 I don't care. We've been mute the whole time. Oh. I guess we have to reintroduce ourselves. Oh my God, you messed up. Well, we're done. Sorry about that. We just, oh, I wish somebody had yelled at us. They could, I don't think they could. Hi, we just realized we were mute. Okay, sorry, so. My apologies. That's okay. It didn't go out on live stream either, right? No. Okay, so this is, once again, it is Tuesday, March 22nd. This is Senate government operations. We're going to be looking at a number of issues around or starting a conversation about EMS. We will continue the conversation. It is one of the areas that I think this committee feels I think this committee feels very, very strongly about and very supportive of. And so we're going to introduce ourselves and then we'll get started here. I'm Jeanette White from Wyndham County. I'm Anthony Cleaning from Washington County. Brian Collamore from the Rutland District. Allison Clarkson, Windsor District. And we will be joined by Senator Ron Hinsale from the Chittenden District. And we were wondering why you were also stony faced while we were introducing ourselves and making really wonderful comments and jokes and all kinds of stuff and you were just sitting there. So that explains it. So Will, you are the new Dan Batesy, is that it? But that is correct. I assumed the responsibilities of the EMS chief about 15 months ago, correct? Great. So I think what we're going to do is this is pretty informal and we don't have a bill or anything but I think what we're going to do is start off with Drew. Would you like to join us? We have a report from Drew that I, it's a wonderful report. And if you would like to just tell us where we are now with EMS, what's happened in the past? Whether we've done anything, whether we need to do anything more. Yeah, I guess I left mine in. Oh, special. Thanks. Is this going this way, Drew? Yep, I never had to get down with it. Okay. So I think that, do you need one for the size? No, I just need the digital version. I think you said it a while ago. Okay. I'm sure that's posted. And it's not, I'll make sure you end over. And we understand that, I mean, Jim Fingers with us and Gwen Zach often will for him and then Haley and Haley, we understand that the senator is very interested in this as an issue and how he might and his office might help us with the EMS issue in Vermont. So welcome. So Drew, would you like to kick us off? Sure. Well, first, thank you for bringing up this topic and inviting us to come and speak. It's really exciting to be back in the building and seeing actual people. I appreciate the Zoom invite, but being here in the room and kind of seeing you guys is exciting to me. I'm hopeful that, you know, all of the pandemic is out there that things continue to improve and we can get back to some more normal life. Seems like forever ago that we were here working on EMS issues. It was really pretty pandemic that we were talking about. You know, some of the very significant challenges facing EMS, where I'm funding workforce development, access to testing and education. And we worked on some pretty, I think some of the changes in the legislation to help address some of the EMS issues. And in fact, a lot of those were enacted just as the pandemic was kicking off, which helped delay things, because, you know, implementation during a time where certainly the health department and every EMS service in the state was overworked. It was tough. Nonetheless, we were able to take the legislative changes, get the rule changes out and make some, what I think is a pretty significant progress in our challenges for workforce development. You know, I'll kind of get into that and we'll report here in a minute. But I think it's, I think I really like to go moment to highlight what we've seen already as part of the remote responder program, something that we actually kind of created as part of the discussion in this room. And it was a new entry level for EMS providers in the state. That program officially kicked off in February. We've already managed to enroll hundreds of people, all right, into that new program. So if you guys remember from history, you know, our EMS system in Vermont is made up of about 2,600, 2,800 people. See a pretty significant turnover, 25 plus percent a year. So adding a new level to kind of entry level to recruit people into is a huge victory for EMS. So at a lower cost, certainly a lower personal commitment to get those people interested in becoming volunteers in your communities. I know in our area, in the last 60 days in Vermont, 40 new EMS volunteers in the county. That's great. So I'm certainly calling that a victory. With that, we've also been working on quality of instruction in Vermont. So as part of the bill that we worked on, there was a change for the instructor coordinator levels. So that process took us a while, but we're officially rolling out the new levels instructor coordinator in Vermont for EMS, which is going to lead to kind of a more consistent experience for students in every district in Vermont. So all those are really good things. On the other side of that, like every other kind of sector of our workforce, the pandemic had a huge effect on us, quick a hit. And first hit on EMS was early when all of our EMS courses that were active had to either be shut down or switched to hybrid, which we weren't set up to do. Something was a concept that we had talked about, bringing access to people through virtual means, but it was something that our EMS system was not ready for. So we lost a lot of students early on in a pandemic that couldn't be transitioned over to online education. So the first eight months, we had nobody coming into our system. We asked for financial assistance early in the care process. You guys have awarded almost $900,000 for EMS education, which we were able to roll out as grants last year ago, over a year ago, a year and a half ago, to stand up our first hybrid education system in Vermont. And to kind of develop that program well, we were responding to the public health crisis. I won't tell you it was perfect if it was challenging. And certainly it was probably not the best program that we've ever run, but we were able to enroll over 300 people into that program in the last few months of the year. And what we really demonstrated by that project was removing the burden of costs, even in the middle of a pandemic brought us more ability to recruit people into EMS. And again, a year and a half later, we're getting better at delivery of hybrid education. And we've learned a lot since we started that first program in the fall of 2020. We're able now to run these programs a little bit better. One of the challenges we have is we're back to a point when there's no financial assistance for people and the fully loaded cost in these programs has actually gone up. So we used to be talking about an EMT class that are getting about $1,000 an hour looking at it to the neighborhood of about $1,500 for the same programs. So good news is we've learned a lot, but not so good news is we still have a significant funding shortfall where it comes to education. So those are kind of the overview of what we did and what the impact was. Certainly, I think I just speak on behalf of everybody and you and us that it was extremely impactful what we did as far as funding the education pandemic, providing for new license level in Vermont. And what we haven't seen the results of yet, but I'm confident we'll be positive. This is where they've done the structure for major expeditions in Vermont for more consistency and access to education. Thank you. Right, I just have a question. How, I'm just curious, what do you, why has cost gone up 50%? For $1,500, what does that reflect? The cost of AMS labor in general is significantly higher than it was. So as well as bringing in instructors to do that, most of the programs increased their delivery costs over the last two years. There's also a cost for the online platforms that are being used. As people start, the programs traditionally run out of the back room of the firehouse are now more technologically advanced with textbooks and access codes for online testing and all that is added additional costs to the language. It's got its pluses and its minuses. Yeah, I