subchapter 13p – emergency medical services and trauma
rules
SECTION .0100 – DEFINITIONS
10a ncac 13p .0101 ABBREVIATIONS
As used in this Subchapter, the following abbreviations
mean:
(1) ACS: American College of Surgeons;
(2) AHA: American Heart Association;
(3) ATLS: Advanced Trauma Life Support;
(4) CA3: Clinical Anesthesiology Year 3;
(5) CRNA: Certified Registered Nurse Anesthetist;
(6) CPR: Cardiopulmonary Resuscitation;
(7) DOA: Dead on Arrival;
(8) ED: Emergency Department;
(9) EMD: Emergency Medical Dispatcher;
(10) EMDPRS: Emergency Medical Dispatch Priority
Reference System;
(11) EMS: Emergency Medical Services;
(12) EMS-NP: EMS Nurse Practitioner;
(13) EMS-PA: EMS Physician Assistant;
(14) EMT: Emergency Medical Technician;
(15) EMT-I: EMT-Intermediate;
(16) EMT-P: EMT-Paramedic;
(17) ENT: Ear, Nose and Throat;
(18) FAA: Federal Aviation Administration;
(19) FAR: Federal Aviation Regulation;
(20) FCC: Federal Communications Commission;
(21) GSC: Glasgow Coma Scale;
(22) ICD: International Classification of Diseases;
(23) ISS: Injury Severity Score;
(24) IV: Intravenous;
(25) LPN: Licensed Practical Nurse;
(26) MICN: Mobile Intensive Care Nurse;
(27) MR: Medical Responder;
(28) NHTSA: National Highway Traffic Safety Administration;
(29) OEMS: Office of Emergency Medical Services;
(30) OMF: Oral maxillofacial;
(31) OR: Operating Room;
(32) PGY2: Post Graduate Year 2;
(33) PGY4; Post Graduate Year 4;
(34) PSAP: Public Safety Answering Point;
(35) RAC: Regional Advisory Committee;
(36) RFP: Request For Proposal;
(37) RN: Registered Nurse;
(38) SCTP: Specialty Care Transport Program;
(39) SMARTT: State Medical Asset and Resource Tracking
Tool;
(40) STEMI: ST Elevation Myocardial Infarction;
(41) TR: Trauma Registrar;
(42) TNC: Trauma Nurse Coordinator;
(43) TPM: Trauma Program Manager; and
(44) US DOT: United States Department of Transportation.
History Note: Authority G.S. 143-508(b);
Temporary Adoption Eff. January 1, 2002;
Eff. April 1, 2003;
Amended Eff. January 1, 2009; January 1, 2004.
10A NCAC 13P .0102 DEFINITIONS
The following definitions apply throughout this Subchapter:
(1) "Advanced Trauma Life Support" means the
course sponsored by the American College of Surgeons.
(2) "Affiliated EMS Provider" means the firm,
corporation, agency, organization, or association identified to a specific
county EMS system as a condition for EMS Provider Licensing as required by Rule
.0204(a)(1) of this Subchapter.
(3) "Affiliated Hospital" means a non-Trauma Center hospital that is owned by the Trauma Center or there exists a contract or
other agreement to allow for the acceptance or transfer of the Trauma Center's patient population to the non-Trauma Center hospital.
(4) "Affiliation" means a reciprocal
agreement and association that includes active participation, collaboration and
involvement in a process or system between two or more parties.
(5) "Air Medical Ambulance" means an aircraft
configured and medically equipped to transport patients by air. The patient care
compartment of air medical ambulances shall be staffed by medical crew members
approved for the mission by the medical director.
(6) "Air Medical Program" means a SCTP or EMS
System utilizing rotary-wing or fixed-wing aircraft configured and operated to
transport patients.
(7) "Assistant Medical Director" means a
physician, EMS-PA, or EMS-NP who assists the medical director with the medical
aspects of the management of an EMS System or EMS SCTP.
(8) "Attending" means a physician who has
completed medical or surgical residency and is either eligible to take boards
in a specialty area or is boarded in a specialty.
(9) "Board Certified, Board Certification, Board
Eligible, Board Prepared, or Boarded" means approval by the American Board
of Medical Specialties, the Advisory Board for Osteopathic Specialties, or the
Royal College of Physicians and Surgeons of Canada unless a further
sub-specialty such as the American Board of Surgery or Emergency Medicine is
specified.
(10) "Bypass" means the transport of an emergency
medical services patient from the scene of an accident or medical emergency
past an emergency medical services receiving facility for the purposes of
accessing a facility with a higher level of care, or a hospital of its own
volition reroutes a patient from the scene of an accident or medical emergency
or referring hospital to a facility with a higher level of care.
(11) "Contingencies" mean conditions placed on
a trauma center's designation that, if unmet, can result in the loss or
amendment of a hospital's designation.
(12) "Convalescent Ambulance" means an
ambulance used on a scheduled basis solely to transport patients having a known
non‑emergency medical condition. Convalescent ambulances shall not be
used in place of any other category of ambulance defined in this Subchapter.
(13) "Clinical Anesthesiology Year 3" means an
anesthesiology resident having completed two clinical years of general
anesthesiology training. A pure laboratory year shall not constitute a
clinical year.
(14) "Deficiency" means the failure to meet
essential criteria for a trauma center's designation as specified in Section
.0900 of this Subchapter, that can serve as the basis for a focused review or
denial of a trauma center designation.
(15) "Department" means the North Carolina
Department of Health and Human Services.
(16) "Diversion" means the hospital is unable
to accept a pediatric or adult patient due to a lack of staffing or resources.
(17) "E-Code" means a numeric identifier that
defines the cause of injury, taken from the ICD.
(18) "Educational Medical Advisor" means the
physician responsible for overseeing the medical aspects of approved EMS
educational programs in continuing education, basic, and advanced EMS educational institutions.
(19) "EMS Care" means all services provided
within each EMS System that relate to the dispatch, response, treatment, and
disposition of any patient that would require the submission of System Data to
the OEMS.
(20) "EMS Educational Institution" means any
agency credentialed by the OEMS to offer EMS educational programs.
(21) "EMS Nontransporting Vehicle" means a
motor vehicle dedicated and equipped to move medical equipment and EMS personnel functioning within the scope of practice of EMT-I or EMT-P to the scene of a
request for assistance. EMS nontransporting vehicles shall not be used for the
transportation of patients on the streets, highways, waterways, or airways of
the state.
(22) "EMS Peer Review Committee" means a
committee as defined in G.S. 131E-155(a)(6b).
(23) "EMS Performance Improvement Toolkits"
mean one or more reports generated from the state EMS data system analyzing the
EMS service delivery, personnel performance, and patient care provided by an
EMS system and its associated EMS agencies and personnel. Each EMS toolkit
focuses on a topic of care such as trauma, cardiac arrest, EMS response times,
stroke, STEMI (heart attack), and pediatric care.
(24) "EMS Provider" means those entities
defined in G.S. 131E-155 (13a) that hold a current license issued by the
Department pursuant to G.S. 131E-155.1.
(25) "EMS System" means a coordinated
arrangement of local resources under the authority of the county government
(including all agencies, personnel, equipment, and facilities) organized to
respond to medical emergencies and integrated with other health care providers
and networks including public health, community health monitoring activities,
and special needs populations.
(26) "EMS System Peer Groups" are defined as:
(a) Urban EMS System means greater than 200,000
population;
(b) Suburban EMS System means from 75,001 to
200,000 population;
(c) Rural EMS System means from 25,001 to 75,000
population; and
(d) Wilderness EMS System means 25,000
population or less.
(27) "Essential Criteria" means those items
listed in Rules .0901, .0902, and .0903 of this Subchapter that are the minimum
requirements for the respective level of trauma center designation (I, II, or
III).
(28) "Focused Review" means an evaluation by
the OEMS of a trauma center's corrective actions to remove contingencies that
are a result of deficiencies placed upon it following a renewal site visit.
(29) "Ground Ambulance" means an ambulance used
to transport patients with traumatic or medical conditions or patients for whom
the need for specialty care or emergency or non-emergency medical care is
anticipated either at the patient location or during transport.
(30) "Hospital" means a licensed facility as
defined in G.S. 131E-176.
(31) "Immediately Available" means the physical
presence of the health professional or the hospital resource within the trauma
center to evaluate and care for the trauma patient without delay.
(32) "Inclusive Trauma System" means an organized,
multi-disciplinary, evidence-based approach to provide quality care and to
improve measurable outcomes for all defined injured patients. EMS, hospitals, other health systems and clinicians shall participate in a structured
manner through leadership, advocacy, injury prevention, education, clinical
care, performance improvement and research resulting in integrated trauma care.
(33) "Infectious Disease Control Policy" means
a written policy describing how the EMS system will protect and prevent its
patients and EMS professionals from exposure and illness associated with
contagions and infectious disease.
(34) "Lead RAC Agency" means the agency
(comprised of one or more Level I or II trauma centers) that provides staff
support and serves as the coordinating entity for trauma planning in a region.
(35) "Level I Trauma Center" means a hospital as
defined by Item (30) of this Rule that has the capability of providing
leadership, research, and total care for every aspect of injury from prevention
to rehabilitation.
(36) "Level II Trauma Center" means a hospital as
defined by Item (30) of this Rule that provides trauma care regardless of the
severity of the injury but may not be able to provide the same comprehensive
care as a Level I trauma center and does not have trauma research as a primary
objective.
(37) "Level III Trauma Center" means a hospital
as defined by Item (30) of this Rule that provides prompt assessment,
resuscitation, emergency operations, and stabilization, and arranges for
hospital transfer as needed to a Level I or II trauma center.
(38) "Licensed Health Care Facility" means any
health care facility or hospital as defined by Item (30) of this Rule licensed
by the Department of Health and Human Services, Division of Health Service
Regulation.
(39) "Medical Crew Member" means EMS personnel
or other health care professionals who are licensed or registered in North Carolina and are affiliated with a SCTP.
(40) "Medical Director" means the physician
responsible for the medical aspects of the management of an EMS System, or SCTP,
or Trauma Center.
(41) "Medical Oversight" means the
responsibility for the management and accountability of the medical care
aspects of an EMS System or SCTP. Medical Oversight includes physician
direction of the initial education and continuing education of EMS personnel or
medical crew members; development and monitoring of both operational and
treatment protocols; evaluation of the medical care rendered by EMS personnel
or medical crew members; participation in system or program evaluation; and
directing, by two-way voice communications, the medical care rendered by the
EMS personnel or medical crew members.
(42) "Mid-level Practitioner" means a nurse practitioner
or physician assistant who routinely cares for trauma patients.
(43) "Model EMS System" means an EMS System
that is recognized and designated by the OEMS for meeting and mastering quality
and performance indicator criteria as defined by Rule .0202 of this Subchapter.
(44) "Off-line Medical Control" means medical
supervision provided through the EMS System Medical Director or SCTP Medical
Director who is responsible for the day to day medical care provided by EMS personnel. This includes EMS personnel education, protocol development, quality
management, peer review activities, and EMS administrative responsibilities
related to assurance of quality medical care.
(45) "Office of Emergency Medical Services"
means a section of the Division of Health Service Regulation of the North
Carolina Department of Health and Human Services located at 701 Barbour Drive, Raleigh, North Carolina 27603.
(46) "On-line Medical Control" means the
medical supervision or oversight provided to EMS personnel through direct
communication in person, via radio, cellular phone, or other communication
device during the time the patient is under the care of an EMS professional. The
source of on-line medical control is typically a designated hospital's
emergency department physician, EMS nurse practitioner, or EMS physician
assistant.
(47) "Operational Protocols" means the
administrative policies and procedures of an EMS System that provide guidance
for the day-to-day operation of the system.
(48) "Participating Hospital" means a hospital
that supplements care within a larger trauma system by the initial evaluation
and assessment of injured patients for transfer to a designated trauma center
if needed.
(49) "Physician" means a medical or osteopathic
doctor licensed by the North Carolina Medical Board to practice medicine in the
state of North Carolina.
(50) "Post Graduate Year Two" means any surgery
resident having completed one clinical year of general surgical training. A
pure laboratory year shall not constitute a clinical year.
(51) "Post Graduate Year Four" means any
surgery resident having completed three clinical years of general surgical
training. A pure laboratory year shall not constitute a clinical year.
(52) "Promptly Available" means the physical
presence of health professionals in a location in the trauma center within a
short period of time, that is defined by the trauma system (director) and
continuously monitored by the performance improvement program.
(53) "Regional Advisory Committee (RAC)" means
a committee comprised of a lead RAC agency and a group representing trauma care
providers and the community, for the purpose of regional trauma planning,
establishing, and maintaining a coordinated trauma system.
(54) "Request for Proposal (RFP)" means a state
document that must be completed by each hospital as defined by Item (30) of
this Rule seeking initial or renewal trauma center designation.
(55) "State Medical Asset and Resource Tracking Tool
(SMARTT)" means the Internet web-based program used by the OEMS both daily
in its operations and during times of disaster to identify, record and monitor
EMS, hospital, health care and sheltering resources statewide, including facilities,
personnel, vehicles, equipment, pharmaceutical and supply caches.
(56) "Specialty Care Transport Program" means a
program designed and operated for the provision of specialized medical care and
transportation of critically ill or injured patients between health care
facilities and for patients who are discharged from a licensed health care
facility to their residence that require specialized medical care during
transport which exceeds the normal capability of the local EMS System.
(57) "Specialty Care Transport Program Continuing
Education Coordinator" means a Level I EMS Instructor within a SCTP who is
responsible for the coordination of EMS continuing education programs for EMS personnel within the program.
(58) "Stroke" means an acute cerebrovascular
hemorrhage or occlusion resulting in a neurologic deficit.
(59) "System Continuing Education Coordinator"
means the Level I EMS Instructor designated by the local EMS System who is
responsible for the coordination of EMS continuing education programs.
(60) "System Data" means all information
required for daily electronic submission to the OEMS by all EMS Systems using
the EMS data set, data dictionary, and file format as specified in "North
Carolina College of Emergency Physicians: Standards for Medical Oversight and
Data Collection," incorporated by reference in accordance with G.S.
150B-21.6, including subsequent amendments and additions. This document is
available from the OEMS, 2707 Mail Service Center, Raleigh, North Carolina 27699-2707, at no cost.
(61) "Transfer Agreement" means a written
agreement between two agencies specifying the appropriate transfer of patient
populations delineating the conditions and methods of transfer.
(62) "Trauma Center" means a hospital as
defined by Item (30) of this Rule designated by the State of North Carolina and
distinguished by its ability to immediately manage, on a 24-hour basis, the
severely injured patient or those at risk for severe injury.
(63) "Trauma Center Criteria" means essential
criteria to define Level I, II, or III trauma centers.
(64) "Trauma Center Designation" means a
process of approval in which a hospital as defined by Item (30) of this Rule
voluntarily seeks to have its trauma care capabilities and performance
evaluated by experienced on-site reviewers.
(65) "Trauma Diversion" means a trauma center
of its own volition declines to accept an acutely injured pediatric or adult
patient due to a lack of staffing or resources.
(66) "Trauma Guidelines" mean standards for
practice in a variety of situations within the trauma system.
(67) "Trauma Minimum Data Set" means the basic
data required of all hospitals for submission to the trauma statewide database.
(68) "Trauma Patient" means any patient with an
ICD-9-CM discharge diagnosis 800.00-959.9 excluding 905-909 (late effects of
injury), 910.0-924 (blisters, contusions, abrasions, and insect bites), and
930-939 (foreign bodies).
(69) "Trauma Program" means an administrative
entity that includes the trauma service and coordinates other trauma related
activities. It must also include the trauma medical director, trauma program
manager/trauma coordinator, and trauma registrar. This program's reporting
structure shall give it the ability to interact with at least equal authority
with other departments providing patient care.
(70) "Trauma Registry" means a disease-specific
data collection composed of a file of uniform data elements that describe the
injury event, demographics, pre-hospital information, diagnosis, care,
outcomes, and costs of treatment for injured patients collected and
electronically submitted as defined by the OEMS.
(71) "Trauma Service" means a clinical service
established by the medical staff that has oversight of and responsibility for
the care of the trauma patient.
(72) "Trauma Team" means a group of health care
professionals organized to provide coordinated and timely care to the trauma
patient.
(73) "Treatment Protocols" means a document
approved by the medical directors of both the local EMS System, Specialty Care
Transport Program, or Trauma Center and the OEMS specifying the diagnostic
procedures, treatment procedures, medication administration, and
patient-care-related policies that shall be completed by EMS personnel or
medical crew members based upon the assessment of a patient.
(74) "Triage" means the assessment and
categorization of a patient to determine the level of EMS and healthcare
facility based care required.
(75) "Water Ambulance" means a watercraft
specifically configured and medically equipped to transport patients.
History Note: Authority G.S. 131E-155(a)(6b); 131E-162;
143-508(b),(d)(1),(d)(3),(d)(4),(d)(6),(d)(7),(d)(8), (d)(13); 143-518(a)(5);
Temporary Adoption Eff. January 1, 2002;
Eff. April 1, 2003;
Amended Eff. March 3, 2009 pursuant to E.O. 9, Beverly
Perdue, March 3, 2009;
Pursuant to G.S. 150B-21.3(c), a bill was not ratified by
the General Assembly to disapprove this rule.
10A NCAC 13P .0103 AIR MEDICAL PROGRAM
10A NCAC 13P .0104 ASSISTANT MEDICAL DIRECTOR
10A NCAC 13P .0105 CONVALESCENT AMBULANCE
10A NCAC 13P .0106 EDUCATIONAL MEDICAL ADVISOR
10A NCAC 13P .0107 EMS EDUCATIONAL INSTITUTION
History Note: Authority G.S. 143-508(b);
143-508(d)(1),(d)(3),(d)(4),(d)(8);
Temporary Adoption Eff. January 1, 2002;
Eff. April 1, 2003;
Repealed Eff. January 1, 2009.
10a ncac 13p .0108 EMS INSTRUCTOR
History Note: Authority G.S. 131E-155(a)(7a);
143-508(b); 143-508(d)(3); 143-508(d)(4);
Temporary Adoption Eff. January 1, 2002;
Repealed Eff. January 1, 2004.
10A NCAC 13P .0109 EMS NONTRANSPORTING VEHICLE
10A NCAC 13P .0110 EMS SYSTEM
10A NCAC 13P .0111 GROUND AMBULANCE
10A NCAC 13P .0112 MEDICAL CREW MEMBERS
10A NCAC 13P .0113 MEDICAL DIRECTOR
10A NCAC 13P .0114 MEDICAL OVERSIGHT
10A NCAC 13P .0115 MODEL EMS SYSTEM
10A NCAC 13P .0116 OFFICE OF EMERGENCY MEDICAL SERVICES
10A NCAC 13P .0117 OPERATIONAL PROTOCOLS
10A NCAC 13P .0118 PHYSICIAN
10a NCAC 13P .0119 EMS PEER REVIEW COMMITTEE
10A NCAC 13P .0120 SPECIALTY CARE TRANSPORT PROGRAM
10a ncac 13p .0121 SPECIALTY CARE TRANSPORT PROGRAM
CONTINUING EDUCATION COORDINATOR
10a ncac 13p .0122 SYSTEM CONTINUING EDUCATION COORDINATOR
10A NCAC 13P .0123 TREATMENT PROTOCOLS
10A NCAC 13P .0124 WATER AMBULANCE
History Note: Authority G.S. 131E-155(a)(6b);
143-508(b); 143-508(d)(1), (d)(3), (d)(6),(d)(7), (d)(8), (d)(13);
143-518(a)(5);
Temporary Adoption Eff. January 1, 2002;
Eff. January 1, 2004; April 1, 2003;
Amended Eff. January 1, 2004;
Repealed Eff. January 1, 2009.
SECTION .0200 – EMS SYSTEMS
10A NCAC 13P .0201 EMS SYSTEM REQUIREMENTS
(a) County governments shall establish EMS Systems. Each
EMS System shall have:
(1) a defined geographical service area for the
EMS System. The minimum service area for an EMS System shall be one county.
There may be multiple EMS Provider service areas within the service area of an
EMS System. The highest level of care offered within any EMS Provider service
area must be available to the citizens within that service area 24 hours per
day;
(2) a defined scope of practice for all EMS personnel, functioning in the EMS System, within the parameters set forth by the North
Carolina Medical Board pursuant to G.S. 143-514;
(3) written policies and procedures describing
the dispatch, coordination and oversight of all responders that provide EMS
care, specialty patient care skills and procedures as defined in Rule
.0301(a)(4) of this Subchapter, and ambulance transport within the system;
(4) at least one licensed EMS Provider;
(5) a listing of permitted ambulances to
provide coverage to the service area 24 hours per day;
(6) personnel credentialed to perform within
the scope of practice of the system and to staff the ambulance vehicles as
required by G.S. 131E-158. There shall be a written plan for the use of
credentialed EMS personnel for all practice settings used within the system;
(7) written policies and procedures specific to
the utilization of the EMS System's EMS Care data for the daily and on-going
management of all EMS System resources;
(8) a written Infectious Disease Control Policy
as defined in Rule .0102(33) of this Subchapter and written procedures which
are approved by the EMS System medical director that address the cleansing and
disinfecting of vehicles and equipment that are used to treat or transport
patients;
(9) a listing of facilities that will provide
online medical direction for all EMS Providers operating within the EMS System;
(10) an EMS communication system that provides
for:
(A) public access using the emergency telephone number
9-1-1 within the public dial telephone network as the primary method for the
public to request emergency assistance. This number shall be connected to the
emergency communications center or PSAP with immediate assistance available
such that no caller will be instructed to hang up the telephone and dial
another telephone number. A person calling for emergency assistance shall not
be required to speak with more than two persons to request emergency medical
assistance;
(B) an emergency communications system operated by
public safety telecommunicators with training in the management of calls for
medical assistance available 24 hours per day;
(C) dispatch of the most appropriate emergency medical
response unit or units to any caller's request for assistance. The dispatch of
all response vehicles shall be in accordance with a written EMS System plan for
the management and deployment of response vehicles including requests for
mutual aid; and
(D) two-way radio voice communications from within the
defined service area to the emergency communications center or PSAP and to
facilities where patients are routinely transported. The emergency
communications system shall maintain all required FCC radio licenses or
authorizations;
(11) written policies and procedures for
addressing the use of SCTP and Air Medical Programs within the system;
(12) a written continuing education program for
all credentialed EMS personnel, under the direction of a System Continuing
Education Coordinator, developed and modified based on feedback from system EMS
Care data, review, and evaluation of patient outcomes and quality management
peer reviews, that follows the guidelines of the:
(A) "US DOT NHTSA First Responder Refresher:
National Standard Curriculum" for MR personnel;
(B) "US DOT NHTSA EMT-Basic Refresher: National
Standard Curriculum" for EMT personnel;
(C) "EMT-P and EMT-I Continuing Education National
Guidelines" for EMT-I and EMT-P personnel; and
(D) "US DOT NHTSA Emergency Medical Dispatcher:
National Standard Curriculum" for EMD personnel.
These documents are incorporated
by reference in accordance with G.S. 150B-21.6, including subsequent amendments
and additions. These documents are available from NHTSA, 400 7th
Street, SW, Washington, D.C. 20590, at no cost;
(13) written policies and procedures to address
management of the EMS System that includes:
(A) triage and transport of all acutely ill and injured
patients with time-dependent or other specialized care issues including trauma,
stroke, STEMI, burn, and pediatric patients that may require the by-pass of
other licensed health care facilities and which are based upon the expanded
clinical capabilities of the selected healthcare facilities;
(B) triage and transport of patients to facilities
outside of the system;
(C) arrangements for transporting patients to
appropriate facilities when diversion or bypass plans are activated;
(D) reporting, monitoring, and establishing standards
for system response times using data provided by the OEMS;
(E) weekly updating of the SMARTT EMS Provider
information;
(F) a disaster plan; and
(G) a mass-gathering plan;
(14) affiliation as defined in Rule .0102(4) of
this Subchapter with the trauma RAC as required by Rule .1101(b) of this
Subchapter; and
(15) medical oversight as required by Section
.0400 of this Subchapter.
(b) An application to establish an EMS System shall be
submitted by the county to the OEMS for review. When the system is comprised
of more than one county, only one application shall be submitted. The proposal
shall demonstrate that the system meets the requirements in Paragraph (a) of
this Rule. System approval shall be granted for a period of six years. Systems
shall apply to OEMS for reapproval.
History Note: Authority G.S. 131E-155(1), (6), (8),
(9), (15);143-508(b), (d)(1), (d)(2), (d)(3), (d)(5), (d)(8), (d)(9), (d)(10),
(d)(13); 143-509(1), (3), (4), (5);143-517; 143-518;
Temporary Adoption Eff. January 1, 2002;
Eff. August 1, 2004;
Amended Eff. January 1, 2009.
10a ncac 13p .0202 MODEL EMS SYSTEMS
History Note: Authority G.S. 143-508(b); 143-508(d)(1),
(d)(3), (d)(5), (d)(8), (d)(9), (d)(10),(d)(13); 143-509(1), (3), (4), (5);
Temporary Adoption Eff. January 1, 2002;
Eff. January 1, 2004;
Repealed Eff. March 1, 2009.
