DEPARTMENT OF HEALTH AND HUMAN SERVICES BUREAU OF EMS TRAUMA AND PREPAREDNESS

EMERGENCY MEDICAL SERVICES - LIFE SUPPORT AGENCIES AND

MEDICAL CONTROL

Filed with the secretary of state on

These rules take effect immediately upon filing with the secretary of state unless adopted under section 33, 44, or 45a(9) of the administrative procedures act of 1969, 1969 PA 306, MCL 24.233, 24.244, or 24.245a.  Rules adopted under these sections become effective 7 days after filing with the secretary of state.

(By authority conferred on the director of the department of health and human services by sections 2233, 20910, and 20975 of the public health code, 1978 PA 368, MCL 333.2233, 333.20910, and 333.20975, and section 2233 of 1978 PA 368, MCL333.2233. Executive Reorganization Order No. 2015-1, MCL 400.227)

R 325.22101, R 325.22102, R 325.22103, R 325.22111, R 325.22112, R 325.22113,

R 325.22114, R 325.22115, R 325.22116, R 325.22117, R 325.22118, R 325.22119,

R 325.22120, R 325.22121, R 325.22122, R 325.22123, R 325.22124,  R 325.22125,

R 325.22126, R 325.22127, R 325.22131, R 325.22132, R 325.22133, R 325.22134,

R 325.22135, R 325.22136, R 325.22137, R 325.22138, R 325.22165, R 325.22181,

R 325.22182, R 325.22183, R 325.22184, R 325.22186, R 325.22187, R 325.22189,

R 325.22190, R 325.22191, R 325.22192, R 325.22193, R 325.22194, R 325.22195,

R 325.22201, R 325.22202, R 325.22203, R 325.22204, R 325.22205, R 325.22206,

R 325.22207, R 325.22208, R 325.22209, R 325.22210, R 325.22211, R 325.22212,

R 325.22213, R 325.22214, R 325.22215, R 325.22216, and R 325.22217 of the Michigan Administrative Code are amended, and R 325.22218 is added, as follows:

PART 1. GENERAL PROVISIONS

R 325.22101  Definitions; A to D.

Rule 101.  As used in these rules:

   (a) "Accountable" means ensuring compliance on the part of each life support agency or emergency medical services personnel in carrying out emergency medical services based upon protocols established by  the medical  control authority and  approved by the department.

   (b) “Air ambulance service” means providing at least advanced life support services utilizing an air ambulance or ambulances that operate in conjunction with a base hospital or hospitals. Other functions of the service may include searches, emergency transportation of drugs, organs, medical supplies, equipment, or personnel.  An air ambulance service may operate a back-up air ambulance when the primary air ambulance or ambulances are not available or for a designated event with prior notification and approval from the local medical control authority.

(c) “Back-up air ambulance” means an air ambulance that is used to provide air ambulance services when the primary air ambulance is not available to provide air ambulance services.  A back-up air ambulance must not be operated at the same time as the primary aircraft for the provision of air ambulance services except for a designated event or disaster.

   (bd) "Board certified in emergency medicine" means current certification by the American board of emergency medicine Board of Emergency Medicine, the  American  board  of  osteopathic emergency medicine Board of Osteopathic Emergency Medicine, or other  organization  approved  by   the department   that meets the standards of these organizations.

   (ce) "Code" means the public health code, 1978 PA 368, MCL 333.1101 to 333.25211. et seq and known as the public health code.

   (df) "Designated event” means a temporary event, such as an air show, of no more than 7 days in duration that requires the full-time on-site availability of an air ambulance.

   (eg) Direct  communication"  means  a  communication  methodology   that ensures medical control authority supervision of  a  life  support agency  when performing emergency medical services through any of the following methods:

   (i) Direct interpersonal communications at the scene of the emergency.

   (ii) Direct verbal communication by means of an approved two-way telecommunications system operating within the medcom requirements.

   (iii) Protocols adopted by the medical control authority and approved by the department.

   (iv) Other means approved by the department that are not in conflict with the medcom requirements.

   (fh) "Disciplinary action" means an action taken by the department against a medical control authority, a life support agency, or individual, or an action taken by a medical  control  authority  against   a    life    support agency  or individual  for  failure  to comply with the code,  rules,  or protocols  approved  by  the  department.  Action  may include suspension, limitation, or removal of medical control from a life support agency of a medical control authority providing medical control, from an individual providing emergency medical services care, or any other action authorized by the code.

R 325.22102  Definitions; E to O.

  Rule 102.  As used in these rules:

  (a) "Emergency medical services intercept" means a situation where  an  ambulance operation is transporting an emergency patient from the scene of an emergency, and requests patient  care  intervention  from  another  transporting ambulance operation.

  (b) "Emergency medical services telecommunications" means the reception and transmission of voice or data, or both, information in the emergency medical services system consistent with the medcom requirements prescribed by the department.

  (c) "Fixed wing aircraft" means a non-rotary aircraft transport vehicle that is primarily used or available to provide patient transportation between health facilities and is capable of providing patient  care according  to orders issued by the patient's  physician.

  (d) "Ground ambulance" means a vehicle that  complies  with  design and  structural specifications, as defined in these rules, and is licensed as an ambulance to provide transportation and basic life support, limited advanced  life  support,  or  advanced life support.

  (e) "Hold itself out" means the agency advertises, announces, or charges specifically for providing emergency medical services as defined in the code.

  (f) "License" means written authorization issued by the department to a  life support agency and its life support vehicles   to   provide   emergency medical services  as defined in the code.

  (g) "License expiration date" means the date of expiration indicated on the license issued by the department.

  (h) "Licensure action"  means  probation,  suspension,  limitation,  or removal by the department of a license for a life support agency or a life support vehicle for violations of the code or these rules.

  (i) “Life support agency” means an ambulance operation, non-transport pre-hospital life support operation, air transport operation, or medical first response service.

  (ij) "Life  support  vehicle"  means an ambulance, a non-transport, prehospital life support vehicle, or a medical first response vehicle as defined in the code.

  (jk) "Medcom requirements" means medical communication requirements for an emergency medical services communication system.

  (kl) "Medical control" means supervising and coordinating emergency medical services through a medical control authority, as prescribed, adopted, and enforced through department-approved protocols, within  an  emergency  medical  services  system.

  (lm) "Medical control authority" means an organization designated by the department to provide medical control.

   (n) "Medical control authority area" means the geographic area composed of a county, group of counties, or parts of an individual county, as designated by the department.

  (mo) "Medical control authority board" means a board appointed by the participating organizations to carry  out  the  responsibilities  and functions of the  medical control authority.

(n) Medical control authority region" means the geographic area composed of a county, group of counties, or parts of an individual county, as designated by the department.

(p) “Mutual aid” means a written agreement between 2 or more licensed life support agencies for the provision of emergency medical services when an agency is unable to respond to a request for emergency services, or an agreement according to the direction of a medical control authority in accordance with department approved protocols.

R 325.22103  Definitions; P to T.

  Rule 103.  As used in these rules:

  (a) "Physician" means a doctor of medicine or doctor of osteopathy who possesses a valid license to practice medicine in the state.

  (b) "Primary dispatch service area" means a service area.

  (c) “Professional Standards Review Organization” means a committee established by a life support agency or a medical control authority for the purpose of improving the quality of medical care.

(d) “Protocol” means a patient care standard, standing orders, policy, or procedure for providing emergency medical services that is established by a medical control authority and approved by the department under section 20919 of the code, MCL 333.20919.

  (ce) "Quality improvement program" means actions  taken  by  a  life support agency, medical control authority, or jointly between a life support agency and medical control   authority   with   a   goal   of   continuous improvement    of   emergency medical services in accordance with section 20919(1)(g) of the code, MCL 333.20919.

  (f) “Regional  trauma network” means an organized group comprised of the local medical control authorities within a region, which integrates into existing regional emergency preparedness, and is responsible for appointing a regional trauma advisory council and creating a regional trauma plan.

  (dg) "Rotary aircraft" means a helicopter that is licensed under the code as an ambulance.

  (eh) "Service area" means the geographic area in which a life support agency is licensed to provide emergency medical services for responding to an emergency.

PART 2. LIFE SUPPORT AGENCIES-GENERAL

R 325.22111  Life support agencies; general provisions.

  Rule 111.  (1) A life  support  agency  shall may not  operate  unless  it  is licensed by  the department and operates under the direction of a medical control authority in accordance with department-approved protocols.  A life support agency must not operate at a level that exceeds its license or violates approved medical control authority protocols, unless otherwise allowed by part 209 of the code, MCL 333.20901 to 333.20979.

(2) A life support agency license shall must do all of the following:

(a) State the level of life support the agency is licensed to provide.A life support agency shall not operate at a level that exceeds its license or violates approved medical control authority protocols.

  (ba) Be responsible for communicating Communicate approved protocols to appropriate emergency medical services personnel.

  (cb) Provide emergency medical services in accordance  with protocols established by the medical control authority and approved by the department.

  (3) A life support agency application shall may not be approved by the department unless signed by the medical  director  of   each  medical control authority responsible for the service area of  the  life   support agency in accordance with R 325.22205(2). The medical director signature shall serves as confirmation that the medical control authority intends to provide medical control to the life support agency.

  (4) A  life  support   agency,   except   a   fixed   wing   aircraft  transport operation, shall must provide at least 1 life support vehicle for response to requests for emergency assistance on a 24-hour-a-day, 7-day-a-week basis in accordance with its licensure level and medical control authority protocols.

  (5) A All life support agencies agency shall respond, or ensure a response is provided, to each request for emergency assistance originating must have a mutual aid agreement with another life support agency in order to ensure a response within the bounds of its service area.

  (6) A life support agency must notify the jurisdictional medical control authority of any of the following:

   (a) Any investigations, disciplinary actions, or exclusions against the life support agency with the potential to impact service delivery.

