DAR File No. 43882

Health, Family Health and Preparedness, Emergency Medical Services

Rule R426-4

Operations

Notice of Proposed Rule

(Amendment)

DAR File No.: 43882
Filed: 07/11/2019 08:47:28 AM

RULE ANALYSIS

Purpose of the rule or reason for the change:

The purpose of these amendments is to include operational requirements for nonemergency secured behavioral health transport, and to ensure emergency medical services (EMS) providers are following safety policies for weather assessment and fatigue management.

Summary of the rule or change:

These amendments add new statutory requirements consistent with Title 26. Chapter 8a, by including operational requirements for nonemergency secured behavioral health providers. They will also add best practices for safety for severe weather conditions and fatigue management.

Statutory or constitutional authorization for this rule:

• Title 26 Chapter 8a

Anticipated cost or savings to:

the state budget:

These proposed rule amendments are not expected to have any fiscal impact on state government revenues or expenditures because new operational requirements and vehicle inspections for nonemergency secured behavioral health transport vehicles are cost neutral since fees are charged for staff time. Policy templates for weather assessments and fatigue management already have been developed, and no additional costs were incurred.

local governments:

These proposed rule amendments are not expected to have any fiscal impact on local governments' revenues or expenditures because new operational requirements and vehicle inspections for nonemergency secured behavioral health transport vehicles are currently not owned or operated by local governments. Policy templates for weather assessments and fatigue management already have been developed, and no additional costs were incurred.

small businesses:

A possible fiscal cost may result to the 17 small businesses in Utah that currently transport qualified behavioral health patients. The fiscal cost would be estimated to be $135 for designation application fees and $100 per permitted vehicle inspection fees. It is assumed that each small business would permit two vehicles. The cost in fees would be 17 providers X $335 = $5,695. Staff training is estimated to cost $300 per employee. An estimate of four employees per small business would be needed. The cost in staff training would be estimated at 17 X 4 X $300 = $20,400. A total cost would be $26,095.

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

A fiscal benefit may be incurred due to lower operational costs for transporting behavioral health patients who do not require an ambulance. A fiscal cost may be incurred to licensed ambulance providers due to a decrease in lower volume of transports where a designated nonemergency secured behavioral health transporter is providing an alternative mode of transportation. Policies for weather assessment and fatigue management are readily available to all providers at no cost.

Compliance costs for affected persons:

Compliance costs for affected behavioral persons would be reduced in cases when a transport by a nonemergency secured behavioral health patient transport is less expensive than an ambulance. Hospitals typically pay for these types of transports.

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

These proposed amendments add operation requirements for nonemergency secured behavioral health providers and to add provisions to ensure that EMS providers are following safety polices for weather assessment and fatigue management. The proposed fiscal impact would increase fees for small businesses and increase the cost of training to approximately $300 per year, however, it may result in lower operational costs for transporting behavioral health patients who do not required an ambulance. These proposed amendments will increase the cost of businesses who provide these services and decrease the volume of transports provided by ambulance service providers but will lower transportation costs for providers ad increase the business of nonemergency secured behavioral health transport providers.

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 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:

09/03/2019

This rule may become effective on:

09/10/2019

Authorized by:

Joseph Miner, Executive Director

Appendix 1: Regulatory Impact Summary Table*

Fiscal Costs	FY 2020	FY 2021	FY 2022
State Government	$0	$0	$0
Local Government	$0	$0	$0
Small Businesses	$26,095	$26,095	$26,095
Non-Small Businesses	$0	$0	$0
Other Person	$0	$0	$0
Total Fiscal Costs:	$26,095	$26,095	$26,095
Fiscal Benefits
State Government	$0	$0	$0
Local Government	$0	$0	$0
Small Businesses	$0	$0	$0
Non-Small Businesses	$0	$0	$0
Other Persons	$0	$0	$0
Total Fiscal Benefits:	$0	$0	$0
Net Fiscal Benefits:	- $26,095	- $26,095	- $26,095

 

*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 in the narrative. Inestimable impacts for Non - Small Businesses are described in Appendix 2.

