This
rule was filed as 7 NMAC 27.3.
TITLE
7 HEALTH
CHAPTER
27 EMERGENCY MEDICAL SERVICES
PART
3 MEDICAL DIRECTION FOR
EMERGENCY MEDICAL SERVICES
7.27.3.1 ISSUING AGENCY: New Mexico Department of Health, Public
Health Division.
[3/16/95,
1/1/97, 4/1/98; Recompiled 10/31/01]
7.27.3.2 SCOPE: These regulations are applicable to all
emergency medical services (EMS), EMS medical directors, EMS administrators,
EMS providers certified/licensed to provide pre-hospital health care in the
state of New Mexico, and the medical direction committee.
[3/16/95,
1/1/97; Recompiled 10/31/01]
7.27.3.3 STATUTORY AUTHORITY: These regulations are promulgated pursuant
to the following statutory authorities:
A. the
Department of Health Act, Section 9-7-6.E NMSA 1978, which authorizes the
secretary of the department of health to “...make and adopt such reasonable and
procedural rules and regulations as may be necessary to carry out the duties of
the department and its divisions”, and
B. the
Emergency Medical Services Act (as amended by Laws of 1993, Chapter 161),
Section 24-10B-4.D NMSA 1978, which authorizes the department of health to
adopt “regulations for medical direction of a provider or emergency medical
system upon the recommendation of the medical direction committee...” The
medical direction committee is established pursuant to Section 24-10B-7C NMSA
1978 of the EMS Act.
[3/16/95,
1/1/97; Recompiled 10/31/01]
7.27.3.4 DURATION: Permanent.
[3/16/95,
1/1/97; Recompiled 10/31/01]
7.27.3.5 EFFECTIVE DATE: January 1, 1997, unless a later date is
cited at the end of a section or paragraph.
[3/16/95,
1/1/97; Recompiled 10/31/01]
[Compiler’s
note: The words or paragraph, above, are no longer applicable. Later dates are now cited only at the end of
sections, in the history notes appearing in brackets.]
7.27.3.6 OBJECTIVE: The purpose of these regulations are three
fold:
A. they
establish the administrative functions for the medical direction committee of
the department; and
B. they
provide guidelines that outline the elements of medical direction necessary for
all components of an EMS system in New Mexico pursuant to Section 24-10B-4D(1)
NMSA 1978 of the EMS Act.
C. they
establish the legal basis for use of “jumpkits” by EMT providers that are
physically separate from ambulance/rescue vehicles.
[3/16/95,
1/1/97, 4/1/98; Recompiled 10/31/01]
7.27.3.7 DEFINITIONS:
A. “Academy”
means the emergency medical services training program administered through the
department of emergency medicine at the university of New Mexico school of
medicine.
B. “Advanced
directive” means a written instruction, such as living will or durable power of
attorney for health care, recognizable
under state law and relating to the provision of health care when a person is
incapacitated.
C. “Advanced
life support (ALS)” means advanced pre-hospital and inter-facility care and
treatment, including basic and intermediate life support, as prescribed by
regulation, which may be performed only by a person licensed as a paramedic by
the bureau and operating under medical control.
D. “Basic
life support (BLS)” means pre-hospital and inter-facility care and treatment,
as prescribed by regulation, which can be performed by all licensed emergency
medical technicians.
E. “Board-certified”
means a physician who has obtained emergency medicine certification by a
recognized board of medicine.
F. “Bureau”
means the injury prevention and emergency medical services bureau of the public
health division of the department.
G. “Commission”
means the New Mexico emergency medical services licensing commission appointed
by the secretary.
H. “Committee”
means the medical direction committee of the bureau.
I. “Consulting
pharmacist” means a pharmacist whose services are engaged on a routine
part-time basis by an EMS service:
(1) to assist in drawing up correct
procedures, rules and regulations for the distribution of dangerous drugs;
(2) to assume the overall responsibility for
the system of control and distribution of drugs;
(3) to see that a designated person has the
responsibility for day-to-day operation of the EMS service’s dangerous drug
supplies; and
(4) to visit the EMS service on a regularly
scheduled basis in the course of his/her duties.
