has  a  hospital  orientation,

               4   which I think is a different slant on what RMP is trying

               5   to do in having a broad-based community representation.

               10              Now, that falts them slightly, but I am a little

               7   suspicious that this is not the vehicle we ought to be encoura-

               8   ging.  We should be encouraging RMP to be the vehicle, or

               9   COMP planning, or some kind of group to work- together.

              10               DR. SCHEIZLIS:  Yes?


              11               DR. JOSLYN:  I don't know whether I should be raising
              12   this, but  I have not read this application, but just  from  what

              13   we are talking about here, it struct me first that her,-- is a

              14   community, whether or not it be hospital-dominated -- and I

              15   would like to know what the other hospitals are in this four-

              16   county area, and whether or not they are involved,  or  maybe  --

              17   I don't know if there are other hospita"-s -- but it  strikes  ME

              18   that here is an area that is active.

              19            .  Now I would like it coordinated w,-th, you licnow,

              20   whatever programs are going on in the total FI,IP but it seems

              21   Me one of the things we have been arguing for is that you
              221  cannot bring- a plan, whether it is developed by the RMP or a
              231  consuitirit, and drop it onto an area.
              241              And I am wondering if,                 this

  e,-Fedetal  Repoitprs,  lric.
              251       is growing up ought at I-e;Ast to be met lialfwci.@,r, in the
                   that




      jrbl2                                                                     133



                I   sense that -- I just don't know -- I  can't  judge  from  here  --
                2   whether this is really a meritorious group or not.
                3               DR. MC PHEDRAN:  It is just that there are a lot
                4   more people in the area, that is the  point  that  Dr.  Besson  is
                5   making.

                6               There are other hospitals and
                7               DR. JOSLYN:  In that four-dounty area?

                8
                                DR. BESSON:  I don't know.  All I know --

                9               DR. MC PHEDRAN:  There are.
              10                DR I.I BEISSON:  This is a group of four hospitals --,hat
              11    are opportunistic enough to create a non-profit corporation,
              12    and T think that we are creating a --  somth4-ng  that  should  be
              13    aborted right noa.
              14                That is not a coirmunity-representative group.  It

              15    doesn't have the linkages that we are after.  After all in the

              16    guidelines we say we should  have  provider,  payer,  public,  and

              17                DR. MC PHED@.N:   All provider.

              181               DR.  BESSON:   But this is just a bia.sed group.
              19i   I don't think  they  can  come up with any community answers.

              20                DR. SCI'&EPLIS:  Ithink we have to keep referring

              21    back to  the  ETIS  guidelines which were given to this group

              22    because these were the bases for  which  the  various  offers  had

              23    been made.

              24                Dr. Gi,-,@Lble, you revie@,@c!d this project, I believe?
    Ff,-(Ierat Ref)ortcts, Inc.
              25                DR.          Thc- only conuiicri-t 1'. c,@).fi i,,ieke, on this




    j rD.L -i                                                                134





                    particular point, I had mentioned that of  28  hospitals  in
                2  the region, five are actively involved.
                3              DR. SCHERLIS: How many hospitals?
                4              DR. GIMBLE:  Twenty-eight in the region, and five

                5  are actively involved.  And much emphasis is the University

                6  of Rochester, that's Strong.  There appears to be active
                7  participation of the CIIPB agency.
                8              DR. BES80N:  In one project only.,,

                9              DR. GIMBLE:  The other problem as-you have already

              10   mentioned,  is the very poor interrelationsh@p@,lbetween the
              11   proposals.   It is alluded to but I think  they  mention-that
              12   the emergency care service will be linked  to  the  telephone

              13   services and that is as far as the linkage is  described  in  the

              14   text.

              15               I had lots of doubts about the entire project.

              16               DR. SCHERLIS: What sort of statement  do  we  get

              1 7  from you two in this regard?
              18@              DR. MC PHEDRAN:  I guess what we agree on, on 30D,
              19   we would recommend it for funding as is.  I gave it the A-ragiiig

              20   of 3.

              21               DR. BESSON:         agree with that, full funding.

              21               DR. MC PIIEDRAN: On 30C, I was mistaken  about  where

              23   that was, and I think that we -- I would go along with Dr.

              24.  Bosson's recorrLwendation for 01, and not 02 and 03, as is, for
    Federal  Reporters,   Inc.
              25   54. -- giving that a rating of c also.

                I                                                                  -




      Irbl4                                                                    I -i




                                DR. BESSON:  Okay.

                2               DR. MC PIIEDRAN:  Or 3.


                3               DR. DESSON:  Okay.

                4               DR. MC PHEDRAN:  For 30A and 30BO, if it is not

                5   sufficiently representative of the community  as  a  whole,  the

                6   Southern Tier Health Services  Corporation,  perhaps  the  thing

                7   to do is simply not to recommend them for funding because

                8   they don't meet the EMS guidelines.

                9               DR. 8CHERLIS: Do you  concur  in  those  recommenda-


              10    tions?


              11                DR. BESSON:  I do.

              12                DR. SCHEP,-LIS: Any other comments from  members  of

              13    the review  group?

              14                All those in favor please say "aye."

              15                (Chorus of "ayes.")

              16                DR. GIMBLE:  "A" and "B" are disapproved
              171   because they don't meet the recommendations of the guidelines.
              18j               DR. SCIIIEI@T IS:  Yes.
              19                DR. GIMBI-.IE:  Project "C" is a 3-rating for one year

              20    and the next project --5or thrc@c years?

              21                DR. MC PHED.RM:  Three years.

              22                DR. SCIlEr@IS:  I thought that was going to take

    Oll Lee   23 1  much  longer.
    CR6307
              24

  f, -Federal Reporters,  Inc.
              25




                                                                              214


    CR 6307
    0 19

                             DR. SCIIERL-ILS.: All right. Any  dissenting  voice?          ON
               2@            Well, then, go ahead to South Dakota.
               3             Mr. Toomey, again.

               4             Following South Dakota, I assume Alabama.  Is that

               5  the correct order?


               0             DR. HINMAN:  Yes, sir.

               71            DR. S;CHERLIS:.  Alabama will be next, so contain

               8  youtL@-elf..
               91            MR. TOO@IEY:  The University .ofSouth Dakota is the
               101applicant.  The funding is requested for the first year, 470,000
               11 and I have none in the second and third vear.
               12@           Is that right?
               13            DR. MC PHEDRAN:  That's right.

               14            MR. TOOIEY:  South Dakota does not have an effective

               15 emergency health service; hence this grant wi.11 cover the entire

               16 state.
               171           The basic problems are those of small rural   popula-

               18!tions with large geographic directions.  There are very few
               19@train(,@d ambulance drivers or emerg(@ricy technical personnel
               20:r,lanning the ambulances of the existing emergency transl-)ortati.on

               21 system.

               22            There is little public knowledge  as  to  lifesaving

               23 techniques in the utilization of ainl.-ulance and training

               24 techniques.

