No. 30856 (Amendment): R426-100. Emergency Medical Services Do Not Resuscitate

DAR File No.: 30856
Filed: 12/18/2007, 04:14
Received by: NL

RULE ANALYSIS

Purpose of the rule or reason for the change:

This rulemaking is necessary because of revisions made to Title 75, Chapter 2a, the Advance Health Care Directive Act, by S.B. 75, 2007 General Session. The change clarifies and conforms the rule to the new statute. (DAR NOTE: S.B. 75 (2007) is found at Chapter 31, Laws of Utah 2007, and was effective 01/01/2008.)

Summary of the rule or change:

The rule will no longer require a terminal illness for a Emergency Medical Services Do Not Resuscitate (EMS/DNR) order, will allow for DNR orders for pediatric patients, and addresses Physician Order for Life Sustaining Treatment (POLST) as it pertains to emergency medical services (EMS).

State statutory or constitutional authorization for this rule:

Title 26, Chapter 8a; and Title 75, Chapter 2a

Anticipated cost or savings to:

the state budget:

It will cost the state $9,500 to train EMS providers on the requirements of the new statute and rule. The training is minimal and may be accomplished through newsletters and information bulletins. The Department of Health will provide forms and other written materials from existing appropriations for this program.

local governments:

Local governments that are EMS providers will receive the training at no cost to them. The training is minimal and will be provided during other required training.

small businesses and persons other than businesses:

Small businesses that are EMS providers will receive the training at no charge to them. The Department of Health has arranged with other health care associations to provide written materials to them to use in informing their members of the change.

Compliance costs for affected persons:

The new statute and rule make it less expensive to execute an EMS/DNR advanced directive. These amendments will decrease costs inherent in executing an EMS/DNR order. The training costs for EMS and other health care providers is negligible. The costs in assisting individuals in the execution of EMS/DNR orders will also be negligibly lower for persons and agencies that assist in this activity. There may be a negligible cost in obtaining the declarant's or declarant's representative's and a witness's signatures on the POLST.

Comments by the department head on the fiscal impact the rule may have on businesses:

This rule reflects changes made in the 22007 Legislative session and should assist emergency services personnel to honor the wishes of the public. David N. Sundwall, MD, Executive Director

The full text of this rule may be inspected, during regular business hours, at the Division of Administrative Rules, or at:

Health
Health Systems Improvement, Emergency Medical Services
CANNON HEALTH BLDG
288 N 1460 W
SALT LAKE CITY UT 84116-3231

Direct questions regarding this rule to:

Don Wood at the above address, by phone at 801-538-6287, by FAX at 801-538-6808, or by Internet E-mail at [e-mail]

Interested persons may present their views on this rule by submitting written comments to the address above no later than 5:00 p.m. on:

02/14/2008

This rule may become effective on:

02/21/2008

Authorized by:

David N. Sundwall, Executive Director

RULE TEXT

R426. Health, Health Systems Improvement, Emergency Medical Services.

R426-100. Emergency Medical Services Do Not Resuscitate.

R426-100-1. Purpose.

This rule implements the prehospital Emergency Medical Services/Do Not Resuscitate (EMS/DNR) provisions of Section 75-2a-1105.5. [and] It clarifies that EMS personnel shall also follow a patient's treating physician's orders, which may include an order not to resuscitate a patient that meets the requirements of Section 75-2a-1105.5, but that does not comply with the formalities of the EMS/DNR form.

 

R426-100-2. EMS/DNR Forms, Directives, Bracelets, and Necklaces.

(1) Only the Utah Department of Health may create EMS/DNR forms. Each EMS/DNR form must have a state of Utah watermark and a unique identifying number provided by the Department.

(2) The Department shall distribute the EMS/DNR directive forms to any licensed physician as requested.

(3) An EMS/DNR directive is valid only if made on an EMS/DNR form upon which a physician licensed to practice medicine under Part 1 of Chapter 12, Title 58, the Utah Osteopathic Medicine Licensing Act, or under Part 5, of Chapter 12, Title 58, the Utah Medical Practice Act, also [makes a determination certifying that the declarant is in a terminal condition]determines these are the patients preferences, and signs the EMS/DNR form.

(4) An EMS/DNR bracelet or necklace may be issued only to [individuals whose physician has determined that the declarant is in a terminal condition]an individual who has executed an advanced directive in accordance with Section 75-2a-1105.5 and who submits, or whose physician submits, a[n] copy of the EMS/DNR directive to the Department.

(5) An EMS/DNR bracelet or necklace may only be issued by either the Department or by an entity approved by the Department through written agreement.

(6) For EMS/DNR bracelets or necklaces issued by a Department-approved entity:

(a) the entity may issue bracelets or necklaces for which the Department has approved the design and construction quality;

(b) the entity may issue an EMS/DNR bracelet or necklace only after verifying with the Department that the individual or the individual's physician has submitted a copy of a valid EMS/DNR directive to the Department;

(c) the bracelet or necklace shall clearly display:

(i) the words "UTAH EMS - DO NOT RESUSCITATE"; and

(ii) the declarant's EMS/DNR number, or a unique identifying number that the entity links to the declarant's EMS/DNR number;

(7) A Department-approved entity must:

(a) keep a hard copy or an electronically scanned image of each EMS/DNR directive for which it has issued a bracelet or necklace;

(b) be continuously available by toll-free telephone service 24-hours every day, including weekends and holidays that is staffed by an EMT or other licensed health care individual knowledgeable in providing medical care;

(c) immediately send a copy of the EMS/DNR directive to an EMS provider in the field upon request, either by facsimile or in a readily readable electronic format, as requested by the EMS provider; and

(d) verify that the bracelet or necklace matches an EMS/DNR order on file with the entity.