J. “Controlled
substance” means any drug, substance or immediate precursor enumerated in
Schedules I through V of the Controlled Substance Act, Section 30-31-1, et seq.
NMSA 1978.
K. “Dangerous
drug” means a drug that is determined by law to be unsafe for self-medication
and that is enumerated in the New Mexico Drug, Device and Cosmetic Act, Section
26-1-1, et seq. NMSA 1978.
L. “Department”
means the New Mexico department of health.
M. “EMS
medical director” means a physician who is responsible for all aspects of
patient care for an EMS system or EMS provider service, including providing for
or ensuring the medical control of EMS providers; the development,
implementation, evaluation of medical protocols; and oversight of quality
assurance activities.
N. “Emergency
medical dispatcher” means a person who is trained and certified pursuant to
Subsection G of Section 24-10B-4 NMSA 1978 to receive calls for emergency
medical assistance, provide pre-arrival medical instructions, dispatch
emergency medical assistance and coordinate its response.
O. “Emergency
medical service (EMS)” means the services rendered by licensed emergency
medical technicians, certified emergency medical services first responders or
emergency medical dispatchers in response to a person’s need for immediate
medical care to prevent loss of life or aggravation of physical or
psychological illness or injury.
P. “Emergency
medical technician (EMT)” means a health care provider who has been certified
or licensed to practice by the bureau.
Q. “Intermediate
life support (ILS)” means certain advanced pre-hospital and inter-facility care
and treatment, including basic life support, as prescribed by regulation, which
may be performed only by a person licensed by the bureau and operating under
medical control.
R. “Jumpkits”
means portable carrying devices that contain emergency medical equipment and/or
approved quantities of dangerous drugs and controlled substances that are in
the possession of a licensed emergency provider and whose contents are
authorized by the service’s EMS medical director.
S. “Medical
control” means supervision provided by or under the direction of physicians to
providers by written protocol or direct communications.
T. “Medical
direction” means guidance or supervision provided by a physician to a provider
or emergency medical services system and which includes authority over and
responsibility for emergency medical dispatch, direct patient care and
transport of patients, arrangements for medical control and all other aspects
of patient care delivered by a provider.
U. “New
Mexico board of pharmacy” means the authorized board established by the New
Mexico Pharmacy Act to regulate pharmaceutical practices in the state of New
Mexico.
V. “Physician”
means a doctor of medicine or doctor of osteopathy who is licensed or otherwise
authorized to practice medicine or osteopathic medicine in New Mexico.
W. “Protocols”
means predetermined, written medical care plans and includes standing orders.
X. “Provider”
means a person or entity delivering emergency medical services in New Mexico.
Y. “Secretary”
means the secretary of the department.
Z. “Scope
of practice” means a listing of skills, techniques and medications allowed for
use by each level of life support in New Mexico.
AA. “Special Skills” means a set of procedures or therapies that
are beyond the usual scope of practice of a given level of life support and
that have been approved by the medical direction committee for use by a
specified provider.
BB. “Standing Orders” means strictly defined written orders for
actions, techniques or drug administration, signed by a physician, to be
utilized when an on-line medical control physician is not available.
