CESSA - Region 3 Committee Meeting Approved Minutes 01/17/2023

Community Emergency Services and Support Act (CESSA) Region 3 Advisory Committee

Meeting Minutes - January 17, 2023 - 8:30-10:30 via Teams

Meeting Minutes - Approved by Members 02/21/2023

Call to Order/Introductions

Diana Knaebe called the meeting to order at 8:32am.
Member Attendees: Matthew Johnston, MD, Diana Knaebe, Kristen Chiaro, Jessica Douglas, Brenda Hampton, Trenda Hedges, Daniel Hough, Olivia Mefford, Christopher Mueller, Scott Pasichow, MD, Mark Schmitz, John Simon, Andrew Wade, Katrina Moseley
Public Attendees: Jessica Frese
Excused: Chad Dooley
Absences: Andrew Dennis, MD, Scott Hough, MD, Raymond Hughes, MD, Devron Ohrn, Sara Rolando, Amy Toberman

Meeting Logistics/Open Meetings Act

Open Meetings Act site at the Office of the Illinois Attorney General
Meetings are recorded. You may choose to turn off your camera.
Minutes will be posted at the Illinois Department of Human Services Division of Mental Health on the Open Meetings page.
Minutes will be posted after they have been approved at the following RAC meeting.
Please remain on mute during the meeting unless you want to have some discussion. If you would like to speak, please raise your hand to get the presenters attention.
Only appointed members may contribute to the discussion at any point during the meeting. Members of the public will be able to speak during the "Public Comment" session of the meeting.

Approval of Minutes from December 15??, 2022 Meeting

Motion to approve the minutes by Kristen Chiaro.
Second by Scott Pasichow, MD.
No corrections needed.
Motion carried. No opposed. No abstentions.

Approval of Charter

Motion to approve the charter by Kristen Chiaro.
Second by Chris Muller.
No questions or comments.
Motion carried. No opposed. No abstentions.

Illinois Department of Public Health/EMS Systems - Dr Matthew Johnston

Jessica Douglas - For Adams County, we are a licensed Emergency Medical Dispatch agency and each of our individual dispatchers are licensed at the Emergency Medical Dispatch level. They must complete the Emergency Medical Dispatch course in order to provide pre-arrival and post-dispatch instructions. We are also licensed by the Department of Public Health under our area EMS system.
Chris Muller - Sangamon County is the same way.
The Emergency Medical Services (EMS) Act gives the minimum standards for our delivery of EMS within the state.
Recognizes that there are differences between both facilities and regions within the state.
Gives us a guideline on how to give care without jeopardizing our stand of care within the regions.
EMS regions are identified within the state and focus on trauma, stroke, pediatric centers, in which both pre-hospital and interfacility transports occur.
It is overseen by the EMS system and the EMS Medical Director.
The EMS Regions are more arbitrary boundaries due to transfers and 911 calls that do cross the boundaries in order to go to the appropriate hospitals.
EMS is an organization of hospitals, vehicle service providers and personnel for a specific area.
The system coordinates and provides pre-hospital, inter-hospital care, non-emergency transport and the guidance to non-transport providers within the area.
Each system has multiple hospitals, but one hospital has to be a Resource Hospital within that system
All other hospitals in that system bust be either an Associate Hospital or a Participating Hospital.
Regarding the EMS Services, there are some standing committees that are present, the Region's EMS Medical Directors Committee (including the Region's EMS Medical Director and a fire department vehicle service provider), the EMS Advisor Committee, Trauma Committee and our standard communities.
Within our region, we have a Stroke Committee that happens quarterly.
The EMS Medical Directors Committee identify different protocols for intersystem and inner region transfers. They address the different levels of providers and the regional standardization that occurs. There are some regions that have protocols and there are some systems that have individual protocols. Just depends on the regional area.
All protocol changing and education must go through the EMS Medical Director with the final approval by the Illinois Department of Public Health.
EMS Medical Directors are responsible for recommending licensures and relicenses of all EMS personnel from EMT to paramedics, hospitals, RNs, PA Dispatchers and all levels of first responders.
Oversee and approve EMS providers, both public and private, whether they are paid or volunteer to function within the system.
Authorize and develop standing medical orders, certain policies for all system personnel.
Approve and develop dispatch protocols and focus them for our areas that we work in.
Oversee education and training of EMS personnel within the system, both primary education and ongoing education.

