Section R9-25-202. On-line 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))

A.      An emergency medical services provider or ambulance service shall:

1.        Ensure that a physician provides on-line medical direc- tion to EMCTs on behalf of the emergency medical ser- vices provider or ambulance service only if the physician

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 that meets the requirements in R9-25- 201(A)(1)(d)(i) through (iii);

2.        For each physician providing on-line medical direction on behalf of the emergency medical services provider or ambulance service, maintain for Department review either:

a.         The name, e-mail address, telephone number, and qualifications of the physician providing on-line medical direction on behalf of the emergency medi- cal services provider or ambulance service; or

b.        If the emergency medical services provider or ambu- lance service provides on-line medical direction through an ALS base hospital or a centralized medi- cal direction communications center, a copy of a written agreement with the ALS base hospital or centralized medical direction communications cen- ter documenting that the physician providing on-line medical direction is qualified under subsection (A)(1);

3.        Ensure that the on-line medical direction provided to an EMCT on behalf of the emergency medical services pro- vider or ambulance service is consistent with:

a.         The EMCT’s scope of practice, as specified in Table 5.1; and

b.        Communication protocols, triage protocols, treat- ment protocols, and protocols for prehospital inci- dent history reports, specified in R9-25-201(E)(2); and

4.        Ensures that a physician providing on-line medical direc- tion on behalf of the emergency medical services pro- vider or ambulance service relays on-line medical direction only through one of the following individuals, under the supervision of the physician and consistent with the individual’s scope of practice:

a.         Another physician,

b.        A physician assistant,

c.         A registered nurse practitioner,

d.        A registered nurse,

e.         A Paramedic, or

f.         An EMT-I(99).

B.       An emergency medical services provider or ambulance service may provide on-line medical direction through an ALS base hospital that is a special hospital, if the emergency medical services provider or ambulance service:

1.        Uses the ALS base hospital that is a special hospital for on-line medical direction only for patients who are chil- dren, 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 on-line medical direction.

C.      An emergency medical services provider or ambulance service shall ensure that the emergency medical services provider or ambulance service, or an ALS base hospital or a centralized medical direction communications center providing on-line medical direction on behalf of the emergency medical services provider or ambulance service, has:

1.        Operational and accessible communication equipment that will allow on-line medical direction to be given to an

meets one of the following:

a.         Has emergency medicine certification issued by a

EMCT;

2.        A written

plan for alternative communications with an

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

EMCT in the event of a disaster, communication equip- ment breakdown or repair, power outage, or malfunction; and

3.        A physician qualified under subsection (A)(1) available to give on-line medical direction to an EMCT 24 hours a day, seven days a week.

Historical Note

Adopted effective October 15, 1996 (Supp. 96-4). Former

R9-25-202 renumbered to R9-25-208; new R9-25-202 made by final rulemaking at 9 A.A.R. 5372, effective January 3, 2004 (Supp. 03-4). Section R9-25-202 renum- bered to Section R9-25-201; new Section R9-25-202 renumbered from R9-25-203 and amended by exempt rulemaking at 19 A.A.R. 4032, effective December 1,

2013 (Supp. 13-4).