TITLE
7 HEALTH
CHAPTER
27 EMERGENCY MEDICAL SERVICES
PART
11 SUPPLEMENTAL LICENSING
PROVISIONS
7.27.11.1 ISSUING AGENCY: New Mexico Department of Health,
Epidemiology and Response Division, Emergency Medical Systems Bureau.
[7.27.11.1 NMAC - Rp, 7.27.11.1 NMAC, 8/15/14]
7.27.11.2 SCOPE: These rules apply to New
Mexico emergency medical services, including the service directors and medical
directors of those services; approved New Mexico EMS training programs and
graduates of approved New Mexico EMS training programs; New Mexico licensed EMS
personnel including those previously licensed; persons trained, certified or
licensed in another state or territory seeking to acquire licensure in New
Mexico; EMS licensing commission; national registry of emergency medical
technicians; and any other entity associated with the licensing of emergency
medical services personnel in New Mexico.
[7.27.11.2 NMAC - Rp, 7.27.11.2 NMAC, 8/15/14]
7.27.11.3 STATUTORY AUTHORITY: These rules are
promulgated pursuant to the following statutory authorities: 1) the New Mexico Department
of Health Act, Subsection E of Section 9-7-6 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; 2) the Emergency Medical Services Act, NMSA
1978, Section 24-10B-4 (“Bureau; duties”).
[7.27.11.3 NMAC - Rp, 7.27.11.3 NMAC, 8/15/14]
7.27.11.4 DURATION: Permanent.
[7.27.11.4 NMAC - Rp, 7.27.11.4 NMAC, 8/15/14]
7.27.11.5 EFFECTIVE DATE: August 15, 2014, unless a
later date is cited at the end of a section.
[7.27.11.5 NMAC - Rp, 7.27.11.5 NMAC, 8/15/14]
7.27.11.6 OBJECTIVE: These rules are
intended to supplement the emergency medical services licensure requirements
for emergency medical services personnel, to provide supplemental and additional
standards for the licensure of emergency medical dispatchers, emergency medical
dispatch-instructors, emergency medical services first responders and emergency
medical technicians, and to assist in the provision of a comprehensive system
of emergency medical services in the state of New Mexico.
[7.27.11.6 NMAC - Rp, 7.27.11.6 NMAC, 8/15/14]
7.27.11.7 DEFINITIONS:
[Refer to 7.27.2.7 NMAC]
7.27.11.8 SCOPES OF PRACTICE FOR LICENSED EMERGENCY
MEDICAL SERVICES PERSONNEL:
A. Medical
director means a physician functioning as the service EMS medical director as
defined and described in 7.27.3 NMAC, Medical Direction for Emergency Medical
Services. Medical control means
supervision provided by or under the direction of a physician.
B. Prior
to approving a new skill, technique, medication, or procedure, it shall be
documented by the service director, medical director, or approved EMS training
institution that the EMS provider has been appropriately trained to perform
those new skills, techniques, medications, or procedures.
C. Service medical director approved: All service medical director approved skills,
techniques, medications, or procedures are considered advanced life support. Prior to utilizing any skill, technique,
medication or procedure designated as service medical director approved, it
shall be documented by the service director, medical director, or approved EMS
training institution that the EMS provider has been appropriately trained to administer
the medications or perform the skills, techniques, medications or procedures.
Additionally, each EMS provider must have a signed authorization from the
service’s medical director on file at the EMS service’s headquarters or
administrative offices.
D. Any
device in an EMS agency’s treatment guideline/protocol designed and utilized to
facilitate successful completion of a skill or other treatment modality,
including but not limited to CPR devices, intraosseous placement devices, and
positive pressure ventilation devices, must be approved by the service medical
director.
E. Wilderness
protocols: The following skills
shall only be used by providers who have a current wilderness certification from
a bureau approved wilderness caregiver course, who are functioning in a
wilderness environment as a wilderness provider (an environment in which time
to a hospital is expected to exceed two hours, except in the case of an
anaphylactic reaction, in which no minimum transport time is required), and are
authorized by their medical director to provide the treatment:
(1) minor wound cleaning and management;
(2) cessation of CPR;
(3) field clearance of the cervical-spine;
(4) reduction of dislocations resulting from
indirect force of the patella, digit, and anterior shoulder.
F. Community
emergency medical services programs:
Community EMS programs shall be provided by EMS caregivers who, after
completing a bureau approved community EMS caregiver course, are functioning as
part of a community emergency medical services program that has been reviewed and
approved by the EMS bureau. The providers
must be authorized by their medical director to perform the skills listed in
their application as part of the community EMS program. These programs may include referrals that
involve transport to non-hospital locations, and for non-transport decisions. Skills and interventions may include any of
the approved skills and interventions for the appropriate level; any skill that
exceeds the scope of practice must be approved through the special skill
process. Skills may include, but are not limited to:
(1) education of patients in self-medication
administration, and assessment of compliance with physician recommendations for
health conditions;
(2) assessments for
preventing falls and other sources of injury by identifying risks in patient
homes;
(3) provide education on
disease prevention;
(4) administering
immunizations;
(5) in collaboration with
a healthcare team, assist in developing a care plan, and educate the patient in
following the care plan;
(6) perform in home
patient assessments commensurate with level of education and licensure in order
to provide information to a care team as to the progress or condition of a
patient receiving therapies for medical conditions;
(7) provide assistance in
locating and contacting appropriate providers of needed social services;
(8) treat discovered
acute healthcare issues, transporting to emergency department if necessary;
(9) for chronic and
non-acute issues, confirmed with online medical direction and agreed to by the
patient, options other than EMS transport may be considered, including:
(a)
arrange for non-emergent and non-EMS transportation to and care at an
appropriate facility, such as a physician’s office or urgent care center;
(b)
provide referral information and arrange for follow up by appropriate
care team members and/or social service personnel;
(10) assist with ongoing
prescribed wound care.