think we fell from driving up here I don't like the online thing. So, but it does certainly have a place in the future. AMS education reduces the cost of it. That's a significant advantage. I think the biggest advantage is increasing the access. And increasing access. Yes, as difficult as far as we'd like to travel. You know, I live in an area where I'm driving an hour to a grocery store. So if we can limit the amount of time of traveling at that continued education to the access that I think we're gonna have more people willing to kind of make that time commitment. So you're probably gonna get to it, but I wanna make sure that people understand a very tiny little thing that we did that's made an impact on you with CFR. So, and I'm glad you brought that up. It's not in this report and I probably would have spaced it. Hello. Hi, sorry to be late. So you made a change and it was actually now three years ago where a DFR was to accept the complaints of the MS because you have a legislation in Vermont that requires insurance companies to pay the Indian services directly. Unfortunately, when they wouldn't do that, we had no leverage in order to get them to do that. Before I got last fall through DFR on their enforcement of that, which is a piece of legislation in the past, there were a handful of cases, like we have six, I'd have to, don't pull me on that, I'd like to put it in the report, where complaints were made to DFR, DFR investigated those and in all cases, the providers would pay directly. So that piece of legislation did kind of, to correct that trend that they were seeing, which was insurance companies paying patients but not the provider directly. And again, that little change seemed to get when we had it seen nearly the numbers of services reporting, direct payments to patients since then. And being if that's an ongoing reporting, I would assume that, as the reports come out, we'll see that insurance companies will stop that behavior based on getting told that. And I just wanted to point that out because I think sometimes we think about big things that we do and big changes and sometimes these smaller changes that don't ever get any airtime at all do make some differences. Oh, I thought that made you know the most. Well, I'm excited. I've been sitting in this community room often on and off for quite a few years and to see some, what I think is really significant progress with EMS related issues is exciting. Especially considering that we had a global pandemic for two years that really set us back. So some highlights from the report that, I think they're important to note, Vermont is still a pandemic, your EMS has been, Vermont is still responding to the pandemic. Whether everybody knows it or not, EMS played a huge role in the public health emergency. Everything from transportation of patients that were infected to other alternative housing sites so that they would not infect, you know, people are living in their home shelters to a massive vaccination campaign. Mass vaccine across the state was done by EMS as well as home deliveries. We're talking about tens of thousands of people that are in their houses that would have not had access to vaccination. It wasn't for the EMS efforts showing up. I was wondering were you, were federal payments helpful for you folks? Did you end up doing it in your own accounts? So good question. This actually was funded through FEMA. So some of the federal funds, the state created a program enrolled EMS providers from all over the state. And again, it's a good indication of the capacity of your EMS system when it's actually funded. We were able to stand this entire program off and certainly will probably speak to the timelines, but we went from no way of delivering vaccines to homebound patients to boots on the ground in every corner of the state within about 14 days. And that came about because again, you have a EMS system that's very capable, especially when it's funded in a way that's sustainable. And you know, right now, there are still units, services that are out providing vaccination. We're also providing multiple antibody treatments. So in areas of the state where the hospitals don't have the capacity to provide the life-saving treatment for COVID, EMS has stepped up and we're actually directly providing treatment services of the hospitals. So through the pandemic, lots of stuff has changed. One of the things that's maintained that's been very consistent is that we're still not getting re-inverse for the cost of delivery services and we're still short on personnel. And that isn't unique to Vermont, that's not unique to any county. Nationwide, EMS is struggling and for a lot of reasons. We recently did, as part of our advising work, some workplace surveys, reached out to the workforce in Vermont, came to what's really going on. Some of the things that we've identified are EMS is the lowest paid health to the person you could be in. So paramedics for the last two years have been working side-by-side with nurses and doctors in emergency rooms and ICU's and, in fact, standalone, confusing clinics. And they're getting paid at half or less the wage of the same qualification of the providers working next to them. I will say we just have been driven up significantly in Vermont, which has made the EMS by nature outlook less sustainable than it was two years ago. We are in crisis and we are in more trouble now coming out of the pandemic than we were going into the pandemic because reimbursement rates have not increased the cost of delivery has significantly increased. All of our Vermont annual services survived the pandemic. So everybody's kind of holding on. Everybody's been able to buckle down and keep their trucks on the road. What we have seen is that the stress is higher and we're seeing the stress is higher because hospitals don't have personnel. So for those services that are going to hospital to hospital, doing those transfers. So for example, in our area, we have precl-access hospitals. They don't provide care for cardiac. They don't provide major trauma care. Those patients have to be transferred to another center. Those centers don't have the staff and the capacity that they once did. So we're transporting patients further than further. So if you're in a gravel area, we're traveling to the main medical center, we're traveling to Hartford, Connecticut, about all the way out into Western New York. We're going to transport you to six different states, quite often calling 12 or 13 different hospitals to try to find and accepting for somebody that's having a critical life-threatening pregnancy. So ambulance is going to be tied up for six, seven, eight hours in a time. We move patients all over New England because then you'll hear us, from the hospitals, from the nurses, the spillover effect on that EMS is more stress to it and already stress EMS is in fact, one of the challenges that we're facing right now is the ability those patients moved in a timely manner. And I'm sure we'll talk more about that. So I mentioned the fall of 2021. You guys infused some money through the CARES Act and our education programs. It was 440 students that we were able to enroll in three months. Again, we're moving that burden of cost. We know Vermont is going to help. They just can't afford it. And we demonstrated that over and over again. Going out of the pandemic, 2021 also brought us 4.3% increase in call volume. Something that has an effect on especially the smaller, the volunteer services. We're asking more and more and more of these people more of their time, more of their money in order to kind of make this stuff, this work. I mentioned the education funding that we don't currently have and what the effect is there. Last year, we asked for some money for EMS education. You guys approved $500,000. That money ended up going to the Vermont College system. Unfortunately, only 244,000 of that went to EMS education. The rest of that might be used in other ways. So I would suggest that we could have done probably some significant workforce development with the quarter of a million dollars that they could use for EMS as part of that appropriation. Do you remember how the appropriate, how it was written and why we would have allowed that to happen? I mean, was