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:
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.
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.
(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.
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.
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.
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.
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.
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.