10a ncac 13p .0203 SPECIAL SITUATIONS
Upon application of citizens in North Carolina, the North
Carolina Medical Care Commission shall approve the furnishing and providing of
programs within the scope of practice of EMD, EMT, EMT-I, or EMT-P in North Carolina
by persons who have been approved to provide these services by an agency of a
state adjoining North Carolina or federal jurisdiction. This approval shall be
granted where the North Carolina Medical Care Commission concludes that the
requirements enumerated in Rule .0201 of this Subchapter cannot be reasonably
obtained by reason of lack of geographical access.
History Note: Authority G.S. 143-508(b);
Temporary Adoption Eff. January 1, 2002;
Eff. April 1, 2003;
Amended Eff. January 1, 2004.
10a ncac 13p .0204 EMS PROVIDER LICENSE REQUIREMENTS
(a) Any firm, corporation, agency, organization or
association that provides emergency medical services shall be licensed as an
EMS Provider by meeting and continuously maintaining the following criteria:
(1) Be affiliated as defined in Rule .0102(4)
of this Subchapter with each EMS System where there is to be a physical base of
operation or where the EMS Provider will provide point-to-point patient
transport within the system;
(2) Present an application for a permit for any
ambulance that will be in service as required by G.S. 131E-156;
(3) Submit a written plan detailing how the EMS
Provider will furnish credentialed personnel;
(4) Where there are franchise ordinances
pursuant to G.S 153A-250 in effect that cover the proposed service areas of
each EMS system of operation, show the affiliation as defined in Rule .0102(4)
of this Subchapter with each EMS System, as required by Subparagraph (a)(1) of
this Rule, by being granted a current franchise to operate, or present written
documentation of impending receipt of a franchise, from each county. In
counties where there is no franchise ordinance in effect, present a signature
from each EMS System representative authorizing the EMS Provider to affiliate as
defined in Rule .0102(4) of this Subchapter and as required by Paragraph (a)(1)
of this Rule;
(5) Provide systematic, periodic inspection,
repair, cleaning, and routine maintenance of all EMS responding ground vehicles
and maintain records available for inspection by the OEMS which verify
compliance with this Subparagraph;
(6) Collect and within 24 hours electronically
submit to the OEMS EMS Care data that uses the EMS data set and data dictionary
as specified in "North Carolina College of Emergency Physicians: Standards
for Medical Oversight and Data Collection," incorporated by reference in
accordance with G.S. 150B-21.6, including subsequent amendments and additions. This
document is available from the OEMS, 2707 Mail Service Center, Raleigh, North Carolina 27699-2707, at no cost.
(7) Develop and implement written operational
protocols for the management of equipment, supplies and medications and
maintain records available for inspection by the OEMS which verify compliance
with this Subparagraph. These protocols shall include a methodology:
(A) to assure that each vehicle contains the required
equipment and supplies on each response;
(B) for cleaning and maintaining the equipment and
vehicles; and
(C) to assure that supplies and medications are not used
beyond the expiration date and stored in a temperature controlled atmosphere
according to manufacturer's specifications.
(b) In addition to the general requirements detailed in
Paragraph (a) of this Rule, if providing fixed-wing air medical services,
affiliation as defined in Rule .0102(4) of this Subchapter with a hospital as
defined in Rule .0102(30) of this Subchapter is required to ensure the
provision of peer review, medical director oversight and treatment protocol
maintenance.
(c) In addition to the general requirements detailed in
Paragraph (a) of this Rule, if providing rotary-wing air medical services, affiliation
as defined in Rule .0102(4) of this Subchapter with a Level I or Level II
Trauma Center as defined in Rules .0102(35) and (36) of this Subchapter
designated by the OEMS is required to ensure the provision of peer review,
medical director oversight and treatment protocol maintenance. Due to the
geographical barriers unique to the County of Dare, the Medical Care Commission
exempts the Dare County EMS System from this Paragraph.
(d) An EMS Provider may renew its license by presenting
documentation to the OEMS that the Provider meets the criteria found in
Paragraphs (a) through (c) of this Rule.
History Note: Authority G.S. 131E-155.1(c);
143-508(d)(1), (d)(5);
Temporary Adoption Eff. January 1, 2002;
Eff. April 1, 2003;
Amended Eff. January 1, 2004;
Amended Eff. March 3, 2009 pursuant to E.O. 9, Beverly
Perdue, March 3, 2009;
Pursuant to G.S. 150B-21(c), a bill was not ratified by
the General Assembly to disapprove this rule.
10a ncac 13p .0205 EMS PROVIDER LICENSE CONDITIONS
(a) Applications for an EMS Provider License must be
received by the OEMS at least 30 days prior to the date that the EMS Provider
proposes to initiate service. Applications for renewal of an EMS Provider
License must be received by the OEMS at least 30 days prior to the expiration
date of the current license.
(b) Only one license shall be issued to each EMS Provider. The
Department shall issue a license to the EMS Provider following verification of
compliance with applicable laws and rules.
(c) EMS Provider Licenses shall not be transferred.
(d) The license shall be posted in a prominent location
accessible to public view at the primary business location of the EMS Provider.
(e) EMS Provider Licenses may not be issued by the
Department to any firm, corporation, agency, organization or association that
does not intend to provide emergency medical services as part of its operation
to the citizens of North Carolina.
History Note: Authority G.S. 131E-155.1(c);
Temporary Adoption Eff. January 1, 2002;
Eff. April 1, 2003;
Amended Eff. February 1, 2009; January 1, 2004.
10A NCAC 13P .0206 TERM OF EMS PROVIDER LICENSE
(a) EMS Provider Licenses remain in effect for six years
unless any of the following occurs:
(1) the Department imposes an administrative
sanction which specifies license expiration;
(2) the EMS Provider closes or goes out of
business;
(3) the EMS Provider changes name or ownership;
or
(4) failure to continue to comply with Rule
.0204 of this Section.
(b) When the name or ownership of the EMS Provider changes,
an EMS Provider License application shall be submitted to the OEMS at least 30
days prior to the effective date of the change.
History Note: Authority G.S. 131E-155.1(c);
Temporary Adoption Eff. January 1, 2002;
Eff. April 1, 2003;
Amended Eff. January 1, 2009.
10a ncac 13p .0207 GROUND AMBULANCE: VEHICLE AND EQUIPMENT
REQUIREMENTS
(a) To be permitted as a Ground Ambulance, a vehicle shall
have:
(1) a patient compartment that meets the
following interior dimensions:
(A) the length, measured on the floor from the back of
the driver's compartment, driver's seat or partition to the inside edge of the
rear loading doors, is at least 102 inches; and
(B) the height is at least 48 inches over the patient
area, measured from the approximate center of the floor, exclusive of cabinets
or equipment;
(2) patient care equipment and supplies as
defined in the "North Carolina College of Emergency Physicians: Standards
for Medical Oversight and Data Collection," incorporated by reference in
accordance with G.S. 150B-21.6, including subsequent amendments and editions. This
document is available from the OEMS, 2707 Mail Service Center, Raleigh, North Carolina 27699-2707, at no cost. The equipment and supplies shall be clean,
in working order, and secured in the vehicle;
(3) other equipment that includes:
(A) one fire extinguisher mounted in a quick release
bracket that is either a dry chemical or all‑purpose type and has a
pressure gauge; and
(B) the availability of one pediatric restraint device
to safely transport pediatric patients and children under 40 pounds in the
patient compartment of the ambulance;
(4) the name of the EMS Provider permanently
displayed on each side of the vehicle;
(5) reflective tape affixed to the vehicle such
that there is reflectivity on all sides of the vehicle;
(6) emergency warning lights and audible
warning devices mounted on the vehicle as required by G.S. 20-125 in addition
to those required by Federal Motor Vehicle Safety Standards. All warning
devices shall function properly;
(7) no structural or functional defects that
may adversely affect the patient, the EMS personnel, or the safe operation of
the vehicle;
(8) an operational two-way radio that:
(A) is mounted to the ambulance and installed for safe
operation and controlled by the ambulance driver;
(B) has sufficient range, radio frequencies, and
capabilities to establish and maintain two-way voice radio communication from
within the defined service area of the EMS System to the emergency
communications center or PSAP designated to direct or dispatch the deployment
of the ambulance;
(C) is capable of establishing two-way voice radio
communication from within the defined service area to the emergency department
of the hospital(s) where patients are routinely transported and to facilities
that provide on-line medical direction to EMS personnel;
(D) is equipped with a radio control device mounted in
the patient compartment capable of operation by the patient attendant to
receive on-line medical direction; and
(E) is licensed or authorized by the FCC;
(9) permanently installed heating and air
conditioning systems; and
(10) a copy of the EMS System patient care
treatment protocols.
(b) Ground ambulances shall not use a radiotelephone device
such as a cellular telephone as the only source of two-way radio voice
communication.
(c) Communication instruments or devices such as data
radio, facsimile, computer, or telemetry radio shall be in addition to the mission
dedicated dispatch radio and shall function independently from the mission
dedicated radio.
History Note: Authority G.S. 131E‑157(a);
143-508(d)(8);
Temporary Adoption Eff. January 1, 2002;
Eff. April 1, 2003;
Amended Eff. January 1, 2009; January 1, 2004.
10a ncac 13p .0208 CONVALESCENT AMBULANCE: VEHICLE AND
EQUIPMENT REQUIREMENTS
(a) To be permitted as a Convalescent Ambulance, a vehicle
shall have:
(1) a patient compartment that meets the
following interior dimensions:
(A) the length, measured on the floor from the back of
the driver's compartment, driver's seat or partition to the inside edge of the
rear loading doors, is at least 102 inches; and
(B) the height is at least 48 inches over the patient
area, measured from the approximate center of the floor, exclusive of cabinets
or equipment;
(2) patient care equipment and supplies as
defined in the "North Carolina College of Emergency Physicians: Standards
for Medical Oversight and Data Collection," incorporated by reference in
accordance with G.S. 150B-21.6, including subsequent amendments and editions. This
document is available from the OEMS, 2707 Mail Service Center, Raleigh, North Carolina 27699-2707, at no cost. The equipment and supplies shall be clean,
in working order, and secured in the vehicle;
(3) other equipment including:
(A) one fire extinguisher mounted in a quick release
bracket that is either a dry chemical or all‑purpose type and has a
pressure gauge; and
(B) the availability of one pediatric restraint device
to safely transport pediatric patients and children under 40 pounds in the
patient compartment of the ambulance;
(4) permanently installed heating and air
conditioning systems; and
(5) a copy of the EMS System patient care
treatment protocols.
(b) Convalescent Ambulances shall:
(1) not be equipped, permanently or
temporarily, with any emergency warning devices, audible or visual, other than
those required by Federal Motor Vehicle Safety Standards;
(2) have the name of the EMS Provider
permanently displayed on each side of the vehicle;
(3) not have emergency medical symbols, such as
the Star of Life, block design cross, or any other medical markings, symbols,
or emblems, including the word "EMERGENCY," on the vehicle;
(4) have the words "CONVALESCENT
AMBULANCE" lettered on both sides and on the rear of the vehicle body; and
(5) have reflective tape affixed to the vehicle
such that there is reflectivity on all sides of the vehicle.
(c) A two-way radio or radiotelephone device such as a
cellular telephone shall be available to summon emergency assistance for a
vehicle permitted as a convalescent ambulance.
(d) The convalescent ambulance shall not have structural or
functional defects that may adversely affect the patient, the EMS personnel, or
the safe operation of the vehicle.
History Note: Authority G.S. 131E‑157(a);
143-508(d)(8);
Temporary Adoption Eff. January 1, 2002;
Eff. April 1, 2003;
Amended Eff. January 1, 2009; January 1, 2004;
10a ncac 13p .0209 AIR MEDICAL AMBULANCE: VEHICLE AND
EQUIPMENT REQUIREMENTS
To be permitted as an Air Medical Ambulance, an aircraft
shall meet the following requirements:
(1) Configuration of the aircraft patient care
compartment does not compromise the ability to provide appropriate care or
prevent performing in-flight emergency patient care procedures as approved by
the program medical director.
(2) The aircraft has on board patient care equipment
and supplies as defined in the treatment protocols for the program. The
equipment and supplies shall be clean, in working order, and secured in the aircraft.
(3) There is installed in the aircraft an internal
voice communication system to allow for communication between the medical crew
and flight crew.
(4) The medical director designates the combination of
medical equipment specified in Item (2) of this Rule that is carried on a
mission based on anticipated patient care needs.
(5) The name of the EMS Provider is permanently
displayed on each side of the aircraft.
(6) The aircraft is equipped with a two-way voice radio
licensed by the FCC capable of operation on any frequency required to allow
communications with public safety agencies such as fire departments, police
departments, ambulance and rescue units, hospitals, and local government
agencies within the service area.
(7) In addition to equipment required by applicable air
worthiness certificates and Federal Aviation Regulations (FAA Part 91 or 135),
any rotary-wing aircraft permitted has the following functioning equipment to
help ensure the safety of patients, crew members and ground personnel, patient
comfort, and medical care:
(a) Global Positioning System;
(b) an external search light that can be
operated from inside the aircraft;
(c) survival gear appropriate for the service
area and the number, age and type of patients;
(d) permanently installed environmental control unit (ECU) capable of both heating
and cooling the patient compartment of the aircraft; and
(e) capability to carry at least a 220 pound
patient load and transport at least 60 nautical miles or nearest Trauma Center
non-stop without refueling.
(8) The availability of one pediatric restraint device
to safely transport pediatric patients and children under 40 pounds in the
patient compartment of the air medical ambulance.
(9) The aircraft has no structural or functional
defects that may adversely affect the patient, or the EMS personnel.
History Note: Authority G.S. 131E‑157(a);
143-508(d)(8);
Temporary Adoption Eff. January 1, 2002;
Eff. April 1, 2003;
Amended Eff. January 1, 2004;
Amended Eff. March 3, 2009 pursuant to E.O. 9, Beverly
Perdue, March 3, 2009;
Pursuant to G.S. 150B-21.3(c), a bill was not ratified by
the General Assembly to disapprove this rule.
10a ncac 13p .0210 WATER AMBULANCE: WATERCRAFT AND
EQUIPMENT REQUIREMENTS
To be permitted as a Water Ambulance, a watercraft shall
meet the following requirements:
(1) The watercraft shall have a patient care area that:
(a) provides access to the head, torso, and
lower extremities of the patient while providing sufficient working space to
render patient care;
(b) is covered to protect the patient and EMS personnel from the elements; and
(c) has an opening of sufficient size to permit
the safe loading and unloading of a person occupying a litter.
(2) The watercraft shall have on board patient care
equipment and supplies as defined in the "North Carolina College of
Emergency Physicians: Standards for Medical Oversight and Data
Collection," incorporated by reference in accordance with G.S. 150B-21.6,
including subsequent amendments and editions. This document is available from
the OEMS, 2707 Mail Service Center, Raleigh, North Carolina 27699-2707, at no cost. The equipment and supplies shall be clean, in working order, and
secured in the vehicle.
(3) Water ambulances shall have the name of the EMS
Provider permanently displayed on each side of the watercraft.
(4) Water ambulances shall have a 360-degree beacon
warning light in addition to warning devices required in Chapter 75A, Article
1, of the North Carolina General Statutes.
(5) Water ambulances shall be equipped with:
(a) two floatable rigid long backboards with
proper accessories for securing infant, pediatric, and adult patients and
stabilization of the head and neck;
(b) one floatable litter with patient
restraining straps and capable of being secured to the watercraft;
(c) one fire extinguisher mounted in a quick
release bracket that is either a dry chemical or all‑purpose type and has
a pressure gauge;
(d) lighted compass;
(e) radio navigational aids such as ADF
(automatic directional finder), Satellite Global Navigational System,
navigational radar, or other comparable radio equipment suited for water
navigation;
(f) marine radio; and
(g) the availability of one pediatric restraint
device to safely transport pediatric patients under 40 pounds in the patient
compartment of the ambulance;
(6) The water ambulance shall not have structural or
functional defects that may adversely affect the patient, the EMS personnel, or
the safe operation of the watercraft.
(7) Water ambulances shall have a copy of the EMS
System patient care treatment protocols.
History Note: Authority G.S. 131E‑157(a);
143-508(d)(8);
Temporary Adoption Eff. January 1, 2002;
Eff. April 1, 2003;
Amended Eff. January 1, 2009; January 1, 2004.
10a NCAC 13P .0211 AMBULANCE PERMIT CONDITIONS
(a) An EMS provider shall apply to the OEMS for the
appropriate Ambulance Permit prior to placing an ambulance in service.
(b) The Department shall issue a permit for an ambulance
following verification of compliance with applicable laws and rules.
(c) Only one Ambulance Permit shall be issued for each
ambulance.
(d) An ambulance shall be permitted in only one category.
(e) Ambulance Permits shall not be transferred except in
the case of Air Medical Ambulance replacement aircraft when the primary
aircraft is out of service.
(f) The Ambulance Permit shall be posted as designated by
the OEMS inspector.
History Note: Authority G.S. 131E‑157(a);
143-508(d)(8);
Temporary Adoption Eff. January 1, 2002;
Eff. April 1, 2003;
Amended Eff. January 1, 2004.
10A NCAC 13P .0212 TERM OF AMBULANCE PERMIT
Ambulance Permits remain in effect for two years unless any
of the following occurs:
(1) The Department imposes an administrative
sanction which specifies permit expiration;
(2) The EMS Provider closes or goes out of
business;
(3) The EMS Provider changes name or ownership;
or
(4) Failure to comply with the applicable
Paragraphs of Rules .0207, .0208, .0209, or .0210 of this Section.
History Note: Authority G.S. 131E‑157(a);
143-508(d)(8);
Temporary Adoption Eff. January 1, 2002;
Eff. April 1, 2003;
Amended Eff. January 1, 2009.
10A NCAC 13P .0213 EMS NONTRANSPORTING VEHICLE
REQUIREMENTS
(a) To be permitted as an EMS Nontransporting Vehicle, a
vehicle shall:
(1) have patient care equipment and supplies as
defined in the treatment protocols for the system. The equipment and supplies
shall be clean, in working order, and secured in the vehicle.
(2) have the name of the EMS Provider
permanently displayed on each side of the vehicle.
(3) have reflective tape affixed to the vehicle
such that there is reflectivity on all sides of the vehicle.
(4) have emergency warning lights and audible
warning devices mounted on the vehicle as required by G.S. 20-125 in addition
to those required by Federal Motor Vehicle Safety Standards. All warning
devices shall function properly.
(5) not have structural or functional defects
that may adversely affect the EMS personnel or the safe operation of the
vehicle.
(6) have one fire extinguisher that is a dry
chemical or all-purpose type with a pressure gauge, mounted in a quick‑release
bracket.
(7) have an
operational two-way radio that:
(A) is mounted to
the EMS Nontransporting Vehicle and installed for safe operation and controlled
by the driver;
(B) has sufficient
range, radio frequencies, and capabilities to establish and maintain two-way
voice radio communication from within the defined service area of the EMS
System to the emergency communications center or PSAP designated to direct or
dispatch the deployment of the ambulance;
(C) is capable of
establishing two-way voice radio communication from within the defined service
area to facilities that provide on-line medical direction to EMS personnel; and
(D) is licensed or
authorized by the FCC.
(8) not
use a radiotelephone device such as a cellular telephone as the only source of
two-way radio voice communication.
(9) have a copy of the local EMS System patient
care treatment protocols.
(b) Communication instruments or devices such as data
radio, facsimile, computer, or telemetry radio shall be in addition to the
mission dedicated dispatch radio and shall function independently from the
mission-dedicated radio.
History Note: Authority G.S. 143-508(d)(8);
Temporary Adoption Eff. January 1, 2002;
Eff. April 1, 2003;
Amended Eff. January 1, 2009.
10a ncac 13p .0214 EMS NONTRANSPORTING VEHICLE PERMIT
CONDITIONS
(a) An EMS Provider shall apply to the OEMS for an EMS
Nontransporting Vehicle Permit prior to placing such a vehicle in service.
(b) The Department shall issue a permit for a vehicle following
verification of compliance with applicable laws and rules.
(c) Only one EMS Nontransporting Vehicle Permit shall be
issued for each vehicle.
(d) EMS Nontransporting Vehicle Permits shall not be
transferred.
(e) The EMS Nontransporting Vehicle Permit shall be posted
as designated by the OEMS inspector.
(f) Vehicles that are not owned or leased by the EMS
Provider are ineligible for permitting.
History Note: Authority G.S. 143-508(d)(8);
Temporary Adoption Eff. January 1, 2002;
Eff. April 1, 2003;
Amended Eff. January 1, 2009; January 1, 2004.
10A NCAC 13P .0215 TERM OF EMS NONTRANSPORTING VEHICLE
PERMIT
EMS Nontransporting Vehicle Permits remain in effect for two
years, unless any of the following occurs:
(1) The Department imposes an administrative
sanction that specifies permit expiration;
(2) The EMS Provider closes or goes out of
business;
(3) The EMS Provider changes name or ownership;
or
(4) Failure to comply with Rule .0213 of this
Section.
History Note: Authority G.S. 143-508(d)(8);
Temporary Adoption Eff. January 1, 2002;
Eff. April 1, 2003;
Amended Eff. January 1, 2009.
10A NCAC 13P .0216 WEAPONS AND EXPLOSIVES FORBIDDEN
(a) Weapons, as defined by the local county district
attorney's office, and explosives shall not be worn or carried aboard an
ambulance or EMS nontransporting vehicle within the State of North Carolina when
the vehicle is operating in any patient treatment or transport capacity or is
available for such function.
(b) This Rule shall apply whether or not such weapons and
explosives are concealed or visible.
(c) This Rule shall not apply to duly appointed law
enforcement officers.
(d) Safety flares are authorized for use on an ambulance
with the following restrictions:
(1) These devices are not stored inside the
patient compartment of the ambulance; and
(2) These devices shall be packaged and stored
so as to prevent accidental discharge or ignition.
History Note: Authority G.S. 131E‑157(a);
143-508(d)(8);
Temporary Adoption Eff. January 1, 2002;
Eff. April 1, 2003.
10A NCAC 13P .0217 MEDICAL AMBULANCE/EVACUATION BUS:
VEHICLE AND EQUIPMENT REQUIREMENTS
(a) A Medical Ambulance/Evacuation bus is a multiple
passenger vehicle configured and medically equipped for emergency and
non-emergency transport of at least three stretcher bound patients with
traumatic or medical conditions.
(b) To be permitted as a Medical Ambulance/Evacuation Bus,
a vehicle shall have:
(1) a non-light penetrating sliding curtain
installed behind the driver from floor-to-ceiling and from side-to-side to keep
all light from the patient compartment from reaching the driver's area during
vehicle operation at night;
(2) patient care equipment and supplies as
defined in the "North Carolina College of Emergency Physicians: Standards for Medical Oversight and Data Collection," which is incorporated by reference,
including subsequent amendments and editions. This document is available from
the OEMS, 2707 Mail Service Center, Raleigh, North Carolina 27699-2707, at no cost. The equipment and supplies shall be clean, in working order, and
secured in the vehicle;
(3) five pound fire extinguishers mounted in a
quick release bracket located inside the patient compartment at the front and
rear of the vehicle that are either a dry chemical or all-purpose type and have
pressure gauges;
(4) monitor alarms installed inside the patient
compartment at the front and rear of the vehicle to warn of unsafe buildup of
carbon monoxide;
(5) the name of the EMS provider permanently
displayed on each side of the vehicle;
(6) reflective tape affixed to the vehicle such
that there is reflectivity on all sides of the vehicle;
(7) emergency warning lights and audible
warning devices mounted on the vehicle as required by G.S. 20-125 in addition
to those required by Federal Motor Vehicle Safety Standards. All warning
devices shall function properly;
(8) no structural or functional defects that
may adversely affect the patient, the EMS personnel, or the safe operation of
the vehicle;
(9) an operational two-way radio that:
(A) is mounted to the ambulance and installed for safe
operation and controlled by the ambulance driver;
(B) has sufficient range, radio frequencies, and
capabilities to establish and maintain two-way voice radio communication from
within the defined service area of the EMS System to the emergency
communications center or PSAP designated to direct or dispatch the deployment
of the ambulance;
(C) is capable of establishing two-way voice radio
communication from within the defined service area to the emergency department
of the hospital(s) where patients are routinely transported and to facilities
that provide on-line medical direction to EMS personnel;
(D) is equipped with a radio control device mounted in
the patient compartment capable of operation by the patient attendant to
receive on-line medical direction; and
(E) is licensed or authorized by the FCC;
(10) permanently installed heating and air
conditioning systems; and
(11) a copy of the EMS System patient care
treatment protocols.
(c) A Medical Ambulance/Evacuation Bus shall not use a
radiotelephone device such as a cellular telephone as the only source of
two-way radio voice communication.
(d) Communication instruments or devices such as data
radio, facsimile, computer, or telemetry radio shall be in addition to the
mission dedicated dispatch radio and shall function independently from the
mission dedicated radio.
(e) The EMS System medical director shall designate the
combination of medical equipment as required in Subparagraph (b)(2) of this
Rule that is carried on a mission based on anticipated patient care needs.