 

Appendix 2: Regulatory Impact to Non - Small Businesses

There is one non-small business in the specialty needs transportation industry in question (NAICS 485991) in Utah. This data was obtained from jobs.utah.gov on Firm Finder. This business was directly contacted, and they do not directly own specialty needs vehicles. All of their specialty needs transports are subcontracted with local small businesses. The small business subcontractors providing the actual transportation will be required to pay a $135 designation fee per business and a $100 permit fee per vehicle.

 

 

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

R426-4. Operations.

R426-4-100. Authority and Purpose.

(1) This rule is establishes standards for the operation of licensed ground EMS providers or designated EMS providers under the provisions of the Utah Emergency Medical Services System Act.

 

R426-4-200. Licensed Ground Ambulance, [ and ]Designated QRU, and Designated Nonemergency Secured Behavioral Health Transport Staffing.

(1) While responding to a call, each permitted QRV shall be staffed by at least one individual licensed at or above the provider's designated level of service.

(2) While responding to a call, each licensed ground ambulance shall be staffed with the following minimum complement of licensed personnel for the [service ]level of service described:

(a) Basic Life Support ambulance: two EMTs, AEMTs, or paramedics, or any combination thereof;

(b) AEMT ambulance: one AEMT and one EMT, AEMT, or paramedic;

(c) EMT-IA ambulance: one EMT-IA and one EMT, AEMT, or Paramedic;

(d) Paramedic ambulance: one paramedic and one EMT, AEMT, EMT-IA, or paramedic;

(e) Paramedic (non-transport): one paramedic;

(f) Paramedic inter-facility: one paramedic and one EMT, AEMT, EMT-IA, or paramedic;

(g) Paramedic tactical: one paramedic.

(3) A paramedic ground ambulance or paramedic provider shall deploy two paramedics to the scene of 911 calls for service requiring Advanced Life Support response, unless otherwise determined by local selective medical dispatch system protocols.

(4) When providing care, responders not in a uniform shall display upon request their level of medical licensure.

(5) Each licensed or designated provider shall maintain a personnel file for each licensed individual. The personnel file shall include records documenting the individual's qualifications, training, endorsements, certifications, licensure, immunizations, and continuing medical education.

(6) A licensed individual may perform only to his licensed EMS provider level of service, even if the licensed EMS or designated provider is licensed or designated at a higher level of service.

(7) During transport each designated nonemergency secured behavioral health transport vehicle shall be staffed with a minimum of two personnel, with at least one who has obtained required training as approved by Department policy for mental health patient de-escalation and American Heart Association cardiopulmonary resuscitation or equivalent.

 

R426-4-300. Permits and Inspections.

(1) A licensed ground ambulance or designated EMS provider shall only use vehicles for which the provider has obtained a permit from the Department. All new ground ambulances shall meet current State approved specifications and standards. Department policy for ground ambulances will be posted on the Bureau of Emergency Medical Services and Preparedness's website.

(2) A permit issued by the Department is valid for one year.

(3) The provider shall display the current permit location on vehicle in a location easily visible at ground level from outside of the vehicle.

(4) Permits and decals are not transferable to other vehicles.

(5) Each licensed ambulance and designated QRU provider shall annually provide proof upon request that every operator of an emergency vehicle has successfully completed an emergency vehicle operator's course approved by the Department.

 

R426-4-400. Licensed Ground Ambulance, [ and] Designated QRU Provider, and Designated Nonemergency Secured Behavioral Health Transport Operations.

(1) Each licensed ground ambulance provider or designated QRU provider shall notify the Department of the permanent location of its ground ambulances and QRVs. The licensed ground EMS provider or designated QRU provider shall notify the Department in writing whenever it changes the permanent location for any permitted vehicles.

(2) Each licensed ground ambulance provider, [or ]designated QRU provider, or designated nonemergency secured behavioral health transport provider shall maintain each operational permitted vehicle on a premise suitable to make it available for immediate use, in good mechanical repair, properly equipped, and in a sanitary condition.

(3) Each licensed ground ambulance provider or designated provider shall maintain each operational vehicle in a clean condition with the interior being thoroughly cleaned after each use in accordance with OSHA standards and the provider's exposure control plan.

(4) Each licensed ground ambulance provider or designated provider shall equip each operational vehicle with adult and child safety restraints. To the point practicable and feasible, all occupants shall be safely restrained during operation.