G. Critical
Care Transport services skills: Paramedic critical care transport skills
shall be used only by paramedic providers who have successfully completed a
bureau approved critical care transport paramedic or critical care flight
paramedic course. Subsequent to
completing the approved course, the critical care paramedic must successfully
complete a bureau administered or approved third party exam within one year. Additionally, the paramedics shall be
functioning as part of a ground or air EMS agency with an approved critical
care transport special skill and authorized by the agency medical director to
utilize these skills. Critical care
transport program skills are only authorized for use during inter-facility
critical care transport activities, with the exception of air ambulance
agencies providing emergency scene response; or ground critical care agencies
requested to a scene by the local authorized and certified 911 response and
transport agencies. Critical care
transport special skills and medications that may be administered include, but
are not limited to any of the below skills and medications; service specific
skills and medication requests must be listed on the EMS agency critical care
transport special skill application completed per 7.27.11.10 NMAC:
(1)
monitoring of infusions including but not limited to anti-arrhythmics,
nitrates, vasopressors, blood products, thrombolytics, sedation, pain
management and antihypertensive medications that have required titration within
the past two hours and may need to have their dosages adjusted during transport;
(2) performance of skills
not listed in the paramedic scope of practice, such as but not limited to
escharotomy, fasciotomy, insertion of chest tubes, pericardiocentesis, blood
administration, and nerve blocks;
(3) administration of
medications, initiation of infusions, and utilization of routes, not listed on
the paramedic scope but requested in the EMS agency’s special skill application
and approved by the medical direction committee and EMS bureau;
(4) utilization of
advanced patient monitoring, such as invasive hemodynamic monitoring via
monitoring of central venous pressure, pulmonary artery pressure, intracranial
pressure monitoring, Swan-Ganz catheters, arterial lines, fetal monitoring,
point of care lab values, and other monitoring or tests not listed in the
paramedic scope, but requested in the EMS agency’s special skill application
and approved by the medical direction committee and EMS Bureau;
(5) utilization of ICU
level ventilator support, to include ventilators delivering positive end
expiratory pressure, with multiple adjustable mode and setting parameters that
include inspiratory plateau pressures, pressure regulated volume control,
pressure support ventilation, pressure control ventilation, airway pressure
release ventilation and others; also, any ventilator delivering a mixture of
nitric oxide or other beneficial gas mixtures;
(6) transport of patients
with intra-aortic balloon pump, temporary internal cardiac pacing, left ventricular
assist device or a bi-ventricular assist device and other appropriate devices
to address hemodynamic instability as requested in the EMS agency’s special
skill application and approved by the medical direction committee and EMS
bureau;
(7) administer paralytics and sedatives to
maintain airway control previously initiated, and administer and perform rapid
sequence airway pharmacology and techniques in order to secure an airway in
response to patient condition, as requested in the EMS agency’s special skill
application and approved by the medical direction committee and EMS bureau;
(8) pediatric intubation
or endotracheal tube management as requested in the EMS agency’s special skill
application and approved by the medical direction committee and EMS bureau.
H. Utilization
of pharmacological agents for the primary purpose of sedation, induction, or
muscle relaxation to facilitate placement of an advanced airway requires
medical direction committee special skills approval.
I. Over the counter (OTC) medications and
products. A physician medical director may approve a list of over the
counter (OTC) medications and products (i.e. NSAID's, antihistamines, anti-diarrheal, laxatives,
antacids, vitamin supplements, hygiene products and other products) for
distribution by an EMS caregiver working under medical direction to a
requesting individual during scheduled stand-by situations. Examples are long-term wildfire responses,
public events (concerts, rodeos, etc), various industry situations such as
movie production & ski patrol, long-term construction & manufacturing
projects, long-term search and rescue or tactical operations, and other
situations where scheduled stand-by EMS is provided.
(1) The OTC medication/product must be properly
labeled in individual dose packaging when distributed to the patient. Distribution from a bulk or multi-dose
container is not permitted by this scope of practice, as well as other state
and federal laws and regulations; medications will be distributed per
manufacturer recommendations and labeling directions.
(2) The agency/EMS
caregiver will maintain a written guideline that contains the list of physician
approved OTC medications/products and the conditions for which they may be
distributed. Specific dosing information
and indications for pediatric patients must be included.
(3) The EMS agency/EMS
caregiver must develop a method of documentation for the appropriate
distribution of the OTC medications/products.
This documentation shall include the OTC medication documentation and
appropriate patient care report, per 7.27.10.12 NMAC (Records and Data
Collection) and 7.27.11.11 NMAC. PRC
certified ambulance agencies shall complete patient care documentation per
18.3.14.24 NMAC.
(4) OTC
medications/products are distributed for the patient’s self-administration and
use. EMS caregivers will not administer
OTC medications/products, unless approved elsewhere in the scope of practice
for specific EMS patient care situations.
J. Licensed emergency medical dispatcher (EMD).
(1) Medical direction is
required for all items in the EMD scope of practice.
(2) The following
allowable skills may be performed by EMDs who are licensed by the EMS bureau
and functioning with an EMS bureau certified New Mexico emergency medical
dispatch agency utilizing protocols and any EMD priority reference system
approved by the EMS bureau and service medical director.
(a)
Process calls for medical assistance in a standardized manner, eliciting
required information for evaluating, advising, and treating sick or injured
individuals, and dispatching an appropriate EMS response.
(b)
Provide pre-arrival instructions to the patient through the caller when
possible and appropriate to do so while functioning in compliance with an
emergency medical dispatch priority reference system (EMDPRS).