[3/16/95,
1/1/97, 4/1/98; Recompiled 10/31/01]
7.27.3.8 MEDICAL DIRECTION
ADMINISTRATION:
A. Duties:
The duties of the medical direction committee shall be:
(1) reviewing the medical appropriateness of
all regulations proposed by the bureau;
(2) reviewing and approving the applications
of providers for special skills authorizations, as outlined in 7 NMAC 27.2 [now
7.27.2 NMAC] “Certification and Licensing of EMS Personnel”, or such other
regulations as may be adopted by the department;
(3) assisting in the development of
regulations pertaining to medical direction;
(4) updating at least annually a list of
skills, techniques, and medications approved for each level of life support
that will be approved by the secretary and issued by the bureau. These skills, techniques and medications
shall be called the “scope of practice” and will be attached as an Appendix to
7 NMAC 27.3 [now 7.27.3 NMAC] “Certification and Licensing of EMS Personnel”,
or such other regulations as may be adopted by the department; and,
(5) as needed, develop guidelines and
appendices to regulations governing medical direction issues as prescribed by
law;
(6) collecting data from the EMS community in
order to oversee the actual medical impact of the approved scope of practice
for each level and for actions undertaken or contemplated.
B. Organization:
Members of the medical direction committee are appointed by the secretary as
provided by law.
(1)
Membership shall be nine individuals including:
(a) the state EMS medical director who shall
serve as chair;
(b) one physician representative experienced
in pre-hospital care selected from a list proposed by the New Mexico chapter of
the American college of emergency physicians;
(c) one physician representative from the EMS
academy;
(d) one physician from each of the EMS
geographic regions (may be the regional medical director or other physician
within the region); and,
(e) one emergency medical technician from
each level of life support.
(f)
There shall be no designated term of service for these members who shall
serve at the pleasure of the secretary.
(2) In the event of a vacancy on the
committee by resignation or removal, the bureau shall immediately notify the
secretary so as to expedite the appointment of a new member.
(3) The committee may recommend to the
secretary the removal of any member for the following reasons:
(a) failing to attend or otherwise
participate in two (2) consecutive meetings without a valid reason; or,
(b) any other good cause.
(4) The state EMS medical director shall
serve as chair. If he/she is unable to
chair a meeting, the chair shall be assumed by a member appointed by the state
EMS medical director.
(5) The bureau shall serve as staff for the
committee.
C. Meetings:
The committee shall meet as needed, but not less than semiannually. Minutes of the meetings shall be taken and
maintained at the bureau.
D. Reconsideration
process: If a recommendation made by the committee is not accepted by the
bureau:
(1) the bureau shall communicate in writing to
the committee as to the reasons for that recommendation not being accepted.
(2) at the request of the committee, the
decision shall be submitted for reconsideration to the director of the public
health division of the department and subsequently to the secretary.
(3) any decision made pursuant to a request
for reconsideration shall be communicated in writing by the department to the
committee.
[3/16/95,
1/1/97, 4/1/98; Recompiled 10/31/01]
7.27.3.9 MEDICAL DIRECTION GUIDELINES:
A. General:
These guidelines provide overall guidance for the performance of medical
direction in New Mexico. The guidelines
set forth the qualifications, responsibilities and activities of a system’s
designated medical director. The
guidelines will also define a process for notifying the EMS bureau of the
withdrawal of medical control by a physician from a provider, and specifying
requirements for medical direction of intermediate and advanced life support
personnel and basic life support personnel with special skills approval. Finally, the guidelines with set forth the
legal requirements for an EMS system to maintain “jumpkits” under the
authorization of the EMS medical director.
Each guideline in Paragraphs 9 and 10 are prefaced by either the word
“mandatory” or the word “recommended”.
Mandatory items are required, while recommended items are highly
recommended.
B. Medical
director oversight:
(1) (Mandatory) A designated medical director
shall be required for all the situations outlined below:
(a) a certified ambulance carrier as defined
in state corporation commission (SCC) Regulation 18 NMAC 4.2 [now 18.4.2 NMAC],
or such other rules as may be promulgated by the SCC or its successor agency;
(b) all advanced life support and
intermediate life support EMTs;
(c) all basic life support EMTs who provide
advanced life support skills, medications, and/or techniques authorized under
the scope of practice or special skills authorizations; and
(d) all EMTs or first responders who provide
semi-automatic defibrillation services.
(2) (Recommended) All other services
operating on a basic life support (BLS) level are urged to have a local or
system-wide medical director as feasible by local situations and
availabilities.