   (b) Action taken by an agency against emergency medical services personnel based on a violation of section 20958 of the code, MCL 333.20958.

R 325.22112  Patient destination; transporting agencies.

  Rule 112.  (1) An ambulance operation, both ground and rotary, shall must transport an emergency patient only to an organized emergency department located in and operated by 1 of the following:

  (a) A hospital licensed under part 215 of the code, MCL 333.21501 to 333.21571 . or to

  (b) A freestanding surgical outpatient facility licensed under part 208 of the code, MCL 333.20801 to 333.20821, that operates a service for treating emergency patients 24-hours-a-day, 7-days-a-week, and complies with medical control authority protocols.

  (c) An off-campus emergency department of a hospital licensed under part 215 of the code, if the off-campus emergency department is available for treating emergency patients 24-hours-a-day, 7-days-a-week, complies with medical control authority protocols, and has obtained provider-based status under 42 CFR 413.65.

  (2) An ambulance operation may transport to an alternate destination requested by the medical control authority and approved by the department under special study status.

R 325.22113  Patient transfers; ground, rotary, aircraft transport.

  Rule 113.  (1) A person shall may not transport a patient by stretcher, cot, litter, or isolette unless it is done in a licensed ambulance or aircraft transport vehicle. The life support agency transporting the patient shall must require that any applicable department-approved protocols of the medical control authority are followed in accordance with section 20921(4) and (5) of the code, MCL 333.20921.

  (2) An out-of-state service that is coming in this state to transfer a patient from a Michigan facility to a facility in another state or country shall must be licensed or certified within its own jurisdiction.

R 325.22114  Professional standards review organization; data collection.

  Rule 114.  Each life support agency or medical control authority, or both, shall must

establish a professional standards review organization for improving the quality of emergency medical services.  As part of the organization, each life support agency shall must collect data to assess the need for and quality of emergency medical services.  The data shall must be submitted to the medical control authority as determined by department-approved medical control authority protocol as required in R 325.22207(1)(h).

R 325.22115 Use of descriptive words, phrases, symbols, advertising.

  Rule 115. A person shall may not use words, phrases, signs, symbols, or insignia that advertise or convey to the public that it provides emergency medical services or that it provides emergency medical services at a particular level unless it is licensed to do so.

R 325.22116  Inability to provide service.

  Rule 116.  (1) If a life support agency cannot operate or staff at least 1 vehicle for response to an emergency within its service area in accordance with the code, these rules, or applicable protocols, then the life support agency shall must do all of the following:

  (a) Immediately notify the department and medical control authority within its service area when it cannot provide at least 1 ambulance available for response to requests for emergency assistance on a 24-hour-a-day, 7-day-a-week basis in accordance with medical control authority protocols. This rule excludes air ambulance services when the weather does not meet weather minimums outlined by a national accrediting body for air ambulance services.

  (b) Immediately notify the department of a change that would alter the information contained on its application.

  (c) Notify the dispatch center that regularly receives requests for its services, and other public safety agencies if appropriate, that it is not available to respond. The notification shall must advise the dispatch center of the period in which the agency will be out of service and the name of the agency that will be covering its service area.

  (d) Notify life support agencies providing secondary response capabilities mutual aid.

  (2) The life support agency shall comply with R 325.22202(4).

(3) A life support agency that does not comply with section 20921(1)(a)  of the code shall be subject to disciplinary action by the department.

R 325.22117  Maintenance of medical records.

  Rule 117.  In accordance with section 20175(1) of the code, MCL 333.20175, Aa life support agency shall must maintain an accurate record of each case where care is rendered on a form format approved by the medical control authority.  Medical records shall must be maintained for 57 years. However, records of minors shall must be maintained until they reach 23 25 years of age.

R 325.22118  Removal  of  vehicle  from  service;  licensure;   interagency vehicle transfer,

  lease, loan, from another life support agency.

  Rule 118.  (1) A life support agency shall must notify the department when it permanently removes a vehicle from service. If a vehicle is permanently removed from service, then the agency shall contact the department, in writing, within 30 days of removal. Notification shall must include the make, model, year, and vehicle identification number on a form an application prescribed by the department. The agency must remove all oscillating, rotating, or flashing lights, and words, phrases, signs, symbols, or insignia that advertise or convey to the public that it provides emergency medical services before transfer or sale of the vehicle.

  (2) A life support vehicle license is nontransferable.  A life support agency may temporarily use a state licensed life support vehicle of another licensed life support agency through a loan. Vehicle loans may occur if mechanical problems prevent an agency from deploying its existing vehicles. The life support agency acquiring the vehicle shall must do all of the following:

   (a) Notify the department of the loan within 3 business days on an form application prescribed by the department.

   (b) Replace an existing licensed vehicle with the loaned vehicle at the agency. The loaned vehicle shall must not increase the total number of vehicles the agency is licensed to use.

   (c) Use the loan for a maximum of 60 calendar days.

  (d) Extend the loan 1 time for 60 additional calendar days if the agency notifies the department on an form application prescribed by the department.

  (3) A life support agency that obtains a vehicle through a gift, lease, transfer, or purchase from another life support agency shall comply with both of the following:

  (a) Submit an application for the vehicle in accordance with R 325.22190(2) or

(3).

  (b) Comply with R 325.22181.

  (3) A life support agency that gives, leases, transfers, or sells a vehicle to another

life support agency shall must comply with subrule (1) of this rule.

R 325.22119  Operational routine vehicle and equipment inspection.

  Rule 119.  A life support agency shall must have a written policy in place to ensure vehicles and equipment are operational and provide documentation of not less than a weekly inspection program for all vehicles, communications equipment, and mechanical and electronic medical equipment.

R 325.22120  Life support agencies licensed in other states or dominion of Canada.

  Rule 120.  (1) A life support agency licensed in another state or the dominion of Canada that responds to emergencies in this state shall must be licensed by the department unless specific intergovernmental agreements exist between the department, the dominion of Canada, or the other state.

  (2) A life support agency licensed in another state or in the dominion of Canada that responds to emergencies shall must be accountable to the medical control authority in whose geographical boundaries initial patient contact is made.

R 325.22121  Inquiry into ability to pay.

  Rule 121.  Life support agencies shall must not inquire about ability to pay or source of payment before providing life support consistent with its license and approved medical control authority protocols to each emergency patient.

R 325.22122  Misleading information concerning emergency response.

  Rule 122. A life support agency shall must not knowingly provide a person with false or misleading information concerning the time at which an emergency response will be initiated or the location from which the response is being initiated. The department or medical control authority may investigate any allegation of wrongdoing submitted under this rule. If a violation of this rule occurs, the department or medical control authority may take any corrective action authorized under the code and these rules.

R 325.22123  Spontaneous   use   of   vehicle   under   exceptional  circumstances; written

  report.

  Rule 123. (1) If an ambulance operation is unable to respond to an  emergency patient within a reasonable time, then the ambulance operation may use a vehicle may be used under exceptional circumstances, to provide, without charge or fee and as a humane service, transportation  for  the  emergency patient. Emergency medical personnel who transport, or who  make  the  decision  to  transport,  an  emergency patient shall file a written report describing the incident with the medical control authority.

   (2) A life support agency that transports Emergency medical personnel who transport, or who make the decision to transport, an emergency patient under subrule (1) of this rule shall must file a written report within 7 days with the medical control authority describing the incident within 7 days.

R 325.22124 Enforcement.

  Rule 124.  (1) The department may take any action authorized by sections 20162, 20165, and 20168 of the code, MCL 333.20162, 333.20164, and 333.20168, or other provisions of the code in response to a violation of the code or these rules.  Enforcement actions include any of the following:

   (a) Denial, suspension, limitation, or revocation of a life support agency license.

   (b) The issuance of a nonrenewable conditional license effective for not more than 1 year.

   (c) The issuance of an administrative order to correct deficiencies and prescribing the actions the department determines to be necessary to obtain compliance with the code or to protect the public health, safety, and welfare.

(d) Imposition of an administrative fine.

   (e) The issuance of an emergency order limiting, suspending, or revoking license.

  (2) A life support agency that is granted a 1-year nonrenewable conditional license by the department shall must comply with, at least a minimum, all of the following:

   (a) Provide at least 1 vehicle for response to requests for emergency assistance on a 24-hour-a-day, 7-day-a-week basis in accordance with its licensure level.   

   (b) Submit a statement of  the  reasons  for  the life support agency's inability to comply with the code for licensure.

   (c) Develop a plan of action to meet all licensure requirements. The plan shall must be submitted to the medical control authority and the department.

   (d) Submit a monthly report to the medical control authority that outlines the progress made on the plan.

   (e) Report all out-of-service time to each involved medical control authority.

  (3) A life support agency that is granted a 1-year nonrenewable conditional license shall must comply with all licensure fee requirements in the code.

R 325.22125  Life support agency; licensure at higher level of care; requirements.

  Rule 125.  (1) A life support agency seeking licensure at a higher level shall qualify qualifies for that license only if the life support agency meets the following requirements:

   (a) Under the provisions of the code, a life support agency that is licensed to provide medical first response life support may apply for licensure at the basic, limited advanced, or advanced life support level.  A life support agency that is licensed to provide basic life support may apply for licensure at the limited advanced or advanced life support level. In the same manner, a life support agency that is licensed to provide limited advanced life support may apply for licensure at the advanced life support level.

   (b) Each life support agency that meets the requirements of subdivision (a) of this subrule shall must apply for a higher level of licensure on forms applications provided by the department and shall meet the requirements of the code and these rules. Included with the application shall be the The application must include the required fee and identification of level of life support of the operation.

  (2) A life support agency that obtains licensure at a higher level shall must provide that level of care 24-hours-a-day, 7-days-a-week.

