1. Rules and Regs

2. Topics Brief Review of National EMS Documents Changes to the EMS Act Proposed Changes to the rules and Regulations

3. National Documents EMS Agenda for the Future – Rural/Frontier EMS Agenda for the Future – EMS Education Agenda for the Future National Practice Analysis National Scope of Practice National EMS Education Standards National EMS Education Guide Lines

4. EMS Act EMS Act Changed in 2010 to reflect the new EMS Provider Level Titles Effective Sept 2010 EMS Act changed to reflect National EMS Scope of Practice and National EMS Educational Standards until modified by the rules and regulations

5. Titles - Found in the EMS Act Old First Responder Emergency Medical Technician Emergency Medical Technician – Intermediate Emergency Medical Technician - Paramedic New Emergency Medical Responder Emergency Medical Technician Advanced Emergency Medical Technician Paramedic

6. Proposed Rules and Regs Rule and Regulations changes have not gone into effect. Im presenting what is PROPOSED

7. EMS Board Scope Of Practice Committee Two Physicians Two Paramedics One Nurse One EMT One 1 st Responder Began working over three years ago Discussed at and input received – State and Local EMS Conferences - Fire School – Training Agency Meetings - Instructor Meetings – Written

8. Regulation Changes Work Done Change to EMS Act – Spring 2010 – Effective Fall 2010 Scope Approved – Fall 2009 Draft of regulation submitted to HHS –March 2010 Draft in proper wording approved by EMS Board June 2010 Several Refinements made between June and December 2010

9. To Be Done Submitted to Governor's Office for Approval March 2011 – Awaiting Approval Public Hearing Board Addresses Comments (if any) Approval by Attorney General Approval By Board of Health Governor signs Becomes effective

10. Regulations Title 172 Chapter 11 – Out of Hospital Emergency Care Providers Title 172 Chapter 12 – EMS Services Title 172 Chapter 13 – Training Agencies Title 172 Chapter 14 – Public Access AED

11. Practices and Procedures a/k/a Scope of Practice

12. Emergency Medical Responder EMR Practices and Procedures

13. Emergency Medical Responder Current - 1st Responder Option One – Non affiliated with a Service Option Two – Member of a Licensed Service – PMD had to Approve Added Skills – Added Training Proposed SAME

14. Emergency Medical Responder Assessment Skills Current - 1st Responder Simple Assessment – Defined in Model Protocols Vitals – Pulse – Resp Rate – BP Proposed Assessment – Defined in Rules and Regs Vitals – Pulse – Resp Rate – BP

15. Emergency Medical Responder A – B – C s Current - 1st Responder Manual Airway Maneuvers No Airway Adjuncts O 2 – ONLY when member of a service and had training and PMD Approval BVM Ambiguous Wording (maybe ????) CPR - Ambiguous Wording AED Proposed Manual Airway Maneuvers Oral Suctioning Oral Airway O 2 Nasal Cannula, NRM BVM With or Without O 2 AED CPR – Manual Only, No Mechanical CPR

16. Emergency Medical Responder Trauma Care Current - 1st Responder Bleeding Control -Bandaging Manual Stabilize – C-Spine – Extremity Injuries Emergency Moves If with a Service and with Training and PMD Approval – Use Immobilization devices Spinal Extremity Proposed Bleeding Control -Bandaging Manual Stabilize – C-Spine – Extremity Injuries Emergency Moves If with a Service and with Training and PMD Approval – Use Immobilization devices Spinal Extremity Transport Devices (stretcher Stair Chairs etc)

17. Emergency Medical Responder Medications Current - 1st Responder If with a Service and with Training and PMD Approval – Aspirin – Epi Auto injector – Oxygen Proposed Auto Injector Antidote Kits * Oxygen in the Base Skill Set If with a Service and with Training and PMD Approval – Aspirin – Epi Auto injector *Not required to be a member of a service – Intended for self administration and disasters

18. Emergency Medical Responder Other Skills Current - 1st Responder Assist an EMT – Ambiguous Wording – Maybe ??? No Patient Transport Childbirth Documentation Proposed If with a Service and with Training and PMD Approval – May assist an EMT or Higher Provider during transport – Transport a Patient Additional Requirement for Services in Chapter 12 Assist with Normal Childbirth Documentation

19. Emergency Medical Responder Added Training Current - 1st Responder Add On Training Modules could be completed as part of the base class Proposed All Add On Training Modules must be completed AFTER the individual has a license. Must complete course and pass and get a license prior to getting the add on training.