C. Medical
director qualifications: The qualifications for an EMS medical director are
provided below. A medical director:
(1) (Mandatory) shall be an M.D. or D.O.
licensed or otherwise authorized to practice medicine in New Mexico;
(2) (Mandatory) shall, if a new medical
director, complete one of the below listed medical direction education/training
methods within one year of assuming the responsibilities of a medical director;
current medical directors shall complete one of the below listed methods of
medical direction education/training within two years of the effective date of
this regulation:
(a) a nationally-recognized EMS medical
director’s course; or
(b) a bureau-recognized orientation course;
or
(c)
a local orientation provided by a regional or state EMS medical
director.
(3) (Mandatory) The bureau shall be notified
within thirty (30) days when a new EMS medical director assumes
responsibilities or when a medical director is no longer providing those duties
for a service.
(4) (Recommended) may be familiar with the
design and operation of EMS systems;
(5) (Recommended) may be experienced in, and
possess current knowledge of, emergency care of patients who are acutely ill or
traumatized (emergency medicine board-certification and/or certification in
recognized training such as advanced cardiac life support (ACLS), advanced
trauma life support (ATLS), or pediatric advanced life support (PALS) are
recommended);
(6) (Recommended) may be actively involved
and knowledgeable in:
(a) the emergency management of acutely ill
or injured patients;
(b) the training and continuing education of
EMS personnel under the medical director’s supervision at their level of
certification;
(c) the quality assurance program of a
service including, but not limited to, medical audit, review and critique of
basic and advanced level EMS personnel;
(d) the administrative and legislative
processes affecting regional and/or state pre-hospital EMS organizations; and
(e) the laws and regulations affecting local, regional and state EMS
services and personnel.
D. Administrative
and system oversight responsibilities: The EMS medical director, in conjunction
with the local EMS service director and other local advisory boards or
committees shall provide the responsibilities outlined below (any element of
these responsibilities may be delegated as appropriate to other qualified
individuals within the EMS system):
(1) advise the program administrator on all
elements of the EMS program as to their medical appropriateness and to assure
the quality medical services are being provided;
(2) approve the level of pre-hospital care
which may be rendered locally by each of the EMS personnel employed by and/or
volunteering with the services under the medical director’s supervision;
(3) regardless of an EMS provider’s level of
state certification or licensure, approve the level that each EMS provider may
function at locally, before the provider is permitted to perform pre-hospital
care to the public;
(4) establish and monitor field performance
standards for EMS personnel in the service;
(5) assist in development of local disaster
and mass casualty plans;
(6) develop and sign a contract or letter of
agreement between the medical director and the EMS service outlining the
specific responsibilities, authorities and, if appropriate, compensation of the
EMS medical director;
(7) develop procedures with the service on a
method by which the medical director may withdraw medical control for an EMS
provider who is non-compliant with these guidelines, other relevant laws and
regulations and accepted medical standards.
The procedure shall be outlined in the contract or letter of agreement
between the medical director and the service; shall reflect any internal
procedures of that EMS service and due process afforded individual providers,
if any, as outlined by the service; and
(8) establish local medical standards for
dispatch procedures to assure the appropriate EMS response units are dispatched
to the medical emergency scene. This
should include development of a relevant emergency medical dispatch system with
the local agency providing dispatch for the EMS service.
E. Protocol
development: The medical director shall:
(1) develop, implement, and revise written
treatment protocols and standing orders governing pre-hospital care and medical
aspects of patient triage, transport, transfer, dispatch, extrication, rescue
and radio telephone communication by the EMS service; and
(2) establish written protocols under which
circumstances the EMS service may:
(a) not transport a patient when there has
been an initial call for services;
(b) transport a patient against his/her will,
in accordance with state law including procedure, appropriate forms and review
process;
(c) handle emergency treatment of a minor,
especially in cases where that patient refuses treatment and transport;
(d) interaction with an intervening health
care provider at the scene of an emergency;
(e) not begin or terminate life support
measures in patients with EMS do not resuscitate (DNR) orders, hospice
protocols and other legally recognized advanced directives; and
(f) triage and transport trauma patients
consistent with state patient triage criteria and transport protocols.
