DAR File No. 39467

Health, Family Health and Preparedness, Emergency Medical Services

Rule R426-2

Emergency Medical Services Provider Designations, Critical Incident Stress Management and Quality Assurance Reviews

Notice of Proposed Rule

(Amendment)

DAR File No.: 39467
Filed: 06/29/2015 09:31:20 AM

RULE ANALYSIS

Purpose of the rule or reason for the change:

The purpose of this amendment is to update and re-organize the designation of pre-hospital emergency medical service providers, critical incident stress management, and quality assurance review rules.

Summary of the rule or change:

The changes clarify terms and designation requirements for EMS providers. The amendment is for the designation of pre-hospital emergency medical service providers, and includes critical incident stress management team and quality assurance review updates.

State statutory or constitutional authorization for this rule:

• Title 26, Chapter 8a

Anticipated cost or savings to:

the state budget:

No effect on state budget. There is no effect because the rule amendments clarify past requirements, standardize wording, and provide consistency with other sections of rule pertaining to Title R426. The changes did not affect state processes or change current staff workload for designation procedures.

local governments:

No effect on local government. There is no effect because the rule amendments clarify past requirements, standardize wording, and provide consistency with other sections of rule pertaining to Title R426. The changes did not add any additional workload or costs to local governments who provide designated pre-hospital services.

small businesses:

Possible fiscal impacts for small businesses because patient transports may decrease in distance. Positive impacts are expected as small business may receive more patients.

persons other than small businesses, businesses, or local governmental entities:

Possible fiscal impacts for other persons because patient transports may decrease in distance. Patients may be transported to other destination decreasing costs.

Compliance costs for affected persons:

Compliance costs for affected persons should not be negatively affected. The amended rule changes do not add any additional requirements for people acquiring services from designated pre-hospital providers.

Comments by the department head on the fiscal impact the rule may have on businesses:

There will be some fiscal impact to business in that the proposed changes may decrease the need for long distance ambulance transport.

David Patton, PhD, Executive Director

The full text of this rule may be inspected, during regular business hours, at the Division of Administrative Rules, or at:

Health
Family Health and Preparedness, Emergency Medical Services
3760 S HIGHLAND DR
SALT LAKE CITY, UT 84106

Direct questions regarding this rule to:

• Guy Dansie at the above address, by phone at 801-273-6671, by FAX at 801-273-4165, or by Internet E-mail at gdansie@utah.gov

Interested persons may present their views on this rule by submitting written comments to the address above no later than 5:00 p.m. on:

08/14/2015

This rule may become effective on:

08/21/2015

Authorized by:

David Patton, Executive Director

R426. Health, Family Health and Preparedness, Emergency Medical Services.

R426-2. Emergency Medical Services Provider Designations for Pre-Hospital Providers, Critical Incident Stress Management and Quality Assurance Reviews.

R426-2-100. Authority and Purpose.

(1) This rule establishes[: standards for the designation]types of [emergency medical service ]providers[;] that require a designation, the application process for a obtaining a designation and minimum designation requirements. The rule also establishes criteria for critical incident stress management[;] and the process for quality assurance reviews.

[(2) The definitions in Title 26, Chapter 8a are adopted and incorporated by reference into this rule.

]

R426-2-200. Pre-hospital Provider Designation Types.

The following type of provider shall obtain a designation from the Department:

(1) Quick Response Unit.[An entity that responds to 911 EMS calls for assistance from the public, but that does not provide ambulance transport or paramedic service, shall obtain a designation from the Department as a quick response unit.]

(2) Emergency Medical Service Dispatch Center.[An entity that accepts calls for 911 EMS assistance from the public, and dispatches emergency medical units or field EMS personnel must first obtain a designation from the Department as an emergency medical dispatch center.

(3) A hospital that provides on-line medical control for prehospital emergency medical care must first obtain a designation from the Department as a resource hospital.]

 

R426-2-300. [Service Levels.]Quick Response Unit Minimum Designation Requirements.

[(1) A quick response unit may only operate and perform the skills at the service level at which it is designated. The Department may issue designations for the following types of service at the given levels: quick response unit;

(a) emergency medical responder;

(b) emergency medical technician; or

(c) advanced-emergency medical technician.