K. EMS first responders (EMSFR).
(1) The
following allowed drugs may be administered and skills and procedures may be
performed without medical direction:
(a) basic airway management;
(b) use of basic adjunctive airway equipment;
(c) suctioning;
(d) cardiopulmonary resuscitation, according
to current ECC guidelines;
(e) obstructed airway management;
(f) bleeding control via direct pressure and
appropriate tourniquet use;
(g) spine immobilization;
(h) splinting (does not include femoral
traction splinting);
(i) scene assessment, triage, scene safety;
(j) use of statewide EMS communications
system;
(k) emergency childbirth;
(l) glucometry;
(m) oxygen;
(n) other non-invasive procedures as taught in
first responder courses adhering to DOT curricula.
(2) The
following require service medical director approval:
(a) allowable
skills:
(i) mechanical positive pressure ventilation
utilizing a device that may have controls for rate, tidal volume, FiO2, and
pressure relief/alarm and does not have multiple automatic ventilation modes;
(ii)
application and use of semi-automatic defibrillators, including cardiac
rhythm acquisition for ALS caregiver interpretation or transmission to a care
facility; this includes multi-lead documentation;
(iii) hemostatic dressings for control of
bleeding;
(iv)
insertion of laryngeal and supraglottic airway devices (examples: king airway,
LMA), excluding multi-lumen airways);
(b) administration of approved medications via
the following routes:
(i) nebulized inhalation;
(ii) nasal mucosal atomization (MA);
(iii) intramuscular;
(iv) oral (PO);
(c) allowable drugs:
(i) oral glucose preparations;
(ii) aspirin PO for adults with suspected
cardiac chest pain;
(iii) atropine and pralidoxime via IM auto-injection
for treatment of chemical or nerve agent exposure;
(iv) albuterol (including isomers) via inhaled
administration;
(v) naloxone via nasal mucosal atomizer;
(vi) epinephrine via auto-injection device;
(d) patient’s own medication that may be
administered:
(i) bronchodilators using
pre-measured or metered dose inhalation device;
(ii) naloxone, if provided with a nasal MA or
IM delivery system.
L. EMT-BASIC (EMT-B):
(1)
The
following allowed drugs may be administered and skills and procedures may be
performed without medical direction:
(a) basic airway management;
(b) use of basic adjunctive airway equipment;
(c) suctioning;
(d) cardiopulmonary resuscitation, according
to current ECC guidelines;
(e) obstructed airway management;
(f)
bleeding control to include appropriate tourniquet usage;
(g) spine immobilization;
(h) splinting;
(i) scene assessment, triage, scene safety;
(j) use of statewide EMS communications
system;
(k) childbirth (imminent delivery);
(l) glucometry;
(m) oxygen;
(n) other non-invasive procedures as taught in
EMT-B courses adhering to DOT curricula;
(o) wound management.
(2) The
following require service medical director approval:
(a) allowable skills:
(i) mechanical positive pressure ventilation
utilizing a device that may have controls for rate, tidal volume, FiO2, and
pressure relief/alarm and does not have multiple automatic ventilation modes; this skill includes devices that provide non-invasive positive pressure ventilation
via continuous positive airway pressure (CPAP);
(ii) use of multi-lumen, supraglottic, and
laryngeal airway devices (examples: PTLA, combi-tube, king airway, LMA) to include
gastric suctioning;
(iii) application and use of semi-automatic
defibrillators, including cardiac rhythm acquisition for ALS caregiver
interpretation or transmission to a care facility; this includes multi-lead
documentation;
(iv) acupressure;
(v) transport of patients with nasogastric
tubes, urinary catheters, heparin/saline locks, PEG tubes, or vascular access
devices intended for outpatient use;
(vi)
performing point of care testing;
examples include serum lactate values, cardiac enzymes, electrolytes, and other
diagnostic values;
(vii) hemostatic
dressings for control of bleeding;
(b) administration of approved medications via
the following routes:
(i) nebulized inhalation;
(ii) subcutaneous;
(iii) intramuscular;
(iv) nasal mucosal atomization (MA);
(v) oral (PO);
(vi) intradermal;
(c) allowable drugs:
(i) oral glucose preparations;
(ii) aspirin PO for adults with suspected
cardiac chest pain;
(iii) activated charcoal PO;
(iv) acetaminophen PO in pediatric patients
with fever;
(v) atropine and pralidoxime via IM
autoinjection for treatment of chemical and/or nerve agent exposure;
(vi) albuterol (including isomers), via inhaled
administration;
(vii) ipratropium, via inhaled administration, in
combination with or after albuterol administration;
(viii) naloxone by SQ, IM, or IN route;
(ix) epinephrine, 1:1000, no single dose
greater than 0.3 ml, subcutaneous or intramuscular injection with a
pre-measured syringe (including autoinjector) or 0.3 ml TB syringe for
anaphylaxis or status asthmaticus refractory to other treatments;
(d) patient’s own medication that may be
administered:
(i) bronchodilators using pre-measured or
metered dose inhalation device;
(ii) sublingual
nitroglycerin for unrelieved chest pain, with on line medical control only;
(iii) situations
may arise involving patients with uncommon conditions requiring specific out of
hospital administered medications or procedures; family members or the
designated caregiver trained and knowledgeable of the special needs of the
patient should be recognized as the expert regarding the care of the patient; EMS can offer assistance in airway management
appropriate to their level of licensure, and administer the patient’s
prescribed medications where appropriate only if the medication is in the EMS
provider’s scope of practice; EMS services are not expected to provide the
prescribed medications for these special needs patients;
(3) Immunizations
and biologicals: Administration of
immunizations, vaccines, biologicals, and TB skin testing is authorized under
the following circumstances:
(a)
to the general public as part of a department of health initiative or
emergency response, utilizing department of health protocols; the
administration of immunizations is to be under the supervision of a physician,
nurse, or other authorized health provider;
(b) TB skin tests may be applied and
interpreted if the licensed provider has successfully completed required
department of health training;
(c) in the event of a disaster or emergency,
the state EMS medical director or chief medical officer of the department of
health may temporarily authorize the administration of pharmaceuticals or tests
not listed above.