(f) The ambulance permit for this vehicle shall remain in
effect for two years unless any of the following occurs:
(1) The Department imposes an administrative
sanction which specifies permit expiration;
(2) The EMS Provider closes or goes out of
business;
(3) The EMS Provider changes name or ownership;
or
(4) Failure to comply with the applicable
Paragraphs of this Rule.
History Note: Authority G.S. 131E-157(a); 143-508(d)(8);
Eff. July 1, 2011.
10a ncac 13p .0218 PEDIATRIC SPECIALTY CARE GROUND
AMBULANCE: VEHICLE AND EQUIPMENT REQUIREMENTS
(a) A Pediatric Specialty Care Ground Ambulance is an
ambulance used to transport only those patients 18 years old or younger with
traumatic or medical conditions or for whom the need for specialty care or
emergency or non-emergency medical care is anticipated during an inter-facility
or discharged patient transport.
(b) To be permitted as a Pediatric Specialty Care Ground
Ambulance, a vehicle shall have:
(1) a patient compartment that meets the
following interior dimensions:
(A) the length, measured on the floor from the back of
the driver's compartment, driver's seat or partition to the inside edge of the
rear loading doors, is at least 102 inches; and
(B) the height is at least 48 inches over the patient
area, measured from the center of the floor, exclusive of cabinets or
equipment;
(2) patient care equipment and supplies as
defined in the "North Carolina College of Emergency Physicians: Standards for Medical Oversight and Data Collection," which is incorporated by reference,
including subsequent amendments and editions. This document is available from
the OEMS, 2707 Mail Service Center, Raleigh, North Carolina 27699-2707, at no cost. The equipment and supplies shall be clean, in working order, and
secured in the vehicle;
(3) one fire extinguisher mounted in a quick
release bracket that is either a dry chemical or all-purpose type and has a
pressure gauge;
(4) the name of the EMS Provider permanently
displayed on each side of the vehicle;
(5) reflective tape affixed to the vehicle such
that there is reflectivity on all sides of the vehicle;
(6) emergency warning lights and audible
warning devices mounted on the vehicle as required by G.S. 20-125 in addition
to those required by Federal Motor Vehicle Safety Standards. All warning
devices shall function properly;
(7) no structural or functional defects that
may adversely affect the patient, the EMS personnel, or the safe operation of
the vehicle;
(8) an operational two-way radio that:
(A) is mounted to the ambulance and installed for safe
operation and controlled by the ambulance driver;
(B) has sufficient range, radio frequencies, and capabilities
to establish and maintain two-way voice radio communication from within the
defined service area of the EMS System to the emergency communications center
or PSAP designated to direct or dispatch the deployment of the ambulance;
(C) is capable of establishing two-way voice radio
communication from within the defined service area to the emergency department
of the hospital(s) where patients are routinely transported and to facilities
that provide on-line medical direction to EMS personnel;
(D) is equipped with a radio control device mounted in
the patient compartment capable of operation by the patient attendant to
receive on-line medical direction; and
(E) is licensed or authorized by the FCC;
(9) permanently installed heating and air
conditioning systems; and
(10) a copy of the EMS System patient care
treatment protocols.
(c) Pediatric Specialty Care Ground ambulances shall not
use a radiotelephone device such as a cellular telephone as the only source of
two-way radio voice communication.
(d) Communication instruments or devices such as data
radio, facsimile, computer, or telemetry radio shall be in addition to the
mission dedicated dispatch radio and shall function independently from the
mission dedicated radio.
(e) The Specialty Care Transport Program medical director
shall designate the combination of medical equipment as required in
Subparagraph (b)(2) of this Rule that is carried on a mission based on
anticipated patient care needs.
(f) The ambulance permit for this vehicle shall remain in effect
for two years unless any of the following occurs:
(1) The Department imposes an administrative
sanction which specifies permit expiration;
(2) The EMS Provider closes or goes out of
business;
(3) The EMS Provider changes name or ownership;
or
(4) Failure to comply with the applicable paragraphs
of this Rule.
History Note: Authority G.S. 131E-157(a); 143-508(d)(8);
Eff. July 1, 2011.
10A NCAC 13P .0219 staffing for medical
ambulance/evacuAtion bus VEHICLES
Medical Ambulance/Evacuation Bus Vehicles are exempt from
the requirements of G.S. 131E-158(a). The EMS System Medical Director shall
determine the combination and number of EMT, EMT-Intermediate, or EMT-Paramedic
personnel that are sufficient to manage the anticipated number and severity of
injury or illness of the patients transported in the Medical Ambulance/Evacuation
Bus vehicle.
History Note: Authority G.S. 131E-158(b);
Eff. July 1, 2011.
10A NCAC 13P .0220 staffing for PEDIATRIC SPECIALTY CARE
GROUND AMBULANCES
Pediatric Specialty Care Ground Ambulances operated within
the approved Specialty Care Transport Program dedicated for inter-facility
transport of non-emergent, emergent, and critically ill or injured or
discharged Neonatal and Pediatric patients are exempt from the requirements of
G.S. 131E-158(a). The Specialty Care Program Medical Director shall determine
the staffing that is sufficient to manage the severity of illness or injury of
the patients transported in the Pediatric Specialty Care Ground Ambulance.
History Note: Authority G.S. 131E-158(b);
Eff. July 1, 2011.
10A NCAC 13P .0221 patient TRANSPORTation between
hospitals
(a) For the purpose of this Rule, hospital means those
facilities as defined in Rule .0102(30) of this Subchapter.
(b) Every ground ambulance when transporting a patient
between hospitals shall be occupied by all of the following:
(1) one person who holds a credential issued by
the OEMS as a Medical Responder or higher who is responsible for the operation
of the vehicle and rendering assistance to the patient caregiver when needed;
and
(2) at least one of the following who is
responsible for the medical aspects of the mission:
(A) Emergency Medical Technician;
(B) EMT-Intermediate;
(C) EMT-Paramedic;
(D) nurse practitioner;
(E) physician;
(F) physician assistant;
(G) registered nurse; or
(H) respiratory therapist.
(c) Information must be provided to the OEMS by the
licensed EMS provider:
(1) describing the intended staffing pursuant
to Rule .0204(a)(3) of this Subchapter; and
(2) showing authorization pursuant to Rule
.0204(a)(4) of this Subchapter by the county in which the EMS provider license
is issued to use the staffing in Paragraph (b) of this Rule.
(d) Ambulances used for patient transports between
hospitals must contain all medical equipment, supplies, and medications
approved by the medical director, based on the treatment protocols.
History Note: Authority G.S. 131E-155.1; 131E-158(b);
143-508(d)(1),(d)(8);
Eff. July 1, 2012.
SECTION .0300 – SPECIALTY CARE TRANSPORT PROGRAMS
10a ncac 13P .0301 SPECIALTY CARE TRANSPORT PROGRAM
CRITERIA
(a) EMS Providers seeking designation to provide specialty
care transports shall submit an application for program approval to the OEMS at
least 60 days prior to field implementation. The application shall document
that the program has:
(1) a defined service area that identifies the
specific transferring and receiving facilities in which the program is intended
to service;
(2) written policies and procedures implemented
for medical oversight meeting the requirements of Section .0400;
(3) service continuously available on a 24 hour
per day basis;
(4) the capability to provide the patient care
skills and procedures as specified in "North Carolina College of Emergency
Physicians: Standards for Medical Oversight and Data Collection,"
incorporated by reference in accordance with G.S. 150B-21.6, including
subsequent amendments and editions. This document is available from the OEMS,
2707 Mail Service Center, Raleigh, North Carolina 27699-2707, at no cost;
(5) a written continuing education program for
EMS personnel, under the direction of the Specialty Care Transport Program
Continuing Education Coordinator, developed and modified based on feedback from
program data, review and evaluation of patient outcomes, and quality management
review that follows the guidelines of the:
(A) "US DOT NHTSA EMT-Basic Refresher: National
Standard Curriculum" for EMT personnel; and
(B) "EMT-P and EMT-I Continuing Education National
Guidelines" for EMT-I and EMT-P personnel.
These documents are incorporated
by reference in accordance with G.S. 150B-21.6, including subsequent amendments
and additions. These documents are available from NHTSA, 400 7th
Street, SW, Washington, D.C. 20590, at no cost;
(6) a communication system that will provide
two-way voice communications for transmission of patient information to medical
crew members anywhere in the service area of the program. The SCTP medical
director shall verify that the communications system is satisfactory for
on-line medical direction;
(7) medical crew members that have all
completed training regarding:
(A) operation of the EMS communications system used in
the program; and
(B) the medical and patient safety equipment specific to
the program. This training shall be conducted every six months;
(8) written operational protocols for the
management of equipment, supplies and medications. These protocols include:
(A) a listing of all standard medical equipment,
supplies, and medications for all vehicles used in the program based on the
treatment protocols and approved by the medical director; and
(B) a methodology to assure that each ground vehicle and
aircraft contains the required equipment, supplies and medications on each
response; and
(9) written policies and procedures specifying
how EMS Systems will dispatch and utilize the ground ambulances and aircraft
operated by the program.
(b) When transporting patients, staffing for the ground
ambulance and aircraft used in the SCTP shall be approved by the SCTP medical
director as medical crew members, using any of the following appropriate for
the condition of the patient:
(1) EMT-Paramedic;
(2) nurse practitioner;
(3) physician;
(4) physician assistant;
(5) registered nurse; and
(6) respiratory therapist.
(c) Specialty Care Transport Programs as defined in Rule
.0102(56) of this Subchapter are exempt from the staffing requirements defined
in G.S. 131E-158(a).
(d) Specialty Care Transport Program approval are valid for
a period to coincide with the EMS Provider License, not to exceed six years.
Programs shall apply to the OEMS for reapproval.
History Note: Authority G.S. 131E-158; 143‑508(d)(1),
(d)(8), (d)(9); 143-508(d)(13);
Temporary Adoption Eff. January 1, 2002;
Eff. January 1, 2004;
Amended Eff. January 1, 2004;
Amended Eff. March 3, 2009 pursuant to E.O. 9, Beverly
Perdue, March 3, 2009;
Pursuant to G.S. 150B-21.3(c), a bill was not ratified by
the General Assembly to disapprove this rule.
10A NCAC 13P .0302 AIR MEDICAL SPECIALTY CARE TRANSPORT
PROGRAM CRITERIA for licensed ems providers using rotary-wing aircraft
(a) Air Medical Programs using rotary-wing aircraft shall
document that the program has:
(1) Medical crew members that have all
completed training regarding:
(A) Altitude physiology; and
(B) The operation of the EMS communications system used
in the program;
(2) Written policies and procedures for
transporting patients to appropriate facilities when diversion or bypass plans
are activated;
(3) Written policies and procedures specifying
how EMS Systems will dispatch and utilize aircraft operated by the program;
(4) Written triage protocols for trauma,
stroke, STEMI, burn, and pediatric patients reviewed and approved by the OEMS
medical director;
(5) Written policies and procedures specifying
how EMS Systems will receive the Specialty Care Transport Services offered
under the program when the aircraft are unavailable for service; and
(6) A copy of the Specialty Care Transport
Program patient care treatment protocols.
(b) All patient response, re-positioning and mission flight
legs must be conducted under FAA part 135 regulations.
History Note: Authority G.S. 143‑508(d)(1),
(d)(3); (d)(13);
Temporary Adoption Eff. January 1, 2002;
Eff. April 1, 2003;
Amended Eff. March 3, 2009 pursuant to E.O. 9, Beverly
Perdue, March 3, 2009;
Pursuant to G.S. 150B-21.3(c), a bill was not ratified by
the General Assembly to disapprove this rule.
10a ncac 13p .0303 GROUND SPECIALTY CARE TRANSPORT
PROGRAMS
10A NCAC 13P .0304 HOSPITAL-AFFILIATED GROUND SPECIALTY
CARE TRANSPORT PROGRAMS USED FOR INPATIENT TRANSPORTS
History Note: Authority G.S. 143‑508(d)(1);
(d)(8); (d)(9);
Temporary Adoption Eff. January 1, 2002;
Eff. April 1, 2003;
Amended Eff. January 1, 2004;
Repealed Eff. January 1, 2009.
10A NCAC 13P .0305 AIR MEDICAL SPECIALTY CARE TRANSPORT
PROGRAM CRITERIA for licensed ems providers using fixed-wing aircraft
(a) In addition to the general requirements of Specialty
Care Transport Programs in Rule .0301 of this Section, Air Medical Programs
using fixed-wing aircraft shall document that:
(1) Medical crew members have all completed
training regarding:
(A) Altitude physiology; and
(B) The operation of the EMS communications system used
in the program;
(2) Written policies and procedures specifying
how ground ambulance services are utilized by the program for patient delivery
and receipt on each end of the transport; and
(3) There is a copy of the Specialty Care
Treatment Program patient care protocols.
(b) All patient, re-positioning, and mission flight legs
must be conducted under FAA part 135 regulations.
History Note: Authority G.S. 143‑508(d)(1),
(d)(3);
Eff. March 3, 2009 pursuant to E.O. 9, Beverly Perdue,
March 3, 2009;
Pursuant to G.S. 150B-21.3(c), a bill was not ratified by
the General Assembly to disapprove this rule.
SECTION .0400 - MEDICAL OVERSIGHT
10a ncac 13p .0401 COMPONENTS OF MEDICAL OVERSIGHT FOR EMS SYSTEMS
Each EMS System shall have the following components in place
to assure medical oversight of the system:
(1) a medical director for adult and pediatric patients
appointed, either directly or by written delegation, by the county responsible
for establishing the EMS System. Systems may elect to appoint one or more
assistant medical directors. The medical director and assistant medical
directors shall meet the criteria defined in the "North Carolina College
of Emergency Physicians: Standards for Medical Oversight and Data
Collection," incorporated by reference in accordance with G.S. 150B-21.6,
including subsequent amendments and editions. This document is available from
the OEMS, 2707 Mail Service Center, Raleigh, North Carolina 27699-2707, at no cost;
(2) written treatment protocols for adult and pediatric
patients for use by EMS personnel;
(3) for systems providing EMD service, an EMDPRS
approved by the medical director;
(4) an EMS Peer Review Committee; and
(5) written procedures for use by EMS personnel to
obtain on-line medical direction. On-line medical direction shall:
(a) be restricted to medical orders that fall
within the scope of practice of the EMS personnel and within the scope of
approved system treatment protocols;
(b) be provided only by a physician, MICN,
EMS-NP, or EMS-PA. Only physicians may deviate from written treatment
protocols; and
(c) be provided by a system of two-way voice
communication that can be maintained throughout the treatment and disposition
of the patient.
History Note: Authority G.S. 143‑508(b);
143-509(12);
Temporary Adoption Eff. January 1, 2002;
Eff. April 1, 2003;
Amended Eff. January 1, 2009; January 1, 2004.
10a ncac 13p .0402 COMPONENTS OF MEDICAL OVERSIGHT FOR
SPECIALTY CARE TRANSPORT PROGRAMS
Each Specialty Care Transport Program shall have the
following components in place to assure Medical Oversight of the system:
(1) a medical director. The administration of the SCTP
shall appoint a medical director following the criteria for medical directors
of Specialty Care Transport Programs as defined by the "North Carolina
College of Emergency Physicians: Standards for Medical Oversight and Data
Collection," incorporated by reference in accordance with G.S. 150B-21.6,
including subsequent amendments and editions. This document is available from
the OEMS, 2707 Mail Service Center, Raleigh, North Carolina 27699-2707, at no cost. The program administration may elect to appoint one or more assistant
medical directors;
(2) treatment protocols for adult and pediatric
patients for use by medical crew members;
(3) an EMS Peer Review Committee; and
(4) a written protocol for use by medical crew members
to obtain on-line medical direction. On-line medical direction shall:
(a) be restricted to medical orders that fall
within the scope of practice of the medical crew members and within the scope
of approved program treatment protocols;
(b) be provided only by a physician, MICN,
EMS-NP, or EMS-PA. Only physicians may deviate from written treatment
protocols; and
(c) be provided by a system of two-way voice
communication that can be maintained throughout the treatment and disposition
of the patient.
History Note: Authority G.S. 143‑508(b); 143-509(12);
Temporary Adoption Eff. January 1, 2002;
Eff. April 1, 2003;
Amended Eff. January 1, 2009; January 1, 2004.
10a NCAC 13P .0403 RESPONSIBILITIES OF THE MEDICAL
DIRECTOR FOR EMS SYSTEMS
(a) The Medical Director for an EMS System is responsible
for the following:
(1) ensuring that medical control is available
24 hours a day;
(2) the establishment, approval and annual
updating of adult and pediatric treatment protocols;
(3) EMD programs, the establishment, approval,
and annual updating of the EMDPRS;
(4) medical supervision of the selection,
system orientation, continuing education and performance of all EMS personnel;
(5) medical supervision of a scope of practice
performance evaluation for all EMS personnel in the system based on the
treatment protocols for the system;
(6) the medical review of the care provided to
patients;
(7) providing guidance regarding decisions
about the equipment, medical supplies, and medications that will be carried on
all ambulances and EMS nontransporting vehicles operating within the system;
(8) keeping the care provided up to date with
current medical practice; and
(9) developing and implementing an orientation
plan for all hospitals within the EMS system that use MICN, EMS-NP, or EMS-PA
personnel to provide on-line medical direction to EMS personnel, which
includes:
(A) a discussion of all EMS System treatment protocols
and procedures;
(B) an explanation of the specific scope of practice for
credentialed EMS personnel, as authorized by the approved EMS System treatment
protocols as required by Rule .0405 of this Section;
(C) a discussion of all practice settings within the EMS
System and how scope of practice may vary in each setting;
(D) a mechanism to assess the ability to effectively use
EMS System communications equipment including hospital and prehospital devices,
EMS communication protocols, and communications contingency plans as related to
on-line medical direction; and
(E) the successful completion of a scope of practice
performance evaluation which verifies competency in Parts (A) through (D) of
this Subparagraph and which is administered under the direction of the medical
director.
(b) Any tasks related to Paragraph (a) of this Rule may be
completed, through written delegation, by assisting physicians, physician
assistants, nurse practitioners, registered nurses, EMD's, or EMT-P's.
(c) The Medical Director may suspend temporarily, pending
due process review, any EMS personnel from further participation in the EMS
System when it is determined the activities or medical care rendered by such
personnel are detrimental to the care of the patient, constitute unprofessional
conduct, or result in non-compliance with credentialing requirements.
History Note: Authority G.S. 143‑508(b); 143‑508(d)(3),(d)(7);
143-509(12);
Temporary Adoption Eff. January 1, 2002;
Eff. April 1, 2003;
Amended Eff. January 1, 2009; January 1, 2004.
10A NCAC 13P .0404 RESPONSIBILITIES OF THE MEDICAL
DIRECTOR FOR SPECIALTY CARE TRANSPORT PROGRAMS
(a) The medical director for a Specialty Care Transport
Program is responsible for the following:
(1) The establishment, approval, and updating
of adult and pediatric treatment protocols;
(2) Medical supervision of the selection,
program orientation, continuing education, and performance of medical crew
members;
(3) Medical supervision of a scope of practice
performance evaluation for all medical crew members in the program based on the
treatment protocols for the program;
(4) The medical review of the care provided to
patients;
(5) Keeping the care provided up to date with
current medical practice; and
(6) In air medical programs, determination and
specification of the medical equipment required in Item (2) of Rule .0209 of
this Subchapter that is carried on a mission based on anticipated patient care
needs.
(b) Any tasks related to Paragraph (a) of this Rule may be
completed, through written delegation, by assisting physicians, physician
assistants, nurse practitioners, registered nurses, or medical crew members.
(c) The medical director may suspend temporarily, pending
due process review, any medical crew members from further participation in the
Specialty Care Transport Program when it is determined the activities or
medical care rendered by such personnel may be detrimental to the care of the
patient, constitute unprofessional conduct, or result in non-compliance with
credentialing requirements.
History Note: Authority G.S. 143‑508(b);
143-509(12);
Temporary Adoption Eff. January 1, 2002;
Eff. April 1, 2003;
Amended Eff. January 1, 2009.
10a ncac 13p .0405 REQUIREMENTS FOR adult and pediatric
TREATMENT PROTOCOLS FOR EMS SYSTEMS
(a) Treatment Protocols used in EMS Systems shall:
(1) Be adopted in their original form from the
standard adult and pediatric treatment protocols as defined in the "North
Carolina College of Emergency Physicians: Standards for Medical Oversight and
Data Collection," incorporated by reference in accordance with G.S.
150B-21.6, including subsequent amendments and editions. This document is
available from the OEMS, 2707 Mail Service Center, Raleigh, North Carolina
27699-2707, at no cost; and
(2) Not contain medical procedures,
medications, or intravenous fluids that exceed the scope of practice defined by
the North Carolina Medical Board pursuant to G.S. 143-514 for the level of care
offered in the EMS System and any other applicable health care licensing board.
(b) Individual adult and pediatric treatment protocols may
be modified locally by EMS Systems if there is a change in a specific protocol
which will optimize care within the local community which adds additional
medications or medical procedures, or rearranges the order of care provided in
the protocol contained within the "North Carolina College of Emergency
Physicians: Standards for Medical Oversight and Data Collection" as
described in Paragraph (a) of this Rule. Additional written Treatment Protocols
may be developed by any EMS System in addition to the required protocols
contained within the "North Carolina College of Emergency Physicians:
Standards for Medical Oversight and Data Collection" as required by the
EMS System. All North Carolina College of Emergency Physicians Policies and
Procedures must be included and may be modified at the local level. All EMS
System Treatment Protocols which have been added or changed by the EMS System
shall be submitted to the OEMS Medical Director for review and approval at
least 30 days prior to the implementation of the change.
History Note: Authority G.S. 143‑508(b);
143-509(12);
Temporary Adoption Eff. January 1, 2002;
Eff. April 1, 2003;
Amended Eff. January 1, 2009; January 1, 2004.
10a ncac 13p .0406 REQUIREMENTS FOR ADULT AND PEDIATRIC
TREATMENT PROTOCOLS FOR SPECIALTY CARE TRANSPORT PROGRAMS
(a) Adult and pediatric treatment protocols used by medical
crew members within a Specialty Care Transport Program shall:
(1) be approved by the OEMS Medical Director
and incorporate all skills, medications, equipment, and supplies for Specialty
Care Transport Programs as defined by the "North Carolina College of
Emergency Physicians: Standards for Medical Oversight and Data Collection,"
incorporated by reference in accordance with G.S. 150B-21.6, including
subsequent amendments and editions. This document is available from the OEMS,
2707 Mail Service Center, Raleigh, North Carolina 27699-2707, at no cost; and
(2) not contain medical procedures,
medications, or intravenous fluids that exceed the scope of practice of the
medical crew members.
(b) All adult and pediatric treatment protocols shall be
reviewed annually, and any change in the treatment protocols shall be submitted
to the OEMS Medical Director for review and approval at least 30 days prior to
the implementation of the change.
History Note: Authority G.S. 143‑508(b);
143-509(12);
Temporary Adoption Eff. January 1, 2002;
Eff. April 1, 2003;
Amended Eff. January 1, 2009; January 1, 2004.
10A NCAC 13P .0407 REQUIREMENTS FOR EMERGENCY MEDICAL
DISPATCH PRIORITY REFERENCE SYSTEM
(a) EMDPRS used by an EMD within an approved EMD program
shall:
(1) be approved by the OEMS Medical Director
and meet or exceed the statewide standard for EMDPRS as defined by the
"North Carolina College of Emergency Physicians: Standards for Medical
Oversight and Data Collection," incorporated by reference in accordance with
G.S. 150B-21.6, including subsequent amendments and editions. This document is
available from the OEMS, 2707 Mail Service Center, Raleigh, North Carolina
27699-2707, at no cost; and
(2) not exceed the EMD scope of practice
defined by the North Carolina Medical Board pursuant to G.S. 143-514.
(b) An EMDPRS developed locally shall be reviewed and
updated annually and submitted to the OEMS Medical Director for approval. Any
change in the EMDPRS shall be submitted to the OEMS Medical Director for review
and approval at least 30 days prior to the implementation of the change.
History Note: Authority G.S. 143‑508(b);
143-509(12);
Temporary Adoption Eff. January 1, 2002;
Eff. April 1, 2003;
Amended Eff. January 1, 2004.
10A NCAC 13P .0408 EMS PEER REVIEW COMMITTEE FOR EMS SYSTEMS
The EMS Peer Review Committee for an EMS System shall:
(1) be composed of membership as defined in G.S.
131E-155(6b).
(2) appoint a physician as chairperson;
(3) meet at least quarterly;
(4) use information gained from the analysis of system
data submitted to the OEMS to evaluate the ongoing quality of patient care and
medical direction within the system;
(5) use information gained from the analysis of system
data submitted to the OEMS to make recommendations regarding the content of
continuing education programs for all EMS personnel functioning within the EMS
system;
(6) review adult and pediatric treatment protocols of
the EMS System and make recommendations to the medical director for changes;
(7) establish and implement a written procedure to
guarantee due process reviews for EMS personnel temporarily suspended by the
medical director;
(8) record and maintain minutes of committee meetings
throughout the approval period of the EMS System;
(9) establish and implement EMS system performance
improvement guidelines that meet or exceed the statewide standard as defined by
the "North Carolina College of Emergency Physicians: Standards for Medical
Oversight and Data Collection," incorporated by reference in accordance
with G.S. 150B-21.6, including subsequent amendments and editions. This
document is available from the OEMS, 2707 Mail Service Center, Raleigh, North
Carolina 27699-2707, at no cost; and
(10) adopt written guidelines that address:
(a) structure of committee membership;
(b) appointment of committee officers;
(c) appointment of committee members;
(d) length of terms of committee members;
(e) frequency of attendance of committee
members;
(f) establishment of a quorum for conducting
business; and
(g) confidentiality of medical records and
personnel issues.