  (3) If a life support agency applies to the department for licensure at a higher level than that of its current level, then the department shall must conduct an inspection of the agency and its vehicles. Verification of compliance with this subrule shall must be included with the application for license for each ground ambulance or non-transport, prehospital life support vehicle by both of the following methods:

   (a) Provide, as part of the application, the name and address of the medical control authority or authorities under which the life support agency is operating. The agency shall must complete an application for licensure, as prescribed by the department, for each medical control authority under which it operates.  The signature on the application of the emergency medical services medical director, from each medical control authority, shall must verify that the medical control authority agrees to provide medical control to the life support agency.

   (b) Attest, by signing the application, to all the following:

    (i) Tthe radio communication system for each ambulance or non-transport, prehospital life support vehicle complies with the medcom requirements.,

    (ii) Eeach vehicle meets minimum equipment requirements.,

    (iii) and that Mminimum staff requirements are being met in order to operate at least 1 vehicle on a 24 hour-a-day, 7 day-a-week basis.

    (iv) In addition, the agency shall document that each Each ground ambulance licensed by the department has a manufacturer certificate of compliance.

  (4) Verification of compliance with this subrule shall must be available to the department upon request.

R 325.22126  Life support agency; medical control; disciplinary action.

  Rule 126.  (1) A medical  control  authority  may  exercise  disciplinary action against a life support agency and its emergency medical services personnel that may result in the life support agency or its personnel not being permitted to provide prehospital emergency care.  The basis for these actions shall must be for noncompliance with protocols established by the medical control authority and approved by the department. Disciplinary action may   include the suspension, limitation, or removal of medical control for the life support agency or its personnel to provide emergency medical services.

(2) If disciplinary action against an agency or individual under subrule (1) of this rule results in the suspension,  limitation,  or  removal  of  medical control, then  the  medical  control  authority  shall  advise  the department,  in writing,  of such action within 1 business day of the removal.

  (32) If a suspension or removal of medical control for a life support agency or individual occurs, the life support agency or individual shall may not operate or practice in that medical control authority region until medical control is restored by the medical control authority.

  (43) If a suspension or removal of medical control for a life support agency or individual occurs, the life support  agency  or   individual   may appeal  the decision to the medical control authority.  After  appeals  to the  medical control authority have been exhausted, the life support agency or individual may appeal the medical control authority's decision to the statewide emergency medical services coordination committee.  An appeal to the emergency medical services coordination committee shall must be filed with the department in writing not more than 30 calendar days following notification to the agency or individual of the final determination of the medical control authority.

   (54) The emergency medical services coordination committee shall must review the appeal of a life support agency or individual and make a recommendation to the department. The department will consider  the  emergency  medical  services coordination committee recommendation and conduct its own review of the appeal. If the department determines that licensure action is required, the department shall must provide for a hearing in accordance with  the  code  and sections 71 to 88 of   Chapter  4  of  the Administrative Procedures Act administrative procedures act of 1969, 1969 PA 369, MCL 24.271 to 24.288. et seq. The hearing officer shall issue a determination that constitutes a  final disposition of the proceedings  to  each  party within 30 days after the conclusion of the haring.  The determination of the  hearings officer shall become the final agency order upon receipt by the parties.

R 325.22127  Life  support  agency;  life  support  vehicle;  inspection; contractor

requirements.

  Rule 127.  (1)  The department shall must, at least annually, inspect or provide for the inspection of each life support agency. The department shall must conduct random inspections of life support vehicles during the agency licensure period.

  (2) A life support agency that receives accreditation from the commission on accreditation of ambulance services Commission on Accreditation of Ambulance Services or other another department-approved national accrediting organizations approved by the department as having equivalent expertise and competency in the accreditation of life support agencies, may not be subject to an agency inspection by the department if the life support agency meets both of the following requirements:

  (a) Submits verification of accreditation described in this rule.

  (b) Maintains accreditation as described in this rule.

  (2) Accreditation of a life support agency does not prevent the department from conducting a life support agency inspection.

  (3) Pursuant to section 20910(2)(b) of the code, MCL 333.20910, if emergency medical  services activities apply to contracts with agencies or individuals for purposes of providing  life  support agency and life support vehicle inspections, the department shall must notify each life support agency and medical control authority of the existence of the contracts,  including  the  roles  and  responsibilities  of  those  agencies or individuals having been awarded contracts.

PART 3. AMBULANCE OPERATIONS LIFE SUPPORT AGENCIES

R 325.22131 Ambulance operation; Life support agency; initial application.; ground; rotary.

  Rule 131.  An ambulance operation life support agency and its ambulances life support vehicles shall must be licensed by the department in accordance with sections 20920, 20926, 20931, and 20941 of the code, MCL 333.20920, 333.20926, 333.20931, and 333.20941. The application for initial licensure shall must include all of the following:

  (a) Be on forms an application provided by the department and include the required fees and identification of level of life support of the operation agency.

  (b)  Specify each ambulance life support vehicle to be operated, the level of life support being provided by that ambulance life support vehicle, and include a certificate of insurance covering each ambulance life support vehicle as identified in subrule (6e) this rule.

  (c) Provide as part of the application, the name and address of each medical control authority under which the life support agency is operating.  The agency shall must complete an application for licensure,  as prescribed by the department, for each medical control authority under which it operates.  A signature on the application by the emergency medical services medical director, from each medical control authority, shall be is proof that the medical control authority agrees to provide medical control to the life support agency.

   (d) An attestation, as evidenced by signing the application, of all of the following:

    (i) Radio communications for each ambulance life support vehicle comply with the medcom requirements.

    (ii) Each vehicle meets minimum equipment requirements.

    (iii) Minimum staff requirements will be met in order to operate at least 1 vehicle on a 24 hour-a-day, 7 day-a-week basis, consistent with sections 20921(3) and (4), 20927(3), 20932(2), or 20941(6) of the code, MCL 333.20921, 333.20927, 333.20932, or 333.20941, as appropriate.

    (iv) A manufacturer certificate of compliance for each ground ambulance licensed by the department.

(e) Verification of compliance with subrules (3) and (4)  of   this   rule is available to the department upon request.

   (fe) Include evidence that the operation possesses not less than $1,000,000.00 insurance coverage or is under a self-insurance program authorized under 1951 PA 35, MCL 124.1 to 124.13 et seq. for property damage and personal injury, except for rotary winged aircraft.  An application for rotary winged aircraft shall include evidence that the operation possesses not less than $5,000,000.00 insurance coverage or is under a self-insurance program authorized under 1951 PA 35, MCL 124.1 to 124.13, et seq. for property damage and personal injury, except under section 20934(6) of the code, MCL 333.20934.

   (gf) Include full disclosure of the operation ownership, including all of the following:

    (i) Copies of documents relating to the official type of legal organization of  the operation, stating whether it  is  an  individual proprietorship,  partnership, corporation, or subsidiary of any other corporation or unit of government. These documents shall must be maintained by the operation and shall be available to the department upon request.

    (ii) Copies of registration of the operation with the secretary of state or other designated official in each state that the agency is chartered, incorporated, or authorized to do business. These documents shall must be maintained by the operation and shall be available to the department upon request.

   (iii) Disclose all legally responsible individuals, owners, or officers of the ambulance operation life support agency at the time of license application, including any trade names  under which the organization operates. These shall must include, but not limited to, the name or names that the ambulance operation life support agency is known to the public.

   (iv) Disclose all parent organizations and any person as defined in section 20908 of the code, MCL 333.20908, that have at least a 10% interest in the applicant operation life support agency.

  (hg) Identify 1 individual who will serve as the primary contact person for the operation  agency licensure administrator for the life support agency. The agency licensure administrator is the point of contact for licensing and inspection activities.

R 325.22132 Ambulance operation Life support agency; operating requirements.

  Rule 132.  In addition to requirements prescribed in  the code and these rules, an ambulance operation shall life support agency must do all of the following:

  (a) Establish and maintain a written procedure that explains the steps that will be followed when a complaint is received by the operation agency. This procedure shall must be maintained by the operation agency and shall be available to the department upon request.

  (b) Maintain evidence of participation in the county, local, or regional disaster plan. Approved protocols may be used to meet this requirement. These documents shall must be maintained by the operation and shall be available to the department upon request.

  (c) Comply with medical record keeping requirements in accordance with rule R 325.22117.

  (d) Maintain written policies and procedures that address safety and accident reduction and comply with all applicable state and federal health and safety laws as prescribed on   the department-approved agency inspection form. These procedures shall must be maintained by the operation and shall be available to the department upon request.

  (e) Require that each individual staffing an ambulance a licensed life support agency is in compliance complies with the code and complies with applicable medical control authority protocols.

  (f) Require that an ambulance life support vehicle is not operated while transporting a patient unless the ambulance is staffed in accordance with section 20921(3), (4) and (5) of the code, MCL 333.20921.

(g) Require that a non-transport prehospital life support vehicle is not operated unless it is staffed in accordance with section 20927(3) and 20941(6) of the code, MCL 333.20927 and 333.20941.

(h) Require that an aircraft transport vehicle is not operated unless it is staffed in              accordance with section 20932(2) of the code, MCL 333.20932.

  (gi) Maintain evidence of an orientation process of emergency medical services personnel that familiarizes them with the agency's policies and procedures and are trained trains them in the use and application of all the equipment carried in the ambulance licensed life support vehicle. Included, Aat a minimum, the orientation process must shall be include an introduction to personnel duties and responsibilities, in addition to medical control authority protocols.

  (hj) Maintain access to the current version a copy of all applicable protocols for each medical control authority under which the agency operates.

  (k) Complete and submit patient care records according to department approved medical control authority protocols.

  (il) Participate in data collection and quality  improvement activities authorized under medical control authority protocols.

  (jm) Ensure that each licensed ambulance life support vehicle meets all applicable vehicle standards and state minimum equipment requirements prescribed by the department and department-approved medical control authority protocols.

  (kn) Require compliance with medcom requirements.