it, if there were the students or what was, how did we allow that to happen? So what we had asked for last year was very similar to the year before which would have been a France program that we ran. Like we ran the year before where the health department issued grants to the public cost of education. Somehow, and not being here, chunk of money that was allotted for E&T and advanced E&T programs fell off somewhere in the budgeting process. And the money for VTC got rolled into some sort of other essential workers grant program that was administered by the college. So it wasn't directly tied to. It was specified that it was for paramedic education but it wasn't administered by the health department. And I guess whatever was it used from that, they're allowed to then use for something else. So, you know, just to. So I'm just curious, is that what we were not here? Yes, you guys weren't in session. Well, you guys were in session but not in the building. Right. So who isn't that we should find out about what happened to that money as a department of health or is it VTC? VTC, it didn't go through the health department. Yeah, okay. We're going to go on for the entire afternoon but I know you're on a tight schedule and you've got a whole bunch more people, so. Well, remember this is the first time we're gonna. Yeah. This, I think is that issue that Senator Romney, so we've been working on this issue for a long time and what a, in my mind, one of the very basic problems that we have is that we still somehow, it might be getting better, but we still somehow consider EMS as part of our transportation system, not as our healthcare system. And it really is part of our healthcare system and we need to shift that whole thinking and I'm not sure exactly how we do that in a meaningful way, but that's one of the things that I'm concerned about. Maybe that is something that needs to do with healthcare. Yeah, I'm not sure how we do it. Part of it is a culture thing, I think, the way we think about it and part of it is how the healthcare system itself thinks about it and then how we reimburse, we reimburse for transports. Right, so. We don't reimburse for a life there. Yeah, so Senator Parkson. So, Drew, there is a huge workforce development bill coming from the House to the Senate. In case you and I both serve on the committee that it will come to. I assume you were at the table on that because you weren't, okay, so. Fine. Certainly, I would urge you to take a peek at it. I can't remember the number off the top of my head to committee bill that came out. Oh, I don't know what they attached to, but it's coming out, they're still worth, there's still pieces that are being worked on, but it's about to come out of the House. And so I'd love to make sure after this conversation of whatever some of your specific needs for EMS are addressed in that. So. I will look for that. Okay, great. So thanks, you can stay right there if you like because I don't think you're gonna leave out. So Jim, do you have anything you'd like to add here? And thanks for joining us again. Thank you, I'm happy to be here. I just wanted Drew's very good at explaining all the issues, but I wanted to make sure you know that everything he said is correct. I can go through the list. COVID has been terrible on the EMS workforce. It's increased our costs significantly for paying, training is not where it should be. The amount of students that are in rolling classes is hurting. This is a long-term problem that needs to be fixed. Our inflation is way up and of course everybody knows the fuel costs, everything we do is up. It's not a good picture and I just wanna make sure we appreciate the help but it's going to take a large effort when you talk about things that are now even being added that there's another subject is again dispatch is going to add a whole lot of costs to services I think or towns and you have to understand that the towns are still funding the differences in people's cost. The volume of volunteers of course is down but that's again putting a strain on the whole workforce because there used to be a lot of volunteers that volunteered their time and had other jobs and now you have the workforce where it's a lot of volunteer agencies running up having some partial or paid personnel, not all. That then waters down the workforce then you have hospitals and other agencies hiring our personnel. The paramedic course when you go to look at the training that was taken away from the funding last year one of the things we said was that we had to have it more than VTC because VTC is extremely expensive. I know they're trying to work on the program but we know still again that you can take the paramedic course when you can send them to one of the nearby states for a third or less of the cost. So I just don't want to be all negative but we really do appreciate everything you do. We appreciate what the federal government's trying to do but this is a immediate problem that's going to take a long time to fix I think but I thank you for the time. Any questions? Thank you. I think what I don't do is jump to Haley. I know the senator is very interested in this issue and has sent us a note that is willing to work with us on however we can work together to help solve this and I wondered if you had any insights into what he was thinking or where that might be moving if you could share with us. Sure, good afternoon and thank you for the opportunity to join you today. As you heard, my name is Haley Parrill. I'm Senator Sanders Outreach Director and I work on a number of issues for the senator including first responder issues. And as you mentioned, EMS issues are a big priority of the senators and so on behalf of Bernie, I just want to thank you for having this hearing, inviting me here today and really working at all levels of government to make sure we support our first responders. I'd be happy to sort of walk you through the work the senator has done on this issue this year and also preview a bill that he's looking to introduce perhaps as early as later this week. So in January, Senator Sanders hosted a town meeting and that was with the U.S. Fire Administrator, Dr. Laurie Moore-Merrill and it was a virtual meeting but it brought together the fire administrator and Vermont first responders to discuss some of the challenges and how the federal government could better support them and what both the senator and Dr. Moore heard a lot from from both fire and DMS in Vermont was the high cost of equipment and training and that recruitment and retaining both volunteers and paid staff was really at a crisis point. We also know that the staffing shortages are not unique to Vermont. We've heard in an American Ambulance Association survey that turnover among paramedics and EMTs ranges from 20 to 30% annually which then equates to 100% turnover every four years and in 2020, nearly one-third of the workforce in ambulance services left after just one year. 11% left within the first three months but we know that despite these staffing shortages local EMS departments are responding to a huge volume of calls 2.85 million nationally and we do understand that funding alone will not address all these challenges for both of the fire and EMS side but it's really been important to the senator to make sure that we increase federal investments and also improve access to grants. We hear a lot from rural departments that they don't have the time or expertise to access the federal funding. So following that initial meeting in January Senator Sanders introduced legislation that would more than triple the funding for two existing federal programs that do primarily serve fire departments. One is called the Assistance to Firefighters Grant and that focuses mostly on equipment and vehicles and then there's a staffing for adequate fire and emergency response grant for hiring, excuse me, recruiting, hiring and retaining firefighters. Also in the bill was again that federal funding piece for technical assistance so that rural departments would have assistance with applying for the money. And even though these challenges are something that both fire and EMS face what we really learned from the meeting is that if you are an EMS agency like many in Vermont that's not affiliated with the fire