M. EMT-INTERMEDIATE (EMT-I):
(1) The
following allowed drugs may be administered and skills and procedures may be
performed without medical direction:
(a) basic airway management;
(b) use of basic adjunctive airway equipment;
(c) suctioning;
(d) cardiopulmonary resuscitation, according
to ECC guidelines;
(e) obstructed airway management;
(f) bleeding control including appropriate use
of tourniquet;
(g) spine immobilization;
(h) splinting;
(i) scene assessment, triage, scene safety;
(j) use of statewide EMS communications
system;
(k) childbirth (imminent delivery);
(l) glucometry;
(m) oxygen;
(n)
wound management.
(2) The
following require service medical director approval:
(a) allowable skills:
(i) mechanical positive pressure ventilation
utilizing a device that may have controls for rate, tidal volume, FiO2, and
pressure relief/alarm and does not have multiple automatic ventilation
modes; this skill includes devices that
provide non-invasive positive pressure
ventilation via continuous positive airway pressure (CPAP);
(ii) use of multi-lumen, supraglottic, and
laryngeal airway devices (examples: PTLA, combi-tube, king airway, LMA) to
include gastric suctioning;
(iii) application and use of semi-automatic
defibrillators, including cardiac rhythm acquisition for ALS caregiver
interpretation or transmission to a care facility; this includes multi-lead
documentation;
(iv)
acupressure;
(v)
transport of patients with nasogastric tubes, urinary catheters,
heparin/saline locks, PEG tubes, or vascular access devices intended for
outpatient use;
(vi) peripheral venous puncture/access;
(vii) blood drawing;
(viii) pediatric intraosseous tibial access;
(ix) adult intraosseous access;
(x) point of care testing; examples include serum
lactate values, cardiac enzymes, electrolytes, and other diagnostic values;
(xi)
hemostatic dressings for
control of bleeding;
(b) administration of approved medications via
the following routes:
(i) intravenous;
(ii) nasal mucosal atomization (MA);
(iii) nebulized
inhalation;
(iv) sublingual;
(v) intradermal;
(vi)
intraosseous;
(vii) endotracheal (for administration of
epinephrine only, under the direct supervision of an EMT-paramedic, or if the
EMS service has an approved special skill for endotracheal intubation);
(viii) oral (PO);
(ix) intramuscular;
(x) subcutaneous;
(c) allowable drugs:
(i) oral glucose preparations;
(ii) aspirin PO for adults with suspected
cardiac chest pain;
(iii) activated charcoal PO;
(iv) acetaminophen PO in pediatric patients
with fever;
(v) IM autoinjection of the following agents
for treatment of chemical or nerve agent exposure: atropine, pralidoxime;
(vi) albuterol (including isomers) via inhaled
administration;
(vii) ipratropium, via inhaled administration in
combination with or after albuterol administration;
(viii) naloxone;
(ix) I.V. fluid therapy (except blood or blood
products);
(x) dextrose;
(xi)
epinephrine (1:1000), SQ or IM (including autoinjector) for anaphylaxis
and known asthmatics in severe respiratory distress (no single dose greater
than 0.3 cc);
(xii) epinephrine (1:10,000) in pulseless
cardiac arrest for both adult and pediatric patients; epinephrine may be
administered via the endotracheal tube in accordance with most current ACLS and
PALS guidelines;
(xiii) nitroglycerin (sublingual) for chest pain
associated with suspected acute coronary syndromes; must have intravenous
access established prior to administration or approval of online medical
control if IV access is unavailable;
(xiv) morphine, fentanyl, or dilaudid for use in
pain control with approval of on-line medical control;
(xv) diphenhydramine for allergic reactions or
dystonic reactions;
(xvi) glucagon, to treat hypoglycemia in
diabetic patients when intravenous access is not obtainable;
(xvii) anti-emetic agents, for use as an
anti-emetic only;
(xviii) methylprednisolone for reactive airway
disease/acute asthma exacerbation;
(xix) Hydroxycobalamine;
(xx) lidocaine (2%, preservative and
epinephrine free for IV use) for administration into the intraosseous space on
pain responsive adult patients while receiving intraosseous fluids or
medications;
(d) patient’s own medication that may be
administered:
(i) bronchodilators using pre-measured or
metered dose inhalation device;
(ii) sublingual nitroglycerin for unrelieved
chest pain; must have intravenous access established prior to administration or
approval of online medical control if IV access is unavailable;
(iii) glucagon;
(iv) situations may arise involving patients
with uncommon conditions requiring specific out of hospital administered
medications or procedures; family members or the designated caregiver trained
and knowledgeable of the special needs of the patient should be recognized as
the expert regarding the care of the patient; EMS can offer assistance in
airway management appropriate to their level of licensure, IV access, and the
administration of the patient’s prescribed medications where appropriate only
if the medication is in the EMS provider’s scope of practice; online (direct
contact) medical control communication must be established with the medical
control physician approving the intervention; EMS services are not expected to
provide the prescribed medications for these special needs patients;
(e) drugs allowed for monitoring during interfacility
transport:
(i) potassium; intermediate EMT’s may monitor IV
solutions that contain potassium during transport (not to exceed 20 mEq/1000cc
or more than 10 mEq/hour);
(ii) antibiotics and other anti-infectives
utilizing an infusion pump; intermediate EMT’s may monitor antibiotic or other
anti-infective agents, provided a hospital initiated infusion has been running
for a minimum of 30 minutes prior to the intermediate initiating the transfer,
and the intermediate EMT is aware of reactions for which to monitor and the
appropriate action to take before assuming responsibility for patient care;
(f) immunizations and biologicals: administration of immunizations, vaccines,
biologicals, and TB skin testing is authorized under the following
circumstances:
(i) to the general public as part of a
department of health initiative or emergency response, utilizing department of
health protocols; the administration of immunizations is to be under the
supervision of a physician, nurse, or other authorized health provider;
(ii) administer vaccines to EMS and public
safety personnel;
(iii) TB skin tests may be applied and
interpreted if the licensed provider has successfully completed required
department of health training;
(iv)
in the event of a disaster or emergency, the state EMS medical director
or chief medical officer of the department of health may temporarily authorize
the administration of pharmaceuticals or tests not listed above.