20. Emergency Medical Responder Transport Requirements (Proposed) Can only be done when an EMT or higher level provider dose not respond. Only for when an EMT or high level provider FAILS TO RESPOND It IS NOT intended for when an EMT or higher level provider responds but is unwilling or unavailable to transport.

21. Emergency Medical Responder Transport Requirements (Proposed) The Individual EMR must hve – Added training – PMD Approval The Service must have – PMD Approval – Recruitment Retention Plan which includes Antidiscrimination policy Budget Leadership Training Recruitment Retention steps

22. Emergency Medical Responder Transport Requirements (Proposed) The Service must have an Active schedule that includes – Date and time periods – Individuals available to respond – Updated not less than monthly – Identifies open places in the schedule and the automatic aid plan is to be follow

23. Emergency Medical Responder Transport Requirements (Proposed) The Service must have an automatic aid plan which includes – Intercepting with a back-up service allow patient care to be transferred to an E M T or higher level provider. – Dispatch of the licensed service and the back-up licensed service at the same time without a requirement for a verbal request from the initial licensed service. – Allows the licensed service to contact the dispatch center to request the backup service when a scheduled providers fails to respond

24. Emergency Medical Responder Transport Requirements (Proposed) The Service must have an automatic aid plan which includes – Allows the service to cancel the back-up service should an EMT or higher level provider respond – Lists the service, the backup service and dispatching agency – Lists the service members responsible for notifying the dispatch to follow the automatic aid plan. – Signed by service and backup service – Acknowledgment of receipt of the plan by the dispatching agency

25. Emergency Medical Responder Transport Requirements (Proposed) The Service must submit a report for each event to the board stating The name of the service The name of the back-up service The names of all the licensed services members or employees that responded to the event The date and time of the event The patient condition and care provided The actions taken to notified Emergency Medical Technician(s) or higher level of out of hospital care provider

26. Emergency Medical Responder Transport Requirements (Proposed) The Service must submit a report for each event to the board stating – Reason(s) the Emergency Medical Technician or higher provider did not respond – The licensed service attests it meets all the Service requirements to allow for EMR Transport

27. Emergency Medical Technician EMT Practices and Procedures

28. Emergency Medical Technician Current Must function with a service Proposed Same No Lone Wolves

29. Emergency Medical Technician Assessment Current Basic Assessment - Ambiguous Wording Vitals - Ambiguous Wording Proposed Assessment Defined in Rules and Regs Better Vitals – Pulse – BP (manual)** – Resp Rate – Pulse Ox ** **See Noninvasive monitoring devices

30. Emergency Medical Technician Assessment Current GCS – Trauma Score – Stroke Scale by board opinion only as a stop gap until new rules and regs approved Proposed Nationally recognized noninvasive scales and scores – GCS – Trauma Score – Stroke Scales

31. Emergency Medical Technician Assessment Current Automatic BP, Pulse Ox and other noninvasive monitoring – Not allowed OR – Wording was ambiguous Proposed Non-invasive patient monitoring devices – Pulse Ox – Automatic BP – CO Monitoring – Temperature – Apply EKG Electrodes – Obtain an EKG for transmission or interpretation by high level provider

32. Emergency Medical Technician Airway Current Manual airway maneuvers Oral Suctioning Oral and Nasal Airways – Place only Proposed Manual airway maneuvers Suctioning – Upper Airway – Stoma Oral and Nasal Airways – Insert and Remove

33. Emergency Medical Technician Advanced Airway Additional Skill Current With Training and PMD Approval Limited by approved course – Combi tube – LMA – Lighted Stylet – Visualized intubation Proposed With Training, PMD Approval, and Licensed Insertion and removal of advanced airway adjuncts limited to – Combi tube – King tube

34. Emergency Medical Technician Breathing/Oxygen Current BVM Flow restricted oxygen powered device Oxygen administration – Nasal Cannula – NRM Proposed Positive pressure ventilation by – Bag valve mask or – Manually triggered oxygen powered device Oxygen administration – Nasal Cannula – NRM – Venturi mask

