rules and regs. topics brief review of national ems documents changes to the ems act proposed...
TRANSCRIPT
Rules and Regs
Topics
• Brief Review of National EMS Documents• Changes to the EMS Act• Proposed Changes to the rules and
Regulations
National Documents
• EMS Agenda for the Future– Rural/Frontier EMS Agenda for the Future– EMS Education Agenda for the Future
• National Practice Analysis• National Scope of Practice• National EMS Education Standards• National EMS Education Guide Lines
EMS Act
• EMS Act Changed in 2010 to reflect the new EMS Provider Level Titles Effective Sept 2010
• EMS Act changed to reflect National EMS Scope of Practice and National EMS Educational Standards until modified by the rules and regulations
Titles - Found in the EMS Act
Old• First Responder• Emergency Medical
Technician• Emergency Medical
Technician – Intermediate
• Emergency Medical Technician - Paramedic
New• Emergency Medical
Responder• Emergency Medical
Technician• Advanced Emergency
Medical Technician• Paramedic
Proposed Rules and Regs
Rule and Regulations changes have not gone into effect.
I’m presenting what is PROPOSED
EMS Board Scope Of Practice Committee
• Two Physicians • Two Paramedics• One Nurse• One EMT • One 1st Responder• Began working over three years ago• Discussed at and input received
– State and Local EMS Conferences - Fire School – Training Agency Meetings - Instructor Meetings– Written
Regulation Changes Work Done
• Change to EMS Act – Spring 2010 – Effective Fall 2010
• Scope Approved – Fall 2009• Draft of regulation submitted to HHS –March
2010• Draft in proper wording approved by EMS Board
June 2010• Several Refinements made between June and
December 2010
To Be Done
• Submitted to Governor's Office for Approval• March 2011 – Awaiting Approval
• Public Hearing• Board Addresses Comments (if any)• Approval by Attorney General• Approval By Board of Health• Governor signs• Becomes effective
Regulations
• Title 172 Chapter 11 – Out of Hospital Emergency Care Providers
• Title 172 Chapter 12 – EMS Services• Title 172 Chapter 13 – Training Agencies• Title 172 Chapter 14 – Public Access AED
Practices and Proceduresa/k/a Scope of Practice
Emergency Medical ResponderEMR
Practices and Procedures
Emergency Medical Responder
Current - 1st Responder• Option One
– Non affiliated with a Service
• Option Two– Member of a Licensed
Service– PMD had to Approve
Added Skills– Added Training
Proposed• SAME
Emergency Medical ResponderAssessment Skills
Current - 1st Responder• Simple Assessment
– Defined in Model Protocols
• Vitals– Pulse– Resp Rate– BP
Proposed• Assessment
– Defined in Rules and Regs
• Vitals– Pulse– Resp Rate– BP
Emergency Medical ResponderA – B – C s
Current - 1st Responder• Manual Airway Maneuvers• No Airway Adjuncts• O2
– ONLY when member of a service and had training and PMD Approval
• BVM Ambiguous Wording (maybe ????)
• CPR - Ambiguous Wording • AED
Proposed• Manual Airway Maneuvers• Oral Suctioning• Oral Airway• O2 Nasal Cannula, NRM
• BVM With or Without O2
• AED• CPR – Manual Only, No
Mechanical CPR
Emergency Medical ResponderTrauma Care
Current - 1st Responder• Bleeding Control -
Bandaging• Manual Stabilize
– C-Spine– Extremity Injuries
• Emergency Moves• If with a Service and with
Training and PMD Approval– Use Immobilization devices
• Spinal• Extremity
Proposed• Bleeding Control -Bandaging• Manual Stabilize
– C-Spine– Extremity Injuries
• Emergency Moves• If with a Service and with
Training and PMD Approval– Use Immobilization devices
• Spinal• Extremity• Transport Devices (stretcher
Stair Chairs etc)
Emergency Medical ResponderMedications
Current - 1st Responder• If with a Service and
with Training and PMD Approval– Aspirin – Epi Auto injector– Oxygen
Proposed• Auto Injector Antidote
Kits *• Oxygen in the Base Skill
Set• If with a Service and
with Training and PMD Approval– Aspirin – Epi Auto injector
*Not required to be a member of a service – Intended for self administration and disasters
Emergency Medical ResponderOther Skills
Current - 1st Responder• Assist an EMT
– Ambiguous Wording– Maybe ???