(2) emergency medical dispatch center; and

(3) resource hospital.

 

R426-2-400. Scope of Operations.

(1) A designated quick response unit may only provide service in its specific geographical service area except as provided by R426-3-800 Aid Agreements.

(2) A designated quick response unit may only provide emergency medical services for its category of designation that corresponds to the certification levels in R426-5.

 

R426-2-500. Quick Response Unit Minimum Designation Requirements.

A person requesting designation must meet the following minimum requirements:

]A quick response unit shall meet the following minimum designation requirements:

(1) Have vehicle(s), equipment, and supplies that meet the current requirements of [R426-4-900]the Department for licensed and designated providers as found on the Bureau of EMS and Preparedness' web-site to carry out its responsibilities under its designation;

(2) Have location(s) for stationing its vehicle(s), equipment and supplies;

(3) Have a current dispatch agreement with a designated Emergency Medical Service Dispatch Center[.];

(4) Have a Department-certified training officer;

(5) Have a current plan of operations, which shall include:

(a) the names, EMS ID Number, and certification level of all personnel;

(b) operational procedures; and

(c) a description of how the designee proposes to interface with other EMS agencies;

(6) Have a current agreement with a Department-certified off-line medical director who will perform the following:

(a) develop and implement patient care standards which include written standing orders and triage, treatment, pre -hospital protocols, and/or pre-arrival instructions to be given by designated emergency medical dispatch centers;

(b) ensure the qualification of field EMS personnel involved in patient care and dispatch through the provision of ongoing continuing medical education programs and appropriate review and evaluation;

(c) develop and implement an effective quality improvement program, including medical audit, review, and critique of patient care;

(d) annually review triage, treatment, and transport protocols and update them as necessary;

(e) suspend from patient care, pending Department review, a field EMS personnel or dispatcher who does not comply with local medical triage, treatment and transport protocols, pre-arrival instruction protocols, or who violates any of the EMS rules, or who the medical director determines is providing emergency medical service in a careless or unsafe manner. The medical director must notify the Department within one business day of the suspension; and

(f) attend meetings of the local EMS Council, if one exists, to participate in the coordination and operations of local EMS providers.

(7) Have current treatment protocols approved by the agencies off-line medical director for the designated service level;

(8) Provide the Department with a copy of its certificate of insurance;

(9) Provide the Department with a letter of support from the licensed provider(s) in the geographical service area; and

(10) Not be disqualified for any of the following reasons:

(a) violation of Subsection 26-8a-504; or

(b) a history of disciplinary action relating to an EMS license, permit, designation or certification in this or any other state.

 

R426-2-[600]400. Emergency Medical Service Dispatch Center Minimum Designation Requirements.

An emergency medical service dispatch center [must]shall meet the following minimum designation requirements:

(1) Have in effect a selective medical dispatch system approved by the off-line medical director[s and the Department,] which includes:

(a) systemized caller interrogation questions;

(b) systemized pre-arrival instructions; and

(c) protocols matching the dispatcher's evaluation of injury or illness severity with vehicle response mode and configuration;

(2) Provide pre-hospital arrival instructions by a certified Emergency Medical Dispatcher.

([2]3) Have a current updated plan of operations, which shall include:

(a) plan of operations to be used in a disaster or emergency;

(b) communication systems, and

(c) aid agreements with other designated medical service dispatch centers.

[(a) the names, training, and certification of Emergency Medical Dispatch personnel;

(b) operational procedures which at a minimum include

(i) a description of how the designee proposes to communicate with EMS agencies;

(ii) a copy of the disaster and disaster recovery plans.

]([3]4) Have a current agreement with a Department-certified off-line medical director.

([4]5) Have an ongoing medical call review quality assurance program; and

[(5) Provide pre-hospital arrival instructions by a certified Emergency Medical Dispatcher at all times.

](6) Have a certified emergency medical dispatcher roster, which shall include:

(a) certified staff names, Department certification numbers and expiration dates; and

(b) national certification number and expiration dates.

 

[R426-2-700. Resource Hospital Minimum Requirements.

A resource hospital must meet the following minimum requirements:

(1) be licensed in Utah or another state as a general acute hospital or be a Veteran's Administration hospital operating in Utah.