(5) Each licensed ground ambulance provider or designated QRU provider shall assure that each emergency vehicle operator who may drive the emergency vehicle:

(a) is at least 18 years of age;

(b) possesses a valid driver license;

(c) successfully passed the provider's criminal background check within the prior four years; and

(d) successfully completed a department approved emergency vehicle operator's course or refresher course within the past two years.

(6) The Department shall verify annually that licensed ground ambulance providers or designated providers are in compliance with this requirement.

 

R426-4-500. Scene and Patient Management.

(1) Designated Emergency medical service dispatch centers shall use a selective medical dispatch system to determine which licensed ambulance provider will be notified for patient transport.

(2) When responding to a medical emergency call, EMS personnel shall follow protocols approved by the service provider's medical director, and act within their scope of practice.

(3) EMS personnel shall establish communication with on-line medical control as soon as reasonable.

(4) Licensed Paramedic tactical service provider may only function at the invitation of the local or state public safety authority. When called upon for assistance, the licensed tactical paramedic provider shall immediately notify the local emergency medical service dispatch center to coordinate patient transportation.

(5) Patients who are to be transferred to a different hospital, patient receiving facility, or mental health facility may be delayed by the licensed ambulance provider for severe weather, hazardous conditions, or any other situation that may endanger the safety of the EMS personnel, employed staff, the person being transported, or the public.

(a) Severe weather should be evaluated based on the licensed ambulance provider's written policies. Policies for weather assessment should be shared with hospitals and other receiving facilities in the geographical service area. During periods of severe weather, the transport should be delayed until the transportation risks are acceptable. The licensed providers shall maintain a weather assessment policy.

(b) When EMS personnel are not immediately able to respond due to unusual demands with other events, the licensed ambulance provider shall communicate the delay with the transferring hospital or facility. Additionally, the transferring hospital or facility should notify the receiving hospital facility, or mental health facility regarding the delay. Communications shall provide an estimated response time. The licensed ambulance provider is responsible to coordinate with the discharging facility an acceptable delay period or make reasonable attempts to arrange the transport with another licensed ambulance provider.

(6) Personnel shall be evaluated by the licensed ambulance provider for fatigue as to reduce possibilities of accidents while driving. If the licensed ambulance provider determines that personnel have fatigue to the point of compromised ability to drive or perform medical skills, the licensed ambulance shall discuss transport options with the transferring facility. Additionally, the transferring facility should notify the delay to the receiving facility. Options may include a possible transport delay, or assistance through mutual agreements.

 

R426-4-600. Pilot Projects.

(1) A person who proposes to undertake a research or study project which requires waiver of any rule shall have a project director who is a physician licensed to practice medicine in Utah, and shall submit a written proposal to the Department for presentation to the EMS Committee for recommendation.

(2) The proposal shall include the following:

(a) a project description that describes the

(b) need for project;

(c) project goal;

(d) specific objectives;

(e) approval by the provider off-line medical director;

(f) methodology for the project implementation;

(g) geographical area involved by the proposed project;

(h) specific rule or portion of rule to be waived;

(i) proposed waiver language;

(j) evaluation methodology;

(k) a list of the EMS providers and hospitals participating in the project; and

(l) a signed statement of endorsement from the participating hospital medical directors and administrators, the director of each participating licensed paramedic and ambulance provider, other project participants, and other parties who may be significantly affected.

(3) If the pilot project requires the use of additional skills, a description of the skills to be utilized by the field EMS licensed personnel and provision for training and supervising the field EMS licensed personnel who are to utilize these skills, including the names of the field EMS licensed personnel.

(4) The name and signature of the project director attesting to his or her support and approval of the project proposal.

(5) If the pilot project involves human subjects' research, the applicant shall also obtain Department Institutional Review Board approval.

(6) The Department or Committee, as appropriate, may require the applicant to meet additional conditions as it considers necessary or helpful to the success of the project, integrity of the EMS system, and safety to the public.

(7) The Department or Committee, as appropriate, may initially grant project approval for one year. The Department or Committee, as appropriate, may grant approval for continuation beyond the initial year based on the achievement and satisfactory progress as evidenced in written progress reports to be submitted to the Department at least 90 days prior to the end of the approved period. A pilot project may not exceed three years.