History Note: Authority G.S. 143‑508(b);
143-509(12);
Temporary Adoption Eff. January 1, 2002;
Eff. April 1, 2003;
Amended Eff. January 1, 2009; January 1, 2004.
10A NCAC 13P .0409 EMS Peer review COMMITTEE FOR SPECIALTY
CARE TRANSPORT PROGRAMS
The EMS Peer Review Committee for a Specialty Care Transport
Program shall:
(1) be composed of membership as defined in G.S.
131E-155(6b);
(2) appoint a physician as chairperson;
(3) meet at least quarterly;
(4) analyze program data to evaluate the ongoing
quality of patient care and medical direction within the program;
(5) use information gained from program data analysis
to make recommendations regarding the content of continuing education programs
for medical crew members;
(6) review adult and pediatric treatment protocols of
the Specialty Care Transport Programs and make recommendations to the medical
director for changes;
(7) establish and implement a written procedure to
guarantee due process reviews for medical crew members temporarily suspended by
the medical director;
(8) record and maintain minutes of committee meetings
throughout the approval period of the Specialty Care Transport Program;
(9) establish and implement EMS system performance
improvement guidelines that meet or exceed the statewide standard as defined by
the "North Carolina College of Emergency Physicians: Standards for Medical
Oversight and Data Collection," incorporated by reference in accordance
with G.S. 150B-21.6, including subsequent amendments and editions. This
document is available from the OEMS, 2707 Mail Service Center, Raleigh, North
Carolina 27699-2707, at no cost; and
(10) adopt written guidelines that address:
(a) structure of committee membership;
(b) appointment of committee officers;
(c) appointment of committee members;
(d) length of terms of committee members;
(e) frequency of attendance of committee
members;
(f) establishment of a quorum for conducting
business; and
(g) confidentiality of medical records and
personnel issues.
History Note: Authority G.S. 143‑508(b);
143-509(12);
Temporary Adoption Eff. January 1, 2002;
Eff. April 1, 2003;
Amended Eff. January 1, 2004;
Amended Eff. March 3, 2009 pursuant to E.O. 9, Beverly
Perdue, March 3, 2009;
Pursuant to G.S. 150B-21.3(c), a bill was not ratified by
the General Assembly to disapprove this rule.
SECTION .0500 – EMS PERSONNEL
10A NCAC 13P .0501 EDUCATIONAL PROGRAMS
(a) An educational program approved by the OEMS to qualify
credentialed EMS personnel to perform within their scope of practice shall be
offered by an EMS educational institution.
(b) Educational programs approved to qualify EMS personnel for credentialing shall meet the educational objectives of the:
(1) "US DOT NHTSA First Responder:
National Standard Curriculum" for MR personnel;
(2) "US DOT NHTSA EMT-Basic: National
Standard Curriculum" for EMT personnel;
(3) "US DOT NHTSA EMT-Paramedic: National
Standard Curriculum" for EMT-I and EMT-P personnel. For EMT-I personnel,
the educational objectives shall be limited to the following:
(A) Module 1: Preparatory
SECTION
TITLE
LESSON OBJECTIVES
1-1
EMS Systems / Roles & Responsibilities
1-1.1 – 1-1.46
1-2
The Well Being of the Paramedic
1-2.1 – 1-2.46
1-4
Medical / Legal Issues
1-4.1 – 1-4.35
1-5
Ethics
1-5.1 – 1-5.11
1-6
General Principles of Pathophysiology
1-6.3; 1-6.5 –1-6.9; 1-6.13 –1-6.16;
1-6.19 – 1-6.25;
1-6.27 – 1-6.31
1-7
Pharmacology
1-7.1 – 1-7.31
1-8
Venous Access / Medication Administration
1-8.1 – 1-8.8;
1-8.10 – 1-8.17;
1-8.19 – 1-8.34;
1-8.36 – 1-8.38;
1-8.40 – 1-8.43
1-9
Therapeutic Communications
1-9.1 – 1-9.21
(B) Module 2: Airway
SECTION
TITLE
LESSON OBJECTIVES
2-1
Airway
Management & Ventilation
2-1.1 – 2-1.10;
2-1.12 – 2-1.40;
2-1.42 – 2-1.64;
2-1.69;
2-1.73 – 2-1.89;
2-1.93 – 2-1.103;
2-1.104a-d;
2-1.105 – 2-1.106;
2-1.108
(C) Module 3: Patient Assessment
SECTION
TITLE
LESSON OBJECTIVES
3-2
Techniques of
Physical Examination
3-2.1 – 3-2.88
(D) Module 4: Trauma
SECTION
TITLE
LESSON OBJECTIVES
4-2
Hemorrhage and
Shock
4-2.1 – 4-2.54
4-4
Burns
4-4.25 – 4-4.30;
4-4.80 – 4-4.81
(E) Module 5: Medical
SECTION
TITLE
LESSON OBJECTIVES
5-1
Pulmonary
5-1.2 – 5-1.7;
5-1.10bcdefjk – 5-1.14
5-2
Cardiology
5-2.1 – 5-2.5;
5-2.8;
5-2.11 – 5-2.12;
5-2.14;
5-2.29 – 5-2.30;
5-2.53;
5-2.65 – 5-2.68;
5-2.70;
5-2.72 – 5-2.73;
5-2.75 – 5-2.77;
5-2.79 – 5-2.81;
5-2.84 – 5-2.89;
5-2.91 – 5-2.95;
5-2.121 – 5-2.125;
5-2.128 – 5-2.133;
5-2.150; 5-2.159;
5-2.162; 5-2.165;
5-2.168;
5-2.179 – 5-2.180;
5-2.184;
5-2.193 – 5-2.194;
5-2.201; 5-2.205ab; 5-2.206 – 5-2.207
5-3
Neurology
5-3.11 – 5-3.17;
5-3.82 – 5-3.83
5-4
Endocrinology
5-4.8 – 5-4.48
5-5
Allergies and
Anaphylaxis
5-5.1 – 5-5.19
5-8
Toxicology
5-8.40 – 5-8.56;
5-8.62
(F) Module 7: Assessment Based Management
SECTION
TITLE
LESSON OBJECTIVES
7-1
Assessment
Based Management
7-1.1 – 7-1.19 (objectives 7-1.12 and 7-1.19 include only
abefhklo)
(4) "US DOT NHTSA Emergency Medical
Dispatcher: National Standard Curriculum" for EMD personnel; and
(5) "National Guidelines for Educating EMS
Instructors" for EMS Instructors.
These documents are incorporated by reference in accordance
with G.S. 150B-21.6, including subsequent amendments and additions. These
documents are available from NHTSA, 400 7th Street, SW, Washington, D.C. 20590, at no cost.
(c) Educational programs approved to qualify EMS personnel for renewal of credentials shall follow the guidelines of the:
(1) "US DOT NHTSA First Responder
Refresher: National Standard Curriculum" for MR personnel;
(2) "US DOT NHTSA EMT-Basic Refresher:
National Standard Curriculum" for EMT personnel;
(3) "EMT-P and EMT-I Continuing Education
National Guidelines" for EMT-I and EMT-P personnel;
(4) "US
DOT NHTSA Emergency Medical Dispatcher: National Standard Curriculum" for
EMD personnel;
(5) "US
DOT NHTSA EMT-Intermediate Refresher: National Standard Curriculum" for
EMT-I personnel; and
(6) "US
DOT NHTSA EMT-Paramedic Refresher: National Standard Curriculum" for EMT-P
personnel.
These documents are incorporated by reference in accordance
with G.S. 150B-21.6, including subsequent amendments and additions. These
documents are available from NHTSA, 400 7th Street, SW, Washington, D.C. 20590, at no cost.
History Note: Authority G.S. 143-508(d)(3), (d)(4);
143-514;
Temporary Adoption Eff. January 1, 2002;
Eff. January 1, 2004;
Amended Eff. January 1, 2009.
10A NCAC 13P .0502 INITIAL CREDENTIALING REQUIREMENTS FOR
MR, EMT, EMT-I, EMT-P, AND EMD
(a) In order to be credentialed as an MR, EMT, EMT-I,
EMT-P, or EMD, individuals shall:
(1) Be at least 18 years of age.
(2) Successfully complete an approved educational
program for their level of application. If the educational program was
completed over one year prior to application, applicants shall submit evidence
of completion of continuing education during the past year. This continuing
education shall be based on the educational objectives in Rule .0501(c) of this
Section consistent with their level of application and approved by the OEMS.
(3) Successfully complete a scope of practice
performance evaluation which uses performance measures based on the cognitive,
psychomotor, and affective educational objectives in Rule .0501(b) of this
Section and which are consistent with their level of application and approved
by the OEMS. This evaluation shall be conducted under the direction of the
educational medical advisor or a Level II EMS Instructor credentialed at or
above the level of application and designated by the educational medical
advisor, and may be included within the educational program or conducted
separately. If the evaluation was completed over one year prior to application,
applicants must repeat the evaluation and submit evidence of successful
completion during the previous year.
(4) Successfully complete a written examination
administered by the OEMS or a written examination approved by OEMS as equivalent
to the examination administered by OEMS.
(b) EMD applicants shall successfully complete, within one
year prior to application, an AHA CPR course or a course determined by the OEMS
to be equivalent to the AHA CPR course, including infant, child, and adult CPR.
History Note: Authority G.S. 131E-159(a)(b);
143-508(d)(3);
Temporary Adoption Eff. January 1, 2002;
Eff. February 1, 2004;
Amended Eff. January 1, 2009.
10A NCAC 13P .0503 TERM OF CREDENTIALS FOR EMS PERSONNEL
Credentials for EMS Personnel shall be valid for a period of
four years.
History Note: Authority G.S. 131E-159 (a);
Temporary Adoption Eff. January 1, 2002;
Eff. April 1, 2003.
10A NCAC 13P .0504 RENEWAL OF CREDENTIALS FOR MR, EMT,
EMT-I, EMT-P, AND EMD
MR, EMT, EMT-I, EMT-P, and EMD applicants shall renew
credentials by presenting documentation to the OEMS that they have successfully
completed an approved educational program as described in Rule .0501(c) of this
Section.
History Note: Authority G.S. 131E-159(a); 143-508(d)(3);
Temporary Adoption Eff. January 1, 2002;
Eff. February 1, 2004;
Amended Eff. January 1, 2009.
10A NCAC 13P .0505 SCOPE OF PRACTICE FOR EMS PERSONNEL
EMS Personnel educated in approved programs, credentialed by
the OEMS, and affiliated with an approved EMS System may perform acts and
administer intravenous fluids and medications as allowed by the North Carolina
Medical Board pursuant to G.S. 143-514.
History Note: Authority G.S. 143-508(d)(6); 143-514;
Temporary Adoption Eff. January 1, 2002;
Eff. April 1, 2003.
10A NCAC 13P .0506 PRACTICE SETTINGS FOR EMS PERSONNEL
Credentialed EMS Personnel may function in the following
practice settings in accordance with the protocols approved by the medical
director of the EMS System or Specialty Care Transport Program with which they
are affiliated, and by the OEMS:
(1) at the location of a physiological or psychological
illness or injury including transportation to an appropriate treatment facility
if required;
(2) at public or community health facilities in
conjunction with public and community health initiatives;
(3) in hospitals and clinics;
(4) in residences, facilities, or other locations as
part of wellness or injury prevention initiatives within the community and the
public health system; and
(5) at mass gatherings or special events.
History Note: Authority G.S. 143-508(d)(7);
Temporary Adoption Eff. January 1, 2002;
Eff. April 1, 2003;
Amended Eff. January 1, 2004.
10A NCAC 13P .0507 CREDENTIALING REQUIREMENTS FOR LEVEL I EMS INSTRUCTORS
(a) Applicants for credentialing as a Level I EMS
Instructor shall:
(1) be currently credentialed by the OEMS as an
EMT, EMT-I, EMT-P, or EMD;
(2) have three years experience at the scope of
practice for the level of application;
(3) within one year prior to application,
successfully complete an evaluation which demonstrates the applicant's ability
to provide didactic and clinical instruction based on the cognitive,
psychomotor, and affective educational objectives in Rule .0501(b) of this
Section consistent with their level of application and approved by the OEMS:
(A) For a credential to teach at the EMT level, this
evaluation shall be conducted under the direction of a Level II EMS Instructor
credentialed at or above the level of application;
(B) For a credential to teach at the EMT-I or EMT-P
levels, this evaluation shall be conducted under the direction of the
educational medical advisor, or a Level II EMS Instructor credentialed at or
above the level of application and designated by the educational medical
advisor; and
(C) For a credential to teach at the EMD level, this
evaluation shall be conducted under the direction of the educational medical
advisor or a Level I EMS Instructor credentialed at the EMD level designated by
the educational medical advisor;
(4) have 100 hours of teaching experience in an
approved EMS educational program or an EMS educational program approved by OEMS
as equivalent to an approved program;
(5) successfully complete an educational
program as described in Rule .0501(b)(5) of this Section;
(6) within one year prior to application,
attend an OEMS Instructor workshop sponsored by the OEMS; and
(7) have a high school diploma or General
Education Development certificate.
(b) The credential of a Level I EMS Instructor shall be
valid for four years, unless any of the following occurs:
(1) the OEMS imposes an administrative action
against the instructor credential; or
(2) the instructor fails to maintain a current
EMT, EMT-I, EMT-P, or EMD credential at the highest level that the instructor
is approved to teach.
History Note: Authority G.S. 143-508(d)(3);
Temporary Adoption Eff. January 1, 2002;
Eff. February 1, 2004;
Amended Eff. January 1, 2009.
10A NCAC 13P .0508 CREDENTIALING REQUIREMENTS FOR LEVEL II
EMS INSTRUCTORS
(a) Applicants for credentialing as a Level II EMS
Instructor shall:
(1) be credentialed by the OEMS as an EMT,
EMT-I, EMT-P, or EMD;
(2) have completed post-secondary level education
equal to or exceeding an Associate Degree;
(3) within one year prior to application,
successfully complete an evaluation which demonstrates the applicant's ability
to provide didactic and clinical instruction based on the cognitive,
psychomotor, and affective educational objectives in Rule .0501(b) of this
Section consistent with their level of application and approved by the OEMS:
(A) For a credential to teach at the EMT level, this
evaluation shall be conducted under the direction of a Level II EMS Instructor
credentialed at or above the level of application; and
(B) For a credential to teach at the EMT-I or EMT-P
level, this evaluation shall be conducted under the direction of the
educational medical advisor, or a Level II EMS Instructor credentialed at or
above the level of application and designated by the educational medical
advisor;
(C) For a credential to teach at the EMD level, this
evaluation shall be conducted under the direction of the educational medical
advisor or a Level I EMS Instructor credentialed at the EMD level designated by
the educational medical advisor;
(4) have two years teaching experience as a
Level I EMS Instructor or a teaching experience approved as equivalent by the
OEMS;
(5) successfully complete the "EMS
Education Administration Course" conducted by a North Carolina Community College; and
(6) attend an OEMS Instructor workshop
sponsored by the OEMS;
(b) The credential of a Level II EMS Instructor is valid
for four years, unless any of the following occurs:
(1) The OEMS imposes an administrative action
against the instructor credential; or
(2) The instructor fails to maintain a current
EMT, EMT-I, EMT-P, or EMD credential at the highest level that the instructor
is approved to teach.
History Note: Authority G.S. 143-508(d)(3);
Temporary Adoption Eff. January 1, 2002;
Eff. February 1, 2004;
Amended Eff. January 1, 2009.
10A NCAC 13P .0509 CREDENTIALING OF INDIVIDUALS TO
ADMINISTER LIFESAVING TREATMENT TO PERSONS SUFFERING AN ADVERSE REACTION TO
AGENTS THAT MIGHT CAUSE ANAPHYLAXIS
(a) To become credentialed by the North Carolina Medical
Care Commission to administer epinephrine to persons who suffer adverse
reactions to agents that might cause anaphylaxis, a person shall meet the
following:
(1) Be 18 years of age or older; and
(2) successfully complete an educational
program taught by a physician licensed to practice medicine in North Carolina or designee of the physician. The educational program shall instruct
individuals in the appropriate use of procedures for the administration of
epinephrine to pediatric and adult victims who suffer adverse reactions to
agents that might cause anaphylaxis and shall include the following:
(A) definition of anaphylaxis;
(B) agents that might cause anaphylaxis and the
distinction between them, including drugs, insects, foods, and inhalants;
(C) recognition of symptoms of anaphylaxis for both
pediatric and adult victims;
(D) appropriate emergency treatment of anaphylaxis as a
result of agents that might cause anaphylaxis;
(E) availability and design of packages containing
equipment for administering epinephrine to victims suffering from anaphylaxis
as a result of agents that might cause anaphylaxis;
(F) pharmacology of epinephrine including indications,
contraindications, and side effects;
(G) discussion of legal implications of rendering aid;
and
(H) instruction that treatment is to be utilized only in
the absence of the availability of physicians or other practitioners who are
authorized to administer the treatment.
(b) A credential to administer epinephrine to persons who
suffer adverse reactions to agents that might cause anaphylaxis shall be issued
by the North Carolina Medical Care Commission upon receipt of a completed
application signed by the applicant and the physician who taught or was
responsible for the educational program. Applications may be obtained from the
OEMS, 2707 Mail Service Center, Raleigh, North Carolina 27699-2707. All
credentials shall be valid for a period of four years.
(c) This Rule enables only those individuals who do not
hold a North Carolina EMS credential and are not associated or affiliated with
an EMS system, EMS agency, or emergency response provider to provide care
pending arrival of the emergency responders dispatched through a 911 center to
an EMS event involving a person suffering an anaphylactic reaction.
History Note: Authority G.S. 143-508(d)(11);
143-509(9);
Temporary Adoption Eff. January 1, 2003; January 1, 2002;
Eff. April 1, 2003;
Amended Eff. January 1, 2009; February 1, 2004.
10A NCAC 13P .0510 renewal of credentials for level i and
level ii ems instructors
(a) Level I and Level II EMS Instructor applicants shall
renew credentials by presenting documentation to the OEMS that they:
(1) are credentialed by the OEMS as an EMT, EMT-I,
or EMT-P, or EMD;
(2) successfully completed, within one year
prior to application, a scope of practice performance evaluation which use
performance measures based on the cognitive, psychomotor, and affective
educational objectives in Rule .0501(b) of this Subchapter consistent with
their level of application and approved by the OEMS:
(A) To renew a credential to teach at the EMT level,
this evaluation shall be conducted under the direction of a Level II EMS Instructor
credentialed at or above the level of application;
(B) To renew a credential to teach at the EMT-I or EMT-P
level, this evaluation shall be conducted under the direction of the
educational medical advisor, or a Level II EMS Instructor credentialed at or
above the level of application and designated by the educational medical
advisor; and
(C) To renew a credential to teach at the EMD level,
this evaluation shall be conducted under the direction of the educational
medical advisor or a Level I EMS Instructor credentialed at the EMD level
designated by the educational medical advisor.
(3) completed 96 hours of EMS instruction at
the level of application; and
(4) completed 40 hours of educational
professional development as defined by the educational institution.
(b) The credential of a Level I or Level II EMS Instructor is
valid for four years, unless any of the following occurs:
(1) the OEMS imposes an administrative action
against the instructor credential; or
(2) the instructor fails to maintain a current
EMT, EMT-I, EMT-P, or EMD credential at the highest level that the instructor
is approved to teach.
History Note: Authority G.S. 131E-159(a)(b);
143-508(d)(3);
Eff. February 1, 2004;
Amended Eff. February 1, 2009.
10A NCAC 13P .0511 CRIMINAL HISTORIES
(a) The criminal background histories for all individuals
who apply for EMS credentials, seek to renew EMS credentials, or hold EMS
credentials shall be reviewed pursuant to G.S. 131E-159(g).
(b) In addition to Paragraph (a) of this Rule, the OEMS
shall carry out the following for all EMS Personnel whose primary residence is
outside North Carolina, individuals who have resided in North Carolina for 60
months or less, and individuals under investigation who may be subject to
administrative enforcement action by the Department under the provisions of
Rule .1507 of this Subchapter:
(1) obtain a signed consent form for a criminal
history check;
(2) obtain fingerprints on an SBI
identification card or live scan electronic fingerprinting system at an agency
approved by the North Carolina Department of Justice, State Bureau of
Investigation;
(3) obtain the criminal history from the
Department of Justice; and
(4) collect any processing fees from the
individual identified in Paragraph (a) or (b) as required by the Department of
Justice pursuant to G.S. 114-19.21 prior to conducting the criminal history
background check.
(c) An individual is not eligible for initial or renewal of
EMS credentials if the applicant refuses to consent to any criminal history
check as required by G.S. 131E-159(g). Since payment is required before the
fingerprints may be processed by the State Bureau of Investigation, failure of
the applicant or credentialed EMS personnel to pay the required fee in advance
shall be considered a refusal to consent for the purposes of issuance or
retention of an EMS credential.
History Note: Authority G.S. 114-19.21; 131E-159(g); 143-508(d)(3),(10);
Eff. January 1, 2009;
Amended Eff. January 1, 2013.
SECTION .0600 – EMS EDUCATIONAL INSTITUTIONS
10A NCAC 13P .0601 CONTINUING EDUCATION EMS EDUCATIONAL
INSTITUTION REQUIREMENTS
(a) Continuing Education EMS Educational Institutions shall
be credentialed by the OEMS to provide EMS continuing education programs.
(b) Continuing Education EMS Educational Institutions shall
have:
(1) at least a Level I EMS Instructor as
program coordinator. The program coordinator shall hold a Level I EMS
Instructor credential at a level equal to or greater than the highest level of
continuing education program offered in the EMS System or Specialty Care
Transport Program;
(2) a continuing education program consistent
with the EMS System or Specialty Care Transport Program continuing education
plan for EMS personnel:
(A) In an EMS System, the continuing education programs
for EMD, EMT-I, and EMT-P shall be reviewed and approved by the medical
director of the EMS System.
(B) In a Model EMS System, the continuing education
program shall be reviewed and approved by the system continuing education
coordinator and medical director.
(C) In a Specialty Care Transport Program, the
continuing education program shall be reviewed and approved by Specialty Care
Transport Program Continuing Education Coordinator and the medical director;
(3) access to instructional supplies and
equipment necessary for students to complete educational programs as defined in
Rule .0501(c) of this Subchapter;
(4) educational programs offered in accordance
with Rule .0501(c) of this Subchapter;
(5) an Educational Medical Advisor if offering
educational programs that have not been reviewed and approved by a medical
director of an EMS System or Specialty Care Transport Program. The Educational
Medical Advisor shall meet the criteria as defined in the "North Carolina
College of Emergency Physicians: Standards for Medical Oversight and Data
Collection," incorporated by reference in accordance with G.S. 150B-21.6,
including subsequent amendments and editions. This document is available from
the OEMS, 2707 Mail Service Center, Raleigh, North Carolina 27699-2707, at no
cost; and
(6) written educational policies and procedures
describing the delivery of educational programs, the record-keeping system
detailing student attendance and performance, and the selection and monitoring
of EMS instructors.
(c) An application for credentialing as a Continuing
Education EMS Educational Institution shall be submitted to the OEMS for
review. The application shall demonstrate that the applicant meets the requirements
in Paragraph (b) of this Rule.
(d) Continuing Education EMS Educational Institution
credentials are valid for a period of four years.
History Note: Authority G.S. 143-508(d)(4), (13);
Temporary Adoption Eff. January 1, 2002;
Eff. January 1, 2004;
Amended Eff. January 1, 2009.
10A NCAC 13P .0602 BASIC EMS EDUCATIONAL INSTITUTION
REQUIREMENTS
(a) Basic EMS Educational Institutions may offer MR, EMT,
and EMD courses for which they have been credentialed by the OEMS.
(b) For initial courses, Basic EMS Educational Institutions
shall have:
(1) at least a Level I EMS Instructor as lead
course instructor for MR and EMT courses. The lead course instructor must be
credentialed at a level equal to or higher than the course offered;
(2) at least a Level I EMS Instructor
credentialed at the EMD level as lead course instructor for EMD courses;
(3) a lead EMS educational program
coordinator. This individual may be either a Level II EMS Instructor
credentialed at or above the highest level of course offered by the
institution, or a combination of staff who cumulatively meet the requirements
of the Level II EMS Instructor referenced in this Subparagraph. These
individuals may share the responsibilities of the lead EMS educational
coordinator. The details of this option shall be defined in the educational
plan required in Subparagraph (b)(5) of this Rule. Basic EMS Educational
Institutions offering only EMD courses may meet this requirement with a Level I
EMS Instructor credentialed at the EMD level;
(4) an Educational Medical Advisor that meets
the criteria as defined in the "North Carolina College of Emergency
Physicians: Standards for Medical Oversight and Data Collection"
incorporated by reference in accordance with G.S. 150B-21.6, including
subsequent amendments and editions. This document is available from the OEMS,
2707 Mail Service Center, Raleigh, North Carolina 27699-2707, at no cost;
(5) written educational policies and procedures
describing the delivery of educational programs, the record-keeping system
detailing student attendance and performance; and the selection and monitoring
of EMS instructors; and
(6) access to instructional supplies and
equipment necessary for students to complete educational programs as defined in
Rule .0501(b) of this Subchapter.
