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Arizona Administrative Code (Last Updated: November 17, 2016) |
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Title 9. HEALTH SERVICES |
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Chapter 25. DEPARTMENT OF HEALTH SERVICES - EMERGENCY MEDICAL SERVICES |
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Article 2. MEDICAL DIRECTION; ALS BASE HOSPITAL CERTIFICATION |
Section R9-25-201. Administrative Medical Direction (Authorized by A.R.S. §§ 36-2201, 36-2202(A)(3) and (A)(4), 36-2204(5), (6), and (7), 36-2204.01, and 36-2205(A) and (D))
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A. An emergency medical services provider or ambulance service shall:
1. Except as specified in subsection (B) or (C), designate a physician as administrative medical director who meets one of the following:
a. Has emergency medicine certification issued by a member board of the American Board of Medical Specialties;
b. Has emergency medical services certification issued by the American Board of Emergency Medicine;
c. Has completed an emergency medicine residency training program accredited by the Accreditation Council for Graduate Medical Education or approved by the American Osteopathic Association; or
d. Is an emergency medicine physician in an emer- gency department located in Arizona and has current certification in:
i. Advanced emergency cardiac life support that includes didactic instruction and a practical skills test, consistent with training recognized by the American Heart Association, in:
(1) Airway management during respiratory arrest;
(2) Recognition of tachycardia, bradycardia, pulseless ventricular tachycardia, ventric- ular fibrillation, pulseless electrical activ- ity, and asystole;
(3) Pharmacologic, mechanical, and electri- cal arrhythmia interventions; and
(4) Immediate post-cardiac arrest care;
ii. Advanced trauma life support recognized by the American College of Surgeons; and
iii. Pediatric advanced life support that includes didactic instruction and a practical skills test, consistent with training recognized by the American Heart Association, in:
(1) Pediatric rhythm interpretation;
(2) Oral, tracheal, and nasal airway manage- ment;
(3) Peripheral and central intravenous lines;
(4) Intraosseous infusion;
(5) Needle thoracostomy; and
(6) Pharmacologic, mechanical, and electri- cal arrhythmia interventions;
2. If the emergency medical services provider or ambulance service designates a physician as administrative director according to subsection (A)(1), notify the Department in writing:
a. Of the identity and qualifications of the designated physician within 10 days after designating the physi- cian as administrative medical director; and
b. Within 10 days after learning that a physician desig- nated as administrative director is no longer quali- fied to be an administrative director; and
3. Maintain for Department review:
a. A copy of the policies, procedures, protocols, and documentation required in subsection (E); and
b. Either:
i. The name, e-mail address, telephone number, and qualifications of the physician providing administrative medical direction on behalf of the emergency medical services provider or ambulance service; or
ii. If the emergency medical services provider or ambulance service provides administrative medical direction through an ALS base hospital or a centralized medical direction communica- tions center, a copy of a written agreement with the ALS base hospital or centralized medical direction communications center documenting that the administrative medical director is qual- ified under subsection (A)(1).
B. Except as provided in R9-25-502(A)(3), if an emergency med- ical services provider or ambulance service provides only BLS, the emergency medical services provider or ambulance service is not required to have an administrative medical direc- tor.
C. If an emergency medical services provider or ambulance ser- vice provides administrative medical direction through an ALS base hospital or a centralized medical direction commu- nications center, the emergency medical services provider or ambulance service shall ensure that the ALS base hospital or centralized medical direction communications center desig- nates a physician as administrative medical director who meets one of the requirements in subsections (A)(1)(a) through (d).
D. An emergency medical services provider or ambulance service may provide administrative medical direction through an ALS base hospital that is a special hospital, if the emergency medi- cal services provider or ambulance service:
1. Uses the ALS base hospital that is a special hospital for administrative medical direction only for patients who are children, and
2. Has a written agreement with an ALS base hospital that meets the requirements in R9-25-203(B)(1) or a central- ized medical direction communications center for the provision of administrative medical direction.
E. An emergency medical services provider or an ambulance ser- vice shall ensure that:
1. An EMCT receives administrative medical direction as required by A.R.S. Title 36, Chapter 21.1 and this Chap- ter;
2. Protocols are established, documented, and implemented by an administrative medical director, consistent with
A.R.S. Title 36, Chapter 21.1 and this Chapter, that include:
a. A communication protocol for:
i. How an EMCT requests and receives on-line medical direction,
ii. When and how an EMCT notifies a health care institution of the EMCT’s intent to transport a patient to the health care institution, and
iii. What procedures an EMCT follows in the event of a communications equipment failure;
b. A triage protocol for:
i. How an EMCT assesses and prioritizes the medical condition of a patient,
ii. How an EMCT selects a health care institution to which a patient may be transported,
iii. How a patient is transported to the health care institution, and
iv. When on-line medical direction is required;
c. A treatment protocol for:
i. How an EMCT performs a medical treatment on a patient or administers an agent to a patient, and
ii. When on-line medical direction is required while an EMCT is providing treatment; and
d. A protocol for the transfer of information to the emergency receiving facility, including:
i. The information required to be communicated to emergency receiving facility staff upon transfer of care, including the condition of the patient, the treatment provided to the patient, and the patient’s response to the treatment;
ii. The information required to be documented on a prehospital incident history report; and