    Ffdeiz4l Reportc,,ts, l@)c
               25            Generally South Dakota ltas f(@@v 1-iost-)it-als and they





                        I  have varying capabilities.   It has a high tourist population in
                        2  the summer months with a high incidence of traffic accidents.
                        3                 The state geographically encompasses  an area the size
                        4  of Delaware, Maryland, Virginia,  and West Virginia, but has only
                        5  1/17th the population.
                        11                The specific objectives of this project include the
                        0
                        7  establishment of medical  technician and training programs,  the
                        8  establishment of hospital technician training programs,
                        9  categorization of present hospital emergency services,  establish
                      lo   ment of health consumer education programs,  and the purchase of
                      11   medical equipment for ambulances.
                                           The planning process  includes three phases of
                      12
                      13   implementation:   Phase one includes planning,  demonstration and
                      14   procurement;  phase two,  the implementation and utilization of
                      15   the planning demonstration projects  and procured resources;And
                      16   phase three,  the operational phase.
                      17                   All three phases encompass  the total components of an
                      1 8  EMS  system      including consumer education,  ambulance purchase and
                      19   equipment procurement,  classification,  categorization of
                           emergency health services,  emergency medical training,
                      201
                      21   standardization of emergency services,  communications develop-
                      22   1inen-t,  physicians'  assistants program,  integration of  emergency
                           health services components  into the curreftt system.
                      231
                                           -Lhe   narrative docs not indicate how                  the,Nrarious

     -Federal Repot ters,  Inc. p-ha!ses v7il@l 1.)e integrated into the existing system.
                      25




    mea-3                                                                    216



                             The geographic area has  been  described.  However,
               2   there is only partial reference to involvement by  providers,
               3   public agencies, planning agencies, and communities.
               4             The narrative does not define existing medical
               5   service areas in the region.  However, it does partially
                   speak to potential resources, and the assessment of needs and
               0
               7   resources in the area.
               8             There are not adequate facts to document statements
               9   referred to in the narrative.  There's inadequate information
                                                                      o 'dinated
               10  to determine how the operating components will be c or
                   with already existing elements of an EMS system,
               12            The narrative does not describe the linkages with
               13  local health care systems nor is there adequate information to
               i4  determine whether there's cooperation in  community  disaster
               15  planning or preventive medical systems.
                              The ap lication speaks briefly to the point of
                                    p
               17  utilizing additional financial resources and for obtaining
               18  additional financial support after the expiration of this

                   grant.
               19
                              There is no general, overall innovative approach to
               201
               21  the development of an EMS system in this area or any assurance
               22  as to the quality of care to be rendered.
               23             Once again, to turn to the staff evaluation --- while
                   this application has mciny good ideas, z).s an  p@)licat;-on, as a
               24@
  ,ce- Federal Reporters, In,,. plan and as a tool to achie\re a total. EMS systeyn, it in iny
               25,
                 I                                                                  I



    me a. -                                                                217



               I opinion fails.

               2            There does not appear to be sufficient depth  in  the

               3 description of the problem of EMS in  South  Dakota.  Statements

               4 are made but they aren't backed with facts.

               5            For example, they state many lives are lost, but

               6 don't state how many, where, why, when, and so on.

               7            The applicant talks about utilizing PERT, PPBS,

               8 management by objectives.  They have demonstrated its use.

               9            The application needs better organization, a clearer

              10 definition of problems, needs and objectives and a clearer
              11 picture of a total EMS plan and a better interpretation  of  the
              12 1 EMS elements.
              13@           DR. SCHERLIS-:  Dr. McPhedran?

              14            DRI. MC PHEDRAN:  I agree essentially with the
              15 evaluation, that it is a portion of what we would want  to  have

              16 in an Bl@,is 'but not the whole thing.
              ]7i           Notice that the projected budget for year one is
                 1
              18 greater than the total annual budget for the South Dakota

              19 regional medical plan.

                            Is that right
              20!
              21            DR. HINI,    Yes, sir, but I think there should be

              22 a co n-,i(-,nt made.
              23            South Dakota is in a planning phase, not an
              24 operational phase.  They have just sl3liL@- froir, Nebtasl-,a last year.

  ,@e-Fedetal Repoftefs, Inc.
              251           Dr.,. MC PIIIEDRAN: I %,ias going to b,-,-ing this out, that




                                                                           218


               I this is really essentially a brand new region.  I would not like
               2,to recommend that they get no funds;  I just think that this is
               3 an enormous amount to expect them to spend sensibly at this

               4 time.
               5             DR. S.CHERLIS.:@ What would be the rating of this?
               6             MR. TOOIIEY:  I would say it would get 2 to 2.5.
               7             DR. MC PHEDRAN. I gave it a 2.

                               .SCliERLIS-.-, . Would you agree
               8             DR.                            on 2?

               9             Two is the rating.
              10             MR. TOOT-EY:  I think they should be given a planning

              11  grant.
              12             DR. SCIIERLIS."  What sum would youthinkwould be
              13             MR. T0014EY:  My estimate would be $50,000.
              14             DR. SCIIERLIS  Dr. McPhedran, what would your

              15  feeling be on that?
              1 6            DR. MC PHEDPAN:  Yes.
              1 7            DR. 5CIIERLIS   These are num!Ders from the air but
              18  at least they are based somewhat on the project itself.
              1 9            DR. MC PHEDPJ@N:  On looking at the figures, that is
                  sort of about half of what they liaCi requested for I)ersonnel -FC,3-
              20  1
              21  1the first year.
              22             I think that is a            figure.
              23             DR. SCIIEPLIS@- Do we have comments from the group
              241 on tIL-,Ii s?
  il@e -Federal Rei)oltefs, Inc. DR.      Did you say 150?
              251
                  1































                                                                                   219
      i,nea--6
      . I


                  ii

                                                  i-if ty -
                               DR. MC PHEDRAlil:
                1
                               DR. SCHERLIS:     Fifty?
                2
                 3              DR. 14C PHEDRAN:  Fifty is what I said.
                                      @1F.RLIS:   All riaht.
                                DR. SC                   1
                 4





                                                                                                               136



             o r - 1                             S(,'I',YE@LIS   Tri-Statc@?

                       2                   DR.       PIIEDIU,,N     I think this is a, very good
                         1                                                                           I  4
                       3  proT)os,.1.1   a)-id I v@ould rate it as a four to f ivc-1.                   L-.hii-Lk it

                                @@c   of   the   t%@)o   or   three   best   that   I   reviewed    among    the
                       4

                       5  one@,          I did as primary and secondary reviewers

                       6                   The proposal is a large proT?osal.   It  is a pro-c-c-t
                                                                                                               .i

                       7  number           and t-l-le requested funds are over about @850  L--Al@(Dusaii<3.

                       8  on the average for each of three years,  or a total of $2.54

                       /0 Mil.lici@.!,    for    the    three    state    area    in    Massachusetts,     Rhode

                     10   Island,  and Ne@q lIzcioshi.re.

                                             found in going through the ratin@f sheets,  tli(@

                                                          liat this proposal real'.v addressed T,, 0 S- t
                     i2   vello@,,  sheets     here,     t,

                     13   of   t@i,@ Particular questions very                        It wE@s  ;-i  deL'-aile,,i

                          proposal and took up virtually everv aspect of mergence,
                     14

                     1-                    to emergencies, designing                         of     educc-@ticii

                                    r      c i o@ r;
                     16

                                           I t @..,a s no4- innovative,  L-,u-L -1 do r4c)t really fl,
                     17
                     18           tc)                L,@l an,,, ("-U,                            is a

                                                      P,@ll th-                  f actc.,,,-        ir@ :ell -rr,,-@4-Jy
                     19

                     20   o -Li t I i i iu' T Jc-i    vcr@, s, tr o i@q@                       x

                                                                            I_)U  ;Lil.c;o @t
                     21

                                                                                    c)f-
                       2

                                           It
                     23


                     24

   ct,--Fr,deraf Repo(to@is,  i-@ic,
                                                      c                             1 a Ci   f o r c@ n IC   C@, s -  a @i- C.
                                                  4
                                         '10  vc'           Or
                     251!'




      e r - 2                                                                                     13 7




                    I  di-.r-fo,,7(-@nt in ,-!aE@s,-ichi-isetts, it is t-le Department of Pul lic

                    2   Ilealth,   and i 1-1 Thode Island, i'- is largely the Hospital

                    3  ,Issociation of Rhode Island,,- and also, I think, the Medical


                    4  Societv.


                    5                And in New Hampshire, beginnings have already been

                    6  made in some emergency planning -- actually in all three states

                    7  'I--hey  have,  but   in   New   Hampshire,   some   planning   for   emergency

                    8  medical systems centering around a project in Hanover have

                    9  already been begun.