  (lo) Not knowingly respond to, or advertise its services, for prehospital emergency patients from outside its service area as defined in these rules, except for mutual aide requests.

  (mp) Require that each individual operating a licensed ground life support vehicle during an emergency response or patient transport has completed a department-approved vehicle operation education and competency assessment.

R 325.22133 Ambulance operation Life support agency; ground; rotary licensure

  requirements.

  Rule 133.  An ambulance operation shall must comply with all of the following:

(a) Provide not less  than  1  staffed   ambulance   as   defined   in section   20921(3) of the code, at the agency  level  of  licensure, available  for response to requests for emergency assistance 24-hours-a-day, 7-days-a-week.

(b) Respond or ensure a response is provided to each request for emergency assistance originating from within the bounds of its service area.

  (ca) Ensure compliance with the code and these rules.

  (db) Advise the department immediately of any changes that would alter the information contained on its licensure application, including any of the following:

   (i) Change of ownership.

   (ii) Change of facility name.

   (iii) Change in vehicle status.

   (iv) Circumstances which preclude the ambulance operation from complying with subrule (1) of this rule or minimum equipment requirements. Change in agency licensure administrator contact information.

   (v) Circumstances that preclude the life support agency from complying with staffing or minimum equipment requirements.

   (vi) Change in communication ability to comply with medcom requirements.

   (vii) Change in service area.

(e) While transporting a patient, require compliance with minimum staffing requirements prescribed in section 20921 (3)(4) and (5) of the code.

  (cf) Require that an individual whose An ambulance operation must require that an individual whose license is at least equal to the level of vehicle license is in the patient compartment when transporting an emergency patient, or consistent with department approved medical control authority protocols.

(g) Ensure that patient  care  and  safety  equipment  carried  on  an ambulance  meet the minimum requirements prescribed by the department and approved medical control authority protocols.

(h) Ensure that each ambulance is equipped with a communications system consistent with the medcom requirements developed by the department.

R 325.22134 Additional licensure requirements for limited  advanced life support

agencies and advanced life support ambulance operations approved to administer

  medications.

  Rule 134.  In addition to meeting the other licensure requirements of the code and these

rules, an ambulance operation life support agency licensed  at  the  limited  advanced and advanced life support level shall do approved to administer medications by their local medical control authority must: all of the following:

  (a) Comply with the procedures of drug acquisition, storage, security, dispensing, and accountability in accordance with the criteria established by the medical control authority, in compliance with federal and state law and approved by the department and R 325.22207(1)(k) and R 325.22207(3) department-approved medical control authority protocols, and federal and state law.

(b) If licensed at the limited advanced or advanced life support level, Ccomply with the acquisition, storage, security, dispensing, and accountability procedures for intravenous solutions, tubing, and related apparatus in accordance with department-approved medical control authority protocols and in compliance with the federal and state law.

(c) Lock and secure storage as required by federal and state law.

R 325.22135  Rotary aircraft ambulance operations; additional licensure requirements.

  Rule 135.  (1) In addition to meeting other licensure requirements of the code and these rules, an ambulance operation providing rotary aircraft transport shall must do all of the following:

   (a) Meet all equipment requirements of the federal aviation administration for the specific type of aircraft and flying conditions under which the aircraft will operate, as specified by the air taxi certificate of operation of the aircraft transport provider.

   (b) Maintain accurate medical flight records concerning the transportation of each emergency patient in intrastate flights or interstate flights originating in Michigan. The records shall must be available to the department and the medical control authority of the originating scene, when requested.

   (c) Meet department licensure requirements and certificate  of  need requirements follow department-approved medical control authority protocols when providing on-scene emergency care. 

   (d) Meet department licensure requirements and  certificate  of  need requirements when providing interfacility transfers.

   (e) Provide verification of Medicaid participation. A new provider not currently enrolled in Medicaid must certify that proof of Medicaid participation will be provided to the department within 6 months from the offering of services.

  (2) An ambulance operation licensed in Michigan that provides rotary aircraft services and has entered into a mutual aid agreement with a rotary aircraft service outside of Michigan shall meet both of the following requirements:  transport and utilizes a rotary aircraft from outside of Michigan to assist with intrastate transfers or mutual aid must ensure that the secondary ambulance operation is licensed in this state.

(a) A rotary aircraft service outside of Michigan that has an agreement to assist with scene

emergency care is not required to have a certificate of need.

(b) A rotary aircraft service outside of Michigan that has an agreement to assist with patient    transfers from 1  in-state  health   facility   to another in-state health facility is required to have a certificate of need.

  (3) An ambulance operation licensed in Michigan that provides rotary aircraft services or fixed wing ambulance service must be  accredited by a department-approved national accrediting organization within 2 years of beginning operation.  During the provisional period between licensing and accreditation, the air ambulance operation must provide all the following:

   (a) Written policies and procedures specifying the levels of patient care to be  provided. The level of patient care provided must be commensurate with the education and experience of the staff and the capabilities of the base hospitals.

   (b) Written patient care protocols including provisions for continuity of care.

   (c) Written policies and procedures that define the roles and responsibilities of all staff members.

   (d) Written policies and procedures addressing the appropriate use of air ambulance services in accordance with section 20932a of the code, MCL 333.20932a.

   (e) A written communicable disease and infection control program.

   (f) A written plan for dealing with situations involving hazardous materials.

   (g) A planned and structured program for initial and continuing education and training, including didactic, clinical, and in-flight, for all scheduled staff members appropriate for the respective duties and responsibilities.

   (h) Written policies and procedures addressing the integration of the air ambulance service with public safety agencies governing the base hospitals including, but not limited to, the federal aviation administration, medical control authorities, life support vehicles and disaster planning.

   (i) A quality management program.

   (j) A clinical data base for utilization review and Professional Standards Review Organization.

   (k) Procedures to screen patients to ensure appropriate utilization of the air ambulance service.

R 325.22136  Ambulance operation; issuance of ground and rotary ambulance license; life

  support agency; issuance of license.

Rule 136.  Receipt of the completed application by the department serves as attestation by the operation life support agency that the operation and ambulances agency and life support vehicles being licensed are in compliance comply with the minimum standards required by the department. Upon approval of the application, the department shall must issue a license to the ambulance operation life support agency. The license shall identify each ambulance being licensed.

R 325.22137 Ambulance operation; false advertising; conflict of interest.

  Rule 137. An ambulance operation shall may not do any of the following:

  (a) Induce or seek to induce any person engaging an ambulance to patronize a long-term care   facility, mortuary, or hospital.

  (b) Advertise, or permit advertising of, within or on the premises of the ambulance operation or within or on an ambulance, the name or the services of an attorney, accident investigator, nurse, physician, long-term care facility, mortuary, or hospital. If 1 of those persons or facilities owns or operates an ambulance operation, then the person or facility may use its business name in the name of the ambulance operation and may display the name of the ambulance operation within or on the premises of the ambulance operation or within or on an ambulance.

  (c) Advertise or disseminate information for the purpose of obtaining contracts under a name other than the name of the person holding an ambulance operation license or the trade or assumed name of the ambulance operation.

  (d) Use the terms "ambulance" or "ambulance operation" or a similar term to describe or refer to the person unless the department under section 20920 of the code, MCL 333.20920, licenses the person.

  (e) Advertise or disseminate information leading the public to believe that the person provides an ambulance operation unless that person does in fact provide that service and is licensed by the department.

R 325.22138 Ambulance operation; relicensure Life support agency; renewal.

Rule 138.  (1) An ambulance operation life support agency shall must complete an application for relicensure renewal and shall return the completed application to the department before the date of license expiration. Failure to receive a notice for relicensure renewal from the department does not relieve the licensee of the responsibility to apply for relicensure renewal.

(2) The license of an ambulance operation life support agency and its ambulances life support vehicles shall will expire on the same date.

(3) An application for licensure renewal received by the department after the license expiration date, but within 60 calendar days after the expiration date of the license, shall must require the ambulance operation life support agency to comply with section 20936 of the code, MCL 333.20936.

  (4) An ambulance operation life support agency may provide emergency medical services during the 60 days following its license expiration date, whether or not the department has received an application.

(5) An application for licensure renewal not received by the department within 60 calendar days following the date of license expiration shall must be considered revoked, effective on the sixty-first day.

(6) Reinstatement of the ambulance  operation life support agency and life support vehicle  licenses shall requires completion of a new application for licensure, including all fees prescribed in section 20936 (1) and (2) of the code, MCL 333.20936.

PART 6. MEDICAL FIRST RESPONSE SERVICES

R 325.22165  Medical first response service; law enforcement; fire suppression agency.

  Rule 165.  (1) A medical first response service means a person licensed by the department to respond under medical control to an emergency scene with a medical first responder and equipment required by the department before the arrival of  the  ambulance. This includes a fire suppression agency only if it is dispatched for medical first response life support.

  (2) A fire suppression agency shall must be licensed as a medical  first response service life support agency, in accordance with R 325.221631, and provide medical first response life support as described in the code and these rules  if  it  is dispatched  to provide any care a  medical first responder is qualified to provide under section 20906(8) of the code, MCL 333.20906.

  (3) A law enforcement agency shall be licensed as a medical first response service life support agency, in accordance with R 325.221631, and provide medical first response life support as described in the code and these rules if both of the following conditions are met:

   (a) "Holds itself out" as a medical first response service.

   (b) BeIs dispatched to provide medical first response life support.

  (4) A law enforcement agency holds  itself  out  as  a  medical  first response service if it advertises or announces that it will provide  patient care  that may include  any care a medical first responder is qualified to provide under section 20906(8) of the code, MCL 333.20906, or charges for those services.

PART 8. LIFE SUPPORT VEHICLES

R 325.22181  Ground ambulance; requirements.