Responsible for supervising personnel within the EMS system.
Approve equipment, medication carried on the vehicles and approve the developer approved Patient Care Reports, covering all types of care.
Responsible for the total management of the system, including the enforcing of protocols, compliance with protocols and system program plan by all participants within our system.
This is a very grand overview of the systems, region systems and EMS Medical directors.

Illinois Department of Human Services/Division of Mental Health - Diana Knaebe

Vision of the Behavioral Health Crisis Continuum is the provide services to anyone, anywhere, anytime. Include crisis lines accepting all calls and dispatching support based on the assessed need of the caller.
Mobile Crisis Response teams are available around the state but not every area of the state is yet equipped. In our region, all but Brown, Cass and Schuyler are covered.
The facility stabilization triage facilities is still a part of the vision. Substance Abuse and Mental Health Services Administration has this in their goal by 2027. Also a goal of the Division of Mental Health. Would be a triage center with police drop off, up to 23 hour observation and longer term for sobering, as well a Mental Health Psychiatric Crisis when the individual does not need an emergency department and does not need psychiatric inpatient care.
Mark Schmitz - the continuum may be looking a lot different as we are looking from the semi urban Sangamon County to the farther stretches of our region, which are more rural.
- Diana - It is the same for us. We are 24/7 in the Sangamon area, but when we start getting out to our outlaying smaller rural counties, we are now responding mostly virtually during after-hours and weekends.
The intention of Mobile Crisis Response programs are to offer community based intervention to individuals where they need it, whether it is at their home, work or someplace in the community.
Services are available to all regardless of the payer source.
Typically there are two members on the team. Ideal that one is a person with lived experience with suicide and/or mental illness.
Partnering with EMS and law enforcement as needed and warranted.
83 different Mobile Crisis Teams from 66 different community providers.
Assist in resolving the crisis and create a plan for safety and follow-up.
Connect individuals to care through warm hand-offs and coordinating transportation when/if situations warrant transition to another location. Is will be a big piece for us to solve. How are we going to get people transported when there is a place that we can get them to that isn't and emergency department.
There were originally six 988 providers in the state, 1 or 2 may have been added.
988 is a universal line. Unlike 911, 988 counselors provide crisis intervention counseling, averaging 20 minutes a call. The intention is to deescalate the person at the call.
If someone needs to be dispatched, the 988 providers need to know which Mobile Crisis Team to dispatch. Calls may not come from the same providing area. This is something that is still in the works.

988 is free, confidential and available 24/7/365. Available through landline, cell phone and voice-over internet device. Available in Spanish, along with interpreter services in 150 different languages. Availability to call, text and chat.
988 centers are intended to be the central point for referring callers to community mental health providers which dispatch, who dispatch Mobile Crisis Response teams as appropriate.
- Brenda Hampton - It is important to note that 988 does not dispatch the Mobile Crisis Response teams. 988 refers to the 590 providers who then dispatch. The 590 providers have an opportunity to do an assessment and see what kind of intervention that they can do before they send a team out to do the more intensive crisis intervention activity.
988 Regional Lifeline Centers are Memorial Behavioral Health is Springfield, Suicide Prevention Services in Batavia, DuPage County Health Department in Wheaton, Community Counseling Centers of Chicago, Lake County Health Department in Waukegan and PATH Inc. in Bloomington who provide statewide coverage and are the backup coverage for the other centers.
Dan Hough - What is the time frame that we are looking at from the time the call originates to the time that someone shows up at the door step?
- Diana - Each of the 590 providers have set up time frames based on how long it would take them to get to wherever the need to go.
- Brenda - it varies based of the geographic area that they have to cover and the number of teams that they have available. One of the things that we are looking at very seriously is if it is indeed a crisis and a person is in a state of despair, if they do not get intervention, they are going to turn around and call 911. The whole purpose of 988 is to avoid calls to 911 for people with behavioral health and mental health crisis. We have to back and look at the times that our vendors have indicated and see if we can get this to be more immediate. This is a work in progress and as we talk with PSAPs and police departments, it is going to be very critical that our 590 providers can respond in a timely fashion.
- Mark - The reason the 988 added the ability for the 590 providers to do an assessment is for the issue of capacity. Also this funded through a grant, which allows you to provide a certain degree of staffing. We are learning as we are going and trying to get a handle on what our demand will be.
- Diana - If we feel that it was a life threatening situation and we are not able to get there fast enough, that is when the relationship with law local law enforcement and EMS is crucial. If they are able to get to there quicker, that is something that should be utilized.
- Dr Johnston - There are situations that become more out of control and EMS and police will have to partner with this. As much as we want to utilize 988 on everybody, this going to be a work in progress.