                   10                I  thought  this   was   a   very   good   proposal   in   nearly

                   11  every respect.   IL-. is an aivful. lot of money.  P-ly word.   And

                   12  yet,  I  roa2.ly  just  do  riot  know  how  to  suggest  that  it   would   be

                   13  i-)ared do,,7n..@  I guess I would recommend that it be funded in

                   14  e@iclt-l of three years, but it seems to me,           inconceivable       that

                   15  @@i(a       have invthi-iig like tl-ie          of money thit-. col-li,,_i

                   116 r@.@et these deTiands for requested funds.

                                     I do not like to be in tle position of su,-
                   171
                   18            arbitrary rc@ciiictic,.,n, but I guess th@it is               I

                   19                DR. SCTI            I think @,7o have b(,ci-i                call.

                   20  T    1. !'I -ri


                                            C)o  y
                                     L                D:i@l. YoiL Dr.              saw, L
                   21


                                     DR.  ;'IC
                   22

                                       T                 Ily conce
                   23                D@l   SC[                     ryi ir3 the ol,)vi.ous         t@li@.it

                               -17
                   241              .-E                                                           gc)

  'kce -Federal Repo;tefs, Inc.
                                        ljzi@ this                     to COT-it.@,,.-act
                   25



    tc,r-3                                                                                      13 8



                    I                DR. BESSO',q:    '!'here has b@,c-n a contract ap,,-)licatio,-i

                    2  from Boston.

                    3                DR. SCIIERLIS:   It does not include this?

                    4                     STOLOV:   They are complimentary because they

                    5  are not included in the projects.
                    6                DR. SCI-IERL@7S:   All ri-t7,1-it. Secondary    revie@,,7er?

                    7                DR. BESSON:      l,et ,is see.
                    8                This is a complex and.a v(,-rk.7 excellent application,
                    9  and if -.r can make a crack at breaking it down,             and  see   if
                  10   we can come to grips with funding a little bit, I would say
                  11   that it is composed of three major efforts.
                  12                 one is to subcontract to B Agencies in the
                  131  t4a.,7,@,aci)usetts  Department  of  Pul:)lic  Ileal.tl-i,  its  equivalent  in
                  14   New  Ilar@i,@shire,  and  its   equivalent   in   Rhode   island,   for   indi-
                  15   vidual project e-Lcforts in their ireas.
                                     Two, is to attemi-)t through            to   provide   a   cooi:-
                  16
                                  effort in the L--ri--statc@ )-..@asis for I.ool:i,-ig to the tri--
                  1 7  (A "
                  ,81  @,;tc-itc, -@,,i-cas as a single, glosDal a,-ca that has certain y)):C'
                                                                                                     7

                  19   in            and                       coor(l-il:).,Iti.ve activities.
                                                           @i -@)ro,-,r T@n for E)3,@iriri)-xig r,,nCi
                  20

                                                                                                1) a].!
                  21


                  22
                                            if %vc, 1(-@-I)k at these t'ir(:,c- offer!   tl c    3
                  231

                                               do,,.iil  -1: o
                  241
  %ce- Federal Repc)rtp-rs, itiI
                    " I                   of               th(-@ii.- o@@i-).
                  25-




    ter-4                                                                          1-39




                I  Massachusetts, Central -@.lassaciusetts, North Sliore, Greater

                2 Boston, Middleborough, Amer.-i.m@-,c Vallev, New ilarnpshire,  and

                3 lzhode Island.

                4              Each of the B agencies in Tia.ssachusetts, as well as

                5  the I)epartment of Public Health, are going'to do a little piece

                6  of the problem, as they see it-- locally.  Now, the sophistication

                7  of each of these groups varies from the sublime to the ri.clicu-

                8  lous. New 'I'lampshire has had some work  in  the  past  and  thev

                9  are quite mature.

               10              Some B agencies in @lassachuscti--s are Dust embryonic.
               11  Arid there is a great variation in the degree of competence in
               12@ei--h of them. But yet, tri-state  Rr4P  is  saying,  let  us  let
               13 ea,;Ii locality set up its o%in program while we learn about
               14  @.7hat to do in viewinu the en@-.4-re tri-state area as a  sinrtlc-
                                         1

               15  r@,clric)n and %.7e @.7ill. enc@,.T.)ass L",icir acti.v-i.tieE; eventually into
                   an o7iorall plan, i%lhich I L-Iiinl- j.!7 -i ],.auc,al-or-,,r wa,:, of alDproac.Iiing
               16

                   the individual pieces without u,,3uriDing locals' i-)rc-.rogati.ves.
               17

                               The                 D(@I)artr,,iont of Pul)li.c ilcalt-ii,
               18'
               19 @tl-,c, other      hz,@s. had its    liti.-Ijl,.e tl-iingE, they C).rc@
                       lencc- --@,ul,-iti.c)n F@nd           which the,
               20                                                      .7 t@ave

                                               oro,'"Iu,,-cci T-)a.ss@-tce of a Fouse bill, c-,i-
               21
                          it is I-)enCti-iiq, to set E'IS Aclvisorv 13oct).--d for the st-atc@.
               22

                  iT'-,ov are ii-iv,)lve(i in               of lic(-,,nsu,,,.-e for e-,-,,,@rqc@ncv
               23


                                                             L    year      n
               24'.

  .e- Federal "pofters, inc.
                                                        t
                                 -L <7, t ecl, c---- a 7-, l@--lila c.@ ,)ii
               25



   ter-5                                                                         140


                   services, and do nto overlap N-7i.tl-i the B agencies, with what

                   2the B agencies are doing.
                   3           So that, for this T)ortion of the application, tliev
                   will subcontract to these groups and hope fUll-,7 in time, bring
                   41                                                -i
                   5them all up to the same level of maturity.  Now, they make some
                   6interesting comments about what the possible alternatives are

                   7so far as their funding is concerne .
                   8           T@'or example, they say, in their narrative, that if
                   9this program cannot be funded in toto, they would suggest that
                   10 each state develop its free standing emergency medical services,
                   11 which is one alternative for ti@, to follow in trying to figure
                   1 2Out "O@-I to get out of this          9.1)@iey also go on to sa,@,
                   in their narrative, that if no fundinc            'lal)le elsewhere,
                   13                                       f is avai
                   the- state will be self-supporting within a three-year period,
                   14
                   which is very encouraging at least, for them to say that they
                   151
                   lwil.1 rqoun-L this amount of Fioiiey at the end of three years;
                   16
                   171bo---h of which I think are very reasonable and mature statements

                   181 to
                               So far as the c)t,it@, t@.;,o i-)rocrai-,,.@,, are concerned, the
                   19                            i  -         j
                   icc--,,,-i-tral ccc)rOi-nation of trainin-, and the planniric and c-,ial.uc-,t-.Lon
                   20
                   21    of  thcT.,-L,  -rL  ir(-,- meritorious.  Tl,,c-@ planning and
                   22 e,,7aluatio,-i, I think, is pdr-Li,c!-k@larly so.  They F4p-,-ak of eval..iicl-
                   tiori as a Iiinction of 'IL-.ri.-stj.)..te   medical proc           11-i-
                   23                                                              inc

