Front Matter 0-010 - Signature Page

CMH EMS & MIH Protocols


This document is only valid for two years after the corresponding signatures dates below. Official copies of signatures are on file with Theron Becker at Citizens Memorial Hospital.

Agency Signatory Name Date Signed Remaining Notes
Bolivar City Fire DepartmentOn Behalf of Agency: Brent Watkins2023-01-03Expires in 0 years, 10 months, 8 days
Medical Director: Keith Butvilas2023-05-25Expires in 1 years, 2 months, 29 days ago
Bolivar Volunteer Fire DepartmentOn Behalf of Agency: Brent Watkins2023-01-03Expires in 0 years, 10 months, 8 days
Medical Director: Keith Butvilas2023-05-22Expires in 1 years, 2 months, 26 days ago
Cedar County First RespondersOn Behalf of Agency: John Wright2022-05-20Expires in 0 years, 2 months, 24 days
Medical Director: Keith Butvilas2023-05-22Expires in 1 years, 2 months, 26 days ago
Cedar County Sheriffs DepartmentOn Behalf of Agency: Blake Lovan2023-03-16Expires in 1 years, 0 months, 18 days
Medical Director: Keith Butvilas2023-05-22Expires in 1 years, 2 months, 26 days ago
Central Hickory Fire RescueOn Behalf of Agency: Jordon Graham2023-06-27Expires in 1 years, 4 months, 1 days
Medical Director: Keith Butvilas2023-05-22Expires in 1 years, 2 months, 26 days ago
Citizens Memorial HospitalOn Behalf of Agency: Theron Becker2023-05-25Expires in 1 years, 2 months, 29 days
Medical Director: Keith Butvilas2023-05-22Expires in 1 years, 2 months, 26 days ago
Collins Fire Protection District
Not Currently Approved
On Behalf of Agency: Jake Smith2018-10-15Expired 3 years, 4 months, 11 days ago
Medical Director: Keith Butvilas2023-05-22Expires in 1 years, 2 months, 26 days ago
Ellett Memorial Hospital
Not Currently Approved
On Behalf of Agency: Robert Coskey2018-10-15Expired 3 years, 4 months, 11 days ago
Medical Director: Paul Kramer2018-10-15Expired 3 years, 4 months, 11 days ago
Halfway Fire and RescueOn Behalf of Agency: Eric Schmidt2023-07-21Expires in 1 years, 4 months, 25 days
Medical Director: Keith Butvilas2023-05-22Expires in 1 years, 2 months, 26 days ago
Humansville Fire and RescueOn Behalf of Agency: Emma McAntire2022-06-20Expires in 0 years, 3 months, 25 days
Medical Director: Keith Butvilas2023-05-22Expires in 1 years, 2 months, 26 days ago
Iconium Fire Protection District
Not Currently Approved
On Behalf of Agency: Shannon Tucker2020-12-17Expired 1 years, 2 months, 9 days ago
Medical Director: Keith Butvilas2023-05-22Expires in 1 years, 2 months, 26 days ago
Lowry City Volunteer Fire DepartmentOn Behalf of Agency: Justin Norris2023-05-31Expires in 1 years, 3 months, 5 days
Medical Director: Keith Butvilas2023-05-22Expires in 1 years, 2 months, 26 days ago
Morrisville Fire Protection District
Not Currently Approved
On Behalf of Agency: Kirk Jones2018-10-15Expired 3 years, 4 months, 11 days ago
Medical Director: None/Unknown0000-00-00Expired 2022 years, 2 months, 26 days ago
Pittsburg Volunteer Fire DepartmentOn Behalf of Agency: David Murphy2022-05-20Expires in 0 years, 2 months, 24 days
Medical Director: Keith Butvilas2023-05-22Expires in 1 years, 2 months, 26 days ago
Pleasant Hope Fire Protection DistrictOn Behalf of Agency: Greg Wood2022-06-06Expires in 0 years, 3 months, 11 days
Medical Director: Kevin Presley2023-01-20Expires in 0 years, 10 months, 25 days ago
Polk County Central Dispatch
Not Currently Approved
On Behalf of Agency: Sarah Newell2020-07-30Expired 1 years, 6 months, 27 days ago
Medical Director: None/Unknown0000-00-00Expired 2022 years, 2 months, 26 days ago
Preston Volunteer Fire DepartmentOn Behalf of Agency: Brian Bennett2022-05-20Expires in 0 years, 2 months, 24 days
Medical Director: Keith Butvilas2023-05-22Expires in 1 years, 2 months, 26 days ago
Sac Osage Fire Protection District
Not Currently Approved
On Behalf of Agency: Cheyenne Smart2019-08-01Expired 2 years, 6 months, 25 days ago
Medical Director: Keith Butvilas2023-05-22Expires in 1 years, 2 months, 26 days ago
Weaubleau Fire DepartmentOn Behalf of Agency: Kenneth Rife2022-05-20Expires in 0 years, 2 months, 24 days
Medical Director: None/Unknown2023-05-22Expires in 1 years, 2 months, 26 days ago

Refer to Front Matter 0-010-01 - Hard-Copy Signature Form.