 

R426-100-3. Issuance of an EMS/DNR Directive, or Bracelet, or Necklace.

(1) If the prospective declarant or proxy desires to make an EMS/DNR directive, the physician who [makes the determination that the declarant is in a terminal condition]executes an order pursuant to the requirements of Subsection 75-2a-1105.5(4) must:

(a) explain to the prospective declarant or proxy, and his family, the significance of making an EMS/DNR directive;

(b) complete the information requested on the EMS/DNR form;

(c) sign and date the EMS/DNR form certifying that the declarant [is in a terminal condition;]or proxy has made and understands this determination.

(d) give the original of the directive with the watermark to the declarant or the proxy; and

(e) fill out and give to the declarant or proxy the authorized EMS/DNR bracelet to be placed on the declarant.

(2) The physician or designee, who places the bracelet, must explain to the declarant or proxy how and by whom the EMS/DNR directive may be revoked.

(3) The physician[ or], designee, or declarant shall confirm with the Department the execution of the EMS/DNR directive and placement of the EMS/DNR [and ]bracelet or necklace by submitting a [duplicate original]copy of the EMS/DNR directive to the Department.

(4) The EMS/DNR directive is effective immediately upon the physician's signing the EMS/DNR directive. The EMS/DNR directive is the property of the declarant and shall be kept with the declarant['s] and a copy of which shall be kept with the medical record, but is not part of the medical record.

(a) To be honored by EMS personnel, the EMS/DNR directive must be placed in an unobstructed view above the declarant on the wall or in close proximity to the head of the bed or the declarant must be wearing the EMS/DNR bracelet, except in health care facilities licensed pursuant to Title 26, Chapter 21.

(b) To be honored by EMS personnel who are called to render service in health care facilities licensed pursuant to Title 26, Chapter 21, the EMS/DNR directive or POLST must be displayed in the declarant's medical record or the declarant must be wearing an EMS/DNR bracelet. Health care facility personnel must present the medical record to responding EMS personnel upon their arrival. Health care facilities shall document for Department review that appropriate health care facility staff have been informed of the declarant's EMS/DNR directive or POLST sufficient to notify EMS personnel of the existence of the EMS/DNR directive or POLST.

(5) If the EMS/DNR directive is not complete or does not appear to conform to statutory and regulatory requirements, the Department shall notify the physician and explain the defect or defects and shall notify the declarant or proxy and EMS agencies likely to respond to the declarant.

 

R426-100-4. Revocation of an EMS/DNR Directive.

(1) An EMS/DNR bracelet is the embodiment of an EMS/DNR directive and shall be given the same legal treatment as the actual EMS/DNR directive. An EMS/DNR directive may be revoked as provided in Section 75-2-1111.

(2) If both the original of the EMS/DNR directive with the watermark and the EMS/DNR bracelet are not intact, or have been defaced, the EMS/DNR directive is invalid. If an EMS/DNR directive is revoked, EMS personnel must provide emergency medical services to the declarant as if no EMS/DNR directive had been issued.

(3) If there is any question about the validity of an EMS/DNR directive, the EMS personnel must provide emergency medical services to the declarant as if no EMS/DNR directive had been issued.

 

R426-100-5. Treatment of a Declarant with an EMS/DNR Directive.

(1) As part of routine patient assessment, the responding EMS personnel must inspect to see if the declarant is wearing an EMS/DNR bracelet or has an EMS/DNR directive or POLST either clearly displayed or located within the declarant's medical record file. If the EMS/DNR directive or POLST appears to be incorrectly executed, incomplete, or otherwise flawed in the making, EMS personnel need not honor the EMS/DNR directive or POLST. EMS personnel are not liable for failure to honor an EMS/DNR directive or POLST.

(2) An EMS/DNR directive only directs that life sustaining procedures be withheld. It does not direct the withholding of medication or the performance of any medical procedure either of which is intended to provide comfort care or to alleviate pain.

(3) In the case of a declarant who has sustained a recent injury clearly unrelated to the [terminal condition]decision that served as the basis for the EMS/DNR directive, EMS personnel may contact medical control regarding the provision of emergency medical services to the declarant.

(4) In the case of a minor, the responding EMS personnel must inspect for an EMS/DNR bracelet or necklace, an EMS/DNR directive with two physician signatures, and an authorized POLST form in compliance with Section 75-2a.

 

R426-100-6. Transferable Physician Order for Life Sustaining Treatment.

(1) EMS personnel shall honor a patient's desires for life-sustaining treatment as expressed through the treating physician's written orders that meet the requirements of Section 75-2a-1105.5. EMS personnel shall comply with treating physician orders for life-sustaining treatment as expressed on Transferable Physician Order for Life-sustaining Treatment Forms, including a physician order not to resuscitate a patient that does not meet the formalities on the EMS/DNR form established in this rule. A patient shall always be provided respect, comfort, and hygienic care.

(2) A health care facility may present a completed Transferable Physician Order for Life-sustaining Treatment Form in lieu of an EMS/DNR directive or bracelet.

 

KEY: emergency medical services, DNR, do not resuscitate, POLST

Date of Enactment or Last Substantive Amendment: [September 6, 2006]2008

Notice of Continuation: October 1, 2004

Authorizing, and Implemented or Interpreted Law: 75-2-1105.5