N. EMT-PARAMEDIC (EMT-P):
(1) The
following allowed drugs may be administered and skills and procedures may be
performed without medical direction:
(a) basic airway management;
(b) use of basic adjunctive airway equipment;
(c) suctioning;
(d) cardiopulmonary resuscitation, according
to current ECC guidelines;
(e) obstructed airway management;
(f) bleeding control including the appropriate
use of tourniquet;
(g) spine immobilization;
(h) splinting;
(i) scene assessment, triage, scene safety;
(j) use of statewide EMS communications
system;
(k) childbirth (imminent delivery);
(l) glucometry;
(m)
oxygen;
(n) wound management.
(2) The following require service medical
director approval:
(a) allowable
skills:
(i)
mechanical positive pressure ventilation utilizing a device that may
have controls for rate, tidal volume, FiO2, and pressure
relief/alarm and has multiple automatic ventilation modes; this skill includes devices that provide non-invasive positive pressure ventilation
(including continuous positive airway pressure (CPAP) and bi-level positive
airway pressure (BPAP);
(ii) use of multi-lumen, supraglottic, and
laryngeal airway devices (examples: PTLA, combi-tube, king airway, LMA) to
include gastric suctioning;
(iii) transport of patients with nasogastric
tubes, urinary catheters, heparin/saline locks, PEG tubes, or vascular access
devices intended for outpatient use;
(iv) application and use of semi-automatic
defibrillators;
(v) acupressure;
(vi) peripheral venous puncture/access;
(vii) blood drawing;
(viii) I.V. fluid therapy;
(ix) direct laryngoscopy for endotracheal
intubation and removal of foreign body in patients 13 and older; for patients
12 and under, for removal of foreign body only;
(x) endotracheal intubation for patients over
the age of 12;
(xi) thoracic decompression (needle
thoracostomy);
(xii) surgical cricothyroidotomy;
(xiii) insertion
of nasogastric tubes;
(xiv) cardioversion
and manual defibrillation;
(xv) external
cardiac pacing;
(xvi) cardiac
monitoring;
(xvii) use of infusion pumps;
(xviii) initiation of blood and blood products
with on-line medical control;
(xix) intraosseous access;
(xx) performing
point of care testing; examples include serum lactate values, cardiac enzymes,
electrolytes, and other diagnostic values;
(xxi)
hemostatic dressings for control of bleeding;
(xxii)
vagal maneuvers.
(b) administration
of approved medications via the following routes:
(i) intravenous;
(ii) nasal mucosal atomization (MA);
(iii) nebulized inhalation;
(iv) sublingual;
(v) intradermal;
(vi) intraosseous;
(vii) endotracheal;
(viii) oral (PO);
(ix) intramuscular;
(x) topical;
(xi) rectal;
(xii) IV drip;
(xiii) subcutaneous;
(c) allowable
drugs:
(i) acetaminophen;
(ii) activated charcoal;
(iii) adenosine;
(iv) albuterol (including isomers);
(v) amiodarone;
(vi) aspirin;
(vii) atropine sulfate;
(viii) benzodiazepines;
(ix) calcium preparations;
(x) corticosteroids;
(xi) dextrose;
(xiii) diphenhydramine;
(xiv) epinephrine;
(xv) furosemide;
(xvi) glucagon;
(xvii) hydroxycobalamine;
(xviii) ipratropium;
(xix) lidocaine;
(xx) magnesium sulfate;
(xxi) naloxone;
(xxii) narcotic analgesics;
(xxiii) nitroglycerin;
(xxiv) oral glucose preparations;
(xxv) oxytocin;
(xxvi) phenylephrine nasal spray;
(xxvii) pralidoxime, IM auto-injection for
treatment of chemical and nerve agent
exposure;
(xxviii) anti-emetic agents, for use as an
anti-emetic only;
(xxix) sodium bicarbonate;
(xxx) thiamine;
(xxxi) topical anesthetic ophthalmic solutions;
(xxxii) vasopressor agents;
(xxxiii) intravenous fluids
(3) Drugs allowed for monitoring during inter-facility transports (initiated
and administered by the sending facility with defined dosing parameters and
requiring an infusion pump when given by continuous infusion unless otherwise
specified); the infusion may be terminated by the paramedic if appropriate, but
if further adjustments are anticipated, appropriate hospital personnel should
accompany the patient, or a critical care transport unit should be utilized:
(a) potassium (no infusion pump needed if
concentration not greater than 20mEq/1000cc;
(b) anticoagulation type blood modifying
agents (such as fibrolytic drugs, heparin, glycoprotein IIb-IIIa
inhibitors/antagonists);
(c) procainamide;
(d) mannitol;
(e) blood and blood products (no pump
required);
(f) aminophylline;
(g) antibiotics and other anti-infective agents;
(h) dobutamine;
(i) sodium nitroprusside;
(j) insulin;
(k) terbutaline;
(l) norepinephrine;
(m) octreotide;
(n) nutritional supplements;
(o) beta blockers;
(p) calcium channel blockers;
(q) nesiritide;
(r) propofol in patients that are intubated
prior to transport;
(s) proton pump inhibitors and H2 antagonists;
(t)
crotalidae polyvalent immune fab (ovine) (“crofab”) crofab may be monitored during inter-facility
transport provided the physician initiated crofab infusion has been running for
a minimum of 30 minutes prior to the paramedic initiating the transfer and assuming
responsibility for patient care.
