DIVISION OF HEALTH INFRASTRUCTURE PREPAREDNESS AND EMERGENCY. Mobility Assistance Vehicle and Basic Life Support Ambulance Services

Transcription

1 HEALTH AND SENIOR SERVICES PUBLIC HEALTH SERVICES BRANCH DIVISION OF HEALTH INFRASTRUCTURE PREPAREDNESS AND EMERGENCY RESPONSE OFFICE OF EMERGENCY MEDICAL SERVICES Mobility Assistance Vehicle and Basic Life Support Ambulance Services Readoption: N.J.A.C. 8:40 Proposed: May 18, 2009 at 41 N.J.R. 2070(a). Adopted:, 2009 by Heather Howard, Commissioner, Department of Health and Senior Services (with the approval of the Health Care Administration Board). Filed:, 2009 as R.2009, d., without change. Authority: N.J.S.A. 26:2H-1 et seq. and 30:4D-6.4 and 6.6. Effective Date:, Expiration Date:, Summary of Public Comments and Agency Responses: NJ City, NJ The Department received timely comments received from the following: 1. Michael Coyle, Chief, Pennsauken EMS, Pennsauken, NJ 2. Randall J. McCargar, EMS Chief, Cherry Hill Fire Department, Cherry Hill, 3. John McNutt, Battalion Chief, Gloucester City Fire Department, Gloucester 4. Joyce Midure, Chief, Winslow EMS, Cedar Brook, NJ

2 5. The Department received letters containing nearly identical comments from the following: Brian Allegretto, EMT-Paramedic, Seaville, NJ James G. Busch, EMT-Paramedic Mary Daley, MICP, RN, Toms River, NJ Barbara L. DeLoune, MICP, Point Pleasant, NJ Vincent DeRosa, MICP, Ocean, NJ Dwight, Red Bank, NJ Ms. Caitlin Dwight, Red Bank, NJ Ms. Martha Dwight, Red Bank, NJ Ms. Sarah Dwight, Red Bank, NJ Deborah Ehling, RN, MICP, CEN, VP, Acting President, Professional Emergency Medical Services Association of New Jersey, Wall, NJ Catherine Geiger, EMT-Paramedic, RN, Ocean, NJ Mary Geiger, EMT-Basic, Ocean, NJ Joe Giberson, EMT-Paramedic, Cedar Run, NJ Lisa Kahle, MICP, Jackson, NJ David B. Kelly, MICP, Red Bank, NJ James Kelly, EMT-Basic, Red Bank, NJ George Ketterer, EMT-Paramedic, Belford, NJ Michael Krot, MICN, RN, EMT-Basic, Jackson, NJ Nancy Krot, RN, EMT-Basic, Jackson, NJ 2

3 Timothy McGarry, MICP, RN, Bayville, NJ George Olschewski, MICN, Wanaque, NJ Christine Pagano, MICP, Forked River, NJ Dante Pagano, RN, MICP, Forked River, NJ Charles F. Russell, Jr., EMT-Basic, Toms River, NJ William F. Scott, EMT-Paramedic, Manahawkin, NJ Dennis W. Smith, EMT-Paramedic, Toms River, NJ John Suanno, EMT-Paramedic, Jackson, NJ Lorraine Taraskus, EMT-Paramedic Robert Trzepizur, MICP, Jackson, NJ Alison Turton, EMT-Basic Henry Wienekeu, EMT-Paramedic, RN, Point Pleasant Borough, NJ 1. COMMENT: A commenter states, readopting the current N.J.A.C. 8:40 without any changes acts as a disservice to the residents and motoring public of the State of New Jersey. The commenter employs several New Jersey certified [EMT- Paramedics] who can only act in an [EMT-Basic] capacity while riding on [the commenter s] ambulances. [EMT-Basics] all have a duty to act when coming upon a medical emergency, while on duty and off. However, [EMT-Paramedics are] forbidden to act in their certified capacity while riding on a BLS ambulance. [The commenter questions] how this benefits the patient. The commenter asserts that increasing the scope of practice of EMT-Basics would enhance the pre-hospital EMS to the residents of New Jersey. The commenter states that the municipal emergency medical services 3