(8) The Department or Committee, as appropriate, may only waive a rule if:

(a) the applicant has met the requirements of this section;

(b) the waiver is not inconsistent with statutory requirements;

(c) there is not already another pilot project being conducted on the same subject; and

(d) it finds that the pilot project has the potential to improve pre-hospital medical care.

(9) Approval of a project allows the field EMS licensed personnel listed in the proposal to exercise the specified skills of the participants in the project. The project director shall submit the names of field EMS licensed personnel not initially approved to the Department.

(10) The Department or Committee, as appropriate, may rescind approval for the project at any time if:

(a) those implementing the project fail to follow the protocols and conditions outlined for the project;

(b) it determines that the waiver is detrimental to public health; or

(c) it determines that the project's risks outweigh the benefits that have been achieved.

(11) The Department or Committee, as appropriate, shall allow the licensed or designated EMS provider involved in the study to appear before the Department or Committee, as appropriate, to explain and express its views before determining to rescind the waiver for the project.

(12) At least six months prior to the planned completion of the project, the medical director shall submit to the Department a report with the preliminary findings of the project and any recommendations for change in the project requirements.

 

R426-4-700. Confidentiality of Patient Information.

(1) Licensed or designated EMS providers and all licensed EMS personnel shall not disclose patient information except as necessary for patient care or as allowed by statute or rule.

 

R426-4-800. Permitted Vehicle Supply Requirements.

(1) In accordance with the licensed EMS provider level or designation type and level, the each permitted vehicle shall carry the quantities of supplies, medications, and equipment as described in the Department inspection requirements. The vehicle requirements shall be approved by the State EMS Medical Director and the State EMS Committee.

(2) Medical directors for licensed or designated providers are responsible to provide protocols, training, and quality assurance for all medications used by licensed individuals performing duties for their respective licensed or designated provider.

(3) If a licensed or designated EMS provider desires to carry different equipment, supplies, or medication from the vehicle supply requirements, the provider shall submit a written request from the certified off-line medical director to the Department requesting the waiver. The request shall include:

(a) a detailed training outline;

(b) protocols;

(c) proficiency testing;

(d) supporting documentation;

(e) local EMS Council or committee comments; and

(f) a detailed letter of justification.

(4) All non-disposable equipment shall be designed and constructed of materials that are durable and capable of withstanding repeated cleaning. The provider shall:

(a) clean the equipment after each use in accordance with OSHA standards;

(b) sanitize or sterilize equipment prior to reuse;

(c) not reuse equipment intended for single use;

(d) clean and change linens after each use; and

(e) store or secure all equipment in a readily accessible and safe manner to prevent its movement.

(5) The provider shall have all equipment tested, maintained, and calibrated according to the manufacturer's standards.

(6) The provider shall document all equipment inspections, testing, maintenance and calibrations. Testing or calibration conducted by an outside service shall be documented. Such inspections, testing and calibration shall be performed monthly. All testing documentation shall be maintained and available for Department review upon request.

(7) A provider required to carry any of the following equipment shall perform monthly inspections to ensure proper functionality:

(a) defibrillator, manual, or automatic;

(b) autovent;

(c) infusion pump;

(d) glucometer;

(e) flow restricted, oxygen-powered ventilation devices;

(f) suction equipment;

(g) electronic Doppler device;

(h) automatic blood pressure/pulse measuring device;

(i) pulse oximeter; and,

(j) any other electronic, battery powered, or critical care device.

(8) The licensed or designated EMS provider shall perform monthly inspections to ensure proper functionality of all equipment that require consumable items, power supplies, electrical cables, pneumatic power lines, hydraulic power lines, or related connectors.

(9) Unless otherwise authorized by the State EMS Medical Director, a licensed or designated EMS provider shall store all medications according to the manufacturers' recommendations, including temperature control and packaging requirements.

(10) All medication known or suspected to have been subjected to temperatures outside the recommended temperature range shall be return to the supplier for replacement.

(11) The Department shall maintain and publish requirements for ground ambulances, QRVs, and other designated providers on the Department's website.

 

KEY: emergency medical services

Date of Enactment or Last Substantive Amendment: [December 12, 2015]2019

Notice of Continuation: October 9, 2018

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