iii. The time-frame, which is associated with the transfer of care, for completion of a prehospital incident history report;
3. Policies and procedures are established, documented, and implemented by an administrative medical director, con- sistent with A.R.S. Title 36, Chapter 21.1 and this Chap- ter, that:
a. Are consistent with an EMCT’s scope of practice, as specified in Table 5.1;
b. Cover:
i. Medical recordkeeping;
ii. Medical reporting;
iii. Processing of prehospital incident history reports;
iv. Obtaining, storing, transferring, and disposing of agents to which an EMCT has access includ- ing methods to:
(1) Identify individuals authorized by the administrative medical director to have access to agents,
(2) Maintain chain of custody for controlled substances, and
(3) Minimize potential degradation of agents due to temperature extremes;
v. Administration, monitoring, or assisting in patient self-administration of an agent;
vi. Monitoring and evaluating an EMCT’s compli- ance with treatment protocols, triage protocols, and communications protocols specified in sub- section (E)(2);
vii. Monitoring and evaluating an EMCT’s compli- ance with medical recordkeeping, medical reporting, and prehospital incident history report requirements;
viii. Monitoring and evaluating an EMCT’s compli- ance with policies and procedures for agents to which the EMCT has access;
ix. Monitoring and evaluating an EMCT’s compe- tency in performing skills authorized for the EMCT by the EMCT’s administrative medical director and within the EMCT’s scope of prac- tice, as specified in Table 5.1;
x. Ongoing education, training, or remediation necessary to maintain or enhance an EMCT’s competency in performing skills within the EMCT’s scope of practice, as specified in Table 5.1;
xi. The process by which administrative medical direction is withdrawn from an EMCT; and
xii. The process for reinstating an EMCT’s admin- istrative medical direction; and
c. Include a quality assurance process to evaluate the effectiveness of the administrative medical direction provided to EMCTs;
4. Protocols in subsection (E)(2) and policies and proce- dures in subsection (E)(3) are reviewed annually by the administrative medical director and updated as necessary;
5. Requirements in A.R.S. Title 36, Chapter 21.1 and this Chapter are reviewed annually by the administrative medical director; and
6. The Department is notified in writing no later than ten days after the date:
a. Administrative medical direction is withdrawn from an EMCT; or
b. An EMCT’s administrative medical direction is rein- stated.
F. An administrative medical director for an emergency medical services provider or ambulance service shall ensure that:
1. An EMCT for whom the administrative medical director provides administrative medical direction:
a. Has access to at least the minimum supply of agents required for the highest level of service to be pro- vided by the EMCT;
b. Administers, monitors, or assists in patient self- administration of an agent according to the require- ments in policies and procedures; and
c. Has access to a copy of the policies and procedures required in subsection (F)(2) while on duty for the emergency medical services provider or ambulance service;
2. Policies and procedures for agents to which an EMCT has access:
a. Specify that an agent is obtained only from a person:
i. Authorized by law to prescribe the agent, or
ii. Licensed under A.R.S. Title 36, Chapter 27;
A.R.S. Title 32, Chapter 18; and 4 A.A.C. 23 to dispense or distribute the agent;
b. Cover chain of custody and transfer procedures for each supply of agents, requiring an EMCT for whom the administrative medical director provides admin- istrative medical direction to:
i. Document the name and the EMCT certifica- tion number or employee identification number of each individual who takes physical control of the supply of agents;
ii. Document the time and date that each individ- ual takes physical control of the supply of agents;
iii. Inspect the supply of agents for expired agents, deteriorated agents, damaged or altered agent containers or labels, and depleted, visibly adul- terated, or missing agents upon taking physical control of the supply of agents;
iv. Document any of the conditions in subsection (F)(2)(b)(iii);
v. Notify the administrative medical director of a depleted, visibly adulterated, or missing con- trolled substance;
vi. Obtain a replacement for each affected agent in subsection (F)(2)(b)(iii) for which the mini- mum supply is not present; and
vii. Record each administration of an agent on a prehospital incident history report;
c. Cover mechanisms for controlling inventory of agents and preventing diversion of controlled sub- stances; and
d. Include that an agent is kept inaccessible to all indi- viduals who are not authorized access to the agent by policies and procedures required under subsec- tion (E)(3)(b)(iv)(1) and, when not being adminis- tered, is:
i. Secured in a dry, clean, washable receptacle;
ii. While on a motor vehicle or aircraft, secured in a manner that restricts movement of the agent and the receptacle specified in subsection (F)(2)(d)(i); and
iii. If a controlled substance, in the receptacle specified in subsection (F)(2)(d)(i) and locked in an ambulance in a hard-shelled container that is difficult to breach without the use of a power cutting tool;
3. The Department is notified in writing within 10 days after the administrative medical director receives notice, as required subsection (F)(2)(b)(v), that any quantity of a controlled substance is depleted, visibly adulterated, or missing; and
4. Except when the emergency medical services provider or ambulance service obtains all agents from an ALS base hospital pharmacy, which retains ownership of the agents, agents to which an EMCT has access are obtained, stored, transferred, and disposed of according to policies and procedures; A.R.S. Title 36, Chapter 27; A.R.S. Title 32, Chapter 18; 4 A.A.C. 23; and requirements of the U.S. Drug Enforcement Administration.
G. An administrative medical director may delegate responsibili- ties to an individual as necessary to fulfill the requirements in this Section, if the individual is:
1. Another physician,
2. A physician assistant,
3. A registered nurse practitioner,
4. A registered nurse,
5. A Paramedic, or
6. An EMT-I(99).
Historical Note
Adopted effective October 15, 1996 (Supp. 96-4). Former R9-25-201 renumbered to R9-25-207; new R9-25-201 made by final rulemaking at 9 A.A.R. 5372, effective January 3, 2004 (Supp. 03-4). Section repealed; new Section R9-25-201 renumbered from R9-25-202 and amended by exempt rulemaking at 19 A.A.R. 4032, effective December 1, 2013 (Supp. 13-4).