                   241

  Ace-Federal  Reporters,   Inc.
                                                                         4
                        T)r,-.)c er, a ad j- c@l- i ng,- @l c)(,-, i-,s  Ln
                   25





                                                                            141


                  pro3ect achievement as a separate look, and then finally, doing

               2 what they call, impact evaluation.
               3             I think that this' is meritorious enough as a  moth-
               4 odology for looking at emergericv medical care systems  that  if
               5 thev can do what ti-iev sa-,7 the-,7 will do in some detail, that

               6 it will T)rovide a verv nice model nationally.
               7             DR. MC PIIEDPJUT: Except they say about the  impact,
               8  they do not "think they can manage it."  This last part, which
               9  sounds      the thir,@g that the,,,,7 have ov-er everybody else,
               10      say thev do not "think they can do it with their pre-
               11 @.achi.nerv," so it would hive -to come outside of this application
               121           DI@. BESS014: I @,@oulCi at least encoura(le th@,,iLi '@v
               1 3--r-iillv funding that'- portion of it, and I suv)l)osc@- --- I do no-L@.
               14      ii-lo@.7 to reach a number N-ii.t@il this, it is Et difficult ques-
               15,     t(,) grai.-)r)le @,?itli. If there is-, ).iiv T,.ic@ri7t to the notion
               16 tli@tt @,,7e ought to dc-,vc-lon as large a dcL@-Ficit as we can I)y
                  a@--, i-,ii-,iay as we can, riiavl)e @.7e can turn off funds
               17
               18                             and r?ut tl-ie,,ii in here so @.-.Ye

               1     @.7cl.l I--,,uv the x,,,hole
                 9
               20              1, Ic. C l@: II L IY (@ s

                                     L,'D Vs
               2 1                          t-.e@f f                o;)servai-,.! c.)ij.

                                                         lan po\iic,-@--
               2 2
                               from the                   and j.-tE
               23

                                                                       f
                                  @nd               tc) 11--l-ic
               24

  Ace-Fedeial Rep,,rters, Inc.
                                                                   Hand     dc;
                       C       co r -o Irlici
               2 5   3




                                                                                                                142



                      I  have a sophisticated evaluator on this.  And maybe this is where

                      2   staff could aid..
                      3                   But, we looked also to  the  staff  out  in  the  Rhode
                      4   island area, the core staff out  in  the  liew  Hampshire  area,
                      5   and we felt maybe, since -thev did  assist,  there  could  be  some
                      6   fine lines  drawn.  However,  not  being  the  technical  budgetary
                      7   person on this, I just threw this  out  as  a  methodology  of  how
                          we wor,e looking at the co-amuni-t@,, base, manpower thing  too;
                      8
                      9   knowing the ambitious budget here.

                                          DR. B-ZSSON:  They  are  really  approaching  the  both
                     10
                          from the  point       of   view    of    encouraging    each    locale    to    do    their
                     1 1
                          own thing,  and       yet saying to themselves, \.jell we  are  going  to
                     12

                          coordinate        the entire  effort   and   at   the   end   of   a   -,,-c!ar   or   so,
                     13
                          they all should have enough maturit:@7,  so that we                      can    look    tO.
                     14
                          the devel,onineiit of a tri-state-vTi6e coordinated system, which,
                     15
                     16     think,    is     ve    nice.
                     17                   @,4hat did ,,,ou recoi,.-ciiei-id.?
                     18                   D)7,,. !,,'IC        :   I' fi,-il-"i it inil-)c)@ssible to  recoi-@,,m.end
                          reduced                in aii@, intelligent N.,,av.          I           go along with
                     19
                          cert,),,Ii,43,-,,,,  fully sul).@or@L---I-nq ,-.',le c-,7E-Ilua4-@ioll p@l),'.'tS. I am
                     20
                                                          l'iand,..,ic,  I       -,ure   they   \,,,ould   not   get
                     21
                     22   full funding                   there  is  n(.-,t  (@c)irg  to  'j.)c2  that   kind   of
                          mc)nc,",,  and I think          can recor-,,%,!Ilic.@,ii(-l @.,Iiatever  kind  of  funding
                     23
                     24'  c     1,@) c@ a -I- I o!L., t o tI I s
   (,e Ftderal Reporteis,  ltic.                                7,@ h      t- i-i    e                   tlii  s?
                     25




                                                                                   14 3




                  I             DR. I-IC PIIEDRAN:  t. 'our to f i.vc@. I think it is


                  2 very good.

                  3             DR. SCHERLIS:   Mr. Besson?

                  4             DR. BESSON: I am  going  to  give  it,  maybe  a  four.

                  5 I am going  to reserve "fivc@" for Alibama.

                  6             DR. SCHERLIS:  The  rating  is  four.  I  think  it  is

                  7 unrealistic to think in terms of full funding for this.

                  8             We might jeopardize a great deal by doing that.

                  9 What is your feeling on this, Dr. Rose?

                10              DR. ROSE:  Dr. Ilinifiaii mi-cjht speak to this.

                11              DR. SCHERLIS:  Yes.

                12              MR. STOLOV:   I kyio@.7  do not use a formula fu-.idin(

                13  as other IIEI,.7 programs have used, but as a yardstick, I i,7ou  d
                14  like to th.-o%v out- a factor, Dr. Besson, who has al@,7ays lo(.)ke
                15  at thinc          aii@itative manner.  Tri-state regional. medical
                           _Is in a qu  -
                16  -@rogram ranks 31 out of 56 regions in terms of funding, per

                17  capita funding, pe-r- that tl,iree-,-statc@, region.
                18              This is jusjt-- a fict to si).pT-)I(:--i,@ient -- that iia-y or

                19  naK,, riot hc-@lp ,,ou @7ith
                20                                             obfuscates  our   entire

                21  proble,-,i.

                                DR. IZ@T-,SSON:  That do vou mean bv treat r(-,mark?
                22 1
                23              MR. SI'0'7-,,,OV: I  di,   not Jrno@.7  or  not vou v,,anted

                    soft        f@-tct--  to h,,-,,J-"-)
                24

  kce-- Federal Reporters,  tr@c.
                25 IT do not '@nc,@,7  i'  it  is  out (@)f




                                                                                           14 4





                                   DR.               'I-lave a concern.   If  you  look  at   the

                    2  breakdown of the budget as per year one, the verv beginning

                    3 of the application

                    4              DR. SCHERLIS:  Opposite page ten.

                    5              DR. IIINI@L:    -- opposite page ten, you will see

                    6 in  the  first  vear,  $251   thousand   for   planning   and   organization,

                    7 and  almost  $600  is  allotted  for  things   that   might   be   considered

                    8 o,-irtiall  implementation.     I  just  wondered  if  1,7e  have  a  mixture
                               y
                    9 hero, and are dealing with an attempt -- they have 119 thousand

                    10 for data collection, and agencies; 251 thousand for planning

                    11 and or(-j,-,n-fza t4 on, and thev are -immediately going into education,

                    12 some (-,crui.r)p,,,en@'.

                    13             DP,. BESSO'@,:  Excuse  me,  Ed.   They   are   dealing   with

                    14 such  a  mixed  bag  here,  tliev  do  not  (To  from  that  to  education.