(c) For EMS continuing education programs, Basic EMS
Educational Institutions shall meet the requirements defined in Paragraphs (a)
and (b) of Rule .0601 of this Section.
(d) An application for credentialing as a Basic EMS
Educational Institution shall be submitted to the OEMS for review. The
proposal shall demonstrate that the applicant meets the requirements in
Paragraphs (b) and (c) of this Rule.
(e) Basic EMS Educational Institution credentials are valid
for a period of four years.
History Note: Authority G.S. 143-508(d)(4), (13);
Temporary Adoption Eff. January 1, 2002;
Eff. January 1, 2004;
Amended Eff. January 1, 2009.
10A NCAC 13P .0603 ADVANCED EMS EDUCATIONAL INSTITUTION
REQUIREMENTS
(a) Advanced EMS Educational Institutions may offer all EMS educational programs for which they have been credentialed by the OEMS.
(b) For initial courses, Advanced EMS Educational Institutions
shall have:
(1) at least a Level I EMS Instructor as lead
course instructor for MR and EMT courses. The lead course instructor must be
credentialed at a level equal to or higher than the course offered;
(2) at least a Level I EMS Instructor credentialed
at the EMD level as lead course instructor for EMD courses;
(3) a Level II EMS Instructor as lead
instructor for EMT-I and EMT-P courses. The lead course instructor must be
credentialed at a level equal to or higher than the course offered;
(4) a lead EMS educational program
coordinator. This individual may be either a Level II EMS Instructor
credentialed at or above the highest level of course offered by the
institution, or a combination of staff who cumulatively meet the requirements
of the Level II EMS Instructor referenced in this Subparagraph. These
individuals may share the responsibilities of the lead EMS educational
coordinator. The details of this option shall be defined in the educational
plan required in Subparagraph (b)(6) of this Rule;
(5) an Educational Medical Advisor that meets
the criteria as defined in the "North Carolina College of Emergency
Physicians: Standards for Medical Oversight and Data Collection,"
incorporated by reference in accordance with G.S. 150B-21.6, including
subsequent amendments and editions. This document is available from the OEMS,
2707 Mail Service Center, Raleigh, North Carolina 27699-2707, at no cost;
(6) written educational policies and procedures
describing the delivery of educational programs, the record-keeping system
detailing student attendance and performance; and the selection and monitoring
of EMS instructors; and
(7) access to instructional supplies and
equipment necessary for students to complete educational programs as defined in
Rule .0501(b) of this Subchapter.
(c) For EMS continuing education programs, Advanced EMS
Educational Institutions shall meet the requirements defined in Paragraphs (a)
and (b) of Rule .0601 of this Section.
(d) An application for credentialing as an Advanced EMS
Educational Institution shall be submitted to the OEMS for review. The
application shall demonstrate that the applicant meets the requirements in
Paragraphs (b) and (c) of this Rule.
(e) Advanced Educational Institution credentials are valid
for a period of four years.
History Note: Authority G.S. 143-508(d)(4), (13);
Temporary Adoption Eff. January 1, 2002;
Eff. February 1, 2004;
Amended Eff. January 1, 2009.
10A NCAC 13P .0604 TRANSITION FOR APPROVED TEACHING
INSTITUTIONS
History Note: Authority G.S. 143-508(b);
Temporary Adoption Eff. January 1, 2002;
Eff. April 1, 2003;
Repealed Eff. January 1, 2004.
SECTION .0700 - ENFORCEMENT
10A NCAC 13P .0701 DENIAL, SUSPENSION, AMENDMENT OR
REVOCATION
History Note: Authority G.S. 131E-155.1(d);
131E-157(c); 131E-159(a),(f); 131E-162; 143-508(d)(10);
Temporary Adoption Eff. January 1, 2002;
Eff. January 1, 2004;
Amended Eff. January 1, 2009;
Repealed Eff. January 1, 2013.
10A NCAC 13P .0702 PROCEDURES FOR DENIAL, SUSPENSION,
AMENDMENT, OR REVOCATION
History Note: Authority G.S. 143-508(d)(10);
Temporary Adoption Eff. January 1, 2002;
Eff. April 1, 2003;
Repealed Eff. January 1, 2013.
SECTION .0800 – TRAUMA SYSTEM DEFINITIONS
10A NCAC 13P .0801 TRAUMA SYSTEM DEFINITIONS
History Note: Authority G.S. 131E-162;
Temporary Adoption Eff. January 1, 2002;
Eff. April 1, 2003;
Repealed Eff. January 1, 2009.
SECTION .0900 – TRAUMA CENTER STANDARDS AND APPROVAL
10A NCAC 13P .0901 LEVEL I TRAUMA CENTER CRITERIA
To receive designation as a Level I Trauma Center, a
hospital shall have the following:
(1) A trauma program and a trauma service that have
been operational for at least 12 months prior to application for designation;
(2) Membership in and inclusion of all trauma patient
records in the North Carolina Trauma Registry for at least 12 months prior to
submitting a Request for Proposal;
(3) A trauma medical director who is a board-certified
general surgeon. The trauma medical director must:
(a) Have a minimum of three years clinical
experience on a trauma service or trauma fellowship training;
(b) Serve on the center's trauma service;
(c) Participate in providing care to patients
with life-threatening or urgent injuries;
(d) Participate in the North Carolina Chapter of
the ACS Committee on Trauma as well as other regional and national trauma
organizations;
(e) Remain a provider in the ACS' ATLS Course
and in the provision of trauma-related instruction to other health care
personnel; and
(f) Be involved with trauma research and the
publication of results and presentations;
(4) A full-time TNC/TPM who is a registered nurse,
licensed by the North Carolina Board of Nursing;
(5) A full-time TR who has a working knowledge of
medical terminology, is able to operate a personal computer, and has the
ability to extract data from the medical record;
(6) A hospital department/division/section for general
surgery, neurological surgery, emergency medicine, anesthesiology, and
orthopaedic surgery, with designated chair or physician liaison to the trauma
program for each;
(7) Clinical capabilities in general surgery with
separate posted call schedules. One shall be for trauma, one for general surgery
and one back-up call schedule for trauma. In those instances where a physician
may simultaneously be listed on more than one schedule, there must be a defined
back-up surgeon listed on the schedule to allow the trauma surgeon to provide
care for the trauma patient. If a trauma surgeon is simultaneously on call at
more than one hospital, there shall be a defined, posted trauma surgery back-up
call schedule composed of surgeons credentialed to serve on the trauma panel;
(8) A trauma team to provide evaluation and treatment
of a trauma patient 24 hours per day that includes:
(a) An in-house trauma attending or PGY4 or
senior general surgical resident. The trauma attending participates in
therapeutic decisions and is present at all operative procedures.
(b) An emergency physician who is present in the
Emergency Department 24 hours per day who is either board-certified or prepared
in emergency medicine (by the American Board of Emergency Medicine or the
American Osteopathic Board of Emergency Medicine). Emergency physicians caring
only for pediatric patients may, as an alternative, be boarded or prepared in
pediatric emergency medicine. Emergency physicians must be board-certified within
five years after successful completion of a residency in emergency medicine and
serve as a designated member of the trauma team to ensure immediate care for
the injured patient until the arrival of the trauma surgeon;
(c) Neurosurgery specialists who are never
simultaneously on-call at another Level II or higher trauma center, who are
promptly available, if requested by the trauma team leader, unless there is
either an in-house attending neurosurgeon, a PGY2 or higher in-house
neurosurgery resident or an in-house trauma surgeon or emergency physician as
long as the institution can document management guidelines and annual
continuing medical education for neurosurgical emergencies. There must be a
specified back-up on the call schedule whenever the neurosurgeon is
simultaneously on-call at a hospital other than the trauma center;
(d) Orthopaedic surgery specialists who are
never simultaneously on-call at another Level II or higher trauma center, who
are promptly available, if requested by the trauma team leader, unless there is
either an in-house attending orthopaedic surgeon, a PGY2 or higher in-house
orthopaedic surgery resident or an in-house trauma surgeon or emergency
physician as long as the institution can document management guidelines and
annual continuing medical education for orthopaedic emergencies. There must be
a specified written back-up on the call schedule whenever the orthopaedist is
simultaneously on-call at a hospital other than the trauma center;
(e) An in-house anesthesiologist or a CA3 resident
as long as an anesthesiologist on-call is advised and promptly available if
requested by the trauma team leader; and
(f) Registered nursing personnel trained in the
care of trauma patients;
(9) A written credentialing process established by the
Department of Surgery to approve mid-level practitioners and attending general
surgeons covering the trauma service. The surgeons must have board
certification in general surgery within five years of completing residency;
(10) Neurosurgeons and orthopaedists serving the trauma
service who are board certified or eligible. Those who are eligible must be
board certified within five years after successful completion of the residency;
(11) Written protocols relating to trauma management
formulated and updated to remain current;
(12) Criteria to ensure team activation prior to arrival,
and trauma attending arrival within 15 minutes of the arrival of trauma and
burn patients that include the following conditions:
(a) Shock;
(b) Respiratory distress;
(c) Airway compromise;
(d) Unresponsiveness (GSC less than nine) with
potential for multiple injuries;
(e) Gunshot wound to neck, chest or abdomen;
(f) Patients receiving blood to maintain vital
signs; and
(g) ED physician's decision to activate;
(13) Surgical evaluation, based upon the following
criteria, by the trauma attending surgeon who is promptly available:
(a) Proximal amputations;
(b) Burns meeting institutional transfer
criteria;
(c) Vascular compromise;
(d) Crush to chest or pelvis;
(e) Two or more proximal long bone fractures;
and
(f) Spinal cord injury.
A PGY4 or higher surgical resident, a
PGY3 or higher emergency medicine resident, a nurse practitioner or physician's
assistant, who is a member of the designated surgical response team, may
initiate the evaluation;
(14) Surgical consults for patients with traumatic
injuries, at the request of the ED physician, will conducted by a member of the
trauma surgical team. Criteria for the consults include:
(a) Falls greater than 20 feet;
(b) Pedestrian struck by motor vehicle;
(c) Motor vehicle crash with:
(i) Ejection (includes motorcycle);
(ii) Rollover;
(iii) Speed greater than 40 mph; or
(iv) Death of another individual in the same
vehicle; and
(d) Extremes of age, less than five or greater
than 70 years.
A senior surgical resident may initiate
the evaluation;
(15) Clinical capabilities (promptly available if
requested by the trauma team leader, with a posted on-call schedule), that
include individuals credentialed in the following:
(a) Cardiac surgery;
(b) Critical care;
(c) Hand surgery;
(d) Microvascular/replant surgery, or if service
is not available, a transfer agreement must exist;
(e) Neurosurgery (The neurosurgeon must be
dedicated to one hospital or a back-up call schedule must be available. If
fewer than 25 emergency neurosurgical trauma operations are done in a year, and
the neurosurgeon is dedicated only to that hospital, then a published back-up
call list is not necessary);
(f) Obstetrics/gynecologic surgery;
(g) Opthalmic surgery;
(h) Oral maxillofacial surgery;
(i) Orthopaedics (dedicated to one hospital or
a back-up call schedule must be available);
(j) Pediatric surgery;
(k) Plastic surgery;
(l) Radiology;
(m) Thoracic surgery; and
(n) Urologic surgery;
(16) An Emergency Department that has:
(a) A designated physician director who is
board-certified or prepared in emergency medicine (by the American Board of
Emergency Medicine or the American Osteopathic Board of Emergency Medicine);
(b) 24-hour-per-day staffing by physicians
physically present in the ED such that:
(i) At least one physician on every shift in
the ED is either board-certified or prepared in emergency medicine (by the
American Board of Emergency Medicine or the American Osteopathic Board of
Emergency Medicine) to serve as the designated member of the trauma team to
ensure immediate care until the arrival of the trauma surgeon. Emergency
physicians caring only for pediatric patients may, as an alternative, be
boarded in pediatric emergency medicine. All emergency physicians must be board-certified
within five years after successful completion of the residency;
(ii) All remaining emergency physicians, if not
board-certified or prepared in emergency medicine as outlined in Subitem
(16)(b)(i) of this Rule, are board-certified, or eligible by the American Board
of Surgery, American Board of Family Practice, or American Board of Internal
Medicine, with each being board-certified within five years after successful
completion of a residency; and
(iii) All emergency physicians practice emergency
medicine as their primary specialty.
(c) Nursing personnel with experience in trauma
care who continually monitor the trauma patient from hospital arrival to
disposition to an intensive care unit, operating room, or patient care unit;
(d) Equipment for patients of all ages to
include:
(i) Airway control and ventilation equipment
(laryngoscopes, endotracheal tubes, bag-mask resuscitators, pocket masks, and
oxygen);
(ii) Pulse oximetry;
(iii) End-tidal carbon dioxide determination
equipment;
(iv) Suction devices;
(v) Electrocardiograph-oscilloscope-defibrillator
with internal paddles;
(vi) Apparatus to establish central venous
pressure monitoring;
(vii) Intravenous fluids and administration
devices that include large bore catheters and intraosseous infusion devices;
(viii) Sterile surgical sets for airway
control/cricothyrotomy, thoracotomy, vascular access, thoracostomy, peritoneal
lavage, and central line insertion;
(ix) Apparatus for gastric decompression;
(x) 24-hour-per-day x-ray capability;
(xi) Two-way communication equipment for
communication with the emergency transport system;
(xii) Skeletal traction devices, including
capability for cervical traction;
(xiii) Arterial catheters;
(xiv) Thermal control equipment for patients;
(xv) Thermal control equipment for blood and
fluids;
(xvi) A rapid infuser system;
(xvii) A dosing reference and measurement system to
ensure appropriate age related medical care;
(xviii) Sonography; and
(xix) A doppler;
(17) An operating suite that is immediately available 24
hours per day and has:
(a) 24-hour-per-day immediate availability of
in-house staffing;
(b) Equipment for patients of all ages that
includes:
(i) Cardiopulmonary bypass capability;
(ii) Thermal control equipment for patients;
(iii) Thermal control equipment for blood and
fluids;
(iv) 24-hour-per-day x-ray capability including
c-arm image intensifier;
(v) Endoscopes and bronchoscopes;
(vi) Craniotomy instruments;
(vii) The capability of fixation of long-bone and
pelvic fractures; and
(viii) A rapid infuser system;
(18) A postanesthetic recovery room or surgical intensive
care unit that has:
(a) 24-hour-per-day in-house staffing by
registered nurses;
(b) Equipment for patients of all ages that
includes:
(i) The capability for resuscitation and
continuous monitoring of temperature, hemodynamics, and gas exchange;
(ii) The capability for continuous monitoring of
intracranial pressure;
(iii) Pulse oximetry;
(iv) End-tidal carbon dioxide determination
capability;
(v) Thermal control equipment for patients; and
(vi) Thermal control equipment for blood and
fluids;
(19) An intensive care unit for trauma patients that has:
(a) A designated surgical director for trauma
patients;
(b) A physician on duty in the intensive care
unit 24 hours per day or immediately available from within the hospital as long
as this physician is not the sole physician on-call for the Emergency
Department;
(c) Ratio of one nurse per two patients on each
shift;
(d) Equipment for patients of all ages that includes:
(i) Airway control and ventilation equipment
(laryngoscopes, endotracheal tubes, bag-mask resuscitators, and pocket masks);
(ii) An oxygen source with concentration
controls;
(iii) A cardiac emergency cart;
(iv) A temporary transvenous pacemaker;
(v) Electrocardiograph-oscilloscope-defibrillator;
(vi) Cardiac output monitoring capability;
(vii) Electronic pressure monitoring capability;
(viii) A mechanical ventilator;
(ix) Patient weighing devices;
(x) Pulmonary function measuring devices;
(xi) Temperature control devices; and
(xii) Intracranial pressure monitoring devices.
(e) Within 30 minutes of request, the ability to
perform blood gas measurements, hematocrit level, and chest x-ray studies;
(20) Acute hemodialysis capability;
(21) Physician-directed burn center staffed by nursing
personnel trained in burn care or a transfer agreement with a burn center;
(22) Acute spinal cord management capability or transfer
agreement with a hospital capable of caring for a spinal cord injured patient;
(23) Radiological capabilities that include:
(a) 24-hour-per-day in-house radiology
technologist;
(b) 24-hour-per-day in-house computerized
tomography technologist;
(c) Sonography;
(d) Computed tomography;
(e) Angiography;
(f) Magnetic resonance imaging; and
(g) Resuscitation equipment that includes airway
management and IV therapy;
(24) Respiratory therapy services available in-house 24
hours per day;
(25) 24-hour-per-day clinical laboratory service that
must include:
(a) Analysis of blood, urine, and other body
fluids, including micro-sampling when appropriate;
(b) Blood-typing and cross-matching;
(c) Coagulation studies;
(d) Comprehensive blood bank or access to
community central blood bank with storage facilities;
(e) Blood gases and pH determination; and
(f) Microbiology;
(26) A rehabilitation service that provides:
(a) A staff trained in rehabilitation care of
critically injured patients;
(b) Functional assessment and recommendations
regarding short- and long-term rehabilitation needs within one week of the
patient's admission to the hospital or as soon as hemodynamically stable;
(c) In-house rehabilitation service or a
transfer agreement with a rehabilitation facility accredited by the Commission
on Accreditation of Rehabilitation Facilities;
(d) Physical, occupational, speech therapies,
and social services; and
(e) Substance abuse evaluation and counseling
capability;
(27) A performance improvement program, as outlined in
the North Carolina Chapter of the American College of Surgeons Committee on Trauma
document "Performance Improvement Guidelines for North Carolina Trauma
Centers," incorporated by reference in accordance with G.S. 150B-21.6,
including subsequent amendments and editions. This document is available from
the OEMS, 2707 Mail Service Center, Raleigh, North Carolina 27699-2707, at no cost. This performance improvement program must include:
(a) The state Trauma Registry whose data is
submitted to the OEMS at least weekly and includes all the center's trauma
patients as defined in Rule .0102(68) of this Subchapter who are either
diverted to an affiliated hospital, admitted to the trauma center for greater
than 24 hours from an ED or hospital, die in the ED, are DOA or are transferred
from the ED to the OR, ICU, or another hospital (including transfer to any
affiliated hospital);
(b) Morbidity and mortality reviews including
all trauma deaths;
(c) Trauma performance committee that meets at
least quarterly and includes physicians, nurses, pre-hospital personnel, and a
variety of other healthcare providers, and reviews policies, procedures, and
system issues and whose members or designee attends at least 50 percent of the
regular meetings;
(d) Multidisciplinary peer review committee that
meets at least quarterly and includes physicians from trauma, neurosurgery,
orthopaedics, emergency medicine, anesthesiology, and other specialty
physicians, as needed, specific to the case, and the trauma nurse
coordinator/program manager and whose members or designee attends at least 50
percent of the regular meetings;
(e) Identification of discretionary and
non-discretionary audit filters;
(f) Documentation and review of times and
reasons for trauma-related diversion of patients from the scene or referring
hospital;
(g) Documentation and review of response times
for trauma surgeons, neurosurgeons, anesthesiologists or airway managers, and
orthopaedists. All must demonstrate 80 percent compliance.
(h) Monitoring of trauma team notification
times;
(i) Review of pre-hospital trauma care that
includes dead-on-arrivals; and
(j) Review of times and reasons for transfer of
injured patients;
(28) An outreach program that includes:
(a) Transfer agreements to address the transfer
and receipt of trauma patients;
(b) Programs for physicians within the community
and within the referral area (that include telephone and on-site consultations)
about how to access the trauma center resources and refer patients within the
system;
(c) Development of a Regional Advisory Committee
as specified in Rule .1102 of this Subchapter;
(d) Development of regional criteria for
coordination of trauma care;
(e) Assessment of trauma system operations at
the regional level; and
(f) ATLS;
(29) A program of injury prevention and public education that
includes:
(a) Epidemiology research that includes studies
in injury control, collaboration with other institutions on research,
monitoring progress of prevention programs, and consultation with researchers
on evaluation measures;
(b) Surveillance methods that includes trauma
registry data, special Emergency Department and field collection projects;
(c) Designation of a injury prevention
coordinator; and
(d) Outreach activities, program development,
information resources, and collaboration with existing national, regional, and
state trauma programs.
(30) A trauma research program designed to produce new
knowledge applicable to the care of injured patients that includes:
(a) An identifiable institutional review board
process;
(b) Educational presentations that must include
12 education/outreach presentations offered outside the trauma center over a
three-year period; and
(c) 10 peer-reviewed publications over a
three-year period that could come from any aspect of the trauma program; and
(31) A written continuing education program for staff
physicians, nurses, allied health personnel, and community physicians that
includes:
(a) A general surgery residency program;
(b) 20 hours of Category I or II trauma-related
continuing medical education (as approved by the Accreditation Council for
Continuing Medical Education) every two years for all attending general
surgeons on the trauma service, orthopedists, and neurosurgeons, with at least 50
percent of this being external education including conferences and meetings
outside of the trauma center. Continuing education based on the reading of
content such as journals or other continuing medical education documents is not
considered education outside of the trauma center;
(c) 20 hours of Category I or II trauma-related
continuing medical education (as approved by the Accreditation Council for
Continuing Medical Education) every two years for all emergency physicians,
with at least 50 percent of this being external education including conferences
and meetings outside of the trauma center or visiting lecturers or speakers
from outside the trauma center. Continuing education based on the reading of
content such as journals or other continuing medical education documents is not
considered education outside of the trauma center;
(d) ATLS completion for general surgeons on the
trauma service and emergency physicians. Emergency physicians, if not boarded
in emergency medicine, must be current in ATLS;
(e) 20 contact hours of trauma-related
continuing education (beyond in-house in-services) every two years for the TNC/TPM;
(f) 16 hours of trauma-registry-related or
trauma-related continuing education every two years, as deemed appropriate by
the trauma nurse coordinator/program manager for the trauma registrar;
(g) At least an 80 percent compliance rate for
16 hours of trauma-related continuing education (as approved by the TNC/TPM)every
two years related to trauma care for RN's and LPN's in transport programs,
Emergency Departments, primary intensive care units, primary trauma floors, and
other areas deemed appropriate by the TNC/TPM; and
(h) 16 hours of trauma-related continuing
education every two years for mid-level practitioners routinely caring for
trauma patients.
History Note: Authority G.S. 131E-162;
Temporary Adoption Eff. January 1, 2002;
Eff. April 1, 2003;
Amended Eff. January 1, 2009; January 1, 2004.
10A NCAC 13P .0902 LEVEL II TRAUMA CENTER CRITERIA
To receive designation as a Level II Trauma Center, a
hospital shall have the following:
(1) A trauma program and a trauma service that have
been operational for at least 12 months prior to application for designation;
(2) Membership in and inclusion of all trauma patient
records in the North Carolina Trauma Registry for at least 12 months prior to
submitting a Request for Proposal;
(3) A trauma medical director who is a board-certified
general surgeon. The trauma medical director must:
(a) Have at least three years clinical
experience on a trauma service or trauma fellowship training;
(b) Serve on the center's trauma service;
(c) Participate in providing care to patients
with life-threatening urgent injuries;
(d) Participate in the North Carolina Chapter of
the ACS' Committee on Trauma as well as other regional and national trauma
organizations; and
(e) Remain a provider in the ACS' ATLS and in
the provision of trauma-related instruction to other health care personnel;
(4) A full-time trauma nurse coordinator TNC/TPM who is
a registered nurse, licensed by the North Carolina Board of Nursing;
(5) A full-time TR who has a working knowledge of
medical terminology, is able to operate a personal computer, and has the
ability to extract data from the medical record;
(6) A hospital department/division/section for general
surgery, neurological surgery, emergency medicine, anesthesiology, and
orthopedic surgery, with designated chair or physician liaison to the trauma
program for each;
(7) Clinical capabilities in general surgery with
separate posted call schedules. One shall be for trauma, one for general
surgery and one back-up call schedule for trauma. In those instances where a
physician may simultaneously be listed on more than one schedule, there must be
a defined back-up surgeon listed on the schedule to allow the trauma surgeon to
provide care for the trauma patient. If a trauma surgeon is simultaneously on
call at more than one hospital, there shall be a defined, posted trauma surgery
back-up call schedule composed of surgeons credentialed to serve on the trauma
panel;
(8) A trauma team to provide evaluation and treatment
of a trauma patient 24 hours per day that includes:
(a) A trauma attending or PGY4 or senior general
surgical resident. The trauma attending participates in therapeutic decisions
and is present at all operative procedures.
