DAR File No. 42555

Health, Family Health and Preparedness, Emergency Medical Services

Rule R426-2

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

Notice of Proposed Rule

(Amendment)

DAR File No.: 42555
Filed: 01/31/2018 10:23:36 AM

RULE ANALYSIS

Purpose of the rule or reason for the change:

The purpose of this amendment is to update language to be consistent with Title 26, Chapter 8a, and to amend medical dispatch designation requirements.

Summary of the rule or change:

Terms and requirements to the emergency medical dispatch center designations are changed to reflect changes in Title 26, Chapter 8.

Statutory or constitutional authorization for this rule:

• Title 26, Chapter 8a

Anticipated cost or savings to:

the state budget:

This proposed rule change is not expected to have any fiscal impact on state government revenues or expenditures because it is for the changing of terminology, training requirements for medical dispatch centers, and requiring medical dispatch to send ambulances based on license type. State expenditures and staff time are not affected.

local governments:

This proposed rule change does not appear to create costs for local governments who fund designated medical dispatch centers, since all designated medical dispatch centers currently use vendor-based systems and associated training. A cost savings will be realized by designated medical dispatch centers due to removing the requirement for a certified training officer. A possible fiscal impact will be to local governments who have performed inter-facility transports via the 911 call system when their license does not allow inter-facility services. This only affects some local governments and a private ambulance provider who were approved with and existing over-lap service area as described in Subsection 26-8a-416(6). Fiscal impacts are estimated up to $1,200,000 annual billable inter-facility ambulance patient transports.

small businesses:

This proposed rule change is not expected to have any fiscal impact on small businesses revenues or expenditures, because no small businesses are included in the entities affected by this amendment.

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

This amendment clarifies proper dispatch of ambulance providers based on license type. It may create fiscal impacts for local governments who have performed inter-facility transports via the 911 call system when their license does not allow inter-facility services. This only affects some local governments and a private ambulance provider who were approved with and existing over-lap service area as described in Subsection 26-8a-416(6). Fiscal impacts are estimated up to $1,200,000 annual billable inter-facility ambulance patient transports.

Compliance costs for affected persons:

This proposed rule amendment is not expected to have any fiscal impact on affected persons.

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

Fiscal impacts are estimated up to $1,200,000 annual billable inter-facility ambulance patient transports.

Joseph K. Miner, MD, Executive Director

The full text of this rule may be inspected, during regular business hours, at the Office 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 [email protected]

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:

03/19/2018

This rule may become effective on:

03/26/2018

Authorized by:

Joseph Miner, Executive Director

Appendix 1: Regulatory Impact Summary Table*

	FY 2018	FY 2019	FY 2020
Fiscal Costs
State Government	$0	$0	$0
Local Government	$1,200,000	$1,200,000	$1,200,000
Small Businesses	$0	$0	$0
Non-Small Businesses	$0	$0	$0
Other Persons	$0	$0	$0
Total Fiscal Costs:	$1,200,000	$1,200,000	$1,200,000
Fiscal Benefits
State Government	$0	$0	$0
Local Government	$4,625	$4,625	$4,625
Small Businesses	$0	$0	$0
Non-Small Businesses	$1,200,000	$1,200,000	$1,200,000
Other Persons	$0	$0	$0
Total Fiscal Benefits:	$1,204,625	$1,204,625	$1,204,625
Net Fiscal Benefits:	$4,625	$4,625	$4,625

 

*This table only includes fiscal impacts that could be measured. If there are inestimable fiscal impacts, they will not be included in this table. Inestimable impacts for State Government, Local Government, Small Businesses and Other Persons are described above. Inestimable impacts for Non-Small Businesses are described below.

 

Appendix 2: Regulatory Impact to Non-Small Businesses

The costs and benefits are based on the assumption that affected local governments are currently transporting inter-facility types of patients in three service areas, and will no longer be allowed to do so. Fiscal data is based on revenues differences from the past calendar year compared to the previous calendar year by the non-small business ambulance provider.

 

A cost to local governments for vendor provided medical dispatch training was not included since all current designated medical dispatch centers currently use vendor-based dispatch systems with associated training for licensed emergency medical dispatchers.

 

Benefits to local governments include a potential savings of $4,625 ($125 per designated medical dispatch centers) by removing the training officer requirement.

 

 

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 types of 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.

 

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

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

(1) Quick Response Unit.

(2) Emergency Medical Service Dispatch Center.

 

R426-2-300. Quick Response Unit Minimum Designation 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 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]license 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]shall 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.

 

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

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

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

(a) systemized caller interrogation questions;

(b) systemized pre-arrival instructions;[and]

(c) a systemized method which produces consistent results to assist a dispatcher in categorizing incoming calls so that dispatcher can notify the proper licensed provider for the level of care, whether an emergency response or an inter-facility patient transfer is needed, as defined in R426-1-200(29); and

([c]d) 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] licensed Emergency Medical Dispatcher.

(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.

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

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

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

(a) [certified]licensed staff names, Department [certification]license numbers and expiration dates; and

(b) [national]dispatch system training certification number and expiration dates.

 

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.

 

R426-2-800. 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]licensed or designated provider 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.

 

R426-2-900. 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.

 

R426-2-1000. 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.

 

R426-2-1100. 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, 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]shall 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 travel expenses incurred in performing his or her duties in accordance with state finance mileage reimbursement policy.

 

R426-2-1200. 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]shall 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.

 

KEY: emergency medical services

Date of Enactment or Last Substantive Amendment: [August 21, 2015]2018

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