                    15 It is that thev are allo@,,ing each region to submit their own
                    16 budget for their particular needs, and I  think  @,71-iaL-  thc-,y  lia\lc@

                    17                               timul..ctted so tli@it cl-,-@lht r(@,-
                      doric- is gotten everybody s                                           here,

                    18 there are not c@i..cfht -- s     pliiF; 3--T7

                    19 Island, are siil),-iii.t.tiiig a        I),Li,(3.cfet.
                    20             It ha,@.@onfq to add u,,) -to 251,,O(,'O, but t'!-i,@,t includes
                    21 -,,loi.,. kno,,,.,-, they are     C\iorNoiie's  ';'-)-@iciget, and then on
                    22 top of  tl,,.,,at,  -For con-dj,.n@.I'L-,e(i   -,n(-,i co,).-L-, @,L I @:i L'-ioii, it is,

                    23 it!.-ic,.y are

                    24

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                    2 c5'





                                                                                                            14 5





                         year on,--?


                     2                   DR.  BESSON:   Yes.

                     3                   DR.  GIP-,IBLE:   The most encouraging part of the

                     4  application is the small amount that has been allocated to

                     5  equipment purchases,  so it looks like they said, we are going

                     6  to plan a lot and buy very little the first year,  and it  looks

                     7  like thev are doing it.

                     8                   DR.  SCIIERLIS:   I just wonder if they asked                    for

                     9   $10 million,  if our support of $10 million would be realistic,

                    10   and T question whether our recommending $850 thousand or $847

                    11   thousand is realistic.
                    121                  T think I would  l,i.k(@ to 1-ir).vE., a motion ra(.3(, for a
                    13   sum,  and if th-- r(-@co2-,-,mendation includes thit,  if additional

                    14   funds c@re available,  they should be funded up to so and so,

                    15 1 at a high I-.)riori-'$--y.

                    16                   DR.  RO,@@E:    It mi,7jli-L- Y)c@ easier  for the commit L'. e c
                    17  to make a recommendation and lot the amount of funds ]De I-iai-icl'Lee(,-,@.

                    18il adriiiiistrativo.-I-,.,, the @udcimen4l-- in terms of  1-io%,.,  ,iiticli  fiii-id@,

                    19   t'l-lev are cToing to be able to qc@t.

                    20                   DR.   SCIIETRILIS:   @@ie          d,D
                    21                   DR.                          the            tliiiicT I,S  r,.ierito- OUS.

                    22                   DR.   :'> C',-'L@ 13 L I SCi   ask        a                        -,or

                                      C'@t tlli.S )C)41,t?
                         a motion
                    23


                                         DR.                1, t
                    24

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                                       @n.
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                                                                                    14 6
    ter-11




                  I             DR. MC PTIEDP,7ill:  I feel so foolish recommending an

                  2  arbitrary figure based on nothing.  I have no way of basing it.

                  3 All I can do is say, it is a meritorious iDrogram and maybe

                  4 these things -- maybe they can consolidate some of this plan-

                  5 nin( , organizational activity.  Maybe, it would not have to

                  6be so costly.

                  7             DR. SCHERLIS:  Are @,ou recommending full support

                  8as rectuested?  1-@7ith a rating of four?

                  9             DR. IIC PIIEDRAN:  I am rating it as. four and re,-ili.ziicr,

                10 that full support is just not going to happen, could not

                11 possibly happen.


                12              DR. SCIIERLIS:  Dr. Besson?


                13              DR. BESSON:  I have a different view of this.  I

                14 do not view this -- it happens to  1),,a  trj--state,  but  it  would

                15 1)(-, likc-- sayincT, x,7ell, what is the eastern operations  branch,

                16 x-7hat ,,ind of Et I,)rogra,@-q do thev h@av-e?  Tlic,@), do not have a single

                171prograin, tliev have 27 nrograms.

                181             We do not have singlc@ program here, \,,le have ten

                19 @rograyis, so tliEit the number that I @,7ould use @.,lc)ul(a be ]-)rec',i-

                20        on tha-'L-1 E,,s an underlying             I tl-.iiij-, that til,@


                                    4- C)r
                21 'Prc)-,(z,!ct -;.s i-t(,-r 9, the      4--'iiing is meritorious, and it
                       i            I          i.@,


                22 I       to I,,c- forces'. to give a @'igurc-, I woill(,l li,-,v@- to say

                   I                                     r.
                23 tIc-, full thing and lot the               @,!hc@rc, they

                24              D l@ C,@ I I @q  I              @'C)U to

  ce -Federal Reporters, Inc.
                    ul.1                 :entering                                  si.,@ll
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   tc!r-1-2                                                                   14 7





                 I  it is quite apparent.
                 2            Any further discussion from members of the Review

                 3 Croup?
                 41           All those in favor, say "ave."

                 5            (Chorus of a@.,es.)

                 6            DR. SCIIERLIS:  opposed?

                 7            DR. BESSON:  I would also remind the Chairman

                 8 that

                 9            DR. SCIIERLIS:  I do not believe you recommended

                 10 the wliole ti-iing.

                 11           DR. BESSOIT: it is only one @,.Ting on a B52.
                 12           DR.          Urij@ort.urritely, we do not even have c-i

   end #12       13 motor on aB52, an engine.

                 14


                 15
                 16@
                 17@


                 18


                 19


                 20
   is            21
                 22


                 23
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                                                                                                1.4 8




        CR t)307                     DR. SCHERLIS:      All right.     @\7irginia.
        #13
        dii-1       2                DR. ROTH:     That one is mine.
                    3                DR. SCHERLIS:   Dr. Roth on Virginia.
                    4                DR. ROTH:   I think the.important thing to point out
                       to begin with about Virginia is that we're talking about a total
                    5
                       request   of   $30,250,   It   is   a   highly   hypothetical   applicet--,-on,
                    0
                                                                                                                  z
                       on behalf of a council which says that it is in the early
                    7
                    8  phases of initiating the organization of a ccnmiunityemergency
                    9  medical   services   council.   And   in   the.makin'gs@,   it   has    covered
                  10   that   whole   planning   problem,   if   approved   and   funded,   would   be
                  11   turned over to this council.
                  12                 It has not been approved by the RAG, and             although
                  13   we have only a request for this $30,250, it rates a                substantial
                  14   operating grant of $244,415.90, for a total 3 yc@z,,x- amount.
                  151                It is distinctly a matter of building upon (:!)L-.i,-@tin@.
                     I s(@-rvi.ces.  It is pretty sophisticated in the use of, for
                  161
                       helicopter  service is availa!Dle i,n the area.   But it is my
                  171
                       i-eelj4-ng that it is such a relatively small aTnoux-).@. ti-tat if  -,(-,.I-ie
                  181
                  19   only matter befor(--,Iu@ riov,7 is the approval of the $30,250,
                                                              2    to 4, ]:)ecause it-. lia!-=
                       @,@ou'd @,,i.ve the proc-      .3
                  20       L                        a
                       a. ),,ase o-i@ accoirt-)Ii-,@imert, ai-i,@,' recommend full finding.
                  21                      1,
                                     DR.              I v7oLil(I like to add o.@,-te          Dr.
                  22
                  23   The ulanniiig portions of this have been                       I-)y Cl-!P and

                                 amid 1-iav(-, bc,,--,i-i
                    4
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                                                                             149




       dh-2     I  "yes,"'  Is that correct?

                2             DR. HINMAN: The earlier ones  didn't.  The  firs'  JO(T-

                3  ing sheet didn't.

                4             DR. SCHERLIS:  But that is a subsequent change in ti-i

                5 operating'data that we received.  The present log sheets state

                6 that they have been reviewed by RAG.

                7,            DR. SILSBEE:  It is the planning portion only.