Illinois State Police/Office of the 911 Administrator - Jessica Douglas & Chris Muller

The 991 System oversight at the state level is the Illinois State Police formally had been Illinois Commerce Commission. The Emergency Telephone System governs a lot of the rules of what we can and cannot do and how we receive some of our funding.
Essentially it ensures that the three digit number, much like 988, is for mental health, 911 has stood up as that easy to remember number for other types of medical, police and fire crisis that might need response.

The PSAP (Public Safety Answering Point) field the calls. We are the first link in the public safety response chain. A critical hub through which all the information flows from the start to finish of an incident.
Priority Dispatch is a widely used system to certify the telecommunicators. Utilize them for medical, police and fire emergencies.
- Chris - Sangamon only utilizes for medical.
Some areas have multiple PSAPs, while others may have a single PSAP. Really depends on how wide the jurisdiction is. Adams County is a joint venture between their municipality and the county. Have a joint emergency telephone system, borders our local oversight. Some just have the county as their oversight.
- Chris - Sangamon County handles everything in our county except one police department who maintain their own dispatchers.
Required to use the EMD (Emergency Medical Dispatch) protocol.
The Emergency Telephone System Act sets forth certain training and standards requirements.
The National Emergency Number Association has trainings and standards as well.
Receive 911 calls from many different sources. Landline calls are not as frequent as wireless calls. About 85% of the calls to 911 centers come from wireless phones. Voice over IP is a technology we do receive. TTY calls are very few. Text to 911 has not completely replaced that system, but it has made access for deaf or hard of hearing population easier. Text to 911 is also available for situations where it is not safe to call 911.
- Diana - Do you end up with more of the landline calls coming from businesses?
- Jessica - Business do account for a large number of our landline calls, such as nursing/residential facilities. We do still have some residential landlines, but more common for businesses.
Sometimes 911 calls are meant for other dispatch centers and in those cases, the calls may be transferred.
The Emergency Telephone System Act does indicated that we provide 80 hours minimum of training to a new telecommunicator before we can put them in a quality taking seat. Do have a lot of discretion at the agency level as to what makes up those 80 hours of training.
Do have to go through an Emergency Medical Dispatch Certification course.
Must be trained in CPR and have an active CPR certificate. Must be recertified every two years.
Must got through Department of Public Health every four years to get their license.
24 hours of continuing education every two years for the Emergency Medical Dispatch certification.
48 hours over a four year period in order to renew the Emergency Medical Dispatchers license.
Work with the Emergency Medical Director to determine what is the best dispatch level, the best response course. Determine the modes of response and which agencies will respond to these certain types of calls.
While looking at the map for the 911 EMS in Region 3, Chris points out that Auburn is no longer a PSAP with Sangamon County.

State Updates - Brenda Hampton

Everyone should have received a letter from December 21st on the clarification for law enforcement and emergency responders. There has been some ambiguity in this document, so the division is working to clarify that information. The whole impetus of the documents is to let law enforcement know that should an individual have an emergency that they are still to respond. There was concern by law enforcement that CESSA said that they were not to have any action.

The CESSA deadline has been pushed back to July 1st. We are working very rapidly in order to make sure that the State of Illinois, as well as the Division of Mental Health, meet that deadline.
For the state to actualize, the work that is done at the regional level would have to go back to the State Advisory Committee for approval, however the State Advisory Committee(SAC) only meets once a month, so this would put us past the July 1st deadline. Two possible solutions were proposed. The first being that technical subcommittees would make their recommendations to the Regional Advisory Committees(RAC) and because RAC members are a part of the technical subcommittees, that would be automatic approval for the RAC and it would not have to the SAC. This would necessitate and amendment to the Charter, because the Charter states that information has to go back to the SAC and that SAC would send it back to the region. The other solution is that the SAC would meet more frequently to approve the recommendations from the RAC. After discussion, solution one was approved and that RAC are now approving recommendations directly from the technical subcommittees and do not need to go back to SAC for approval.
OMA said that meetings could be held virtually due to the pandemic. There was concern that the meetings would have to go back to in person. Right now, nothing has changed. The States Attorney's Office is still stating that meetings can be held virtually. Should things change in the future, we will get advance notice.