(2) have the ability to communicate with other EMS providers operating in the area.

(3) provide on-line medical control for all prehospital EMS providers who request assistance for patient care, 24 hours-a-day, seven days a week. A resource hospital must also:

(a) create and abide by written prehospital emergency patient care protocols for use in providing on-line medical control for prehospital EMS providers;

(b) train new staff on the protocols before the new staff is permitted to provide on-line medical control; and annually review with physician and nursing staff

(c) annually provide in-service training on the protocols to all physicians and nurses who provide on-line medical control; and

(d) make the protocols immediately available to staff for reference.

(4) The on-line medical control shall be by direct voice communication with a physician or a registered nurse or physician's assistant licensed in Utah who is in voice contact with a physician.

(5) A resource hospital must establish and actively implement a quality improvement process. This process will include:

(a) a medical control committee.

(i) the committee must meet at least quarterly to review and evaluate prehospital emergency runs, continuing medical education needs, and EMS system administration problems;

(ii) committee members must include an emergency physician representative, hospital nurse representative, hospital administration representative, and ambulance and emergency services representatives; and

(iii) the hospital must keep minutes of the medical control committee's meetings and make them available for Department review.

(b) the hospital must appoint a quality review coordinator for the prehospital quality improvement process.

(c) the hospital must cooperate with the prehospital EMS providers' off-line medical directors in the quality review process, including granting access to hospital medical records of patients served by the particular prehospital EMS provider.

(d) the hospital must assist the Department in evaluating EMS system effectiveness by submitting to the Department, in an electronic format specified by the Department, quarterly data specified by the Department.

 

R426-2-710. Stroke Treatment and Stroke Receiving Center Designation Requirements.

A hospital desiring to be a Stroke Treatment Center (Primary or Comprehensive) must be accredited as such by the Joint Commission on Accreditation of healthcare Organizations (JACHO) or other nationally recognized accrediting body. A hospital desiring to be designated as a Stroke Receiving Center for receiving stroke patients via Emergency Medical Services shall meet the following requirements:

(1) Be licensed as an acute care hospital in Utah.

(2) Have an emergency department staffed by a Registered Nurse at all time.

(3) Require physician response to the emergency department in less that thirty (30) minutes for treatment of stroke patients.

(4) Maintain the ability of physician and nursing staff to utilize a standardized assessment tool for ischemic stroke patients.

(5) Maintain, have readily available and utilize approved thrombolytic medications for treatment of patients meeting criteria for administration of thrombolytic therapy.

(6) Have a standardized acute stroke protocol in place and provide authority of appropriate emergency department staff to implement the protocol when appropriate.

(7) Maintain availability of ancillary equipment and personnel to diagnose and treat acute stroke patients in a timely manner.

(8) Have in place patient transport protocols with designated stroke treatment centers.

(9) Have an active and functioning performance improvement program for acute stroke care and report required data to the Utah Department of Health as required by the Department.

(10) Submit to a formal survey by representatives of the Department

(11) Upon successful designation, the Department may, in consultation with off line EMS medical direction and protocol, recommend direct transport of stroke patients to a Stroke Receiving Center or a Stroke Treatment Center by an EMS agency.

 

R426-2-720. Percutaneous Coronary Intervention (PCI) Center Requirements.

A hospital desiring to be designated as a Percutaneous Coronary Intervention (PCI) Center for the purpose of receiving acute ST-elevation myocardial infarction (STEMI) patients via EMS shall meet to following requirements:

(1) Be licensed as an acute care hospital in Utah.

(2) Have an emergency department staffed by at least one (1) Physician and one (1) Registered Nurse at all times.

(3) Have the ability to receive 12 lead EKG data from EMS agencies transporting patients to the hospital for treatment of ST Segment Elevation Myocardial Infarction (STEMI).

(4) Have and maintain the ability to provide cardiac catheterization and PCI of STEMI patients within ninety (90) minutes of patient arrival in the emergency department 24/7.

(5) Have an active and functioning performance improvement program for STEMI care and report required data to the Utah Department of Health as required by the Department.

(6) Submit to a forma survey by representatives of the Department.

(7) Upon successful designation, the Department may, in consultation with offline EMS medical direction and protocol, recommend direct transport of STEMI patients to a STEMI Treatment Center by an EMS agency.