                8             DR. SCIIERLIS:  That is all we are tall@ing about,

                9 planning, at this time.  I am secondary reviewer on this and I

                10 also review it as essentially a planning  phase,  since  they  state

                11 Ithey want to eN?aluate,, categorize, and coordinate  their  existing
                1 2 emergency. services, and I think in view of the  fact  that  thisi

                13 is a planning phasef and they have devoted considerable thought

                14 on how to go about it, I would coi,iciir v7ith the feeling of the

                15 primary reviewer on this and would also recommend support for

                16 the sum requested which is for one year, a total of $30,,250.
                17@           I would concur with that recoiiimendati on.
                18            DR. ROTIJ:  This I would ass,uic..f-, malres no commitments

                9                       -i.ncf but tho@        -is.
                IIon our part for anvt'l'i.            c)perati-ox

                20            DR. SCIIE.'Rj'iTS: Ti-iis i,-,- pti..,@-c-ly for one yc-,,@ir.

                              Any othc5- coriin(--,rits on Virgi.i-iia?
                21

                                thought it was 3.
                22            L

                              DR. IIOTIII: 3.  That's good.
                23

                                  SClil;:!"LIS:  Ariy otli,,@:c
                241

  i.t:e- Federal Repo@ters,  Inc.
                              All those in favc)r -,ziy ziyo@,
                25,




                                                                                                          150




           clh-3      I

                      2                 All right.  Next is West Virginia, Dr. Roth. That is

                      3  a series  of  3  projects.

                      4                 DR. ROTH:  West Virginia is a series of 3 very

                      5  sketchy requests, the first for a rural, multi--county -- and it

                      0
                         .Ls actually 4 counties -- in Northern West Virginia, and the

                      7  second cne is for actually a single county building @,7ithin a
                      8@single hospital,  primarily,  have  access  to  taking  care  of  emer-
                      9  gency cases. And            the final third one is a state wide  progr@irtt,l

                    10   or it would have state wide  application  ability,  to  train  emerge,,

                    I I  cy i-fiedi-@,il technicians.

                    12                  The probl.em here, it-isn't fair to poke                  fun at a

                    13   gr@int request, but I would say-that the grantsmanship il.lusti-a-                                  z

                    14   t(-@d   here   was   unsophisticated   in   the   extreme.   Dr.   Besson   poixit,.,(@c:L!,

                    l@   out that he had a series of letters which were like fill'Lr@g III

                    16   !-,!-allies,  ind that has clearly been the operation here in West

                         V i- r @i
                    17;

                    18,                 Somebody, a coordinator, wrote a letter and ,;aid "I

                    19   thi.iik i-t          be  nice  if  yoi,-,   all.   sent   back   something   along   ti@@@is

                    20             so they    fill copied          letter,  and just cl-iange@i the

                    21                  Fine. -out-- .-;-n the names.


                                        DR.   S"""IIEPLIS:   A lot of these are trom voluntary
                    22



                         i: a. r c@-)ar
                    23                 t]7,orlts,   too.

                    2 4                                  es      @'n    a.
   cf,, -Federal Rel)cjf ters,  iric.   -,hcir(-, ar(--  20                                         2il.
                    25!;





                                                                                              15 1




        dh-4        I  from  individual  nei-,-,bers  of  a  -iewly  formed  Dodridge   County   einer-

                    2  gency squad.  The letters go something like this:

                    3               "We have this emergency squad formed, and it would

                    4  be nice if we just had a radio that we could find out where it

                    5  is we are supposed to be going, and if we could see that we

                    6   could have        a  doctor  or  somebody  in   the   hospital   when   we   got
                    7@ back."
                    8               There  is  one  delightful   one   where   the   young   lad   savs,

                    9  "We hope to finish our class soon on heart de-           f 4bulatioii, in  tlic-@

                  10   care of heart patients.  And as a member of the class, I                  realize

                  11   the great need for conmiunicati.ons."

                  12                This  is   the   heart   of   this   request.   So   youarc   given

                  13   a situation in which you have virtually no medical personae               1   to

                  14   provide the care, and once you can herd it in, you have prac-
                  15   tically  nothing  except  hearses  available  to  be  the  mechan-,.sili!7,   ok.
                  16   transportation.      @ou have bad roads, you have a relativt,@l,y sa
                  1711 T)opulati,)n  --  I'm  ,,,,re  you  don't  have  an  awful  lot   of   transiert,
                     I -
                       travel,
                  18            so   you're   not   worring   so   much   about   automobile   accidents
                  19   and c;,@ on as you rely be ak)c)ut,.  myocardial    infractions    arid    indus-

                  20   trial accidents, and tli,.!,ncTr,, of that sort.

                                    But it is a testizi@,:)ny to ax.)-;c--ct need ii-i an area  wliic',,
                  21
                  22   lac.!-,f7, resources of all kinds, and the requc@st,, even       though   inod-
                  23   est, translates ii-t:o i  fairly  high  ratio  in  terms  of  dollars  to

                       noT)ulation.
                  24                   I3ut if need is on(! of the qiiali.fi.ca@j-o,-is for

  kce@Feder,,)l Reportets,  Inc.
                                   I woulc-" .-,ay this ran<-jet; 4 I)I,iis in acted, -Iri(3 vc,..r@ kill,
                  25








       dh-5      I in  terms of the resources  to  work  with  which  tempers  your  en-

                 2 thusiasm, or at '..east your predictions, about how much will come

                 3 of it.  But I think for an application with a strongly Appala-

                 4 chian flabor, that it deserves our consideration.

                 5              The 3 are somewhat complimentary.  The one for a

                 6 single county,  Jackson  County,  and  a  single  hospital.,  really,
                 7 @tO my way of thinking, there is scant use in correcting all
                 8 these emergencies  unless  you  have  somewhere  to  take  them  with

                 9 sortie kind of care to give.

                10             'And they certainly need the instructioi-i@ of the

                11 emergency medical technicians.  So I would lump them all. to-
                12 Igether as being, to a degree, somewhere relatedt tending towards
                1 3systematisation.
                141             By taking a figure of practically zero for the state
                1510f the art   but a figure of 4 for the de-ree of the need I would
                  icolne out averaging that off with aboi).t a 2 and recon-L-q(-iid f uiic.-
                16@

                17 ing.

                                DR, SCHEP\TISZ.  For all 3?
                181

                1 9             DR. IZOT@-,i:  For all 3.

                20              DA*             I am, secondary              I -ilso
                21 arrived a-!,-- a grace .DE 2. I was very,concerned al--out  the  ini.-

                   ti.al 2 requests Llo-.- furidj.r-.g, -1@.i.rst of all in of who is to
                22
                  Ido  the              The first ol-io, for            was to  be  done
                23

                   IDY, @-,s I @t-iitc-r-orc@t i@L, a staff @i-ri -tl-io.      of
                24

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                                                                                        15  3




      dh-6         1                agree,  some  training  should  be  done.   I   felt   more
                   2 and  more  as  I  read,it  that  they  should  have  one   training   center,

                   1% that  was  the  Davis  and  Elkins  College,  for  a  sum  of   $28,000,

                   4 rather  -than  dispersing  this  in  3  different   areas   with   different
                   5 levels  of  ability  and  I  would  concur  with  2,  but  I  thought  the
                   6 total  funding  should  be  about  $30,000,  because   I   didn't   have
                   7 some  concern  about  dispersing  the  training   into   the   other   areas.
                   8              What  was  your  reaction  about  the   action   of   Stonewall
                   9Jackson I-lospital as far as being able to carry       out   the   program?
                 10               DR* ROTIIA:  It was apparent to me throughout the
                    Ithing    that they're  going  to  have  to  import  talent  to  do  --   they
                    I
                    'just    don't have  the  capacity  there.  And   this   Davis   Elkins   Col-
                 l 21
                    1lege    thing seeried to me to be by far the best.
                 131