35. Emergency Medical Technician Circulation Current AED CPR Proposed AED CPR – Manual – Mechanical

36. Emergency Medical Technician Trauma Current Manual Stabilization – Ambiguous Wording Spinal Immobilization – Ambiguous Wording Extremity Immobilization Bleeding control Bandaging Treat Shock Proposed Manual stabilization Immobilization – spinal and – extremity injuries Application of cold and heat Control hemorrhaging including tourniquet Bandaging wounds Non - Invasive treatment of shock

37. Emergency Medical Technician Medications Current Assisted Medications – Sublingual nitroglycerin – Epinephrine auto-injectors – Hand-held aerosol inhalers. Oral Glucose Activated Charcoal Proposed Assisted Medications – Nitroglycerin – Epinephrine auto injector – Bronchodilators Oral Glucose Aspirin Auto Injector Antidote kit Self Administration certain meds for protection of from infectious disease after an exposure

38. Emergency Medical Technician Other Medications – Additional Skill Current With Training and PMD Approval – Epi Auto Injector – Aspirin – Albuterol Proposed With Training, PMD Approval, and Licensed – Epi Auto Injector – Albuterol Aspirin in base skills no added training

39. Emergency Medical Technician Other Skills Current Child birth With Training and PMD Approval Proposed Child birth Monitor an established – Gastric Tube – Urinary Catheter

40. Emergency Medical Technician Additional Skills Current With Training and PMD Approval – IV Monitor – IV Access – Fluids listed as isotonic Proposed With Training, PMD Approval, and Licensed IV Monitor limited to – Normal Saline – Lactated Ringers – D5W Establish Peripheral IV – Limited to same fluids

41. Emergency Medical Technician Additional Skills Current With Training and PMD Approval – Glucose monitor Proposed With Training, PMD Approval, and Licensed – Glucose monitor

42. Emergency Medical Technician Additional Skills = Added Training Current Add On Training Modules could be completed as part of the base class Proposed All Add On Training Modules must be completed AFTER the individual has a license – Must complete course and pass and get a license prior to getting the add on training.

43. Advanced Emergency Medical Technician AEMT Practices and Procedures

44. AEMT – All New To function as an AEMT must be member of an ALS Service In Addition to All the EMT Skills – Advanced Airway – Combi tube and King Tube – IV Start and Monitor – Medications Aspirin Nitroglycerin Albuterol Epi 1:1000 Glucagon Dextrose 50% Naloxone Morphine

45. EMT-Intermediate Can function as long as the EMT-I – Doesnt let his/her license lapse Includes filing for renewal after 12/31 of the year – Doesn't surrender or loose license – Doesn't upgrade or down grade levels Wording Changed Scope Remained the same

46. Paramedic Wording Changed Some ambiguous wording is cleared up. Scope is same

47. Chapter 11 Other PROPOSED Changes

48. Added the names for the new provider licensure categories; Emergency Medical Responder, Advanced Emergency Medical Technician, and Paramedic. Replaces the current classification of first responders, EMT- Intermediate, and EMT- Paramedic. Delineates the requirements for EMT- Intermediates to renew or reinstate their license after 9-1-10.

49. Provides for the issuance of a temporary license for an individual who has completed the training but has not passed the licensure examination. Adopts the U.S. Department of Transportation National Emergency Medical Services Education Standards and the National Emergency Medical Services Scope of Practice. Added verification of lawful presence in the U.S. for all applicants who are applying for initial licensure, renewal or reinstatement of a license.

50. Further delineates acts or behaviors considered unprofessional conduct – Fraud – Cheating on licensing exam – False Identification of level – Breach of Confidentiality – Practice out of scope – Patient Abuse

51. Changed renewal from triennial to biennial and decreased the number of continuing education hours required for renewal of the following licenses: CurrentRevision Emergency Medical Responder2014 Emergency Medical Technician3020 EMT-Intermediate`4530 Paramedic6040 (Changed the renewal date for all licensees to 12/31 even years, except for all EMTs who will renew on 12/31 odd years.