 

R426-2-800. Designation Application.

An entity desiring a designation or a renewal of its designation shall submit:

(a) applicable fees and an application on Department-approved forms to the Department.

(b) documentation that it meets the minimum requirements for the designation listed in this rule.

(c) other information the Department determines to be necessary for processing the application and oversight of the designated entity and the following:

(2) Quick Response Unit;

(a) identifying information about the entity and its principals, if a resource hospital the name of the hospital;

(b) the name of the person or governmental entity financially and otherwise responsible for the service provided by the designee and documentation from that entity accepting the responsibility;

(c) identifying information about the entity that will provide the service and its principals;

(d) if the applicant is not a governmental entity, a statement of type of entity and certified copies of the documents creating the entity;

(e) a description of the geographical area that it will serve; and

(f) demonstrate a need for said service.

(3) Emergency Medical Dispatch Center;

(a) documentation of the on-going medical call review and quality assurance program; and

(b) documentation of any modifications to the medical dispatch protocols.

(4) Resource Hospital;

(a) the hospital's address;

(b) the name and phone number of the individual who supervises the hospital's responsibilities as a designated resource hospital.

 

R426-2-810. Stroke Designation Application.

A hospital desiring to be designated as a Stroke Receiving Center shall submit the applicable fees and an application on Department-approved forms to the Department. As part of the application, the applicant shall provide:

(1) The name of the hospital to be designated.

(2) The hospital address

(3) The name and phone number of the person responsible for supervision of the hospital's stroke care.

(4) Other information that the department deems necessary for processing of the application and oversight of the designated entity.

(5) Hospitals desiring designation must be verified by hosting a site visit by the Department.

(6) The Department and its consultants my conduct observation, review and monitor activities with any designated stroke center to verify ongoing compliance with designation requirements.

(7) Submit performance improvement data to the Department as required.

 

R426-2-820. Percutaneous Coronary Intervention (PCI) Center Application.

A hospital desiring to be designated as a ST Segment Elevation Myocardial Infarction (STEMI) Treatment Center shall submit the applicable fees and an application on Department-approved forms to the Department. As part of the application, the applicant shall provide:

(1) The name of the hospital to be designated.

(2) The hospital address

(3) The name and phone number of the person responsible for supervision of the hospital's STEMI care.

(4) Other information that the department deems necessary for processing of the application and oversight of the designated entity.

(5) Hospitals desiring designation must be verified by hosting a site visit by the Department.

(6) The Department and its consultants my conduct observation, review and monitor activities with any designated stroke center to verify ongoing compliance with designation requirements.

(7) Submit performance improvement data to the Department as required.

 

]R426-2-500. Designation Applications.

Any provider applying for designation shall submit to the Department: applications fees, complete application on Department approved forms, and documentation verifying that the provider meets the minimum requirements for the designation, as listed in this rule. The Department may determine other information is necessary for processing, and will provide a list of those requirements to the applicant. Additional items specific to the designation type are required as outlined below. A provider applying for re-designation shall submit an application as described above 90 days prior to the expiration of its designation.

 

R426-2-600. Quick Response Unit Designation Applications.

A Quick Response Unit shall provide:

(1) Name of the organization and its principles.

(2) Name of the person or organization financially responsible for the service and documentation from that entity accepting responsibility.

(3) If the applicant is privately owned, they shall submit certified copies of the document creating the entity.

(4) A description of the geographical area of service.

(5) A demonstrated need for the service.

 

R462-2-700. Emergency Medical Service Dispatch Center Designation Applications.

An Emergency Medical Service Dispatch Center shall provide:

(1) Name of the organization and its principles.

(2) Name of the person or organization financially responsible for the service provided by the designee and documentation from that entity accepting responsibility.

(3) If the applicant is privately owned, they shall submit certified copies of the document creating the entity.

(4) A description of the geographical area of service.

(5) A demonstrated need for the service.

 

R426-2-[900]800. Criteria for Denial or Revocation of Designation.