                                  DR. SCIIERLLS.-  I was concerned        for   example,   in
                 15  the first   one under training, they stated          the 4 physicians
                     in  Louis  Colinty,  the  !one  physician  in  @)odridge  County,  and   the
                 1 6
                 17  national health corps physician in C-il,,iter County, which        is  the  if
                    !total medical compli-inei-ite 1-jave @agr(l..(-,C). to conduct training cour--
                 181
                 19  ses for these men.
                                  Thc@vli-e goiii(7 t-o dc,.liv(.:.,r t",'ie 82 hour course.  This
                 20
                 21  requires, I tliinle-I more i--',-)j,lity t.li@iii t'li(-@y can i-tiu.ster, f or. t',Iat-
                 22  sort of a training effo.,:-k@.
                 23               DR. B-CSSON:   I @,7oxider-                   not   be   worth-
                            in @-hc, :idvi.cc? 1--o -t.-@h.i.s to work jointly wit'-II the
                 241
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            p    25 1 state of ,'Aaine on -their                  is very si,rlil  r,  -and  their




                                                                                       154



      dh-7           solution,  which  is  perhaps  ideal  for  this  kind  of  area.   if   thc@
                 2    are     production  video  tapes,  there  is  no  reason  why  the   videc
                 3   tapes can't be used in West Virginia in these rural counties,

                 4   just as well,as they're used in Maine.
                 5               DR. SCHERLIS:  The second one, they say ""'Upon fund-
                 6   ing of this application the hospital will recruit and immediately
                 7   train  80  emergency  technicians"  and  again   I   question   their
                 8   ability, without the sort of help that you referred to.
                 9               My suggestion would be that we go along with the third
                 10 Iregional training center, which is the Davison-Elkins Group, an
                     maybe expand their  program  @-or@.iewhat  so  they  can  incorporate
                   I traini-nc  the  others.  I  have  a  certain  reluctance  as  far  as  the!
                 1 2
                              f funds they have requested for the first 2 hospitals,
                 131 amount  o
                 14  concerning what might come out of it when they are done.
                 15              DR. ROTII:   I I 11 agree -with this, completely.
                 16              It has always been a. problem to rii(-2 to          think
                 17  Jerry Besson spoke about        our issuing the  @-c-.&,di.ings,  or  watch
                     .ng them. There isn't even a  seedling  here  to  nourish,  y--u  h,@a7.,c,
                 18@
                   i
                 19  to start doing sorae planting.
                                 DR. S'-!iERLIS:  is  anyone h--rc from -the West V;-rgi.n-',.ai
                 20

                     area      could coi-,ir@i,@nt?
                 21
                 22              Dr. lic@yi(aerson, cto you w,2@@i-L to cony(ti(-2yt on the probl(@l.(I@l

                   I of thi-s I,)roject?
                 231
                   1             DR.
                 24

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                   ' been irt,3dc- are accurate.  f have b(-@c@)i, sc,!iiiriing application
                 251




                                                                                    15 5




      dli-B       I her(-- for a few minutes.  The fact that they have submitted 3

                  2 proposals  that  are  very  similar  in  nature  and  have  essentially

                  3 all the  same  working  necessities  brings  me  again  to  Dr.  Roth's

                  4 consideration of the need.

                  5             Now  actually,  the  heart  of  all  this  is  employment  of

                  6 former  military  types  to  function  as  emergency  medical   service

                  7 technicians.  This  may  give  this  thing  a  bit  more  rooting  than

                  8 if they were to be starting at scratch and wandering around
                  gilooking for  people  to  train.  In  the  light  of-that  and  in  view
                10  of the need, would it be practical to fund just one of the 3

                11  proposals?
                1 2             Number 18, the first one, goes in the direction of
                131trying  to  provide  priority  health  care  services  for  rural   com-

                       4tieS
                141mun.L      that have none,  or  counties.  Tlie@price  tag  on  this  onel
                15 is  said  to  be  $6,000.  And  even  though  there  is  spotty  support
                16  for doing it, if they can in fact apply it, previous military

                                                                       0 W4    Wor'l@ -It
                171 corpsman, and if they can find a     physician -v7li
                   .runni,.)@'i t                  L @
                18i           !!E,@ project, to me @'- would be worth doing.   Because   then
                    it r-ticlht- f,)ro-..Ti(le-the impetus to en,%,i:-gizo activi ties in the re-
                19

                    gior,@s cl@          proposals.
                201
                   1            i@4,R. TOOMEY: The tliing that bothers  me,  and  it  is  not
                21 1
                    on my list  to read and I I,.avei-ilt read it --- the thi-rig that  both-
                22
                    ets me is that knowing that i'lest Virginia has a state %,aide
                23
                    PI        orc,,an 41;lal@@4on fiindect uiad@r tli(--
                214+

  @ce-Fedc@int Reportets,  Inc.
                  511
                   11            Act   zird  f rom     I  hear ,   it     quite
                2



  pp,                                                                         15 6



      dh-9      I that there has been, as I would read  it,  little  contact  between
                2 this project and the Appalachia Project, or the Applachian
                3 program.  And with the fifth or sixth years of expenses under
                4 the Appalachian Health Program, which is  a  specific  section  of
                5 the Appalachina Region National Development  Act,  it  seems  that
                6 they should have been farther down the  road  than  what  apparentl

                7 has come out from this RMP.
                8             My point is that I think that they ought  to  look  at

                9 each   other.
               10             DR4 SCHERLIS:  Any comment from staff on that?

               11             Yes?
               1 2            VOICE:    TI)e application as it is does  not  reflect
                  the true working relationship that exists between  RYiPs  and  the
               13
               14 Appalachian TCIIPA.Agency.  Ti-ie application does reflect the
               15 cooperation between the IU,.IP and the local B Agency, which is

                                                                      group 4-0
               16 the -- the liaison @iian working with the advisory        a-  the
               17 B Agency in determining the local needs and priorities.
                              Someone made a coni-,Itient about why do we have 3 Liini-lzir
               18
                  proposals from 3 separate areac;. Well, N,@lien @Vest@vitginia 1-1-@"e-.C"
               19
               20 field ,;ta4Lf very effee--t4-vc!ly, '@-hci-e "Ls a field man assign('-(.'k
               21 to these areas, he has quite z@@ bit of knowledge in E?6,IS.

                                      fore 4
               22j            So there      -his    one reason -these particular
                 lpro,nosal.s come frorti that particular area. And one other  thing
               23 I- -                                                              I
                 ,4-C)O.  'Phe W(-@s- Virgini,-,     n-it?cli.cil prog@t:am lias just ro..ceril.1'
               241
  @l-e- Federal Repofteis, Inc.
               25 restated their objf@cti,@7c-.@@, aiic:i on(@, of -thc@,i.r proposed arc--a-objc,,C@t-




                                                                                                  157



        dh-10       I  ives is the emergency medical service.

                    2                DR. IIINMAlq:   Norm, are you saying that there are
                    3 laccountive working relationships between the Applachian Health
                    4  Program Planning Council and the West Virginia PJIP?

                    5                VOICE:   Have definitely.
                    6                DR. ROTH:   Beyond how much Virtue it-is, but that first
                    7  project , the 4 county project, serving a population of 103,000
                    8  people,  working  out  at  about   73   center   per   capita   in   an   area
                    9  where, as far as I know, there is very little              overall support

                  10   given.