Citations:


Change Log:

DateLink to
previous
version
Description of change
08/29/13pdfVersion 2 approved by Roger Merk, MD.
12/16/13pdfVersion 3 approved by Roger Merk, MD.
12/20/13Version 3 re-approved by Roger Merk, MD (includes CVA and STEMI changes).
04/14/15pdf4/1/15 version approved and signed by Dr. Merk and Neal Taylor.
05/31/15Added comments about medications and equipment currently available on ambulances can be found in Section 7-001 - Medications Currently on Response Vehicles and Section 8-001 - Equipment Currently on Response Vehicles. Also added space to fill in who the hard copy is issued to.
11/18/15pdfVersion 5 dated December 1st, 2015 approved and signed my Dr. Merk, Dr. Kramer, Neal Taylor, and Cathy Menninga. Created two cover pages (one for CMH and one for EMH) for signatures.
01/27/16pdfAdded MPDS medical direction details for sections requiring specific instructions in card set.
02/03/16Combined all signature pages into one page for ease of maintaining.
02/06/16Added community responder AED content.
07/05/17pdfChanged medical director and agency heads names to reflect current staff.
08/24/17Added link to download most recent version. Changed William Proctor to Kirk Jones. Moved list of licenses to Section 0-020. Removed paragraph indicating protocols may not reflect what is actually on ambulances.
08/25/17Added Humansville Fire Rescue under Dr. Carter. Added Dr. Presley and Pleasant Hope Fire Ptoection District.
10/17/17Obtained signatures from Megan Carter and Neal Taylor.
10/18/17Obtained signatures from Whitney Gibson and John Hopkins.
10/20/17Obtained signature from Dr. Presley.
10/25/17Obtained signature from Kirk Jones.
11/29/17pdfObtained signatures from Megan Carter and Neal Taylor.
08/24/18pdfAdded two-year expiration to the title page. Added Collins Fire, Iconium Fire, Lowry City Fire, Sac Osage Fire,Wheatland Fire. Changed signatory names as needed for new personnel. Changed definition of pediatric from 18 yr to 16 yr old.
10/01/18Obtained signature from Neal TaylorJordon Graham.
10/10/18Obtained signature from Abel Smith.
10/16/18Changed Melissa Fletcher to Robert Coskey for Ellett.
10/17/18Added signatures from Kirk Jones, Kevin Presley,James Ludden.
10/18/18Removed Iconium Fire from list of associated fire departments.
10/31/18Added signatures from Megan Carter, LaDell Heryford, Travis Foley, Robert Coskey, Justin Norris,Paul Kramer.
11/01/18Changed John Hopkins to Emma Igo. Added signatures from Emma IgoGreg Wood.
11/05/18Added signature from Sarah Newell.
07/31/19Changed medical director to Gustavo Nix.
08/01/19Changed medical director to Tony Cauchi.
08/14/19pdfChanged Travis Foley to Cheyenne Stone for signature for Sac Osage Fire.
11/27/19pdfAdded Halfway FireRescue as signing agency.
12/03/19Dr. Cauchi signature added.
04/21/20Dr. Nicholes reviewed all protocolssigned approval. He also reviewed hard-copy medicationequipment protocols that were yet to be added to the online formatapproved those as well with the understanding they will be added to the website laterstill bear his approval.
09/27/20Added Halfway FireRescue as a signing agency.
10/01/20pdfAdded info from recently signed signature pages from Cedar County Dispatch, Halfway Fire,Humansville Fire.
11/13/20Added links to be able to view only those changes that have happened since each approval signature.
12/18/20pdfAdded Iconium Fire Protection District as protocol signatory agencies.
01/02/21pdfAdded code that displays expiration status for signatures.
03/15/21pdfReceived signature from Justin Norris, Fire Chief for Lowry Volunteer Fire Department.
03/22/21pdfAdded signature page from Central Hickory Fire. Been sitting on my desk for a couple week, but just now got to it.
06/05/21pdfMoved to emsprotocols.online
09/02/21pdfRemoved Morrisville Fire Rescue as a CMH protocol agency.
12/16/21pdfUpdated signature page on file from Dr. Nicholes.
03/18/22Removed Ellett Memorial Hospital per Bruce Goddard on 3/18/2022
05/20/22pdfAdded Pittsburg Volunteer Fire Department as a signatory agency.
05/20/22Added Preston Volunteer Fire Department as protocol signatory agency.
05/21/22Added Weaubleau Fire Department.
05/23/22pdfUpdated Cedar County First Responders signature.
06/20/22pdfUpdated Humansville signature date.
07/12/22pdfAdded new signature from Greg Wood, Pleasant Hope Fire.
12/28/22pdfDr. Butvilas reviewed and approved protocols for CMH and other affiliated agencies.
03/16/23pdfAdded signatures from Dr. Presley and Brent Watkins that have been sitting in my email for a while. Updated Cedar Dispatch from Dakota Newman to Blake Lovan and added Blakes signature.
04/27/23pdfRemoved Polk County Central Dispatch at the request of Director Sarah Newell on 4/4/23.
05/25/23pdfMoved all signature information into a database instead of hand-coded into this page.

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CMH Pre-Hospital Services Mission: "Provide safe, exceptional, and compassionate care to our communities with an emphasis on highly trained and empowered staff." CMH Mobile Integrated Healthcare Mission: "Provide exceptional, compassionate, and patient-centered care by a mobile collaborative team to improve patient experience, improve quality outcomes, and reduce healthcare costs."
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