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Rules and Regs

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

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Rules and Regs

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  1. Rules and Regs

  2. Topics • Brief Review of National EMS Documents • Changes to the EMS Act • Proposed Changes to the rules and Regulations

  3. 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

  4. 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

  5. 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 Titles - Found in the EMS Act

  6. Proposed Rules and Regs Rule and Regulations changes have not gone into effect. I’m presenting what is PROPOSED

  7. 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

  8. 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

  9. 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

  10. 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

  11. Practices and Proceduresa/k/a Scope of Practice

  12. Emergency Medical ResponderEMR Practices and Procedures

  13. 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 Responder

  14. 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 ResponderAssessment Skills

  15. 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 ResponderA – B – C s

  16. 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 ResponderTrauma Care

  17. 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 Emergency Medical ResponderMedications *Not required to be a member of a service – Intended for self administration and disasters

  18. 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 ResponderOther Skills

  19. 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 ResponderAdded Training

  20. 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.

  21. 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

  22. 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

  23. 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

  24. 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

  25. 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

  26. 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

  27. Emergency Medical TechnicianEMT Practices and Procedures

  28. Current Must function with a service Proposed Same Emergency Medical Technician No Lone Wolves

  29. 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

  30. 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

  31. 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 TechnicianAssessment

  32. 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 TechnicianAirway

  33. 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 TechnicianAdvanced Airway Additional Skill

  34. 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 TechnicianBreathing/Oxygen

  35. Current AED CPR Proposed AED CPR Manual Mechanical Emergency Medical TechnicianCirculation

  36. 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 TechnicianTrauma

  37. 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 TechnicianMedications

  38. 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 Medications – Additional Skill

  39. Current Child birth With Training and PMD Approval Proposed Child birth Monitor an established Gastric Tube Urinary Catheter Emergency Medical TechnicianOther Skills

  40. 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

  41. Current With Training and PMD Approval Glucose monitor Proposed With Training, PMD Approval, and Licensed Glucose monitor Emergency Medical TechnicianAdditional Skills

  42. 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. Emergency Medical TechnicianAdditional Skills = Added Training

  43. Advanced Emergency Medical TechnicianAEMT Practices and Procedures

  44. 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

  45. 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

  46. Paramedic • Wording Changed • Some ambiguous wording is cleared up. • Scope is same

  47. Chapter 11 Other PROPOSED Changes

  48. 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.

  49. 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.

  50. 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

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