52. Added a section on defining acceptable and non-acceptable continuing education activities.(11-007) Added endotrachael injections of approved medication to paramedic practice and procedures.(11-009) Added the utilization of nationally recognized scales and/or scores to a basic patient assessment under the practice and procedures section for EMTs.(11-009)

53. Added practice and procedure sections for temporary license holders and Advanced EMTs. (11-009) Added the allowance of one hour of credit for each hour of instruction by a licensee acting as an instructor of an EMS course as defined in the regulations under 11-002. One third of the total CE hours required for renewal may be used by this method.(11-007.06)

54. Added section on voluntary surrender or limitation.(11-011) Added section on reinstatement of licenses for those who previously held licenses (11-012)

55. Chapter 12 PROPOSED Changes

56. Added a definition for emergency call, incident and incident commander (12-002) Revised requirements for what a back up response plan must contain and that it must be signed by both physician medical directors of the transport and non- transport services. (12 – 003) Lists requirements that a service must meet when it utilizes EMRs to transport patients.12- 004.10 item 2)

57. Revises inspection section to include: – Onsite inspections that include random inspections completed by a Department inspector; and – Self-inspections to be completed by each service at the time they are required to renew their license ( every 2 years) – Acceptance of a current certification from the Commission on Accreditation of Medical Transport Systems in place of the self inspection or random audit.(12-005)

58. Renewal period changes- All emergency medical services will expire on the same date, 12/31 even years.(12-007) Two years after the effective date of these proposed changes to chapter 12, patient care and incident information must be submitted to the Department electronically and within 48 hours of the incident.(12-004.09C4) Clarifies that all services must document and submit to the Department patient care information even if the service does not transport. (12-004.09C)

59. Requires identification of the provider responsible for patient care in each patient care record.(12- 004.09C1 item 27) Clarifies that documentation of all required training for out-of-hospital emergency care providers will be maintained by the service. (12-004.07A) Clarifies that a service must report to the Department each month that the service has not completed a run during that month.(12-004.09C2)

60. Clarifies that the documentation that the service maintains for providers continuing education hours must include the certificates of attendance /participation.(12-004.09A item 2) Added section on disciplinary action that includes: temporary suspension, sanctions and additional terms and conditions of discipline (12-008) Added section on voluntary surrender or limitation.(12-009) Added section on re-application for services who were previously licensed (12-010)

61. Chapter 13 PROPOSED Changes

62. Adds definition for Additional Skills Course as the one that includes all the additional skills that can be performed by an EMR or EMT over and above the basic EMR or EMT course. (13-002) Mandates that Training Agencies may only teach EMRs or EMTs the additional skills course after the individual has received their State license. The additional skills may be taught independently, grouped in 2-3 topics or consolidated into one course. (This is determined by the training agency) (13-002)

63. Added definitions for field experience (for students), field supervisions (for temporary license holders), and field supervisor that may supervise either a student or temporary license holder) (13-002) Requires all training agencies that provide paramedic training to be accredited by CoAEMSP on January 1, 2012. (13-003.01 item 1) Lists additional requirements to be printed on the official verification given to students who complete an EMS course. (13-004.06) Requires training agencies to maintain student, instructor and course records for five years. (13- 004.07)

64. Decreased EMS instructor continuing education hours from 18 to 12 hours due to change in the renewal period from every three years to every two years and changed the renewal date to 12/31 every even year. The 12 continuing education hours must cover all of the following subjects; EMS course curriculum updates, EMS legislation and regulations, EMS evaluation methods, and Fundamentals of teaching adults. Added information on audit and waiver of continuing education hours. (13-012) Added teaching outside the limit of the practices and procedures for out-of-hospital emergency providers as a ground for disciplining the license of an EMS instructor.(13- 013)

66. Added to the list of qualifications required for approval as an EMS training agency.(13-003) Clarified that training agencies must conduct the practical skills component of the licensing examination at the end of the course and use qualified examiners as determined by NREMT.(13- 004.04 and 13-004.05) Revises the definition of distributive learning and that all distributive learning courses must be taught by an approved distributive learning provider. (13- 002)

67. Added that all applicants for a license are required to verify their lawful presence in the United States.(13- 010) Added section on disciplinary action that includes: unprofessional conduct, temporary suspension, sanctions and additional terms and conditions of discipline (13-013) Added section on voluntary surrender or limitation.(13-014) Added section on reinstatement of instructor license (13-015)

68. **These regulations are only proposed.