• No Patient Transport• Childbirth• Documentation
Proposed• If with a Service and with
Training and PMD Approval– May assist an EMT or Higher
Provider during transport– Transport a Patient
• Additional Requirement for Services in Chapter 12
• Assist with Normal Childbirth
• Documentation
Emergency Medical ResponderAdded Training
Current - 1st Responder• Add On Training
Modules could be completed as part of the base class
Proposed• All Add On Training
Modules must be completed AFTER the individual has a license. Must complete course and pass and get a license prior to getting the add on training.
Emergency Medical ResponderTransport Requirements (Proposed)
• Can only be done when an EMT or higher level provider dose not respond.
• Only for when an EMT or high level provider “FAILS TO RESPOND”
• It IS NOT intended for when an EMT or higher level provider responds but is unwilling or unavailable to transport.
Emergency Medical ResponderTransport Requirements (Proposed)
• The Individual EMR must hve– Added training– PMD Approval
• The Service must have– PMD Approval– Recruitment Retention Plan which includes
• Antidiscrimination policy• Budget• Leadership Training• Recruitment Retention steps
Emergency Medical ResponderTransport Requirements (Proposed)
• The Service must have an Active schedule that includes
– Date and time periods – Individuals available to respond– Updated not less than monthly– Identifies open places in the schedule and
the automatic aid plan is to be follow
Emergency Medical ResponderTransport Requirements (Proposed)
• The Service must have an automatic aid plan which includes
– Intercepting with a back-up service• allow patient care to be transferred to an E M T or
higher level provider.– Dispatch of the licensed service and the back-up
licensed service at the same time without a requirement for a verbal request from the initial licensed service.
– Allows the licensed service to contact the dispatch center to request the backup service when a scheduled providers fails to respond
Emergency Medical ResponderTransport Requirements (Proposed)
• The Service must have an automatic aid plan which includes
– Allows the service to cancel the back-up service should an EMT or higher level provider respond
– Lists the service, the backup service and dispatching agency
– Lists the service members responsible for notifying the dispatch to follow the automatic aid plan.
– Signed by service and backup service– Acknowledgment of receipt of the plan by the
dispatching agency
Emergency Medical ResponderTransport Requirements (Proposed)
• The Service must submit a report for each event to the board stating
• The name of the service• The name of the back-up service• The names of all the licensed service’s members or
employees that responded to the event• The date and time of the event• The patient condition and care provided• The actions taken to notified Emergency Medical
Technician(s) or higher level of out of hospital care provider
Emergency Medical ResponderTransport Requirements (Proposed)
• The Service must submit a report for each event to the board stating– Reason(s) the Emergency Medical Technician or
higher provider did not respond– The licensed service attests it meets all the Service
requirements to allow for EMR Transport
Emergency Medical TechnicianEMT
Practices and Procedures
Emergency Medical Technician
Current • Must function with a
service
Proposed• Same
No Lone Wolves
Emergency Medical TechnicianAssessment
Current• Basic Assessment -
Ambiguous Wording • Vitals - Ambiguous
Wording
Proposed• Assessment Defined in
Rules and Regs Better• Vitals
– Pulse– BP (manual)**– Resp Rate– Pulse Ox ****See Noninvasive
monitoring devices
Emergency Medical TechnicianAssessment
Current• GCS – Trauma Score –
Stroke Scale by board opinion only as a stop gap until new rules and regs approved
Proposed• Nationally recognized
noninvasive scales and scores – GCS– Trauma Score– Stroke Scales
Emergency Medical TechnicianAssessment
Current• Automatic BP, Pulse Ox and
other noninvasive monitoring – Not allowed OR– Wording was ambiguous
Proposed• Non-invasive patient
monitoring devices – Pulse Ox– Automatic BP– CO Monitoring– Temperature– Apply EKG Electrodes– Obtain an EKG for
transmission or interpretation by high level provider
Emergency Medical TechnicianAirway
Current • Manual airway
maneuvers• Oral Suctioning• Oral and Nasal Airways
– Place only
Proposed• Manual airway
maneuvers• Suctioning
– Upper Airway– Stoma
• Oral and Nasal Airways– Insert and Remove
Emergency Medical TechnicianAdvanced Airway Additional Skill
Current • With Training and PMD
Approval• Limited by approved
course– Combi tube– LMA– Lighted Stylet– Visualized intubation
Proposed• With Training, PMD
Approval, and Licensed• Insertion and removal
of advanced airway adjuncts limited to– Combi tube– King tube
Emergency Medical TechnicianBreathing/Oxygen
Current• BVM • Flow restricted oxygen
powered device • Oxygen administration
– Nasal Cannula– NRM
Proposed• Positive pressure
ventilation by – Bag valve mask or– Manually triggered
oxygen powered device
• Oxygen administration– Nasal Cannula– NRM– Venturi mask
Emergency Medical TechnicianCirculation
Current• AED• CPR
Proposed• AED• CPR
– Manual– Mechanical
Emergency Medical TechnicianTrauma
Current• Manual Stabilization
– Ambiguous Wording• Spinal Immobilization
– Ambiguous Wording• Extremity Immobilization• Bleeding control• Bandaging • Treat Shock
Proposed• Manual stabilization • Immobilization
– spinal and– extremity injuries
• Application of cold and heat
• Control hemorrhaging including tourniquet
• Bandaging wounds• Non - Invasive treatment
of shock
Emergency Medical TechnicianMedications
Current• Assisted Medications
– Sublingual nitroglycerin – Epinephrine auto-injectors – Hand-held aerosol inhalers.