(1) The Department may deny an application for a designation for any of the following reasons:

(a) failure to meet requirements as specified in the rules governing the service;

(b) failure to meet vehicle, equipment, or staffing requirements;

(c) failure to meet requirements for renewal or upgrade;

(d) conduct during the performance of duties relating to its responsibilities as an EMS provider that is contrary to accepted standards of conduct for EMS personnel described in Sections 26-8a-502 and 26-8a-504;

(e) failure to meet agreements covering training standards or testing standards;

(f) a history of disciplinary action relating to a license, permit, designation, or certification in this or any other state;

(g) a history of criminal activity by the licensee or its principals while licensed or designated as an EMS provider or while operating as an EMS service with permitted vehicles;

(h) falsifying or misrepresenting any information required for licensure or designation or by the application for either;

(i) failure to pay the required designation or permitting fees or failure to pay outstanding balances owed to the Department;

(j) failure to submit records and other data to the Department as required by statute or rule;

(k) misuse of grant funds received under Section 26-8a-207; and

(l) violation of OSHA or other federal standards that it is required to meet in the provision of the EMS service.

(2) An applicant who has been denied a designation may request a Department review by filing a written request for reconsideration within thirty calendar days of the issuance of the Department's denial.

 

R426-2-[1000]900. Application Review and Award.

(1) If the Department finds that an application for designation is complete and that the applicant meets all requirements, it may approve the designation.

(2) Issuance of a designation by the Department is contingent upon the applicant's demonstration of compliance with all applicable rules and a successful Department quality assurance review.

(3) A designation may be issued for up to a four-year period. The Department may alter the length of the designation to standardize renewal cycles.

 

R426-2-[1100]1000. Change in Designated Service Level.

(1) A quick response unit may apply to provide a higher designated level of service by:

(a) submitting the applicable fees; and

(b) submitting an application on Department-approved forms to the Department.

(2) As part of the application, the applicant shall provide:

(a) a copy of the new treatment protocols for the higher level of service approved by the off-line medical director;

(b) an updated plan of operations demonstrating the applicant's ability to provide the higher level of service;

(c) a written assessment of the performance of the applicant's field performance by the applicant's off-line medical director; and

(d) provide the Department with a letter of support from the licensed provider(s) in the geographical service area.

(3) If the Department finds that the applicant has demonstrated the ability to provide the upgraded service, it shall issue a new designation reflecting the higher level of service.

 

R426-2-[1200]1100. Critical Incident Stress Management.

(1) The Department may establish a critical incident stress management (CISM) team to meet its public health responsibilities under Utah Code Section 26-8a-206.

(2) The CISM team may conduct stress debriefings, [and ]defusings, demobilizations, education, and other critical incident stress interventions upon request for persons who have been exposed to one or more stressful incidents in the course of providing emergency services.

(3) Individuals who serve on the CISM team must complete initial and ongoing training.

(4) While serving as a CISM team member, the individual is acting on behalf of the Department. All records collected by the CISM team are Department records. CISM team members shall maintain all information in strict confidence as provided in Utah Code Title 26, Chapter 3.

(5) The Department may reimburse a CISM team member for [mileage]travel expenses incurred in performing his or her duties in accordance with state finance mileage reimbursement policy.

 

R426-2-[1300]1200. Quality Assurance Reviews.

(1) The Department may conduct quality assurance reviews of licensed and designated organizations and training programs on an annual basis or more frequently as necessary to enforce this rule;

(2) The Department shall conduct a quality assurance review prior to issuing a new license or designation.

(3) The Department may conduct quality assurance reviews on all personnel, vehicles, facilities, communications, equipment, documents, records, methods, procedures, materials and all other attributes or characteristics of the organization, which may include audits, surveys, and other activities as necessary for the enforcement of the Emergency Medical Services System Act and the rules promulgated pursuant to it.

(a) The Department shall record its findings and provide the organization with a copy.

(b) The organization must correct all deficiencies within 30 days of receipt of the Department's findings.

(c) The organization shall immediately notify the Department on a Department-approved form when the deficiencies have been corrected.

 

[R426-2-1400. Penalties.

As required by Subsection 63G-3-201(5): Any person that violates any provision of this rule may be assessed a civil money penalty as provided in Section 26-23-6 and/or revocation of designation.

 

]KEY: emergency medical services

Date of Enactment or Last Substantive Amendment: [October 18, 2013]2015

Authorizing, and Implemented or Interpreted Law: 26-8a