  Rule 181.  (1) An ambulance operation shall must maintain the manufacturer's certificate of compliance on file at the time of application to the department for licensure of each ground ambulance. The certificate of compliance shall must be executed by the final manufacturer of each ground ambulance and be on a form prescribed by the department.

  (2) The manufacturer of a ground ambulance executing a certificate of compliance shall must comply with the ambulance structural and mechanical specifications with one 1 of  the following standards that was in effect at the time of manufacture:

   (a) Federal KKK-A-1822 standards, excluding the paint scheme.

   (b) The Commission on Accreditation of Ambulance Services (CAAS) Ground Vehicle Standard for Ambulances (GVSA) in its entirety.

   (c) The National Fire Protection Association (NFPA) 1917 Standard for Automotive Ambulances in its entirety.

  (3) The manufacturer shall must maintain test data demonstrating compliance.

  (4) Once licensed for service, an ambulance shall must not be required to meet later modified state vehicle standards during its use by the ambulance operation that obtained the license.

  (5) A ground ambulance referred to in subrule (2) of this rule shall must not be modified to alter its original design upon which the certificate of compliance was based, unless a new certificate is issued verifying that the modifications have not altered the integrity of the vehicle.

  (6) The patient compartment of a ground ambulance that has met applicable standards at the time of manufacture may be remounted on to a different chassis. by a qualified vehicle modifier as designated by the chassis manufacturer. The remounter may be a member of 1 or more of the following: Ford Qualified Vehicle Modifier, Mercedes Benz Sprinter Preferred Upfitter, Ram Q Pro Programs, or the National Truck Equipment Association Member Verification Program. A new manufacturer’s certificate of compliance must be  issued  that   identifies the new   vehicle identification number and demonstrates compliance with either KKK, GVSA, or NFPA standards in accordance with subrule (2) of this rule.

(7) A new manufacturer’s certificate of compliance must  be  issued  that  identifies the new vehicle identification number and demonstrates compliance with either KKK, GVSA, or NFPA standards in accordance with subrule (2) of this rule.

R 325.22182  Non-qualifying vehicles for licensure.

Rule 182.  (1) A ground ambulance that was originally manufactured before January 1, 1982 shall may not qualify for licensure by the department and shall must not be sold or donated in this state for use as a ground ambulance. This subrule shall does not apply to a ground ambulance that has been licensed and is currently licensed by the department and has been in continuous service before January 1, 1982.

(2)  A ground ambulance manufactured after January 1, 1982, whose age from the date of manufacture exceeds 2 years, shall must have a safety inspection by a certified mechanic being sold to provide ground ambulance services. The inspection shall must be documented on a form developed by the department and shall must include a notarized statement by the previous owner attesting that the ground ambulance has not been involved in a vehicular accident altering its safety. The documents required by this subrule shall must be submitted to the department by the purchaser as part of the application for licensure by the new owner.

R 325.22183  Ground ambulance sanitation.

  Rule 183.  A ground ambulance operation shall must require that equipment, linen, and supplies shall must be cleaned or exchanged following each patient care use.

R 325.22184  Life support vehicles; displaying of name.

  Rule 184.  (1)  A life support agency name shall must be prominently displayed on the left and right side of all licensed life support vehicles.

  (2) If the life support agency is operated by or advertised with a name different than the company life support agency name, then the name may be displayed on the left and right side of the life support vehicle below the name of the company life support agency.  The advertised name must be smaller than the life support agency name.

  (3) A life support agency that identifies a level of licensure in its name or brand that is higher than the level of life support provided by a specific licensed vehicle, must prominently display the actual level of licensure of the vehicle on the sides of the vehicle.

R 325.22186  Life support vehicles; patient care and safety equipment; review.

   Rule 186.  (1)  The department shall must, with the advice of the emergency medical services coordination committee, annually review and modify, as necessary, the patient care and safety minimum equipment standards for life support vehicles.

(2) The department shall, with the advice of the emergency medical services coordination committee, review and modify, as necessary, the patient care critical equipment items.

R 325.22187  Rotary ambulance; requirements.

  Rule 187.  A rotary ambulance shall must meet all of the following standards:

  (a) Be capable of on-scene response and transportation of emergency patients.

  (b) Be staffed in accordance with section 20921(3), (4), and (5) of the code, MCL 333.20921.

  (c) Allow for patient access and treatment to the patient by the rotary ambulance personnel.

  (d) Possess access that allows for safe loading and unloading of a patient without excessive maneuvering of the patient.

  (e) Be temperature controlled for the comfort of the patient.

  (f) Have adequate lighting for patient care and observation.

  (g) Be equipped with communication capability with hospitals, ground  units life support vehicles, and medical control in accordance with the medcom requirements.

  (h) Be capable of carrying a minimum of 1 patient in  a  horizontal position. on  a litter located so as not to obstruct the pilot's  vision  or interfere with the performance  of any member of the flight crew or required air medical personnel.

  (i) Securely store equipment and make readily accessible.

  (j) Operate under the medical control authority. for the geographic area where on-scene patient care is being provided.

R 325.22189  Fixed wing vehicle; requirements.

  Rule 189.  A fixed wing vehicle shall must comply with all of the following:

  (a) Be authorized as part of a licensed aircraft transport operation.

  (b) Be capable of carrying a minimum of 1 patient in a horizontal position. on  a litter located so as not to obstruct the pilot's  vision  or interfere with the performance  of any member of the flight crew or air medical personnel.

  (c) Provide a means of securing the litter while supporting a patient to the floor, walls, seats, specific litter rack, or any combination thereof.

(d) If transporting more than 1 patient, there  shall  be  a  minimum vertical  spacing of 30 inches between each patient's litter.

(e) Ensure that the upper surface of the single or upper litter is not less than 30 inches from the ceiling of the aircraft.

(f) Ensure that the head and thorax of a patient secured to  a  litter is accessible to air medical personnel from at least 1 side of the litter without obstruction.

(gd) Ensure that the patient compartment has adequate lighting available for patient observation.

   (he) Require that equipment is secured to the aircraft, readily accessible, and when not in use, securely stored.

   (if) Ensure that the interior of each vehicle affords an adequate patient care and treatment area.

   (jg) Ensure that each vehicle is equipped with a cargo door or other entry that allows for loading and unloading of the patient without excessive maneuvering of the patient.

   (kh) Ensure that the interior of each vehicle is equipped with temperature control for the comfort of the patient.

R 325.22190  Life support vehicles; licensure and relicensure inspections; new and

  replacement vehicles; licensure at higher level of care.

  Rule 190.  Life support vehicles shall must be inspected as follows:

  (a) The department may conduct random renewal inspections of life support vehicles, including medical first response vehicles. Inspections shall be are unannounced unless circumstances warrant notifying a life support agency in advance that an inspection of its life support vehicles will be conducted. The department shall determine  if prior notification of an inspection is warranted. A vehicle license may be renewed without an inspection.

  (b) Submission of a licensure renewal application shall be is considered an attestation by the life support  agency  that  the  vehicle meets all licensure requirements.

  (c) A life support agency that is adding a new or higher licensure level for a  life support vehicle shall must submit  an  application,  on  forms  provided  by  the department, and include the required fee. New  and  higher level of  care vehicles shall must be inspected before being placed into service. Upon receipt of the application and required fee, the department shall must inspect new or upgrade vehicles within 15 days of receipt of application.

  (d) A life support agency that is replacing a life support vehicle shall must submit an application, on forms provided by the department, and include the required fee. A replacement vehicle means a life support agency has removed a vehicle from service and has replaced the vehicle with another.

  (e) Replacement vehicles may be placed into service upon submission of an application and the required fee to the  department. Upon receipt of the application and required fee, the  department shall must inspect the replacement vehicle within 15 days of receipt of the application.

  (f) With written notification in a format specified by the department, a rotary ambulance back-up vehicle may be put into service for 30 days before it has to comply with subrules rules (a) to (e) of this rule.

R 325.22191  Life support vehicles inspected; non-compliance; corrective measures.

  Rule 191.  If the department determines that a life support vehicle is does not in compliance comply with the requirements of the code and these rules, then the following shall apply applies:

  (a) If an agency has a vehicle determined to be noncompliant on  critical with minimum equipment items as identified on the inspection form, the agency shall have has 24 hours to bring the vehicle into compliance and to notify the department in writing of the corrections  made.  The vehicle may be returned to service before a reinspection with approval of the department. A reinspection shall must occur within 15 days of notification by the life support agency.

  (b) If an agency fails to bring a vehicle into compliance within An agency has 24 hours, to bring a vehicle into compliance from the time it is determined to be out of compliance due to  missing  critical equipment items. Tthe agency shall must remove the vehicle from service until the life support agency submits a written explanation of corrective action  to  the department and the  department  reinspects the vehicle. A vehicle taken out of service shall may not function  as  an ambulance or life support vehicle until the vehicle passes the department reinspection.

  (c) If a vehicle remains out of compliance for more than 15 calendar days from the date of inspection, then its license shall be is automatically revoked. Reinstatement of the life support vehicle license shall requires reapplication for licensure, payment of the licensure fee prescribed in the code, and a reinspection of the vehicle.

(d) If an agency has a vehicle determined to be noncompliant, but not missing critical equipment items, the agency shall be allowed 15 calendar days from the date of inspection to provide the department with  a  written explanation of corrective action.  The life support vehicle may remain in service during the 15-day period unless the department has ordered that the vehicle be taken out of service pursuant to subdivision of this rule.

  (ed)The department may immediately order a  life  support   vehicle   out of service if it determines that the health and welfare of a patient may be in jeopardy due to noncompliance with critical minimum equipment  standards  or defective and nonfunctional  critical minimum equipment. A notice of such action shall must be immediately provided to the life support agency by the department based upon the deficiencies found.

 (fe) A life support agency that takes corrective measures to bring a life support vehicle into compliance during the time of a department inspection shall will not receive notice  of  noncompliance.  The inspection report shall must reflect that the corrective action and compliance have been met.