department and our understanding is that also accounts for 60% of all EMS in the country that you don't have access to that funding. The fire grants only allocate 2% to non-affiliated EMS and there's only one small grant funded at about $6 million nationally dedicated to EMS. And as I mentioned, we're particularly concerned about rural EMS and the low reimbursement rates for Medicare and Medicaid that don't cover the actual cost of service. So Senator Sanders to address EMS costs and needs is currently working on legislation. It would create a brand new grant program similar to what we see available for firefighters but this grant program would be exclusively for EMS and to fund those needs. It's still being finalized but I can sort of check through a few things that it could be used to fund. That could be used for hiring personnel, recruiting and retaining volunteers, training and reimbursement for the training, implementation of apprenticeship programs to really grow the workforce, purchasing new equipment, vehicles, medical supplies, supporting the wellbeing of EMS personnel, improving station facilities and also establishing community paramedicine and integrated mobile healthcare initiatives and lastly improving regional coordination. Like the fire bill, it would include funding for technical assistance as well. And it would also request two reports. One would look at reimbursement rates since we do know those are major challenges. It would ask the secretary of the US Department of Health and Human Services to provide Congressional Report. They would detail those challenges, the disparities, the inequities and ensure that they have a recommendation for action how we can address that. It would also ask HHS to provide Congressional Report detailing the challenges specific to rural EMS departments and to non-affiliated EMS departments and again, develop an action plan. So that's what the bill in its draft form entails. Right now it's probably around $500 million which would be the available funding for grants and I'm happy to keep this committee and the EMS community at large posted on when that's officially introduced and happy to answer any questions. So I do have one and I may have misheard you but I thought one of the things that you talked about was the relationship with the EMS to rural health centers isn't the word you use but my concern about that is that in the area where I live and where Drew primarily priming a large part of his catchment area, we don't qualify for a federally qualified health center. So if it's tied to the FQHCs, we wouldn't benefit. Well, very few communities in Vermont because we have so few FQHCs. Right, I will double check but I don't think there's any tie to federally qualified health centers or any rural health care facilities. But thank you for that helpful flag that that would be problematic for many folks in the state. Yeah, we have very few I can't remember but don't be, I mean, isn't that right? Am I, I think we have like three or five. Oh no, no, I don't know. They serve about 25% of all Vermonters. I unfortunately don't know the total number around the state. Yeah, but it's not as many as you think so. Anyway, okay. All right, any questions for Hayley? If you actually could send us, send to Gail a link to those, the firefighter grants and then any ongoing information about the EMS potential. Certainly, as soon as it's introduced, we can send sort of a one page summary and the legislative texts as well. Thank you, thank you. Thank you. So we hope that you're going to stay with us as we continue to have this conversation because I think this is more than a one off conversation. We've been having it for a long, long time and have, as Drew said, been kind of slowly plotting our way. We would have been a lot further if we hadn't had a pandemic, but we did and we're dealing with it. So yeah, I'd be happy to stay engaged on behalf of the Senator. And we need to figure out a way of increasing the wages for the EMS people because of fear that I haven't, maybe this is unrealistic, but is that the hospitals themselves are so short staff. And if they have EMS people working alongside their staff, they're going to scoop them up where they can make more money. And I lost 12 in the last two years to hospitals. Yeah. Were we surprised in their training and education got their experience and the hospital very overpaid at a rate that we just can't actually achieve. Yeah. So Will, would you like to weigh in and give us your thoughts here on kind of the beginning of this conversation? Yeah, sure. I will thank the chair and all of members of the committee for the opportunity to speak with you today. You know, in the interest of avoiding overlap and I think drew to a really nice job of reviewing the highlights of the annual report of the EMS Advisory Committee. I think I want to take my time with you today and specifically focus on what is also a, very much a hot conversation piece. And that is the conversation around regionalized dispatch. And, you know, my intention and asked to speak with you folks today is to really help inform you on how we think about what type of 21st century solution we should be seeking when we begin to imagine these alternatives for, you know, regionalized dispatch systems and what the future of dispatch systems look like in the state of Vermont. And, you know, really where I would like to start is, you know, communicating the fact that dispatch centers today are different than what you would likely imagine, you know, from the 1980s and 90s and certainly early 2000s. And that we look at our dispatch centers today as 21st century emergency communications platforms that serve many different purposes and also specific unique groups, right? So first and foremost, you know, emergency communication centers provide the public rapid access to the emergency response system by utilizing things like technology to both receive and process and decide. And then dispatch first responders to ensure that the public receives, you know, timely and time sensitive life-threatening interventions before they arrive at a hospital. You know, and that starts with a system that allows for the efficient call answering and the transfer of essential information between the call taker, the dispatcher, and then ultimately out to the EMS unit, whether it's a first response or a transport ambulance. You know, modern 21st century dispatch systems include, you know, functionality such as priority dispatching that improves both public and EMS partitioner safety by balancing both the use of lights and sirens against the need to deliver time-sensitive pre-hospital emergency care. You know, there's a lot of research out there that points to the fact that we as an industry overutilize lights and sirens and unnecessarily put the public at risk. And our EMS practitioners at risk and modern dispatch centers utilize priority dispatching to assign a level of priority that communicates the responding unit, the degree of emphasis on their response and whether or not it's appropriate to use lights and sirens and or it would be, you know, just as appropriate to go with the flow of traffic and therefore reduce the risk for both the public and the first responders in their response unit. So a modern 21st century emergency communication center also utilizes and offers centralized coordination and monitoring of precious limited EMS resources across the system. You know, these systems utilize technology such as computer area dispatching to efficiently deploy and manage those resources to meet both the demands of the 911 system in our inter-facility transfer system. That, you know, and with the goals of really maximizing efficiency and improving health outcomes, you know. So utilizing technology that exists today, you know, these systems both track and identify the closest appropriate units based on the calculated location of the emergency response call and then identifies that information automatically for the dispatcher so they can rapidly identify, select, and dispatch the closest appropriate unit. You know, modern 21st century dispatch systems, you know, also not only support the 911 system, but as I alluded to, they support the inter-facility transfer system, right? So this is those EMS