• Oral Glucose• Activated Charcoal
Proposed• Assisted Medications
– Nitroglycerin– Epinephrine auto injector– Bronchodilators
• Oral Glucose• Aspirin
• Auto Injector Antidote kit• Self Administration certain
meds for protection of from infectious disease after an exposure
Emergency Medical TechnicianOther Medications – Additional Skill
Current• With Training and PMD
Approval– Epi Auto Injector– Aspirin– Albuterol
Proposed• With Training, PMD
Approval, and Licensed– Epi Auto Injector– Albuterol
• Aspirin in base skills no added training
Emergency Medical TechnicianOther Skills
Current• Child birth• With Training and PMD
Approval
Proposed• Child birth• Monitor an established
– Gastric Tube– Urinary Catheter
Emergency Medical TechnicianAdditional Skills
Current• With Training and PMD
Approval– IV Monitor– IV Access– Fluids listed as isotonic
Proposed• With Training, PMD
Approval, and Licensed• IV Monitor limited to
– Normal Saline– Lactated Ringers– D5W
• Establish Peripheral IV– Limited to same fluids
Emergency Medical TechnicianAdditional Skills
Current• With Training and PMD
Approval– Glucose monitor
Proposed• With Training, PMD
Approval, and Licensed– Glucose monitor
Emergency Medical TechnicianAdditional Skills = Added Training
Current• Add On Training
Modules could be completed as part of the base class
Proposed• All Add On Training
Modules must be completed AFTER the individual has a license– Must complete course
and pass and get a license prior to getting the add on training.
Advanced Emergency Medical Technician
AEMT
Practices and Procedures
AEMT – All New• To function as an AEMT must be member of an ALS
Service• In Addition to All the EMT Skills
– Advanced Airway – Combi tube and King Tube– IV Start and Monitor– Medications
• Aspirin• Nitroglycerin • Albuterol• Epi 1:1000• Glucagon• Dextrose 50%• Naloxone• Morphine
EMT-Intermediate
• Can function as long as the EMT-I – Doesn’t let his/her license lapse
• Includes filing for renewal after 12/31 of the year
– Doesn't surrender or loose license– Doesn't upgrade or down grade levels
• Wording Changed• Scope Remained the same
Paramedic
• Wording Changed• Some ambiguous wording is cleared up. • Scope is same
Chapter 11Other PROPOSED Changes
• Added the names for the new provider licensure categories; Emergency Medical Responder, Advanced Emergency Medical Technician, and Paramedic. Replaces the current classification of first responders, EMT-Intermediate, and EMT- Paramedic.
• Delineates the requirements for EMT-Intermediates to renew or reinstate their license after 9-1-10.
• Provides for the issuance of a temporary license for an individual who has completed the training but has not passed the licensure examination.
• Adopts the U.S. Department of Transportation National Emergency Medical Services Education Standards and the National Emergency Medical Services Scope of Practice.
• Added verification of lawful presence in the U.S. for all applicants who are applying for initial licensure, renewal or reinstatement of a license.
• Further delineates acts or behaviors considered unprofessional conduct– Fraud– Cheating on licensing exam– False Identification of level– Breach of Confidentiality– Practice out of scope– Patient Abuse
• Changed renewal from triennial to biennial and decreased the number of continuing education hours required for renewal of the following licenses:
• Current Revision• Emergency Medical Responder 20 14• Emergency Medical Technician 30 20• EMT-Intermediate` 45 30• Paramedic 60 40
(Changed the renewal date for all licensees to 12/31 even years, except for all EMTs who will renew on 12/31 odd years.