(4) Immunizations
and biologicals: administration of
immunizations, vaccines, biologicals, and TB skin testing is authorized under
the following circumstances:
(a) to the general public as part of a
department of health initiative or emergency response, utilizing department of
health protocols; the administration of immunizations is to be under the
supervision of a physician, nurse, or other authorized health provider;
(b) administer vaccines to EMS and public
safety personnel;
(c) TB skin tests may be applied and
interpreted if the licensed provider has successfully completed required
department of health training;
(d) in the event of a disaster or emergency,
the state EMS medical director or chief medical officer of the department of
health may temporarily authorize the administration of other pharmaceuticals or
tests not listed above.
(5) Skills
approved for monitoring in transport:
(a) internal cardiac pacing;
(b) chest tubes.
(6) Medications
for administration during patient transfer:
(a) retavase (second dose only);
(b) protamine sulfate;
(c) non-depolarizing neuromuscular blocking
agents in patients that are intubated prior to transport;
(d) acetylcysteine;
(7) Patient’s
own medication that may be administered:
(a) epoprostenol sodium, treprostinil sodium,
or other medications utilized for certain types of pulmonary hypertension;
(b) bronchodilators using pre-measured or
metered dose inhalation device;
(c) sublingual nitroglycerin for unrelieved
chest pain; must have intravenous access established prior to administration;
(d)
glucagon;
(e) situations may arise involving patients
with uncommon conditions requiring specific out of hospital administered
medications or procedures; family members or the designated caregiver trained
and knowledgeable of the special needs of the patient should be recognized as
the expert regarding the care of the patient; EMS can offer assistance in
airway management appropriate to their level of licensure, IV access, and the
administration of the patient’s prescribed medications where appropriate only
if the medication is in the EMS provider’s scope of practice; online (direct
contact) medical control communication must be established with the medical
control physician approving the intervention; EMS services are not expected to
provide the prescribed medications for these special needs patients.
[7.27.11.8 NMAC - Rp, 7.27.11.8 NMAC, 8/15/14]
7.27.11.9 APPROVED TRAINING PROGRAMS: “Approved emergency medical
services training program” means a New Mexico emergency medical services
training program that is sponsored by a post-secondary educational institution,
is accredited by the national accrediting organization for emergency medical
services or active in the accreditation process, and is approved by the joint
organization on education (JOE) and participates in the joint organization on
education. Currently, there are five approved EMS training programs.
A. Emergency medical services academy. University of New Mexico, (700 Camino De
Salud NE., Albuquerque, New Mexico 87106, Tel: 505-272-5757). The EMS academy
is designated as the lead training agency for providers in New Mexico as stated
in Section 24-10B-12 NMSA 1978. The EMS academy teaches formal EMS education courses
including EMS first responder, EMT-basic, EMT-intermediate, and EMT-paramedic.
B. Dona Ana branch community college. New Mexico state university, (Box 30001, Las
Cruces, NM 88003-000 1 ,Tel: 505-527-7530). Dona Ana branch community college
teaches formal EMS education courses including EMS first responder, EMT-basic,
EMT-intermediate, and EMT-paramedic.
C. Eastern New Mexico university. EMS program, (Box 6000, Roswell, NM 88202-6000,
Tel: 505- 624-7000). The eastern New Mexico university teaches formal EMS education
courses including EMS first responder, EMT-basic, EMT-intermediate, and
EMT-paramedic.
D. Central
New Mexico community college. EMS
program, (525 Buena Vista Rd. SE, Albuquerque, NM 87106, Tel: 505-224-4000).
Central New Mexico community college teaches formal EMS education courses
including EMS first responder, EMT-basic, EMT-intermediate, and EMT-paramedic.
E. San Juan college EMS Program. (4601
College Blvd; Farmington, NM 87402;
505-566-3857). San Juan College conducts
formal EMS education courses including EMS first responder, EMT-basic,
EMT-intermediate, and EMT-paramedic.
[7.27.11.9 NMAC - Rp, 7.27.11.9 NMAC, 8/15/14]
7.27.11.10 SPECIAL SKILLS APPLICATION AND REPORTING
PROCEDURES:
A. Purpose: Special skills are those skills, procedures,
and medications that are requested by an EMS service to enhance emergency
treatment capabilities beyond the normal scope of practice, as defined in the Emergency
Medical Services Act. Use the enclosed
procedures for application, reporting and renewal for special skills.
Applications are reviewed and approved or disapproved by the medical direction
committee, and once approved, become a legally recognized addition to the service
capabilities.
B. General: All levels of EMS personnel, including
licensed EMS first responders and all levels of licensed EMTs are eligible for
special skills consideration for any procedure, skill or medication.
C. Application procedure: The EMS service medical director, or his
designee, shall coordinate with the EMS service director, and shall apply for
special skills to the EMS medical direction committee.
D. Application
document: The application document
for a special skill must be tailored to the level of the request. While the
degree of detail in each section may vary to match the nature of the skill
requested, all applications should include the following elements, in order:
(1) application cover page: titled to state
the requested special skill, date of application, name of service, service
director name and medical director name;
(2) contact information page: must include
address and contact information for the service, service director and medical
director;
(3) letters of support: must include
individual letters of support from the service director and medical director;
additional letters of support from the local medical community or evidence of
notification of the local medical community may be required; the need for
letters of notification and support from the local medical community and who
provides the letters must be adjusted to match the nature of the special skill
requested;
(4) service description: provide a concise
description of the EMS service; this includes such items as basic call
demographics relevant to the applicant, level of licensure of providers and
names and locations of the primary receiving medical facilities;
(5)
description of the special skill: provide a description of the
procedure, medication or requested skill; include information on risks,
benefits, indications and contraindications;
(6) justification and statement of need:
provide a statement explaining why the special skill is needed; this should
include a description of the current medical intervention or alternative
practice to the special skill and a risk or benefit analysis that supports the
special skill requested; the estimated number of potential interventions per
year, other relevant statistical data and a statement indicating the level of
current scientific information/studies to support the requested special skill;
the level of scientific justification can be adjusted to match the level of the
special skill requested;
(7) protocol: provide a copy of the treatment
protocol; include other operational protocols relevant to the special skill, if
applicable;
(8) training: provide a training syllabus;
this must include learning objectives and the training hours for initial and
continuing education; this section should also include a description of the
instructors, how training will be completed, and a description of the method
used to initially evaluate the skill; once initial training is completed, a
list of trained and approved personnel shall be provided to the medical
direction committee; these special skill authorized licensed EMS personnel
must appear on the service’s personnel
list on the New Mexico EMS tracking and reporting
system database.