PART 9.  COMMUNICATIONS REQUIREMENT

R 325.22192  Communications requirements; life support agencies.

  Rule 192.  A life support agency providing emergency medical services shall must use applicable communication systems consistent with its level of licensure in compliance with the code, these rules, and the medcom requirements as prescribed by  the department.

R 325.22193  Medcom requirements.

  Rule 193.  Medcom requirements shall must be reviewed annually and updated, if necessary, with the advice and recommendations of the emergency medical services coordination committee.

R 325.22194  Illegal interception of radio communications.

  Rule 194.  A person who receives any radio communication not intended for the general public shall may not use the contents of the communication for initiating an emergency medical service response as described in section 20963(2) of the code, MCL 333.20963.

R 325.22195  Communications system application process; life support agencies; medical

  control authorities.

  Rule  195. (1) A life support agency shall must comply with the ambulance-to-hospital radio communications system consistent with the medcom requirements in the medical control authorities in which they operate.

  (2) A medical control authority shall must comply with the ambulance-to-hospital radio communications system approval, as prescribed by the medcom requirements, under any of the following conditions:

   (a) A medical control authority upgrades to provide limited advanced or advanced life support oversight.

   (b) An existing medical control authority changes the infrastructure of its communication system affecting ambulance-to-hospital communications.

   (c) A change is made in an existing communications system that results in an inability of an agency or hospital to communicate with each other.

PART 10. MEDICAL CONTROL AUTHORITY

R 325.22201  Medical control authorities; designation.

  Rule 201.  (1) The department shall must designated a medical control authority to provide medical control for emergency medical services for a particular geographic area. The Medical Control Authority medical control authority shall operate in accordance with the code. terms and  level of its designation within its medical control authority region.

(2) Level of designation shall be basic life support, limited  advanced life support, or advanced life support. Basic designation includes medical first responder. Limited advanced life support designation includes medical first responder and basic life support. Advanced life support  designation includes medical first responder, basic and limited  life support.

(3) The department shall designate medical control authorities to cover a county or part of a county, except that the  department  may  designate  a  medical  control  authority  to  cover  2  or  more  counties  if the department determines  that   the available  resources  would  be  better utilized  under   a multiple county  medical   control authority. In designating a medical control authority, the  department  shall  assure that  there is  a  reasonable  relationship  between  the  existing  emergency medical services capacity in  the geographical area to be served by   the   medical   control authority  and  the estimated demand for emergency medical  services in that  area.

  (42) A medical control authority shall must be administered by the following: the participating hospitals of the designated medical control authority region.

   (5a) Each hospital licensed under part 215 of the code, MCL 333.21501 to 333.21571, that operates a service for treating emergency patients 24-hours-a-day, 7-days-a-week, may participate and serve on the medical control authority board in the ongoing planning and development activities of the medical control authority designated by the department.

   (6b) Each freestanding surgical outpatient facility licensed under part 208 of the code, MCL 333.20801 to 333.20821, that operates a service for treating emergency patients 24-hours-a-day, 7-days-a-week and meets standards established by the medical control authority may participate and serve on the medical control authority board in the ongoing planning and development activities of  the  medical  control  authority  designated  by  the  department. If a freestanding surgical outpatient facility participates in the medical control authority as described in this rule, the  facility shall must meet all applicable standards established by the medical control authority.

   (7c) Each hospital, off-campus emergency department with provider-based status as defined in R 325.22112(1)(c),  and freestanding   surgical   outpatient   facility shall must comply with protocols for providing services to a patient before care of the patient is transferred to hospital personnel.

R 325.22202  Medical control authorities; authority board; advisory body; medical director;

  responsibilities; approval.

  Rule 202.  (1) A medical control authority, as defined in the code, shall must be approved by the department and do all of the following:

   (a) Develop bylaws that define the medical control authority organizational structure.

   (b) Appoint a medical control authority board, as defined in these rules, to administer the medical control authority. The majority of the board shall must be comprised, at a minimum, of  members  of  the  hospitals  and, when applicable, freestanding surgical outpatient facilities and off-campus emergency department with provider-based status as defined in R 325.22112(1)(c) . The board may include representation of life support agencies other entities as determined by the medical control authority bylaws.

   (c) If the board also functions as the advisory body to the  medical control  authority as described in this  rule,  then  the  board  shall must include  a representative of each type of life support agency  and  emergency  medical services personnel  functioning within the medical control authority's region.

   (d) Appoint an advisory body as defined in section 20918(2) and (4) of the code, MCL 333.20918. The advisory body shall meet at least quarterly.

   (e) Appoint a medical director, with the advice of the advisory body,  in accordance with section 20918(3) of  the  code, MCL 333.20918.  The   medical director is responsible for medical control for the  emergency  medical  services system  served  by  the   medical control authority. The medical  control authority,  with the advice of the  advisory body, may appoint more than 1 physician to serve as  medical  director  provided the individual meets all applicable criteria, and or is approved by the department.

   (f) Appoint a professional standards review organization, as defined in these  rules, for the purpose of monitoring and improving the quality of medical care.

   (g) Make Hold each licensed life support agency and individual accountable to the medical control authority in the provision of emergency medical services, as defined in department-approved protocols.

   (h) Establish written Provide protocols for the practice of life support agencies and emergency medical services personnel as prescribed or approved by the department. Protocols shall be provided to all affected life support agencies.

   (i) Collect data as necessary to assess the quality and needs of emergency medical services throughout its medical control authority region area.

  (2) Each  participating   and   nonparticipating   hospital, off-campus emergency department with provider-based status as defined in R 325.22112(1)(c), and   freestanding   surgical   outpatient facility  within   a medical  control authority region shall must follow all standards, policies, procedures, and protocols established by the medical control authority as approved by the department.

  (3) Each medical control authority shall must submit to  the  department current protocols for department review and approval. Department  approval shall  be on a 3-year cycle, or as defined by the department.

  (4) The medical control authority shall must notify the department if a life support agency is consistently unable to provide  at  least  1 life support vehicle 24-hours-a-day, 7-days-a-week.

R 325.22203  Medical control authority; denial, revocation, or suspension of designation.

  Rule 203.  (1)  The department  may  deny, revoke, limit, or suspend designation of a medical control authority upon finding that the  medical control authority meets 1 or more of the following:

   (a) Is guilty of fraud or deceit in securing its medical control designation.

   (b) Has failed  to  perform  in  accordance  with  the  terms   of   its designation and its department-approved protocols.

   (c) Has not maintained minimum criteria for medical control authorities, as established by the department.

   (d) Has failed to develop protocols as identified in the code to protect the public health.

  (2) If the department denies, revokes, limits, or suspends a medical control authority designation, then the department shall must designate a medical control authority to serve that medical control authority region area.

  (3) The department shall provide notice of intent to deny, revoke, limit, or suspend medical control authority designation and  shall  provide  for  a hearing in accordance with the code and Chapter 4 of the Administrative Procedures Act administrative procedures act of 1969, 1969 PA 306, MCL 24.271 to 24.328.  et  seq.  The   hearing   officer shall   issue   a determination that constitutes a final disposition of the proceedings to each party within 30 days after the conclusion of the hearing. The determination of the hearings officer shall become the final  agency order upon receipt by the parties.

R 325.22204  Medical control authority; advisory body.

  Rule 204.  A medical control authority shall must appoint an advisory body as defined in section 20918(2) and (4) of the code, MCL 333.20918. The advisory body shall must, at a minimum, do all of the following:

  (a) Advise the medical control authority on the appointment of a medical director.

  (b) Advise the medical control authority on the development of protocols.

  (c) Meet at least quarterly.

R 325.22205  Medical control authority; medical director; responsibilities.

   Rule 205.  (1) The medical director is an agent of the medical control authority and is responsible for medical control for the emergency medical services system.

  (2) The medical director shall must ensure the provision of medical control. The medical director's signature on a life support agency's application for licensure or relicensure affirms that the  medical  control  authority intends to provide medical control to the life support agency. If the medical director refuses to sign the life support agency application for licensure or relicensure, then the medical director shall must notify the department in writing, within 5 business days, providing  justification for denial based on a department-approved protocol. Refusal of a medical director to sign a life support agency application shall will result in denial justification review by the department.

  (3) The medical director shall must do all of the following:

   (a) Participate every 2 years in not less than 1 department-approved educational program relating to medical control issues.

   (b) Be responsible for the supervision, coordination, implementation, and compliance with protocols of the medical control authority.

   (c) Receive input from, and be responsive to, the advisory body.

(d) Complete, within 1 year of initial appointment, a medical director's  educational program provided by the department.

R 325.22206  Medical control authority; region.

  Rule 206.  (1) Not more than 1 medical  control authority shall may be approved in  each designated region.

  (2) A medical control authority shall must obtain approval from the department to change or combine medical control authority regions areas, or to assume a temporary contractual responsibility for a portion of another medical control authority's region.

R 325.22207  Medical control authority; protocol  development;  promulgation of protocols;

  emergency protocol.

  Rule 207.  (1)   Each medical control authority shall must establish written protocols as defined in section 20919 of the code, MCL 333.20919, which  shall must include, but is not be limited to, all of the following:

   (a) The acts, tasks, or functions that may be performed by each level  of emergency medical services personnel licensed under this part. Emergency medical services personnel shall must not provide life support  at  a level  that exceeds  the  life   support agency license and approved medical control authority protocols.

   (b) Procedures to assure ensure that life support agencies are providing clinical competency assessments to emergency medical services personnel before the individual provides emergency medical services within the medical control authority region area.

   (c) Medical protocols to require the appropriate dispatching of a life support agency based upon medical need and the capability of the emergency medical services system.

   (d) A do-not-resuscitate protocol consistent with section 20919(1)(c) of the code, MCL 333.20919.