(b) An emergency physician who is present in the
Emergency Department 24 hours per day who is either board-certified or prepared
in emergency medicine (by the American Board of Emergency Medicine or the
American Osteopathic Board of Emergency Medicine) or board-certified or
eligible by the American Board of Surgery, American Board of Family Practice,
or American Board of Internal Medicine and practices emergency medicine as his
primary specialty. This emergency physician if prepared or eligible must be
board-certified within five years after successful completion of the residency
and serves as a designated member of the trauma team to ensure immediate care
for the injured patient until the arrival of the trauma surgeon;
(c) Neurosurgery specialists who are never
simultaneously on-call at another Level II or higher trauma center, who are
promptly available, if requested by the trauma team leader, as long as there is
either an in-house attending neurosurgeon; a PGY2 or higher in-house
neurosurgery resident; or in-house emergency physician or the on-call trauma
surgeon as long as the institution can document management guidelines and
annual continuing medical education for neurosurgical emergencies. There must
be a specified back-up on the call schedule whenever the neurosurgeon is
simultaneously on-call at a hospital other than the trauma center;
(d) Orthopaedic surgery specialists who are
never simultaneously on-call at another Level II or higher trauma center, who
are promptly available, if requested by the trauma team leader, as long as
there is either an in-house attending orthopaedic surgeon; a PGY2 or higher
in-house orthopaedic surgery resident; or in-house emergency physician or the
on-call trauma surgeon as long as the institution can document management
guidelines and annual continuing medical education for orthopaedic emergencies.
There must be a specified back-up on the call schedule whenever the orthopaedic
surgeon is simultaneously on-call at a hospital other than the trauma center;
and
(e) An in-house anesthesiologist or a CA3 resident
unless an anesthesiologist on-call is advised and promptly available after
notification or an in-house CRNA under physician supervision, practicing in
accordance with G.S. 90-171.20(7)e, pending the arrival of the
anesthesiologist;
(9) A credentialing process established by the
Department of Surgery to approve mid-level practitioners and attending general
surgeons covering the trauma service. The surgeons must have board
certification in general surgery within five years of completing residency;
(10) Neurosurgeons and orthopaedists serving the trauma
service who are board certified or eligible. Those who are eligible must be
board certified within five years after successful completion of the residency;
(11) Written protocols relating to trauma care management
formulated and updated to remain current;
(12) Criteria to ensure team activation prior to arrival,
and attending arrival within 20 minutes of the arrival of trauma and burn
patients that include the following conditions:
(a) Shock;
(b) Respiratory distress;
(c) Airway compromise;
(d) Unresponsiveness (GCS less than nine with
potential for multiple injuries;
(e) Gunshot wound to neck, chest or abdomen;
(f) Patients receiving blood to maintain vital
signs; and
(g) ED physician's decision to activate;
(13) Surgical evaluation, based upon the following
criteria, by the health professional who is promptly available:
(a) Proximal amputations;
(b) Burns meeting institutional transfer
criteria;
(c) Vascular compromise;
(d) Crush to chest or pelvis;
(e) Two or more proximal long bone fractures;
and
(f) Spinal cord injury;
(14) Surgical consults, based upon the following
criteria, by the health professional who is promptly available:
(a) Falls greater than 20 feet;
(b) Pedestrian struck by motor vehicle;
(c) Motor vehicle crash with:
(i) Ejection (includes motorcycle);
(ii) Rollover;
(iii) Speed greater than 40 mph; or
(iv) Death of another individual in the same
vehicle; or
(d) Extremes of age, less than five or greater
than 70 years;
(15) Clinical capabilities (promptly available if
requested by the trauma team leader, with a posted on-call schedule), that
include individuals credentialed in the following:
(a) Critical care;
(b) Hand surgery;
(c) Neurosurgery (The neurosurgeon must be
dedicated to one hospital or a back-up call schedule must be available. If
fewer than 25 emergency neurosurgical trauma operations are done in a year, and
the neurosurgeon is dedicated only to that hospital, then a published back-up
call list is not necessary.);
(d) Obstetrics/gynecologic surgery;
(e) Opthalmic surgery;
(f) Oral maxillofacial surgery;
(g) Orthopaedics (dedicated to one hospital or a
back-up call schedule must be available);
(h) Plastic surgery;
(i) Radiology;
(j) Thoracic surgery; and
(k) Urologic surgery;
(16) An Emergency Department that has:
(a) A physician director who is board-certified
or prepared in emergency medicine (by the American Board of Emergency Medicine
or the American Osteopathic Board of Emergency Medicine);
(b) 24-hour-per-day staffing by physicians
physically present in the Emergency Department who:
(i) Are either board-certified or prepared in
emergency medicine (by the American Board of Emergency Medicine or the American
Osteopathic Board of Emergency Medicine or board-certified or eligible by the
American Board of Surgery, American Board of Family Practice, or American Board
of Internal Medicine). These emergency physicians must be board-certified
within five years after successful completion of a residency;
(ii) Are hospital designated members of the
trauma team; and
(iii) Practice emergency medicine as their
primary specialty;
(c) Nursing personnel with experience in trauma
care who continually monitor the trauma patient from hospital arrival to
disposition to an intensive care unit, operating room, or patient care unit;
(d) Equipment for patients of all ages that
includes:
(i) Airway control and ventilation equipment
(laryngoscopes, endotracheal tubes, bag-mask resuscitators, pocket masks, and
oxygen);
(ii) Pulse oximetry;
(iii) End-tidal carbon dioxide determination
equipment;
(iv) Suction devices;
(v) An
electrocardiograph-oscilloscope-defibrillator with internal paddles;
(vi) An apparatus to establish central venous
pressure monitoring;
(vii) Intravenous fluids and administration
devices that include large bore catheters and intraosseous infusion devices;
(viii) Sterile surgical sets for airway
control/cricothyrotomy, thoracotomy, vascular access, thoracostomy, peritoneal
lavage, and central line insertion;
(ix) An apparatus for gastric decompression;
(x) 24-hour-per-day x-ray capability;
(xi) Two-way communication equipment for
communication with the emergency transport system;
(xii) Skeletal traction devices, including
capability for cervical traction;
(xiii) Arterial catheters;
(xiv) Thermal control equipment for patients;
(xv) Thermal control equipment for blood and
fluids;
(xvi) A rapid infuser system;
(xvii) A dosing reference and measurement system to
ensure appropriate age related medical care;
(xviii) Sonography; and
(xix) A Doppler;
(17) An operating suite that is immediately available 24
hours per day and has:
(a) 24-hour-per-day immediate availability of
in-house staffing;
(b) Equipment for patients of all ages that
includes:
(i) Thermal control equipment for patients;
(ii) Thermal control equipment for blood and fluids;
(iii) 24-hour-per-day x-ray capability, including
c-arm image intensifier;
(iv) Endoscopes and bronchoscopes;
(v) Craniotomy instruments;
(vi) The capability of fixation of long-bone and
pelvic fractures; and
(vii) A rapid infuser system;
(18) A postanesthetic recovery room or surgical intensive
care unit that has:
(a) 24-hour-per-day in-house staffing by
registered nurses;
(b) Equipment for patients of all ages to
include:
(i) Capability for resuscitation and continuous
monitoring of temperature, hemodynamics, and gas exchange;
(ii) Capability for continuous monitoring of
intracranial pressure;
(iii) Pulse oximetry;
(iv) End-tidal carbon dioxide determination
capability;
(v) Thermal control equipment for patients; and
(vi) Thermal control equipment for blood and
fluids;
(19) An intensive care unit for trauma patients that has:
(a) A hospital designated surgical director of
trauma patients;
(b) A physician on duty in the intensive care
unit 24 hours per day or immediately available from within the hospital as long
as this physician is not the sole physician on-call for the Emergency
Department;
(c) Ratio of one nurse per two patients on each
shift;
(d) Equipment for patients of all ages that
includes:
(i) Airway control and ventilation equipment
(laryngoscopes, endotracheal tubes, bag-mask resuscitators, and pocket masks);
(ii) An oxygen source with concentration
controls;
(iii) A cardiac emergency cart;
(iv) A temporary transvenous pacemaker;
(v) Electrocardiograph-oscilloscope-defibrillator;
(vi) Cardiac output monitoring capability;
(vii) Electronic pressure monitoring capability;
(viii) A mechanical ventilator;
(ix) Patient weighing devices;
(x) Pulmonary function measuring devices;
(xi) Temperature control devices; and
(xii) Intracranial pressure monitoring devices;
and
(e) Within 30 minutes of request, the ability to
perform blood gas measurements, hematocrit level, and chest x-ray studies;
(20) Acute hemodialysis capability or utilization of a
transfer agreement;
(21) Physician-directed burn center staffed by nursing
personnel trained in burn care or a transfer agreement with a burn center;
(22) Acute spinal cord management capability or transfer
agreement with a hospital capable of caring for a spinal cord injured patient;
(23) Radiological capabilities that include:
(a) 24-hour-per-day in-house radiology
technologist;
(b) 24-hour-per-day in-house computerized
tomography technologist;
(c) Sonography;
(d) Computed tomography;
(e) Angiography; and
(f) Resuscitation equipment that includes airway
management and IV therapy;
(24) Respiratory therapy services available in-house 24
hours per day;
(25) 24-hour-per-day clinical laboratory service that
must include:
(a) Analysis of blood, urine, and other body
fluids, including micro-sampling when appropriate;
(b) Blood-typing and cross-matching;
(c) Coagulation studies;
(d) Comprehensive blood bank or access to a
community central blood bank with storage facilities;
(e) Blood gases and pH determination; and
(f) Microbiology;
(26) A rehabilitation service that provides:
(a) A staff trained in rehabilitation care of
critically injured patients;
(b) For trauma patients, functional assessment
and recommendation regarding short- and long-term rehabilitation needs within
one week of the patient's admission to the hospital or as soon as
hemodynamically stable;
(c) In-house rehabilitation service or a
transfer agreement with a rehabilitation facility accredited by the Commission
on Accreditation of Rehabilitation Facilities;
(d) Physical, occupational, speech therapies,
and social services; and
(e) Substance abuse evaluation and counseling
capability;
(27) A performance improvement program, as outlined in
the North Carolina Chapter of the American College of Surgeons Committee on
Trauma document "Performance Improvement Guidelines for North Carolina
Trauma Centers," incorporated by reference in accordance with G.S.
150B-21.6, including subsequent amendments and editions. This document is
available from the OEMS, 2707 Mail Service Center, Raleigh, North Carolina 27699-2707, at no cost. This performance improvement program must include:
(a) The state Trauma Registry whose data is
submitted to the OEMS at least weekly and includes all the center's trauma
patients as defined in Rule .0102(68) of this Subchapter who are either
diverted to an affiliated hospital, admitted to the trauma center for greater
than 24 hours from an ED or hospital, die in the ED, are DOA or are transferred
from the ED to the OR, ICU, or another hospital (including transfer to any
affiliated hospital);
(b) Morbidity and mortality reviews that include
all trauma deaths;
(c) Trauma performance committee that meets at
least quarterly and includes physicians, nurses, pre-hospital personnel, and a
variety of other healthcare providers, and reviews policies, procedures, and
system issues and whose members or designee attends at least 50 percent of the
regular meetings;
(d) Multidisciplinary peer review committee that
meets at least quarterly and includes physicians from trauma, neurosurgery,
orthopaedics, emergency medicine, anesthesiology, and other specialty
physicians, as needed, specific to the case, and the TNC/TPM and whose members
or designee attends at least 50 percent of the regular meetings;
(e) Identification of discretionary and
non-discretionary audit filters;
(f) Documentation and review of times and
reasons for trauma-related diversion of patients from the scene or referring
hospital;
(g) Documentation and review of response times
for trauma surgeons, neurosurgeons, anesthesiologists or airway managers, and
orthopaedists. All must demonstrate 80 percent compliance;
(h) Monitoring of trauma team notification
times;
(i) Review of pre-hospital trauma care to
include dead-on-arrivals; and
(j) Review of times and reasons for transfer of
injured patients;
(28) An outreach program that includes:
(a) Transfer agreements to address the transfer
and receipt of trauma patients;
(b) Programs for physicians within the community
and within the referral area (that include telephone and on-site consultations)
about how to access the trauma center resources and refer patients within the
system;
(c) Development of a Regional Advisory Committee
as specified in Rule .1102 of this Subchapter;
(d) Development of regional criteria for
coordination of trauma care; and
(e) Assessment of trauma system operations at
the regional level;
(29) A program of injury prevention and public education that
includes:
(a) Designation of an injury prevention
coordinator; and
(b) Outreach activities, program development,
information resources, and collaboration with existing national, regional, and
state trauma programs; and
(30) A written continuing education program for staff physicians,
nurses, allied health personnel, and community physicians that includes:
(a) 20 hours of Category I or II trauma-related
continuing medical education (as approved by the Accreditation Council for
Continuing Medical Education) every two years for all attending general
surgeons on the trauma service, orthopaedics, and neurosurgeons, with at least
50 percent of this being external education including conferences and meetings
outside of the trauma center or visiting lecturers or speakers from outside the
trauma center. Continuing education based on the reading of content such as
journals or other continuing medical education documents is not considered
education outside of the trauma center;
(b) 20 hours of Category I or II trauma-related
continuing medical education (as approved by the Accreditation Council for
Continuing Medical Education) every two years for all emergency physicians,
with at least 50 percent of this being external education including
conferences and meetings outside of the trauma center or visiting lecturers or
speakers from outside the trauma center. Continuing education based on the
reading of content such as journals or other continuing medical education
documents is not considered education outside of the trauma center;
(c) ATLS completion for general surgeons on the
trauma service and emergency physicians. Emergency physicians, if not boarded
in emergency medicine, must be current in ATLS.
(d) 20 contact hours of trauma-related
continuing education (beyond in-house in-services) every two years for the TNC/TPM;
(e) 16 hours of trauma-registry-related or
trauma-related continuing education every two years, as deemed appropriate by
the TNC/TPM, for the trauma registrar;
(f) at least 80 percent compliance rate for 16
hours of trauma-related continuing education (as approved by the TNC/TPM)every
two years related to trauma care for RN's and LPN's in transport programs,
Emergency Departments, primary intensive care units, primary trauma floors, and
other areas deemed appropriate by the trauma nurse coordinator/program manager;
and
(g) 16 contact hours of trauma-related
continuing education every two years for mid-level practitioners routinely
caring for trauma patients.
History Note: Authority G.S. 131E-162;
Temporary Adoption Eff. January 1, 2002;
Eff. April 1, 2003;
Amended Eff. January 1, 2009; January 1, 2004.
10A NCAC 13P .0903 LEVEL III TRAUMA CENTER CRITERIA
To receive designation as a Level III Trauma Center, a hospital shall have the following:
(1) A trauma program and a trauma service that have
been operational for at least 12 months prior to application for designation;
(2) Membership in and inclusion of all trauma patient
records in the North Carolina Trauma Registry for at least 12 months prior to
submitting a Request for Proposal application;
(3) A trauma medical director who is a board-certified
general surgeon. The trauma medical director must:
(a) Serve on the center's trauma service;
(b) Participate in providing care to patients
with life-threatening or urgent injuries;
(c) Participate in the North Carolina Chapter of
the ACS' Committee on Trauma; and
(d) Remain a provider in the ACS' ATLS Course in
the provision of trauma-related instruction to other health care personnel;
(4) A hospital designated trauma nurse coordinator
TNC/TPM who is a registered nurse, licensed by the North Carolina Board of Nursing;
(5) A TR who has a working knowledge of medical
terminology, is able to operate a personal computer, and has the ability to
extract data from the medical record;
(6) A hospital department/division/section for general
surgery, emergency medicine, anesthesiology, and orthopaedic surgery, with
designated chair or physician liaison to the trauma program for each;
(7) Clinical capabilities in general surgery with a
written posted call schedule that indicates who is on call for both trauma and
general surgery. If a trauma surgeon is simultaneously on call at more than one
hospital, there must be a defined, posted trauma surgery back-up call schedule
composed of surgeons credentialed to serve on the trauma panel. The trauma
service director shall specify, in writing, the specific credentials that each
back-up surgeon must have. These must state that the back-up surgeon has
surgical privileges at the trauma center and is boarded or eligible in general
surgery (with board certification in general surgery within five years of
completing residency);
(8) Response of a trauma team to provide evaluation and
treatment of a trauma patient 24 hours per day that includes:
(a) A trauma attending whose presence at the
patient's bedside within 30 minutes of notification is documented and who
participates in therapeutic decisions and is present at all operative
procedures;
(b) An emergency physician who is present in the
ED 24 hours per day who is either board-certified or prepared in emergency
medicine (by the American Board of Emergency Medicine or the American
Osteopathic Board of Emergency Medicine) or board-certified or eligible by the
American Board of Surgery, American Board of Family Practice, or American Board
of Internal Medicine and practices emergency medicine as his primary specialty.
This emergency physician if prepared or eligible must be board-certified within
five years after successful completion of the residency and serve as a hospital
designated member of the trauma team to ensure immediate care for the trauma
patient until the arrival of the trauma surgeon; and
(c) An anesthesiologist who is on-call and
promptly available after notification by the trauma team leader or an in-house
CRNA under physician supervision, practicing in accordance with G.S. 90-171.20(7)e,
pending the arrival of the anesthesiologist within 30 minutes of notification;
(9) A credentialing process established by the
Department of Surgery to approve mid-level practitioners and attending general
surgeons covering the trauma service. The surgeons must have board certification
in general surgery within five years of completing residency;
(10) Board certification or eligibility of orthopaedists
and neurosurgeons (if participating),with board certification within five years
after successful completion of residency;
(11) Written protocols relating to trauma care management
formulated and updated. Activation guidelines shall reflect criteria that
ensures patients receive timely and appropriate treatment including
stabilization, intervention and transfer. Documentation of effectiveness of
variances from activation criteria addressed in Items (12), (13), and (14) of
this Rule must be available for review;
(12) Criteria to ensure team activation prior to arrival
of trauma and burn patients that include the following conditions:
(a) Shock;
(b) Respiratory distress;
(c) Airway compromise;
(d) Unresponsiveness (GSC less than nine) with
evidence for multiple injuries;
(e) Gunshot wound to neck, or torso; or
(f) ED physician's decision to activate;
(13) Trauma Treatment Guidelines based on facility
capabilities that ensure surgical evaluation or appropriate transfer, based
upon the following criteria, by the health professional who is promptly
available:
(a) Proximal amputations;
(b) Burns meeting institutional transfer
criteria;
(c) Vascular compromise;
(d) Crush to chest or pelvis;
(e) Two or more proximal long bone fractures;
(f) Spinal cord injury; and
(g) Gunshot wound to the head;
(14) Surgical consults or appropriate transfers
determined by Trauma Treatment Guidelines based on facility capabilities, based
upon the following criteria, by the health professional who is promptly
available:
(a) Falls greater than 20 feet;
(b) Pedestrian struck by motor vehicle;
(c) Motor vehicle crash with:
(i) Ejection (includes motorcycle);
(ii) Rollover;
(iii) Speed greater than 40 mph; or
(iv) Death of another individual in the same
vehicle; and
(d) Extremes of age, less than five or greater
than 70 years;
(15) Clinical capabilities (promptly available if
requested by the trauma team leader, with a posted on-call schedule) that
include individuals credentialed in the following:
(a) Orthopaedics;
(b) Radiology; and
(c) Neurosurgery, if actively participating in
the acute resuscitation and operative management of patients managed by the
trauma team;
(16) An Emergency Department that has:
(a) A physician director who is board-certified
or prepared in emergency medicine (by the American Board of Emergency Medicine
or the American Osteopathic Board of Emergency Medicine);
(b) 24-hour-per-day staffing by physicians
physically present in the Emergency Department who:
(i) Are either board-certified or prepared in
emergency medicine (by the American Board of Emergency Medicine or the American
Osteopathic Board of Emergency Medicine) or board-certified or eligible by the
American Board of Surgery, American Board of Family Practice, or American Board
of Internal Medicine. These emergency physicians must be board-certified within
five years after successful completion of a residency;
(ii) Are designated members of the trauma team
to ensure immediate care to the trauma patient; and
(iii) Practice emergency medicine as their primary
specialty;
(c) Nursing personnel with experience in trauma
care who continually monitor the trauma patient from hospital arrival to
disposition to an intensive care unit, operating room, or patient care unit;
(d) Resuscitation equipment for patients of all
ages that includes:
(i) Airway control and ventilation equipment
(laryngoscopes, endotracheal tubes, bag-mask resuscitators, pocket masks, and
oxygen);
(ii) Pulse oximetry;
(iii) End-tidal carbon dioxide determination
equipment;
(iv) Suction devices;
(v) An
Electrocardiograph-oscilloscope-defibrillator with internal paddles;
(vi) Apparatus to establish central venous
pressure monitoring;
(vii) Intravenous fluids and administration
devices that include large bore catheters and intraosseous infusion devices;
(viii) Sterile surgical sets for airway
control/cricothyrotomy, thoracotomy, vascular access, thoracostomy, peritoneal
lavage, and central line insertion;
(ix) Apparatus for gastric decompression;
(x) 24-hour-per-day x-ray capability;
(xi) Two-way communication equipment for
communication with the emergency transport system;
(xii) Skeletal traction devices;
(xiii) Thermal control equipment for patients;
(xiv) Thermal control equipment for blood and
fluids;
(xv) A rapid infuser system;
(xvi) A dosing reference and measurement system to
ensure appropriate age related medical care; and
(xvii) A Doppler;
(17) An operating suite that has:
(a) Personnel available 24 hours a day, on-call,
and available within 30 minutes of notification unless in-house;
(b) Age-specific equipment that includes:
(i) Thermal control equipment for patients;
(ii) Thermal control equipment for blood and
fluids;
(iii) 24-hour-per-day x-ray capability, including
c-arm image intensifier;
(iv) Endoscopes and bronchoscopes;
(v) Equipment for long bone and pelvic fracture
fixation; and
(vi) A rapid infuser system;
(18) A postanesthetic recovery room or surgical intensive
care unit that has:
(a) 24-hour-per-day availability of registered
nurses within 30 minutes from inside or outside the hospital;
(b) Equipment for patients of all ages that
includes:
(i) The capability for resuscitation and
continuous monitoring of temperature, hemodynamics, and gas exchange;
(ii) Pulse oximetry;
(iii) End-tidal carbon dioxide determination;
(iv) Thermal control equipment for patients; and
(v) Thermal control equipment for blood and
fluids;
(19) An intensive care unit for trauma patients that has:
(a) A trauma surgeon who actively participates
in the committee overseeing the ICU;
(b) A physician on duty in the intensive care
unit 24-hours-per-day or immediately available from within the hospital (which
may be a physician who is the sole physician on-call for the ED);
(c) Equipment for patients of all ages that
includes:
(i) Airway control and ventilation equipment
(laryngoscopes, endotracheal tubes, bag-mask resuscitators and pocket masks);
(ii) An oxygen source with concentration
controls;
(iii) A cardiac emergency cart;
(iv) A temporary transvenous pacemaker;
(v) An
electrocardiograph-oscilloscope-defibrillator;
(vi) Cardiac output monitoring capability;
(vii) Electronic pressure monitoring capability;
(viii) A mechanical ventilator;
(ix) Patient weighing devices;
(x) Pulmonary function measuring devices; and
(xi) Temperature control devices; and
(d) Within 30 minutes of request, the ability to
perform blood gas measurements, hematocrit level, and chest x-ray studies;
(20) Acute hemodialysis capability or utilization of a
written transfer agreement;
(21) Physician-directed burn center staffed by nursing
personnel trained in burn care or a written transfer agreement with a burn
center;
(22) Acute spinal cord management capability or transfer
agreement with a hospital capable of caring for a spinal cord injured patient;
(23) Acute head injury management capability or transfer
agreement with a hospital capable of caring for a head injury;
(24) Radiological capabilities that include:
(a) Radiology technologist and computer
tomography technologist available within 30 minutes of notification or
documentation that procedures are available within 30 minutes;
(b) Computed Tomography;
(c) Sonography; and
(d) Resuscitation equipment that includes airway
management and IV therapy;
(25) Respiratory therapy services on-call 24 hours per
day;
(26) 24-hour-per-day clinical laboratory service that
must include:
(a) Analysis of blood, urine, and other body
fluids, including micro-sampling when appropriate;
(b) Blood-typing and cross-matching;
(c) Coagulation studies;
(d) Comprehensive blood bank or access to a
community central blood bank with storage facilities;
(e) Blood gases and pH determination; and
(f) Microbiology;
(27) In-house rehabilitation service or transfer
agreement with a rehabilitation facility accredited by the Commission on
Accreditation of Rehabilitation Facilities;
(28) Physical therapy and social services;
(29) A performance improvement program, as outlined in
the North Carolina Chapter of the American College of Surgeons Committee on
Trauma document "Performance Improvement Guidelines for North Carolina
Trauma Centers," incorporated by reference in accordance with G.S.