(9)
QA/QI program: provide a
description of the QA/QI process for the special skill, including frequency of
evaluation, names and qualifications of the personnel involved in the process;
include a copy of the evaluation tool or forms that will be used, if
applicable; and
(10) the application and all supporting
documentation shall be submitted to the EMS bureau, attn: state EMS training
coordinator.
E. Applicants
may involve the EMS regional offices when preparing a special skill request and
include a letter evidencing regional review. Applicants shall forward a copy of
their application to their EMS regional office when completed.
F. Upon
receipt, the state EMS medical director and state EMS training coordinator will
review the application. The service will be notified if the application is
found to be incomplete or to contain significant errors.
G. Applications
must be received at the bureau at least 45 days prior to the next regularly
scheduled medical direction committee meeting to be placed on the agenda of
that meeting for consideration by the medical direction committee.
H. The
medical direction committee shall take action on all special skills
applications on the agenda at their regularly scheduled meeting. The medical
direction committee may take the following actions on the application: approved
with limitations or restrictions, denied or tabled with a request for a formal presentation
or additional information by the requesting service medical director or their
designee.
I. The
medical direction committee may give an approval subject to specific
conditions, limitations or restrictions. This may include a written and practical
examination.
J. Within
10 working days following the decision of the medical direction committee, the
state EMS training coordinator shall provide a written response to the
applicant regarding the action of the medical direction committee.
K. Special
skills may not be utilized until receipt of the special skill approval letter
from the bureau. Any specific conditions or limitations will be evidenced in
the approval letter from the bureau.
L. Monitoring: It is expected that EMS services with
approved special skills will continuously comply with the requirements of their
application and approval letter. This includes, but is not limited to, such
items as training curricula, approved instructors, quality assurance, protocols
and data collection. Any changes to the approved application shall be sent to
the state EMS training coordinator for concurrence/coordination with the
medical direction committee.
M. The
medical direction committee may immediately suspend or revoke special skill
privileges for an individual or service that loses medical direction, or fails
to comply with the stated requirements, or for any other reason to protect the
health and welfare of the people of New Mexico.
N. If
a new medical director assumes control of a service with an active special
skill program, the bureau shall receive a letter of support from the new
medical director within 30 days or the special skill approval may be withdrawn.
O. The
service shall maintain a current list of all providers trained and approved to
utilize the special skill. This list must be provided to the bureau upon
request.
P. Reporting: The service shall provide to the state EMS
training coordinator periodic written special skill reports. During the first
year, the report shall be due semi-annually, occurring on June 1 and December
1. Subsequent reports shall be due annually on June 1.
Q. Report
document: The written special skill report shall include the following minimum
elements:
(1) report cover page: titled to state the
special skill reported, date, name of service, service director and medical
director;
(2) contact information page: shall include
address and contact information for the service, service director and medical
director;
(3) letters of support: must include
individual letters of continued support from the service director and service
medical director;
(4) statistics and outcome data: provide data
on the utilization and patient outcomes involving the special skill; do not
include patient identifiers; all adverse outcomes related to the special skill
must be reported;
(5) continuing education: provide evidence of
the continuing education program and refresher program;
(6) personnel list: provide a list of all
personnel authorized to perform the special skill; these special skill
authorized licensed EMS personnel must appear on the service’s personnel list required
for the New Mexico EMS tracking and reporting
system database.
(7) QA/QI program: provide evidence of the
ongoing QA/QI program;
(8) renewal: during a regularly scheduled
meeting, the medical direction committee shall review all ongoing individual
special skills programs on their three year anniversary and make a
determination on renewal;
(9) if the medical direction committee
determines not to provide automatic renewal on an ongoing special skill
program, the state EMS training coordinator shall provide a written
notification to the service director and the service medical director within 10
working days; and
(10) the special skills program will be placed
on the agenda of the next, or subsequent, regularly scheduled meeting of the
medical direction committee and final determination regarding renewal will be
made.
R. Special
skills programs will remain active until a final determination regarding
renewal has been made.
S. Special
skills application:
(1) general section;
(2) EMS service name;
(3) address;
(4) service chief/director;
(5) contact phone number;
(6)
physician medical director;
(7) physician/medical director contact phone
number;
(8) special skill proposed;
(9) level of licensure necessary for special
skill;
(10) estimated number of personnel to be
trained;
(11) estimated date of initial training;
(12) training/quality assurance;
(13) describe or identify the curriculum,
including learning objectives, training hours, etc.;
(14) please identify the lead instructor and
provide a brief summary of their qualifications or attach a resume;
(15) resumes required for new instructors;
(16) if training/experience is required,
provide a letter of commitment from the supporting institution;
(17) describe or attach a proposed continuing
education plan;
(18) attach a description of quality assurance
plan, including periodic case reviews and ongoing problems;
(19) identification and steps for remedial
action if necessary;
(20) signatures; person completing the
application, service chief/service director and medical director;
(21) submit 10 copies of the application in its
entirety to: EMS bureau, state EMS training coordinator, (1301 Siler Rd.,
Building F, Santa Fe, NM 87507);
(22) submit one copy to the regional office.