resources that are utilized primarily by hospitals to facilitate the movement of patients between facilities. You know, sometimes that's to take a patient from a tertiary care center to a long-term care facility, but oftentimes, you know, it's the movement of a patient from a remote hospital to a specialized care center that, for example, has a catheterization lab. And that's both, you know, that is time-sensitive treatment that patient needs, they experience a positive health outcome. And one of the things that, you know, that we saw during COVID was that, you know, we had an EMS system that was under tremendous level of stress and, you know, not every organization was able to operate at the level of efficiency or capacity that they otherwise would have been able to pre-pandemic. So those resources that were utilized to move patients between facilities were limited. And what really became apparent as these types of stresses boiled up from the system and were communicated back to us by our healthcare partners was that we do not have a coordinated dispatch system that has eyes on the state and is able to both identify and manage those resources in such a way that we can effectively, you know, keep ambulances moving and doing so with patients in the back to connect them to the resources and to get them to where they need to be. And that, you know, the inter-facility transfer system really operates in a silo in that, you know, we have around 26 services statewide that provide IFT transportation and most of those organizations operate in a communication silo. And without that centralized dispatch or that ritualized dispatch system, you know, we don't have eyes on and the ability to sort of identify and track all of our resources to therefore maximize efficiency and, you know, move patients within the system in a timely manner. The other thing I would mention is that new 21st century communication systems also serve the EMS practitioners themselves by transferring bio-information electronically between the dispatch center and the first response unit, right? So when we do that, so, you know, many of you have likely seen the insider police car. And one of the things you would note is there's oftentimes a computer, you know, sort of sitting between the driver's seat and the front passenger seat, right? Those are commonly referred to as a mobile data terminal. And there's a transfer, you know, in real time of vital information that law enforcement officers depend on. You know, our dispatch system is for firing EMS. For the most part, that technology is largely absent. And the transfer of communications primarily done using voice, right? So the dispatcher communicating directly to the person who's answering the radio on the other end. And so when we talk about things like, you know, really adverse work conditions for our dispatchers, that's one of the reasons why, right? Because every time that data is transferred, that's a touch point. That's a position where that's a point in time where the dispatcher has to pick up a radio mic and directly communicate that information as compared to other near peer modern communication centers that utilize the technology to transfer that information seamlessly and allows that information in that real-time data link to always be accessible over the duration of the call. And it's not just the emergency at hand. It's the other emergencies that may have occurred at that location previously. You know, for example, we, you know, sometimes our EMS practitioners and teams will respond to, you know, either a home or a location where there are unique security concerns specific for our first responders. You know, for the majority of our EMS services across the state today, you know, we don't have systems in place that allow for that information to be flagged and then visually represented for the responding crew so that they're aware of that information and unless there's a verbal transfer of that information, those crews go without and may inadvertently find themselves in the situation where had they had that information available to them, they would have avoided an unnecessary level of risk. You know, so when we talk about the transfer of vital information, you know, we should really be ensuring that our future solutions can do so in a timely and accurate way. It improves provider situational awareness. It reduces errors and certainly better balances both dispatcher and EMS practitioner workloads by avoiding unnecessary radio traffic and making that type of data electronically available and displayed for folks to review and to flag within their own team at a time that makes the most sense during the response. The last thing that I would flag, you know, as sort of a quality that we should look for in these 21st century solutions is a dispatch system that employs technology to improve interoperability, both between dispatch centers and our EMS response units or our fire trucks, whatever it might be, but it's utilizing technology to make these interoperability connections that allows us to both transfer data but to also support other emergency and non-emergency operations. You know, when you look at, you know, certainly our out-of-state counterparts and our more large and more mature EMS systems, they find ways to integrate all of their critical systems which allows for the better utilization and reduced workload and therefore more tenable working conditions for both our, you know, for all sorts of first responders whether you're in the fire service or you're an EMS practitioner. You know, it's that seamless and automated data transfer systems that both improves our data entry, our efficiency, accuracy and completeness. So really what I've taken the last few minutes to do is to identify, you know, what are those key elements? What are those key attributes that when we look at our near peer counterparts who have modern dispatch systems and they're doing so on a regional basis, these are the types of attributes that we see that allow their systems to stand out. And those, you know, that's what I would say or certainly would offer to you that, you know, as we think about the future of dispatch and the future of our emergency communications systems and our platforms across the state of Vermont, it's those types of qualities that we should be asking, you know, whether or not, you know, we are essentially being handed a 21st century solution or is it something contrary to that? And I'll just close by saying a few more things. First is that, you know, I do agree with Commissioner Sherling in that regional dispatch should be the future of dispatch across our state. You know, those topics have been studied time and time again over several decades and more often not the conclusion is the same. You know, I do think there is an opportunity for us, you know, we know that there is a significant funding on the table that's been offered to facility with your staff. I'm sorry, go ahead. It's okay, but I'm going to remind you that we have kind of made a shift here and we have all Thursday afternoon that we're talking about dispatch. The, I mean, I know that EMS and dispatch are very intimately connected, but we have not started our discussion yet on dispatch. So I don't want you to get too deep into that because that's the Thursday conversation. Correct. My apologies, that is my fault. And I'm sorry if I've taken up the time on, or your time on the wrong topic today. So I'm happy to pause there and I'm happy to revisit that on Thursday. And I can speak to any other questions about some of the topics that Drew has raised today. So I have one particular and I am not sure that what the source of this money is, it's money that's meant to go out to the regions, to the EMS regions. And my understanding is that there's still $400,000 sitting in the Department of Health that can't be distributed to the regional EMS offices for some bureaucratic snafu. Can you tell us what that is and how we get by that? Because they need that $400,000. Yeah. So I think there are a few sort of nuances that are relevant to this conversation. So every year we publicize the special fund and what type of expenses that EMS districts can essentially request reimbursement for their activities related to things like EMS