   (e) A protocol consistent with part 56B of the code,  MCL 333.5671 to 333.5685.

(ef) Protocols defining the process, actions, and sanctions a medical control authority may use in holding life support agency or personnel accountable. This shall must include disciplinary action against a life support agency or emergency medical services personnel.

   (fg) Protocols defining the process to immediately remove medical control if the medical control authority determines that an immediate threat to the  public health, safety, or welfare exists. These protocols shall must specify that a medical control authority has 3 business days to hold a hearing and make a determination.

   (gh) Protocols that ensure establishing that if medical  control  has  been  removed  or  suspended from a participant, that the participant will not provide prehospital services in that within their medical control authority area_, then the participant shall not provide prehospital care until  medical  control  is  reinstated. If medical control is removed or suspended from a participant in the medical control authority, then the department and life support agency shall must be notified within 1 business day of the removal.       Medical control must inform the department when medical control is reinstated.

   (hi) Protocols that ensure a quality improvement program is in place as follows:.

(i) The quality improvement program shall must include a requirement that each life support agency  collects and submits  data  to  the  medical  control authority.

(ii) Data  shall must be reviewed by the medical control authority professional standards review organization.

(iii) Data  shall must be protected in accordance with section 20919(1)(g) of the code, MCL 333.20919.

   (ij) Protocols that ensure an appeals process of a medical control decision is in effect.

   (jk) Protocols that delineate specify that if life support agencies routinely transport prehospital patients to hospitals outside of their originating medical control authority regionarea, they will comply with their own medical control authority protocols.

(k) Written procedures for the security, control, dispensing, and exchange of pharmaceuticals, intravenous solutions, tubing, and related apparatus. Life support agency medication exchange shall only take place with a participating hospital or freestanding surgical outpatient facility.

  (2) Each  medical  control  authority  shall must develop  standards for the withdrawal or restoration of a hospital or free standing surgical outpatient facility, or off-campus emergency department with provider-based status as defined in R 325.22112(1)(c) from to a medical control authority. or the restoration of a hospital or free standing surgical outpatient facility to a medical control authority The protocol must include a provision to notify the regional trauma network of the withdrawal or restoration of a facility.

  (3) Each  medical  control  authority  shall must develop   specific  protocols applicable to the acquisition,  storage,  and  use  of  drugs, intravenous  fluids, and medical devices. Protocols must include:

   (a) All drug and intravenous fluids shall must be under the control of a pharmacist licensed in  this  state affiliated  with  a participating medical control  authority hospital, or free standing surgical outpatient facility, or off-campus emergency department with provider-based status as defined in R 325.22112(1)(c).

(b) The medical control authority participating pharmacy must provide medication and intravenous fluid exchange services in accordance with the protocols developed by the individual medical control authority and approved by the medical control authority medical control director and the department.

   (c) In the instance of a recall relating to medical control authority participating pharmacy supplied medications or devices, the pharmacy must notify the medical control authorities.

   (d) All medication storage containers must be numbered.  Each medication storage container must be inspected and inventoried by a medical control authority-approved pharmacy at least annually. 

   (e) All medication storage containers must have at least the following information affixed to the outside of the container:

    (i) The name of the medical control approved pharmacy that most recently restocked the container.

    (ii) The date of the most recent restock.

    (iii) The name and date of the medications with the soonest expiration dates.

    (iv) Notation of the licensed pharmacy personnel who completed and sealed the medication container. 

   (f) The medical control authority participating facility or agency in possession of intravenous fluids, tubing, and supplies must have a method for verifying and tracking that the supplies are within their expiration date and do not have any active recall notices. 

   (g) The medication containers must be stored in a method that will maintain the stability, integrity, and effectiveness of the medication contained therein.

(4) Each medical control authority considering the adoption of protocols shall comply with section 20919 (3) (a) of the code.

  (5) Each medical control authority may establish  an  emergency protocol  necessary to preserve the health or safety of  individuals   within its   region in response to a present medical emergency or disaster in accordance with section 20919 (3)(a) of  the  code.   Emergency protocols   developed   in accordance with section 20919(3)(e)  of  the  code, MCL 333.20919, shall must be submitted  to  the department, within 5 business days,  for  review and shall must remain in effect for not more than 60 days unless approved  by the department.

R 325.22208  Medical control authority protocols;  department  review; approval; adoption by

  medical control authority.

  Rule 208.  (1) A medical control authority shall must circulate, at least 60 days before adoption, a draft of proposed protocols to all affected life support agencies within the emergency medical services system under the medical control authority.

  (2) A medical control authority shall must submit  a written  draft  of proposed protocols to the department for review by the  quality  assurance task   force not later than the   tenth day of any given month. A protocol received not later than the tenth day of a given month will be reviewed that month. A protocol received after the tenth day of a given month will be reviewed the next month following the date of receipt by the department.

  (3) The department shall must consider any written comments received from persons within the medical control authority when reviewing a protocol.

  (4) The department shall must provide written  recommendations to the medical control authority within 60 days  of  receipt of a protocol in compliance with this rule, and comments, suggested changes, deletions, denial, or approval on the proposed protocol. Protocols resubmitted with changes or modifications by the medical control authority fall under the 60-day response deadline as prescribed in this rule.

  (5) Following department  approval  of  a  protocol, the medical control  authority may formally adopt the protocol.

R 325.22209  Medical control authority; additional standards.

  Rule 209.  A medical control  authority  may  adopt  protocols  that require  additional or more stringent standards for life support agencies, equipment,  and personnel than those already required by the department to enhance its system in the interest of prehospital emergency care. If a life support agency or emergency medical services personnel within the medical control authority disagree with the proposed protocol, then the medical control authority  shall must provide the department with the medical and economic considerations such enhancements may have on the local community. The quality assurance task force shall must review and make recommendations to the department before department approval.

R  325.22210  Medical  control  authority;  life  support  agencies   and personnel; compliance

  with protocols.

  Rule 210. (1) Each life  support  agency  and  emergency  medical services personnel licensed under this part is accountable to the medical control authority in the provision of emergency medical services within the medical  control  authority  region,  as defined in department-approved protocols.

  (21) A medical control authority shall must establish written procedures protocols the process, actions, and sanctions a medical control authority may use in holding a life support agency or personnel accountable. These procedures protocols shall must include disciplinary action against a life support agency or emergency medical services personnel to assure ensure compliance with standards of  medical care, all protocols, and operational procedures or to protect the public health, safety, or welfare.

  (32) A medical control authority may exercise disciplinary action against a life support agency and its emergency medical  services  personnel   that may result in the  life support agency or its personnel not being permitted to provide emergency medical services care. The basis for these actions shall must be for noncompliance with policies, procedures, or protocols established by the  medical control authority. Such disciplinary action may include the suspension, limitation, or removal of a life support agency or its personnel to provide emergency medical services within the medical  control authority region area.

   (43) If disciplinary action against an agency or individual under subrule (1) of this rule results in the suspension,  limitation,  or  removal  of  medical control,  the  medical  control  authority shall must advise the department, in writing, of such action within 1 business day.

   (54) If a suspension or removal of medical control to a life support agency or individual occurs by the medical control authority, the life support agency or individual shall may not operate or practice in that medical control authority region until medical control is restored by the medical control authority.

   (65) If a suspension or removal of medical control to a life support agency or individual occurs, then the by the medical control authority, the  life  support  agency  or individual must not operate or practice in that medical control authority area until medical control is restored by the medical control authority. life support agency or individual may appeal the decision to the medical control authority. After appeals to the medical control authority have been exhausted, the life support agency or individual may appeal the medical control authority's decision to the statewide emergency medical services coordination  committee.  An appeal  to   the  emergency medical services coordination committee  shall be filed with the department in writing  not  more  than  30  calendar  days  following   notification  to  the  agency  or   individual   of   the   final determination of the medical control authority.

   (76) In cases of malfeasance, misfeasance, or nonfeasance on the part of the medical control authority, the  department  shall must implement take action that to preserve medical control in a medical control authority region.

R 325.22211  Medical control authority; quality improvement.

  Rule 211. (1) A medical control authority shall must establish a quality improvement protocol to ensure a quality improvement program is in place and functional.

  (2) Data submitted by the life support agencies within the medical control  authority region area shall must be reviewed by the medical control authority professional standards  review organization for the purpose of improving the quality of medical care within the medical control authority region area.

(3) A quality improvement program shall comply with section 20919(1)(g) of the code.

R 325.22212  Medical control authority; appeals.

  Rule 212.  (1) A medical control authority shall must incorporate procedures for the  appeal of decisions made by the authority against a life support agency and emergency medical  services  personnel.  Once  appeals   to   the medical  control authority have been exhausted, the  decision  made  by  the medical control authority may be appealed to the statewide emergency medical services coordination committee. An appeal to the emergency medical services coordination committee shall must be filed with the department in writing not more than 30 calendar days following notification to the agency or individual of the final determination of the medical control authority. The emergency medical services coordination committee shall must issue an opinion on whether the actions or decisions of the medical control authority are in accordance comply with the department-approved protocols of the medical control authority and the code.

  (2) If a decision of the medical control authority is appealed to the emergency medical services coordination committee, then the medical control authority shall must document their decision to the statewide emergency medical services coordination committee for their review.

(3) If the statewide emergency medical services coordination committee determines that the actions or decisions of the medical control authority are not in accordance with department-approved protocols or the code, then  the  emergency medical services coordination  committee  shall recommend  to  the department that it  not take enforcement action under the code.

(4) If the statewide emergency medical services coordination committee determines that the actions or decisions of the medical control authority are in  accordance with department approved protocols or the code, then  the emergency  medical services coordination committee shall recommend to the department that it take enforcement action a under the code.

R 325.22213  Medical control authority; data collection; data confidentiality.