[7.27.11.10 NMAC - Rp, 7.27.11.10 NMAC, 8/15/14]
7.27.11.11 EMS
PERSONNEL JOB DESCRIPTIONS:
A. Introduction: The bureau is providing the following general
position description for the New Mexico EMS provider positions for first
responder, EMT-basic, EMT-intermediate, and EMT-paramedic. It is the ultimate
responsibility of an employer to define specific job descriptions within each
EMS service.
B. Qualifications:
(1) successfully complete a recognized
training course from an approved EMS training institution;
(2) possess a valid course completion
certificate, and accomplish all state licensure examination application
requirements;
(3) additionally, applicants shall meet all
established requirements for initial licensing as identified by the current EMS
licensure regulations;
(4) a copy of these regulations is available
through the EMS bureau;
(5) generally, the knowledge and skills
required demonstrate the need for a high school education or equivalent;
(6) ability to communicate verbally; via
telephone and radio equipment;
(7) ability to lift, carry, and balance up to
125 pounds (250 pounds with assistance);
(8) ability to interpret written, oral, and
diagnostic form instructions;
(9) ability to use good judgment and to remain
calm in high-stress situations;
(10) ability to work effectively in an
environment with loud noises and flashing lights;
(11) ability to function efficiently throughout
an entire work shift;
(12) ability to calculate weight and volume
ratios and read small English print, both under life threatening time
constraints;
(13) ability to read and understand English
language manuals and road maps;
(14) accurately discern street signs and
address numbers;
(15) ability to interview patient, family
members, and bystanders;
(16) ability to document, in writing, all
relevant information in a prescribed format;
(17)
ability to converse orally and in
written form in English with coworkers and hospital staff as to status of
patient;
(18) good manual dexterity, with ability to
perform all tasks related to the highest quality of patient care;
(19) ability to assume a variety of postural
positions to carry out emergency and non-emergency patient care, including
light extrication; from crawling, kneeling, squatting, twisting, turning,
bending, to climbing stairs and ladders, and the ability to withstand varied
environmental conditions such as extreme heat, cold, and moisture; and
(20) ability to work in low light, confined
spaces and other dangerous environments.
C. Competency areas:
(1)
Licensed EMS first responder: Must demonstrate competency handling
emergencies utilizing all basic life support equipment and skills in accordance
with all behavioral objectives of the approved New Mexico curriculum of first
responder, to include the ability to demonstrate competency for all skills and
procedures currently approved for the first responder, as identified by the
current scope of practice document.
(2) Emergency
medical technician-basic: Must
demonstrate competency handling emergencies utilizing all basic life support
equipment and skills in accordance with all behavioral objectives of the
approved New Mexico curriculum of EMT-basic, and to include the ability to
demonstrate competency for all skills and procedures currently approved for the
EMT-basic, as identified by the current scope of practice document.
(3) Emergency
medical technician-intermediate:
Must demonstrate competency handling emergencies utilizing all basic
life support and intermediate life support equipment and skills in accordance
with all behavioral objectives of the approved New Mexico curriculum of
EMT-intermediate, and to include the ability to demonstrate competency for all
skills and procedures currently approved for the EMT-intermediate, as
identified by the current scope of practice document.
(4) Emergency
medical technician-paramedic: Must
demonstrate competency handling emergencies utilizing all basic life support
and advanced life support equipment and skills in accordance with all
behavioral objectives of an approved New Mexico curriculum of EMT-paramedic,
and to include the ability to demonstrate competency for all skills and
procedures currently approved for the EMT-paramedic, as identified by the
current scope of practice document.
D. Description of tasks for all EMS levels:
(1) Receives call from dispatcher, responds
verbally to emergency calls, reads maps, may drive emergency vehicle to
emergency site, uses most expeditious route, and observes traffic ordinances
and regulations.
(2) Determines nature and extent of illness or
injury, takes pulse, blood pressure, visually observes changes in skin color,
auscultate breath sounds, makes determination regarding patient status,
establishes priority for emergency care, may administer intravenous drugs or
fluid replacement as authorized by level of licensure and scope of practice.
(3) May use equipment and other devices and
procedures as authorized by level of licensure and scope of practice.
(4) Assists in lifting, carrying, and
transporting patient to an ambulance and to a medical facility.
(5) Reassures patients and bystanders and
searches for medical identification emblem to aid in care.
(6) Extricates patient from entrapment,
assesses extent of injury, uses prescribed techniques and appliances, radio
dispatcher for additional assistance or services, provides light rescue service
if required and trained, provides additional emergency care following service
established protocols.
(7) Complies with regulations in handling
deceased, notifies authorities, arranges for protection of property and
evidence at scene.
(8) Determines appropriate facility to which
patient will be transported, report nature and extent of injuries or illness to
the facility, asks for direction from hospital physician or emergency
department staff.
(9) Observes patient in route and administers
care as directed by physician or service- established protocols.
(10) Identifies diagnostic signs that require
communication with facility.
(11) Assists in removing patient(s) from
ambulance and into emergency facility.
(l2) Reports verbally, and in writing,
observations about and care of patient at the scene, en-route to facility, and
to the receiving facility. Written
reports shall be completed for all patient interactions, which include any
visual, verbal, or physical patient contact, by the most appropriate EMS
caregiver, whether or not the patient was transported to a facility, including
patient refusals.
(13) Provides assistance to emergency
department staff as required.
(14) Replaces supplies, sends used supplies for
sterilization, checks all equipment for future readiness, maintains ambulance in
operable condition, ensures ambulance cleanliness and orderliness of equipment
and supplies, decontaminates vehicle interior, determines vehicle readiness by
checking oil, gas, water in battery and radiator, and tire pressure, maintains
familiarity with all specialized equipment.
[7.27.11.11 NMAC - Rp, 7.27.11.12 NMAC, 8/15/14]
HISTORY
OF 7.27.11 NMAC:
History
of Repealed Material:
7.27.11 NMAC, Supplemental Licensing
Provisions (filed 12/17/2012) repealed 8/15/14.