4 squad the commenter represents has retained a medical director who is willing to provide necessary training, and the municipality is willing to provide funding for training costs, to increase the scope of practice of the EMT-Basics in its employ. The commenter does not intend the comment to serve as an indictment of the ALS MICUs in New Jersey. The commenter asserts that with increasing call volume, there are not enough of them. The commenter provides statistics on the call volume in geographic the commenter represents as an example of the insufficient number of ALS MICU services to meet demand. The commenter asserts that expanding the scope of practice of EMT-Basics would meet the goal of supplementing, rather than replacing, ALS MICU services. The commenter asserts that readopting N.J.A.C. 8:40 without change to expand the scope of practice of enhance EMT-Basics is the same as taking a step backwards. (1) 2. COMMENT: Two commenters state that the readoption without change of existing N.J.A.C. 8:40 fails to recognize recommendations for changes to the rules from the New Jersey EMS Advisory Council s EMS System Redesign Committee (Committee). The commenters state that the Committee supported the adoption of the National EMS Scope of Practice Model. The commenters state, The National EMS Scope of Practice Model has been accepted and reinforced by the recently adopted National EMS Education Standards that are scheduled to replace the National Standard Curricula within [two] years. The commenters state that N.J.A.C. 8:40-7.1(b), which establishes the scope of practice of EMT-Basics, cites to the National Standard 4

5 Curriculum. The commenters state that N.J.A.C. 8:40-7.1(b) will fail to meet National EMS Education Standards. Current [rules] prohibit the implementation of the components of the National EMS Scope of Practice Model without a number of waivers to be issued by the Commissioner. The commenters state that specific examples of how existing N.J.A.C. 8:40 fails to meet current practice appear at N.J.A.C. 8: and With respect to N.J.A.C. 8:40-3.6, the commenters state that the Department provides an electronic patient care reporting system for any BLS agency in New Jersey. While this is clearly an advance in technology and practice, as well as an initiative supported by recommendation in the 2007 EMS System Review, all participating agencies are in direct violation of [N.J.A.C. 8:40-3.6]. The continuation of this practice will require the Commissioner to issue waivers. The commenters state that N.J.A.C. 8: requires BLS ambulances to carry METTAG -brand emergency triage tags for mass casualty incidents, that the Department provides non-mettag brand tags to providers for this purpose, and that use of the Department-provided tag instead of a METTAG -brand tag would violate N.J.A.C. 8: The commenters assert that existing N.J.A.C. 8:40 does not allow political subdivisions or municipalities to improve life support service within their territorial boundaries, regardless of the inability of the existing [ALS] system to met the needs of the community. The commenters provides statistics describing use of services in the municipalities they represent to indicate that many BLS patients who require ALS level 5

6 of care were unable to receive that care during transport because the municipal BLS providers did not qualify for ALS-level licensure because municipal BLS providers are not sponsored by MICU hospitals. The commenters suggest that municipal BLS providers should be able to provide ALS services using certified EMT-Paramedics if the BLS provider maintains an affiliation with a medical director, who can provide operational, clinical, and quality assurance oversight, and education. The commenters suggest that the Department establish a pilot program involving multiple jurisdictions sharing a single Medical Director. (2, 4). 3. COMMENT: A commenter supports revision of N.J.A.C. 8:40, and states, Failure to make changes is a failure to address the needs of our communities with regard to current levels of service being provided in New Jersey. The commenter recommends that the Department revise N.J.A.C. 8:40 to expand the scope of practice of EMT-Basics to authorize them to use more advanced pre-hospital skills, in accordance with a model that NHTSA has adopted for Advanced EMTs. The commenter states, This new scope if adopted would greatly improve patient outcome, especially when ALS is unavailable or not within a rapid response time. Another benefit is that ALS units would be freed up to handle cases that truly require the scope of practice set aside for ALS care. The commenter also supports the idea of a pilot program that would allow current [EMT-Paramedics] working in a BLS service to expand the care provided to 6

7 include the EMT Advanced skills. This would move the program along while training is taking place. Over time the program would be expanded to the BLS level. (3) RESPONSE TO COMMENTS 1 THROUGH 3: The readoption without change of existing rules would recognize the effectiveness of the existing rules and would maintain the validity of the existing rules while the Department considers changes to the rules based upon medical advancements and recommendations from organizations such as the EMS Advisory Council and the National Highway Traffic Safety Administration (NHTSA). The National EMS Education Standards (Standards), NHTSA, January 2009, are nonbinding guidelines published by NHTSA. The Standards are available at or by writing for publication number DOT HS A to NHTSA Resource Center, 3341 East 75th Avenue, Suite F, Landover, MD The Standards contain instructional guidelines (IG) which do not establish a curriculum. NHTSA did not intend that the states adopt the standards; rather, the IG provide guidance to instructors and regulators regarding the content that may be included within each area of the Standards. Standards at 61. Accordingly, existing N.J.A.C. 8:40-7.1(b) would not conflict with the Standards and would continue to establish the scope of practice for EMT-Basics in New Jersey unless and until the Department were to determine to modify the scope of practice for EMT- Basics. The use of electronic patient care reports would not violate N.J.A.C. 8: provided the electronic process would enable compliance with N.J.A.C. 8: That is, crewmembers would need to be able to record the data set that N.J.A.C. 8:40-3.6(a) 7