F. Training
responsibilities: The medical director shall:
(1) establish and monitor the training
standards of a service for initial and continuing medical education; and
(2) provide, as appropriate, educational
sessions for EMS personnel within the service.
G. Quality
assurance/improvement responsibilities: The medical director shall plan,
develop and implement a system for ongoing medical audit of pre-hospital
patient care rendered by the EMS service and its personnel. This auditing system shall provide for, but
not be limited to:
(1) an
organized method for internal collection of operational and patient care data,
including access to both pre-hospital and outcome records to permit identification
and resolution of problems impacting the quality of patient care;
(2) a
comprehensive mechanism for receipt, investigation and resolution of
medically-related complaints about the EMS service;
(3) regular review and on-site evaluation of
EMS personnel operating within the service; and
(4) regular review of the overall system to
assure compliance with state corporation commission Regulation 18 NMAC 4.2 [now
18.4.2 NMAC], or such other rules as may be adopted by the SCC or its successor
agency.
H. Medical
liaison responsibilities: The medical director shall:
(1) function as the liaison between the EMS
system and the local medical community, medical facilities and regional/state
EMS medical directors; and
(2) as needed, be available to represent the
medical aspects of an EMS service to local, regional or state
boards/committees, as well as political subdivisions such as municipal
governing bodies or legislatures.
I. Notification
of withdrawal or restriction of medical support: An EMS medical director may
withdraw or restrict all or any of the medical control authorized to a provider
under his/her medical direction in the following manner:
(1) the withdrawal or restriction shall be
made in writing and sent to the EMS provider, EMS service director and
operations section of the bureau within five (5) working days of the action;
and
(2) the bureau shall perform a preliminary
investigation and decide, after consultation with the EMS medical director and
service director, whether or not the matter shall be referred to the commission
for investigation with potential impact on licensure or be handled locally
within the service.
J. Medication
control and storage: The EMS medical director shall: if appropriate for the
local service, develop a program whereby reasonable quantities of dangerous
drugs may be possessed and transported to other locations by authorized
personnel in “jumpkits”. These
“jumpkits” will be kept at the authorized personnel’s residence(s) or
vehicle(s) and will be stored according to the New Mexico board of pharmacy
regulations (i.e., temperature control and security).
(1) The specific dangerous drugs and the
quantities allowed in “jumpkits” will be determined and approved by the EMS
medical director and made available to the New Mexico board of pharmacy or its
staff, as requested.
(2) A list of authorized personnel who
maintain “jumpkits” shall be made available at the request of the New Mexico
board of pharmacy or its staff.
(3) An inventory of all dangerous drugs,
including controlled substances, issued to authorized personnel for “jumpkits”
will be kept for a period of three (3) years and will include the following:
(a) date issued;
(b) name of authorized personnel;
(c) name and strength of dangerous drugs or
controlled substances issued.
(4) The “jumpkits” will be made available
during consulting pharmacist inspections, as requested, and with advance
notice, to the New Mexico board of pharmacy inspectors.
(5) “Jumpkits” which are authorized by the
EMS medical director, to including [sic] specifically approved quantities of
controlled substances, shall be on the EMT’s person or double-locked and
secure. Controlled substances shall not
be stored in unattended vehicles.
[3/16/95,
1/1/97, 4/1/98; Recompiled 10/31/01]
HISTORY
OF 7.27.3 NMAC:
Pre-NMAC
History: The material in this part was
derived from that previously filed with the State Records Center:
DOH
Regulation 95-02 (CHSD), Regulations Governing Emergency Medical Services
Medical Direction for the State of New Mexico, 3/16/95.
History
of Repealed Material: [RESERVED]