                                     The second one works out somewhere inbetween $3 and
                  11
                  12   $4 per capita and I would be willing to drop that one out
                  13   completely.   But somehow or other 1 would like to do something
                  14ltO get those rad      40   Sets   into   these   pseudo   ambulances,   to   get
                  ,5@  something into that 4 cou@ty area of West Virginia,
                      I              DR. SCIIERLIS:     I really think in terms of the 4 cLunl@-!",.,
                  16
                  17@  area, that    is as far as there bei.xig.adeqtiate information or
                       they're ,-eall.y having paid attention to the good lines in havinc
                  181
                  19   at  the  time  all.  system  care,  t.1-ierc,  are  se)-ious  shortco,-ni.nq8.
                                     Aiid ve-t, pea-i-iaps ti-ic--y should liev(, enough fun('4s  to.
                  20
                  21   z,.-t !.east      a staa:-;'_- of                             about   6   full
                  22  i pat,--h@,rs, 2 parzir,-Ii@di.c,,;, It is a I,)i).dget @.iliich,, whil.e -Lt  adds
                      I
                                           e                                                        d
                       to @,'76,000, I qu stioii @,rhctlic@r o,,.  not t) r,,,y might  better  siDei.
                  231

                       soTic of t)iosc funds fo-i@-
                  241

  kce
     -Fedeial Reportf,,ts,  Inc.
                  25                 DR. l@OTli:   They cou).d   do a           deal         less-








     dh-11      I  half of that.
                2           DR. SCIIERLIS:  This .,)hat I feel and I think if we
                3 could talk in terms of putting more into planning and getting
                4 a small course started, than perhaps a reasonable sum instead
                5 of $76,000 might be something like $35,000.  But for quality
                6 of training I still think that Davison Elkins looks good.

                7           DR. ROTE:   Yes.
                8            DR. SCHERLI S:  And the first one would be for $35,000,
                9 and the second is zero, the third for $28,000-and crossing out
                10 the second.  I'll put that on as a motion.  $35,000 for the
                11 first one, zero for the second phase, the third phase, $23,0
                12 as requested and that rating was 2, 2 for each of those.
                13i          Any further suggestions?
                141          (]\To response.)
                15           All right, all in favor
                16@          (Chorus of ayes.)
                171          Opposed?
                18           We now ,Ytove out.of the eastern brancl-i regions into
                19    sou,th central l@raiicli regior,, and the irrepressible Dr.
      end -al3
      CP-@ 6307 20
                21@

                22


                23,


                24

  4ce-Fcderal  Repn,;,,ei.,,  Inc.
                25





                                                   Too,
                        17                                            r
                                             DR.  SCIT                     still in     sovth centr,,,
                                                      IT", 'LIS:   IliSCOnSi_


                                                                                                           -"j.scollsi
                                                                                                                     _n
                                                                                               ttec,
                      20                                                  Xt has    a
                                                       t 1,  s                                     reqlle
                                                                                                          :Dtec3 of
                     21                                                   f j.. r
                                                                                                     0 Zi C"?  t
                     22                   1 11,11,7C,                                 ',ear.
                                                      'I to,
                    23 to      o
                                          _t?                                                       ou

     Pece
                                                   t
                                                                                                      cO.,
                                                                                       'I) to
                                                                 t


                                                      c                                                                          cn
                                                                                                               Ol't


                                                                                                                                cn




                                                                                                                                                        2  7  6

       t   r


                                    emergency         medical         services         system,.         it         is          factual,          has          clearlv
                              2   defined  objectives  and  methods  for  evaluating  the  effective-

                              3     ness  of  a  total,  comprehensive  operating  system.
                              4                            It  includes  in  its  formulation  --  it  includes  efforts
                              5     1),v        the        people        in         the         Highway         Safety         Program,         Comprehensive
                              6     171calth  Planning  Agency,  the  Hospital  Association,  P-le-dical
                              7     Societv,         Governor's         task         force,         a         health         program         and         policy
                              8     council,  greater  '.Iil.waukee  agencies  and  I,,Iil@iaukee  Countv  '@"Tedical

                              9     Society.
                             10                            The         applicant         reTiresents         the         "-          the          application
                             11     represents        the        efforts        of        ke@7        groups        of        health        providers        in
                             12     tho  development  of  this  program  over  the  past  five  vears.
                             13     think  it  i.s  the  best  one  I  have  read.                                   I  give  it  a          rating
                             14@    Of  'Live  and.would  recommend  full  funding.
                             15                            DR.  SCIIERLIS:    Dr.  McPhedraii?
                             1  6                          DR.  ',",C  Pil@D-?.AZ4:           I  concur.             It     is     one     of     the     t@-jo

                             171              tha@L.  I  read.
                                  1
                             18,                           il)Yll.  SC411EI-ll,)"L'S      @,@7hEit           the  other  one?

                                                           D,7 .     C  P      1)                 i-)),ouq'it      tr,      -state      @.ia-s      verN,7,      verv
                             19
                                    g C)             h  i  s       t                              too,     and     it      has      }@,c-en      long      in
                             20,


                                    P"'
                             2  1     .1-1                                                                                                                          1   1
                                                                                                          rating         I         gave         ti-i-stac,@,.   I
                             22
                             23                                                                              I  do  no-L-  think  T.  gc,-Iv-c  it  a

                                                        @i o Li -1 'a'  ,7              @t           s
                             241
    --e-Fedc-ial Repofters,  Inc.
                             25




                                                                                                                                          27 7
             3


                           I    ay),nlication,  where  the  argliricnt  is  luilt  up  about  how  the  thing

                           2   is  to  be  ti-me-phased,  and  w'tia                   4-  thc@ metl'iods  are,  what  are

                           3   the  assumptions  on  ..,,hich  each  step  is  based,  and  how  these

                           4   assumptions  can  be  validated.

                           5                          It  is  really  very  good.

                           6                          MR.  TOOMEY:    It  provides  for  an  organizational

                           7    structure  to  carrv  it  out  from  the  start  to  the  finish.
                           81                         DR.  SCIIERLIS:    IIhat  about  the  money  recommendation?
                           9                          !,IR.  T00i@'-,EY:     I  concur  with  the  funding.                       It  seems

                          10    for,tlie  nroject,  in  relationship  to  some  of  the  requests  for

                          11    other  funding,  this  is  quite  reasonable.

                          12                          DR.  SCHERLIS:    All  right.    The  record  should  show

                          13    that  they will  be  funded  as  reciuestcd,  for  three  years?

                          14                          MR.  TOOMEY:  Yes,  sir.

                          15                          DR.   SCIIERLIS:    A13.  right.

                          16                          DR.                    IIhat  is  the  rating?

                          17                          Pli@. TOO"IEY:    Did  we  submit  it?

                          18                          DR.   SCHERLIS:            Bet@,7een  four  ind  five.
                          19                          DR.   !@IC  P'tll7@DRT-@,'-@:  I              sa-,7  4.5,  and        yoti  are  going

                          20   to  say  fv@',  right?
                          21                          DR.  SCIILRLIS:            let  iii--,  mal-,e  that  five,  then.

                                                      Df@ . TT I'@T@.@' I
                          22
                          23                          DR.   SCIIE@T-"LIS:    The  staff  has  suggest we  use  -the

                                nurrfl:)cr   f i -,7 (-  ,                           .  .. .
                                                          since  than,                        us  -.-  @@7e  have  ',-)c2en  cTi.vL3 -ri  @l
                          24
    ce- Federal Reporters, Inc. @,i).c)ta                                                     niii,,i))cr  of  fives.
                          25                          Ha@ we used up all of our twos and threes?
                                                      DR. ROSE:   Right,  several times over.