education, recruitment and attention, those things that are necessary to facilitate the delivery of emergency medical services in their respective districts. When you look at the way the statute is written, there's pretty broad discretion on the part of the EMS districts to sort of spend money in creative ways to both support and facilitate the delivery of EMS. So here is sort of where the tracks diverge. We have every EMS district, if we back up and say this way, EMS districts are not equal. We have some EMS districts that are very, very active and have robust executive boards and participation across all of the services that make up that district. And then we have EMS districts that are sort of on the opposite end of the scale and have very limited participation and therefore limited capacity to support the infrastructure they need to both submit for reimbursement and or even before that act in such a capacity that they're playing a sort of forward leaning role in the facilitation of the administration of EMS in their districts. So while some EMS districts request for reimbursement for expenses made, they do so every single year and capitalize on every dollar that's made available to them. That's not the case, as I've said, with every EMS districts and some just aren't new as active. So as the years have gone by and this program has been in place for around 12 years. And every year as time has passed, we've had dollars that have gone unallocated because we have not had broad participation across the entire state. Many EMS districts leave their money essentially on the table year after year after year. And so that is just one of the reasons why we've seen this pool of money grow and grow and to remain unspent sitting in the count and certainly within the department of health. So what you were getting at though is how do we take advantage of that? How do we get at and how do we utilize those unspent dollars? So there is absolutely room for a conversation around that. This is certainly not an excuse, but both me and my staff and almost every single member of our division has been committed to the COVID response for more than two years now. So our capacity to begin to sort of put eyes and brain space on other really important topics has been very limited. As I've said to folks within our EMS advisory committee, it is certainly my commitment that we do put the time and effort into working with our business office within the department of health to identify mechanisms that we can take that money and to support various EMS programs that would both help and facilitate the delivery of emergency services across the state. So it's not a straightforward answer. There are several sort of layers to that onion as you peel it back that would explain why that pool of money has grown over time. But that is the brief answer that I will provide you today. Thank you. I bet we can come up with some ways of getting that money out there pretty quickly. Just put these five little minds together here and we'll come up with it. Oh, so... They're big minds when it comes to... I'm Drew and then I'm gonna jump to Gwynn here and then we have another topic. So just on the district training funds, one of the biggest challenges right now are the very deliverables that you need in order to get reimbursed are not able to be delivered by the areas that need the services the most. So it's reimbursement for classes that you can already offer. And if you have an area that can't offer classes because they don't have the capacity and they can't access the funds to hold the classes that they need in order to. So we've got like a tail and dog rat a circle thing. We can get the money to the places that actually need it. And that's kind of part of the reason why this fund continues to grow. I bet we can figure that out. We can spend $400,000 pretty quickly. We know the needs out there and we'll just do it. Give us 20 minutes. Yeah. So I'm gonna jump to Gwynn to see if you have anything to say and then we're gonna jump to another bill here for a few minutes. Hello, committee. Gwynn-Zakka from Utley Gives Cities and Towns. I don't have anything to add. I think the report from the EMS Advisory Committee speaks for itself and Jim, Will and Drew has always did a good job of laying out the issues. Just as a point of reference, I'm one of the members of that advisory committee and I think I might be the only one that doesn't have an EMS background. And it's a very interesting committee to be on and a lot of hardworking, very smart individuals that it's one of the few study groups or committees that I'm on where there is a lot of consensus and a lot of the issues and everyone is sort of singing the same tune. So everything you see in the report is pretty much a meeting of the minds of a lot of folks. So for whatever that's worth, I think that's relatively positive and a strong message for the committee to work from. But always a comment on the dispatching stuff for later in the week. Yeah, good. Thanks. Yeah, and we are going to look at dispatch and we're gonna look at the money that's being set aside for dispatch, both for hardware and for setting up the seats and dispatch as it relates to kind of all three, the EMS system, the law enforcement and fire and how they relate to each other and how we do that on a regional basis. So that's gonna be, that's one of those other topics that we don't have a bill for or anything. But I think our input on both of these might be through the Appropriations Committee, that's, so. So people schedule something next week, except because everybody's me. Sure. Are there any days that we can't? Okay. So we haven't scheduled anything for next week yet. So that's a bad response from me, unless it's to say there's any days you can. Oh my God, I'm not on it. I'll be in time for you any day. With 315 calls a day. That is true. I saw that. I saw that. We have many calls every day, services in Vermont are very busy. Yes. You guys keep us hungry. And I didn't even call when I fell. I was gonna say. Yeah. What did you do? The system would have taken good care of you. Yeah. I mean, it would have had to get a ski. I'm not sure you would have gotten it to her. See, that's a challenge we love. But in our world, people try that every single year. I have swam out to islands and picked people up. I have planned vertical cliffs to get them. You have. I actually had to spend the entire night on a mountain top for people, because I couldn't get them out. So that challenge is accepted. EMS will get you in Vermont somehow. I don't go fall again. You have to test it. The other night he was teaching water rescue to our fire department. Thank you, Drew. I hope not. Thank you, Jim, Kelly. Thanks, Drew. Well, thank you all. You are not. Okay. Now Drew, would you like me to dive over for you? Drew, I thought you live in Jamaica, not on the ferry, right? Yes. That's what I thought. I was gonna tell you, you just got moved to. Yeah, I was gonna say. I don't think I've ever been here. I've been all around. No, you're Jamaica State. Oh, okay. I know on the house side, Kelly's no longer a representative. I guess they moved me on that side. Yeah, I think so. I'm a who represents me now. I know. I will find them. Maybe you'll run. Maybe. I don't think they have started. And the pay isn't even as good as what he's getting now. Are you going to drop them? Yes, I am. I'm just choosing one and passing them around. So, was it real, Kevin? Okay. We held. I thought, Evan. Evan, Julio, and Mark Sherman. Okay. So, she's grown. I was pulling up your hand. That's great. Yeah, that's kind of the quick and dirty part. But we still are. Do you have any questions? Yeah. Yeah. I'm sure. Thank you for joining us and Ben is here with us. The question came up on the floor. First of all, I have to say that I thought that Senator Rom-Hinsale did a great job of reporting the bill. You did a terrific job. And answering the questions you did. That one that Joe asked was particularly sticky. And I don't have my notes here. But the question was on the Julio, Julio, like Jello. Okay. J-I-L-L-Y-O. Okay. On the Julio letter database, there was a question in two or three places it appeared alleged, alleged. What did it say, Ben? Alleged? So, it is considered Senator White. This