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PA EMS System Act Regulations Act 37

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Overview Future of EMS Regulations Update Continuing Education EMS Agencies Patient Care Reports Bureau Priorities Question/Answer

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Regulations Update Submitted to Attorney Generals Office August 27, 2013 Promulgated in PA Bulletin on Oct. 10, 2013 The regulations will be phased-in over a six month period. The outgoing regulations will be phased-out over the same time period EMS System Act The remainder of the Act will go into effect April 10, 2014 The Department is not able to implement any of the new features created under the Act or the new regulations until April 10, 2014

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Regulations Update (Continued) CMP EMS Providers including non-certified providers ($1000); EMS Agencies including unlicensed agencies & PCR Vendors ($5000) The Department can issue conditional temporary licenses (provisional licenses) indefinitely if the Department determines it is in the public interest to do so. Previously, the Department could only issue these licenses for up to 18 months

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Regulation Update (Continued) Even when some sections take effect, specific subsections within a section have their own phase-in periods Example - EMS Agency Dispatch Centers Use County EMD Program within 270 days after publication in PA Bulletin, which is 90 days after effective date of 1027.4. Use PEMA-certified Call-takers and Dispatchers within 2 years after publication in PA Bulletin, which is one and a half years after effective date of 1027.4

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Continuing Education Lapse of Certification Expired 1 Day to 2 Years Con-Ed (All required CEUs for 3 years prior to date of lapse AND up to time of reinstatement) NREMT Cognitive Exam 2 Years or Greater Con-Ed (All required CEUs for 3 years prior to date of lapse AND up to time of reinstatement) NREMT Psychomotor Exam NREMT Cognitive Exam

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Continuing Education Testing Written (Cognitive) Testing January 1, 2014 ALL testing done via Pearson Vue system Regardless of where you are in your attempts Practical (Psychomotor Skills) Testing Follow NREMT guidelines Statewide testing calendar Regions will work with Educational Institutes to develop planning and schedules

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Continuing Education Scope of practice for EMS providers follows the EMS Scope of Practice Model that the National Association of State EMS Officials has developed for the National Highway Traffic Safety Administration Licenses and certifications of EMS providers are permanent (subject to discipline), but continued practice is conditioned upon biennial or triennial re- registration and meeting Con-Ed requirements Ambulance vehicle operators will now be certified, regulated, and required to meet Con-Ed requirements

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Continuing Education The Act provides for the establishment of three new EMS providers the Emergency Medical Responder (EMR), the Advanced Emergency Medical Technician (AEMT), and the Pre-hospital Physician Extender (PHPE) The EMR replaces Ambulance Attendants and First Responders ( 1023.23) Current First Responders will be converted to EMRs automatically Current Ambulance Attendants will be converted to EMRs automatically. There is a grandfather provision that permits Ambulance Attendants to remain as EMRs without full EMR certification for 2 years after the 6 month phase-in period for the regulations (April 10 th, 2014)

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CONTINUING EDUCATION EMS PROVIDER OLD REQUIREMENTS + CPR NEW REQUIREMENTS + CPR EMSVO alone EMSVO & BLS EMSVO & ALS N/A 2 hours/2 years 3 hours/3 years 2 hours/2 years EMRFR 16/3 years*12 Med/Trauma, 4 Other/3 years* EMT24/3 years*18 Med/Trauma, 6 Other/3 years* AEMTN/A27 Med/Trauma, 9 Other/2 years* Paramedic18/1 year*27 Med/Trauma, 9 Other/2 years* PHRN18/1 year*27 Med/Trauma, 9 Other/2 years* PHPE & PHPN/A27 Med/Trauma, 9 Other/2 years* **ANY AMOUNT OF CEUS, EITHER MED/TRAUMA OR OTHER, MAY BE DONE ONLINE**

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1 Credit for every 60 minutes Credits will be within 30 minutes blocks of time If a student misses more then 15% of the time assigned for program, receives no credit **ANY AMOUNT OF CEUS, EITHER MED/TRAUMA OR OTHER, MAY BE DONE ONLINE** Continuing Education Credits

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Continuing Education Con-Ed Tracking PERSONAL responsibility Get a completion certificate for ALL classes attended Maintain Class completion certificates for a possible audit at time of re-registration

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Re-Registration Dates ALL Providers at ALS levels will now have re-registration dates. For initial renewal period, ALS providers will receive pro rated CEUs to balance Con Ed requirements as follows: REMEMBER: It is the responsibility of each Provider to track completed and required CEUs, and to have all required CEUs completed by the renewal date on their card to remain Command Eligible. This information is readily available in each Providers individual EMSRS Account. There will be NO reminder notification sent.

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Gone Are The Days

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Revised, further defined use of Lights and Sirens policy - protocols When transporting or responding to a call involving a patient who presents or is in good faith perceived to present a combination of circumstances that may lead to worsened patient outcomes if additional medical interventions were delayed by the amount of time estimated to be saved by the use of emergency lights or audible warning devices. Lights and sirens may be used on an ambulance when transporting a patient ONLY when medical interventions is BEYOND the capabilities of the ambulance crew using available supplies and equipment

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Disciplinary Action REINSTATEMENT OF REVOKED EMS PROVIDERS Five (5) years prior to requesting If request denied, applicant would wait one (1) year prior to secondary request. DISCIPLINE OF EMSVO Emergency Suspension Clear and immediate danger to public Department would need credible evidence Hearing within 30 days The BEMS has the authority to. Automatically Suspend a certification Agencies, Con-Ed/Education Institutes Command Facilities, PCR Software Vendors Civil money penalty for providers now in place. For Agency after April 10 th, 2014 Impose civil money penalties against entities that conduct EMS operations without being licensed as an EMS agency.