  Rule 213.  (1) A medical control authority shall must collect data under the department-approved quality improvement protocol from each life support agency within the medical control authority region area. Data collected shall must be reviewed by the medical control authority professional standards review organization to improve the quality of medical care within the medical control authority region and shall comply  with  section 20919(1)(g) of the code, MCL 333.20919. All data collected under this section of the code are confidential, not public record, not discoverable, and shall may not be used as evidence in a civil action or administrative proceeding.

  (2) A medical control authority shall must  submit  data  to  the  department  as  prescribed by the department and approved by the emergency medical services coordination committee.

 (3) Medical control authorities must have access to quality data residing within the Michigan EMS Information System for incidents that occur within the medical control authority’s geographic area.

R 325.22214  Medical control authority; special studies.

  Rule 214.  (1) A medical control authority that intends to establish a protocol involving skills, techniques, procedures, or equipment that is not included in this state or national approved curriculum, but  are consistent with the emergency medical services personnel  licensure  is   not may need to establish the practice as a special study. This skill, technique, procedure, or equipment is not a special study if it complies with the following: Determination that a proposed protocol is acceptable under current practice or requires a special study is decided by the quality assurance task force. A protocol may be approved as a medical control authority protocol under the following conditions:

   (a) The medical control authority Pprovides documentation that the skill, technique, procedure, or equipment complies with either 1 of the following:

(i) The practice Iis recognized by a national organization as an acceptable. guideline.

    (ii) Published studies that support  the  safety  and  efficacy in its application within the emergency setting.The practice has existing precedent in EMS outside of the state.

    (iii) Published studies that support  the  safety  and  efficacy in its application within the emergency setting.

   (b) The medical authority Pprovides the educational outline that will be implemented to instruct the emergency medical services personnel in the new skill, technique, procedure, or equipment, as well as the verification of competency that will be utilized.

(c) A letter of support, justifying the need for the practice, signed by the medical director for the medical control authority that will be participating in the practice implementation. 

   (d) The medical control authority submits protocols that will be used for the practice.

   (e) The quality assurance task force may require data submission to the state for approval of the practice.  If data is required for approval, the approval will be indicated as approval of the practice as a special study.

(2) A medical  control  authority   that   intends to establish a protocol involving skills, techniques, procedures, or equipment that is not included in this state or national approved curriculum, and is not consistent with its level of licensure shall requires a special study and must comply with all of the following:

   (a) The department shall support the study. Provide any available studies or supporting documentation indicating the practice has been studied.  Published studies supporting the safety and efficacy of its applications within the emergency setting should also be submitted.

   (b) Submit endorsements by the medical control authority and medical director. The medical control authority provides an educational outline that will be implemented to instruct the emergency medical services personnel in the new skill, technique, procedure, or equipment, as well as the verification of competency that will be utilized and the plan for continued competency assurance, i.e. CE plan.

(c) Obtain and submit a hospital institutional review board approval. If a hospital does not have an institutional review board, then all of the following are acceptable alternatives:

(i) Hospital risk management or equivalent. 

(ii)  Hospital quality review committee or equivalent.

(iii) A clinical department involved with emergency medical services that has an ongoing quality review process.

   (c) A letter of support, justifying the need for the practice, signed by the medical director for the medical control authority that will be participating in the special study.

   (d) Submit a time line clarifying the  duration  of  study.  The timeline shall  include the number of cases to reach conclusion of the study with an estimated date to reach requirement. The medical control authority submits protocols that will be used for the practice.

(e) Submit initial and refresher education requirements. Refresher education requirements shall include frequency and content of refresher to maintain proficiency in skill, technique, procedure, or equipment. Education requirements shall include  minimum proficiency requirements.

(e) Identify life support agencies involved in the special  study, their licensure  level, the number of emergency medical services personnel to be trained, and their respective licensure levels.

   (gf) If providing mutual aid outside its medical control authority region, the  medical control authority shall have a written agreement with another medical control authority to continue to utilize its protocols. Submit a timeline indicating the proposed duration of the study.

   (hg) Identify a special study coordinator. Describe the proposed data to be submitted to the state for the duration of the study.  Generally, data submission will be required quarterly.

   (ih) Identify data parameters to be collected and the  quality  review process that shall be implemented.  The  medical  control  authority  shall submit quarterly reports, and upon completion of a special study, submit a final report to the department. If the medical control authority intends to publish the results of the study, they must also submit Institutional Review Board approval or the letter of exemption status for the study.

(j) Submit protocols that shall be included in the special study.

  (3) A medical  control  authority that intends to establish a protocol involving skills, techniques, procedures, or equipment that is  not included in this  state  or  national  approved   curriculum,   but   is consistent   with generally accepted  practices at their level of licensure shall not require a special study. Those skills, techniques, procedures, or types of equipment shall and is not consistent with the level of licensure or scope of practice, involves human subject research under CFR Title 45, Part 46, or intends the human subject research to be published, must not require a special study if it complies with all of the following:

   (a) The department shall support the protocol. Provide any available studies or supporting documentation indicating the practice has been studied.  Published studies supporting the safety or efficacy of its application within the emergency setting should also be submitted.

(b) Submit endorsements by the medical control authority and medical director.

   (cb) Submit initial and refresher education requirements and provide an educational outline that will be implemented to instruct the emergency medical services personnel in the new skill, technique, procedure, or equipment, as well as verification of competency that will be utilized. Refresher education requirements shall must include frequency and content of refresher to maintain proficiency in skill, technique, procedure, or equipment. Education requirements shall include minimum proficiency requirements.

   (dc) Identify life support agencies involved, their licensure level, the number of emergency medical services personnel to be trained, and their respective licensure levels.

   (ed) If providing mutual aid outside its medical control authority region, the medical control authority shall must have a written agreement with another medical control authority to continue to utilize its protocols.

(fe) Identify the quality review process that will be implemented.

   (gf) Submit protocols that will be included in the special study.

(g) Identify data parameters to be collected and the quality review process that will be implemented.  The medical control authority must submit quarterly reports, and upon completion of the study, submit a final report to the department.

   (h) Obtain and submit an institutional review board approval or an institutional review board official exemption.  If a randomized study, include the consent form, method of institutional review board approval and institutional review board approval letter.

  (4) A special study may be terminated by the department, with the advice of the emergency medical services coordination committee quality  assurance task force, for  any of the following reasons:

   (a) The special study jeopardizes the health, safety, or welfare of the citizens of this state.

   (b) There is evidence of failure to follow study parameters.

   (c) There is evidence of failure to submit reports.

   (d) The medical control authority or medical director requests termination.

   (e) There is not sufficient data to support continuation.

(5) A special study may be considered complete when outcomes have been met, the timeline has been completed or the study has been terminated by the department with the advice of the quality assurance task force. A final report must be submitted to the department by the medical control authority when the study is complete unless the study is terminated by the department.  The medical control authority may request any of the following for the protocol being studied:

   (a) Become a standard protocol for the requesting medical control authority.    

   (b) Become a standard protocol for the state.

   (c) Be extended.

   (d) Be terminated.

  (6) Disposition of the protocol will be determined by the quality assurance task force.

R 325.22215  Medical control authority; communication requirements.

  Rule 215.  (1) A medical control authority shall must comply with the ambulance-to-hospital radio communications  system  approval  process, as prescribed  by the medcom requirements., under any of the following conditions:

(a) A medical control authority upgrades to provide  limited  advanced  or advanced life support oversight.

(b) An existing medical control authority changes the infrastructure of its communication system affecting ambulance-to-hospital communications.

(c) A change is made in an existing communications system that results in the inability of an agency or hospital to communicate with each other.

  (2) Each medical control authority  shall must designate  an  individual  or organization  to   be   responsible for maintaining records of the telecommunications activities in support of  medical  control. The records shall must be in the form of electronic recordings and shall be kept retained for 60 days.

  (3) The department may add additional frequencies or other methods of communications to the  medcom  requirements. The  department, before implementation, shall must approve new requirements and technologies for ambulance-to-hospital communication.

(4) A medical control authority shall comply with all of the following:

(a) Operate under a department-approved radio communications system plan applicable to each level of care proposed by each life support agency and its geographic service area. The plan shall be  consistent  with  the medcom requirements, established  by the department, for radio  conservation, regional compatibility, channel utilization,  and medical control.

(b) Utilize medcom channel assignments and operating  procedures  as established by the department under the code.

(c) Develop protocols to assure all components of the communications system comply with medcom requirements.

R 325.22216  Medical  control  authority;  interface  with  public  safety agencies; authority for

  management of patient.

  Rule 216.  A medical control authority shall must establish protocols that do all of the following:

  (a) Clarify the authority for the management of a patient in an emergency is vested in  the  licensed  health  professional or licensed emergency medical services personnel at the scene of the emergency who has the most training specific to the provision of emergency medical care.

  (b) Identify when a life support agency is present at the scene of an emergency, authority for the management of  an  emergency  patient  in an emergency is vested in the physician responsible for medical control until that physician relinquishes management of the patient to a licensed physician at the scene of an emergency.

  (c) Specify that the appropriate public safety agency shall manage the scene of an emergency.

  (d) Specify if an emergency is declared, the declaration that an emergency no longer exists shall may be made only by an individual licensed under the code or a health professional licensed under the code who has training specific to the provision of emergency medical services in accordance with department-approved protocols.

R 325.22217  Medical control authority; interfacility transfers.

  Rule 217.  (1) A medical control authority may adopt a protocol that governs the transport of a patient from 1 health facility to another. If a medical control authority has not established department-approved protocols for the interfacility transport of a patient, then patient care shall must be determined according to written orders of the transferring physician within the scope of practice of the emergency medical services personnel.

   (2) A life support agency shall must be accountable as defined in these rules to a medical control authority in which it has been approved to operate.

R 325.22218  Medical control authority; stretcher transport of nonemergency patients.

Rule 218.  With department approval, a medical control authority may implement a protocol that governs the treatment and stretcher transport of nonemergency patients.