is Ben Overgross from the Office of Legislative Council. So, Senator Redding's concerns were in regards to what section two of the bill under subsection B2, 3, and 5. So, the concerns about any past or pending criminal charge brought against the law enforcement officer, any allegation of misconduct bearing upon truthfulness, bias, or integrity that is subject of a pending investigation, and then any misconduct finding or pending misconduct allegation that either cast a substantial doubt upon the accuracy of a law enforcement officer as a witness, including testimony that a prosecutor intends to rely on to prove an element of any crime charged, or that might have a significant bearing on the admissibility of prosecution evidence. Yes. And his concern was why would a pending or an alleged violation go into the letter in the report? My understanding was from listening to the testimony here that that was the way he currently reads and that this came from, this language came from. And I've got myself all confused here, rule 15 and rule 57. And I think that was even in a different committee. But can somebody answer us, please, so that Senator Roninzell will be able to answer this on the floor? And what I'm going to do is, Keisha, if you understand there, that's OK. But just so that you know how to answer it. Exactly. Yeah. Yeah. Evan, can you start off here, maybe? And then, Mike, about how law enforcement felt about that. Those are the two questions. I do want to add. I mean, I don't know if we're counting it, but I was going to ask Ben, too. I mean, I did want to try to give some deference to Senator Ron's question about what qualifies as coercive. Oh, right. Gosh. So I mean, I want to try to honor that. I don't know if there's a way to get a legal standard definition that we can all agree on. Yeah, and I think I'll find a bit on that one. OK, great. OK, so let's do the pending and alleged first and then do the course. So Evan. Sure, I can certainly try and answer the questions pertaining to proposed sections 2370, B2, 3, and 5. So I think one thing to keep in mind when it comes to these sections is that what Section 2 tries to do is create a central repository for information that may bear on a law enforcement officer's credibility. It doesn't necessarily mean that all of that information will be admissible in court. That will be dictated under the applicable rules of evidence, specifically Vermont rules of evidence 608 and 609. So I think that's important to keep in mind because what Section 2 is trying to do is capture the universe of information that might bear on someone's credibility. But it doesn't mean that appending criminal charge will necessarily the court will allow that to be used in court or that appending an unresolved allegation of misconduct could be used. But the real question is, does the state of Vermont want to have a database like this that prosecutors can tap in order to make sure that they don't run afoul of their discovery obligations and give defendants an opportunity to just ask the court, can I use this at any trial or at any hearing to help defend myself? One interesting thing about Subsection B2, Pastor Pending Criminal Charges brought against the law enforcement officer, that section does stand out a little bit from the other sections because the other ones all have some sort of caveat or qualifier built in there that the misconduct or the alleged misconduct has to reflect on or bear on the law enforcement officer's truthfulness or potential bias. Not all alleged criminal conduct is going to do that, for example, alleging that an officer provided false information to another police officer during an investigation, obviously does bear on that first officer's credibility. If a law enforcement officer is alleged to have committed a simple assault, especially off duty, that's not necessarily gonna bear on someone's truthfulness. So if the point of the question is how might we tighten up some of this language, that could potentially be one way to tighten it up. I'm not sure if that answers the question, but I hope that it does. I guess I would leave it up to you then. I mean, I wonder if we can hear from Julio as well, just because I do think this is somewhat related to federal language. So I don't know, I wanna make sure, like I get narrowing it, but I also wanna make sure we're honoring sort of the Supreme Court decision that I think the promulgated the law of the language. Sure, I think that keeping Evan's original point in mind that this is just material that would be available for prosecutors, for prosecutors to make the judgment. I mean, the constitutional standard under Julio, and that's how it's pronounced in Julio, is that the center of the judgment comes out of the prosecutor's office because they are the office that knows what testimony they plan to put on, what witnesses they plan to put on. And therefore they are the ones, at least in the first instance, to know how material, that is how relevant, how informative this information about the officer is either casting doubt on their credibility or also casting doubt on the admissibility of other evidence. So that's the point of the database is basically to inform prosecutors and provided that this is really a locked tight database with very limited access. I think the committee ought to err on inclusiveness. There is a caveat at the beginning of section two, if I could pull it up on my screen here, that says potential impeachment information. So potential is one caveat, doesn't mean it is impeachment information. And then two, it says it may include, doesn't say it must include, and it doesn't say it may never include. So when I look at a May clause like that, and I look at the different criteria or examples that are listed below, my question is like, may it include? Well, is it possible or to test it, I would say, would we say that it may, it would never include it? Like there would never be a case where a past or pending criminal charge brought against the law enforcement officer might be impeachable. I don't know that you could say never for number two, because impeachment is not just for the truthfulness of the officer generally, but it also, well, I mean, it doesn't have to be whether they've engaged in an act of dishonesty. An officer who's a detective in an arson case, I would think any prosecutor would wanna know that that officer is facing two criminal charges for arson himself, for example. That whether or not they actually go to trial or make decisions, that's information that I would think state's attorneys or these attorney general's office would want to have. And that's really the purpose of this database is to give a full picture so that prosecutors aren't blindsided by that information and they can make judgments on the case overall. Maybe that in my example, which was an extreme example but that was the point is that, would we wanna have a statutory exclusion where that information was never available to the prosecutor because they weren't comfortable with the list. So I guess I would stop there if there are any questions about that. I just think that I would like to have the commissioner weigh in also on that because that was also a question about how law enforcement use this database. Well, and how that election of that name. Good afternoon, Madam Chair and committee. The answer to, for the record, Mike Shirley, Commissioner of Public Safety, the answer to that question is one we sometimes struggle with, not relative to truthfulness because I should preface everything I'm going to say with if an officer has truthfulness issues or in the event that there are arson charges pending against someone, that those things are typically and should be fatal to an officer's career. So the question of whether they end up on the stand in a case is not something I've encountered in Vermont as an issue if there is a substantive underlying truthfulness issue with an officer or they have criminal charges that are past or present. The pending criminal charge sometimes gets a little muddy in that if someone has an accusation against them and it is a truly contested set of facts that the personnel action, they're usually not working, but the nature of the personnel action is usually awaiting the outcome