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Accessing Your EMSRS

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EMS Agencies Ambulance Services Classified as EMS Agencies Capabilities Licensed Under One License Safety Committee Quarterly Meeting of Committee required QI/PI Committee Quarterly Meeting of Committee required

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Members and employees of a peer review committee and persons who furnish professional services to a peer review committee. An individual who is a member or employee of a peer review committee or who provides professional services to a peer review committee conducting peer review under this section has the same protections from civil and criminal liability for the performance of any duty, function or activity required of the peer review committee as a person who performs the duty, function or activity under the Peer Review Protection Act. Peer Review Peer Protection

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EMS Agencies Staffing Plan

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EMS Agencies Command Forms

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EMS Agencies (Continued) 1.Ground Ambulance Services BLS; Intermediate ALS; and ALS (includes critical care transport ambulance services) 2.Air Ambulance Services 3.Water Ambulance Services BLS; Intermediate ALS; and ALS 4.Squad Services BLS; Intermediate ALS; and ALS 5.QRS 6.Special Operations EMS Services Tactical EMS; Wilderness EMS; Mass-gathering EMS; and Urban Search & Rescue EMS 7.EMS Agency Dispatch Centers

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EMS Agencies (Continued) EMS Agency Dispatch Centers ( 1027.4) Certification Required. Effective October 13, 2015, an EMS agency that operates an EMS agency dispatch center shall use call-takers and dispatchers who are certified and maintain certification as call-takers and dispatchers by the Pennsylvania Emergency Management Agency under 35 Pa.C.S. 5303(a)(6) (relating to telecommunications management) Must obtain an EMS agency license to operate an EMS agency dispatch center

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EMS Agencies (Continued) Subject to certain exceptions, EMS agencies are required to operate 24-7-365 Exceptions: Conditional Temporary Licenses ( 1027.12) A.K.A. Provisional Licenses County or Broader Level EMS plan approved by the Department ( 1027.6) Tactical EMS response services except when their affiliated law enforcement service requests their assistance Water Ambulances Air Ambulances Intermediate ALS Ambulance Services provided the EMS agency also operates a BLS or ALS Service at the same location

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EMS Agencies (Continued) Special Operations EMS ( 1027.41) Tactical EMS Provides EMS support to law enforcement during a tactical law enforcement operation Wilderness EMS Provides EMS in the wilderness, backcountry, or other wild, uncultivated area Mass-Gathering EMS Provides EMS where there is a large gathering of people under circumstances illustrated in the regulation Urban Search & Rescue EMS Provides EMS at an incident in which there patients entrapped by a structural collapse or other entrapment for an extended period of time

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EMS Agencies (Continued) Stretcher and Wheelchair Vehicles An entity may not operate a stretcher or wheelchair vehicle to transport a person who the entity knows, or should reasonably know, requires: Medical Assessment Monitoring Treatment And/or observation during Transport

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Patient Care Reports EMS Agencies shall collect, maintain, and electronically report complete, accurate and reliable patient data Report should be complete no later than 72 hours after the EMS Agency concludes patient care EMS Agency must submit, within 30 days, all PCR data to their home Regional EMS Council Upon transfer of care, the provider must provide, verbally and in writing or other means by which information is recorded, report to the individual at the receiving facility assuming patient care Within 24 hours, the receiving facility shall receive a completed EMS PCR PCRs shall be retained by the EMS Agency for a minimum of 7 years

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Bureau Priorities Safety Providers Wellness Vehicle Operations Patients Error Reduction Decision Making Public Vehicle Operations

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Bureau Priorities (Continued) Personal Accountability System Development Advancement Education vs Re-Education Efficiencies & Effectiveness Capacity Building & Preparedness

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Bureau Priorities (Continued) Mass Casualty Incidents Event Planning Event Coordination Regional Initiatives Asset Management

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Timeline Four Year Process August 18, 2009 EMS System Act (Act 37-2009) signed into law October 11, 2011 Department submits 6 th draft as the proposed regulation to the Standing Committees and the Independent Regulatory Review Commission (IRRC) October 29, 2011 The Legislative Reference Bureau (LRB) publishes the proposed regulation in The Pennsylvania Bulletin

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Timeline (Continued) July 16, 2013 The Department delivers the final-form regulation (7 th draft) to the Standing Committees and IRRC August 21, 2013 The Standing Committees deem approve the final-form regulation August 22, 2013 IRRC unanimously approves the final-form regulation August 27, 2013 The Department delivers the final-form regulation to the Office of Attorney General (OAG) for review September 17, 2013 OAG approves the regulations October 10, 2013 The Legislative Reference Bureau publishes the regulations

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Timeline (Continued) Act 37 - 2009 provides a phase-in for sections of the EMS System Act and the corresponding sections in the regulation August 18, 2009 10% of Act in effect February 16, 2010 48% April 10, 2014 100%

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Thank you