8 through (c) require and furnish a usable patient care report, either electronically or in hard copy, to the receiving health care facility, and licensed providers would need to be able to retain electronic records in accordance with N.J.A.C. 8:40-3.6(e). Contrary to the commenters assertion, the use of the re-designed triage tags would not violate N.J.A.C. 8: because that rule does not require the use of METTAG triage tags. The Department refers to the brand name, METTAG, in parentheses at existing N.J.A.C. 8: to serve as an example of a medical emergency triage tag that would satisfy the rule. N.J.S.A. 26:2K-12 provides that only a hospital authorized by the Commissioner with an accredited emergency service, that is, a MICU can provide pre-hospital ALS. The Department is without authority to license a municipal agency to provide prehospital ALS using certified EMT-Paramedics even if the municipal agency maintains an affiliation with a medical director. N.J.S.A. 26:2K-10 and 26:2K-12, read in concert, authorize EMT-Paramedics to perform ALS services only while they maintain direct voice communication with either a licensed physician, or a physician-directed registered professional nurse, who is affiliated with a hospital licensed to operate a MICU. This requirement benefits patients by helping to ensure the quality of the ALS services rendered. Accordingly, EMT- Paramedics can function only to the level of an EMT-Basic in any other setting, such as when they are serving as crewmembers on a municipal BLS squad. 8

9 In general, a certified EMT-Basic or EMT-Paramedic does not have a legal duty to act when coming upon a medical emergency unless the certified EMT-Basic or EMT- Paramedic is on duty. The Department is reviewing the NHTSA publication, National EMS Scope of Practice Model, NHTSA, February 2007, which establishes a new EMT category called Advanced EMT, to evaluate whether incorporating standards contained in this model into New Jersey s EMS regulatory scheme would have a positive effect on New Jersey s EMS system, improve patient care, and comply with existing statutory requirements, with a view toward the conduct of future rulemaking as may be appropriate. The publication is available from or by writing for publication number DOT HS to NHTSA Resource Center, 3341 East 75th Avenue, Suite F, Landover, MD The Department acknowledges the commenters support of the idea of a pilot program. 4. COMMENT: The Department received 32 separate comments that appear to contain similar form content. The commenters state that they are responding to the proposed readoption without change of N.J.A.C. 8:40 and N.J.A.C. 8:41A, the latter of which appears at 41 N.J.R. 1928(a) (May 4, 2009). The commenters state that EMT-Paramedics should be licensed by a newly created EMS licensing board under the jurisdiction of the Board of Medical Examiners, describe the existing continuing education unit (CEU) requirements needed to maintain certification, specify that the licensure fee should be $25.00 for non-volunteers, and assert that, Since the Board of 9

10 Nursing now tracks CEU requirements for RNs, there is nothing in this proposal that will cause the State to come up with new procedures or incur additional cost. (5) RESPONSE: The comments appear to exceed the scope of the proposal inasmuch as N.J.A.C. 8:40 establishes standards applicable to EMT-Basics and does not establish standards for EMT-Paramedics. N.J.A.C. 8:41A proposed for readoption establishes standards applicable to EMT-Paramedics. The Department will respond to the comments in the context of its response to comments on the notice of proposal to readopt N.J.A.C. 8:41A. Federal Standards Statement The Department is adopting the readoption without changes pursuant to N.J.S.A. 26:2H-1, et seq. and 30:4D-6.4 and 6.6. The Department is not adopting the readoption without changes under the authority of, or in order to implement, comply with, or participate in any program established under Federal law, or under a State statute that incorporates or refers to Federal law, standards or requirements. Therefore, a Federal standards analysis is not required. Full text of the readopted rules can be found in the New Jersey Administrative Code at N.J.A.C. 8:40. 10

11 H:\Legal\Rulemaking\NJAC 8-40\Readoption 2009\Notice of Adoption 2.doc 11