150B-21.6, including subsequent amendments and editions. This document is
available from the OEMS, 2707 Mail Service Center, Raleigh, North Carolina 27699-2707, at no cost. This performance improvement program must include:
(a) The state Trauma Registry whose data is
submitted to the OEMS at least weekly and includes all the center's trauma
patients as defined in Rule .0102(68) of this Subchapter who are either
diverted to an affiliated hospital, admitted to the trauma center for greater
than 24 hours from an ED or hospital, die in the ED, are DOA or are transferred
from the ED to the OR, ICU, or another hospital (including transfer to any
affiliated hospital);
(b) Morbidity and mortality reviews including
all trauma deaths;
(c) Trauma performance committee that meets at
least quarterly and includes physicians, orthopaedics and neurosurgery if
participating in trauma service, nurses, pre-hospital personnel, and a variety
of other healthcare providers, and reviews policies, procedures, and system
issues and whose members or designee attends at least 50 percent of the regular
meetings;
(d) Multidisciplinary peer review committee that
meets at least quarterly and includes physicians from trauma, emergency
medicine, and other specialty physicians as needed specific to the case, and
the trauma nurse coordinator/program manager and whose members or designee
attends at least 50 percent of the regular meetings;
(e) Identification of discretionary and
non-discretionary audit filters;
(f) Documentation and review of times and
reasons for trauma-related diversion of patients from the scene or referring
hospital;
(g) Documentation and review of response times
for trauma surgeons, airway managers, and orthopaedists. All must demonstrate 80
percent compliance;
(h) Monitoring of trauma team notification
times;
(i) Documentation (unless in-house) and review
of Emergency Department response times for anesthesiologists or airway managers
and computerized tomography technologist;
(j) Documentation of availability of the surgeon
on-call for trauma, such that compliance is 90 percent or greater where there
is no trauma surgeon back-up call schedule;
(k) Trauma performance and multidisciplinary
peer review committees may be incorporated together or included in other staff
meetings as appropriate for the facility performance improvement rules;
(l) Review of pre-hospital trauma care including
dead-on-arrivals; and
(m) Review of times and reasons for transfer of
injured patients;
(30) An outreach program that includes:
(a) Transfer agreements to address the transfer
and receipt of trauma patients; and
(b) Participation in a RAC;
(31) Coordination or participation in community
prevention activities; and
(32) A written continuing education program for staff
physicians, nurses, allied health personnel, and community physicians that
includes:
(a) 20 hours of Category I or II trauma-related
continuing medical education (as approved by the Accreditation Council for
Continuing Medical Education) every two years for all attending general
surgeons on the trauma service, orthopaedists, and neurosurgeons if
participating in trauma service, with at least 50 percent of this being
external education including conferences and meetings outside of the trauma
center or visiting lecturers or speakers from outside the trauma center.
Continuing education based on the reading of content such as journals or other
continuing medical education documents is not considered education outside of
the trauma center;
(b) 20 hours of Category I or II trauma-related
continuing medical education (as approved by the Accreditation Council for
Continuing Medical Education)every two years for all emergency physicians, with
at least 50 percent of this being external education including conferences and
meetings outside of the trauma center or visiting lecturers or speakers from
outside the trauma center. Continuing education based on the reading of content
such as journals or other continuing medical education documents is not
considered education outside of the trauma center;
(c) ATLS completion for general surgeons on the
trauma service and emergency physicians. Emergency physicians, if not boarded
in emergency medicine, must be current in ATLS;
(d) 20 contact hours of trauma-related
continuing education (beyond in-house in- services) every two years for the TNC/TPM;
(e) 16 hours of trauma-registry-related or
trauma-related continuing education every two years, as deemed appropriate by
the TNC/TPM, for the trauma registrar;
(f) At least an 80 percent compliance rate for
16 hours of trauma-related continuing education (as approved by the trauma
nurse coordinator/program manager) every two years related to trauma care for
RN's and LPN's in transport programs, Emergency Departments, primary intensive
care units, primary trauma floors, and other areas deemed appropriate by the
trauma nurse coordinator/program manager; and
(g) 16 hours of trauma-related continuing
education every two years for mid-level practitioners routinely caring for
trauma patients.
History Note: Authority G.S. 131E-162;
Temporary Adoption Eff. January 1, 2002;
Eff. April 1, 2003;
Amended Eff. January 1, 2009; January 1, 2004.
10A NCAC 13P .0904 INITIAL DESIGNATION PROCESS
(a) For initial Trauma Center designation, the hospital
shall request a consult visit by OEMS and have the consult within one year
prior to submission of the RFP.
(b) A hospital interested in pursuing Trauma Center designation shall submit a letter of intent 180 days prior to the submission of an RFP
to the OEMS. The letter shall define the hospital's primary trauma catchment
area. Simultaneously, Level I or II applicants shall also demonstrate the need
for the Trauma Center designation by submitting one original and three copies
of documents that include:
(1) The population to be served and the extent
to which the population is underserved for trauma care with the methodology
used to reach this conclusion;
(2) Geographic considerations to include trauma
primary and secondary catchment area and distance from other Trauma Centers; and
(3) Evidence the Trauma Center will admit at
least 1200 trauma patients yearly or show that its trauma service will be taking
care of at least 240 trauma patients with an Injury Severity Score (ISS)
greater than or equal to 15 yearly. This criteria shall be met without
compromising the quality of care or cost effectiveness of any other designated
Level I or II Trauma Center sharing all or part of its catchment area or by
jeopardizing the existing Trauma Center's ability to meet this same 240-patient
minimum.
(c) The hospital must be actively participating in the
state Trauma Registry and submit data to the OEMS at least weekly and include all
the Trauma Center's trauma patients as defined in Rule .0102(68) of this
Subchapter who are either diverted to an affiliated hospital, admitted to the
Trauma Center for greater than 24 hours from an ED or hospital, die in the ED,
are DOA or are transferred from the ED to the OR, ICU, or another hospital
(including transfer to any affiliated hospital) a minimum of 12 months prior to
application.
(d) OEMS shall review the regional Trauma Registry data,
from both the applicant and the existing trauma center(s), and ascertain the
applicant's ability to satisfy the justification of need information required
in Subparagraphs (b)(1) through (3) of this Rule. Simultaneously, the
applicant's primary RAC shall be notified by the OEMS of the application and be
provided the regional data as required in Subparagraphs (b)(1) through (3) of
this Rule submitted by the applicant for review and comment. The RAC shall be
given a minimum of 30 days to submit any concerns in writing for OEMS'
consideration. If no comments are received, OEMS shall proceed.
(e) OEMS shall notify the hospital in writing of its
decision to allow submission of an RFP. The RAC shall also be notified by the
OEMS so that any necessary changes in protocols can be considered.
(f) OEMS shall notify the respective Board of County
Commissioners in the applicant's trauma primary catchment area of the request
for initial designation to allow for comment.
(g) Hospitals desiring to be considered for initial trauma
center designation shall complete and submit one paper copy with signatures and
an electronic copy of the RFP to the OEMS at least 90 days prior to the
proposed site visit date.
(h) For Level I, II, and III applicants, the RFP shall
demonstrate that the hospital meets the standards for the designation level
applied for as found in Rules .0901, .0902, or .0903 of this Section.
(i) If OEMS does not recommend a site visit based upon
failure to comply with Rules .0901, .0902, or .0903, the reasons shall be
forwarded to the hospital in writing within 30 days of the decision. The
hospital may reapply for designation within six months following the submission
of an updated RFP. If the hospital fails to respond within six months, the
hospital shall reapply following the process outlined in Paragraphs (a) through
(h) of this Rule.
(j) If the OEMS recommends the hospital for a site visit,
the OEMS shall notify the hospital within 30 days and the site visit shall be
conducted within six months of the recommendation. The site visit date shall be
mutually agreeable to the hospital and the OEMS.
(k) Any in-state reviewer for a Level I or II visit (except
the OEMS representatives) shall be from outside the planning region in which
the hospital is located. The composition of a Level I or II state site survey
team shall be as follows:
(1) One out-of-state Fellow of the ACS,
experienced as a site surveyor, who shall be designated the primary reviewer;
(2) One emergency physician who works in a
trauma center, is a member of the American College of Emergency Physicians, and
is boarded in emergency medicine (by the American Board of Emergency Medicine
or the American Osteopathic Board of Emergency Medicine);
(3) One in-state trauma surgeon who is a member
of the North Carolina Committee on Trauma;
(4) One out-of-state trauma nurse
coordinator/program manager and one in-state trauma nurse coordinator/program
manager; and
(5) OEMS Staff.
(l) All site team members for a Level III visit shall be
from in-state, and all (except for the OEMS representatives) shall be from
outside the planning region in which the hospital is located. The composition
of a Level III state site survey team shall be as follows:
(1) One Fellow of the ACS, who is a member of
the North Carolina Committee on Trauma and shall be designated the primary
reviewer;
(2) One emergency physician who currently works
in a designated trauma center, is a member of the North Carolina College of
Emergency Physicians, and is boarded in emergency medicine (by the American
Board of Emergency Medicine or the American Osteopathic Board of Emergency
Medicine);
(3) A trauma nurse coordinator/program manager;
and
(4) OEMS Staff.
(m) On the day of the site visit the hospital shall make
available all requested patient medical charts.
(n) The lead researcher of the site review team shall give
a verbal post-conference report representing a consensus of the site review
team at the summary conference. A written consensus report shall be completed,
to include a peer review report, by the primary reviewer and submitted to OEMS
within 30 days of the site visit.
(o) The report of the site survey team and the staff
recommendations shall be reviewed by the State Emergency Medical Services
Advisory Council at its next regularly scheduled meeting which is more than 45
days following the site visit. Based upon the site visit report and the staff
recommendation, the State Emergency Medical Services Advisory Council shall
recommend to the OEMS that the request for Trauma Center designation be
approved or denied.
(p) All criteria defined in Rule .0901, .0902, or .0903 of
this Section shall be met for initial designation at the level requested.
Initial designation shall not be granted if deficiencies exist.
(q) Hospitals with a deficiency(ies) shall be given up to
12 months to demonstrate compliance. Satisfaction of deficiency(ies) may
require an additional site visit. If compliance is not demonstrated within the
time period, to be defined by OEMS, the hospital shall submit a new application
and updated RFP and follow the process outlined in Paragraphs (a) through (h) of
this Rule.
(r) The final decision regarding Trauma Center designation shall be rendered by the OEMS.
(s) The OEMS shall notify the hospital in writing, of the
State Emergency Medical Services Advisory Council's and OEMS' final
recommendation within 30 days of the Advisory Council meeting.
(t) If a trauma center changes its trauma program
administrative structure (such that the trauma service, trauma medical
director, trauma nurse coordinator/program manager or trauma registrar are
relocated on the hospital's organizational chart) at any time, it shall notify
OEMS of this change in writing within 30 days of the occurrence.
(u) Initial designation as a trauma center is valid for a
period of three years.
History Note: Authority G.S. 131E-162; 143-509(3);
Temporary Adoption Eff. January 1, 2002;
Eff. April 1, 2003;
Amended Eff. January 1, 2009.
10A NCAC 13P .0905 RENEWAL DESIGNATION PROCESS
(a) Hospitals may utilize one of two options to achieve Trauma Center renewal:
(1) Undergo a site visit conducted by OEMS to
obtain a four-year renewal designation; or
(2) Undergo a verification visit arranged by
the ACS, in conjunction with OEMS, to obtain a four-year renewal designation.
(b) For hospitals choosing Subparagraph (a)(1) of this
Rule:
(1) Prior to the end of the designation period,
the OEMS shall forward to the hospital an RFP for completion. The hospital
shall, within 10 days of receipt of the RFP, define for OEMS the Trauma Center's trauma primary catchment area. Upon this notification, OEMS shall notify
the respective Board of County Commissioners in the applicant's trauma primary
catchment area of the request for renewal to allow for comment.
(2) Hospitals shall complete and submit one
paper copy and an electronic copy of the RFP to the OEMS and the specified site
surveyors at least 30 days prior to the site visit. The RFP shall include
information that supports compliance with the criteria contained in Rule .0901,
.0902, or .0903 of this Section as it relates to the Trauma Center's level of designation.
(3) All criteria defined in Rule .0901, .0902,
or .0903 of this Section, as relates to the Trauma Center's level of
designation, shall be met for renewal designation.
(4) A site visit shall be conducted within 120
days prior to the end of the designation period. The site visit shall be
scheduled on a date mutually agreeable to the hospital and the OEMS.
(5) The composition of a Level I or II site
survey team shall be the same as that specified in Rule .0904(k) of this
Section.
(6) The composition of a Level III site survey
team shall be the same as that specified in Rule .0904(l) of this Section.
(7) On the day of the site visit the hospital
shall make available all requested patient medical charts.
(8) The primary reviewer of the site review
team shall give a verbal post-conference report representing a consensus of the
site review team at the summary conference. A written consensus report shall
be completed, to include a peer review report, by the primary reviewer and
submitted to OEMS within 30 days of the site visit.
(9) The report of the site survey team and a
staff recommendation shall be reviewed by the State Emergency Medical Services
Advisory Council at its next regularly scheduled meeting which is more than 30
days following the site visit. Based upon the site visit report and the staff
recommendation, the State Emergency Medical Services Advisory Council shall
recommend to the OEMS that the request for Trauma Center renewal be approved;
approved with a contingency(ies) due to a deficiency(ies) requiring a focused
review; approved with a contingency(ies) not due to a deficiency(ies) requiring
a consultative visit; or denied.
(10) Hospitals with a deficiency(ies) have up to
10 working days prior to the State EMS Advisory Council meeting to provide
documentation to demonstrate compliance. If the hospital has a deficiency that
cannot be corrected in this period prior to the State EMS Advisory Council
meeting, the hospital, instead of a four-year renewal, shall be given 12 months
by the OEMS to demonstrate compliance and undergo a focused review, that may
require an additional site visit. The hospital shall retain its Trauma Center designation during the focused review period. If compliance is demonstrated
within the prescribed time period, the hospital shall be granted its
designation for the four-year period from the previous designation's expiration
date. If compliance is not demonstrated within the time period, as specified by
OEMS, the Trauma Center designation shall not be renewed. To become
redesignated, the hospital shall submit an updated RFP and follow the initial
applicant process outlined in Rule .0904 of this Section.
(11) The final decision regarding trauma center
renewal shall be rendered by the OEMS.
(12) The OEMS shall notify the hospital of the
State Emergency Medical Services Advisory Council's and OEMS' final
recommendation within 30 days of the Advisory Council meeting.
(13) The four-year renewal date that may be
eventually granted shall not be extended due to the focused review period.
(c) For hospitals choosing Subparagraph (a)(2) of this
Rule:
(1) At least six months prior to the end of the
Trauma Center's designation period, the trauma center must notify the OEMS of
its intent to undergo an ACS verification visit. It must simultaneously define
in writing to the OEMS its trauma primary catchment area. Trauma Centers
choosing this option must then comply with all the ACS' verification
procedures, as well as any additional state criteria as outlined in Rule .0901,
.0902, or .0903, as apply to their level of designation.
(2) When completing the ACS' documentation for
verification, the Trauma Center must ensure access to the ACS on-line PRQ
(pre-review questionnaire) to OEMS. The Trauma Center must simultaneously
complete documents supplied by OEMS to verify compliance with additional North Carolina criteria (i.e., criteria that exceed the ACS criteria) and forward these to
OEMS and the ACS.
(3) The OEMS shall notify the Board of County
Commissioners within the trauma center's trauma primary catchment area of the Trauma Center's request for renewal to allow for comments.
(4) The Trauma Center must make sure the site
visit is scheduled to ensure that the ACS' final written report, accompanying
medical record reviews and cover letter are received by OEMS at least 30 days
prior to a regularly scheduled State Emergency Medical Services Advisory
Council meeting to ensure that the Trauma Center's state designation period
does not terminate without consideration by the State Emergency Medical
Services Advisory Council.
(5) The composition of the Level I or Level II
site team must be as specified in Rule .0904(k) of this Section, except that
both the required trauma surgeons and the emergency physician may be from
out-of-state. Neither North Carolina Committee on Trauma nor North Carolina
College of Emergency Physician membership is required of the surgeons or
emergency physician, respectively, if from out-of-state. The date, time, and
all proposed site team members of the site visit team must be submitted to the
OEMS for review at least 45 days prior to the site visit. The OEMS shall
approve the site visit schedule if the schedule does not conflict with the
ability of attendance by required OEMS staff. The OEMS shall approve the
proposed site team members if the OEMS determines there is no conflict of interest,
such as previous employment, by any site team member associated with the site
visit.
(6) The composition of the Level III site team
must be as specified in Rule .0904(l) of this Section, except that the trauma
surgeon, emergency physician, and trauma nurse coordinator/program manager may
be from out-of-state. Neither North Carolina Committee on Trauma nor North
Carolina College of Emergency Physician membership is required of the surgeon
or emergency physician, respectively, if from out-of-state. The date, time,
and all proposed site team members of the site visit team must be submitted to
the OEMS for review at least 45 days prior to the site visit. The OEMS shall
approve the site visit schedule if the schedule does not conflict with the
ability of attendance by required OEMS staff. The OEMS shall approve the
proposed site team members if the OEMS determines there is no conflict of
interest, such as previous employment, by any site team member associated with
the site visit.
(7) All state Trauma Center criteria must be
met as defined in Rules .0901, .0902, and .0903 of this Section, for renewal of
state designation. An ACS' verification is not required for state designation.
An ACS' verification does not ensure a state designation.
(8) ACS reviewers shall complete the state
designation preliminary reporting form immediately prior to the post conference
meeting. This document and the ACS final written report and supporting
documentation described in Subparagraph (c)(4) of this Rule shall be used to
generate a staff summary of findings report following the post conference
meeting for presentation to the NC EMS Advisory Council for redesignation.
(9) The final written report issued by the ACS'
verification review committee, the accompanying medical record reviews (from
which all identifiers may be removed), and cover letter must be forwarded to
OEMS within 10 working days of its receipt by the Trauma Center seeking
renewal.
(10) The OEMS shall present its summary of
findings report to the State Emergency Medical Services Advisory Council at its
next regularly scheduled meeting. The State EMS Advisory Council shall
recommend to the Chief of the OEMS that the request for Trauma Center renewal be approved; approved with a contingency(ies) due to a deficiency(ies) requiring
a focused review; approved with a contingency(ies) not due to a
deficiency(ies); or denied.
(11) The OEMS shall notify the hospital in
writing of the State Emergency Medical Services Advisory Council's and OEMS'
final recommendation within 30 days of the Advisory Council meeting.
(12) Hospitals with contingencies, as the result
of a deficiency(ies), as determined by OEMS, have up to 10 working days prior
to the State EMS Advisory Council meeting to provide documentation to demonstrate
compliance. If the hospital has a deficiency that cannot be corrected in this
time period prior to the State EMS Advisory Council meeting, the hospital,
instead of a four-year renewal, may undergo a focused review (to be conducted
by the OEMS) whereby the Trauma Center is given 12 months by the OEMS to
demonstrate compliance. Satisfaction of contingency(ies) may require an
additional site visit. The hospital shall retain its Trauma Center designation during the focused review period. If compliance is demonstrated within the
prescribed time period, the hospital shall be granted its designation for the
four-year period from the previous designation's expiration date. If
compliance is not demonstrated within the time period, as specified by OEMS,
the Trauma Center designation shall not be renewed. To become redesignated,
the hospital shall submit a new RFP and follow the initial applicant process
outlined in Rule .0904 of this Section.
(d) If a Trauma Center currently using the ACS'
verification process chooses not to renew using this process, it must notify
the OEMS at least six months prior to the end of its state trauma center
designation period of its intention to exercise the option in Subparagraph
(a)(1) of this Rule.
History Note: Authority G.S. 131E-162; 143-509(3);
Temporary Adoption Eff. January 1, 2002;
Eff. April 1, 2003;
Amended Eff. April 1, 2009; January 1, 2009; January 1,
2004.
SECTION .1000 – TRAUMA CENTER DESIGNATION ENFORCEMENT
10A NCAC 13P .1001 DENIAL, FOCUSED REVIEW, VOLUNTARY
WITHDRAWAL, OR REVOCATION OF TRAUMA CENTER DESIGNATION
10A NCAC 13P .1002 PROCEDURES FOR APPEAL OF DENIAL,
FOCUSED REVIEW, OR REVOCATION
History Note: Authority G.S. 131E-162;
Temporary Adoption Eff. January 1, 2002;
Eff. April 1, 2003;
Repealed Eff. January 1, 2009.
10A NCAC 13P .1003 MISREPRESENTATION OF DESIGNATION
(a) Hospitals shall not represent themselves as trauma
centers unless they are currently designated by the Department pursuant to
Section .0900 of this Subchapter.
(b) Designation applies only to the hospital that submitted
the RFP and underwent the formal site survey and does not extend to its
satellite facilities or affiliates.
History Note: Authority G.S. 131E-162;
Temporary Adoption Eff. January 1, 2002;
Eff. April 1, 2003.
SECTION .1100 – TRAUMA SYSTEM DESIGN
10A NCAC 13P .1101 STATE TRAUMA SYSTEM
(a) The state trauma system consists of regional plans,
policies, guidelines and performance improvement initiatives by the RACs to
create an Inclusive Trauma System monitored by the OEMS.
(b) Each hospital and EMS System shall affiliate as defined
in Rule .0102(4) of this Subchapter and participate with the RAC that includes
the Level I or II Trauma Center in which the majority of trauma patient
referrals and transports occur. Each hospital and EMS System shall submit to
the OEMS patient transfer patterns from data sources that support the choice of
their primary RAC affiliation. Each RAC shall include at least one Level I or
II Trauma Center.
(c) The OEMS shall notify each RAC of its hospital and EMS
System membership.
(d) Each hospital and each EMS System must update and
submit its RAC affiliation information to the OEMS no later than July 1 of each
year. RAC affiliation may only be changed during this annual update and only if
supported by a change in transfer patterns. Documentation detailing these new
transfer patterns must be included in the request to change affiliation.
History Note: Authority G.S. 131E-162;
Temporary Adoption Eff. January 1, 2002;
Eff. April 1, 2003;
Amended Eff. January 1, 2009.
10A NCAC 13P .1102 REGIONAL TRAUMA SYSTEM PLAN
(a) A Level I or II Trauma Center shall facilitate
development of and provide RAC staff support that includes the following:
(1) The trauma medical director(s) from the
lead RAC agency;
(2) Trauma nurse coordinator(s) or program
manager(s) from the lead RAC agency; and
(3) An individual to coordinate RAC activities.
(b) The RAC membership shall include the following:
(1) The trauma medical director(s) and the
trauma nurse coordinator(s) or program manager(s) from the lead RAC agency;
(2) If on staff, an outreach coordinator(s),
injury prevention coordinator(s) or designee(s), as well as a RAC registrar or
designee(s) from the lead RAC agency;
(3) A senior level hospital administrator;
(4) An emergency physician;
(5) A representative from each EMS system participating in the RAC;
(6) A representative from each hospital
participating in the RAC;
(7) Community representatives; and
(8) An EMS System physician involved in medical
oversight.
(c) The RAC shall develop and submit a plan within one year
of notification of the RAC membership, or for existing RACs within six months
of the implementation date of this rule, to the OEMS containing:
(1) Organizational structure to include the
roles of the members of the system;
(2) Goals and objectives to include the
orientation of the providers to the regional system;
(3) RAC membership list, rules of order, terms
of office, meeting schedule (held at a minimum of two times per year);
(4) Copies of documents and information
required by the OEMS as defined in Rule .1103 of this Section;
(5) System evaluation tools to be utilized;
(6) Written documentation of regional support
for the plan; and
(7) Performance improvement activities to
include utilization of patient care data.
(d) The RAC shall submit to the OEMS an annual progress
report no later than July 1 of each year that assesses compliance with the
regional trauma system plan and specifies any updates to the plan.
(e) Upon OEMS' receipt of a letter of intent for initial
Level I or II Trauma Center designation pursuant to Rule .0904(b) of this
Subchapter, the applicant's RAC shall be provided the applicant's data from
OEMS to review and comment.
(f) The RAC has 30 days to comment on the request for
initial designation.
(g) The OEMS shall notify the RAC of the OEMS approval to
submit an RFP so that necessary changes in protocols can be considered.
History Note: Authority G.S. 131E-162;
Temporary Adoption Eff. January 1, 2002;
Eff. April 1, 2003;
Amended Eff. January 1, 2009.
10A NCAC 13P .1103 REGIONAL TRAUMA SYSTEM POLICY
DEVELOPMENT
The RAC shall oversee the development, implementation, and
evaluation of the regional trauma system that includes:
(1) A public information and education program to
include system access and injury prevention;
(2) Written trauma system guidelines addressing the
following:
(a) Regional communications;
(b) Triage;
(c) Treatment at the accident scene, and in the pre-hospital,
inter-hospital, and Emergency Department to include guidelines to facilitate
the rapid assessment and initial resuscitation of the severely injured patient.
Criteria addressing management during transport shall include continued
assessment and management of airway, cervical spine, breathing, circulation,
neurologic and secondary parameters, communication, and documentation;
(d) Transport to determine the appropriate mode
of transport and level of care required to transport, considering patient
condition, requirement for trauma center resources, family requests, and
capability of transferring entity;
(e) Bypass procedures that define:
(i) circumstances and criteria for bypass
decisions;
(ii) time and distance criteria; and
(iii) mode of transport which bypasses closer
facilities; and
(f) Accident scene and inter-hospital diversion
procedures that include delineation of specific factors such as hospital census
or acuity, physician availability, staffing issues, disaster status, or
transportation which would require routing of a patient to another hospital or
Trauma Center;
(3) Transfer agreements (including those with other
hospitals, as well as specialty care facilities such as burn, pediatrics,
spinal cord, and rehabilitation) which shall outline mutual understandings
between facilities to transfer/accept certain patients. These shall specify
responsible parties, documentation requirements, and minimum care requirements;
and
(4) A performance improvement plan that includes:
(a) A regional trauma peer review committee of
the RAC:
(i) whose membership and responsibilities are
defined in G.S. 131E-162; and
(ii) that continuously evaluates the regional
trauma system through structured review of process of care and outcomes; and
(b) Utilization of patient care data.