• Added a section on defining acceptable and non-acceptable continuing education activities.(11-007)
• Added endotrachael injections of approved medication to paramedic practice and procedures.(11-009)
• Added the utilization of nationally recognized scales and/or scores to a basic patient assessment under the practice and procedures section for EMTs.(11-009)
• Added practice and procedure sections for temporary license holders and Advanced EMTs. (11-009)
• Added the allowance of one hour of credit for each hour of instruction by a licensee acting as an instructor of an EMS course as defined in the regulations under 11-002. One third of the total CE hours required for renewal may be used by this method.(11-007.06)
• Added section on voluntary surrender or limitation.(11-011)
• Added section on reinstatement of licenses for those who previously held licenses (11-012)
Chapter 12PROPOSED Changes
• Added a definition for emergency call, incident and incident commander (12-002)
• Revised requirements for what a back up response plan must contain and that it must be signed by both physician medical directors of the transport and non- transport services. (12 – 003)
• Lists requirements that a service must meet when it utilizes EMRs to transport patients.12-004.10 item 2)
• Revises inspection section to include:– Onsite inspections that include random
inspections completed by a Department inspector; and
– Self-inspections to be completed by each service at the time they are required to renew their license ( every 2 years)
– Acceptance of a current certification from the Commission on Accreditation of Medical Transport Systems in place of the self inspection or random audit.(12-005)
• Renewal period changes- All emergency medical services will expire on the same date, 12/31 even years.(12-007)
• Two years after the effective date of these proposed changes to chapter 12, patient care and incident information must be submitted to the Department electronically and within 48 hours of the incident.(12-004.09C4)
• Clarifies that all services must document and submit to the Department patient care information even if the service does not transport. (12-004.09C)
• Requires identification of the provider responsible for patient care in each patient care record.(12-004.09C1 item 27)
• Clarifies that documentation of all required training for out-of-hospital emergency care providers will be maintained by the service. (12-004.07A)
• Clarifies that a service must report to the Department each month that the service has not completed a run during that month.(12-004.09C2)
• Clarifies that the documentation that the service maintains for provider’s continuing education hours must include the certificates of attendance /participation.(12-004.09A item 2)
• Added section on disciplinary action that includes: temporary suspension, sanctions and additional terms and conditions of discipline (12-008)
• Added section on voluntary surrender or limitation.(12-009)
• Added section on re-application for services who were previously licensed (12-010)
Chapter 13
PROPOSED Changes
• Adds definition for Additional Skills Course as the one that includes all the additional skills that can be performed by an EMR or EMT over and above the basic EMR or EMT course. (13-002)
• Mandates that Training Agencies may only teach EMRs or EMTs the additional skills course after the individual has received their State license. The additional skills may be taught independently, grouped in 2-3 topics or consolidated into one course. (This is determined by the training agency) (13-002)
• Added definitions for field experience (for students), field supervisions (for temporary license holders), and field supervisor that may supervise either a student or temporary license holder) (13-002)
• Requires all training agencies that provide paramedic training to be accredited by CoAEMSP on January 1, 2012. (13-003.01 item 1)
• Lists additional requirements to be printed on the official verification given to students who complete an EMS course. (13-004.06)
• Requires training agencies to maintain student, instructor and course records for five years. (13-004.07)
• Decreased EMS instructor continuing education hours from 18 to 12 hours due to change in the renewal period from every three years to every two years and changed the renewal date to 12/31 every even year. The 12 continuing education hours must cover all of the following subjects; EMS course curriculum updates, EMS legislation and regulations, EMS evaluation methods, and Fundamentals of teaching adults. Added information on audit and waiver of continuing education hours. (13-012)
• Added teaching outside the limit of the practices and procedures for out-of-hospital emergency providers as a ground for disciplining the license of an EMS instructor.(13-013)
• Added teaching outside the limit of the practices and procedures for out-of-hospital emergency providers as a ground for disciplining the license of an EMS instructor.(13-013)
• Added to the list of qualifications required for approval as an EMS training agency.(13-003)
• Clarified that training agencies must conduct the practical skills component of the licensing examination at the end of the course and use qualified examiners as determined by NREMT.(13-004.04 and 13-004.05)
• Revises the definition of distributive learning and that all distributive learning courses must be taught by an approved distributive learning provider. (13-002)
• Added that all applicants for a license are required to verify their lawful presence in the United States.(13-010)
• Added section on disciplinary action that includes: unprofessional conduct, temporary suspension, sanctions and additional terms and conditions of discipline (13-013)
• Added section on voluntary surrender or limitation.(13-014)
• Added section on reinstatement of instructor license (13-015)
• **These regulations are only proposed.