of that criminal case and not all allegations against any cross-section of the population are always true. So I do have concerns about pending things being in the database, but as an operational reality, if a police officer has a pending criminal charge, they should not be working. So it shouldn't be, they should not be available as a prosecution witness under that circumstance. I agree. Okay. More, if I may, while I have the floor, Madam Chair, I just want to flag for the committee. We are with you in spirit on where you're headed here and believe that a database does make sense, but are in kind of a position where, as we're reviewing the text of the bill in detail, have a variety of concerns that things are missing or not worded as well as they could be or should be in order to actually operationalize this for, I'll give you just a couple of examples in section four. I'm not sure exactly what it's trying to say because the semicolon and the comma are in odd spots, but it appears to say that a knowing false statement in writing would go into this database, although the semicolon causes that to be called into question, but in writing doesn't really modify the rest of that sentence. So what I guess what I'm saying is a knowing false statement whether in writing or not should be in the database. And if it's a substantive false statement that isn't in writing, if it's substantive, I believe that should be fatal to an officer's career as well. It doesn't matter whether it's in writing or not. And the second half of number four, I just need to flag for the committee that an unlawful search or seizure or an illegally obtained confession does not equate to misconduct in the vast majority of cases. The courts frequently may be an overstatement, but regularly throw out evidence as a result of procedural either errors or new law that the courts are making and deem a search to be not lawful under the Fourth Amendment or Article 11 or a confession and not be lawful into the circumstances because custody existed and Miranda was not read or something along those lines, those do not necessarily equate to misconduct and as written, every piece of evidence that was challenged and successfully in an officer's case would end up in this database and that doesn't make a lot of operational sense. That's the way that the system works. So to create a database with every single hearing where a piece of evidence is lost would be problematic. It would cloud the issues pretty significantly. I'm not gonna go through every potential flag but in the confidentiality section, this appears to be at odds with current public records law. There are instances where these kinds of things are public facing right now. That's not universal. It depends on a variety of circumstances but the way it's written, it would shield them from public view in a more restrictive way than currently exists. So a flag that for you, I think that's problematic in the age of trying to be as transparent as possible with our operations. And then the last one I'll flag is there are some significant due process concerns here both on the front end and the back end. How does something actually make its way to the database? It's not clear the path through the prosecutor. And I think Evan and Julio both mentioned that there's a key prosecutorial assessment that has to happen to sort of assess the veracity issues of a piece of information. And so having a process to get these things into the system is important. And we believe it's equally important to have some mechanism for something that has been entered into the system to have a way to appeal that. So if for example, a prosecutor Smith decides to put it in, if that's the mechanism that's created and other prosecutors disagree, the agency disagrees, there should be a method to appeal the inclusion in the database if we think that someone has made an error in judgment for including it. And none of that is present as drafted. So really long way of saying, we're supportive of the concept, we're not trying to slow the process down, but there is a lot of additional work that needs to go into this. And the question for us is, will the house have time to continue to work on it? Or does it make sense to ask the Senate to pass out more of a directive, not if to create a database, but to direct the attorney general's office, the state's attorneys, DPS, and the council together with stakeholders to deliver a mechanism to implement this on a particular timeline. Julia, what's his hand? Oh, yeah, Julio, I do have to say that we're a little behind ourselves here, but so Julio, quickly, do you have a? Yeah, I guess I would react just to the last point about point five really has to do with the judicial judge finding that the officer conducted an unlawful search and seizure. It would strike us, I think, as a little anomalous that you would, by statute, if you drop that section, what you're saying is that it may not include that finding and therefore you would deny prosecutors access to that information so that they can make an informed judgment about whether and to what extent to put the officer on the stand, and maybe in a case where lawfulness of a search is contested or is one of the issues, and also what information to disclose to the defense. So our orientation here is that the purpose of the database is to provide information for prosecutors so they can make the most informed decision. And I agree fully with the commissioner in that finding that evidence is excluded because of some defect in the search warrant or in the way it was obtained may not necessarily be misconduct, but it also may nonetheless be something that would affect the prosecutor's decision-making with respect to that officer in this case. So whether the prosecutor styles it as misconduct or not, I think the aim here is just to provide as full of information as possible. And we're really talking about a judicial finding. So that's gonna be a ruling from a judge about the lawfulness of a search that judges don't make a decision that this was misconduct, just simply that it didn't comply with the fourth amendment or so forth. So that's all I needed to add. So my suggestion here is that we answered the questions about pending and alleged violations on the floor that you kind of give that background about the intent of this and how it would be used. And then it is confidential. And my guess is that this will go to judiciary in the house, but I'm not entirely sure. But wherever it goes, Senator Rom-Hinsdale and I can have a conversation with the chair of that committee to tell them where we see some of the issues are and how some of the language might need to be, I think a little bit to the Senate. Senator, everybody, I don't know that that is an ideal answer. Well, I was at this point, I think that's the answer where we are with the bill because we can't reopen the bill at the moment other than I think to answer these questions. Right. And the house we have, we don't, a whole couple of months and a half to solve those particular concerns in our house. Yeah, that's about my suggestion that we do that. And if it passes the Senate, then it will go to the house and we will have the conversation with the chairs, whether it's vaccine grad or seroculant responses. It would be one of the two of them. And I'm trying to work out, because I think that that section, language or on that section is the only place where there was any concern. And then can you work offline with them around coercion? Just because we're, yeah, we're not going to do an amendment with the definition of coercion. I just don't want to take up the time here for them to work offline to come up like I said. Yeah, because we're supposed to be doing the Springfield charter. I just said I could look into the definition of coercion and make sure it's, I think the fullest picture possible is what I think the database needs to be able to do. We're talking, we're not talking about the database. We're going to go on to talk to the best version of that answer. Yeah, okay, great, thanks. Thank you, Ben. Thanks so much. All right, so do we have Springfield people here? Oh, we have Walter here and there's Patrick. We're going to have a break. I just want to get my start. Okay, I'm live. Thank you, Ben.