History Note: Authority G.S. 131E-162;
Temporary Adoption Eff. January 1, 2002;
Eff. April 1, 2003;
Amended Eff. January 1, 2009; January 1, 2004.
SECTION .1200 - TRAUMA SYSTEM DESIGN
10A NCAC 13P .1201 STATE TRAUMA SYSTEM PLAN
10A NCAC 13P .1202 regional trauma system plan
10A NCAC 13P .1203 regional trauma system policy
development
History Note: Authority G.S. 131E-162;
Eff. August 1, 1998;
Repealed Eff. January 1, 2004.
SECTION .1300 - FORMS
10A ncac 13P .1301 SOURCE OF FORMS AND DOCUMENTS
History Note: Authority G.S. 131E-162;
Eff. August 1, 1998;
Repealed Eff. January 1, 2004.
SECTION 1400 – RECOVERY AND REHABILITATION OF CHEMICALLY
DEPENDENT EMS PERSONNEL
10A NCAC 13P .1401 chemical addiction or abuse treatment
program requirements
(a) The OEMS shall provide a treatment program for aiding
in the recovery and rehabilitation of EMS personnel subject to disciplinary
action for being unable to perform as credentialed EMS personnel with
reasonable skill and safety to patients and the public by reason of use of
alcohol, drugs, chemicals, or any other type of material and who are recommended
by the EMS Disciplinary Committee pursuant to G.S. 143-519.
(b) This program requires:
(1) an initial assessment by a healthcare
professional specialized in chemical dependency affiliated with the treatment
program;
(2) a treatment plan developed for the
individual using the findings of the initial assessment;
(3) random body fluid screenings;
(4) the individual attend three self-help
recovery meetings each week for the first year of participation, and two each
week for the remainder of participation in the treatment program;
(5) monitoring of the individual for compliance
with the treatment program; and
(6) written progress reports available for
review by the EMS Disciplinary Committee:
(A) upon completion of the initial assessment by the treatment
program;
(B) upon request by the EMS Disciplinary Committee
throughout the individual's participation in the treatment program;
(C) upon completion of the treatment program;
(D) of all body fluid screenings showing chain of
custody;
(E) by the therapist or counselor assigned to the
individual during the course of the treatment program; and
(F) listing attendance at self-help recovery meetings.
History Note: Authority G.S. 131E-159(f);
143-508(d)(10); 143-509(13); 143-519;
Eff. October 1, 2010.
10A NCAC 13P .1402 provisions for participation in the
chemical addiction or abuse treatment program
Individuals recommended by the EMS Disciplinary Committee to
enter the Treatment Program defined in Rule .1401 of this Section may
participate if:
(1) the individual acknowledges, in writing,
the actions which violated the performance requirements found in this
Subchapter;
(2) the individual has not been charged or
convicted of diverting chemicals for the purpose of sale or distribution or
dealing or selling illicit drugs;
(3) the individual is not under investigation
or subject to pending criminal charges by law enforcement;
(4) the individual ceases in the direct
delivery of any patient care and surrenders all EMS credentials until either
the individual is eligible for issuance of an encumbered EMS credential
pursuant to Rule .1403 of this Section, or has successfully completed the
treatment program established in Rule .1401 of this Section; and
(5) the individual agrees to accept
responsibility for all costs including assessment, treatment, monitoring, and
body fluid screening.
History Note: Authority G.S. 131E-159(f);
143-508(d)(10); 143-509(13); 143-519;
Eff. October 1, 2010.
10A NCAC 13P .1403 conditions for restricted practice with
limited privileges
(a) Individuals who have surrendered their EMS credential
as a condition of entry into the treatment program may be reviewed by the EMS
Disciplinary Committee to determine if a recommendation to the OEMS for
issuance of an encumbered EMS credential is warranted.
(b) In order to obtain an encumbered credential with
limited privileges, an individual must:
(1) be compliant for a minimum of 90
consecutive days with the treatment program described in Paragraph (b) of Rule
.1402 of this Section;
(2) be recommended in writing for review by the
individual's treatment counselor;
(3) be interviewed by the EMS Disciplinary
Committee; and
(4) be recommended in writing by the EMS
Disciplinary Committee for issuance of an encumbered EMS credential. The EMS
Disciplinary Committee shall detail in their recommendation to the OEMS all
restrictions and limitations to the individual's practice privileges.
(c) The individual must agree to sign a consent agreement
with the OEMS which details the practice restrictions and privilege limitations
of the encumbered EMS credential, and which contains the consequences of
failure to abide by the terms of this agreement.
(d) The individual shall be issued the encumbered
credential within 10 business days following execution of the consent agreement
described in Paragraph (c).
History Note: Authority G.S. 131E-159(f); 143-508(d)(10);
143-509(13); 143-519;
Eff. October 1, 2010.
10A NCAC 13P .1404 Reinstatement of an unencumbered ems credential
Reinstatement of an unencumbered EMS credential is dependant
upon the individual successfully completing all requirements of the treatment
program as defined in this Section.
History Note: Authority G.S. 131E-159(f); 143-508(d)(10);
143-509(13);
Eff. October 1, 2010.
10A NCAC 13P .1405 failure to COMPLETE The chemical
addiction or abuse treatment program
Individuals who fail to complete the treatment program, upon
review and recommendation by the North Carolina EMS Disciplinary Committee to
the OEMS, are subject to revocation of their EMS credential.
History Note: Authority G.S. 131E-159(f);
143-508(d)(10); 143-519;
Eff. October 1, 2010.
SECTION .1500 - DENIAL, SUSPENSION, AMENDMENT, OR REVOCATION
10A NCAC 13P .1501 ENFORCEMENT DEFINITIONS
Notwithstanding Section .0100 of this Subchapter, for the
purpose of this Section, the following definitions apply to Rules .1502, .1503,
.1504, and .1506 for EMS Systems, Licensed EMS Providers, Specialty Care
Transport Programs, and EMS Educational Institutions:
(1) "Contingencies" mean conditions placed on
an initial or renewal designation, approval or license that, if unmet, can
result in the loss or amendment of the designation, approval, or license.
(2) "Deficiency" means the failure to meet
essential criteria for credentialing, approval, or licensing as specified in
Sections .0200, .0300 or .0600 of this Subchapter that can serve as the basis
for a focused review or denial of a designation, approval or license.
(3) "Essential Criteria" means those items
listed in Sections .0200, .0300 or .0600 of this Subchapter that are the
minimum requirements for the respective application for initial or renewal
designation, approval, or licensing.
(4) "Focused Review" means an evaluation by
the OEMS of a regulated entity's corrective actions to remove contingencies
that are a result of deficiencies placed upon it following review of an
application for renewal.
History Note: Authority G.S. 131E-155(13a);
143-508(b),(d)(1),(d)(4),(d)(13);
Eff. January 1, 2013.
10A NCAC 13P .1502 LICENSED EMS PROVIDERS
(a) The Department shall amend any EMS Provider license by
reducing it from a full license to a provisional license whenever the
Department finds that:
(1) the licensee failed to comply with the
provisions of G.S. 131E, Article 7, and the rules adopted under that article;
(2) there is a reasonable probability that the
licensee can remedy the licensure deficiencies within a reasonable length of
time; and
(3) there is a reasonable probability that the
licensee will be able thereafter to remain in compliance with the licensure
rules for the foreseeable future.
(b) The Department shall give the licensee written notice
of the amendment of the EMS Provider license. This notice shall be given
personally or by certified mail and shall set forth:
(1) the length of the provisional EMS Provider
license;
(2) the factual allegations;
(3) the statutes or rules alleged to be
violated; and
(4) notice of the EMS provider's right to a
contested case hearing on the amendment of the EMS Provider license.
(c) The provisional EMS Provider license is effective
immediately upon its receipt by the licensee and shall be posted in a location
at the primary business location of the EMS Provider, accessible to public
view, in lieu of the full license. The provisional license remains in effect
until the Department:
(1) restores the licensee to full licensure
status; or
(2) revokes the licensee's license.
(d) The Department shall revoke or suspend an EMS Provider
license whenever the Department finds that the licensee:
(1) failed to comply with the provisions of
G.S. 131E, Article 7, and the rules adopted under that article and it is not
reasonably probable that the licensee can remedy the licensure deficiencies
within 12 months or less;
(2) failed to comply with the provisions of
G.S. 131E, Article 7, and the rules adopted under that Article and, although
the licensee may be able to remedy the deficiencies, it is not reasonably
probable that the licensee will be able to remain in compliance with licensure
rules for the foreseeable future;
(3) failed to comply with the provision of G.S.
131E, Article 7, and the rules adopted under that article that endanger the
health, safety or welfare of the patients cared for or transported by the
licensee;
(4) obtained or attempted to obtain an
ambulance permit, EMS nontransporting vehicle permit, or EMS Provider license
through fraud or misrepresentation;
(5) repeated deficiencies placed on the EMS
Provider License in previous compliance site visits;
(6) failed to provide emergency medical care
within the defined EMS service area in a timely manner as determined by the EMS
System;
(7) altered, destroyed, attempted to destroy,
withheld or delayed release of evidence, records, or documents needed for a
complaint investigation; or
(8) continues to operate within an EMS System
after a Board of County Commissioners has terminated its affiliation with the
licensee.
(e) The issuance of a provisional EMS Provider license is
not a procedural prerequisite to the revocation or suspension of a license
pursuant to Paragraph (d) of this Rule.
History Note: Authority G.S. 131E-155.1(d);
143-508(d)(10);
Eff. January 1, 2013.
10A NCAC 13P .1503 SPECIALTY CARE TRANSPORT PROGRAMS
(a) The Department shall deny the initial or renewal
approval, without first allowing a focused review, of a SCTP for any of the following
reasons:
(1) failure to comply with the provisions of
G.S.131E, Article 7 and the rules adopted under that Article;
(2) obtaining or attempting to obtain approval
through fraud or misrepresentation;
(3) endangerment to the health, safety, or welfare
of patients cared for by the SCTP; or
(4) repeated deficiencies placed on the program
in previous site visits.
(b) When an SCTP is required to have a focused review, it
must demonstrate compliance with the provisions of G.S. 131E, Article 7 and the
rules adopted under that Article within 12 months or less.
(c) The Department shall revoke an SCTP approval at any
time or deny a request for renewal of approval whenever the Department finds
that the SCTP failed to comply with the provisions of G.S.131E, Article 7 and
the rules adopted under that Article; and
(1) it is not probable that the SCTP can remedy
the deficiencies within 12 months or less;
(2) although the SCTP may be able to remedy the
deficiencies, it is not probable that the SCTP shall be able to remain in
compliance with designation rules for the foreseeable future;
(3) the SCTP fails to meet the requirements of
a focused review;
(4) endangerment to the health, safety, or
welfare of patients cared for or transported by the SCTP;
(5) fails to provide SCTP services within the
defined service area in a timely manner as determined by the Department;
(6) continues to operate within an EMS System
after a Board of County Commissioners has terminated its affiliation with the
SCTP; or
(7) alters, destroys or attempts to destroy
evidence needed for a complaint investigation.
(d) The Department shall give the SCTP written notice of
revocation. This notice shall be given personally or by certified mail and
shall set forth:
(1) the factual allegations;
(2) the statutes or rules alleged to be
violated; and
(3) notice of the program's right to a
contested case hearing on the revocation of the approval.
(e) Focused review is not a procedural prerequisite to the
revocation of an approval pursuant to Paragraph (c) of this Rule.
History Note: Authority 143-508(d)(10), (d)(13);
Eff. January 1, 2013.
10A NCAC 13P .1504 TRAUMA CENTERS
(a) The Department shall deny the initial or renewal
designation, without first allowing a focused review, of a trauma center for
any of the following reasons:
(1) failure to comply with G.S. 131E-162 and
the rules adopted under that Statute;
(2) obtaining or attempting to obtain a trauma
center designation through fraud or misrepresentation;
(3) endangerment to the health, safety, or
welfare of patients cared for in the hospital; or
(4) repeated deficiencies placed on the trauma
center in previous site visits.
(b) When a trauma center is required to have a focused
review, it must demonstrate compliance with the provisions of G.S. 131E-162 and
the rules adopted under that Statute within 12 months or less.
(c) The Department shall revoke a trauma center designation
at any time or deny a request for renewal of designation, whenever the
Department finds that the trauma center has failed to comply with the
provisions of G.S. 131E-162 and the rules adopted under that Statute; and
(1) it is not probable that the trauma center
can remedy the deficiencies within 12 months or less;
(2) although the trauma center may be able to
remedy the deficiencies it is not probable that the trauma center shall be able
to remain in compliance with designation rules for the foreseeable future;
(3) the trauma center failed to meet the
requirements of a focused review;
(4) failure to comply endangers the health,
safety, or welfare of patients cared for in the trauma center; or
(5) the trauma center altered, destroyed or
attempted to destroy evidence needed for a complaint investigation.
(d) The Department shall give the trauma center written
notice of revocation. This notice shall be given personally or by certified
mail and shall set forth:
(1) the factual allegations;
(2) the statutes or rules alleged to be
violated; and
(3) notice of the hospital's right to a
contested case hearing on the revocation of the designation.
(e) Focused review is not a procedural prerequisite to the
revocation of a designation pursuant to Paragraph (c) of this Rule.
(f) A trauma center may voluntarily withdraw its
designation for a maximum of one year by submitting a written request to the
Department. This request shall include the reasons for withdrawal and a plan
for resolution of the issues. To reactivate the designation, the facility shall
provide to the Department written documentation of compliance. Voluntary
withdrawal does not affect the original expiration date of the trauma center's
designation.
(g) If the trauma center fails to resolve the issues which
resulted in a voluntary withdrawal within one year, the Department shall revoke
the trauma center designation.
(h) In the event of a revocation or voluntary withdrawal,
the Department shall provide written notification to all hospitals and
emergency medical services providers within the trauma center's defined trauma
primary catchment area. The Department shall provide written notification to
all hospitals and emergency medical services providers within the trauma
center's defined trauma primary catchment area if, and when, the voluntary
withdrawal reactivates to full designation.
History Note: Authority G.S. 131E-162; 143-508(d)(10);
Eff. January 1, 2013.
10A NCAC 13P .1505 EMS EDUCATIONAL INSTITUTIONS
(a) The Department shall deny the initial or renewal
credential, without first allowing a focused review, of an EMS Educational Institution
for any of the following reasons:
(1) failure to comply with the provisions of
Section .0600 of this Subchapter;
(2) attempting to obtain an EMS Educational
Institution designation through fraud or misrepresentation;
(3) endangerment to the health, safety, or
welfare of patients cared by students of the EMS Educational Institution; or
(4) repetition of deficiencies placed on the
EMS Educational Institution in previous compliance site visits.
(b) When an EMS Educational Institution is required to have
a focused review, it must demonstrate compliance with the provisions of Section
.0600 of this Subchapter within 12 months or less.
(c) The Department will revoke an EMS Educational
Institution credential at any time or deny a request for renewal of credential,
whenever the Department finds that the EMS Educational Institution has failed
to comply with the provisions of Section .0600 of this Subchapter; and:
(1) it is not probable that the EMS Educational
Institution can remedy the deficiencies within 12 months or less;
(2) although the EMS Educational Institution
may be able to remedy the deficiencies, it is not probable that the EMS
Educational Institution shall be able to remain in compliance with
credentialing rules for the foreseeable future;
(3) the EMS Educational Institution failed to
meet the requirements of a focused review;
(4) the failure to comply endangered the
health, safety, or welfare of patients cared for as part of an EMS educational
program; or
(5) the EMS Educational Institution altered,
destroyed or attempted to destroy evidence needed for a complaint
investigation.
(d) The Department shall give the EMS Educational
Institution written notice of revocation. This notice shall be given personally
or by certified mail and shall set forth:
(1) the factual allegations;
(2) the statutes or rules alleged to be
violated; and
(3) notice of the EMS Educational Institution's
right to a contested case hearing on the revocation of the credential.
(e) Focused review is not a procedural prerequisite to the
revocation of a credential pursuant to Paragraph (c) of this Rule.
(f) An EMS Educational Institution may voluntarily withdraw
its credential for a maximum of one year by submitting a written request. This
request shall include the reasons for withdrawal and a plan for resolution of
the deficiencies. To reactivate the credential, the institution shall provide
to the Department written documentation of compliance. Voluntary withdrawal
does not affect the original expiration date of the EMS Educational
Institution's credential.
(g) If the institution fails to resolve the issues which
resulted in a voluntary withdrawal within one year, the Department shall revoke
the EMS Educational Institution credential.
(h) In the event of a revocation or voluntary withdrawal,
the Department shall provide written notification to all EMS Systems within the
EMS Educational Institution's defined service area. The Department shall
provide written notification to all EMS Systems within the EMS Educational
Institution's defined service area if, and when, the voluntary withdrawal
reactivates to full credential.
History Note: Authority G.S. 143-508(d)(4),(d)(10);
Eff. January 1, 2013.
10A NCAC 13P .1506 EMS VEHICLE PERMITS
(a) The Department shall deny, suspend, or revoke the
permit of an ambulance or EMS nontransporting vehicle if the EMS Provider:
(1) failed to comply with the provisions of
G.S. 131E, Article 7, and the rules adopted under that Article;
(2) obtained or attempted to obtain a permit
through fraud or misrepresentation;
(3) has continued deficiencies identified as
repeated from previous compliance site visits;
(4) failed to provide emergency medical care
within the defined EMS service area in a timely manner as determined by the EMS
System;
(5) continued to operate the ambulance or
nontransporting vehicle in a county after written notification by a Board of
Commissioners to cease operations in that county;
(6) altered, destroyed or attempted to destroy
evidence needed for a complaint investigation; or
(7) does not possess a valid EMS Provider
License.
(b) In lieu of suspension or revocation, the Department
shall issue a temporary permit for an ambulance or EMS nontransporting vehicle
whenever the Department finds that:
(1) the EMS Provider to which that vehicle is
assigned has failed to comply with the provisions of G.S. 131E, Article 7, and
the rules adopted under that Article;
(2) there is a reasonable probability that the
EMS Provider can remedy the permit deficiencies within a length of time
determined by the Department; and
(3) there is a reasonable probability that the
EMS Provider will be willing and able to remain in compliance with the rules
regarding vehicle permits for the foreseeable future.
(c) The Department shall give the EMS Provider written
notice of the temporary permit. This notice shall be given personally or by
certified mail and shall set forth:
(1) the duration of the temporary permit not to
exceed 60 days;
(2) a copy of the vehicle inspection form;
(3) the statutes or rules alleged to be
violated; and
(4) notice of the EMS Provider's right to a
contested case hearing on the temporary permit.
(d) The temporary permit is effective immediately upon its
receipt by the EMS Provider and remains in effect until the earlier of the
expiration date of the permit or until the Department:
(1) restores the vehicle to full permitted
status; or
(2) suspends or revokes the vehicle permit.
History Note: Authority G.S. 131E-156(c),(d);
131E-157(c);
Eff. January 1, 2013.
10A NCAC 13P .1507 ems personnel credentials
(a) An EMS credential which has been forfeited under
G.S.15A-1331A may not be reinstated until the person has successfully complied
with the court's requirements, has petitioned the Department for reinstatement,
has appeared before the EMS Disciplinary Committee, and has had reinstatement
approved.
(b) The Department shall amend, deny, suspend, or revoke
the credentials of EMS personnel for any of the following reasons:
(1) failure to comply with the applicable
performance and credentialing requirements as found in this Subchapter;
(2) making false statements or representations
to the Department or willfully concealing information in connection with an
application for credentials;
(3) making false statements or representations,
willfully concealing information, or failing to respond within a reasonable
period of time and in a reasonable manner to inquiries from the Department
during a complaint investigation;
(4) tampering with or falsifying any record
used in the process of obtaining an initial EMS credential or in the renewal of
an EMS credential;
(5) in any manner or using any medium, engaging
in the stealing, manipulating, copying, reproducing or reconstructing of any
written EMS credentialing examination questions or scenarios;
(6) cheating or assisting others to cheat while
preparing to take or when taking a written EMS credentialing examination;
(7) altering an EMS credential, using an EMS
credential that has been altered or permitting or allowing another person to
use his or her EMS credential for the purpose of alteration. Altering includes
changing the name, expiration date or any other information appearing on the
EMS credential;
(8) unprofessional conduct, including a failure
to comply with the rules relating to the proper function of credentialed EMS
personnel contained in this Subchapter or the performance of or attempt to
perform a procedure that is detrimental to the health and safety of any person
or that is beyond the scope of practice of credentialed EMS personnel or EMS
instructors;
(9) being unable to perform as credentialed EMS
personnel with reasonable skill and safety to patients and the public by reason
of illness; use of alcohol, drugs, chemicals, or any other type of material; or
any physical or mental abnormality;
(10) conviction in any court of a crime involving
moral turpitude, a conviction of a felony, or conviction of a crime involving
the scope of practice of credentialed EMS personnel;
(11) by false representations obtaining or
attempting to obtain money or anything of value from a patient;
(12) adjudication of mental incompetence;
(13) lack of competence to practice with a
reasonable degree of skill and safety for patients including a failure to
perform a prescribed procedure, failure to perform a prescribed procedure
competently or performance of a procedure that is not within the scope of
practice of credentialed EMS personnel or EMS instructors;
(14) performing as an EMT-I, EMT-P, or EMD in any
EMS System in which the individual is not affiliated and authorized to
function;
(15) testing positive for any substance, legal or
illegal, that has impaired the physical or psychological ability of the
credentialed EMS personnel to perform all required or expected functions while
on duty;
(16) failure to comply with G.S. 143-518
regarding the use or disclosure of records or data associated with EMS Systems,
Specialty Care Transport Programs, or patients;
(17) refusing to consent to any criminal history
check required by G.S. 131E-159;
(18) abandoning or neglecting a patient who is in
need of care, without making reasonable arrangements for the continuation of
such care;
(19) falsifying a patient's record or any
controlled substance records;
(20) harassing, abusing, or intimidating a
patient either physically or verbally;
(21) engaging in any activities of a sexual
nature with a patient including kissing, fondling or touching while responsible
for the care of that individual;
(22) any criminal arrests that involve charges
which have been determined by the Department to indicate a necessity to seek
action in order to further protect the public pending adjudication by a court;
(23) altering, destroying or attempting to destroy
evidence needed for a complaint investigation;
(24) as a condition to the issuance of an
encumbered EMS credential with limited and restricted practices for persons in
the chemical addiction or abuse treatment program; or
(25) representing or allowing others to represent
that the credentialed EMS personnel has a credential that the credentialed EMS
personnel does not in fact have.
(c) Pursuant to the provisions of S.L. 2011-37, any person
listed on the North Carolina Department of Justice Sex Offender and Public
Protection Registry shall be denied initial or renewal EMS credentials.
(d) When a person who is credentialed to practice as an EMS
professional is also credentialed in another jurisdiction and that other
jurisdiction takes disciplinary action against the person, the Department shall
summarily impose the same or lesser disciplinary action upon receipt of the
other jurisdiction's action. The EMS professional may request a hearing before
the EMS Disciplinary Committee. At the hearing the issues shall be limited to:
(1) whether the person against whom action was
taken by the other jurisdiction and the Department are the same person;
(2) whether the conduct found by the other
jurisdiction also violates the rules of the Medical Care Commission; and
(3) whether the sanction imposed by the other
jurisdiction is lawful under North Carolina law.
History Note: Authority G.S. 131E-159(f),(g);
143-508(d)(10); S.L. 2011-37;
Eff. January 1, 2013.
10A NCAC 13P .1508 SUMMARY SUSPENSION
In accordance with G.S. 150B-3(c) an EMS Provider License,
EMS Vehicle Permit, or EMS credential may be summarily suspended if the public
health, safety, or welfare requires emergency action. This determination is
delegated to the Chief of the OEMS. For EMS credentials, this determination
shall be made following review by the EMS Disciplinary Committee pursuant to
G.S. 131E-159(f). Such a finding shall be incorporated with the order of the
Department and the order is effective on the date specified in the order or on
service of the certified copy of the order at the last known address of the
affected party, whichever is later, and continues to be effective during the
proceedings. Failure to receive the order because of refusal of service or
unknown address does not invalidate the order.
History Note: Authority G.S. 131E-159(f); 150B-3(c);
Eff. January 1, 2013.
10A NCAC 13P .1509 PROCEDURES FOR DENIAL, SUSPENSION,
AMENDMENT, OR REVOCATION
The procedures for contested cases in G.S. 150B, Article 3,
apply to the denial, suspension, amendment or revocation of credentials,
licenses, permits, approvals, or designations.
History Note: Authority G.S. 143-508(d)(10);
Eff. January 1, 2013.
